|
Sleep Study (Polysomnography)
|
$3,030.60 |
$3,030.60 |
$3,030.60 |
$3,734.50
|
|
Sleep study unattended
|
$1,183.20 |
$1,183.20 |
$1,183.20 |
$594.00
|
|
Sling arm deluxe w/pad xs
|
$16.80 |
$16.80 |
$16.80 |
$30.35
|
|
Sling pelv split sam med
|
$23.40 |
$23.40 |
$23.40 |
$150.00
|
|
Sling suprapubic suburetheral
|
$3,130.80 |
$3,130.80 |
$3,130.80 |
$9,679.96
|
|
Slp pure tone screening
|
$24.00 |
$24.00 |
$24.00 |
$64.50
|
|
Small Bowel Barium X-ray (Follow-Through)
|
$352.80 |
$352.80 |
$352.80 |
$557.70
|
|
Small bowel endoscopy
|
$325.80 |
$325.80 |
$325.80 |
$2,596.41
|
|
Small bowel endoscopy
|
$310.20 |
$310.20 |
$310.20 |
$2,244.82
|
|
Small bowel endoscopy
|
$369.00 |
$369.00 |
$369.00 |
$2,638.57
|
|
Small bowel endoscopy
|
$372.00 |
$372.00 |
$372.00 |
$2,518.10
|
|
Small bowel endoscopy
|
$589.20 |
$589.20 |
$589.20 |
$2,638.57
|
|
Small bowel endoscopy
|
$307.20 |
$307.20 |
$307.20 |
$2,088.00
|
|
Small bowel endoscopy >2nd w/remove 44363
|
$411.60 |
$411.60 |
$411.60 |
$2,590.33
|
|
Small bowel endoscopy 44365
|
$378.00 |
$378.00 |
$378.00 |
$2,244.82
|
|
Small bowel endoscopy/biopsy
|
$312.00 |
$312.00 |
$312.00 |
$2,490.15
|
|
Small bowel endoscopy br/wa
|
$253.80 |
$253.80 |
$253.80 |
$1,924.00
|
|
Small bowel endoscopy/stent 44370
|
$405.00 |
$405.00 |
$405.00 |
$4,992.00
|
|
Smear fluorescent and/or acid fast stain
|
$150.00 |
$150.00 |
$150.00 |
$64.20
|
|
Smear gram stain
|
$48.00 |
$48.00 |
$48.00 |
$55.42
|
|
Smear nasal eosinophil
|
$41.40 |
$41.40 |
$41.40 |
$46.20
|
|
Smear special stain inclusion bodies/parasites
|
$32.40 |
$32.40 |
$32.40 |
$73.15
|
|
Smear wet mount
|
$48.00 |
$48.00 |
$48.00 |
$67.49
|
|
Sodium 24 hour urine
|
$45.60 |
$45.60 |
$45.60 |
$48.75
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$68.74 |
$68.74 |
$68.74 |
$80.73
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$432.56 |
$432.56 |
$432.56 |
$410.40
|
|
Sodium serum/plasma/whole blood
|
$46.80 |
$46.80 |
$46.80 |
$46.26
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$170.35 |
$170.35 |
$170.35 |
$177.52
|
|
Spacer bag/reservoir
|
$6.60 |
$6.60 |
$6.60 |
$26.00
|
|
Special casting material
|
$36.60 |
$36.60 |
$36.60 |
$47.45
|
|
Special supplies phys/qhp
|
$8.40 |
$8.40 |
$8.40 |
$60.00
|
|
Specific gravity body fluid
|
$21.00 |
$21.00 |
$21.00 |
$22.00
|
|
Speech and Language Evaluation (comprehensive)
|
$303.60 |
$303.60 |
$303.60 |
$385.00
|
|
Speech recep thresh
|
$41.40 |
$41.40 |
$41.40 |
$82.88
|
|
Speech Therapy Session (one-on-one)
|
$283.20 |
$283.20 |
$283.20 |
$248.30
|
|
Sperm washing 58323
|
$39.60 |
$39.60 |
$39.60 |
$238.06
|
|
Sphincteroplasty inc/prolapse adult 46750
|
$1,456.20 |
$1,456.20 |
$1,456.20 |
$3,245.23
|
|
Spinal bone allograftstructural 20931
|
$243.00 |
$243.00 |
$243.00 |
$266.40
|
|
Spinal bone autograftlocal 20936
|
$424.20 |
$424.20 |
$424.20 |
$424.20
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$1,032.60 |
$1,032.60 |
$1,032.60 |
$1,457.50
|
|
Spine X-ray (single view, one level)
|
$148.20 |
$148.20 |
$148.20 |
$251.00
|
|
Splenectomy total open 38100
|
$2,166.00 |
$2,166.00 |
$2,166.00 |
$2,166.00
|
|
Splint arm vnyl coated padded lft med
|
$48.00 |
$48.00 |
$48.00 |
$48.00
|
|
Splint extn xsm w sof-stretch rolyan
|
$36.00 |
$36.00 |
$36.00 |
$71.44
|
|
Splint finger 4 prong foam sm
|
$16.80 |
$16.80 |
$16.80 |
$34.00
|
|
Splint finger frog med
|
$3.00 |
$3.00 |
$3.00 |
$38.08
|
|
Splint fing stax assort 1-7in
|
$3.60 |
$3.60 |
$3.60 |
$5.60
|
|
Splint func pos polyflex ii med
|
$4.80 |
$4.80 |
$4.80 |
$61.64
|
|
Splint rstrc wrst/cmc right med
|
$16.20 |
$16.20 |
$16.20 |
$99.04
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$1,651.80 |
$1,651.80 |
$1,651.80 |
$4,689.60
|
|
Spontaneous nystagmus study
|
$52.20 |
$52.20 |
$52.20 |
$130.65
|
|
Staging lapro hodgkins disease/lymphoma 49220
|
$1,826.40 |
$1,826.40 |
$1,826.40 |
$1,826.40
|
|
St analysis behavior qualitative voice/resonance
|
$225.60 |
$225.60 |
$225.60 |
$297.60
|
|
St cognitve performance testing healthcare professional each hour
|
$78.60 |
$78.60 |
$78.60 |
$286.00
|
|
Stent/athrectomy/fem/pop/unilat 37227
|
$1,219.80 |
$1,219.80 |
$1,219.80 |
$21,568.80
|
|
Stent axios caut enh 15x10mm electrocaut
|
$14,157.00 |
$14,157.00 |
$14,157.00 |
$32,403.15
|
|
Stent bili dbl pgtl 10fx5cm
|
$691.20 |
$691.20 |
$691.20 |
$2,649.79
|
|
Stent bili rx wallflx 10x80 uncvr
|
$11,238.60 |
$11,238.60 |
$11,238.60 |
$20,962.50
|
|
Stent iliac/open or perc/uni/init 37221
|
$831.60 |
$831.60 |
$831.60 |
$14,356.50
|
|
Stent iliac/open/perc/ea ad/ipsila 37223
|
$2,378.40 |
$2,378.40 |
$2,378.40 |
$8,948.40
|
|
Stent placemt retro carotid
|
$1,645.20 |
$1,645.20 |
$1,645.20 |
$5,328.00
|
|
Stent/tib/peroneal/unilat/initial 37230
|
$1,173.60 |
$1,173.60 |
$1,173.60 |
$16,875.93
|
|
Stereotactic bx aspir/exc burr intracranial les 61750
|
$2,587.80 |
$2,587.80 |
$2,587.80 |
$3,308.00
|
|
Sternal debridement
|
$1,048.20 |
$1,048.20 |
$1,048.20 |
$1,318.40
|
|
St evaluate speech sound production
|
$225.60 |
$225.60 |
$225.60 |
$292.95
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$244.80 |
$244.80 |
$244.80 |
$400.00
|
|
Stot/tot hysterectomy after cesaren delivery 59525
|
$1,000.20 |
$1,000.20 |
$1,000.20 |
$2,723.50
|
|
Strapping of ankle and/or ft 29540
|
$70.80 |
$70.80 |
$70.80 |
$223.45
|
|
Strapping of elbow or wrist 29260
|
$99.00 |
$99.00 |
$99.00 |
$157.46
|
|
Strapping of toes 29550
|
$60.00 |
$60.00 |
$60.00 |
$164.70
|
|
Streptokinase 1.5 m-units inj
|
$917.47 |
$917.47 |
$917.47 |
$917.47
|
|
Streptomycin injection
|
$150.80 |
$150.80 |
$150.80 |
$138.30
|
|
Streptozocin injection
|
$270.37 |
$270.37 |
$270.37 |
$785.95
|
|
Stress test pulmonary
|
$73.20 |
$73.20 |
$73.20 |
$324.00
|
|
Subdural tap fontanelle/sutur infant init 61000
|
$214.20 |
$214.20 |
$214.20 |
$878.24
|
|
Subq i/p critical care pr day age 28 days/less than 99469
|
$842.40 |
$842.40 |
$842.40 |
$717.60
|
|
Subsequent intensive care infant 1500-2500 grams 99479
|
$257.40 |
$257.40 |
$257.40 |
$224.80
|
|
Subsequent intensive care infant 2501-5000 grams 99480
|
$242.40 |
$242.40 |
$242.40 |
$216.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$46.73 |
$46.73 |
$46.73 |
$54.80
|
|
Suction lipectomy head&neck
|
$1,147.20 |
$1,147.20 |
$1,147.20 |
$4,332.25
|
|
Suction lipectomy lwr extrem
|
$1,081.20 |
$1,081.20 |
$1,081.20 |
$5,661.00
|
|
Suction lipectomy trunk
|
$1,081.20 |
$1,081.20 |
$1,081.20 |
$4,385.50
|
|
Suction lipectomy upr extrem
|
$477.60 |
$477.60 |
$477.60 |
$4,544.00
|
|
Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution
|
$4,374.50 |
$4,374.50 |
$4,374.50 |
$7,345.98
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$96.23 |
$96.23 |
$96.23 |
$82.46
|
|
Sulfonylurea screen qn-sendout
|
$213.60 |
$213.60 |
$213.60 |
$160.05
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$359.84 |
$359.84 |
$359.84 |
$126.63
|
|
Sup of prep of antigen # of vials 95144
|
$24.00 |
$24.00 |
$24.00 |
$54.60
|
|
Support clav 29.6-40.5in med
|
$86.40 |
$86.40 |
$86.40 |
$94.08
|
|
Surg dx exam anorectal
|
$204.60 |
$204.60 |
$204.60 |
$3,480.50
|
|
Surg ect salp-oophorectomy 59120
|
$1,632.60 |
$1,632.60 |
$1,632.60 |
$1,632.60
|
|
Surg ect without salp-oophorectomy 59121
|
$1,634.40 |
$1,634.40 |
$1,634.40 |
$1,634.40
|
|
Surgical exposure prostate 55860
|
$1,639.80 |
$1,639.80 |
$1,639.80 |
$5,626.86
|
|
Surgical opening of stomach 43500
|
$1,477.80 |
$1,477.80 |
$1,477.80 |
$1,477.80
|
|
Surgical pathology level 1 gross examination only
|
$30.60 |
$30.60 |
$30.60 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$73.80 |
$73.80 |
$73.80 |
$142.20
|
|
Surgical pathology level 3 gross & microscopic examination
|
$74.40 |
$74.40 |
$74.40 |
$182.25
|
|
Surgical pathology level 4 gross & microscopic examination
|
$71.40 |
$71.40 |
$71.40 |
$248.00
|
|
Surgical pathology level 5 gross & microscopic examination
|
$99.00 |
$99.00 |
$99.00 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$154.20 |
$154.20 |
$154.20 |
$720.75
|
