|
Simple cystometrogram 51725
|
$522.40 |
$522.40 |
$522.40 |
$614.00
|
|
Sincalide 5 mcg solution for injection
|
$213.81 |
$213.81 |
$628.40 |
$309.14
|
|
Single energy x-ray study
|
$76.80 |
$76.80 |
$76.80 |
$125.84
|
|
Sinus CT scan (with and without contrast)
|
$1,246.48 |
$1,246.48 |
$1,300.00 |
$1,788.60
|
|
Sinus CT scan (with contrast)
|
$1,111.00 |
$1,111.00 |
$1,788.15 |
$1,519.50
|
|
Sinus CT scan (without contrast)
|
$719.47 |
$719.47 |
$1,609.40 |
$1,283.87
|
|
Sinus/juglr venogram s&i
|
$474.40 |
$474.40 |
$474.40 |
$2,537.60
|
|
Sinusotomy maxillary sinus 31020
|
$2,321.60 |
$2,321.60 |
$2,321.60 |
$2,616.15
|
|
Sinusotomy sinus remove polyps 31032
|
$2,859.20 |
$2,859.20 |
$2,859.20 |
$6,465.11
|
|
Sinusotomy sphenoid w/wo bx 31050
|
$2,446.40 |
$2,446.40 |
$2,446.40 |
$6,465.11
|
|
Sinus X-ray (complete)
|
$163.80 |
$163.80 |
$266.32 |
$345.24
|
|
Sinus X-ray (limited)
|
$81.90 |
$81.90 |
$113.07 |
$214.50
|
|
Sirolimus, oral
|
$3.30 |
$3.30 |
$3.30 |
$41.70
|
|
Sirolimus-protein bound 100 mg intravenous suspension
|
$42,938.50 |
$42,938.50 |
$42,938.50 |
$14,361.10
|
|
Skeletal muscle relaxant 1/2
|
$72.14 |
$72.14 |
$83.85 |
$80.10
|
|
Skel musc relaxant 3 or more
|
$13.60 |
$13.60 |
$13.60 |
$16.12
|
|
Skin and muscle repair face
|
$2,522.40 |
$2,522.40 |
$2,522.40 |
$4,332.25
|
|
Skin Biopsy
|
$422.35 |
$422.35 |
$953.00 |
$362.40
|
|
Skin full graft 20sq cm less 15200
|
$3,375.25 |
$3,375.25 |
$3,375.25 |
$2,379.00
|
|
Skin full graft add-on 15241
|
$445.60 |
$445.60 |
$445.60 |
$560.01
|
|
Skin pedicle flap arms/legs
|
$2,168.80 |
$2,168.80 |
$2,168.80 |
$4,332.25
|
|
Skin pedicle flap trunk
|
$2,240.00 |
$2,240.00 |
$2,240.00 |
$2,501.86
|
|
Skin split graft addl 100sq cm 15101
|
$460.00 |
$460.00 |
$460.00 |
$1,793.40
|
|
Skin test unlisted antigen ea
|
$48.57 |
$48.57 |
$48.57 |
$48.57
|
|
Skull X-ray (1 to 3 views)
|
$123.34 |
$123.34 |
$559.65 |
$297.00
|
|
Skull X-ray (complete)
|
$301.60 |
$301.60 |
$394.32 |
$417.50
|
|
Skyla, 13.5 mg
|
$1,324.80 |
$1,324.80 |
$1,324.80 |
$1,643.47
|
|
Slco1b1 gene com variants
|
$350.40 |
$350.40 |
$350.40 |
$235.20
|
|
Sleep study attended
|
$931.20 |
$931.20 |
$931.20 |
$1,329.00
|
|
Sleep Study (Polysomnography)
|
$2,879.24 |
$2,879.24 |
$3,866.20 |
$3,721.41
|
|
Sleep study unattended
|
$776.76 |
$776.76 |
$1,129.05 |
$594.00
|
|
Sleeve fing rolyan med
|
$37.65 |
$37.65 |
$37.65 |
$204.60
|
|
Sleeve irr assura 1pc disp
|
$0.65 |
$0.65 |
$0.65 |
$0.65
|
|
Sling arm deluxe w/pad xs
|
$21.60 |
$21.60 |
$529.06 |
$30.35
|
|
Sling pelv split sam med
|
$165.55 |
$165.55 |
$165.55 |
$150.00
|
|
Sling suprapubic suburetheral
|
$9,671.50 |
$9,671.50 |
$20,213.80 |
$9,679.96
|
|
Slitting of prepuce
|
$388.80 |
$388.80 |
$388.80 |
$4,061.71
|
|
Slitting of prepuce
|
$3,176.92 |
$3,176.92 |
$3,176.92 |
$3,376.23
|
|
Slp eval for nonspeech dev ea addl 30 mins
|
$75.20 |
$75.20 |
$75.20 |
$139.44
|
|
Slp eval non-spch gen comm dev
|
$211.20 |
$211.20 |
$211.20 |
$285.09
|
|
Slp pure tone screening
|
$24.80 |
$24.80 |
$24.80 |
$64.50
|
|
Slp stdy unatnd w/anal
|
$776.76 |
$776.76 |
$776.76 |
$285.00
|
|
Slp ther svc non-spch gen
|
$186.40 |
$186.40 |
$186.40 |
$188.00
|
|
Sm-153 lexidron ther
|
$57,456.00 |
$57,456.00 |
$57,456.00 |
$7,320.12
|
|
Small animal inoculation
|
$42.40 |
$42.40 |
$42.40 |
$23.24
|
|
Small Bowel Barium X-ray (Follow-Through)
|
$324.35 |
$324.35 |
$745.64 |
$557.70
|
|
Small bowel endoscopy
|
$363.20 |
$363.20 |
$363.20 |
$2,596.41
|
|
Small bowel endoscopy
|
$517.60 |
$517.60 |
$517.60 |
$2,244.82
|
|
Small bowel endoscopy
|
$608.00 |
$608.00 |
$874.00 |
$2,638.57
|
|
Small bowel endoscopy
|
$623.20 |
$623.20 |
$894.00 |
$2,518.10
|
|
Small bowel endoscopy
|
$720.00 |
$720.00 |
$720.00 |
$2,638.57
|
|
Small bowel endoscopy
|
$975.20 |
$975.20 |
$975.20 |
$3,265.60
|
|
Small bowel endoscopy
|
$270.00 |
$270.00 |
$698.40 |
$2,088.00
|
|
Small bowel endoscopy
|
$388.00 |
$388.00 |
$388.00 |
$2,956.20
|
|
Small bowel endoscopy >2nd w/remove 44363
|
$484.80 |
$484.80 |
$484.80 |
$2,590.33
|
|
Small bowel endoscopy 44365
|
$460.00 |
$460.00 |
$460.00 |
$2,244.82
|
|
Small bowel endoscopy/biopsy
|
$400.80 |
$400.80 |
$5,896.75 |
$2,490.15
|
|
Small bowel endoscopy/biopsy
|
$756.80 |
$756.80 |
$756.80 |
$2,244.82
|
|
Small bowel endoscopy br/wa
|
$447.20 |
$447.20 |
$447.20 |
$1,924.00
|
|
Small bowel endoscopy br/wa
|
$2,381.60 |
$2,381.60 |
$2,381.60 |
$2,406.40
|
|
Small bowel endoscopy/stent 44370
|
$673.60 |
$673.60 |
$673.60 |
$4,992.00
|
|
Smear fluorescent and/or acid fast stain
|
$24.05 |
$24.05 |
$38.58 |
$64.00
|
|
Smear gram stain
|
$20.80 |
$20.80 |
$38.58 |
$54.03
|
|
Smear nasal eosinophil
|
$18.20 |
$18.20 |
$56.44 |
$45.50
|
|
Smear special stain inclusion bodies/parasites
|
$38.58 |
$38.58 |
$89.05 |
$71.81
|
|
Smear wet mount
|
$38.58 |
$38.58 |
$87.75 |
$66.30
|
|
Smn1 gene full gene sequence
|
$289.30 |
$289.30 |
$289.30 |
$495.69
|
|
Smn1 gen nown famil seq vrnt
|
$177.80 |
$177.80 |
$177.80 |
$255.58
|
|
Smpd1 gene common variants
|
$127.86 |
$127.86 |
$127.86 |
$133.84
|
|
Snrpn/ube3a gene
|
$127.86 |
$127.86 |
$127.86 |
$228.80
|
|
Sock fracture or equal each
|
$72.80 |
$72.80 |
$72.80 |
$74.51
|
|
Sock wool above knee
|
$56.42 |
$56.42 |
$158.68 |
$51.18
|
|
Sodium 24 hour urine
|
$33.57 |
$33.57 |
$55.25 |
$48.75
|
|
Sodium chloride 0.9 % intravenous solution
|
$48.00 |
$48.00 |
$18,233.64 |
$48.58
|
|
Sodium chloride 0.9 % IV bolus
|
$22.50 |
$22.50 |
$48.00 |
$45.56
|
|
Sodium chloride 0.9 % IV bolus
|
$48.00 |
$48.00 |
$9,894.40 |
$37.64
|
|
Sodium chloride 3 % ivpb
|
$30.00 |
$30.00 |
$30.00 |
$39.60
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$16.40 |
$16.40 |
$292.60 |
$80.73
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$172.00 |
$172.00 |
$172.00 |
$410.40
|
|
Sodium serum/plasma/whole blood
|
$33.57 |
$33.57 |
$206.00 |
$45.60
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$495.00 |
$495.00 |
$495.00 |
$177.52
|
|
Soft interface below knee se
|
$196.00 |
$196.00 |
$196.00 |
$179.08
|
|
So gsap cl fr cpy nmbr&mcrst
|
$323.55 |
$323.55 |
$323.55 |
$1,345.31
|
|
Somatosensory testing
|
$357.60 |
$357.60 |
$357.60 |
$816.00
|
|
So neo gsap dna/dna&rna
|
$2,869.97 |
$2,869.97 |
$2,869.97 |
$2,989.55
|
|
So neo gsap dna mcrstl ins
|
$861.00 |
$861.00 |
$861.00 |
$2,175.00
|
|
Sp bone agrft morsel add-on
|
$406.40 |
$406.40 |
$406.40 |
$406.40
|
|
Sp bone agrft struct add-on
|
$442.40 |
$442.40 |
$442.40 |
$442.40
|
|
Sp bone algrft morsel add-on
|
$291.20 |
$291.20 |
$291.20 |
$498.55
|
|
Special casting material
|
$47.20 |
$47.20 |
$2,778.00 |
$47.45
|
|
Special physics consult
|
$261.60 |
$261.60 |
$261.60 |
$725.00
|
|
Special pump services
|
$928.00 |
$928.00 |
$928.00 |
$901.60
|
|
Special pump services
|
$649.60 |
$649.60 |
$649.60 |
$548.80
|
|
Special pump services
|
$464.80 |
$464.80 |
$464.80 |
$392.00
|
|
Special radiation dosimetry
|
$129.60 |
$129.60 |
$393.25 |
$392.73
|
|
Special radiation treatment
|
$561.60 |
$561.60 |
$82,721.00 |
$2,045.50
|
|
Special supplies phys/qhp
|
$90.40 |
$90.40 |
$90.40 |
$60.00
|
|
Special teletx port plan
|
$226.40 |
$226.40 |
$1,974.70 |
$1,086.99
|
|
Specific gravity body fluid
|
$33.57 |
$33.57 |
$39.00 |
$22.00
|
|
Specimen fat stain
|
$56.44 |
$56.44 |
$56.44 |
$35.10
|