|
Shoulder AC Joint X-ray (both sides)
|
$129.60 |
$249.60 |
$542.00 |
|
|
Shoulder Arthroscopy (Rotator Cuff Repair)
|
$3,671.00 |
$5,272.00 |
$70,167.83 |
|
|
Shoulder Blade (Scapula) X-ray (both sides)
|
$144.96 |
$307.42 |
$957.00 |
|
|
Shoulder MRI (with and without contrast)
|
$1,490.16 |
$3,989.60 |
$11,106.00 |
|
|
Shoulder MRI (with contrast)
|
$1,396.50 |
$3,332.00 |
$9,717.00 |
|
|
Shoulder MRI (without contrast)
|
$1,011.42 |
$2,729.83 |
$7,839.00 |
|
|
Shoulder prosthesis removal
|
$5,259.20 |
$5,259.20 |
$5,259.20 |
|
|
Shoulder X-ray
|
$189.12 |
$360.80 |
$46,960.00 |
|
|
Shoulder X-ray (single view, both shoulders)
|
$98.12 |
$203.69 |
$42,541.71 |
|
|
Shrinker prosth above knee
|
$141.04 |
$230.16 |
$584.16 |
|
|
Shrinker prosth below knee
|
$178.39 |
$178.63 |
$428.64 |
|
|
Shunt glaucoma baerveldt 350mm
|
$2,411.64 |
$3,209.23 |
$7,110.20 |
|
|
Shuntogram nonvascular supervision & interpretation
|
$167.70 |
$313.45 |
$758.00 |
|
|
Sialidase enzyme assay
|
$38.58 |
$38.58 |
$38.58 |
|
|
Sialography s&i
|
$215.20 |
$264.00 |
$534.40 |
|
|
Sialolithotomy 42330
|
$433.20 |
$572.00 |
$5,353.88 |
|
|
Sickling rbc
|
$25.20 |
$37.70 |
$143.00 |
|
|
Sigmoidoscopy and biopsy
|
$100.80 |
$672.00 |
$13,774.50 |
|
|
Sigmoidoscopy flex decompression 45337
|
$153.12 |
$291.20 |
$1,844.20 |
|
|
Sigmoidoscopy for bleeding
|
$428.00 |
$1,288.80 |
$2,545.80 |
|
|
Sigmoidoscopy/submucosal injection 45335
|
$266.62 |
$649.60 |
$7,008.70 |
|
|
Sigmoidoscopy w/ablation
|
$585.00 |
$6,681.60 |
$7,364.45 |
|
|
Sigmoidoscopy w/fb removal 45332
|
$384.96 |
$648.00 |
$2,126.74 |
|
|
Sigmoidoscopy w/plcmt stent
|
$205.92 |
$388.80 |
$388.80 |
|
|
Sigmoidoscopy w/resection
|
$301.80 |
$501.60 |
$501.60 |
|
|
Sigmoidoscopy w/tumr remove
|
$416.16 |
$694.40 |
$11,000.60 |
|
|
Sigmoidoscopy w/ultrasound
|
$166.08 |
$312.00 |
$312.00 |
|
|
Sigmoidoscopy w/us guide bx
|
$227.04 |
$428.80 |
$428.80 |
|
|
Sigmoid/rmv tumor/polyp/hot bx for 45333
|
$356.50 |
$764.00 |
$1,108.38 |
|
|
Signal avg ecg w or without ecg 93278
|
$70.40 |
$123.60 |
$519.19 |
|
|
Sig w/tndsc balloon dilation
|
$284.00 |
$1,105.60 |
$6,717.53 |
|
|
Sim ang w/prs cath rad emb
|
$24,129.56 |
$24,129.56 |
$24,129.56 |
|
|
Simple cystometrogram 51725
|
$363.60 |
$522.40 |
$1,309.75 |
|
|
Sincalide 5 mcg solution for injection
|
$137.60 |
$288.32 |
$651.10 |
|
|
Single energy x-ray study
|
$76.80 |
$76.80 |
$76.80 |
|
|
Sinus CT scan (with and without contrast)
|
$842.90 |
$1,593.80 |
$5,193.00 |
|
|
Sinus CT scan (with contrast)
|
$758.16 |
$1,773.96 |
$3,821.00 |
|
|
Sinus CT scan (without contrast)
|
$683.83 |
$1,326.36 |
$3,710.00 |
|
|
Sinus/juglr venogram s&i
|
$474.40 |
$919.80 |
$4,738.85 |
|
|
Sinusotomy maxillary sinus 31020
|
$892.80 |
$2,321.60 |
$56,881.64 |
|
|
Sinusotomy sinus remove polyps 31032
|
$1,057.80 |
$2,859.20 |
$2,859.20 |
|
|
Sinusotomy sphenoid w/wo bx 31050
|
$902.40 |
$2,446.40 |
$2,446.40 |
|
|
Sinus X-ray (complete)
|
$163.80 |
$266.32 |
$645.00 |
|
|
Sinus X-ray (limited)
|
$81.90 |
$165.10 |
$323.04 |
|
|
Sipuleucel-t - su
|
$98,900.28 |
$98,900.28 |
$98,900.28 |
|
|
Sirolimus, oral
|
$3.30 |
$47.68 |
$5,812.78 |
|
|
Sirolimus-protein bound 100 mg intravenous suspension
|
$42,938.50 |
$42,938.50 |
$42,938.50 |
|
|
Skeletal muscle relaxant 1/2
|
$72.14 |
$72.14 |
$83.85 |
|
|
Skel musc relaxant 3 or more
|
$13.60 |
$13.60 |
$13.60 |
|
|
Skin and muscle repair face
|
$2,522.40 |
$2,522.40 |
$2,522.40 |
|
|
Skin Biopsy
|
$128.64 |
$337.00 |
$1,850.00 |
|
|
Skin full graft 20sq cm less 15200
|
$1,498.20 |
$2,052.80 |
$59,728.88 |
|
|
Skin full graft add-on 15241
|
$255.60 |
$445.60 |
$445.60 |
|
|
Skin pedicle flap arms/legs
|
$2,168.80 |
$2,168.80 |
$49,715.25 |
|
|
Skin pedicle flap trunk
|
$2,240.00 |
$2,240.00 |
$2,240.00 |
|
|
Skin split graft addl 100sq cm 15101
|
$337.20 |
$460.00 |
$35,119.33 |
|
|
Skin test unlisted antigen ea
|
$43.80 |
$48.57 |
$71.40 |
|
|
Skull X-ray (1 to 3 views)
|
$123.34 |
$221.27 |
$571.00 |
|
|
Skull X-ray (complete)
|
$232.98 |
$301.60 |
$823.00 |
|
|
Skyla, 13.5 mg
|
$1,324.80 |
$1,324.80 |
$5,297.60 |
|
|
Slco1b1 gene com variants
|
$350.40 |
$350.40 |
$350.40 |
|
|
Sleep study attended
|
$824.04 |
$931.20 |
$2,131.46 |
|
|
Sleep Study (Polysomnography)
|
$1,396.80 |
$3,244.80 |
$6,003.40 |
|
|
Sleep study unattended
|
$276.96 |
$776.76 |
$1,799.19 |
|
|
Sleeve fing rolyan med
|
$37.65 |
$37.65 |
$321.50 |
|
|
Sleeve irr assura 1pc disp
|
$0.65 |
$0.65 |
$2.60 |
|
|
Sling arm deluxe w/pad xs
|
$16.20 |
$44.59 |
$813.94 |
|
|
Sling pelv split sam med
|
$22.20 |
$165.55 |
$278.40 |
|
|
Sling suprapubic suburetheral
|
$3,114.40 |
$9,197.11 |
$20,213.80 |
|
|
Slitting of prepuce
|
$388.80 |
$388.80 |
$388.80 |
|
|
Slitting of prepuce
|
$480.80 |
$480.80 |
$5,018.12 |
|
|
Slp eval for nonspeech dev ea addl 30 mins
|
$74.76 |
$75.20 |
$131.32 |
|
|
Slp eval non-spch gen comm dev
|
$125.16 |
$211.20 |
$399.20 |
|
|
Slp pure tone screening
|
$16.80 |
$24.80 |
$102.90 |
|
|
Slp stdy unatnd w/anal
|
$39.36 |
$196.00 |
$1,357.48 |
|
|
Slp ther svc non-spch gen
|
$186.40 |
$186.40 |
$339.08 |
|
|
Sm-153 lexidron ther
|
$4,258.80 |
$57,456.00 |
$57,456.00 |
|
|
Small animal inoculation
|
$42.40 |
$42.40 |
$42.40 |
|
|
Small Bowel Barium X-ray (Follow-Through)
|
$187.68 |
$411.12 |
$1,011.00 |
|
|
Small bowel endoscopy
|
$192.00 |
$363.20 |
$363.20 |
|
|
Small bowel endoscopy
|
$273.12 |
$517.60 |
$517.60 |
|
|
Small bowel endoscopy
|
$321.12 |
$608.00 |
$874.00 |
|
|
Small bowel endoscopy
|
$328.80 |
$623.20 |
$8,526.88 |
|
|
Small bowel endoscopy
|
$380.64 |
$720.00 |
$720.00 |
|
|
Small bowel endoscopy
|
$515.52 |
$975.20 |
$975.20 |
|
|
Small bowel endoscopy
|
$270.00 |
$698.40 |
$698.40 |
|
|
Small bowel endoscopy
|
$205.92 |
$388.00 |
$388.00 |
|
|
Small bowel endoscopy >2nd w/remove 44363
|
$256.32 |
$484.80 |
$484.80 |
|
|
Small bowel endoscopy 44365
|
$243.36 |
$460.00 |
$460.00 |
|
|
Small bowel endoscopy/biopsy
|
$212.16 |
$400.80 |
$8,798.24 |
|
|
Small bowel endoscopy/biopsy
|
$400.32 |
$756.80 |
$756.80 |
|
|
Small bowel endoscopy br/wa
|
$241.80 |
$447.20 |
$447.20 |
|
|
Small bowel endoscopy br/wa
|
$2,381.60 |
$2,381.60 |
$2,381.60 |
|
|
Small bowel endoscopy/stent 44370
|
$356.64 |
$673.60 |
$673.60 |
|
|
Smear fluorescent and/or acid fast stain
|
$24.05 |
$50.70 |
$19,115.87 |
|
|
Smear gram stain
|
$20.80 |
$38.58 |
$11,327.62 |
|
|
Smear nasal eosinophil
|
$18.20 |
$45.60 |
$106.00 |
|
|
Smear special stain inclusion bodies/parasites
|
$32.40 |
$54.60 |
$243.00 |
|
|
Smear wet mount
|
$38.58 |
$41.60 |
$1,496.30 |
|
|
Smn1 gene full gene sequence
|
$289.30 |
$289.30 |
$289.30 |
|
