|
Shoulder MRI (with contrast)
|
$2,183.30 |
$2,446.60 |
$3,136.80 |
|
|
Shoulder MRI (without contrast)
|
$1,366.70 |
$2,139.80 |
$2,554.55 |
|
|
Shoulder X-ray
|
$220.70 |
$421.90 |
$473.75 |
|
|
Shoulder X-ray (single view, both shoulders)
|
$179.75 |
$244.85 |
$473.75 |
|
|
Shunt glaucoma baerveldt 350mm
|
$2,500.00 |
$2,800.00 |
$2,800.00 |
|
|
Shuntogram nonvascular supervision & interpretation
|
$53.00 |
$444.50 |
$645.15 |
|
|
Sialography s&i
|
$978.55 |
$1,409.90 |
$1,409.90 |
|
|
Sialolithotomy 42330
|
$434.55 |
$434.55 |
$434.55 |
|
|
Sickling rbc
|
$34.70 |
$63.40 |
$201.10 |
|
|
Sigmoidoscopy flex decompression 45337
|
$244.25 |
$1,545.25 |
$2,702.00 |
|
|
Sigmoidoscopy w/fb removal 45332
|
$475.10 |
$475.10 |
$475.10 |
|
|
Sincalide 5 mcg solution for injection
|
$250.90 |
$559.95 |
$1,273.29 |
|
|
Sinus CT scan (with and without contrast)
|
$1,647.60 |
$2,598.20 |
$3,247.35 |
|
|
Sinus CT scan (with contrast)
|
$963.40 |
$1,893.70 |
$3,247.35 |
|
|
Sinus CT scan (without contrast)
|
$799.75 |
$1,382.10 |
$1,920.60 |
|
|
Sinus/juglr venogram s&i
|
$2,628.40 |
$2,628.40 |
$2,628.40 |
|
|
Sinus X-ray (complete)
|
$320.90 |
$543.00 |
$645.15 |
|
|
Sinus X-ray (limited)
|
$175.65 |
$288.80 |
$663.00 |
|
|
Sipuleucel-t - su
|
$149,482.25 |
$149,482.25 |
$149,482.25 |
|
|
Skin Biopsy
|
$214.60 |
$260.75 |
$378.65 |
|
|
Skull X-ray (1 to 3 views)
|
$292.50 |
$430.50 |
$663.00 |
|
|
Skull X-ray (complete)
|
$374.70 |
$543.95 |
$1,160.70 |
|
|
Skyla, 13.5 mg
|
$1,537.91 |
$2,414.97 |
$4,404.46 |
|
|
Sleep study attended
|
$707.20 |
$707.20 |
$2,681.85 |
|
|
Sleep Study (Polysomnography)
|
$3,094.85 |
$3,312.90 |
$5,591.75 |
|
|
Sleep study unattended
|
$446.15 |
$446.15 |
$446.15 |
|
|
Sleeve fing rolyan med
|
$170.05 |
$562.75 |
$934.00 |
|
|
Sling arm deluxe w/pad xs
|
$14.00 |
$14.00 |
$14.00 |
|
|
Sling suprapubic suburetheral
|
$1,066.05 |
$1,479.00 |
$2,133.00 |
|
|
Slitting of prepuce
|
$607.35 |
$607.35 |
$3,690.10 |
|
|
Slp eval non-spch gen comm dev
|
$548.15 |
$548.15 |
$844.95 |
|
|
Slp pure tone screening
|
$56.70 |
$59.00 |
$141.65 |
|
|
Slp ther svc non-spch gen
|
$413.40 |
$413.40 |
$486.65 |
|
|
Small Bowel Barium X-ray (Follow-Through)
|
$728.85 |
$805.80 |
$1,504.95 |
|
|
Smear fluorescent and/or acid fast stain
|
$25.80 |
$52.35 |
$93.45 |
|
|
Smear gram stain
|
$49.85 |
$77.85 |
$90.40 |
|
|
Smear nasal eosinophil
|
$33.35 |
$94.50 |
$161.75 |
|
|
Smear special stain inclusion bodies/parasites
|
$67.35 |
$92.50 |
$135.25 |
|
|
Smear wet mount
|
$17.25 |
$48.35 |
$148.45 |
|
|
Smpd1 gene common variants
|
$87.00 |
$158.10 |
$335.15 |
|
|
Sodium 24 hour urine
|
$39.10 |
$95.85 |
$164.75 |
|
|
Sodium chloride 0.9 % intravenous solution
|
$12.92 |
$25.19 |
$157.14 |
|
|
Sodium chloride 0.9 % IV bolus
|
$0.11 |
$0.22 |
$34.95 |
|
|
Sodium chloride 0.9 % IV bolus
|
$7.35 |
$25.19 |
$157.14 |
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$62.37 |
$62.37 |
$310.36 |
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$811.62 |
$811.62 |
$811.62 |
|
|
Sodium serum/plasma/whole blood
|
$41.80 |
$94.50 |
$99.25 |
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$277.14 |
$451.15 |
$790.54 |
|
|
Spacer bag/reservoir
|
$20.00 |
$26.00 |
$26.00 |
|
|
Special casting material
|
$38.00 |
$38.00 |
$38.00 |
|
|
Special supplies phys/qhp
|
$337.40 |
$337.40 |
$337.40 |
|
|
Specific gravity body fluid
|
$9.70 |
$25.10 |
$68.80 |
|
|
Speech and Language Evaluation (comprehensive)
|
$315.85 |
$475.25 |
$685.65 |
|
|
Speech audiometry complete
|
$121.45 |
$121.45 |
$132.30 |
|
|
Speech evaluation complex
|
$811.20 |
$811.20 |
$811.20 |
|
|
Speech recep thresh
|
$82.35 |
$82.35 |
$129.65 |
|
|
Speech Therapy Session (one-on-one)
|
$132.90 |
$334.30 |
$688.40 |
|
|
Sperm washing 58323
|
$28.60 |
$28.60 |
$28.60 |
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$932.85 |
$2,519.55 |
$2,645.35 |
|
|
Spine X-ray (single view, one level)
|
$191.35 |
$288.60 |
$473.75 |
|
|
Spleen imaging
|
$51.00 |
$51.00 |
$2,081.20 |
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$153.85 |
$930.40 |
$1,850.45 |
|
|
Splint extn xsm w sof-stretch rolyan
|
$53.40 |
$53.40 |
$236.15 |
|
|
Splint finger 4 prong foam sm
|
$14.00 |
$14.00 |
$14.00 |
|
|
Splint finger fold over sm
|
$57.75 |
$155.75 |
$283.40 |
|
|
Splint finger frog med
|
$155.20 |
$155.20 |
$155.20 |
|
|
Splint fing stax assort 1-7in
|
$17.00 |
$17.00 |
$17.00 |
|
|
Splint func pos polyflex ii med
|
$101.80 |
$101.80 |
$101.80 |
|
|
Splint rstrc wrst/cmc right med
|
$148.45 |
$148.45 |
$523.70 |
|
|
Split blood or products
|
$235.50 |
$235.50 |
$256.15 |
|
|
Staggered spondaic word test
|
$134.95 |
$134.95 |
$267.80 |
|
|
St analysis behavior qualitative voice/resonance
|
$158.65 |
$436.85 |
$685.65 |
|
|
Static or dynami afo pre ots
|
$167.15 |
$167.15 |
$167.15 |
|
|
St cognitve performance testing healthcare professional each hour
|
$265.00 |
$406.50 |
$704.55 |
|
|
Stenger test pure tone
|
$87.65 |
$87.65 |
$106.70 |
|
|
Stenger test speech
|
$167.35 |
$167.35 |
$940.10 |
|
|
Stent axios caut enh 15x10mm electrocaut
|
$2,095.00 |
$2,095.00 |
$7,084.00 |
|
|
Stent bili dbl pgtl 10fx5cm
|
$108.37 |
$170.97 |
$2,136.75 |
|
|
Stent bili rx wallflx 10x80 uncvr
|
$1,000.00 |
$1,032.76 |
$2,136.75 |
|
|
Stent iliac/open or perc/uni/init 37221
|
$17,856.30 |
$17,856.30 |
$17,856.30 |
|
|
Stent iliac/open/perc/ea ad/ipsila 37223
|
$16,767.55 |
$16,767.55 |
$16,767.55 |
|
|
Sterile needle
|
$123.60 |
$155.50 |
$261.50 |
|
|
Sterile water/saline, 10 ml
|
$4.00 |
$4.00 |
$4.00 |
|
|
St evaluate speech sound production
|
$154.65 |
$315.85 |
$685.65 |
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$381.95 |
$545.70 |
$754.45 |
|
|
Stomach Emptying Scan (Nuclear Medicine)
|
$1,686.40 |
$2,043.10 |
$3,165.05 |
|
|
Strapping of ankle and/or ft 29540
|
$184.85 |
$225.70 |
$288.80 |
|
|
Strapping of chest
|
$103.90 |
$103.90 |
$103.90 |
|
|
Strapping of elbow or wrist 29260
|
$67.45 |
$116.05 |
$168.75 |
|
|
Strapping of hand or finger
|
$116.05 |
$236.90 |
$372.10 |
|
|
Strapping of hip
|
$103.90 |
$260.00 |
$260.00 |
|
|
Strapping of knee
|
$116.05 |
$170.05 |
$245.80 |
|
|
Strapping of toes 29550
|
$43.20 |
$190.25 |
$202.25 |
|
|
Strep a ag ia
|
$43.70 |
$104.90 |
$150.40 |
|
|
Stress test pulmonary
|
$63.45 |
$291.20 |
$592.35 |
|
|
Stress tte complete
|
$1,434.75 |
$1,434.75 |
$1,899.05 |
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$6.08 |
$52.39 |
$67.36 |
|
|
Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution
|
$4,064.40 |
$7,914.03 |
$11,546.90 |
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$63.17 |
$79.93 |
$152.35 |
|
|
Sulfonylurea screen qn-sendout
|
$208.85 |
$208.85 |
$208.85 |
|