|
Sinus CT scan (with contrast)
|
$1,076.00 |
$1,076.00 |
$1,218.40 |
|
|
Sinus CT scan (without contrast)
|
$799.20 |
$799.20 |
$999.20 |
|
|
Sinus/juglr venogram s&i
|
$1,084.80 |
$1,084.80 |
$1,084.80 |
|
|
Sirolimus, oral
|
$47.46 |
$47.46 |
$47.46 |
|
|
Skin Biopsy
|
$152.00 |
$152.00 |
$397.60 |
|
|
Skin split graft addl 100sq cm 15101
|
$280.80 |
$280.80 |
$280.80 |
|
|
Skin test unlisted antigen ea
|
$80.00 |
$80.00 |
$80.00 |
|
|
Skyla, 13.5 mg
|
$839.20 |
$839.20 |
$839.20 |
|
|
Sleep study attended
|
$1,223.20 |
$1,223.20 |
$1,355.20 |
|
|
Sleep Study (Polysomnography)
|
$1,616.80 |
$1,616.80 |
$1,885.60 |
|
|
Sleep study unattended
|
$189.60 |
$189.60 |
$358.40 |
|
|
Sleeve fing rolyan med
|
$164.80 |
$164.80 |
$164.80 |
|
|
Sling arm deluxe w/pad xs
|
$15.48 |
$15.48 |
$15.48 |
|
|
Sling pelv split sam med
|
$103.20 |
$103.20 |
$103.20 |
|
|
Sling suprapubic suburetheral
|
$9,617.58 |
$9,617.58 |
$9,617.58 |
|
|
Slitting of prepuce
|
$291.20 |
$291.20 |
$2,559.20 |
|
|
Slp eval non-spch gen comm dev
|
$90.40 |
$90.40 |
$90.40 |
|
|
Slp pure tone screening
|
$19.20 |
$19.20 |
$19.20 |
|
|
Small bowel endoscopy br/wa
|
$1,371.20 |
$1,371.20 |
$1,371.20 |
|
|
Smear fluorescent and/or acid fast stain
|
$48.80 |
$48.80 |
$81.60 |
|
|
Smear gram stain
|
$60.00 |
$60.00 |
$66.40 |
|
|
Smear nasal eosinophil
|
$72.00 |
$72.00 |
$83.20 |
|
|
Smear special stain inclusion bodies/parasites
|
$92.80 |
$92.80 |
$109.60 |
|
|
Smear wet mount
|
$69.60 |
$69.60 |
$77.60 |
|
|
Sodium 24 hour urine
|
$42.40 |
$42.40 |
$102.40 |
|
|
Sodium chloride 0.9 % intravenous solution
|
$36.28 |
$36.28 |
$70.84 |
|
|
Sodium chloride 0.9 % IV bolus
|
$63.75 |
$63.75 |
$77.92 |
|
|
Sodium chloride 0.9 % IV bolus
|
$53.13 |
$53.13 |
$67.30 |
|
|
Sodium chloride 3 % ivpb
|
$42.50 |
$42.50 |
$42.50 |
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$177.71 |
$177.71 |
$179.44 |
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$182.40 |
$182.40 |
$182.40 |
|
|
Sodium serum/plasma/whole blood
|
$32.00 |
$32.00 |
$35.20 |
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$74.58 |
$74.58 |
$74.58 |
|
|
Special physics consult
|
$515.20 |
$515.20 |
$515.20 |
|
|
Special radiation treatment
|
$2,492.80 |
$2,492.80 |
$2,492.80 |
|
|
Special teletx port plan
|
$713.60 |
$713.60 |
$713.60 |
|
|
Specific gravity body fluid
|
$35.20 |
$35.20 |
$35.20 |
|
|
Specimen fat stain
|
$68.00 |
$68.00 |
$68.00 |
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$1,038.40 |
$1,038.40 |
$1,482.40 |
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$291.20 |
$291.20 |
$302.40 |
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$344.00 |
$344.00 |
$344.00 |
|
|
Splint rstrc wrst/cmc right med
|
$66.80 |
$66.80 |
$66.80 |
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$1,244.00 |
$1,244.00 |
$4,689.60 |
|
|
Srs linear based
|
$14,454.40 |
$14,454.40 |
$14,454.40 |
|
|
St analysis behavior qualitative voice/resonance
|
$202.40 |
$202.40 |
$224.80 |
|
|
Staph a dna amp probe
|
$154.40 |
$154.40 |
$168.00 |
|
|
St cognitve performance testing healthcare professional each hour
|
$191.20 |
$191.20 |
$212.80 |
|
|
Stent/athrectomy/fem/pop/unilat 37227
|
$32,634.40 |
$32,634.40 |
$32,634.40 |
|
|
Stent axios caut enh 15x10mm electrocaut
|
$39,200.00 |
$39,200.00 |
$39,200.00 |
|
|
Stent bili dbl pgtl 10fx5cm
|
$22,318.76 |
$22,318.76 |
$22,318.76 |
|
|
Stent bili rx wallflx 10x80 uncvr
|
$20,827.04 |
$20,827.04 |
$20,827.04 |
|
|
Stent bronch dumon sil 10x40mm
|
$4,939.20 |
$4,939.20 |
$4,939.20 |
|
|
Stent iliac/open or perc/uni/init 37221
|
$9,973.60 |
$9,973.60 |
$9,973.60 |
|
|
Stent iliac/open/perc/ea ad/ipsila 37223
|
$9,973.60 |
$9,973.60 |
$9,973.60 |
|
|
Stent/tib/peroneal/unilat/initial 37230
|
$32,284.80 |
$32,284.80 |
$32,284.80 |
|
|
St evaluate speech sound production
|
$202.40 |
$202.40 |
$224.80 |
|
|
St evaluate speech sound production comprehensive/expressive
|
$224.80 |
$224.80 |
$343.20 |
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$295.20 |
$295.20 |
$382.40 |
|
|
St evaluation swallow function
|
$128.00 |
$128.00 |
$216.00 |
|
|
Strapping of ankle and/or ft 29540
|
$42.40 |
$42.40 |
$201.60 |
|
|
Strapping of chest
|
$201.60 |
$201.60 |
$201.60 |
|
|
Strapping of elbow or wrist 29260
|
$43.20 |
$43.20 |
$79.20 |
|
|
Strapping of hand or finger
|
$44.80 |
$44.80 |
$79.20 |
|
|
Strapping of hip
|
$160.00 |
$160.00 |
$160.00 |
|
|
Strapping of knee
|
$44.00 |
$44.00 |
$160.00 |
|
|
Strapping of toes 29550
|
$29.60 |
$29.60 |
$79.20 |
|
|
Strep a ag ia
|
$51.20 |
$51.20 |
$51.20 |
|
|
Strep b assay w/optic
|
$51.20 |
$51.20 |
$51.20 |
|
|
Strep b dna amp probe
|
$218.40 |
$218.40 |
$237.60 |
|
|
Stress test pulmonary
|
$182.40 |
$182.40 |
$273.60 |
|
|
Stress tte complete
|
$341.60 |
$341.60 |
$341.60 |
|
|
St treatment speech individual
|
$118.40 |
$118.40 |
$131.20 |
|
|
St treatment swallow dysfunction/oral
|
$115.20 |
$115.20 |
$148.80 |
|
|
Subq njx filling matrl 1cc/<
|
$117.60 |
$117.60 |
$117.60 |
|
|
Subq njx fil matrl 5.1-10cc
|
$218.40 |
$218.40 |
$218.40 |
|
|
Subsequent intensive care infant 1500-2500 grams 99479
|
$179.20 |
$179.20 |
$179.20 |
|
|
Subsequent intensive care infant 2501-5000 grams 99480
|
$172.00 |
$172.00 |
$172.00 |
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$94.34 |
$94.34 |
$132.98 |
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$114.01 |
$114.01 |
$114.01 |
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$94.62 |
$94.62 |
$309.18 |
|
|
Support clav 29.6-40.5in med
|
$46.23 |
$46.23 |
$46.23 |
|
|
Surg dx exam anorectal
|
$154.40 |
$154.40 |
$154.40 |
|
|
Surg ect salp-oophorectomy 59120
|
$1,207.20 |
$1,207.20 |
$1,207.20 |
|
|
Surgical pathology level 1 gross examination only
|
$73.60 |
$73.60 |
$96.80 |
|
|
Surgical pathology level 2 gross & microscopic examination
|
$79.20 |
$79.20 |
$137.60 |
|
|
Surgical pathology level 3 gross & microscopic examination
|
$81.60 |
$81.60 |
$288.80 |
|
|
Surgical pathology level 4 gross & microscopic examination
|
$223.20 |
$223.20 |
$288.80 |
|
|
Surgical pathology level 5 gross & microscopic examination
|
$144.80 |
$144.80 |
$614.40 |
|
|
Surgical pathology level 6 gross & microscopic examination
|
$336.80 |
$336.80 |
$625.60 |
|
|
Susceptibility agar dilution per agent
|
$72.00 |
$72.00 |
$89.60 |
|
|
Susceptibility enzyme detection per enzyme
|
$32.80 |
$32.80 |
$43.20 |
|
|
Susceptibility mic per plate
|
$92.80 |
$92.80 |
$208.00 |
|
|
Suspension of testis
|
$446.40 |
$446.40 |
$446.40 |
|
|
Svc venogram s&i
|
$2,502.40 |
$2,502.40 |
$2,502.40 |
|
|
Synvisc or synvisc-one
|
$345.30 |
$345.30 |
$1,742.98 |
|
|
System cardiomems hosp electronics
|
$28,458.00 |
$28,458.00 |
$28,458.00 |
|
|
System pacing micra av
|
$17,856.00 |
$17,856.00 |
$17,856.00 |
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$6,604.80 |
$6,604.80 |
$6,604.80 |
|
|
System sealant biosentry tract
|
$837.90 |
$837.90 |
$837.90 |
|
|
T3 (triiodothyronine) free
|
$178.40 |
$178.40 |
$178.40 |
|
