|
Shoulder MRI (with contrast)
|
$739.80 |
$739.80 |
$739.80 |
$2,483.00
|
|
Shoulder MRI (without contrast)
|
$685.80 |
$685.80 |
$685.80 |
$2,088.20
|
|
Shoulder X-ray
|
$133.80 |
$133.80 |
$133.80 |
$341.40
|
|
Shoulder X-ray (single view, both shoulders)
|
$102.60 |
$102.60 |
$102.60 |
$264.00
|
|
Sickling rbc
|
$13.20 |
$13.20 |
$13.20 |
$59.40
|
|
Sigmoidoscopy and biopsy
|
$402.00 |
$402.00 |
$402.00 |
$1,446.90
|
|
Sigmoidoscopy flex decompression 45337
|
$749.40 |
$749.40 |
$749.40 |
$1,078.88
|
|
Sigmoidoscopy for bleeding
|
$993.60 |
$993.60 |
$993.60 |
$1,993.08
|
|
Sigmoidoscopy/submucosal injection 45335
|
$749.40 |
$749.40 |
$749.40 |
$1,650.75
|
|
Sigmoidoscopy w/fb removal 45332
|
$749.40 |
$749.40 |
$749.40 |
$1,395.28
|
|
Sigmoidoscopy w/tumr remove
|
$993.60 |
$993.60 |
$993.60 |
$1,645.43
|
|
Sigmoidoscopy w/ultrasound
|
$993.60 |
$993.60 |
$993.60 |
$1,740.57
|
|
Sigmoid/rmv tumor/polyp/hot bx for 45333
|
$993.60 |
$993.60 |
$993.60 |
$1,976.25
|
|
Sig w/tndsc balloon dilation
|
$993.60 |
$993.60 |
$993.60 |
$2,288.00
|
|
Sincalide 5 mcg solution for injection
|
$492.00 |
$492.00 |
$492.00 |
$309.14
|
|
Sinus CT scan (with and without contrast)
|
$795.00 |
$795.00 |
$795.00 |
$1,796.50
|
|
Sinus CT scan (with contrast)
|
$652.20 |
$652.20 |
$652.20 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$507.60 |
$507.60 |
$507.60 |
$1,289.00
|
|
Sinus/juglr venogram s&i
|
$734.40 |
$734.40 |
$734.40 |
$2,517.48
|
|
Sinus X-ray (complete)
|
$181.80 |
$181.80 |
$181.80 |
$347.10
|
|
Sinus X-ray (limited)
|
$50.40 |
$50.40 |
$50.40 |
$215.75
|
|
Sirolimus, oral
|
$11.00 |
$11.00 |
$11.00 |
$41.70
|
|
Skin Biopsy
|
$326.40 |
$326.40 |
$326.40 |
$361.20
|
|
Skull X-ray (1 to 3 views)
|
$155.40 |
$155.40 |
$155.40 |
$294.66
|
|
Skull X-ray (complete)
|
$200.40 |
$200.40 |
$200.40 |
$423.15
|
|
Skyla, 13.5 mg
|
$1,345.80 |
$1,345.80 |
$1,345.80 |
$1,643.47
|
|
Sleep Study (Polysomnography)
|
$1,188.00 |
$1,188.00 |
$1,188.00 |
$3,734.50
|
|
Sleep study unattended
|
$213.60 |
$213.60 |
$213.60 |
$594.00
|
|
Sling arm deluxe w/pad xs
|
$144.60 |
$144.60 |
$144.60 |
$30.35
|
|
Sling suprapubic suburetheral
|
$3,118.20 |
$3,118.20 |
$3,118.20 |
$9,679.96
|
|
Slp pure tone screening
|
$58.80 |
$58.80 |
$58.80 |
$64.50
|
|
Small Bowel Barium X-ray (Follow-Through)
|
$291.00 |
$291.00 |
$291.00 |
$557.70
|
|
Small bowel endoscopy
|
$1,738.20 |
$1,738.20 |
$1,738.20 |
$2,596.41
|
|
Small bowel endoscopy/biopsy
|
$2,413.20 |
$2,413.20 |
$2,413.20 |
$2,490.15
|
|
Small bowel endoscopy br/wa
|
$671.40 |
$671.40 |
$671.40 |
$1,924.00
|
|
Small bowel endoscopy br/wa
|
$807.00 |
$807.00 |
$807.00 |
$2,406.40
|
|
Smear fluorescent and/or acid fast stain
|
$13.20 |
$13.20 |
$13.20 |
$64.20
|
|
Smear gram stain
|
$10.20 |
$10.20 |
$10.20 |
$55.42
|
|
Smear nasal eosinophil
|
$11.40 |
$11.40 |
$11.40 |
$46.20
|
|
Smear special stain inclusion bodies/parasites
|
$14.40 |
$14.40 |
$14.40 |
$73.15
|
|
Smear wet mount
|
$10.20 |
$10.20 |
$10.20 |
$67.49
|
|
Sodium 24 hour urine
|
$12.00 |
$12.00 |
$12.00 |
$48.75
|
|
Sodium chloride 0.9 % intravenous solution
|
$4.40 |
$4.40 |
$4.40 |
$48.58
|
|
Sodium chloride 0.9 % IV bolus
|
$4.20 |
$4.20 |
$4.20 |
$45.56
|
|
Sodium chloride 0.9 % IV bolus
|
$122.40 |
$122.40 |
$122.40 |
$37.64
|
|
Sodium chloride 3 % ivpb
|
$22.80 |
$22.80 |
$22.80 |
$39.60
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$13.40 |
$13.40 |
$13.40 |
$80.73
|
|
Sodium serum/plasma/whole blood
|
$12.00 |
$12.00 |
$12.00 |
$46.26
|
|
Solid skin barrier 6x6
|
$7.20 |
$7.20 |
$7.20 |
$6.51
|
|
Speech and Language Evaluation (comprehensive)
|
$243.00 |
$243.00 |
$243.00 |
$385.00
|
|
Speech audiometry complete
|
$58.80 |
$58.80 |
$58.80 |
$109.20
|
|
Speech recep thresh
|
$36.00 |
$36.00 |
$36.00 |
$82.88
|
|
Speech Therapy Session (one-on-one)
|
$135.60 |
$135.60 |
$135.60 |
$248.30
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$1,357.80 |
$1,357.80 |
$1,357.80 |
$1,457.50
|
|
Spine X-ray (single view, one level)
|
$108.60 |
$108.60 |
$108.60 |
$251.00
|
|
Splint rstrc wrst/cmc right med
|
$121.20 |
$121.20 |
$121.20 |
$99.04
|
|
St analysis behavior qualitative voice/resonance
|
$243.00 |
$243.00 |
$243.00 |
$297.60
|
|
Staph a dna amp probe
|
$99.00 |
$99.00 |
$99.00 |
$125.00
|
|
Stent/athrectomy/fem/pop/unilat 37227
|
$12,528.60 |
$12,528.60 |
$12,528.60 |
$21,568.80
|
|
Stent axios caut enh 15x10mm electrocaut
|
$8,620.80 |
$8,620.80 |
$8,620.80 |
$32,403.15
|
|
Stent bili dbl pgtl 10fx5cm
|
$293.40 |
$293.40 |
$293.40 |
$2,649.79
|
|
Stent bili rx wallflx 10x80 uncvr
|
$2,703.00 |
$2,703.00 |
$2,703.00 |
$20,962.50
|
|
Stent iliac/open or perc/uni/init 37221
|
$3,420.60 |
$3,420.60 |
$3,420.60 |
$14,356.50
|
|
Stent iliac/open/perc/ea ad/ipsila 37223
|
$3,420.60 |
$3,420.60 |
$3,420.60 |
$8,948.40
|
|
Sterile gauze <= 16 sq in
|
$1.80 |
$1.80 |
$1.80 |
$1.52
|
|
Sterile needle
|
$2,119.80 |
$2,119.80 |
$2,119.80 |
$190.13
|
|
Sterile water/saline, 10 ml
|
$5.00 |
$5.00 |
$5.00 |
$13.32
|
|
Sterile water/saline, 500 ml
|
$3.20 |
$3.20 |
$3.20 |
$28.11
|
|
St evaluate speech sound production
|
$171.00 |
$171.00 |
$171.00 |
$292.95
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$212.40 |
$212.40 |
$212.40 |
$400.00
|
|
Stomach Emptying Scan (Nuclear Medicine)
|
$840.60 |
$840.60 |
$840.60 |
$1,342.00
|
|
Strapping of ankle and/or ft 29540
|
$690.00 |
$690.00 |
$690.00 |
$223.45
|
|
Strep b dna amp probe
|
$99.00 |
$99.00 |
$99.00 |
$122.43
|
|
Stress test pulmonary
|
$151.80 |
$151.80 |
$151.80 |
$324.00
|
|
Stress tte complete
|
$594.00 |
$594.00 |
$594.00 |
$1,894.20
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$63.80 |
$63.80 |
$63.80 |
$54.80
|
|
Sugars single quant
|
$201.60 |
$201.60 |
$201.60 |
$64.28
|
|
Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution
|
$13,842.00 |
$13,842.00 |
$13,842.00 |
$7,345.98
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$0.32 |
$0.32 |
$0.32 |
$82.46
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$41.00 |
$41.00 |
$41.00 |
$126.63
|
|
Supp non-insulin inf cath/wk
|
$17.40 |
$17.40 |
$17.40 |
$8.45
|
|
Support clav 29.6-40.5in med
|
$121.20 |
$121.20 |
$121.20 |
$94.08
|
|
Surgical pathology level 1 gross examination only
|
$35.40 |
$35.40 |
$35.40 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$35.40 |
$35.40 |
$35.40 |
$142.20
|
|
Surgical pathology level 3 gross & microscopic examination
|
$66.00 |
$66.00 |
$66.00 |
$182.25
|
|
Surgical pathology level 4 gross & microscopic examination
|
$108.60 |
$108.60 |
$108.60 |
$248.00
|
|
Surgical pathology level 5 gross & microscopic examination
|
$401.40 |
$401.40 |
$401.40 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$566.40 |
$566.40 |
$566.40 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$21.00 |
$21.00 |
$21.00 |
$45.45
|
|
Susceptibility enzyme detection per enzyme
|
$11.40 |
$11.40 |
$11.40 |
$35.75
|
|
Susceptibility mic per plate
|
$21.00 |
$21.00 |
$21.00 |
$105.75
|
|
Suscept studies macrobroth dilution ea
|
$70.80 |
$70.80 |
$70.80 |
$59.28
|
|
Swallowing Evaluation (Bedside)
|
$210.00 |
$210.00 |
$210.00 |
$316.55
|
|
Swallowing Therapy Session
|
$118.20 |
$118.20 |
$118.20 |
$240.31
|
|
Synvisc or synvisc-one
|
$30.60 |
$30.60 |
$30.60 |
$1,242.63
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$10.80 |
$10.80 |
$10.80 |
$41.60
|
|
System pacing micra av
|
$7,800.60 |
$7,800.60 |
$7,800.60 |
$24,293.25
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$11,490.60 |
$11,490.60 |
$11,490.60 |
$12,003.00
|
|
T3 (triiodothyronine) free
|
$122.40 |
$122.40 |
$122.40 |
$100.32
|
|
T3 (triiodothyronine) total
|
$34.80 |
$34.80 |
$34.80 |
$93.52
|
