|
Simple cystometrogram 51725
|
$46.20 |
$46.20 |
$46.20 |
$614.00
|
|
Sincalide 5 mcg solution for injection
|
$100.46 |
$100.46 |
$100.46 |
$309.14
|
|
Single energy x-ray study
|
$6.82 |
$6.82 |
$6.82 |
$125.84
|
|
Single transfer toe-hand
|
$2,011.24 |
$2,011.24 |
$2,011.24 |
$7,413.38
|
|
Sinus CT scan (with and without contrast)
|
$1,887.60 |
$1,887.60 |
$1,887.60 |
$1,788.60
|
|
Sinus CT scan (with contrast)
|
$1,510.08 |
$1,510.08 |
$1,510.08 |
$1,519.50
|
|
Sinus CT scan (without contrast)
|
$902.46 |
$902.46 |
$902.46 |
$1,283.87
|
|
Sinus/juglr venogram s&i
|
$33.22 |
$33.22 |
$33.22 |
$2,537.60
|
|
Sinusotomy maxillary sinus 31020
|
$209.44 |
$209.44 |
$209.44 |
$2,616.15
|
|
Sinusotomy sinus remove polyps 31032
|
$363.88 |
$363.88 |
$363.88 |
$6,465.11
|
|
Sinusotomy sphenoid w/wo bx 31050
|
$314.82 |
$314.82 |
$314.82 |
$6,465.11
|
|
Sinus X-ray (complete)
|
$354.12 |
$354.12 |
$354.12 |
$345.24
|
|
Sinus X-ray (limited)
|
$283.14 |
$283.14 |
$283.14 |
$214.50
|
|
Skin and muscle repair face
|
$656.70 |
$656.70 |
$656.70 |
$4,332.25
|
|
Skin Biopsy
|
$464.88 |
$464.88 |
$464.88 |
$362.40
|
|
Skin full graft 20sq cm less 15200
|
$415.14 |
$415.14 |
$415.14 |
$2,379.00
|
|
Skin full graft add-on 15241
|
$65.56 |
$65.56 |
$65.56 |
$560.01
|
|
Skin pedicle flap arms/legs
|
$455.18 |
$455.18 |
$455.18 |
$4,332.25
|
|
Skin pedicle flap trunk
|
$449.68 |
$449.68 |
$449.68 |
$2,501.86
|
|
Skin split graft addl 100sq cm 15101
|
$67.76 |
$67.76 |
$67.76 |
$1,793.40
|
|
Skull base/brainstem surgery
|
$1,559.80 |
$1,559.80 |
$1,559.80 |
$3,770.91
|
|
Skull base/brainstem surgery
|
$2,590.28 |
$2,590.28 |
$2,590.28 |
$6,428.85
|
|
Skull X-ray (1 to 3 views)
|
$342.42 |
$342.42 |
$342.42 |
$297.00
|
|
Skull X-ray (complete)
|
$427.44 |
$427.44 |
$427.44 |
$417.50
|
|
Slco1b1 gene com variants
|
$115.28 |
$115.28 |
$115.28 |
$235.20
|
|
Sleep study attended
|
$35.86 |
$35.86 |
$35.86 |
$1,329.00
|
|
Sleep Study (Polysomnography)
|
$2,975.70 |
$2,975.70 |
$2,975.70 |
$3,721.41
|
|
Sleep study unattended
|
$26.84 |
$26.84 |
$26.84 |
$594.00
|
|
Sleeve pneumonectomy
|
$1,854.38 |
$1,854.38 |
$1,854.38 |
$4,314.34
|
|
Slitting of prepuce
|
$69.08 |
$69.08 |
$69.08 |
$4,061.71
|
|
Slitting of prepuce
|
$87.34 |
$87.34 |
$87.34 |
$3,376.23
|
|
Slp eval for nonspeech dev ea addl 30 mins
|
$20.46 |
$20.46 |
$20.46 |
$139.44
|
|
Slp eval non-spch gen comm dev
|
$55.44 |
$55.44 |
$55.44 |
$285.09
|
|
Slp stdy unatnd w/anal
|
$24.86 |
$24.86 |
$24.86 |
$285.00
|
|
Slp ther svc non-spch gen
|
$44.00 |
$44.00 |
$44.00 |
$188.00
|
|
Small animal inoculation
|
$11.00 |
$11.00 |
$11.00 |
$23.24
|
|
Small Bowel Barium X-ray (Follow-Through)
|
$572.52 |
$572.52 |
$572.52 |
$557.70
|
|
Small bowel endoscopy
|
$87.34 |
$87.34 |
$87.34 |
$2,596.41
|
|
Small bowel endoscopy
|
$124.30 |
$124.30 |
$124.30 |
$2,244.82
|
|
Small bowel endoscopy
|
$145.64 |
$145.64 |
$145.64 |
$2,638.57
|
|
Small bowel endoscopy
|
$149.16 |
$149.16 |
$149.16 |
$2,518.10
|
|
Small bowel endoscopy
|
$172.70 |
$172.70 |
$172.70 |
$2,638.57
|
|
Small bowel endoscopy
|
$233.42 |
$233.42 |
$233.42 |
$3,265.60
|
|
Small bowel endoscopy
|
$45.32 |
$45.32 |
$45.32 |
$2,088.00
|
|
Small bowel endoscopy
|
$93.50 |
$93.50 |
$93.50 |
$2,956.20
|
|
Small bowel endoscopy >2nd w/remove 44363
|
$116.38 |
$116.38 |
$116.38 |
$2,590.33
|
|
Small bowel endoscopy 44365
|
$110.88 |
$110.88 |
$110.88 |
$2,244.82
|
|
Small bowel endoscopy/biopsy
|
$96.58 |
$96.58 |
$96.58 |
$2,490.15
|
|
Small bowel endoscopy/biopsy
|
$181.28 |
$181.28 |
$181.28 |
$2,244.82
|
|
Small bowel endoscopy br/wa
|
$35.42 |
$35.42 |
$35.42 |
$1,924.00
|
|
Small bowel endoscopy br/wa
|
$51.48 |
$51.48 |
$51.48 |
$2,406.40
|
|
Small bowel endoscopy/stent 44370
|
$162.14 |
$162.14 |
$162.14 |
$4,992.00
|
|
Smear fluorescent and/or acid fast stain
|
$28.86 |
$28.86 |
$28.86 |
$64.00
|
|
Smear gram stain
|
$22.62 |
$22.62 |
$22.62 |
$54.03
|
|
Smear nasal eosinophil
|
$3.96 |
$3.96 |
$3.96 |
$45.50
|
|
Smear special stain inclusion bodies/parasites
|
$31.98 |
$31.98 |
$31.98 |
$71.81
|
|
Smear wet mount
|
$30.42 |
$30.42 |
$30.42 |
$66.30
|
|
Smn1 gene full gene sequence
|
$198.88 |
$198.88 |
$198.88 |
$495.69
|
|
Smn1 gen nown famil seq vrnt
|
$122.32 |
$122.32 |
$122.32 |
$255.58
|
|
Smpd1 gene common variants
|
$31.24 |
$31.24 |
$31.24 |
$133.84
|
|
Sodium 24 hour urine
|
$27.30 |
$27.30 |
$27.30 |
$48.75
|
|
Sodium chloride 0.9 % intravenous solution
|
$5.39 |
$5.39 |
$5.39 |
$48.58
|
|
Sodium chloride 0.9 % IV bolus
|
$4.62 |
$4.62 |
$4.62 |
$45.56
|
|
Sodium chloride 0.9 % IV bolus
|
$4.04 |
$4.04 |
$4.04 |
$37.64
|
|
Sodium chloride 3 % ivpb
|
$5.00 |
$5.00 |
$5.00 |
$39.60
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$97.94 |
$97.94 |
$97.94 |
$80.73
|
|
Sodium serum/plasma/whole blood
|
$24.96 |
$24.96 |
$24.96 |
$45.60
|
|
Somatosensory testing
|
$16.50 |
$16.50 |
$16.50 |
$816.00
|
|
So neo gsap dna/dna&rna
|
$6,995.82 |
$6,995.82 |
$6,995.82 |
$2,989.55
|
|
Sp bone agrft morsel add-on
|
$102.96 |
$102.96 |
$102.96 |
$406.40
|
|
Sp bone agrft struct add-on
|
$112.64 |
$112.64 |
$112.64 |
$442.40
|
|
Sp bone algrft morsel add-on
|
$53.68 |
$53.68 |
$53.68 |
$498.55
|
|
Special radiation dosimetry
|
$28.60 |
$28.60 |
$28.60 |
$392.73
|
|
Special radiation treatment
|
$66.66 |
$66.66 |
$66.66 |
$2,045.50
|
|
Special supplies phys/qhp
|
$3.96 |
$3.96 |
$3.96 |
$60.00
|
|
Special teletx port plan
|
$31.02 |
$31.02 |
$31.02 |
$1,086.99
|
|
Specific gravity body fluid
|
$17.94 |
$17.94 |
$17.94 |
$22.00
|
|
Specimen fat stain
|
$3.96 |
$3.96 |
$3.96 |
$35.10
|
|
Speech evaluation complex
|
$25.74 |
$25.74 |
$25.74 |
$527.06
|
|
Sperm antibody test
|
$7.04 |
$7.04 |
$7.04 |
$57.85
|
|
Sperm evaluation test
|
$12.76 |
$12.76 |
$12.76 |
$27.03
|
|
Sperm identification
|
$80.30 |
$80.30 |
$80.30 |
$101.55
|
|
Sperm isolation complex
|
$37.84 |
$37.84 |
$37.84 |
$176.28
|
|
Sperm isolation simple
|
$24.20 |
$24.20 |
$24.20 |
$126.05
|
|
Sperm washing 58323
|
$7.48 |
$7.48 |
$7.48 |
$238.06
|
|
Sphenoid sinus surgery
|
$420.64 |
$420.64 |
$420.64 |
$6,547.81
|
|
Sphincteroplasty inc/prolapse adult 46750
|
$462.00 |
$462.00 |
$462.00 |
$3,245.23
|
|
Spinal bone allograftstructural 20931
|
$68.20 |
$68.20 |
$68.20 |
$266.40
|
|
Spinal bone autograftlocal 20936
|
$57.20 |
$57.20 |
$57.20 |
$424.20
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$1,620.84 |
$1,620.84 |
$1,620.84 |
$1,474.00
|
|
Spine X-ray (single view, one level)
|
$283.14 |
$283.14 |
$283.14 |
$251.40
|
|
Spirmtry w/brnchdil inf-2 yr
|
$84.48 |
$84.48 |
$84.48 |
$368.50
|
|
Spirometry up to 2 yrs old
|
$51.92 |
$51.92 |
$51.92 |
$242.25
|
|
Spleen imaging
|
$10.12 |
$10.12 |
$10.12 |
$679.00
|
|
Splenectomy total open 38100
|
$710.82 |
$710.82 |
$710.82 |
$2,166.00
|
|
Splice spleen/kidney veins
|
$1,429.34 |
$1,429.34 |
$1,429.34 |
$2,547.00
|
|
Splicing of ureters
|
$710.16 |
$710.16 |
$710.16 |
$1,493.66
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$426.36 |
$426.36 |
$426.36 |
$4,687.20
|
|
Splt agrft f/s/n/h/f/g/m ea
|
$80.30 |
$80.30 |
$80.30 |
$1,612.78
|
|
Srs cranial lesion complex
|
$862.40 |
$862.40 |
$862.40 |
$3,244.00
|