|
Sigmoidoscopy w/tumr remove
|
$984.00 |
$984.00 |
$984.00 |
$1,558.80
|
|
Sigmoid/rmv tumor/polyp/hot bx for 45333
|
$833.28 |
$833.28 |
$833.28 |
$1,664.40
|
|
Sincalide 5 mcg solution for injection
|
$331.75 |
$331.75 |
$331.75 |
$307.58
|
|
Sinus CT scan (with and without contrast)
|
$1,704.00 |
$1,704.00 |
$1,704.00 |
$1,790.00
|
|
Sinus CT scan (with contrast)
|
$1,348.32 |
$1,348.32 |
$1,348.32 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$891.84 |
$891.84 |
$891.84 |
$1,292.04
|
|
Sirolimus, oral
|
$1,083.84 |
$1,083.84 |
$1,083.84 |
$41.25
|
|
Skin Biopsy
|
$154.08 |
$154.08 |
$154.08 |
$360.34
|
|
Skin full graft 20sq cm less 15200
|
$3,189.12 |
$3,189.12 |
$3,189.12 |
$2,371.50
|
|
Skin full graft add-on 15241
|
$1,594.08 |
$1,594.08 |
$1,594.08 |
$675.58
|
|
Skin pedicle flap arms/legs
|
$5,850.72 |
$5,850.72 |
$5,850.72 |
$4,332.25
|
|
Skin pedicle flap trunk
|
$3,189.12 |
$3,189.12 |
$3,189.12 |
$2,501.86
|
|
Skin split graft addl 100sq cm 15101
|
$1,594.08 |
$1,594.08 |
$1,594.08 |
$1,793.40
|
|
Sleep Study (Polysomnography)
|
$2,188.80 |
$2,188.80 |
$2,188.80 |
$3,607.50
|
|
Sleep study unattended
|
$272.64 |
$272.64 |
$272.64 |
$580.87
|
|
Slitting of prepuce
|
$305.28 |
$305.28 |
$305.28 |
$3,365.50
|
|
Slp eval non-spch gen comm dev
|
$240.00 |
$240.00 |
$240.00 |
$285.09
|
|
Slp pure tone screening
|
$19.68 |
$19.68 |
$19.68 |
$60.48
|
|
Slp ther svc non-spch gen
|
$187.75 |
$187.75 |
$187.75 |
$188.50
|
|
Sm-153 lexidron ther
|
$8,175.36 |
$8,175.36 |
$8,175.36 |
$7,320.12
|
|
Small bowel endoscopy
|
$216.48 |
$216.48 |
$216.48 |
$2,463.36
|
|
Small bowel endoscopy
|
$425.28 |
$425.28 |
$425.28 |
$2,638.57
|
|
Small bowel endoscopy
|
$1,544.64 |
$1,544.64 |
$1,544.64 |
$1,620.78
|
|
Small bowel endoscopy br/wa
|
$1,556.64 |
$1,556.64 |
$1,556.64 |
$1,924.00
|
|
Smear fluorescent and/or acid fast stain
|
$37.65 |
$37.65 |
$37.65 |
$64.20
|
|
Smear gram stain
|
$32.05 |
$32.05 |
$32.05 |
$55.25
|
|
Smear nasal eosinophil
|
$26.97 |
$26.97 |
$26.97 |
$46.20
|
|
Smear special stain inclusion bodies/parasites
|
$101.25 |
$101.25 |
$101.25 |
$73.15
|
|
Smear wet mount
|
$29.51 |
$29.51 |
$29.51 |
$67.49
|
|
Snrpn/ube3a gene
|
$104.30 |
$104.30 |
$104.30 |
$231.85
|
|
Sodium 24 hour urine
|
$22.39 |
$22.39 |
$22.39 |
$48.60
|
|
Sodium chloride 3 % ivpb
|
$20.11 |
$20.11 |
$20.11 |
$40.61
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$118.21 |
$118.21 |
$118.21 |
$77.77
|
|
Sodium serum/plasma/whole blood
|
$18.83 |
$18.83 |
$18.83 |
$45.60
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$312.96 |
$312.96 |
$312.96 |
$177.52
|
|
Special physics consult
|
$568.32 |
$568.32 |
$568.32 |
$725.00
|
|
Special radiation dosimetry
|
$224.38 |
$224.38 |
$224.38 |
$392.50
|
|
Special radiation treatment
|
$1,425.12 |
$1,425.12 |
$1,425.12 |
$1,986.00
|
|
Special teletx port plan
|
$791.52 |
$791.52 |
$791.52 |
$1,086.99
|
|
Speech audiometry complete
|
$69.12 |
$69.12 |
$69.12 |
$109.20
|
|
Speech recep thresh
|
$44.64 |
$44.64 |
$44.64 |
$82.88
|
|
Sphincteroplasty inc/prolapse adult 46750
|
$4,760.16 |
$4,760.16 |
$4,760.16 |
$3,245.23
|
|
Spirmtry w/brnchdil inf-2 yr
|
$208.80 |
$208.80 |
$208.80 |
$368.50
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$398.88 |
$398.88 |
$398.88 |
$543.26
|
|
Splenectomy total open 38100
|
$1,752.96 |
$1,752.96 |
$1,752.96 |
$2,166.00
|
|
Splicing of ureters
|
$1,744.32 |
$1,744.32 |
$1,744.32 |
$1,493.66
|
|
Splint fing stax assort 1-7in
|
$3.36 |
$3.36 |
$3.36 |
$5.60
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$5,850.72 |
$5,850.72 |
$5,850.72 |
$4,619.65
|
|
Splt agrft f/s/n/h/f/g/m ea
|
$2,925.12 |
$2,925.12 |
$2,925.12 |
$1,612.78
|
|
Sputum specimen collection
|
$197.92 |
$197.92 |
$197.92 |
$180.00
|
|
Sr-89 stront chlor ther / mci
|
$12,319.20 |
$12,319.20 |
$12,319.20 |
$2,667.94
|
|
St analysis behavior qualitative voice/resonance
|
$150.10 |
$150.10 |
$150.10 |
$297.60
|
|
St cognitve performance testing healthcare professional each hour
|
$287.04 |
$287.04 |
$287.04 |
$286.00
|
|
St evaluate speech sound production
|
$147.04 |
$147.04 |
$147.04 |
$292.95
|
|
St evaluate speech sound production comprehensive/expressive
|
$232.52 |
$232.52 |
$232.52 |
$377.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$299.52 |
$299.52 |
$299.52 |
$399.60
|
|
St evaluation swallow function
|
$232.52 |
$232.52 |
$232.52 |
$314.40
|
|
Strapping of ankle and/or ft 29540
|
$242.40 |
$242.40 |
$242.40 |
$223.45
|
|
Strapping of elbow or wrist 29260
|
$242.40 |
$242.40 |
$242.40 |
$154.70
|
|
Strapping of hand or finger
|
$242.40 |
$242.40 |
$242.40 |
$174.82
|
|
Strapping of knee
|
$242.40 |
$242.40 |
$242.40 |
$205.20
|
|
Strapping of toes 29550
|
$242.40 |
$242.40 |
$242.40 |
$164.70
|
|
Strep a ag ia
|
$62.58 |
$62.58 |
$62.58 |
$75.40
|
|
Stress test pulmonary
|
$163.32 |
$163.32 |
$163.32 |
$322.85
|
|
Stress tte complete
|
$1,414.08 |
$1,414.08 |
$1,414.08 |
$1,870.50
|
|
St treatment speech individual
|
$256.32 |
$256.32 |
$256.32 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$210.64 |
$210.64 |
$210.64 |
$240.31
|
|
Subq i/p critical care pr day age 28 days/less than 99469
|
$489.60 |
$489.60 |
$489.60 |
$717.60
|
|
Subsequent intensive care infant 1500-2500 grams 99479
|
$153.60 |
$153.60 |
$153.60 |
$224.80
|
|
Subsequent intensive care infant 2501-5000 grams 99480
|
$147.84 |
$147.84 |
$147.84 |
$216.00
|
|
Subtalar arthro w/deb
|
$1,007.04 |
$1,007.04 |
$1,007.04 |
$3,839.54
|
|
Subtalar arthro w/exc
|
$790.08 |
$790.08 |
$790.08 |
$7,907.11
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$94.49 |
$94.49 |
$94.49 |
$52.31
|
|
Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution
|
$17,431.46 |
$17,431.46 |
$17,431.46 |
$7,345.98
|
|
Sulfonylurea screen qn-sendout
|
$71.74 |
$71.74 |
$71.74 |
$156.16
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$1,161.86 |
$1,161.86 |
$1,161.86 |
$114.88
|
|
Surg dx exam anorectal
|
$4,771.68 |
$4,771.68 |
$4,771.68 |
$3,245.23
|
|
Surg ect salp-oophorectomy 59120
|
$1,260.00 |
$1,260.00 |
$1,260.00 |
$1,632.60
|
|
Surgical exposure prostate 55860
|
$1,326.72 |
$1,326.72 |
$1,326.72 |
$5,626.86
|
|
Surgical opening of stomach 43500
|
$1,205.28 |
$1,205.28 |
$1,205.28 |
$1,477.80
|
|
Surgical pathology level 1 gross examination only
|
$47.32 |
$47.32 |
$47.32 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$101.76 |
$101.76 |
$101.76 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$74.28 |
$74.28 |
$74.28 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$1,214.40 |
$1,214.40 |
$1,214.40 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$359.52 |
$359.52 |
$359.52 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$406.08 |
$406.08 |
$406.08 |
$718.00
|
|
Surg tx anal fistula 2nd stage 46285
|
$864.96 |
$864.96 |
$864.96 |
$3,245.23
|
|
Susceptibility agar dilution per agent
|
$11.19 |
$11.19 |
$11.19 |
$45.45
|
|
Susceptibility enzyme detection per enzyme
|
$20.86 |
$20.86 |
$20.86 |
$35.70
|
|
Susceptibility mic per plate
|
$100.74 |
$100.74 |
$100.74 |
$106.00
|
|
Suscept studies macrobroth dilution ea
|
$13.05 |
$13.05 |
$13.05 |
$59.28
|
|
Suspend bowel w/prosthesis
|
$1,522.56 |
$1,522.56 |
$1,522.56 |
$1,351.05
|
|
Suspension of testis
|
$454.56 |
$454.56 |
$454.56 |
$4,061.71
|
|
Suspension of uterus 58400
|
$714.24 |
$714.24 |
$714.24 |
$1,136.00
|
|
Sutr lg intestine 1/mult perf without colostomy 44604
|
$1,604.64 |
$1,604.64 |
$1,604.64 |
$1,995.00
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$16.79 |
$16.79 |
$16.79 |
$41.60
|
|
T3 (triiodothyronine) free
|
$77.85 |
$77.85 |
$77.85 |
$99.20
|
|
T3 (triiodothyronine) total
|
$67.16 |
$67.16 |
$67.16 |
$93.52
|
|
T4 (thyroxine) free
|
$46.30 |
$46.30 |
$46.30 |
$85.20
|
|
T4 (thyroxine) total
|
$30.53 |
$30.53 |
$30.53 |
$69.00
|
