|
Set radiation therapy field
|
$655.20 |
$655.20 |
$655.20 |
$782.61
|
|
Set radiation therapy field
|
$1,029.00 |
$1,029.00 |
$1,029.00 |
$1,159.03
|
|
Set radiation therapy field
|
$1,273.20 |
$1,273.20 |
$1,273.20 |
$1,636.36
|
|
Sevelamer carbonate 800 mg tablet
|
$3.60 |
$3.60 |
$3.60 |
$7.14
|
|
Sevelamer carbonate pdr 20mg
|
$10.20 |
$10.20 |
$10.20 |
$21.42
|
|
Sex chromatin identification
|
$43.20 |
$43.20 |
$43.20 |
$45.60
|
|
Shave sgl skin lsn f/e/e/n/l/m 0.5cm/<
|
$520.80 |
$520.80 |
$520.80 |
$284.00
|
|
Shave sgl skin lsn f/e/e/n/l/m 0.6-1.0cm
|
$520.80 |
$520.80 |
$520.80 |
$284.88
|
|
Shave sgl skin lsn f/e/e/n/l/m 1.1-2cm
|
$819.00 |
$819.00 |
$819.00 |
$436.64
|
|
Shave sgl skin lsn f/e/e/n/l/m >2cm
|
$1,341.60 |
$1,341.60 |
$1,341.60 |
$472.79
|
|
Shave sgl skin lsn s/n/h/f/g 0.5cm/<
|
$520.80 |
$520.80 |
$520.80 |
$235.13
|
|
Shave sgl skin lsn s/n/h/f/g 0.6-1.0 cm
|
$520.80 |
$520.80 |
$520.80 |
$223.00
|
|
Shave sgl skin lsn s/n/h/f/g 1.1-2cm
|
$575.40 |
$575.40 |
$575.40 |
$268.47
|
|
Shave sgl skin lsn t/a/l 0.5cm/<
|
$520.80 |
$520.80 |
$520.80 |
$314.00
|
|
Shave sgl skin lsn t/a/l 1.1-2.0cm
|
$660.00 |
$660.00 |
$660.00 |
$286.89
|
|
Shot (Injection into Muscle or Under the Skin)
|
$171.60 |
$171.60 |
$171.60 |
$136.20
|
|
Shoulder AC Joint X-ray (both sides)
|
$188.40 |
$188.40 |
$188.40 |
$270.20
|
|
Shoulder Blade (Scapula) X-ray (both sides)
|
$262.80 |
$262.80 |
$262.80 |
$287.25
|
|
Shoulder MRI (with and without contrast)
|
$2,713.80 |
$2,713.80 |
$2,713.80 |
$2,761.80
|
|
Shoulder MRI (with contrast)
|
$2,713.80 |
$2,713.80 |
$2,713.80 |
$2,483.00
|
|
Shoulder MRI (without contrast)
|
$1,656.00 |
$1,656.00 |
$1,656.00 |
$2,096.84
|
|
Shoulder X-ray
|
$188.40 |
$188.40 |
$188.40 |
$340.40
|
|
Shoulder X-ray (single view, both shoulders)
|
$188.40 |
$188.40 |
$188.40 |
$263.25
|
|
Shuntogram nonvascular supervision & interpretation
|
$262.80 |
$262.80 |
$262.80 |
$355.80
|
|
Sialography s&i
|
$547.80 |
$547.80 |
$547.80 |
$499.20
|
|
Sialolithotomy 42330
|
$3,971.40 |
$3,971.40 |
$3,971.40 |
$3,837.72
|
|
Sickling rbc
|
$28.80 |
$28.80 |
$28.80 |
$59.40
|
|
Sincalide 5 mcg solution for injection
|
$81.60 |
$81.60 |
$81.60 |
$309.14
|
|
Sinus CT scan (with and without contrast)
|
$1,294.80 |
$1,294.80 |
$1,294.80 |
$1,796.50
|
|
Sinus CT scan (with contrast)
|
$1,294.80 |
$1,294.80 |
$1,294.80 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$796.80 |
$796.80 |
$796.80 |
$1,289.00
|
|
Sinus/juglr venogram s&i
|
$5,906.40 |
$5,906.40 |
$5,906.40 |
$2,517.48
|
|
Sinus X-ray (complete)
|
$188.40 |
$188.40 |
$188.40 |
$347.10
|
|
Sinus X-ray (limited)
|
$188.40 |
$188.40 |
$188.40 |
$215.66
|
|
Sipuleucel-t - su
|
$150.00 |
$150.00 |
$150.00 |
$100,990.51
|
|
Sirolimus, oral
|
$20.40 |
$20.40 |
$20.40 |
$41.70
|
|
Skin Biopsy
|
$575.40 |
$575.40 |
$575.40 |
$361.20
|
|
Skin split graft addl 100sq cm 15101
|
$3,200.40 |
$3,200.40 |
$3,200.40 |
$1,793.40
|
|
Skull X-ray (1 to 3 views)
|
$262.80 |
$262.80 |
$262.80 |
$294.66
|
|
Skull X-ray (complete)
|
$262.80 |
$262.80 |
$262.80 |
$423.15
|
|
Sleep study attended
|
$1,830.00 |
$1,830.00 |
$1,830.00 |
$1,329.00
|
|
Sleep Study (Polysomnography)
|
$4,279.20 |
$4,279.20 |
$4,279.20 |
$3,734.50
|
|
Sleep study unattended
|
$984.00 |
$984.00 |
$984.00 |
$594.00
|
|
Slitting of prepuce
|
$4,029.00 |
$4,029.00 |
$4,029.00 |
$3,376.23
|
|
Slp eval non-spch gen comm dev
|
$497.40 |
$497.40 |
$497.40 |
$285.09
|
|
Sm-153 lexidron ther
|
$5,947.80 |
$5,947.80 |
$5,947.80 |
$7,320.12
|
|
Small Bowel Barium X-ray (Follow-Through)
|
$427.80 |
$427.80 |
$427.80 |
$557.70
|
|
Smear fluorescent and/or acid fast stain
|
$30.60 |
$30.60 |
$30.60 |
$64.35
|
|
Smear gram stain
|
$24.00 |
$24.00 |
$24.00 |
$55.47
|
|
Smear special stain inclusion bodies/parasites
|
$33.00 |
$33.00 |
$33.00 |
$73.16
|
|
Smear wet mount
|
$32.40 |
$32.40 |
$32.40 |
$67.49
|
|
Sodium 24 hour urine
|
$25.20 |
$25.20 |
$25.20 |
$48.75
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$3.60 |
$3.60 |
$3.60 |
$80.73
|
|
Sodium serum/plasma/whole blood
|
$24.60 |
$24.60 |
$24.60 |
$46.26
|
|
Somatosensory testing
|
$583.80 |
$583.80 |
$583.80 |
$812.40
|
|
Special physics consult
|
$892.20 |
$892.20 |
$892.20 |
$725.00
|
|
Special radiation dosimetry
|
$739.80 |
$739.80 |
$739.80 |
$392.50
|
|
Special radiation treatment
|
$2,055.00 |
$2,055.00 |
$2,055.00 |
$2,052.00
|
|
Special supplies phys/qhp
|
$55.20 |
$55.20 |
$55.20 |
$60.00
|
|
Special teletx port plan
|
$939.60 |
$939.60 |
$939.60 |
$1,095.05
|
|
Specific gravity body fluid
|
$17.40 |
$17.40 |
$17.40 |
$22.00
|
|
Speech and Language Evaluation (comprehensive)
|
$865.20 |
$865.20 |
$865.20 |
$384.80
|
|
Speech evaluation complex
|
$547.80 |
$547.80 |
$547.80 |
$527.06
|
|
Speech Therapy Session (one-on-one)
|
$459.00 |
$459.00 |
$459.00 |
$248.30
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$2,461.20 |
$2,461.20 |
$2,461.20 |
$1,457.50
|
|
Spine X-ray (single view, one level)
|
$188.40 |
$188.40 |
$188.40 |
$251.00
|
|
Spleen imaging
|
$1,228.80 |
$1,228.80 |
$1,228.80 |
$679.00
|
|
Splint func pos polyflex ii med
|
$116.40 |
$116.40 |
$116.40 |
$61.64
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$5,983.20 |
$5,983.20 |
$5,983.20 |
$4,689.60
|
|
Split blood or products
|
$201.60 |
$201.60 |
$201.60 |
$127.80
|
|
Splt agrft f/s/n/h/f/g/m ea
|
$2,538.00 |
$2,538.00 |
$2,538.00 |
$1,612.78
|
|
Sputum specimen collection
|
$1,087.80 |
$1,087.80 |
$1,087.80 |
$180.00
|
|
Sr-89 stront chlor ther / mci
|
$5,445.60 |
$5,445.60 |
$5,445.60 |
$2,515.15
|
|
Srs linear based
|
$12,437.40 |
$12,437.40 |
$12,437.40 |
$14,124.25
|
|
St analysis behavior qualitative voice/resonance
|
$435.00 |
$435.00 |
$435.00 |
$297.60
|
|
St cognitve performance testing healthcare professional each hour
|
$601.20 |
$601.20 |
$601.20 |
$286.00
|
|
Stent/athrectomy/fem/pop/unilat 37227
|
$24,161.40 |
$24,161.40 |
$24,161.40 |
$21,568.80
|
|
Stent iliac/open or perc/uni/init 37221
|
$17,281.80 |
$17,281.80 |
$17,281.80 |
$14,356.50
|
|
Stent iliac/open/perc/ea ad/ipsila 37223
|
$8,640.60 |
$8,640.60 |
$8,640.60 |
$8,948.40
|
|
Stent/tib/peroneal/unilat/initial 37230
|
$24,161.40 |
$24,161.40 |
$24,161.40 |
$16,222.77
|
|
St evaluate speech sound production
|
$414.00 |
$414.00 |
$414.00 |
$292.95
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$263.40 |
$263.40 |
$263.40 |
$400.00
|
|
Stomach Emptying Scan (Nuclear Medicine)
|
$1,228.80 |
$1,228.80 |
$1,228.80 |
$1,344.00
|
|
Strapping of ankle and/or ft 29540
|
$520.80 |
$520.80 |
$520.80 |
$223.45
|
|
Strapping of chest
|
$378.60 |
$378.60 |
$378.60 |
$194.46
|
|
Strapping of elbow or wrist 29260
|
$204.60 |
$204.60 |
$204.60 |
$157.46
|
|
Strapping of hand or finger
|
$204.60 |
$204.60 |
$204.60 |
$174.82
|
|
Strapping of hip
|
$411.60 |
$411.60 |
$411.60 |
$164.70
|
|
Strapping of knee
|
$411.60 |
$411.60 |
$411.60 |
$205.20
|
|
Strapping of toes 29550
|
$204.60 |
$204.60 |
$204.60 |
$164.70
|
|
Streptozocin injection
|
$209.40 |
$209.40 |
$209.40 |
$785.95
|
|
Stress test pulmonary
|
$399.00 |
$399.00 |
$399.00 |
$324.00
|
|
Str markers specimen anal
|
$505.20 |
$505.20 |
$505.20 |
$751.50
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$4.80 |
$4.80 |
$4.80 |
$54.80
|
|
Sugars single quant
|
$58.80 |
$58.80 |
$58.80 |
$63.60
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$0.60 |
$0.60 |
$0.60 |
$82.46
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$105.60 |
$105.60 |
$105.60 |
$126.63
|
|
Surgical pathology level 1 gross examination only
|
$54.60 |
$54.60 |
$54.60 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$54.60 |
$54.60 |
$54.60 |
$143.00
|
|
Surgical pathology level 3 gross & microscopic examination
|
$116.40 |
$116.40 |
$116.40 |
$182.28
|
