|
Shoulder MRI (without contrast)
|
$3,682.80 |
$4,125.00 |
$6,214.20 |
$2,088.20
|
|
Shoulder X-ray
|
$405.00 |
$456.60 |
$686.40 |
$341.40
|
|
Shoulder X-ray (single view, both shoulders)
|
$405.00 |
$456.60 |
$686.40 |
$264.00
|
|
Shunt glaucoma baerveldt 350mm
|
$4,395.00 |
$5,235.60 |
$10,690.80 |
$4,538.82
|
|
Shuntogram nonvascular supervision & interpretation
|
$257.40 |
$354.60 |
$355.80 |
$355.80
|
|
Sialidase enzyme assay
|
$130.80 |
$143.40 |
$145.80 |
$54.99
|
|
Sialography s&i
|
$3,618.60 |
$3,618.60 |
$3,618.60 |
$499.20
|
|
Sickling rbc
|
$34.20 |
$76.80 |
$405.00 |
$59.40
|
|
Sigmoidoscopy and biopsy
|
$1,550.40 |
$1,788.60 |
$3,235.80 |
$1,446.90
|
|
Sigmoidoscopy flex decompression 45337
|
$2,571.60 |
$2,710.80 |
$8,428.80 |
$1,078.88
|
|
Sigmoidoscopy for bleeding
|
$1,366.20 |
$1,885.20 |
$8,947.80 |
$1,993.08
|
|
Sigmoidoscopy/submucosal injection 45335
|
$1,315.20 |
$2,232.00 |
$3,480.00 |
$1,650.75
|
|
Sigmoidoscopy w/ablation
|
$2,791.20 |
$2,959.80 |
$8,947.80 |
$2,604.00
|
|
Sigmoidoscopy w/fb removal 45332
|
$1,885.20 |
$3,073.80 |
$4,095.60 |
$1,395.28
|
|
Sigmoidoscopy w/plcmt stent
|
$2,592.60 |
$2,919.00 |
$9,549.00 |
$3,692.00
|
|
Sigmoidoscopy w/resection
|
$2,564.40 |
$2,564.40 |
$3,417.60 |
$2,997.10
|
|
Sigmoidoscopy w/tumr remove
|
$628.80 |
$1,727.40 |
$3,235.80 |
$1,645.43
|
|
Sigmoidoscopy w/ultrasound
|
$1,215.60 |
$1,233.60 |
$1,380.60 |
$1,740.57
|
|
Sigmoidoscopy w/us guide bx
|
$1,741.80 |
$1,805.40 |
$2,106.60 |
$2,288.00
|
|
Sigmoid/rmv tumor/polyp/hot bx for 45333
|
$1,356.00 |
$1,764.00 |
$3,596.40 |
$1,976.25
|
|
Signal avg ecg w or without ecg 93278
|
$317.40 |
$372.60 |
$505.20 |
$280.00
|
|
Sig w/tndsc balloon dilation
|
$2,736.60 |
$3,763.20 |
$9,642.00 |
$2,288.00
|
|
Simple cystometrogram 51725
|
$1,956.00 |
$1,956.00 |
$1,956.00 |
$589.45
|
|
Sincalide 5 mcg solution for injection
|
$228.80 |
$753.00 |
$753.00 |
$309.14
|
|
Sinus CT scan (with and without contrast)
|
$2,953.20 |
$3,394.80 |
$5,112.00 |
$1,796.50
|
|
Sinus CT scan (with contrast)
|
$2,654.40 |
$3,054.00 |
$4,599.60 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$1,740.00 |
$1,950.00 |
$2,937.00 |
$1,289.00
|
|
Sinus/juglr venogram s&i
|
$2,226.60 |
$2,500.80 |
$9,229.80 |
$2,517.48
|
|
Sinus X-ray (complete)
|
$405.00 |
$456.60 |
$686.40 |
$347.10
|
|
Sinus X-ray (limited)
|
$405.00 |
$443.40 |
$686.40 |
$215.75
|
|
Sipuleucel-t - su
|
$118,513.80 |
$118,513.80 |
$118,513.80 |
$100,990.51
|
|
Sirolimus, oral
|
$63.00 |
$300.00 |
$1,122.00 |
$41.70
|
|
Sirolimus-protein bound 100 mg intravenous suspension
|
$153.00 |
$153.00 |
$153.00 |
$14,361.10
|
|
Skin barrier with flange
|
$1.80 |
$1.80 |
$1.80 |
$1.65
|
|
Skin Biopsy
|
$639.00 |
$823.80 |
$1,055.40 |
$361.20
|
|
Skin full graft 20sq cm less 15200
|
$4,321.20 |
$4,321.20 |
$4,321.20 |
$2,379.00
|
|
Skin test unlisted antigen ea
|
$53.40 |
$53.40 |
$53.40 |
$48.57
|
|
Skull X-ray (1 to 3 views)
|
$405.00 |
$456.60 |
$686.40 |
$294.66
|
|
Skull X-ray (complete)
|
$666.60 |
$765.60 |
$1,154.40 |
$423.15
|
|
Skyla, 13.5 mg
|
$2,343.60 |
$2,484.00 |
$3,186.00 |
$1,643.47
|
|
Sleep Study (Polysomnography)
|
$4,569.00 |
$7,861.80 |
$8,373.60 |
$3,734.50
|
|
Sleep study unattended
|
$919.80 |
$1,653.60 |
$2,371.20 |
$594.00
|
|
Sling arm deluxe w/pad xs
|
$138.00 |
$210.00 |
$215.40 |
$30.35
|
|
Sling suprapubic suburetheral
|
$6,976.80 |
$7,586.40 |
$21,560.40 |
$9,679.96
|
|
Slitting of prepuce
|
$3,058.80 |
$3,058.80 |
$3,058.80 |
$3,376.23
|
|
Slp pure tone screening
|
$93.00 |
$93.00 |
$93.00 |
$64.50
|
|
Sm-153 lexidron ther
|
$7,168.80 |
$7,168.80 |
$31,245.00 |
$7,320.12
|
|
Small Bowel Barium X-ray (Follow-Through)
|
$779.40 |
$873.00 |
$1,312.80 |
$557.70
|
|
Small bowel endoscopy
|
$1,843.20 |
$4,047.00 |
$4,736.40 |
$2,596.41
|
|
Small bowel endoscopy
|
$2,012.40 |
$2,133.00 |
$6,099.00 |
$2,244.82
|
|
Small bowel endoscopy
|
$1,843.20 |
$5,236.20 |
$8,934.60 |
$2,638.57
|
|
Small bowel endoscopy
|
$1,843.20 |
$3,166.20 |
$11,984.40 |
$2,518.10
|
|
Small bowel endoscopy
|
$2,740.80 |
$2,740.80 |
$2,740.80 |
$2,638.57
|
|
Small bowel endoscopy
|
$2,734.20 |
$2,734.20 |
$2,734.20 |
$3,265.60
|
|
Small bowel endoscopy
|
$1,294.80 |
$1,885.20 |
$8,947.80 |
$2,088.00
|
|
Small bowel endoscopy
|
$1,967.40 |
$1,967.40 |
$1,967.40 |
$2,956.20
|
|
Small bowel endoscopy >2nd w/remove 44363
|
$2,403.60 |
$3,660.60 |
$5,407.20 |
$2,590.33
|
|
Small bowel endoscopy/biopsy
|
$1,843.20 |
$4,047.00 |
$5,743.80 |
$2,490.15
|
|
Small bowel endoscopy/biopsy
|
$2,740.80 |
$2,740.80 |
$2,740.80 |
$2,244.82
|
|
Small bowel endoscopy br/wa
|
$1,372.20 |
$1,895.40 |
$8,947.80 |
$1,924.00
|
|
Small bowel endoscopy br/wa
|
$1,474.80 |
$2,798.40 |
$3,523.20 |
$2,406.40
|
|
Small bowel endoscopy/stent 44370
|
$10,842.00 |
$13,989.00 |
$26,215.20 |
$4,992.00
|
|
Smallpox&monkeypox vac 0.5ml
|
$614.40 |
$614.40 |
$614.40 |
$474.54
|
|
Smear fluorescent and/or acid fast stain
|
$26.40 |
$84.60 |
$507.60 |
$64.20
|
|
Smear gram stain
|
$41.40 |
$63.00 |
$686.40 |
$55.42
|
|
Smear nasal eosinophil
|
$66.60 |
$89.40 |
$492.00 |
$46.20
|
|
Smear special stain inclusion bodies/parasites
|
$43.20 |
$142.20 |
$840.60 |
$73.15
|
|
Smear wet mount
|
$43.20 |
$102.60 |
$165.00 |
$67.49
|
|
Smpd1 gene common variants
|
$1,189.20 |
$1,189.20 |
$1,260.60 |
$133.84
|
|
Snrpn/ube3a gene
|
$681.00 |
$681.00 |
$681.00 |
$228.80
|
|
Sodium 24 hour urine
|
$39.60 |
$85.20 |
$508.20 |
$48.75
|
|
Sodium chloride 0.9 % intravenous solution
|
$55.65 |
$57.20 |
$76.80 |
$48.58
|
|
Sodium chloride 0.9 % IV bolus
|
$31.20 |
$76.20 |
$79.80 |
$45.56
|
|
Sodium chloride 0.9 % IV bolus
|
$29.80 |
$76.20 |
$79.80 |
$37.64
|
|
Sodium chloride 3 % ivpb
|
$0.60 |
$18.00 |
$80.40 |
$39.60
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$43.20 |
$89.40 |
$539.40 |
$80.73
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$1,648.80 |
$2,100.80 |
$2,860.80 |
$410.40
|
|
Sodium serum/plasma/whole blood
|
$40.20 |
$88.20 |
$215.40 |
$46.26
|
|
Solid skin barrier
|
$7.80 |
$7.80 |
$7.80 |
$2.84
|
|
Solid skin barrier 6x6
|
$17.40 |
$17.40 |
$17.40 |
$6.51
|
|
Somatosensory testing
|
$760.80 |
$812.40 |
$864.60 |
$816.00
|
|
Somatropin injection
|
$1,973.40 |
$2,111.40 |
$2,519.40 |
$2,111.40
|
|
So neo gsap dna/dna&rna
|
$4,153.80 |
$4,153.80 |
$4,153.80 |
$2,989.55
|
|
Spacer bag/reservoir
|
$189.60 |
$189.60 |
$587.20 |
$26.00
|
|
Special casting material
|
$286.20 |
$286.20 |
$286.20 |
$47.45
|
|
Special physics consult
|
$591.00 |
$1,201.20 |
$1,254.00 |
$725.00
|
|
Special radiation dosimetry
|
$942.00 |
$1,002.60 |
$1,048.20 |
$392.50
|
|
Special radiation treatment
|
$1,247.40 |
$2,509.80 |
$4,554.00 |
$2,052.00
|
|
Special supplies phys/qhp
|
$648.60 |
$648.60 |
$648.60 |
$60.00
|
|
Special teletx port plan
|
$1,035.60 |
$1,078.80 |
$1,286.40 |
$1,095.05
|
|
Specific gravity body fluid
|
$24.60 |
$37.20 |
$209.40 |
$22.00
|
|
Specimen fat stain
|
$357.00 |
$357.00 |
$357.00 |
$35.10
|
|
Speech and Language Evaluation (comprehensive)
|
$228.60 |
$348.60 |
$429.60 |
$385.00
|
|
Speech audiometry complete
|
$122.40 |
$122.40 |
$122.40 |
$109.20
|
|
Speech evaluation complex
|
$1,349.40 |
$1,349.40 |
$1,349.40 |
$527.06
|
|
Speech Therapy Session (one-on-one)
|
$190.20 |
$225.60 |
$260.40 |
$248.30
|
|
Sperm antibody test
|
$71.40 |
$73.80 |
$239.40 |
$57.85
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$1,357.80 |
$1,439.40 |
$1,918.80 |
$1,457.50
|
|
Spine X-ray (single view, one level)
|
$405.00 |
$456.60 |
$686.40 |
$251.00
|
|
Spleen imaging
|
$958.80 |
$958.80 |
$992.40 |
$679.00
|
