|
Sigmoidoscopy/submucosal injection 45335
|
$547.05 |
$547.05 |
$547.05 |
$1,444.83
|
|
Sigmoidoscopy w/plcmt stent
|
$3,571.80 |
$3,571.80 |
$3,571.80 |
$3,692.00
|
|
Sigmoidoscopy w/tumr remove
|
$748.50 |
$748.50 |
$748.50 |
$1,558.80
|
|
Sig w/tndsc balloon dilation
|
$748.50 |
$748.50 |
$748.50 |
$1,901.90
|
|
Sinus CT scan (with and without contrast)
|
$2,312.25 |
$2,312.25 |
$2,312.25 |
$1,790.00
|
|
Sinus CT scan (with contrast)
|
$1,767.90 |
$1,767.90 |
$1,767.90 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$1,666.95 |
$1,666.95 |
$1,666.95 |
$1,292.04
|
|
Sirolimus, oral
|
$41.25 |
$41.25 |
$41.25 |
$41.25
|
|
Skin barrier with flange
|
$1.65 |
$1.65 |
$1.65 |
$1.65
|
|
Skin Biopsy
|
$449.25 |
$449.25 |
$449.25 |
$360.34
|
|
Sleep Study (Polysomnography)
|
$4,830.30 |
$4,830.30 |
$4,830.30 |
$3,607.50
|
|
Sling arm deluxe w/pad xs
|
$188.84 |
$188.84 |
$188.84 |
$30.35
|
|
Sling pelv split sam med
|
$246.05 |
$246.05 |
$246.05 |
$150.00
|
|
Sling suprapubic suburetheral
|
$14,547.60 |
$14,547.60 |
$14,547.60 |
$9,679.96
|
|
Slitting of prepuce
|
$3,281.10 |
$3,281.10 |
$3,281.10 |
$3,365.50
|
|
Small bowel endoscopy
|
$2,045.40 |
$2,045.40 |
$2,045.40 |
$2,463.36
|
|
Small bowel endoscopy
|
$562.65 |
$562.65 |
$562.65 |
$1,620.78
|
|
Small bowel endoscopy/biopsy
|
$1,138.20 |
$1,138.20 |
$1,138.20 |
$2,413.20
|
|
Small bowel endoscopy br/wa
|
$2,104.50 |
$2,104.50 |
$2,104.50 |
$1,924.00
|
|
Smear fluorescent and/or acid fast stain
|
$150.15 |
$150.15 |
$150.15 |
$64.20
|
|
Smear gram stain
|
$91.35 |
$91.35 |
$91.35 |
$55.25
|
|
Smear special stain inclusion bodies/parasites
|
$206.70 |
$206.70 |
$206.70 |
$73.15
|
|
Smear wet mount
|
$132.15 |
$132.15 |
$132.15 |
$67.49
|
|
Socket insert w lock mech
|
$1,609.98 |
$1,609.98 |
$1,609.98 |
$1,544.50
|
|
Sock fracture or equal each
|
$78.08 |
$78.08 |
$78.08 |
$74.51
|
|
Sock wool above knee
|
$95.50 |
$95.50 |
$95.50 |
$51.18
|
|
Sodium 24 hour urine
|
$127.05 |
$127.05 |
$127.05 |
$48.60
|
|
Sodium chloride 0.9 % intravenous solution
|
$30.00 |
$30.00 |
$30.00 |
$48.11
|
|
Sodium chloride 0.9 % IV bolus
|
$30.00 |
$30.00 |
$30.00 |
$37.50
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$160.28 |
$160.28 |
$160.28 |
$77.77
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$410.40 |
$410.40 |
$410.40 |
$410.40
|
|
Sodium serum/plasma/whole blood
|
$135.45 |
$135.45 |
$135.45 |
$45.60
|
|
Soft interface below knee se
|
$170.43 |
$170.43 |
$170.43 |
$179.08
|
|
Solid skin barrier
|
$2.84 |
$2.84 |
$2.84 |
$2.84
|
|
Solid skin barrier 6x6
|
$6.51 |
$6.51 |
$6.51 |
$6.51
|
|
Somatropin injection
|
$1,204.34 |
$1,204.34 |
$1,204.34 |
$2,381.48
|
|
Special supplies phys/qhp
|
$60.00 |
$60.00 |
$60.00 |
$60.00
|
|
Specific gravity body fluid
|
$43.50 |
$43.50 |
$43.50 |
$22.00
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$2,776.65 |
$2,776.65 |
$2,776.65 |
$1,439.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$454.65 |
$454.65 |
$454.65 |
$543.26
|
|
Splint extn xsm w sof-stretch rolyan
|
$87.92 |
$87.92 |
$87.92 |
$68.25
|
|
Splint finger frog med
|
$21.47 |
$21.47 |
$21.47 |
$38.08
|
|
Splint func pos polyflex ii med
|
$307.50 |
$307.50 |
$307.50 |
$58.65
|
|
Splint rstrc wrst/cmc right med
|
$88.81 |
$88.81 |
$88.81 |
$99.04
|
|
Split blood or products
|
$102.90 |
$102.90 |
$102.90 |
$127.48
|
|
Sputum specimen collection
|
$102.90 |
$102.90 |
$102.90 |
$180.00
|
|
Staph a dna amp probe
|
$155.25 |
$155.25 |
$155.25 |
$125.00
|
|
Static or dynami afo pre ots
|
$416.73 |
$416.73 |
$416.73 |
$284.60
|
|
Stent axios caut enh 15x10mm electrocaut
|
$42,000.00 |
$42,000.00 |
$42,000.00 |
$32,403.15
|
|
Stent bili dbl pgtl 10fx5cm
|
$12,150.00 |
$12,150.00 |
$12,150.00 |
$2,520.08
|
|
Stent bili rx wallflx 10x80 uncvr
|
$26,820.30 |
$26,820.30 |
$26,820.30 |
$20,962.50
|
|
Stent bronch dumon sil 10x40mm
|
$1,599.00 |
$1,599.00 |
$1,599.00 |
$4,939.20
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$731.70 |
$731.70 |
$731.70 |
$399.60
|
|
St evaluation swallow function
|
$1,672.05 |
$1,672.05 |
$1,672.05 |
$314.40
|
|
Stot/tot hysterectomy after cesaren delivery 59525
|
$5,454.00 |
$5,454.00 |
$5,454.00 |
$2,607.60
|
|
Strapping of ankle and/or ft 29540
|
$205.20 |
$205.20 |
$205.20 |
$223.45
|
|
Strapping of elbow or wrist 29260
|
$225.15 |
$225.15 |
$225.15 |
$154.70
|
|
Strapping of hand or finger
|
$225.15 |
$225.15 |
$225.15 |
$174.82
|
|
Strapping of knee
|
$205.20 |
$205.20 |
$205.20 |
$205.20
|
|
Strapping of toes 29550
|
$142.05 |
$142.05 |
$142.05 |
$164.70
|
|
Strep a ag ia
|
$141.00 |
$141.00 |
$141.00 |
$75.40
|
|
Streptomycin injection
|
$87.75 |
$87.75 |
$87.75 |
$138.30
|
|
Stress test pulmonary
|
$324.00 |
$324.00 |
$324.00 |
$322.85
|
|
Stress tte complete
|
$2,680.20 |
$2,680.20 |
$2,680.20 |
$1,870.50
|
|
St treatment speech individual
|
$524.40 |
$524.40 |
$524.40 |
$248.84
|
|
St treatment swallow dysfunction/oral
|
$710.40 |
$710.40 |
$710.40 |
$240.31
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$63.42 |
$63.42 |
$63.42 |
$52.31
|
|
Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution
|
$295.20 |
$295.20 |
$295.20 |
$7,345.98
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$32.84 |
$32.84 |
$32.84 |
$114.88
|
|
Support clav 29.6-40.5in med
|
$124.85 |
$124.85 |
$124.85 |
$94.19
|
|
Supprelin la implant
|
$93,838.08 |
$93,838.08 |
$93,838.08 |
$80,935.72
|
|
Surgical pathology level 1 gross examination only
|
$63.15 |
$63.15 |
$63.15 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$107.85 |
$107.85 |
$107.85 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$97.05 |
$97.05 |
$97.05 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$528.90 |
$528.90 |
$528.90 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$330.45 |
$330.45 |
$330.45 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$490.20 |
$490.20 |
$490.20 |
$718.00
|
|
Susceptibility agar dilution per agent
|
$177.75 |
$177.75 |
$177.75 |
$45.45
|
|
Susceptibility enzyme detection per enzyme
|
$46.05 |
$46.05 |
$46.05 |
$35.70
|
|
Susceptibility mic per plate
|
$258.30 |
$258.30 |
$258.30 |
$106.00
|
|
Synvisc or synvisc-one
|
$2,711.85 |
$2,711.85 |
$2,711.85 |
$1,274.94
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$136.35 |
$136.35 |
$136.35 |
$41.60
|
|
System cardiomems hosp electronics
|
$30,006.00 |
$30,006.00 |
$30,006.00 |
$39,037.95
|
|
System pacing micra av
|
$34,155.00 |
$34,155.00 |
$34,155.00 |
$24,577.07
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$12,003.00 |
$12,003.00 |
$12,003.00 |
$12,003.00
|
|
System sealant biosentry tract
|
$904.05 |
$904.05 |
$904.05 |
$889.35
|
|
T3 (triiodothyronine) free
|
$324.00 |
$324.00 |
$324.00 |
$99.20
|
|
T3 (triiodothyronine) total
|
$188.70 |
$188.70 |
$188.70 |
$93.52
|
|
T4 (thyroxine) free
|
$284.70 |
$284.70 |
$284.70 |
$85.20
|
|
T4 (thyroxine) total
|
$110.40 |
$110.40 |
$110.40 |
$69.00
|
|
Tacrol envarsus ex rel oral
|
$10.86 |
$10.86 |
$10.86 |
$15.60
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$9.78 |
$9.78 |
$9.78 |
$9.84
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$534.82 |
$534.82 |
$534.82 |
$601.95
|
|
Tacrolimus therapeutic drug level
|
$239.40 |
$239.40 |
$239.40 |
$122.40
|
|
Tap block bilat cont infusion 64489
|
$1,541.40 |
$1,541.40 |
$1,541.40 |
$1,407.60
|
|
Tap block uni by cont infusion 64487
|
$771.00 |
$771.00 |
$771.00 |
$869.40
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$863.75 |
$863.75 |
$863.75 |
$937.50
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$184.80 |
$184.80 |
$184.80 |
$194.35
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$221.40 |
$221.40 |
$221.40 |
$177.65
|
|
Tc-99m exame autol wbc diag per dose
|
$2,431.95 |
$2,431.95 |
$2,431.95 |
$2,435.36
|
