|
Sim ang w/prs cath rad emb
|
$7,965.00 |
$7,965.00 |
$8,850.00 |
|
|
Simple cystometrogram 51725
|
$78.50 |
$209.00 |
$1,068.00 |
|
|
Sincalide 5 mcg solution for injection
|
$47.65 |
$261.45 |
$545.40 |
|
|
Sinus CT scan (with and without contrast)
|
$542.50 |
$1,328.50 |
$2,276.40 |
|
|
Sinus CT scan (with contrast)
|
$442.50 |
$919.50 |
$1,999.80 |
|
|
Sinus CT scan (without contrast)
|
$296.00 |
$698.50 |
$1,585.80 |
|
|
Sinus/juglr venogram s&i
|
$112.80 |
$2,803.00 |
$4,941.00 |
|
|
Sinusotomy maxillary sinus 31020
|
$7,352.50 |
$7,352.50 |
$7,352.50 |
|
|
Sinusotomy sinus remove polyps 31032
|
$19,076.67 |
$19,076.67 |
$19,076.67 |
|
|
Sirolimus, oral
|
$64.75 |
$64.75 |
$64.75 |
|
|
Sirolimus-protein bound 100 mg intravenous suspension
|
$31,063.63 |
$31,063.63 |
$31,063.63 |
|
|
Skel musc relaxant 3 or more
|
$5.00 |
$5.00 |
$18.50 |
|
|
Skin and muscle repair face
|
$8,156.75 |
$8,156.75 |
$8,156.75 |
|
|
Skin Biopsy
|
$61.20 |
$414.50 |
$4,228.50 |
|
|
Skin full graft 20sq cm less 15200
|
$679.00 |
$1,086.40 |
$25,711.50 |
|
|
Skin full graft add-on 15241
|
$1,024.25 |
$1,945.31 |
$2,163.00 |
|
|
Skin split graft addl 100sq cm 15101
|
$116.50 |
$122.00 |
$3,656.67 |
|
|
Skyla, 13.5 mg
|
$1,517.50 |
$2,276.00 |
$2,428.00 |
|
|
Slco1b1 gene com variants
|
$52.50 |
$455.50 |
$654.50 |
|
|
Sleep study attended
|
$680.50 |
$836.50 |
$2,011.80 |
|
|
Sleep Study (Polysomnography)
|
$2,284.00 |
$2,970.50 |
$3,745.80 |
|
|
Sleep study unattended
|
$44.50 |
$375.50 |
$701.50 |
|
|
Sleeve fing rolyan med
|
$44.00 |
$116.50 |
$241.00 |
|
|
Sling arm deluxe w/pad xs
|
$6.50 |
$6.50 |
$12.50 |
|
|
Sling suprapubic suburetheral
|
$1,484.00 |
$2,531.40 |
$5,685.90 |
|
|
Slitting of prepuce
|
$145.50 |
$147.00 |
$5,408.67 |
|
|
Slp pure tone screening
|
$13.50 |
$29.50 |
$39.00 |
|
|
Slp stdy unatnd w/anal
|
$55.50 |
$212.50 |
$530.00 |
|
|
Slp ther svc non-spch gen
|
$46.50 |
$154.00 |
$266.50 |
|
|
Sm-153 lexidron ther
|
$16,597.00 |
$16,597.00 |
$16,597.00 |
|
|
Small bowel endoscopy
|
$984.67 |
$999.34 |
$1,152.00 |
|
|
Small bowel endoscopy
|
$2,920.00 |
$2,920.00 |
$2,920.00 |
|
|
Small bowel endoscopy
|
$1,320.00 |
$2,250.00 |
$2,538.67 |
|
|
Small bowel endoscopy
|
$1,240.34 |
$1,240.34 |
$2,756.00 |
|
|
Small bowel endoscopy
|
$1,242.00 |
$1,242.00 |
$11,400.67 |
|
|
Small bowel endoscopy
|
$1,392.00 |
$1,392.00 |
$3,486.34 |
|
|
Small bowel endoscopy
|
$1,963.00 |
$1,963.00 |
$2,088.00 |
|
|
Small bowel endoscopy >2nd w/remove 44363
|
$1,672.00 |
$1,672.00 |
$1,672.00 |
|
|
Small bowel endoscopy/biopsy
|
$159.50 |
$163.00 |
$1,717.67 |
|
|
Small bowel endoscopy/biopsy
|
$298.50 |
$306.50 |
$3,281.00 |
|
|
Small bowel endoscopy br/wa
|
$509.00 |
$1,208.33 |
$2,118.00 |
|
|
Small bowel endoscopy br/wa
|
$1,349.34 |
$1,349.34 |
$1,349.34 |
|
|
Smear fluorescent and/or acid fast stain
|
$12.50 |
$36.00 |
$205.80 |
|
|
Smear gram stain
|
$12.00 |
$30.50 |
$88.00 |
|
|
Smear nasal eosinophil
|
$25.00 |
$25.00 |
$52.00 |
|
|
Smear special stain inclusion bodies/parasites
|
$8.00 |
$54.00 |
$184.00 |
|
|
Smear wet mount
|
$11.00 |
$36.00 |
$119.00 |
|
|
Smpd1 gene common variants
|
$25.50 |
$25.50 |
$25.50 |
|
|
Snrpn/ube3a gene
|
$178.00 |
$178.00 |
$618.50 |
|
|
So cap design without jnts cf
|
$199.50 |
$199.50 |
$199.50 |
|
|
Socket insert without lock mech
|
$1,167.50 |
$1,192.50 |
$1,319.00 |
|
|
Socket insert w lock mech
|
$1,367.00 |
$1,397.50 |
$1,544.50 |
|
|
Sodium 24 hour urine
|
$15.00 |
$34.00 |
$108.00 |
|
|
Sodium chloride 0.9 % intravenous solution
|
$7.00 |
$60.00 |
$180.00 |
|
|
Sodium chloride 0.9 % IV bolus
|
$6.00 |
$9.60 |
$89.50 |
|
|
Sodium chloride 3 % ivpb
|
$27.00 |
$27.00 |
$27.00 |
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$2.50 |
$48.23 |
$144.68 |
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$356.00 |
$541.00 |
$1,031.00 |
|
|
Sodium serum/plasma/whole blood
|
$15.00 |
$31.50 |
$89.40 |
|
|
Somatosensory testing
|
$350.50 |
$418.50 |
$500.50 |
|
|
Sp bone agrft morsel add-on
|
$177.00 |
$181.00 |
$5,905.81 |
|
|
Sp bone agrft struct add-on
|
$2,380.95 |
$2,380.95 |
$4,156.83 |
|
|
Sp bone algrft morsel add-on
|
$2,082.50 |
$3,181.33 |
$5,592.25 |
|
|
Special casting material
|
$84.50 |
$84.50 |
$84.50 |
|
|
Special physics consult
|
$161.50 |
$416.50 |
$585.00 |
|
|
Special radiation dosimetry
|
$87.50 |
$368.00 |
$436.00 |
|
|
Special radiation treatment
|
$377.00 |
$1,321.50 |
$2,120.00 |
|
|
Special supplies phys/qhp
|
$2.50 |
$2.50 |
$10.00 |
|
|
Special teletx port plan
|
$175.50 |
$742.00 |
$1,319.50 |
|
|
Specific gravity body fluid
|
$5.50 |
$14.50 |
$18.00 |
|
|
Specimen fat stain
|
$30.00 |
$30.00 |
$72.50 |
|
|
Speech audiometry complete
|
$27.00 |
$67.00 |
$148.50 |
|
|
Speech evaluation complex
|
$434.50 |
$434.50 |
$471.50 |
|
|
Speech recep thresh
|
$17.50 |
$30.00 |
$129.50 |
|
|
Sphincteroplasty inc/prolapse adult 46750
|
$6,573.50 |
$6,573.50 |
$6,573.50 |
|
|
Spinal bone allograftstructural 20931
|
$3,273.80 |
$3,944.08 |
$19,554.00 |
|
|
Spinal bone autograftlocal 20936
|
$2,923.32 |
$3,061.42 |
$8,677.00 |
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$85.50 |
$1,142.40 |
$3,612.50 |
|
|
Spirmtry w/brnchdil inf-2 yr
|
$298.50 |
$406.50 |
$545.50 |
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$241.50 |
$411.50 |
$657.00 |
|
|
Spirometry up to 2 yrs old
|
$297.00 |
$297.00 |
$339.00 |
|
|
Splenectomy total open 38100
|
$1,237.00 |
$1,267.00 |
$9,196.00 |
|
|
Splice spleen/kidney veins
|
$2,502.50 |
$2,547.00 |
$4,075.20 |
|
|
Splint arm vnyl coated padded lft med
|
$17.00 |
$17.00 |
$18.00 |
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$240.50 |
$470.00 |
$679.00 |
|
|
Splint extn xsm w sof-stretch rolyan
|
$90.50 |
$90.50 |
$141.00 |
|
|
Splint finger 4 prong foam sm
|
$53.50 |
$53.50 |
$53.50 |
|
|
Splint finger frog med
|
$87.00 |
$87.00 |
$87.00 |
|
|
Splint fing stax assort 1-7in
|
$3.50 |
$3.50 |
$5.00 |
|
|
Splint rstrc wrst/cmc right med
|
$270.00 |
$270.00 |
$270.00 |
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$696.00 |
$1,113.60 |
$12,467.50 |
|
|
Split blood or products
|
$135.00 |
$149.00 |
$458.50 |
|
|
Split flat caliper stirr & p
|
$159.00 |
$164.50 |
$169.00 |
|
|
Splt agrft f/s/n/h/f/g/m ea
|
$3,181.58 |
$3,181.58 |
$3,181.58 |
|
|
Sprchoroidal spc njx rx agt
|
$316.50 |
$452.00 |
$508.50 |
|
|
Sputum specimen collection
|
$41.50 |
$114.50 |
$488.00 |
|
|
Sr-89 stront chlor ther / mci
|
$1,699.50 |
$1,699.50 |
$6,837.50 |
|
|
Srs cranial lesion simple
|
$598.00 |
$598.00 |
$598.00 |
|
|
Srs cran les simple addl
|
$299.00 |
$299.00 |
$299.00 |
|
|
Srs linear based
|
$4,919.50 |
$7,175.50 |
$11,365.50 |
|
