|
Special pump services
|
$362.50 |
$362.50 |
$362.50 |
|
|
Special radiation dosimetry
|
$267.90 |
$392.50 |
$552.26 |
|
|
Special radiation treatment
|
$400.40 |
$1,909.38 |
$5,240.00 |
|
|
Special supplies phys/qhp
|
$16.43 |
$16.43 |
$16.43 |
|
|
Special teletx port plan
|
$686.28 |
$1,358.28 |
$1,900.00 |
|
|
Specific gravity body fluid
|
$7.41 |
$16.43 |
$33.98 |
|
|
Specimen fat stain
|
$19.61 |
$47.50 |
$49.50 |
|
|
Speech and Language Evaluation (comprehensive)
|
$258.50 |
$340.00 |
$569.80 |
|
|
Speech audiometry complete
|
$57.75 |
$62.13 |
$84.00 |
|
|
Speech evaluation complex
|
$551.76 |
$551.76 |
$551.76 |
|
|
Speech recep thresh
|
$32.50 |
$36.57 |
$44.00 |
|
|
Speech Therapy Session (one-on-one)
|
$130.90 |
$255.00 |
$516.03 |
|
|
Sperm antibody test
|
$45.05 |
$55.44 |
$94.05 |
|
|
Sperm isolation simple
|
$314.40 |
$314.40 |
$314.40 |
|
|
Sphenoid sinus surgery
|
$6,640.00 |
$6,640.00 |
$6,640.00 |
|
|
Sphincteroplasty inc/prolapse adult 46750
|
$2,968.00 |
$2,968.00 |
$2,968.00 |
|
|
Spinal bone allograftstructural 20931
|
$328.00 |
$328.00 |
$328.00 |
|
|
Spinal bone autograftlocal 20936
|
$1,335.20 |
$1,335.20 |
$1,335.20 |
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$851.40 |
$1,155.55 |
$2,310.33 |
|
|
Spine X-ray (single view, one level)
|
$63.84 |
$237.05 |
$601.04 |
|
|
Spleen imaging
|
$980.00 |
$980.00 |
$1,432.65 |
|
|
Splenectomy total open 38100
|
$5,942.40 |
$5,942.40 |
$5,942.40 |
|
|
Splint arm vnyl coated padded lft med
|
$86.40 |
$86.40 |
$86.40 |
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$86.91 |
$345.94 |
$1,267.11 |
|
|
Splint extn xsm w sof-stretch rolyan
|
$42.50 |
$42.50 |
$164.16 |
|
|
Splint finger 4 prong foam sm
|
$13.25 |
$13.25 |
$35.20 |
|
|
Splint finger frog med
|
$10.64 |
$42.50 |
$103.74 |
|
|
Splint fing stax assort 1-7in
|
$72.80 |
$72.80 |
$72.80 |
|
|
Splint rstrc wrst/cmc right med
|
$62.50 |
$62.50 |
$110.24 |
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$4,228.62 |
$4,228.62 |
$4,768.80 |
|
|
Split blood or products
|
$41.61 |
$75.00 |
$363.60 |
|
|
Splt agrft f/s/n/h/f/g/m ea
|
$268.18 |
$268.18 |
$2,781.60 |
|
|
Sprchoroidal spc njx rx agt
|
$447.20 |
$447.20 |
$447.20 |
|
|
Sputum specimen collection
|
$133.76 |
$198.00 |
$246.95 |
|
|
Sr-89 stront chlor ther / mci
|
$2,515.15 |
$2,515.15 |
$2,515.15 |
|
|
Srs linear based
|
$7,677.78 |
$20,693.85 |
$35,175.00 |
|
|
Srs multisource
|
$17,525.00 |
$17,525.00 |
$98,343.21 |
|
|
Staggered spondaic word test
|
$81.09 |
$81.09 |
$216.00 |
|
|
St analysis behavior qualitative voice/resonance
|
$174.90 |
$227.50 |
$562.52 |
|
|
Staph a dna amp probe
|
$73.53 |
$125.00 |
$237.60 |
|
|
Static or dynami afo pre ots
|
$85.80 |
$167.50 |
$167.50 |
|
|
St cognitve performance testing healthcare professional each hour
|
$184.80 |
$230.00 |
$506.40 |
|
|
Stem cells total count
|
$245.03 |
$245.03 |
$245.03 |
|
|
Stenger test pure tone
|
$25.44 |
$50.40 |
$70.00 |
|
|
Stenger test speech
|
$38.16 |
$54.40 |
$68.20 |
|
|
Stent/athrectomy/fem/pop/unilat 37227
|
$10,683.75 |
$17,895.00 |
$55,087.90 |
|
|
Stent axios caut enh 15x10mm electrocaut
|
$872.77 |
$6,408.72 |
$52,874.85 |
|
|
Stent bili dbl pgtl 10fx5cm
|
$172.50 |
$401.95 |
$7,364.61 |
|
|
Stent bili rx wallflx 10x80 uncvr
|
$768.62 |
$3,626.00 |
$22,415.85 |
|
|
Stent bronch dumon sil 10x40mm
|
$118.42 |
$229.88 |
$9,120.00 |
|
|
Stent iliac/open or perc/uni/init 37221
|
$6,421.25 |
$13,098.36 |
$27,390.00 |
|
|
Stent iliac/open/perc/ea ad/ipsila 37223
|
$2,895.00 |
$9,784.50 |
$16,928.05 |
|
|
Stent placemt retro carotid
|
$4,440.00 |
$4,540.14 |
$25,328.20 |
|
|
Stent/tib/peroneal/unilat/initial 37230
|
$7,700.00 |
$13,010.00 |
$40,476.27 |
|
|
Stereoscopic x-ray guidance
|
$254.10 |
$254.10 |
$254.10 |
|
|
Sterile gauze <= 16 sq in
|
$1.59 |
$1.59 |
$1.59 |
|
|
Sterile water/saline, 10 ml
|
$15.90 |
$15.90 |
$15.90 |
|
|
Sternal debridement
|
$2,500.80 |
$2,500.80 |
$2,500.80 |
|
|
St evaluate speech sound production
|
$168.15 |
$227.50 |
$562.52 |
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$198.36 |
$337.50 |
$719.95 |
|
|
Stimulants synthetic
|
$139.70 |
$152.50 |
$156.00 |
|
|
Stomach Emptying Scan (Nuclear Medicine)
|
$396.00 |
$1,290.00 |
$3,039.55 |
|
|
Stot/tot hysterectomy after cesaren delivery 59525
|
$1,112.64 |
$2,397.60 |
$2,607.60 |
|
|
Strapping of ankle and/or ft 29540
|
$16.43 |
$110.00 |
$955.13 |
|
|
Strapping of chest
|
$110.00 |
$113.30 |
$447.70 |
|
|
Strapping of elbow or wrist 29260
|
$30.74 |
$110.00 |
$428.45 |
|
|
Strapping of hand or finger
|
$65.19 |
$97.50 |
$382.80 |
|
|
Strapping of hip
|
$110.00 |
$138.60 |
$500.54 |
|
|
Strapping of knee
|
$32.33 |
$110.00 |
$525.55 |
|
|
Strapping of toes 29550
|
$18.02 |
$219.45 |
$530.51 |
|
|
Strep a ag ia
|
$20.00 |
$20.00 |
$196.90 |
|
|
Strep a dna dir probe
|
$81.09 |
$81.09 |
$81.09 |
|
|
Strep a dna quant
|
$168.01 |
$168.01 |
$168.01 |
|
|
Strep b assay w/optic
|
$20.67 |
$116.82 |
$116.82 |
|
|
Strep b dna amp probe
|
$42.90 |
$90.00 |
$314.92 |
|
|
Streptomycin injection
|
$38.16 |
$38.16 |
$38.16 |
|
|
Streptozocin injection
|
$400.68 |
$400.68 |
$400.68 |
|
|
Stress test pulmonary
|
$92.40 |
$217.50 |
$1,094.56 |
|
|
Stress tte complete
|
$940.50 |
$2,050.62 |
$4,861.69 |
|
|
Str markers specimen anal
|
$380.00 |
$380.00 |
$835.28 |
|
|
Subdural tap fontanelle/sutur infant init 61000
|
$853.60 |
$853.60 |
$853.60 |
|
|
Subq njx filling matrl 1cc/<
|
$56.18 |
$56.18 |
$1,144.00 |
|
|
Subq njx fil matrl 5.1-10cc
|
$202.99 |
$202.99 |
$1,144.00 |
|
|
Subsequent intensive care infant 1500-2500 grams 99479
|
$357.39 |
$357.39 |
$357.39 |
|
|
Subsequent intensive care infant 2501-5000 grams 99480
|
$334.02 |
$334.02 |
$334.02 |
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$6.47 |
$9.21 |
$76.49 |
|
|
Suction lipectomy head&neck
|
$2,334.40 |
$2,334.40 |
$2,334.40 |
|
|
Suction lipectomy lwr extrem
|
$3,501.60 |
$3,501.60 |
$3,501.60 |
|
|
Suction lipectomy trunk
|
$2,334.40 |
$2,334.40 |
$2,334.40 |
|
|
Sugars single quant
|
$38.50 |
$52.47 |
$143.88 |
|
|
Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution
|
$4.77 |
$2,390.58 |
$6,686.57 |
|
|
Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution
|
$0.38 |
$0.38 |
$0.39 |
|
|
Sulfonylurea screen qn-sendout
|
$39.22 |
$160.05 |
$258.50 |
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$42.40 |
$58.48 |
$198.40 |
|
|
Sup of prep of antigen # of vials 95144
|
$19.08 |
$19.08 |
$19.08 |
|
|
Support clav 29.6-40.5in med
|
$51.94 |
$70.00 |
$235.50 |
|
|
Surg dx exam anorectal
|
$531.20 |
$531.20 |
$531.20 |
|
|
Surgery to stop leg growth
|
$4,889.60 |
$4,889.60 |
$4,889.60 |
|
|
Surgery to stop leg growth
|
$5,406.40 |
$5,406.40 |
$5,406.40 |
|
|
Surgery to stop leg growth
|
$6,533.60 |
$6,533.60 |
$6,533.60 |
|
