|
Screening Colonoscopy (high risk)
|
$133.50 |
$133.50 |
$133.50 |
$1,951.46
|
|
Screening colorectal cancer fecal occult blood immunoassay 1-3 simultaneous determinations
|
$61.80 |
$61.80 |
$61.80 |
$57.60
|
|
Screening hepatitis c antibody high risk
|
$34.80 |
$34.80 |
$34.80 |
$99.66
|
|
Screening Mammogram
|
$379.50 |
$379.50 |
$379.50 |
$312.55
|
|
Screening prostate cancer PSA
|
$105.60 |
$105.60 |
$105.60 |
$100.63
|
|
Screen/visual acuity/bilat/quant 99173
|
$42.90 |
$42.90 |
$42.90 |
$28.86
|
|
Screw cortex 2.0 x 10mm
|
$20,873.40 |
$20,873.40 |
$20,873.40 |
$29,055.00
|
|
Sec abd wall suture evisceration/dehsn 49900
|
$844.20 |
$844.20 |
$844.20 |
$2,139.60
|
|
Sec art mech thrmbc non-intracranial add-on
|
$234.00 |
$234.00 |
$234.00 |
$4,377.50
|
|
Sedimentation rate erythrocyte automated
|
$42.30 |
$42.30 |
$42.30 |
$42.00
|
|
Segmentectomy 32484
|
$1,400.40 |
$1,400.40 |
$1,400.40 |
$3,491.20
|
|
Self-adher band w>=3" <5"/yd
|
$0.90 |
$0.90 |
$0.90 |
$2.07
|
|
Self-meas bp 2 readg bid 30d
|
$13.20 |
$13.20 |
$13.20 |
$11.88
|
|
Self-mgmt educ/train 2-4 pt 30min
|
$15.30 |
$15.30 |
$15.30 |
$51.98
|
|
Self-mgmt educ/train 5-8 pt 30min
|
$11.40 |
$11.40 |
$11.40 |
$33.04
|
|
Semen analysis presence/motility
|
$91.50 |
$91.50 |
$91.50 |
$71.05
|
|
Separate eyelid adhesions
|
$416.40 |
$416.40 |
$416.40 |
$2,857.60
|
|
Serial tonometry
|
$66.00 |
$66.00 |
$66.00 |
$131.02
|
|
Serpina1 gene
|
$13.10 |
$13.10 |
$13.10 |
$197.00
|
|
Sertraline (zoloft) - sendout
|
$27.00 |
$27.00 |
$27.00 |
$126.43
|
|
Set radiation therapy field
|
$45.30 |
$45.30 |
$45.30 |
$762.40
|
|
Set radiation therapy field
|
$68.10 |
$68.10 |
$68.10 |
$1,157.38
|
|
Set radiation therapy field
|
$99.30 |
$99.30 |
$99.30 |
$1,636.36
|
|
Sgmdsc w/band ligation
|
$102.90 |
$102.90 |
$102.90 |
$2,146.95
|
|
Shave sgl skin lsn f/e/e/n/l/m 0.5cm/<
|
$123.00 |
$123.00 |
$123.00 |
$284.00
|
|
Shave sgl skin lsn f/e/e/n/l/m 0.6-1.0cm
|
$145.80 |
$145.80 |
$145.80 |
$284.88
|
|
Shave sgl skin lsn f/e/e/n/l/m 1.1-2cm
|
$165.60 |
$165.60 |
$165.60 |
$442.22
|
|
Shave sgl skin lsn f/e/e/n/l/m >2cm
|
$192.30 |
$192.30 |
$192.30 |
$472.79
|
|
Shave sgl skin lsn s/n/h/f/g 0.5cm/<
|
$111.90 |
$111.90 |
$111.90 |
$235.13
|
|
Shave sgl skin lsn s/n/h/f/g 0.6-1.0 cm
|
$129.90 |
$129.90 |
$129.90 |
$223.00
|
|
Shave sgl skin lsn s/n/h/f/g 1.1-2cm
|
$146.10 |
$146.10 |
$146.10 |
$269.50
|
|
Shave sgl skin lsn s/n/h/f/g >2cm
|
$153.30 |
$153.30 |
$153.30 |
$400.65
|
|
Shave sgl skin lsn t/a/l 0.5cm/<
|
$131.10 |
$131.10 |
$131.10 |
$314.00
|
|
Shave sgl skin lsn t/a/l 0.6-1.0cm
|
$129.00 |
$129.00 |
$129.00 |
$235.13
|
|
Shave sgl skin lsn t/a/l 1.1-2.0cm
|
$176.40 |
$176.40 |
$176.40 |
$289.30
|
|
Sho arthrs dx +- synovial bx
|
$500.40 |
$500.40 |
$500.40 |
$3,821.05
|
|
Sho arthrs srg bicp tenodsis
|
$954.00 |
$954.00 |
$954.00 |
$4,950.40
|
|
Sho arthrs srg capsulorraphy
|
$1,101.30 |
$1,101.30 |
$1,101.30 |
$6,311.00
|
|
Sho arthrs srg compl synvct
|
$627.60 |
$627.60 |
$627.60 |
$3,839.54
|
|
Sho arthrs srg lmtd dbrdmt
|
$574.50 |
$574.50 |
$574.50 |
$4,521.67
|
|
Sho arthrs srg lss&rescj ads
|
$620.10 |
$620.10 |
$620.10 |
$3,839.54
|
|
Sho arthrs srg prtl synvct
|
$565.50 |
$565.50 |
$565.50 |
$5,855.00
|
|
Sho arthrs srg rmvl loose/fb
|
$619.50 |
$619.50 |
$619.50 |
$3,839.54
|
|
Sho arthrs srg rpr slap les
|
$1,076.70 |
$1,076.70 |
$1,076.70 |
$6,311.00
|
|
Sho arthrs srg xtnsv dbrdmt
|
$624.90 |
$624.90 |
$624.90 |
$5,148.00
|
|
Shoe post-op mens m
|
$183.00 |
$183.00 |
$183.00 |
$52.20
|
|
Shortening of hand tendon
|
$722.10 |
$722.10 |
$722.10 |
$3,821.05
|
|
Shorten radius or ulna
|
$810.90 |
$810.90 |
$810.90 |
$6,609.96
|
|
Shoulder Arthroscopy (Rotator Cuff Repair)
|
$1,108.80 |
$1,108.80 |
$1,108.80 |
$7,807.24
|
|
Shoulder MRI (with and without contrast)
|
$2,761.80 |
$2,761.80 |
$2,761.80 |
$2,713.80
|
|
Shoulder MRI (with contrast)
|
$2,250.00 |
$2,250.00 |
$2,250.00 |
$2,448.60
|
|
Shoulder MRI (without contrast)
|
$1,967.40 |
$1,967.40 |
$1,967.40 |
$2,065.05
|
|
Shoulder prosthesis removal
|
$1,104.90 |
$1,104.90 |
$1,104.90 |
$3,870.38
|
|
Shoulder prosthesis removal
|
$1,308.00 |
$1,308.00 |
$1,308.00 |
$4,832.80
|
|
Shoulder X-ray
|
$404.10 |
$404.10 |
$404.10 |
$339.50
|
|
Shuntogram nonvascular supervision & interpretation
|
$99.00 |
$99.00 |
$99.00 |
$349.20
|
|
Sialography s&i
|
$21.30 |
$21.30 |
$21.30 |
$499.20
|
|
Sialolithotomy 42330
|
$249.60 |
$249.60 |
$249.60 |
$3,837.72
|
|
Sickling rbc
|
$1.36 |
$1.36 |
$1.36 |
$57.92
|
|
Sigmoidoscopy and biopsy
|
$306.30 |
$306.30 |
$306.30 |
$1,351.63
|
|
Sigmoidoscopy flex decompression 45337
|
$115.20 |
$115.20 |
$115.20 |
$1,078.88
|
|
Sigmoidoscopy for bleeding
|
$119.70 |
$119.70 |
$119.70 |
$1,890.00
|
|
Sigmoidoscopy/submucosal injection 45335
|
$311.70 |
$311.70 |
$311.70 |
$1,444.83
|
|
Sigmoidoscopy w/ablation
|
$162.60 |
$162.60 |
$162.60 |
$2,604.00
|
|
Sigmoidoscopy w/fb removal 45332
|
$107.40 |
$107.40 |
$107.40 |
$1,388.56
|
|
Sigmoidoscopy w/plcmt stent
|
$156.00 |
$156.00 |
$156.00 |
$3,692.00
|
|
Sigmoidoscopy w/resection
|
$222.60 |
$222.60 |
$222.60 |
$2,564.40
|
|
Sigmoidoscopy w/tumr remove
|
$122.40 |
$122.40 |
$122.40 |
$1,558.80
|
|
Sigmoidoscopy w/ultrasound
|
$126.30 |
$126.30 |
$126.30 |
$1,740.57
|
|
Sigmoidoscopy w/us guide bx
|
$171.90 |
$171.90 |
$171.90 |
$2,106.60
|
|
Sigmoid/rmv tumor/polyp/hot bx for 45333
|
$96.00 |
$96.00 |
$96.00 |
$1,664.40
|
|
Sig w/tndsc balloon dilation
|
$79.80 |
$79.80 |
$79.80 |
$1,901.90
|
|
Simple cystometrogram 51725
|
$223.20 |
$223.20 |
$223.20 |
$589.45
|
|
Sinus CT scan (with and without contrast)
|
$1,417.50 |
$1,417.50 |
$1,417.50 |
$1,790.00
|
|
Sinus CT scan (with contrast)
|
$1,423.50 |
$1,423.50 |
$1,423.50 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$1,160.10 |
$1,160.10 |
$1,160.10 |
$1,292.04
|
|
Sinus/juglr venogram s&i
|
$62.40 |
$62.40 |
$62.40 |
$2,489.25
|
|
Sinusotomy maxillary sinus 31020
|
$556.50 |
$556.50 |
$556.50 |
$2,616.15
|
|
Sinusotomy sinus remove polyps 31032
|
$632.40 |
$632.40 |
$632.40 |
$6,177.60
|
|
Skel musc relaxant 3 or more
|
$1.80 |
$1.80 |
$1.80 |
$16.12
|
|
Skin Biopsy
|
$130.80 |
$130.80 |
$130.80 |
$360.34
|
|
Skin full graft 20sq cm less 15200
|
$703.50 |
$703.50 |
$703.50 |
$2,371.50
|
|
Skin full graft add-on 15241
|
$108.30 |
$108.30 |
$108.30 |
$675.58
|
|
Skin pedicle flap trunk
|
$755.40 |
$755.40 |
$755.40 |
$2,501.86
|
|
Skin split graft addl 100sq cm 15101
|
$111.30 |
$111.30 |
$111.30 |
$1,793.40
|
|
Skyla, 13.5 mg
|
$548.10 |
$548.10 |
$548.10 |
$1,643.47
|
|
Sleep study attended
|
$42.90 |
$42.90 |
$42.90 |
$1,329.00
|
|
Sleep Study (Polysomnography)
|
$490.80 |
$490.80 |
$490.80 |
$3,607.50
|
|
Sleep study unattended
|
$32.10 |
$32.10 |
$32.10 |
$580.87
|
|
Sling arm deluxe w/pad xs
|
$100.80 |
$100.80 |
$100.80 |
$30.35
|
|
Sling suprapubic suburetheral
|
$2,973.90 |
$2,973.90 |
$2,973.90 |
$9,679.96
|
|
Slitting of prepuce
|
$147.30 |
$147.30 |
$147.30 |
$3,365.50
|
|
Slp pure tone screening
|
$23.40 |
$23.40 |
$23.40 |
$60.48
|
|
Slp stdy unatnd w/anal
|
$75.30 |
$75.30 |
$75.30 |
$296.34
|
|
Slp ther svc non-spch gen
|
$178.80 |
$178.80 |
$178.80 |
$188.50
|
|
Small bowel endoscopy
|
$145.80 |
$145.80 |
$145.80 |
$2,463.36
|
|
Small bowel endoscopy
|
$206.70 |
$206.70 |
$206.70 |
$2,244.82
|
|
Small bowel endoscopy
|
$242.10 |
$242.10 |
$242.10 |
$2,638.57
|
|
Small bowel endoscopy
|
$248.10 |
$248.10 |
$248.10 |
$2,389.40
|
|
Small bowel endoscopy
|
$286.80 |
$286.80 |
$286.80 |
$2,638.57
|