|
Rpr aa hrn 1st < 3 ncr/strn
|
$294.80 |
$6,904.15 |
$7,033.70 |
|
|
Rpr aa hrn rcr > 10 ncr/strn
|
$770.00 |
$770.00 |
$770.00 |
|
|
Rpr aa hrn rcr > 10 rdc
|
$549.56 |
$549.56 |
$549.56 |
|
|
Rpr aa hrn rcr 3-10 ncr/strn
|
$531.08 |
$531.08 |
$531.08 |
|
|
Rpr aa hrn rcr 3-10 rdc
|
$395.34 |
$7,383.87 |
$7,383.87 |
|
|
Rpr aa hrn rcr < 3 ncr/strn
|
$353.54 |
$6,904.15 |
$6,904.15 |
|
|
Rpr aa hrn rcr < 3 rdc
|
$260.48 |
$4,176.15 |
$4,176.15 |
|
|
Rpr acq av fistula thrx&abd
|
$915.42 |
$915.42 |
$915.42 |
|
|
Rpr blood ves w/vein graft/up ext 35236
|
$614.24 |
$6,396.89 |
$6,396.89 |
|
|
Rpr blood vsl grf oth vein lo ex
|
$561.66 |
$6,396.89 |
$11,980.07 |
|
|
Rpr blvs gr ot/th vn ntrth w
|
$839.96 |
$839.96 |
$839.96 |
|
|
Rpr blvs gr ot/t vn ntrth wo
|
$885.94 |
$885.94 |
$885.94 |
|
|
Rpr blvsl gr ot/th vn ntr-ab
|
$992.20 |
$992.20 |
$992.20 |
|
|
Rpr blvsl vn grf intra-abdl
|
$1,051.60 |
$1,051.60 |
$1,051.60 |
|
|
Rpr blvsl vn grf ntrthrc w/b
|
$871.86 |
$871.86 |
$871.86 |
|
|
Rpr cgen av fistula thrx&abd
|
$1,091.64 |
$1,091.64 |
$1,091.64 |
|
|
Rpr choanal atresia ntranasl
|
$449.24 |
$7,000.36 |
$7,000.36 |
|
|
Rpr choanal atresia trsnpltn
|
$609.40 |
$7,000.36 |
$7,000.36 |
|
|
Rpr csf leak/pseudomeng/laminectomy63709
|
$695.20 |
$695.20 |
$695.20 |
|
|
Rpr diaphragm hernia/chronic/not neonate 39541
|
$577.50 |
$577.50 |
$577.50 |
|
|
Rpr diaphragm lac/any approach 39501
|
$525.14 |
$525.14 |
$525.14 |
|
|
Rpr fem hernia init blocked
|
$393.58 |
$4,176.15 |
$4,176.15 |
|
|
Rpr hern preemie reduc
|
$495.88 |
$6,904.15 |
$6,904.15 |
|
|
Rpr hypopl a-arch w/byp
|
$1,116.94 |
$1,116.94 |
$1,116.94 |
|
|
Rpr hypopl a-arch wo byp
|
$854.48 |
$854.48 |
$854.48 |
|
|
Rpr hypspad comp dsj & urtp
|
$623.48 |
$6,015.75 |
$6,015.75 |
|
|
Rpr hypspad comp simple
|
$352.66 |
$4,081.37 |
$4,081.37 |
|
|
Rpr ing hernia baby blocked
|
$383.46 |
$4,176.15 |
$4,176.15 |
|
|
Rpr ing hernia baby reduc
|
$254.98 |
$4,176.15 |
$4,176.15 |
|
|
Rpr ing hernia init blocked
|
$377.96 |
$4,176.15 |
$4,176.15 |
|
|
Rpr ing hernia init reduce
|
$259.38 |
$7,383.87 |
$7,383.87 |
|
|
Rpr ing hern premie blocked
|
$595.54 |
$4,176.15 |
$4,176.15 |
|
|
Rpr intst excl anrect fist
|
$3,245.23 |
$3,245.23 |
$3,245.23 |
|
|
Rpr nsl vlv collapse w/implt
|
$104.28 |
$7,000.36 |
$7,000.36 |
|
|
Rpr nsl vlv collapse w/rmdlg
|
$92.40 |
$7,000.36 |
$7,000.36 |
|
|
Rpr parastomal hernia rdc 49621
|
$465.74 |
$465.74 |
$465.74 |
|
|
Rpr parastomal hrna ncr/strn 49622
|
$579.26 |
$579.26 |
$579.26 |
|
|
Rpr pul art unifocal without cpb
|
$1,042.80 |
$1,042.80 |
$1,042.80 |
|
|
Rpr&refitg spect xcp aphakia
|
$10.12 |
$10.12 |
$10.12 |
|
|
Rpr&refit spct prsth aphakia
|
$70.29 |
$70.29 |
$70.29 |
|
|
Rpr rem hernia init reduce
|
$360.36 |
$4,176.15 |
$4,176.15 |
|
|
Rpr tga aortic pulm art rcns
|
$1,428.24 |
$1,428.24 |
$1,428.24 |
|
|
Rpr tga atr bfl clsr vsd
|
$1,194.60 |
$1,194.60 |
$1,194.60 |
|
|
Rpr tga atr bfl rmvl plm bnd
|
$1,129.48 |
$1,129.48 |
$1,129.48 |
|
|
Rpr tga atrial baffle px
|
$1,097.58 |
$1,097.58 |
$1,097.58 |
|
|
Rpr tga bfl rpr sbpulm obstr
|
$1,149.94 |
$1,149.94 |
$1,149.94 |
|
|
Rpr tga rcnstj clsr vsd
|
$1,436.16 |
$1,436.16 |
$1,436.16 |
|
|
Rpr tga rcnstj rmvl plm bnd
|
$1,408.66 |
$1,408.66 |
$1,408.66 |
|
|
Rpr tga rcnstj rpr sbpl obst
|
$1,400.30 |
$1,400.30 |
$1,400.30 |
|
|
Rpr tga without surg enlgmnt vsd
|
$1,283.70 |
$1,283.70 |
$1,283.70 |
|
|
Rpr tga w/surg enlgmnt vsd
|
$1,319.56 |
$1,319.56 |
$1,319.56 |
|
|
Rpr xtnsr tndn leg prim without grft ea tndn
|
$223.08 |
$8,453.60 |
$14,590.10 |
|
|
Rp therapy unlisted px
|
$265.23 |
$265.23 |
$676.80 |
|
|
Rrp hypspad comp moblj&urtp
|
$583.00 |
$10,942.71 |
$10,942.71 |
|
|
Rsect hip tum incl femur
|
$1,268.52 |
$7,413.38 |
$7,413.38 |
|
|
Rsv assay w/optic
|
$13.10 |
$13.10 |
$69.42 |
|
|
Rtm 1st set-up&pt educaj eqp
|
$152.50 |
$152.50 |
$152.50 |
|
|
Rtm dev sply cbt 16-30 d
|
$44.13 |
$44.13 |
$44.13 |
|
|
Rtm dev sply mscskl 16-30 d
|
$44.13 |
$44.13 |
$44.13 |
|
|
Rtm dev sply resp sys 16-30d
|
$44.13 |
$44.13 |
$44.13 |
|
|
Rtm tx mgmt 1st 20 min
|
$18.92 |
$33.53 |
$33.53 |
|
|
Rtm tx mgmt ea addl 20 min
|
$18.48 |
$32.80 |
$32.80 |
|
|
Rubella antibody igg
|
$14.39 |
$35.40 |
$211.00 |
|
|
Rubeola ag if
|
$40.04 |
$60.80 |
$60.80 |
|
|
Rubeola antibody igg
|
$12.88 |
$23.40 |
$250.00 |
|
|
Runx1 gene targeted seq alys
|
$217.36 |
$329.51 |
$329.51 |
|
|
Russell viper venom diluted
|
$9.58 |
$23.40 |
$278.00 |
|
|
Rx metab gen seq alys pnl 6
|
$917.08 |
$917.08 |
$8,747.92 |
|
|
Sacituzumab govitecan-hziy 180 mg intravenous solution
|
$34.67 |
$34.67 |
$8,623.86 |
|
|
Sacroiliac Joint X-ray (3 or more views)
|
$125.84 |
$145.80 |
$907.00 |
|
|
Safety plan interven
|
$26.62 |
$45.23 |
$45.23 |
|
|
Salivary gland function exam
|
$11.66 |
$475.51 |
$1,146.14 |
|
|
Salivary gland imaging
|
$12.98 |
$475.51 |
$1,273.00 |
|
|
Salivary glnd img serial img
|
$12.98 |
$475.51 |
$2,265.00 |
|
|
Salmonella antibody
|
$8.80 |
$13.19 |
$144.60 |
|
|
Salpingostomy 58770
|
$531.96 |
$3,762.53 |
$3,762.53 |
|
|
Same day nb discharge 99463
|
$66.22 |
$152.50 |
$152.50 |
|
|
Sargramostim injection
|
$60.28 |
$60.28 |
$1,031.56 |
|
|
Sars-cov-2 antb quantitative
|
$51.43 |
$51.43 |
$51.43 |
|
|
Sarscov2 vac 5mcg/0.5ml im
|
$616.74 |
$616.74 |
$616.74 |
|
|
Sarscov coronavirus ag ia
|
$23.32 |
$35.33 |
$148.01 |
|
|
Sarscov & inf vir a&b ag ia
|
$46.20 |
$70.29 |
$70.29 |
|
|
S bowel endoscope w/stent
|
$248.16 |
$7,044.32 |
$7,044.32 |
|
|
Sbrt management
|
$400.62 |
$400.62 |
$400.62 |
|
|
Sbrt w/positron emission del
|
$4,438.19 |
$4,438.19 |
$4,438.19 |
|
|
Sbsq ic vlbw inf<1,500 gm
|
$81.18 |
$81.18 |
$81.18 |
|
|
Sbsq nurs facil care/day unstabl/new prob 35 min 99310
|
$94.38 |
$94.38 |
$94.38 |
|
|
Sbsq nursing facil care/day minor complj 15 min
|
$45.54 |
$45.54 |
$45.54 |
|
|
Sbsq nursing facil care/day new problem 25 min
|
$66.22 |
$66.22 |
$66.22 |
|
|
Sbsq nursing facility care/day e/m stable 10 min
|
$24.42 |
$24.42 |
$24.42 |
|
|
Sbsq psyc collab care mgmt
|
$63.14 |
$109.46 |
$308.00 |
|
|
Scan duplex aorta/ivc/iliac or bypass grafts complete
|
$286.04 |
$286.04 |
$1,853.00 |
|
|
Scan duplex aorta/ivc/iliac unilateral/limited
|
$125.84 |
$125.84 |
$996.00 |
|
|
Scan duplex extracranial arteries unilateral/limited study
|
$125.84 |
$125.84 |
$1,856.00 |
|
|
Scan duplex extremity veins unilateral/limited study
|
$125.84 |
$222.60 |
$3,976.00 |
|
|
Scan duplex lower extremity arteries unilateral/limited study left
|
$125.84 |
$222.60 |
$2,457.00 |
|
|
Scan duplex upper extremity arteries unilateral/limited study left
|
$125.84 |
$222.60 |
$2,401.00 |
|
|
Scan proc cranial extra
|
$106.48 |
$106.48 |
$106.48 |
|
|
Scan proc cranial intra 61781
|
$145.64 |
$145.64 |
$145.64 |
|
|
Scan proc spinal
|
$142.78 |
$142.78 |
$142.78 |
|
