|
Shave sgl skin lsn s/n/h/f/g 1.1-2cm
|
$387.40 |
$387.40 |
$387.40 |
$269.50
|
|
Shave sgl skin lsn s/n/h/f/g >2cm
|
$779.35 |
$779.35 |
$779.35 |
$400.40
|
|
Shave sgl skin lsn t/a/l 0.5cm/<
|
$779.35 |
$779.35 |
$779.35 |
$314.00
|
|
Shave sgl skin lsn t/a/l 0.6-1.0cm
|
$387.40 |
$387.40 |
$387.40 |
$235.13
|
|
Shave sgl skin lsn t/a/l 1.1-2.0cm
|
$387.40 |
$387.40 |
$387.40 |
$289.30
|
|
Sheath below knee
|
$59.80 |
$59.80 |
$59.80 |
$40.88
|
|
Sho arthrs dx +- synovial bx
|
$1,567.80 |
$1,567.80 |
$1,567.80 |
$3,839.54
|
|
Sho arthrs srg bicp tenodsis
|
$3,763.50 |
$3,763.50 |
$3,763.50 |
$4,950.40
|
|
Sho arthrs srg capsulorraphy
|
$3,936.40 |
$3,936.40 |
$3,936.40 |
$7,166.67
|
|
Sho arthrs srg compl synvct
|
$2,051.40 |
$2,051.40 |
$2,051.40 |
$4,399.11
|
|
Sho arthrs srg lmtd dbrdmt
|
$2,010.45 |
$2,010.45 |
$2,010.45 |
$4,807.00
|
|
Sho arthrs srg lss&rescj ads
|
$2,025.40 |
$2,025.40 |
$2,025.40 |
$3,839.54
|
|
Sho arthrs srg prtl synvct
|
$1,874.60 |
$1,874.60 |
$1,874.60 |
$5,886.74
|
|
Sho arthrs srg rmvl loose/fb
|
$2,025.40 |
$2,025.40 |
$2,025.40 |
$3,839.54
|
|
Sho arthrs srg rpr slap les
|
$3,814.20 |
$3,814.20 |
$3,814.20 |
$6,740.20
|
|
Sho arthrs srg xtnsv dbrdmt
|
$2,282.15 |
$2,282.15 |
$2,282.15 |
$5,148.00
|
|
Shoe heel pad & depress for
|
$33.15 |
$33.15 |
$33.15 |
$149.60
|
|
Shoe post-op mens m
|
$29.90 |
$29.90 |
$29.90 |
$53.20
|
|
Shorten radius or ulna
|
$2,782.00 |
$2,782.00 |
$2,782.00 |
$6,609.96
|
|
Shot (Injection into Muscle or Under the Skin)
|
$319.15 |
$319.15 |
$319.15 |
$138.00
|
|
Shoulder AC Joint X-ray (both sides)
|
$446.55 |
$446.55 |
$446.55 |
$270.69
|
|
Shoulder Arthroscopy (Rotator Cuff Repair)
|
$4,053.40 |
$4,053.40 |
$4,053.40 |
$7,907.11
|
|
Shoulder Blade (Scapula) X-ray (both sides)
|
$525.85 |
$525.85 |
$525.85 |
$288.75
|
|
Shoulder MRI (with and without contrast)
|
$1,601.60 |
$1,601.60 |
$1,601.60 |
$2,825.55
|
|
Shoulder MRI (with contrast)
|
$3,543.15 |
$3,543.15 |
$3,543.15 |
$2,511.20
|
|
Shoulder MRI (without contrast)
|
$1,084.20 |
$1,084.20 |
$1,084.20 |
$2,102.80
|
|
Shoulder prosthesis removal
|
$4,030.00 |
$4,030.00 |
$4,030.00 |
$3,870.38
|
|
Shoulder prosthesis removal
|
$4,940.00 |
$4,940.00 |
$4,940.00 |
$4,832.80
|
|
Shoulder X-ray
|
$446.55 |
$446.55 |
$446.55 |
$343.70
|
|
Shoulder X-ray (single view, both shoulders)
|
$438.10 |
$438.10 |
$438.10 |
$264.00
|
|
Shrinker prosth above knee
|
$229.45 |
$229.45 |
$229.45 |
$168.89
|
|
Shrinker prosth below knee
|
$154.05 |
$154.05 |
$154.05 |
$109.00
|
|
Shuntogram nonvascular supervision & interpretation
|
$134.55 |
$134.55 |
$134.55 |
$359.55
|
|
Sialidase enzyme assay
|
$54.60 |
$54.60 |
$54.60 |
$54.99
|
|
Sialolithotomy 42330
|
$587.60 |
$587.60 |
$587.60 |
$3,864.00
|
|
Sickling rbc
|
$24.70 |
$24.70 |
$24.70 |
$59.15
|
|
Sigmoidoscopy and biopsy
|
$326.30 |
$326.30 |
$326.30 |
$1,459.20
|
|
Sigmoidoscopy flex decompression 45337
|
$600.60 |
$600.60 |
$600.60 |
$1,078.88
|
|
Sigmoidoscopy for bleeding
|
$572.00 |
$572.00 |
$572.00 |
$1,993.08
|
|
Sigmoidoscopy/submucosal injection 45335
|
$297.70 |
$297.70 |
$297.70 |
$1,650.75
|
|
Sigmoidoscopy w/ablation
|
$803.40 |
$803.40 |
$803.40 |
$2,604.00
|
|
Sigmoidoscopy w/fb removal 45332
|
$503.10 |
$503.10 |
$503.10 |
$1,395.28
|
|
Sigmoidoscopy w/plcmt stent
|
$778.05 |
$778.05 |
$778.05 |
$3,692.00
|
|
Sigmoidoscopy w/resection
|
$1,006.85 |
$1,006.85 |
$1,006.85 |
$2,997.10
|
|
Sigmoidoscopy w/tumr remove
|
$586.30 |
$586.30 |
$586.30 |
$1,645.43
|
|
Sigmoidoscopy w/ultrasound
|
$606.45 |
$606.45 |
$606.45 |
$1,740.57
|
|
Sigmoid/rmv tumor/polyp/hot bx for 45333
|
$443.30 |
$443.30 |
$443.30 |
$1,976.25
|
|
Sig w/tndsc balloon dilation
|
$357.50 |
$357.50 |
$357.50 |
$2,288.00
|
|
Sim ang w/prs cath rad emb
|
$20,094.75 |
$20,094.75 |
$20,094.75 |
$18,145.20
|
|
Simple cystometrogram 51725
|
$727.35 |
$727.35 |
$727.35 |
$589.45
|
|
Sincalide 5 mcg solution for injection
|
$305.29 |
$305.29 |
$305.29 |
$309.14
|
|
Sinus CT scan (with and without contrast)
|
$798.20 |
$798.20 |
$798.20 |
$1,796.50
|
|
Sinus CT scan (with contrast)
|
$798.20 |
$798.20 |
$798.20 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$720.20 |
$720.20 |
$720.20 |
$1,289.00
|
|
Sinus/juglr venogram s&i
|
$14,413.10 |
$14,413.10 |
$14,413.10 |
$2,565.12
|
|
Sinus X-ray (complete)
|
$458.25 |
$458.25 |
$458.25 |
$347.31
|
|
Sinus X-ray (limited)
|
$439.40 |
$439.40 |
$439.40 |
$216.00
|
|
Sipuleucel-t - su
|
$585.96 |
$585.96 |
$585.96 |
$100,990.51
|
|
Sirolimus, oral
|
$56.88 |
$56.88 |
$56.88 |
$41.70
|
|
Skin Biopsy
|
$387.40 |
$387.40 |
$387.40 |
$362.40
|
|
Skin full graft 20sq cm less 15200
|
$3,567.20 |
$3,567.20 |
$3,567.20 |
$2,379.00
|
|
Skin full graft add-on 15241
|
$531.70 |
$531.70 |
$531.70 |
$560.01
|
|
Skin split graft addl 100sq cm 15101
|
$447.20 |
$447.20 |
$447.20 |
$1,793.40
|
|
Skin test unlisted antigen ea
|
$109.85 |
$109.85 |
$109.85 |
$48.57
|
|
Skull base/brainstem surgery
|
$9,505.60 |
$9,505.60 |
$9,505.60 |
$3,770.91
|
|
Skull X-ray (1 to 3 views)
|
$528.45 |
$528.45 |
$528.45 |
$295.10
|
|
Skull X-ray (complete)
|
$549.90 |
$549.90 |
$549.90 |
$424.80
|
|
Skyla, 13.5 mg
|
$1,577.76 |
$1,577.76 |
$1,577.76 |
$1,643.47
|
|
Sleep study attended
|
$2,745.60 |
$2,745.60 |
$2,745.60 |
$1,329.00
|
|
Sleep Study (Polysomnography)
|
$5,278.00 |
$5,278.00 |
$5,278.00 |
$3,734.50
|
|
Sleep study unattended
|
$967.85 |
$967.85 |
$967.85 |
$594.00
|
|
Sleeve fing rolyan med
|
$158.60 |
$158.60 |
$158.60 |
$206.00
|
|
Sling arm deluxe w/pad xs
|
$18.20 |
$18.20 |
$18.20 |
$30.35
|
|
Sling pelv split sam med
|
$103.35 |
$103.35 |
$103.35 |
$150.00
|
|
Slitting of prepuce
|
$6,124.95 |
$6,124.95 |
$6,124.95 |
$3,376.23
|
|
Slp eval non-spch gen comm dev
|
$503.75 |
$503.75 |
$503.75 |
$285.09
|
|
Slp pure tone screening
|
$41.60 |
$41.60 |
$41.60 |
$64.50
|
|
Slp ther svc non-spch gen
|
$134.55 |
$134.55 |
$134.55 |
$188.00
|
|
Small Bowel Barium X-ray (Follow-Through)
|
$798.20 |
$798.20 |
$798.20 |
$561.60
|
|
Small bowel endoscopy
|
$647.40 |
$647.40 |
$647.40 |
$2,596.41
|
|
Small bowel endoscopy
|
$943.80 |
$943.80 |
$943.80 |
$2,244.82
|
|
Small bowel endoscopy
|
$1,118.00 |
$1,118.00 |
$1,118.00 |
$2,638.57
|
|
Small bowel endoscopy
|
$1,146.60 |
$1,146.60 |
$1,146.60 |
$2,518.10
|
|
Small bowel endoscopy
|
$1,339.00 |
$1,339.00 |
$1,339.00 |
$2,638.57
|
|
Small bowel endoscopy
|
$1,825.20 |
$1,825.20 |
$1,825.20 |
$3,265.60
|
|
Small bowel endoscopy
|
$304.20 |
$304.20 |
$304.20 |
$2,088.00
|
|
Small bowel endoscopy
|
$741.00 |
$741.00 |
$741.00 |
$2,956.20
|
|
Small bowel endoscopy >2nd w/remove 44363
|
$881.40 |
$881.40 |
$881.40 |
$2,590.33
|
|
Small bowel endoscopy 44365
|
$834.60 |
$834.60 |
$834.60 |
$2,244.82
|
|
Small bowel endoscopy/biopsy
|
$720.20 |
$720.20 |
$720.20 |
$2,490.15
|
|
Small bowel endoscopy/biopsy
|
$1,409.20 |
$1,409.20 |
$1,409.20 |
$2,244.82
|
|
Small bowel endoscopy br/wa
|
$226.20 |
$226.20 |
$226.20 |
$1,924.00
|
|
Small bowel endoscopy br/wa
|
$358.80 |
$358.80 |
$358.80 |
$2,406.40
|
|
Small bowel endoscopy/stent 44370
|
$1,219.40 |
$1,219.40 |
$1,219.40 |
$4,992.00
|
|
Smallpox&monkeypox vac 0.5ml
|
$510.71 |
$510.71 |
$510.71 |
$474.54
|
|
Smear fluorescent and/or acid fast stain
|
$24.05 |
$24.05 |
$24.05 |
$64.00
|
|
Smear gram stain
|
$18.85 |
$18.85 |
$18.85 |
$55.35
|
|
Smear nasal eosinophil
|
$26.00 |
$26.00 |
$26.00 |
$45.83
|
|
Smear special stain inclusion bodies/parasites
|
$26.65 |
$26.65 |
$26.65 |
$73.15
|
|
Smear wet mount
|
$26.00 |
$26.00 |
$26.00 |
$67.55
|
