|
Semen analysis presence/motility
|
$172.80 |
$172.80 |
$172.80 |
$75.40
|
|
Semen analysis w/count
|
$54.60 |
$54.60 |
$54.60 |
$56.44
|
|
Serpina1 gene
|
$116.40 |
$116.40 |
$116.40 |
$197.00
|
|
Set radiation therapy field
|
$2,820.60 |
$2,820.60 |
$2,820.60 |
$753.60
|
|
Set radiation therapy field
|
$4,111.20 |
$4,111.20 |
$4,111.20 |
$1,149.50
|
|
Set radiation therapy field
|
$4,801.80 |
$4,801.80 |
$4,801.80 |
$1,636.36
|
|
Sevelamer carbonate pdr 20mg
|
$36.36 |
$36.36 |
$36.36 |
$22.02
|
|
Sewho cap design without jnts cf
|
$4,107.22 |
$4,107.22 |
$4,107.22 |
$1,685.60
|
|
Sheath below knee
|
$43.31 |
$43.31 |
$43.31 |
$40.88
|
|
Sheath gldlight lasr 12fx50cm
|
$9,905.57 |
$9,905.57 |
$9,905.57 |
$6,711.28
|
|
Sheath laser cavaclear 14f
|
$14,880.70 |
$14,880.70 |
$14,880.70 |
$8,264.23
|
|
Sho arthrs srg bicp tenodsis
|
$36,189.02 |
$36,189.02 |
$36,189.02 |
$4,950.40
|
|
Sho arthrs srg capsulorraphy
|
$37,654.16 |
$37,654.16 |
$37,654.16 |
$5,886.74
|
|
Sho arthrs srg lmtd dbrdmt
|
$19,664.44 |
$19,664.44 |
$19,664.44 |
$4,521.67
|
|
Sho arthrs srg lss&rescj ads
|
$12,561.94 |
$12,561.94 |
$12,561.94 |
$3,839.54
|
|
Sho arthrs srg rpr slap les
|
$30,596.39 |
$30,596.39 |
$30,596.39 |
$5,855.00
|
|
Sho arthrs srg xtnsv dbrdmt
|
$24,493.95 |
$24,493.95 |
$24,493.95 |
$5,148.00
|
|
Shoe clubfoot wedge
|
$133.22 |
$133.22 |
$133.22 |
$111.56
|
|
Shoe dennis browne splint bo
|
$116.21 |
$116.21 |
$116.21 |
$93.52
|
|
Shoe heel new leather standa
|
$109.33 |
$109.33 |
$109.33 |
$88.03
|
|
Shoe heel new rubber standar
|
$92.29 |
$92.29 |
$92.29 |
$63.70
|
|
Shoe heel pad & depress for
|
$167.36 |
$167.36 |
$167.36 |
$149.60
|
|
Shoe heel sach cushion type
|
$283.46 |
$283.46 |
$283.46 |
$228.09
|
|
Shoe heel thomas extend to b
|
$167.36 |
$167.36 |
$167.36 |
$134.68
|
|
Shoe heel thomas with wedge
|
$157.24 |
$157.24 |
$157.24 |
$126.56
|
|
Shoe lift elev heel/sole neo
|
$198.89 |
$198.89 |
$198.89 |
$175.19
|
|
Shoe metatarsal bar between
|
$249.35 |
$249.35 |
$249.35 |
$200.76
|
|
Shoe metatarsal bar wedge ro
|
$109.33 |
$109.33 |
$109.33 |
$75.46
|
|
Shoe outflare wedge
|
$133.22 |
$133.22 |
$133.22 |
$107.24
|
|
Shoe post-op mens m
|
$327.70 |
$327.70 |
$327.70 |
$49.25
|
|
Shoe sole wedge between sole
|
$133.22 |
$133.22 |
$133.22 |
$107.24
|
|
Shoe sole wedge outside sole
|
$95.63 |
$95.63 |
$95.63 |
$77.00
|
|
Shoe wedge sach
|
$228.95 |
$228.95 |
$228.95 |
$179.99
|
|
Sho heel count plast reinfor
|
$430.45 |
$430.45 |
$430.45 |
$346.47
|
|
Sho insert w arch toe filler
|
$1,389.97 |
$1,389.97 |
$1,389.97 |
$1,224.38
|
|
Sho lift taper to metatarsal
|
$140.08 |
$140.08 |
$140.08 |
$111.14
|
|
Shoulder Arthroscopy (Rotator Cuff Repair)
|
$28,691.25 |
$28,691.25 |
$28,691.25 |
$6,311.00
|
|
Shoulder X-ray
|
$630.60 |
$630.60 |
$630.60 |
$344.38
|
|
Shrinker prosth above knee
|
$226.83 |
$226.83 |
$226.83 |
$168.89
|
|
Shrinker prosth below knee
|
$159.56 |
$159.56 |
$159.56 |
$105.12
|
|
Shunt glaucoma baerveldt 350mm
|
$8,639.45 |
$8,639.45 |
$8,639.45 |
$4,631.18
|
|
Shuntogram nonvascular supervision & interpretation
|
$226.20 |
$226.20 |
$226.20 |
$359.20
|
|
Sialography s&i
|
$332.40 |
$332.40 |
$332.40 |
$513.60
|
|
Sickling rbc
|
$52.20 |
$52.20 |
$52.20 |
$57.00
|
|
Sigmoidoscopy and biopsy
|
$7,430.52 |
$7,430.52 |
$7,430.52 |
$1,351.63
|
|
Sigmoidoscopy w/plcmt stent
|
$15,238.01 |
$15,238.01 |
$15,238.01 |
$3,692.00
|
|
Sigmoidoscopy w/tumr remove
|
$6,119.88 |
$6,119.88 |
$6,119.88 |
$1,398.60
|
|
Sincalide 5 mcg solution for injection
|
$532.32 |
$532.32 |
$532.32 |
$309.14
|
|
Sinus CT scan (with and without contrast)
|
$1,459.80 |
$1,459.80 |
$1,459.80 |
$1,796.50
|
|
Sinus CT scan (with contrast)
|
$2,833.80 |
$2,833.80 |
$2,833.80 |
$1,545.60
|
|
Sinus CT scan (without contrast)
|
$1,972.20 |
$1,972.20 |
$1,972.20 |
$1,296.85
|
|
Sinus/juglr venogram s&i
|
$2,988.60 |
$2,988.60 |
$2,988.60 |
$2,517.48
|
|
Sio flex pelvisacral custom
|
$717.94 |
$717.94 |
$717.94 |
$561.79
|
|
Sio rig pnl pelv/sac pre ots
|
$475.38 |
$475.38 |
$475.38 |
$424.85
|
|
Sirolimus, oral
|
$181.02 |
$181.02 |
$181.02 |
$41.25
|
|
Skin Biopsy
|
$320.40 |
$320.40 |
$320.40 |
$360.34
|
|
Sleeve fing rolyan med
|
$521.62 |
$521.62 |
$521.62 |
$203.58
|
|
Sling pelv split sam med
|
$231.59 |
$231.59 |
$231.59 |
$144.21
|
|
Sling suprapubic suburetheral
|
$20,255.87 |
$20,255.87 |
$20,255.87 |
$9,077.08
|
|
Slp eval non-spch gen comm dev
|
$411.60 |
$411.60 |
$411.60 |
$285.09
|
|
Slp ther svc non-spch gen
|
$244.80 |
$244.80 |
$244.80 |
$191.00
|
|
Small bowel endoscopy
|
$11,208.52 |
$11,208.52 |
$11,208.52 |
$2,389.40
|
|
Smear fluorescent and/or acid fast stain
|
$68.40 |
$68.40 |
$68.40 |
$64.48
|
|
Smear gram stain
|
$63.00 |
$63.00 |
$63.00 |
$54.75
|
|
Smear nasal eosinophil
|
$54.60 |
$54.60 |
$54.60 |
$46.50
|
|
Smear special stain inclusion bodies/parasites
|
$82.80 |
$82.80 |
$82.80 |
$71.82
|
|
Smear wet mount
|
$95.40 |
$95.40 |
$95.40 |
$67.49
|
|
Smpd1 gene common variants
|
$330.60 |
$330.60 |
$330.60 |
$140.00
|
|
Snrpn/ube3a gene
|
$252.60 |
$252.60 |
$252.60 |
$228.80
|
|
So airplane w/wo joint cf
|
$2,889.57 |
$2,889.57 |
$2,889.57 |
$1,276.80
|
|
So cap design without jnts cf
|
$2,202.70 |
$2,202.70 |
$2,202.70 |
$856.10
|
|
Socket insert without lock mech
|
$1,459.98 |
$1,459.98 |
$1,459.98 |
$1,286.05
|
|
Sock fracture or equal each
|
$81.69 |
$81.69 |
$81.69 |
$74.51
|
|
Sodium 24 hour urine
|
$99.60 |
$99.60 |
$99.60 |
$48.68
|
|
Sodium chloride 0.9 % intravenous solution
|
$30.00 |
$30.00 |
$30.00 |
$48.00
|
|
Sodium chloride 0.9 % IV bolus
|
$46.20 |
$46.20 |
$46.20 |
$43.45
|
|
Sodium chloride 0.9 % IV bolus
|
$30.00 |
$30.00 |
$30.00 |
$37.50
|
|
Sodium chloride 3 % ivpb
|
$30.00 |
$30.00 |
$30.00 |
$37.80
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$129.78 |
$129.78 |
$129.78 |
$77.77
|
|
Sodium hyaluronate 20 mg/2 ml syringe
|
$661.86 |
$661.86 |
$661.86 |
$417.76
|
|
Sodium serum/plasma/whole blood
|
$53.40 |
$53.40 |
$53.40 |
$46.00
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$9.00 |
$9.00 |
$9.00 |
$177.52
|
|
Soft interface below knee se
|
$203.30 |
$203.30 |
$203.30 |
$179.08
|
|
So vest canvas/web pre ots
|
$429.08 |
$429.08 |
$429.08 |
$256.54
|
|
Sp bone agrft morsel add-on
|
$52,662.41 |
$52,662.41 |
$52,662.41 |
$406.40
|
|
Sp bone algrft morsel add-on
|
$50,767.30 |
$50,767.30 |
$50,767.30 |
$498.55
|
|
Special physics consult
|
$874.20 |
$874.20 |
$874.20 |
$709.00
|
|
Special radiation dosimetry
|
$729.60 |
$729.60 |
$729.60 |
$398.47
|
|
Special radiation treatment
|
$3,436.80 |
$3,436.80 |
$3,436.80 |
$1,960.40
|
|
Special teletx port plan
|
$2,155.20 |
$2,155.20 |
$2,155.20 |
$1,056.31
|
|
Specific gravity body fluid
|
$13.20 |
$13.20 |
$13.20 |
$22.10
|
|
Sperm antibody test
|
$108.60 |
$108.60 |
$108.60 |
$57.85
|
|
Spinal bone allograftstructural 20931
|
$27,905.63 |
$27,905.63 |
$27,905.63 |
$266.40
|
|
Spinal bone autograftlocal 20936
|
$45,062.16 |
$45,062.16 |
$45,062.16 |
$424.20
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$2,764.80 |
$2,764.80 |
$2,764.80 |
$1,439.40
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$1,238.84 |
$1,238.84 |
$1,238.84 |
$392.09
|
|
Splint extn xsm w sof-stretch rolyan
|
$160.57 |
$160.57 |
$160.57 |
$67.76
|
|
Splint finger fold over sm
|
$236.12 |
$236.12 |
$236.12 |
$131.14
|
|
Splint finger frog med
|
$240.29 |
$240.29 |
$240.29 |
$38.08
|
|
Splint rstrc wrst/cmc right med
|
$236.12 |
$236.12 |
$236.12 |
$100.00
|
