|
Rpr aa hrn rcr < 3 ncr/strn
|
$1,162.62 |
$1,162.62 |
$1,162.62 |
$6,376.26
|
|
Rpr aa hrn rcr < 3 rdc
|
$858.60 |
$858.60 |
$858.60 |
$4,176.15
|
|
Rpr fem hernia init blocked
|
$1,308.42 |
$1,308.42 |
$1,308.42 |
$4,176.15
|
|
Rpr parastomal hernia rdc 49621
|
$1,534.68 |
$1,534.68 |
$1,534.68 |
$1,450.40
|
|
Rpr parastomal hrna ncr/strn 49622
|
$1,905.12 |
$1,905.12 |
$1,905.12 |
$1,786.40
|
|
Rpr rem hernia init reduce
|
$2,093.58 |
$2,093.58 |
$2,093.58 |
$3,817.38
|
|
Rpr xtnsr tndn leg prim without grft ea tndn
|
$761.40 |
$761.40 |
$761.40 |
$5,959.65
|
|
Sacituzumab govitecan-hziy 180 mg intravenous solution
|
$2,657.84 |
$2,657.84 |
$2,657.84 |
$5,051.50
|
|
Same day nb discharge 99463
|
$153.36 |
$153.36 |
$153.36 |
$183.07
|
|
Sbsq nursing facil care/day minor complj 15 min
|
$106.38 |
$106.38 |
$106.38 |
$109.85
|
|
Sbsq nursing facil care/day new problem 25 min
|
$154.44 |
$154.44 |
$154.44 |
$144.30
|
|
Sbsq nursing facility care/day e/m stable 10 min
|
$59.40 |
$59.40 |
$59.40 |
$67.84
|
|
Scan duplex abd/pelvis/retroperitoneal complete
|
$255.42 |
$255.42 |
$255.42 |
$975.60
|
|
Scan duplex extremity veins unilateral/limited study
|
$73.98 |
$73.98 |
$73.98 |
$721.20
|
|
Scan duplex lower extremity arteries complete bilateral
|
$131.22 |
$131.22 |
$131.22 |
$985.20
|
|
Scan duplex lower extremity arteries unilateral/limited study left
|
$79.92 |
$79.92 |
$79.92 |
$648.80
|
|
Scan proc cranial extra
|
$356.40 |
$356.40 |
$356.40 |
$2,366.00
|
|
Scope plantar fasciotomy
|
$942.30 |
$942.30 |
$942.30 |
$3,839.54
|
|
Screening Colonoscopy (average risk)
|
$446.58 |
$446.58 |
$446.58 |
$1,700.40
|
|
Screening Colonoscopy (high risk)
|
$446.58 |
$446.58 |
$446.58 |
$1,864.80
|
|
Screening Mammogram
|
$129.60 |
$129.60 |
$129.60 |
$313.35
|
|
Screen/visual acuity/bilat/quant 99173
|
$8.64 |
$8.64 |
$8.64 |
$28.86
|
|
Sec abd wall suture evisceration/dehsn 49900
|
$1,713.15 |
$1,713.15 |
$1,713.15 |
$2,139.60
|
|
Shave sgl skin lsn f/e/e/n/l/m 0.5cm/<
|
$239.76 |
$239.76 |
$239.76 |
$284.00
|
|
Shave sgl skin lsn f/e/e/n/l/m 0.6-1.0cm
|
$285.12 |
$285.12 |
$285.12 |
$284.88
|
|
Shave sgl skin lsn f/e/e/n/l/m 1.1-2cm
|
$324.54 |
$324.54 |
$324.54 |
$442.22
|
|
Shave sgl skin lsn f/e/e/n/l/m >2cm
|
$378.00 |
$378.00 |
$378.00 |
$472.79
|
|
Shave sgl skin lsn s/n/h/f/g 0.5cm/<
|
$218.16 |
$218.16 |
$218.16 |
$246.18
|
|
Shave sgl skin lsn s/n/h/f/g 0.6-1.0 cm
|
$253.80 |
$253.80 |
$253.80 |
$225.50
|
|
Shave sgl skin lsn s/n/h/f/g 1.1-2cm
|
$286.20 |
$286.20 |
$286.20 |
$275.88
|
|
Shave sgl skin lsn s/n/h/f/g >2cm
|
$301.86 |
$301.86 |
$301.86 |
$415.22
|
|
Shave sgl skin lsn t/a/l 0.5cm/<
|
$207.36 |
$207.36 |
$207.36 |
$314.00
|
|
Shave sgl skin lsn t/a/l 0.6-1.0cm
|
$252.18 |
$252.18 |
$252.18 |
$235.13
|
|
Shave sgl skin lsn t/a/l 1.1-2.0cm
|
$285.66 |
$285.66 |
$285.66 |
$289.30
|
|
Sho arthrs srg bicp tenodsis
|
$1,920.24 |
$1,920.24 |
$1,920.24 |
$4,950.40
|
|
Sho arthrs srg lmtd dbrdmt
|
$1,318.14 |
$1,318.14 |
$1,318.14 |
$4,521.67
|
|
Sho arthrs srg lss&rescj ads
|
$1,242.00 |
$1,242.00 |
$1,242.00 |
$3,839.54
|
|
Sho arthrs srg prtl synvct
|
$1,133.46 |
$1,133.46 |
$1,133.46 |
$5,855.00
|
|
Sho arthrs srg rmvl loose/fb
|
$1,347.57 |
$1,347.57 |
$1,347.57 |
$3,839.54
|
|
Sho arthrs srg xtnsv dbrdmt
|
$1,437.75 |
$1,437.75 |
$1,437.75 |
$5,148.00
|
|
Shoulder Arthroscopy (Rotator Cuff Repair)
|
$2,233.98 |
$2,233.98 |
$2,233.98 |
$6,311.00
|
|
Shoulder MRI (with and without contrast)
|
$381.24 |
$381.24 |
$381.24 |
$2,739.30
|
|
Shoulder MRI (with contrast)
|
$457.38 |
$457.38 |
$457.38 |
$2,449.80
|
|
Shoulder MRI (without contrast)
|
$383.40 |
$383.40 |
$383.40 |
$2,087.25
|
|
Shoulder X-ray
|
$128.52 |
$128.52 |
$128.52 |
$340.10
|
|
Sialolithotomy 42330
|
$491.40 |
$491.40 |
$491.40 |
$3,837.72
|
|
Sigmoidoscopy and biopsy
|
$321.03 |
$321.03 |
$321.03 |
$1,351.63
|
|
Sigmoidoscopy flex decompression 45337
|
$240.30 |
$240.30 |
$240.30 |
$1,078.88
|
|
Sigmoidoscopy for bleeding
|
$332.91 |
$332.91 |
$332.91 |
$1,836.00
|
|
Sigmoidoscopy/submucosal injection 45335
|
$421.20 |
$421.20 |
$421.20 |
$1,287.33
|
|
Sigmoidoscopy w/tumr remove
|
$616.68 |
$616.68 |
$616.68 |
$1,398.60
|
|
Sigmoid/rmv tumor/polyp/hot bx for 45333
|
$552.96 |
$552.96 |
$552.96 |
$1,356.00
|
|
Simple cystometrogram 51725
|
$456.57 |
$456.57 |
$456.57 |
$589.45
|
|
Sincalide 5 mcg solution for injection
|
$228.26 |
$228.26 |
$228.26 |
$309.04
|
|
Sinus CT scan (with and without contrast)
|
$224.64 |
$224.64 |
$224.64 |
$1,796.50
|
|
Sinus CT scan (with contrast)
|
$199.80 |
$199.80 |
$199.80 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$162.81 |
$162.81 |
$162.81 |
$1,290.19
|
|
Skin Biopsy
|
$208.44 |
$208.44 |
$208.44 |
$360.34
|
|
Skyla, 13.5 mg
|
$451.44 |
$451.44 |
$451.44 |
$1,643.47
|
|
Sleep Study (Polysomnography)
|
$301.86 |
$301.86 |
$301.86 |
$3,598.50
|
|
Sleep study unattended
|
$151.20 |
$151.20 |
$151.20 |
$585.00
|
|
Slitting of prepuce
|
$302.94 |
$302.94 |
$302.94 |
$3,616.86
|
|
Small bowel endoscopy
|
$650.97 |
$650.97 |
$650.97 |
$2,244.82
|
|
Smear wet mount
|
$22.14 |
$22.14 |
$22.14 |
$66.30
|
|
Sodium chloride 0.9 % intravenous solution
|
$28.56 |
$28.56 |
$28.56 |
$48.00
|
|
Sodium chloride 0.9 % IV bolus
|
$24.30 |
$24.30 |
$24.30 |
$43.45
|
|
Sodium chloride 0.9 % IV bolus
|
$21.43 |
$21.43 |
$21.43 |
$36.21
|
|
Sodium chloride 3 % ivpb
|
$21.60 |
$21.60 |
$21.60 |
$37.80
|
|
Speech audiometry complete
|
$78.30 |
$78.30 |
$78.30 |
$109.20
|
|
Speech recep thresh
|
$50.22 |
$50.22 |
$50.22 |
$82.88
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$205.47 |
$205.47 |
$205.47 |
$1,416.00
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$166.32 |
$166.32 |
$166.32 |
$543.26
|
|
Splenectomy total open 38100
|
$2,448.63 |
$2,448.63 |
$2,448.63 |
$2,166.00
|
|
Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 %
|
$1,971.00 |
$1,971.00 |
$1,971.00 |
$4,713.66
|
|
Stot/tot hysterectomy after cesaren delivery 59525
|
$1,151.28 |
$1,151.28 |
$1,151.28 |
$2,607.60
|
|
Strapping of ankle and/or ft 29540
|
$50.22 |
$50.22 |
$50.22 |
$217.70
|
|
Strapping of knee
|
$50.22 |
$50.22 |
$50.22 |
$206.50
|
|
Strapping of toes 29550
|
$32.40 |
$32.40 |
$32.40 |
$164.70
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$11.34 |
$11.34 |
$11.34 |
$53.40
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$25.92 |
$25.92 |
$25.92 |
$121.84
|
|
Surg dx exam anorectal
|
$219.78 |
$219.78 |
$219.78 |
$3,245.23
|
|
Surg ect salp-oophorectomy 59120
|
$1,687.50 |
$1,687.50 |
$1,687.50 |
$1,632.60
|
|
Surgical pathology level 1 gross examination only
|
$43.74 |
$43.74 |
$43.74 |
$79.20
|
|
Surgical pathology level 2 gross & microscopic examination
|
$92.88 |
$92.88 |
$92.88 |
$143.65
|
|
Surgical pathology level 3 gross & microscopic examination
|
$92.88 |
$92.88 |
$92.88 |
$182.25
|
|
Surgical pathology level 4 gross & microscopic examination
|
$160.92 |
$160.92 |
$160.92 |
$252.60
|
|
Surgical pathology level 5 gross & microscopic examination
|
$287.28 |
$287.28 |
$287.28 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$507.06 |
$507.06 |
$507.06 |
$720.75
|
|
Surgical repair stomach bleedin ulcer 43501
|
$2,771.82 |
$2,771.82 |
$2,771.82 |
$2,536.20
|
|
Surgical revision intestine
|
$2,400.84 |
$2,400.84 |
$2,400.84 |
$2,607.20
|
|
Suspension of testis
|
$624.78 |
$624.78 |
$624.78 |
$4,081.37
|
|
Sutr lg intestine 1/mult perf without colostomy 44604
|
$2,152.44 |
$2,152.44 |
$2,152.44 |
$1,995.00
|
|
Synvisc or synvisc-one
|
$16.74 |
$16.74 |
$16.74 |
$1,274.94
|
|
Tah w/mmk 58152
|
$2,557.98 |
$2,557.98 |
$2,557.98 |
$2,428.80
|
|
Telavancin injection
|
$2.86 |
$2.86 |
$2.86 |
$1,191.80
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$38.34 |
$38.34 |
$38.34 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$10,484.42 |
$10,484.42 |
$10,484.42 |
$15,245.38
|
|
Tenosynovectomy radic 26145
|
$1,105.92 |
$1,105.92 |
$1,105.92 |
$1,893.86
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$45.32 |
$45.32 |
$45.32 |
$37.76
|
|
Ther fx nasal inf turbinate
|
$375.84 |
$375.84 |
$375.84 |
$3,592.74
|