|
Screening Colonoscopy (high risk)
|
$7,841.62 |
$7,841.62 |
$9,186.58 |
$1,951.46
|
|
Screening hepatitis b non-obstetric high risk
|
$84.60 |
$84.60 |
$84.60 |
$60.00
|
|
Screening Mammogram
|
$315.00 |
$315.00 |
$315.00 |
$312.55
|
|
Screening prostate cancer PSA
|
$242.40 |
$242.40 |
$242.40 |
$100.63
|
|
Screw cortex 2.0 x 10mm
|
$676,652.13 |
$676,652.13 |
$676,652.13 |
$29,055.00
|
|
Sec art mech thrmbc non-intracranial add-on
|
$8,705.40 |
$8,705.40 |
$8,705.40 |
$4,377.50
|
|
Sedimentation rate erythrocyte automated
|
$97.20 |
$97.20 |
$97.20 |
$42.00
|
|
Serpina1 gene
|
$218.40 |
$218.40 |
$218.40 |
$197.00
|
|
Sevelamer carbonate 800 mg tablet
|
$27.00 |
$27.00 |
$27.00 |
$7.14
|
|
Sewho cap design without jnts cf
|
$8,644.26 |
$8,644.26 |
$8,644.26 |
$1,685.60
|
|
Shave sgl skin lsn t/a/l 0.5cm/<
|
$889.80 |
$889.80 |
$889.80 |
$314.00
|
|
Sheath below knee
|
$91.16 |
$91.16 |
$91.16 |
$40.88
|
|
Sheath gldlight lasr 12fx50cm
|
$20,847.75 |
$20,847.75 |
$20,847.75 |
$6,570.70
|
|
Sheath laser cavaclear 14f
|
$31,318.65 |
$31,318.65 |
$31,318.65 |
$7,625.52
|
|
Sho arthrs srg bicp tenodsis
|
$33,186.54 |
$33,186.54 |
$37,066.75 |
$4,950.40
|
|
Sho arthrs srg capsulorraphy
|
$29,591.59 |
$29,591.59 |
$47,463.13 |
$6,311.00
|
|
Sho arthrs srg lmtd dbrdmt
|
$23,229.54 |
$23,229.54 |
$23,229.54 |
$4,521.67
|
|
Sho arthrs srg lss&rescj ads
|
$16,190.12 |
$16,190.12 |
$17,416.32 |
$3,839.54
|
|
Sho arthrs srg rpr slap les
|
$32,106.47 |
$32,106.47 |
$38,013.39 |
$6,311.00
|
|
Sho arthrs srg xtnsv dbrdmt
|
$28,821.76 |
$28,821.76 |
$31,183.41 |
$5,148.00
|
|
Shoe clubfoot wedge
|
$280.39 |
$280.39 |
$280.39 |
$111.56
|
|
Shoe dennis browne splint bo
|
$244.59 |
$244.59 |
$244.59 |
$93.52
|
|
Shoe heel new leather standa
|
$230.11 |
$230.11 |
$230.11 |
$88.03
|
|
Shoe heel new rubber standar
|
$194.24 |
$194.24 |
$194.24 |
$63.70
|
|
Shoe heel pad & depress for
|
$352.25 |
$352.25 |
$352.25 |
$149.60
|
|
Shoe heel sach cushion type
|
$596.59 |
$596.59 |
$596.59 |
$228.09
|
|
Shoe heel thomas extend to b
|
$352.25 |
$352.25 |
$352.25 |
$134.68
|
|
Shoe heel thomas with wedge
|
$330.93 |
$330.93 |
$330.93 |
$126.56
|
|
Shoe lift elev heel/sole neo
|
$418.58 |
$418.58 |
$418.58 |
$175.04
|
|
Shoe metatarsal bar between
|
$524.80 |
$524.80 |
$524.80 |
$200.76
|
|
Shoe metatarsal bar wedge ro
|
$230.11 |
$230.11 |
$230.11 |
$69.03
|
|
Shoe outflare wedge
|
$280.39 |
$280.39 |
$280.39 |
$107.24
|
|
Shoe post-op mens m
|
$689.70 |
$689.70 |
$689.70 |
$52.20
|
|
Shoe sole wedge between sole
|
$280.39 |
$280.39 |
$280.39 |
$107.24
|
|
Shoe sole wedge outside sole
|
$201.27 |
$201.27 |
$201.27 |
$77.00
|
|
Shoe wedge sach
|
$481.85 |
$481.85 |
$481.85 |
$171.44
|
|
Sho heel count plast reinfor
|
$905.95 |
$905.95 |
$905.95 |
$346.47
|
|
Sho insert w arch toe filler
|
$2,925.40 |
$2,925.40 |
$2,925.40 |
$1,224.38
|
|
Sho lift taper to metatarsal
|
$294.82 |
$294.82 |
$294.82 |
$111.14
|
|
Shorten radius or ulna
|
$28,846.21 |
$28,846.21 |
$28,846.21 |
$6,609.96
|
|
Shoulder Arthroscopy (Rotator Cuff Repair)
|
$22,860.17 |
$22,860.17 |
$34,575.13 |
$7,807.24
|
|
Shoulder MRI (with and without contrast)
|
$3,358.80 |
$3,358.80 |
$3,358.80 |
$2,713.80
|
|
Shoulder MRI (with contrast)
|
$3,585.00 |
$3,585.00 |
$3,585.00 |
$2,448.60
|
|
Shoulder MRI (without contrast)
|
$2,302.20 |
$2,302.20 |
$2,302.20 |
$2,065.05
|
|
Shoulder X-ray
|
$423.00 |
$423.00 |
$423.00 |
$339.50
|
|
Shrinker prosth above knee
|
$477.40 |
$477.40 |
$477.40 |
$168.89
|
|
Shrinker prosth below knee
|
$335.82 |
$335.82 |
$335.82 |
$105.12
|
|
Shunt glaucoma baerveldt 350mm
|
$18,183.00 |
$18,183.00 |
$18,183.00 |
$4,636.80
|
|
Sialidase enzyme assay
|
$54.00 |
$54.00 |
$54.00 |
$54.60
|
|
Sialolithotomy 42330
|
$10,371.75 |
$10,371.75 |
$10,371.75 |
$3,837.72
|
|
Sickling rbc
|
$137.40 |
$137.40 |
$137.40 |
$57.92
|
|
Sigmoidoscopy and biopsy
|
$7,092.60 |
$7,092.60 |
$7,229.42 |
$1,351.63
|
|
Sigmoidoscopy/submucosal injection 45335
|
$7,092.60 |
$7,092.60 |
$7,117.33 |
$1,444.83
|
|
Sigmoidoscopy w/fb removal 45332
|
$6,157.05 |
$6,157.05 |
$6,157.05 |
$1,388.56
|
|
Sigmoidoscopy w/tumr remove
|
$7,549.60 |
$7,549.60 |
$12,311.73 |
$1,558.80
|
|
Sigmoidoscopy w/ultrasound
|
$6,522.85 |
$6,522.85 |
$6,522.85 |
$1,740.57
|
|
Sincalide 5 mcg solution for injection
|
$1,084.15 |
$1,084.15 |
$1,213.31 |
$307.58
|
|
Sinus CT scan (with and without contrast)
|
$1,199.40 |
$1,199.40 |
$1,199.40 |
$1,790.00
|
|
Sinus CT scan (with contrast)
|
$1,357.80 |
$1,357.80 |
$1,357.80 |
$1,527.60
|
|
Sinus CT scan (without contrast)
|
$1,268.40 |
$1,268.40 |
$1,268.40 |
$1,292.04
|
|
Sio flex pelvisacral custom
|
$1,511.01 |
$1,511.01 |
$1,511.01 |
$561.79
|
|
Sio rig pnl pelv/sac pre ots
|
$1,000.51 |
$1,000.51 |
$1,000.51 |
$418.75
|
|
Sipuleucel-t - su
|
$187,807.50 |
$187,807.50 |
$187,807.50 |
$100,990.51
|
|
Skin Biopsy
|
$318.00 |
$318.00 |
$318.00 |
$360.34
|
|
Sleep Study (Polysomnography)
|
$3,885.00 |
$3,885.00 |
$3,885.00 |
$3,607.50
|
|
Sleep study unattended
|
$815.40 |
$815.40 |
$815.40 |
$580.87
|
|
Sleeve fing rolyan med
|
$1,097.81 |
$1,097.81 |
$1,097.81 |
$203.58
|
|
Sling pelv split sam med
|
$487.43 |
$487.43 |
$487.43 |
$150.00
|
|
Sling suprapubic suburetheral
|
$42,631.49 |
$42,631.49 |
$42,631.49 |
$9,679.96
|
|
Slitting of prepuce
|
$11,286.71 |
$11,286.71 |
$11,286.71 |
$3,365.50
|
|
Small bowel endoscopy br/wa
|
$8,133.02 |
$8,133.02 |
$8,133.02 |
$1,924.00
|
|
Smear fluorescent and/or acid fast stain
|
$78.60 |
$78.60 |
$78.60 |
$64.20
|
|
Smear gram stain
|
$99.60 |
$99.60 |
$99.60 |
$55.25
|
|
Smear nasal eosinophil
|
$65.40 |
$65.40 |
$65.40 |
$46.20
|
|
Smear special stain inclusion bodies/parasites
|
$125.40 |
$125.40 |
$125.40 |
$73.15
|
|
Smear wet mount
|
$67.80 |
$67.80 |
$67.80 |
$67.49
|
|
So airplane w/wo joint cf
|
$6,081.52 |
$6,081.52 |
$6,081.52 |
$1,276.80
|
|
So cap design without jnts cf
|
$4,635.91 |
$4,635.91 |
$4,635.91 |
$606.35
|
|
Socket insert without lock mech
|
$3,072.74 |
$3,072.74 |
$3,072.74 |
$1,192.50
|
|
Sock fracture or equal each
|
$171.92 |
$171.92 |
$171.92 |
$74.51
|
|
Sodium 24 hour urine
|
$58.20 |
$58.20 |
$58.20 |
$48.60
|
|
Sodium chloride 0.9 % intravenous solution
|
$105.00 |
$105.00 |
$108.00 |
$48.11
|
|
Sodium chloride 0.9 % IV bolus
|
$105.00 |
$105.00 |
$105.00 |
$46.00
|
|
Sodium chloride 0.9 % IV bolus
|
$106.95 |
$106.95 |
$124.20 |
$37.50
|
|
Sodium chloride 3 % ivpb
|
$127.97 |
$127.97 |
$143.22 |
$40.61
|
|
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous
|
$264.26 |
$264.26 |
$295.74 |
$77.77
|
|
Sodium serum/plasma/whole blood
|
$45.60 |
$45.60 |
$45.60 |
$45.60
|
|
Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution
|
$45.00 |
$45.00 |
$45.00 |
$177.52
|
|
Soft interface below knee se
|
$427.87 |
$427.87 |
$427.87 |
$179.08
|
|
So neo gsap dna/dna&rna
|
$4,484.40 |
$4,484.40 |
$4,484.40 |
$2,989.55
|
|
So vest canvas/web pre ots
|
$903.07 |
$903.07 |
$903.07 |
$256.54
|
|
Sp bone algrft morsel add-on
|
$57,906.53 |
$57,906.53 |
$57,906.53 |
$498.55
|
|
Specimen fat stain
|
$69.60 |
$69.60 |
$69.60 |
$35.10
|
|
Spinal bone allograftstructural 20931
|
$47,489.02 |
$47,489.02 |
$47,489.02 |
$266.40
|
|
Spinal bone autograftlocal 20936
|
$101,759.35 |
$101,759.35 |
$101,759.35 |
$424.20
|
|
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance
|
$3,135.00 |
$3,135.00 |
$3,135.00 |
$1,439.40
|
|
Spirometry bronchodilation responsiveness pre/post bronchodilator administration
|
$330.60 |
$330.60 |
$330.60 |
$543.26
|
|
Splint dorsal bloc wh med perf 3.2mm lf polyflex ii
|
$2,607.32 |
$2,607.32 |
$2,607.32 |
$392.09
|
|
Splint extn xsm w sof-stretch rolyan
|
$337.96 |
$337.96 |
$337.96 |
$68.25
|
|
Splint finger fold over sm
|
$496.96 |
$496.96 |
$496.96 |
$146.88
|
