|
Repair lip full thkns =<one-half vert height
|
$317.40 |
$317.40 |
$317.40 |
$1,308.00
|
|
Repair rpr lac tongue floor mouth > 2.6 cm/cmplx
|
$144.60 |
$144.60 |
$144.60 |
$1,026.40
|
|
Repair rpr lip full thickness vermilion only
|
$317.40 |
$317.40 |
$317.40 |
$1,224.63
|
|
Repair tendon extensor foot 1/2 each tendon
|
$2,067.90 |
$2,067.90 |
$2,067.90 |
$3,839.54
|
|
Repair tendon/muscle forearm/wrist prime sngl ea
|
$2,067.90 |
$2,067.90 |
$2,067.90 |
$4,350.00
|
|
Repair tongue lac <2.5cm past 1/3 tongue 41251
|
$144.60 |
$144.60 |
$144.60 |
$478.00
|
|
Replace duod/jej tube perc
|
$573.90 |
$573.90 |
$573.90 |
$1,354.54
|
|
Replace g/c tube perc
|
$377.10 |
$377.10 |
$377.10 |
$1,273.20
|
|
Repl trach puncture dilator
|
$153.87 |
$153.87 |
$153.87 |
$244.05
|
|
Restorigin 1 sq cm
|
$3,970.80 |
$3,970.80 |
$3,970.80 |
$171.12
|
|
Resuscitation cardiopulmonary
|
$1,426.20 |
$1,426.20 |
$1,426.20 |
$751.00
|
|
Reticulocyte automated
|
$55.50 |
$55.50 |
$55.50 |
$52.80
|
|
Revise/replace knee joint
|
$29,033.08 |
$29,033.08 |
$29,033.08 |
$5,491.20
|
|
Revise/replace knee joint
|
$47,812.57 |
$47,812.57 |
$47,812.57 |
$7,048.60
|
|
Revision of cervix
|
$1,964.10 |
$1,964.10 |
$1,964.10 |
$3,760.68
|
|
Revision of eyelid
|
$1,468.50 |
$1,468.50 |
$1,468.50 |
$2,760.73
|
|
Revision of knee joint
|
$31,125.08 |
$31,125.08 |
$31,125.08 |
$14,241.77
|
|
Revision of penis
|
$2,226.60 |
$2,226.60 |
$2,226.60 |
$4,081.37
|
|
Rheumatoid factor quantitative
|
$66.60 |
$66.60 |
$66.60 |
$56.58
|
|
Rho(d) immune globulin 1,500 unit (300 mcg)/2 ml injection syringe
|
$852.46 |
$852.46 |
$852.46 |
$247.55
|
|
Rho d immune globulin inj
|
$852.46 |
$852.46 |
$852.46 |
$217.71
|
|
Rib gusset (elastic) each
|
$130.34 |
$130.34 |
$130.34 |
$188.94
|
|
Ring flange plas/leather mol
|
$474.99 |
$474.99 |
$474.99 |
$669.31
|
|
Ring flange plastic/leather
|
$283.30 |
$283.30 |
$283.30 |
$410.59
|
|
Ring fx reform 11-13x17mm
|
$1,457.62 |
$1,457.62 |
$1,457.62 |
$1,509.75
|
|
Rituximab 1,400 mg/11.7 ml (120 mg/ml)-hyaluronidase subcutaneous soln
|
$24,859.48 |
$24,859.48 |
$24,859.48 |
$14,663.39
|
|
Rocker bottom, contact afo
|
$144.92 |
$144.92 |
$144.92 |
$210.00
|
|
Ropivacaine 0.2 % epidural pca - 1 hour dose limit
|
$36.43 |
$36.43 |
$36.43 |
$188.50
|
|
Rp loclzj tum 2+area 1+d img
|
$345.00 |
$345.00 |
$345.00 |
$1,343.22
|
|
Rpl picc wo subq port/pump incl image guidnc w/s&i
|
$1,120.50 |
$1,120.50 |
$1,120.50 |
$2,173.60
|
|
Rpr xtnsr tndn leg prim without grft ea tndn
|
$17,924.74 |
$17,924.74 |
$17,924.74 |
$5,959.65
|
|
Rsv assay w/optic
|
$121.50 |
$121.50 |
$121.50 |
$82.68
|
|
Rubella antibody igg
|
$45.90 |
$45.90 |
$45.90 |
$76.86
|
|
Rubeola antibody igg
|
$149.70 |
$149.70 |
$149.70 |
$80.00
|
|
Russell viper venom diluted
|
$62.10 |
$62.10 |
$62.10 |
$71.88
|
|
Salmonella antibody
|
$19.80 |
$19.80 |
$19.80 |
$39.60
|
|
Scan duplex abd/pelvis/retroperitoneal complete
|
$1,032.90 |
$1,032.90 |
$1,032.90 |
$983.50
|
|
Scan duplex abd/pelvis/retroperitoneal limited
|
$713.40 |
$713.40 |
$713.40 |
$662.40
|
|
Scan duplex aorta/ivc/iliac or bypass grafts complete
|
$1,032.90 |
$1,032.90 |
$1,032.90 |
$761.15
|
|
Scan duplex extracranial arteries unilateral/limited study
|
$832.80 |
$832.80 |
$832.80 |
$583.00
|
|
Scan duplex extremity veins unilateral/limited study
|
$644.10 |
$644.10 |
$644.10 |
$721.20
|
|
Scan duplex lower extremity arteries complete bilateral
|
$760.80 |
$760.80 |
$760.80 |
$985.20
|
|
Scan duplex lower extremity arteries unilateral/limited study left
|
$697.50 |
$697.50 |
$697.50 |
$658.45
|
|
Scan duplex upper extremity arteries unilateral/limited study left
|
$624.30 |
$624.30 |
$624.30 |
$583.20
|
|
Scope uretscp lithovue dig disp
|
$9,678.82 |
$9,678.82 |
$9,678.82 |
$4,800.00
|
|
Screening Colonoscopy (average risk)
|
$4,034.05 |
$4,034.05 |
$4,034.05 |
$1,700.40
|
|
Screening Colonoscopy (high risk)
|
$4,089.19 |
$4,089.19 |
$4,089.19 |
$1,864.80
|
|
Screening hepatitis b non-obstetric high risk
|
$46.50 |
$46.50 |
$46.50 |
$56.55
|
|
Screening Mammogram
|
$144.30 |
$144.30 |
$144.30 |
$313.35
|
|
Screening prostate cancer PSA
|
$74.40 |
$74.40 |
$74.40 |
$98.28
|
|
Screw cortex 2.0 x 10mm
|
$178,551.99 |
$178,551.99 |
$178,551.99 |
$28,563.75
|
|
Sevelamer carbonate 800 mg tablet
|
$9.00 |
$9.00 |
$9.00 |
$7.14
|
|
Sewho cap design without jnts cf
|
$2,281.01 |
$2,281.01 |
$2,281.01 |
$1,685.60
|
|
Sf3b1 gene common variants
|
$319.50 |
$319.50 |
$319.50 |
$243.34
|
|
Shave sgl skin lsn t/a/l 0.5cm/<
|
$259.20 |
$259.20 |
$259.20 |
$314.00
|
|
Sheath below knee
|
$24.06 |
$24.06 |
$24.06 |
$40.88
|
|
Sheath gldlight lasr 12fx50cm
|
$5,501.21 |
$5,501.21 |
$5,501.21 |
$6,739.20
|
|
Sheath laser cavaclear 14f
|
$8,264.23 |
$8,264.23 |
$8,264.23 |
$8,264.23
|
|
Sho arthrs srg xtnsv dbrdmt
|
$13,140.87 |
$13,140.87 |
$13,140.87 |
$5,148.00
|
|
Shoe clubfoot wedge
|
$73.99 |
$73.99 |
$73.99 |
$111.56
|
|
Shoe dennis browne splint bo
|
$64.54 |
$64.54 |
$64.54 |
$93.52
|
|
Shoe heel new leather standa
|
$60.72 |
$60.72 |
$60.72 |
$88.03
|
|
Shoe heel new rubber standar
|
$51.25 |
$51.25 |
$51.25 |
$63.70
|
|
Shoe heel pad & depress for
|
$92.95 |
$92.95 |
$92.95 |
$149.60
|
|
Shoe heel sach cushion type
|
$157.42 |
$157.42 |
$157.42 |
$228.09
|
|
Shoe heel thomas extend to b
|
$92.95 |
$92.95 |
$92.95 |
$134.68
|
|
Shoe heel thomas with wedge
|
$87.32 |
$87.32 |
$87.32 |
$126.56
|
|
Shoe lift elev heel/sole neo
|
$110.45 |
$110.45 |
$110.45 |
$175.19
|
|
Shoe metatarsal bar between
|
$138.48 |
$138.48 |
$138.48 |
$200.76
|
|
Shoe metatarsal bar wedge ro
|
$60.72 |
$60.72 |
$60.72 |
$69.03
|
|
Shoe outflare wedge
|
$73.99 |
$73.99 |
$73.99 |
$107.24
|
|
Shoe post-op mens m
|
$181.99 |
$181.99 |
$181.99 |
$49.25
|
|
Shoe sole wedge between sole
|
$73.99 |
$73.99 |
$73.99 |
$107.24
|
|
Shoe sole wedge outside sole
|
$53.11 |
$53.11 |
$53.11 |
$77.00
|
|
Shoe wedge sach
|
$127.15 |
$127.15 |
$127.15 |
$171.44
|
|
Sho heel count plast reinfor
|
$239.06 |
$239.06 |
$239.06 |
$346.47
|
|
Sho insert w arch toe filler
|
$771.94 |
$771.94 |
$771.94 |
$1,224.38
|
|
Sho lift taper to metatarsal
|
$77.80 |
$77.80 |
$77.80 |
$111.14
|
|
Shoulder Arthroscopy (Rotator Cuff Repair)
|
$13,140.87 |
$13,140.87 |
$13,140.87 |
$6,311.00
|
|
Shoulder MRI (with and without contrast)
|
$1,699.80 |
$1,699.80 |
$1,699.80 |
$2,739.30
|
|
Shoulder MRI (with contrast)
|
$2,542.20 |
$2,542.20 |
$2,542.20 |
$2,456.30
|
|
Shoulder MRI (without contrast)
|
$913.50 |
$913.50 |
$913.50 |
$2,110.00
|
|
Shoulder X-ray
|
$225.30 |
$225.30 |
$225.30 |
$344.38
|
|
Shrinker prosth above knee
|
$125.97 |
$125.97 |
$125.97 |
$168.89
|
|
Shrinker prosth below knee
|
$88.61 |
$88.61 |
$88.61 |
$104.00
|
|
Shunt glaucoma baerveldt 350mm
|
$4,798.05 |
$4,798.05 |
$4,798.05 |
$4,636.80
|
|
Shuntogram nonvascular supervision & interpretation
|
$143.10 |
$143.10 |
$143.10 |
$359.55
|
|
Sickling rbc
|
$26.70 |
$26.70 |
$26.70 |
$57.00
|
|
Sincalide 5 mcg solution for injection
|
$861.06 |
$861.06 |
$861.06 |
$309.14
|
|
Sinus CT scan (with and without contrast)
|
$608.70 |
$608.70 |
$608.70 |
$1,796.50
|
|
Sinus CT scan (with contrast)
|
$863.40 |
$863.40 |
$863.40 |
$1,530.90
|
|
Sinus CT scan (without contrast)
|
$422.70 |
$422.70 |
$422.70 |
$1,292.04
|
|
Sio flex pelvisacral custom
|
$398.72 |
$398.72 |
$398.72 |
$561.79
|
|
Sio rig pnl pelv/sac pre ots
|
$264.01 |
$264.01 |
$264.01 |
$424.85
|
|
Skin Biopsy
|
$125.70 |
$125.70 |
$125.70 |
$357.60
|
|
Sleeve fing rolyan med
|
$289.69 |
$289.69 |
$289.69 |
$203.58
|
|
Sling pelv split sam med
|
$128.62 |
$128.62 |
$128.62 |
$146.40
|
|
Sling suprapubic suburetheral
|
$11,249.41 |
$11,249.41 |
$11,249.41 |
$9,077.08
|
|
Smear fluorescent and/or acid fast stain
|
$33.60 |
$33.60 |
$33.60 |
$64.35
|
|
Smear gram stain
|
$73.20 |
$73.20 |
$73.20 |
$54.75
|
