|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$1,867.11 |
$1,867.11 |
$1,867.11 |
$4,713.66
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$122.74 |
$122.74 |
$122.74 |
$2,357.04
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$945.54 |
$945.54 |
$945.54 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$488.07 |
$488.07 |
$488.07 |
$3,078.00
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$484.16 |
$484.16 |
$484.16 |
$2,371.50
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$540.77 |
$540.77 |
$540.77 |
$2,371.50
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$1,600.38 |
$1,600.38 |
$1,600.38 |
$2,406.77
|
|
Troponin quantitative
|
$156.74 |
$156.74 |
$156.74 |
$127.20
|
|
Trurl dstrj prst8 tiss rf wv
|
$226.95 |
$226.95 |
$226.95 |
$4,228.00
|
|
Tubal Ligation (Laparoscopic)
|
$216.75 |
$216.75 |
$216.75 |
$4,323.20
|
|
Tvh >250 gms 58290
|
$661.64 |
$661.64 |
$661.64 |
$6,872.92
|
|
Tvh w/mmk 58267
|
$616.93 |
$616.93 |
$616.93 |
$2,058.60
|
|
Tx closed hip disl traumatic without anes
|
$99.45 |
$99.45 |
$99.45 |
$581.07
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$350.37 |
$350.37 |
$350.37 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$219.13 |
$219.13 |
$219.13 |
$535.60
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$446.42 |
$446.42 |
$446.42 |
$4,499.12
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$308.21 |
$308.21 |
$308.21 |
$4,468.55
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$335.07 |
$335.07 |
$335.07 |
$4,421.00
|
|
Tx open nsl fx uncomp
|
$269.79 |
$269.79 |
$269.79 |
$3,837.72
|
|
Tx open nsl sptl fx
|
$384.03 |
$384.03 |
$384.03 |
$4,308.40
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$1,259.19 |
$1,259.19 |
$1,259.19 |
$4,499.12
|
|
Tx septic abortion surgical 59830
|
$264.69 |
$264.69 |
$264.69 |
$896.40
|
|
Tx tarsal bone fx without manip 28450
|
$133.28 |
$133.28 |
$133.28 |
$416.16
|
|
Tympanic membrane repair
|
$885.36 |
$885.36 |
$885.36 |
$2,638.87
|
|
Tympanolysis transcanal 69450
|
$327.76 |
$327.76 |
$327.76 |
$3,837.72
|
|
Tympanometry & reflex thresh
|
$13.26 |
$13.26 |
$13.26 |
$170.00
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$245.31 |
$245.31 |
$245.31 |
$911.43
|
|
Ua w/micro/comp poc
|
$8.16 |
$8.16 |
$8.16 |
$23.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$24,024.26 |
$24,024.26 |
$24,024.26 |
$20,945.01
|
|
Ultrasound abdomen aorta screening study aaa
|
$250.75 |
$250.75 |
$250.75 |
$394.20
|
|
Ultrasound breast complete
|
$134.30 |
$134.30 |
$134.30 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$156.57 |
$156.57 |
$156.57 |
$449.35
|
|
Ultrasound chest
|
$269.96 |
$269.96 |
$269.96 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$94.18 |
$94.18 |
$94.18 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$33.15 |
$33.15 |
$33.15 |
$296.80
|
|
Ultrasound elastography parenchyma
|
$19.04 |
$19.04 |
$19.04 |
$307.00
|
|
Ultrasound encephalogram
|
$95.54 |
$95.54 |
$95.54 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$292.57 |
$292.57 |
$292.57 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$256.87 |
$256.87 |
$256.87 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$579.53 |
$579.53 |
$579.53 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$302.60 |
$302.60 |
$302.60 |
$720.15
|
|
Ultrasound guide intraoperative
|
$98.77 |
$98.77 |
$98.77 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$65.45 |
$65.45 |
$65.45 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$90.95 |
$90.95 |
$90.95 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$19.72 |
$19.72 |
$19.72 |
$311.25
|
|
Ultrasound joint complete left
|
$183.60 |
$183.60 |
$183.60 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$225.76 |
$225.76 |
$225.76 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$108.12 |
$108.12 |
$108.12 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$87.55 |
$87.55 |
$87.55 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$123.76 |
$123.76 |
$123.76 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$120.87 |
$120.87 |
$120.87 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$351.90 |
$351.90 |
$351.90 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$164.90 |
$164.90 |
$164.90 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$139.91 |
$139.91 |
$139.91 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$198.56 |
$198.56 |
$198.56 |
$486.50
|
|
Ultrasound scrotum and contents
|
$264.35 |
$264.35 |
$264.35 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$75.99 |
$75.99 |
$75.99 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$56.78 |
$56.78 |
$56.78 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$207.23 |
$207.23 |
$207.23 |
$558.35
|
|
Umbilical artery cath newborn 36660
|
$39.10 |
$39.10 |
$39.10 |
$206.64
|
|
Umbilicoplasty 15847
|
$366.86 |
$366.86 |
$366.86 |
$4,172.97
|
|
Unlistd noninvas vasc dx std
|
$7.99 |
$7.99 |
$7.99 |
$528.80
|
|
Unlisted chemotherapy px
|
$48.62 |
$48.62 |
$48.62 |
$150.00
|
|
Unlisted fluoroscopic px
|
$126.82 |
$126.82 |
$126.82 |
$305.76
|
|
Unlisted laparoscopic liver biopy 47379
|
$625.09 |
$625.09 |
$625.09 |
$5,419.00
|
|
Unlisted laparoscopic procedure 49659
|
$182.24 |
$182.24 |
$182.24 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$724.71 |
$724.71 |
$724.71 |
$5,419.00
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$59.16 |
$59.16 |
$59.16 |
$6,463.42
|
|
Unlisted laps px bladder
|
$957.61 |
$957.61 |
$957.61 |
$5,082.74
|
|
Unlisted laps px ovidct ovry
|
$155.04 |
$155.04 |
$155.04 |
$6,904.15
|
|
Unlisted laps px renal
|
$440.30 |
$440.30 |
$440.30 |
$5,110.00
|
|
Unlisted laps px spleen
|
$768.57 |
$768.57 |
$768.57 |
$4,627.00
|
|
Unlisted laps px uterus
|
$340.34 |
$340.34 |
$340.34 |
$4,627.00
|
|
Unlisted maaa
|
$42.00 |
$42.00 |
$42.00 |
$235.20
|
|
Unlisted misc path test
|
$1.59 |
$1.59 |
$1.59 |
$89.40
|
|
Unlisted oph svc/procedure
|
$10.37 |
$10.37 |
$10.37 |
$40.26
|
|
Unlisted orl service/px
|
$30.94 |
$30.94 |
$30.94 |
$132.60
|
|
Unlisted procedure microbiology
|
$75.31 |
$75.31 |
$75.31 |
$523.50
|
|
Unlisted procedure rectum
|
$204.34 |
$204.34 |
$204.34 |
$1,220.35
|
|
Unlisted procedure urinary 58750
|
$524.96 |
$524.96 |
$524.96 |
$1,181.29
|
|
Unlisted px abdomen muscskel
|
$360.57 |
$360.57 |
$360.57 |
$1,848.60
|
|
Unlisted px accessory sinus
|
$74.63 |
$74.63 |
$74.63 |
$3,335.28
|
|
Unlisted px ant segment eye
|
$107.10 |
$107.10 |
$107.10 |
$2,698.92
|
|
Unlisted px arthroscopy
|
$417.86 |
$417.86 |
$417.86 |
$2,765.60
|
|
Unlisted px casting/strpg
|
$24.82 |
$24.82 |
$24.82 |
$219.70
|
|
Unlisted px conjunctiva
|
$44.03 |
$44.03 |
$44.03 |
$479.62
|
|
Unlisted px external ear
|
$94.18 |
$94.18 |
$94.18 |
$325.68
|
|
Unlisted px foot/toes
|
$929.22 |
$929.22 |
$929.22 |
$1,225.50
|
|
Unlisted px leg/ankle
|
$499.97 |
$499.97 |
$499.97 |
$811.00
|
|
Unlisted px male genital sys
|
$164.05 |
$164.05 |
$164.05 |
$343.55
|
|
Unlisted px middle ear
|
$53.72 |
$53.72 |
$53.72 |
$343.50
|
|
Unlisted px neck/thorax
|
$74.97 |
$74.97 |
$74.97 |
$571.20
|
|
Unlisted px pelvis/hip joint
|
$44.03 |
$44.03 |
$44.03 |
$3,118.44
|
|
Unlisted px small intestine
|
$932.96 |
$932.96 |
$932.96 |
$2,102.10
|
|
Unlisted px tongue flr mouth
|
$46.58 |
$46.58 |
$46.58 |
$282.50
|
|
Unlisted special svc px/rprt
|
$37.91 |
$37.91 |
$37.91 |
$90.00
|
|
Unlisted transfusion med px
|
$11.05 |
$11.05 |
$11.05 |
$147.50
|
|
Unlisted ultrasound procedure
|
$238.17 |
$238.17 |
$238.17 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$482.80 |
$482.80 |
$482.80 |
$1,268.17
|
|
Upgrade pm system
|
$3,071.05 |
$3,071.05 |
$3,071.05 |
$12,077.00
|
