|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$137.18 |
$137.18 |
$137.18 |
$2,357.04
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$444.60 |
$444.60 |
$444.60 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$545.49 |
$545.49 |
$545.49 |
$3,078.00
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$472.72 |
$472.72 |
$472.72 |
$2,371.50
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$432.06 |
$432.06 |
$432.06 |
$2,371.50
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$337.06 |
$337.06 |
$337.06 |
$2,406.77
|
|
Troponin quantitative
|
$100.51 |
$100.51 |
$100.51 |
$127.20
|
|
Trurl dstrj prst8 tiss rf wv
|
$253.65 |
$253.65 |
$253.65 |
$4,228.00
|
|
Truss add to std pad scrotal
|
$15.20 |
$15.20 |
$15.20 |
$75.60
|
|
Tubal Ligation (Laparoscopic)
|
$242.25 |
$242.25 |
$242.25 |
$4,323.20
|
|
Tvh >250 gms 58290
|
$739.48 |
$739.48 |
$739.48 |
$6,872.92
|
|
Tvh w/mmk 58267
|
$689.51 |
$689.51 |
$689.51 |
$2,058.60
|
|
Tx atrial fib pulm vein isol
|
$17,825.61 |
$17,825.61 |
$17,825.61 |
$29,030.54
|
|
Tx closed hip disl traumatic without anes
|
$111.15 |
$111.15 |
$111.15 |
$581.07
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$391.59 |
$391.59 |
$391.59 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$226.10 |
$226.10 |
$226.10 |
$535.60
|
|
Tx l/r atrial fib addl
|
$4,609.40 |
$4,609.40 |
$4,609.40 |
$6,769.00
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$498.94 |
$498.94 |
$498.94 |
$4,499.12
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$344.47 |
$344.47 |
$344.47 |
$4,468.55
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$374.49 |
$374.49 |
$374.49 |
$4,421.00
|
|
Tx open nsl fx uncomp
|
$301.53 |
$301.53 |
$301.53 |
$3,837.72
|
|
Tx open nsl sptl fx
|
$429.21 |
$429.21 |
$429.21 |
$4,308.40
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$403.75 |
$403.75 |
$403.75 |
$4,499.12
|
|
Tx septic abortion surgical 59830
|
$295.83 |
$295.83 |
$295.83 |
$896.40
|
|
Tx tarsal bone fx without manip 28450
|
$134.33 |
$134.33 |
$134.33 |
$416.16
|
|
Tympanic membrane repair
|
$188.86 |
$188.86 |
$188.86 |
$2,638.87
|
|
Tympanolysis transcanal 69450
|
$366.32 |
$366.32 |
$366.32 |
$3,837.72
|
|
Tympanometry & reflex thresh
|
$14.82 |
$14.82 |
$14.82 |
$170.00
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$89.49 |
$89.49 |
$89.49 |
$911.43
|
|
Ultrasound abdomen aorta screening study aaa
|
$171.00 |
$171.00 |
$171.00 |
$394.20
|
|
Ultrasound breast complete
|
$237.69 |
$237.69 |
$237.69 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$201.21 |
$201.21 |
$201.21 |
$449.35
|
|
Ultrasound chest
|
$262.77 |
$262.77 |
$262.77 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$17.67 |
$17.67 |
$17.67 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$76.95 |
$76.95 |
$76.95 |
$296.80
|
|
Ultrasound elastography parenchyma
|
$21.28 |
$21.28 |
$21.28 |
$307.00
|
|
Ultrasound encephalogram
|
$206.91 |
$206.91 |
$206.91 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$422.94 |
$422.94 |
$422.94 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$258.78 |
$258.78 |
$258.78 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$153.90 |
$153.90 |
$153.90 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$336.87 |
$336.87 |
$336.87 |
$720.15
|
|
Ultrasound guide intraoperative
|
$298.87 |
$298.87 |
$298.87 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$73.15 |
$73.15 |
$73.15 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$26.22 |
$26.22 |
$26.22 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$206.91 |
$206.91 |
$206.91 |
$311.25
|
|
Ultrasound joint complete left
|
$258.78 |
$258.78 |
$258.78 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$251.18 |
$251.18 |
$251.18 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$258.78 |
$258.78 |
$258.78 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$166.63 |
$166.63 |
$166.63 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$443.27 |
$443.27 |
$443.27 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$153.33 |
$153.33 |
$153.33 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$187.91 |
$187.91 |
$187.91 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$258.78 |
$258.78 |
$258.78 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$263.15 |
$263.15 |
$263.15 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$258.78 |
$258.78 |
$258.78 |
$486.50
|
|
Ultrasound scrotum and contents
|
$258.78 |
$258.78 |
$258.78 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$220.21 |
$220.21 |
$220.21 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$206.91 |
$206.91 |
$206.91 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$258.78 |
$258.78 |
$258.78 |
$558.35
|
|
Umbilical artery cath newborn 36660
|
$43.70 |
$43.70 |
$43.70 |
$206.64
|
|
Umbilicoplasty 15847
|
$410.02 |
$410.02 |
$410.02 |
$4,172.97
|
|
Unlistd noninvas vasc dx std
|
$8.93 |
$8.93 |
$8.93 |
$528.80
|
|
Unlisted CT procedure
|
$154.28 |
$154.28 |
$154.28 |
$732.70
|
|
Unlisted fluoroscopic px
|
$60.04 |
$60.04 |
$60.04 |
$305.76
|
|
Unlisted laparoscopic liver biopy 47379
|
$698.63 |
$698.63 |
$698.63 |
$5,419.00
|
|
Unlisted laparoscopic procedure 49659
|
$203.68 |
$203.68 |
$203.68 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$809.97 |
$809.97 |
$809.97 |
$5,419.00
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$66.12 |
$66.12 |
$66.12 |
$6,463.42
|
|
Unlisted laps px bladder
|
$1,070.27 |
$1,070.27 |
$1,070.27 |
$5,082.74
|
|
Unlisted laps px ovidct ovry
|
$173.28 |
$173.28 |
$173.28 |
$6,904.15
|
|
Unlisted laps px renal
|
$492.10 |
$492.10 |
$492.10 |
$5,110.00
|
|
Unlisted laps px spleen
|
$858.99 |
$858.99 |
$858.99 |
$4,627.00
|
|
Unlisted laps px uterus
|
$380.38 |
$380.38 |
$380.38 |
$4,627.00
|
|
Unlisted maaa
|
$46.94 |
$46.94 |
$46.94 |
$235.20
|
|
Unlisted misc path test
|
$1.78 |
$1.78 |
$1.78 |
$89.40
|
|
Unlisted oph svc/procedure
|
$11.59 |
$11.59 |
$11.59 |
$40.26
|
|
Unlisted procedure microbiology
|
$84.17 |
$84.17 |
$84.17 |
$523.50
|
|
Unlisted procedure rectum
|
$228.38 |
$228.38 |
$228.38 |
$1,220.35
|
|
Unlisted procedure urinary 58750
|
$586.72 |
$586.72 |
$586.72 |
$1,181.29
|
|
Unlisted px abdomen muscskel
|
$402.99 |
$402.99 |
$402.99 |
$1,848.60
|
|
Unlisted px accessory sinus
|
$83.41 |
$83.41 |
$83.41 |
$3,335.28
|
|
Unlisted px ant segment eye
|
$119.70 |
$119.70 |
$119.70 |
$2,698.92
|
|
Unlisted px arthroscopy
|
$467.02 |
$467.02 |
$467.02 |
$2,765.60
|
|
Unlisted px casting/strpg
|
$111.34 |
$111.34 |
$111.34 |
$219.70
|
|
Unlisted px conjunctiva
|
$49.21 |
$49.21 |
$49.21 |
$479.62
|
|
Unlisted px external ear
|
$49.21 |
$49.21 |
$49.21 |
$325.68
|
|
Unlisted px foot/toes
|
$1,038.54 |
$1,038.54 |
$1,038.54 |
$1,225.50
|
|
Unlisted px leg/ankle
|
$199.69 |
$199.69 |
$199.69 |
$811.00
|
|
Unlisted px male genital sys
|
$183.35 |
$183.35 |
$183.35 |
$343.55
|
|
Unlisted px middle ear
|
$60.04 |
$60.04 |
$60.04 |
$343.50
|
|
Unlisted px neck/thorax
|
$49.40 |
$49.40 |
$49.40 |
$571.20
|
|
Unlisted px pelvis/hip joint
|
$49.21 |
$49.21 |
$49.21 |
$3,118.44
|
|
Unlisted px small intestine
|
$1,042.72 |
$1,042.72 |
$1,042.72 |
$2,102.10
|
|
Unlisted px tongue flr mouth
|
$52.06 |
$52.06 |
$52.06 |
$282.50
|
|
Unlisted special svc px/rprt
|
$42.37 |
$42.37 |
$42.37 |
$90.00
|
|
Unlisted ultrasound procedure
|
$226.67 |
$226.67 |
$226.67 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$1,022.39 |
$1,022.39 |
$1,022.39 |
$1,268.17
|
|
Upgrade pm system
|
$9,271.62 |
$9,271.62 |
$9,271.62 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,983.79 |
$1,983.79 |
$1,983.79 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,341.97 |
$1,341.97 |
$1,341.97 |
$2,364.35
|
