|
Tvh w/mmk 58267
|
$725.80 |
$725.80 |
$725.80 |
$2,058.60
|
|
Tx closed hip disl traumatic without anes
|
$117.00 |
$117.00 |
$117.00 |
$581.07
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$412.20 |
$412.20 |
$412.20 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$257.80 |
$257.80 |
$257.80 |
$535.60
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$525.20 |
$525.20 |
$525.20 |
$4,499.12
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$362.60 |
$362.60 |
$362.60 |
$4,468.55
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$394.20 |
$394.20 |
$394.20 |
$4,421.00
|
|
Tx open nsl fx uncomp
|
$317.40 |
$317.40 |
$317.40 |
$3,837.72
|
|
Tx open nsl sptl fx
|
$451.80 |
$451.80 |
$451.80 |
$4,308.40
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$425.00 |
$425.00 |
$425.00 |
$4,499.12
|
|
Tx septic abortion surgical 59830
|
$311.40 |
$311.40 |
$311.40 |
$896.40
|
|
Tx tarsal bone fx without manip 28450
|
$156.80 |
$156.80 |
$156.80 |
$416.16
|
|
Tympanic membrane repair
|
$268.60 |
$268.60 |
$268.60 |
$2,638.87
|
|
Tympanolysis transcanal 69450
|
$385.60 |
$385.60 |
$385.60 |
$3,837.72
|
|
Tympanometry & reflex thresh
|
$49.80 |
$49.80 |
$49.80 |
$170.00
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$216.00 |
$216.00 |
$216.00 |
$911.43
|
|
Ua w/micro/comp poc
|
$4.60 |
$4.60 |
$4.60 |
$23.00
|
|
Ugt1a1 gene analy common variants
|
$46.43 |
$46.43 |
$46.43 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$228.80 |
$228.80 |
$228.80 |
$394.20
|
|
Ultrasound breast complete
|
$282.60 |
$282.60 |
$282.60 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$288.60 |
$288.60 |
$288.60 |
$449.35
|
|
Ultrasound chest
|
$231.60 |
$231.60 |
$231.60 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$233.40 |
$233.40 |
$233.40 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$39.00 |
$39.00 |
$39.00 |
$296.80
|
|
Ultrasound elastography parenchyma
|
$22.40 |
$22.40 |
$22.40 |
$307.00
|
|
Ultrasound encephalogram
|
$145.60 |
$145.60 |
$145.60 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$432.60 |
$432.60 |
$432.60 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$284.20 |
$284.20 |
$284.20 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$150.80 |
$150.80 |
$150.80 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$281.00 |
$281.00 |
$281.00 |
$720.15
|
|
Ultrasound guide intraoperative
|
$302.20 |
$302.20 |
$302.20 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$77.00 |
$77.00 |
$77.00 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$138.40 |
$138.40 |
$138.40 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$23.20 |
$23.20 |
$23.20 |
$311.25
|
|
Ultrasound joint complete left
|
$246.40 |
$246.40 |
$246.40 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$280.80 |
$280.80 |
$280.80 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$233.80 |
$233.80 |
$233.80 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$233.80 |
$233.80 |
$233.80 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$722.40 |
$722.40 |
$722.40 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$140.80 |
$140.80 |
$140.80 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$251.80 |
$251.80 |
$251.80 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$261.20 |
$261.20 |
$261.20 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$164.60 |
$164.60 |
$164.60 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$259.60 |
$259.60 |
$259.60 |
$486.50
|
|
Ultrasound scrotum and contents
|
$283.80 |
$283.80 |
$283.80 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$145.60 |
$145.60 |
$145.60 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$67.00 |
$67.00 |
$67.00 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$250.20 |
$250.20 |
$250.20 |
$558.35
|
|
Umbilical artery cath newborn 36660
|
$46.00 |
$46.00 |
$46.00 |
$206.64
|
|
Umbilicoplasty 15847
|
$431.60 |
$431.60 |
$431.60 |
$4,172.97
|
|
Unlistd noninvas vasc dx std
|
$9.40 |
$9.40 |
$9.40 |
$528.80
|
|
Unlisted chemotherapy px
|
$87.80 |
$87.80 |
$87.80 |
$150.00
|
|
Unlisted cytogenetic study
|
$6.20 |
$6.20 |
$6.20 |
$160.18
|
|
Unlisted laparoscopic liver biopy 47379
|
$735.40 |
$735.40 |
$735.40 |
$5,419.00
|
|
Unlisted laparoscopic procedure 49659
|
$214.40 |
$214.40 |
$214.40 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$852.60 |
$852.60 |
$852.60 |
$5,419.00
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$69.60 |
$69.60 |
$69.60 |
$6,463.42
|
|
Unlisted laps px bladder
|
$1,126.60 |
$1,126.60 |
$1,126.60 |
$5,082.74
|
|
Unlisted laps px ovidct ovry
|
$182.40 |
$182.40 |
$182.40 |
$6,904.15
|
|
Unlisted laps px renal
|
$518.00 |
$518.00 |
$518.00 |
$5,110.00
|
|
Unlisted laps px spleen
|
$904.20 |
$904.20 |
$904.20 |
$4,627.00
|
|
Unlisted laps px uterus
|
$400.40 |
$400.40 |
$400.40 |
$4,627.00
|
|
Unlisted mr procedure
|
$712.40 |
$712.40 |
$712.40 |
$1,163.00
|
|
Unlisted oph svc/procedure
|
$12.20 |
$12.20 |
$12.20 |
$40.26
|
|
Unlisted orl service/px
|
$29.80 |
$29.80 |
$29.80 |
$132.60
|
|
Unlisted procedure rectum
|
$240.40 |
$240.40 |
$240.40 |
$1,220.35
|
|
Unlisted procedure urinary 58750
|
$617.60 |
$617.60 |
$617.60 |
$1,181.29
|
|
Unlisted px abdomen muscskel
|
$424.20 |
$424.20 |
$424.20 |
$1,848.60
|
|
Unlisted px accessory sinus
|
$87.80 |
$87.80 |
$87.80 |
$3,335.28
|
|
Unlisted px ant segment eye
|
$126.00 |
$126.00 |
$126.00 |
$2,698.92
|
|
Unlisted px arthroscopy
|
$491.60 |
$491.60 |
$491.60 |
$2,765.60
|
|
Unlisted px conjunctiva
|
$77.60 |
$77.60 |
$77.60 |
$479.62
|
|
Unlisted px external ear
|
$51.80 |
$51.80 |
$51.80 |
$325.68
|
|
Unlisted px foot/toes
|
$1,093.20 |
$1,093.20 |
$1,093.20 |
$1,225.50
|
|
Unlisted px leg/ankle
|
$588.20 |
$588.20 |
$588.20 |
$811.00
|
|
Unlisted px male genital sys
|
$193.00 |
$193.00 |
$193.00 |
$343.55
|
|
Unlisted px middle ear
|
$63.20 |
$63.20 |
$63.20 |
$343.50
|
|
Unlisted px neck/thorax
|
$88.20 |
$88.20 |
$88.20 |
$571.20
|
|
Unlisted px pelvis/hip joint
|
$51.80 |
$51.80 |
$51.80 |
$3,118.44
|
|
Unlisted px small intestine
|
$1,097.60 |
$1,097.60 |
$1,097.60 |
$2,102.10
|
|
Unlisted px tongue flr mouth
|
$54.80 |
$54.80 |
$54.80 |
$282.50
|
|
Unlisted special svc px/rprt
|
$44.60 |
$44.60 |
$44.60 |
$90.00
|
|
Unlisted ultrasound procedure
|
$194.60 |
$194.60 |
$194.60 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$531.40 |
$531.40 |
$531.40 |
$1,268.17
|
|
Upgrade pm system
|
$316.80 |
$316.80 |
$316.80 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,800.00 |
$1,800.00 |
$1,800.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,170.80 |
$1,170.80 |
$1,170.80 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,029.40 |
$1,029.40 |
$1,029.40 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$280.60 |
$280.60 |
$280.60 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$93.60 |
$93.60 |
$93.60 |
$1,768.00
|
|
Uppr gi scope w/submuc inj
|
$93.60 |
$93.60 |
$93.60 |
$1,872.00
|
|
Urachal cyst/sinus excision 51500
|
$440.00 |
$440.00 |
$440.00 |
$6,082.67
|
|
Urea nitrogen
|
$22.20 |
$22.20 |
$22.20 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$27.80 |
$27.80 |
$27.80 |
$51.75
|
|
Ureteral reflux study
|
$354.00 |
$354.00 |
$354.00 |
$952.50
|
|
Ureter endoscopy & treatment
|
$212.00 |
$212.00 |
$212.00 |
$5,631.74
|
|
Ureteroneocystostomy 50780
|
$755.40 |
$755.40 |
$755.40 |
$4,457.05
|
|
Ureteroureterostomy 50760
|
$764.20 |
$764.20 |
$764.20 |
$2,999.40
|
|
Urethrcystgrphy rtrgrde s&i
|
$350.40 |
$350.40 |
$350.40 |
$579.73
|
|
Urethrlys transvag with scope
|
$510.80 |
$510.80 |
$510.80 |
$4,081.37
|
