|
Trnscath retrv pq vasc fb w/guide
|
$292.50 |
$292.50 |
$292.50 |
$4,523.96
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$372.90 |
$372.90 |
$372.90 |
$5,069.50
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$223.20 |
$223.20 |
$223.20 |
$4,250.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$117.90 |
$117.90 |
$117.90 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$327.60 |
$327.60 |
$327.60 |
$3,866.70
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$903.30 |
$903.30 |
$903.30 |
$4,713.66
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$216.60 |
$216.60 |
$216.60 |
$2,357.04
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$817.80 |
$817.80 |
$817.80 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$861.30 |
$861.30 |
$861.30 |
$3,078.00
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$746.40 |
$746.40 |
$746.40 |
$2,371.50
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$682.20 |
$682.20 |
$682.20 |
$2,371.50
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$678.60 |
$678.60 |
$678.60 |
$2,406.77
|
|
Troponin quantitative
|
$133.20 |
$133.20 |
$133.20 |
$127.20
|
|
Trurl dstrj prst8 tiss rf wv
|
$400.50 |
$400.50 |
$400.50 |
$4,228.00
|
|
Tubal Ligation (Laparoscopic)
|
$382.50 |
$382.50 |
$382.50 |
$4,323.20
|
|
Tvh >250 gms 58290
|
$1,167.60 |
$1,167.60 |
$1,167.60 |
$6,872.92
|
|
Tvh w/mmk 58267
|
$1,088.70 |
$1,088.70 |
$1,088.70 |
$2,058.60
|
|
Tx closed hip disl traumatic without anes
|
$175.50 |
$175.50 |
$175.50 |
$581.07
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$618.30 |
$618.30 |
$618.30 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$386.70 |
$386.70 |
$386.70 |
$535.60
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$787.80 |
$787.80 |
$787.80 |
$4,499.12
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$543.90 |
$543.90 |
$543.90 |
$4,468.55
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$591.30 |
$591.30 |
$591.30 |
$4,421.00
|
|
Tx open nsl fx uncomp
|
$476.10 |
$476.10 |
$476.10 |
$3,837.72
|
|
Tx open nsl sptl fx
|
$677.70 |
$677.70 |
$677.70 |
$4,308.40
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$637.50 |
$637.50 |
$637.50 |
$4,499.12
|
|
Tx septic abortion surgical 59830
|
$467.10 |
$467.10 |
$467.10 |
$896.40
|
|
Tx tarsal bone fx without manip 28450
|
$235.20 |
$235.20 |
$235.20 |
$416.16
|
|
Tympanic membrane repair
|
$402.90 |
$402.90 |
$402.90 |
$2,638.87
|
|
Tympanolysis transcanal 69450
|
$578.40 |
$578.40 |
$578.40 |
$3,837.72
|
|
Tympanometry & reflex thresh
|
$23.40 |
$23.40 |
$23.40 |
$170.00
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$324.00 |
$324.00 |
$324.00 |
$911.43
|
|
Ua w/micro/comp poc
|
$6.60 |
$6.60 |
$6.60 |
$23.00
|
|
Ugt1a1 gene analy common variants
|
$69.64 |
$69.64 |
$69.64 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$133.20 |
$133.20 |
$133.20 |
$394.20
|
|
Ultrasound breast complete
|
$452.70 |
$452.70 |
$452.70 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$373.20 |
$373.20 |
$373.20 |
$449.35
|
|
Ultrasound chest
|
$347.40 |
$347.40 |
$347.40 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$136.20 |
$136.20 |
$136.20 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$58.50 |
$58.50 |
$58.50 |
$296.80
|
|
Ultrasound elastography parenchyma
|
$33.60 |
$33.60 |
$33.60 |
$307.00
|
|
Ultrasound encephalogram
|
$417.00 |
$417.00 |
$417.00 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$441.30 |
$441.30 |
$441.30 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$105.90 |
$105.90 |
$105.90 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$273.90 |
$273.90 |
$273.90 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$387.00 |
$387.00 |
$387.00 |
$720.15
|
|
Ultrasound guide intraoperative
|
$252.60 |
$252.60 |
$252.60 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$115.50 |
$115.50 |
$115.50 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$41.40 |
$41.40 |
$41.40 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$34.80 |
$34.80 |
$34.80 |
$311.25
|
|
Ultrasound joint complete left
|
$314.70 |
$314.70 |
$314.70 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$312.90 |
$312.90 |
$312.90 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$219.60 |
$219.60 |
$219.60 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$224.70 |
$224.70 |
$224.70 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$758.40 |
$758.40 |
$758.40 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$215.40 |
$215.40 |
$215.40 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$270.60 |
$270.60 |
$270.60 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$436.20 |
$436.20 |
$436.20 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$246.90 |
$246.90 |
$246.90 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$353.70 |
$353.70 |
$353.70 |
$486.50
|
|
Ultrasound scrotum and contents
|
$377.70 |
$377.70 |
$377.70 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$72.00 |
$72.00 |
$72.00 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$100.50 |
$100.50 |
$100.50 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$354.60 |
$354.60 |
$354.60 |
$558.35
|
|
Umbilical artery cath newborn 36660
|
$69.00 |
$69.00 |
$69.00 |
$206.64
|
|
Umbilicoplasty 15847
|
$647.40 |
$647.40 |
$647.40 |
$4,172.97
|
|
Unlistd noninvas vasc dx std
|
$14.10 |
$14.10 |
$14.10 |
$528.80
|
|
Unlisted laparoscopic liver biopy 47379
|
$1,103.10 |
$1,103.10 |
$1,103.10 |
$5,419.00
|
|
Unlisted laparoscopic procedure 49659
|
$321.60 |
$321.60 |
$321.60 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$1,278.90 |
$1,278.90 |
$1,278.90 |
$5,419.00
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$104.40 |
$104.40 |
$104.40 |
$6,463.42
|
|
Unlisted laps px bladder
|
$1,689.90 |
$1,689.90 |
$1,689.90 |
$5,082.74
|
|
Unlisted laps px ovidct ovry
|
$273.60 |
$273.60 |
$273.60 |
$6,904.15
|
|
Unlisted laps px renal
|
$777.00 |
$777.00 |
$777.00 |
$5,110.00
|
|
Unlisted laps px spleen
|
$1,356.30 |
$1,356.30 |
$1,356.30 |
$4,627.00
|
|
Unlisted laps px uterus
|
$600.60 |
$600.60 |
$600.60 |
$4,627.00
|
|
Unlisted oph svc/procedure
|
$18.30 |
$18.30 |
$18.30 |
$40.26
|
|
Unlisted procedure rectum
|
$360.60 |
$360.60 |
$360.60 |
$1,220.35
|
|
Unlisted procedure urinary 58750
|
$926.40 |
$926.40 |
$926.40 |
$1,181.29
|
|
Unlisted px abdomen muscskel
|
$636.30 |
$636.30 |
$636.30 |
$1,848.60
|
|
Unlisted px accessory sinus
|
$131.70 |
$131.70 |
$131.70 |
$3,335.28
|
|
Unlisted px ant segment eye
|
$189.00 |
$189.00 |
$189.00 |
$2,698.92
|
|
Unlisted px arthroscopy
|
$737.40 |
$737.40 |
$737.40 |
$2,765.60
|
|
Unlisted px conjunctiva
|
$77.70 |
$77.70 |
$77.70 |
$479.62
|
|
Unlisted px external ear
|
$77.70 |
$77.70 |
$77.70 |
$325.68
|
|
Unlisted px foot/toes
|
$1,639.80 |
$1,639.80 |
$1,639.80 |
$1,225.50
|
|
Unlisted px leg/ankle
|
$882.30 |
$882.30 |
$882.30 |
$811.00
|
|
Unlisted px male genital sys
|
$289.50 |
$289.50 |
$289.50 |
$343.55
|
|
Unlisted px middle ear
|
$94.80 |
$94.80 |
$94.80 |
$343.50
|
|
Unlisted px neck/thorax
|
$132.30 |
$132.30 |
$132.30 |
$571.20
|
|
Unlisted px pelvis/hip joint
|
$77.70 |
$77.70 |
$77.70 |
$3,118.44
|
|
Unlisted px small intestine
|
$1,646.40 |
$1,646.40 |
$1,646.40 |
$2,102.10
|
|
Unlisted px tongue flr mouth
|
$82.20 |
$82.20 |
$82.20 |
$282.50
|
|
Unlisted special svc px/rprt
|
$66.90 |
$66.90 |
$66.90 |
$90.00
|
|
Unlisted ultrasound procedure
|
$291.90 |
$291.90 |
$291.90 |
$321.20
|
|
Upgrade pm system
|
$475.20 |
$475.20 |
$475.20 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,046.60 |
$2,046.60 |
$2,046.60 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,650.00 |
$1,650.00 |
$1,650.00 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,473.30 |
$1,473.30 |
$1,473.30 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$125.10 |
$125.10 |
$125.10 |
$1,751.66
|
