|
Tte w or without fol w/cont, com
|
$1,220.31 |
$1,220.31 |
$4,757.00 |
|
|
Tte w or without fol w/cont, f/u
|
$2,621.00 |
$2,621.00 |
$2,621.00 |
|
|
Tubal Ligation (Laparoscopic)
|
$8,661.00 |
$8,661.00 |
$8,661.00 |
|
|
Tube trach disp innr can 5 xlt
|
$532.41 |
$532.41 |
$532.41 |
|
|
Tube trach fen sz 6 uncuffed
|
$132.40 |
$132.40 |
$132.40 |
|
|
Tx atrial fib pulm vein isol
|
$14,880.45 |
$16,666.00 |
$64,184.00 |
|
|
Tx closed distal humerus fx
|
$262.86 |
$262.86 |
$11,148.00 |
|
|
Tx closed hip disl traumatic without anes
|
$858.00 |
$900.51 |
$2,344.36 |
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$9,945.00 |
$9,945.00 |
$9,945.00 |
|
|
Tx closed tib shaft fx without manip
|
$413.79 |
$620.00 |
$1,419.51 |
|
|
Tx contour defects 1.1-5.0cc 11951
|
$1,762.00 |
$1,762.00 |
$1,762.00 |
|
|
Tx l/r atrial fib addl
|
$496.69 |
$6,986.85 |
$23,450.45 |
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$9,383.00 |
$9,383.00 |
$9,383.00 |
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$3,777.93 |
$3,777.93 |
$20,940.47 |
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$5,507.00 |
$5,507.00 |
$11,959.00 |
|
|
Tx open nsl fx uncomp
|
$7,811.00 |
$7,811.00 |
$7,811.00 |
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$8,241.00 |
$8,241.00 |
$8,241.00 |
|
|
Tx septic abortion surgical 59830
|
$11,483.00 |
$11,483.00 |
$11,483.00 |
|
|
Tx tarsal bone fx without manip 28450
|
$858.00 |
$900.51 |
$6,653.00 |
|
|
Tympanometry & reflex thresh
|
$184.86 |
$184.86 |
$461.00 |
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$911.43 |
$911.43 |
$911.43 |
|
|
Ua w/micro/comp poc
|
$8.58 |
$8.58 |
$90.00 |
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$172.59 |
$172.59 |
$38,832.03 |
|
|
Ugt1a1 gene analy common variants
|
$406.38 |
$406.38 |
$1,794.44 |
|
|
Ultrasound breast complete
|
$285.79 |
$382.20 |
$1,584.86 |
|
|
Ultrasound breast unilateral limited (both sides)
|
$199.23 |
$382.20 |
$1,821.11 |
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$404.00 |
$463.32 |
$478.00 |
|
|
Ultrasound dx ophth b-scan
|
$145.08 |
$145.08 |
$3,970.00 |
|
|
Ultrasound elastography ea l target les
|
$136.11 |
$136.11 |
$576.00 |
|
|
Ultrasound elastography parenchyma
|
$136.11 |
$136.11 |
$584.00 |
|
|
Ultrasound encephalogram
|
$450.29 |
$693.03 |
$1,754.00 |
|
|
Ultrasound exam k transpl w/doppler
|
$307.32 |
$307.32 |
$1,128.00 |
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$505.44 |
$505.44 |
$1,140.60 |
|
|
Ultrasound Guidance for a Needle Procedure
|
$352.24 |
$670.02 |
$3,523.59 |
|
|
Ultrasound guidance for vascular access
|
$229.11 |
$290.16 |
$3,521.70 |
|
|
Ultrasound guide intraoperative
|
$370.30 |
$819.00 |
$1,741.95 |
|
|
Ultrasound guide tissue ablation
|
$397.00 |
$590.85 |
$946.00 |
|
|
Ultrasound hips infant dynamic
|
$475.00 |
$556.14 |
$1,162.81 |
|
|
Ultrasound infant hips ltd without stress
|
$556.14 |
$556.14 |
$556.14 |
|
|
Ultrasound joint complete left
|
$556.14 |
$556.14 |
$4,872.01 |
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$312.00 |
$312.00 |
$312.00 |
|
|
Ultrasound ob >=14wks ea addl gest
|
$276.90 |
$276.90 |
$717.00 |
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$239.46 |
$250.12 |
$1,028.89 |
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$539.37 |
$539.37 |
$539.37 |
|
|
Ultrasound pregnant uterus follow up per fetus
|
$323.70 |
$323.70 |
$1,584.86 |
|
|
Ultrasound prostate/transrectal
|
$289.20 |
$595.53 |
$3,970.00 |
|
|
Ultrasound spinal canal and contents
|
$524.55 |
$524.55 |
$606.00 |
|
|
Ultrasound transabd ea addl gest
|
$203.19 |
$203.19 |
$203.19 |
|
|
Umbilical artery cath newborn 36660
|
$359.97 |
$359.97 |
$522.00 |
|
|
Umbilicoplasty 15847
|
$7,418.00 |
$7,418.00 |
$7,418.00 |
|
|
Unit mobile power mpu
|
$13,305.60 |
$14,010.69 |
$14,010.69 |
|
|
Unlistd noninvas vasc dx std
|
$608.01 |
$608.01 |
$1,408.00 |
|
|
Unlisted chemotherapy px
|
$121.00 |
$121.00 |
$121.00 |
|
|
Unlisted cv px dx nuc med
|
$8,594.00 |
$8,594.00 |
$8,594.00 |
|
|
Unlisted cytopathology px
|
$195.78 |
$195.78 |
$195.78 |
|
|
Unlisted endocrine px dx nuc
|
$346.71 |
$346.71 |
$346.71 |
|
|
Unlisted fluoroscopic px
|
$139.23 |
$139.23 |
$317.00 |
|
|
Unlisted hematology&coagj px
|
$41.00 |
$92.43 |
$92.43 |
|
|
Unlisted hystsc px uterus
|
$8,661.00 |
$8,661.00 |
$8,661.00 |
|
|
Unlisted laparoscopic liver biopy 47379
|
$8,446.00 |
$8,446.00 |
$8,446.00 |
|
|
Unlisted laps px ureter
|
$8,446.00 |
$8,446.00 |
$8,446.00 |
|
|
Unlisted maaa
|
$421.20 |
$421.20 |
$421.20 |
|
|
Unlisted misc path test
|
$119.34 |
$119.34 |
$119.34 |
|
|
Unlisted mr procedure
|
$1,316.25 |
$1,316.25 |
$2,296.00 |
|
|
Unlisted muscskel px head
|
$11,148.00 |
$11,148.00 |
$11,148.00 |
|
|
Unlisted orl service/px
|
$22.80 |
$22.80 |
$22.80 |
|
|
Unlisted procedure colon
|
$9,900.00 |
$9,900.00 |
$9,900.00 |
|
|
Unlisted procedure esophagus
|
$6,905.00 |
$6,905.00 |
$6,905.00 |
|
|
Unlisted procedure eyelids
|
$10,476.00 |
$10,476.00 |
$10,476.00 |
|
|
Unlisted procedure larynx
|
$375.00 |
$511.68 |
$511.68 |
|
|
Unlisted procedure liver
|
$5,139.00 |
$5,139.00 |
$5,139.00 |
|
|
Unlisted procedure microbiology
|
$23.00 |
$795.00 |
$795.00 |
|
|
Unlisted procedure orbit
|
$5,364.00 |
$5,364.00 |
$5,364.00 |
|
|
Unlisted procedure pancreas
|
$11,936.00 |
$11,936.00 |
$11,936.00 |
|
|
Unlisted procedure rectum
|
$1,397.37 |
$1,397.37 |
$3,363.00 |
|
|
Unlisted procedure spine
|
$308.10 |
$308.10 |
$308.10 |
|
|
Unlisted psychiatric service/proc 90899
|
$418.08 |
$418.08 |
$418.08 |
|
|
Unlisted px abdomen muscskel
|
$5,500.95 |
$5,500.95 |
$6,588.00 |
|
|
Unlisted px accessory sinus
|
$16,385.00 |
$16,385.00 |
$16,385.00 |
|
|
Unlisted px ant segment eye
|
$4,684.00 |
$4,684.00 |
$4,684.00 |
|
|
Unlisted px arthroscopy
|
$8,295.00 |
$8,295.00 |
$8,295.00 |
|
|
Unlisted px biliary tract
|
$11,936.00 |
$11,936.00 |
$11,936.00 |
|
|
Unlisted px casting/strpg
|
$586.56 |
$586.56 |
$2,052.93 |
|
|
Unlisted px foot/toes
|
$10,290.00 |
$10,290.00 |
$10,290.00 |
|
|
Unlisted px forearm/wrist
|
$6,949.00 |
$6,949.00 |
$6,949.00 |
|
|
Unlisted px leg/ankle
|
$9,800.00 |
$9,800.00 |
$9,800.00 |
|
|
Unlisted px male genital sys
|
$1,925.04 |
$1,925.04 |
$23,713.00 |
|
|
Unlisted px neck/thorax
|
$5,335.00 |
$5,335.00 |
$5,335.00 |
|
|
Unlisted px pelvis/hip joint
|
$10,290.00 |
$10,290.00 |
$10,290.00 |
|
|
Unlisted px small intestine
|
$918.49 |
$9,791.00 |
$9,791.00 |
|
|
Unlisted px tongue flr mouth
|
$937.00 |
$1,553.76 |
$1,553.76 |
|
|
Unlisted resp px dx nuc med
|
$545.61 |
$545.61 |
$545.61 |
|
|
Unlisted spec derm svc/px
|
$173.55 |
$173.55 |
$173.55 |
|
|
Unlisted special svc px/rprt
|
$7,309.00 |
$7,309.00 |
$7,309.00 |
|
|
Unlisted surgical path px
|
$439.92 |
$439.92 |
$439.92 |
|
|
Unlisted transfusion med px
|
$78.00 |
$698.10 |
$698.10 |
|
|
Unlisted ultrasound procedure
|
$291.33 |
$291.33 |
$568.00 |
|
|
Unlisted urinalysis px
|
$29.64 |
$29.64 |
$29.64 |
|
|
Unsched dialysis esrd pt hos
|
$1,267.00 |
$4,290.00 |
$4,701.06 |
|
|
Upgrade pm system
|
$1,254.16 |
$5,840.64 |
$37,644.00 |
|
