|
Trim nail(s)
|
$37.20 |
$37.20 |
$37.20 |
$78.40
|
|
Trim nondyst nails
|
$42.60 |
$42.60 |
$42.60 |
$114.48
|
|
Triptorelin pamoate
|
$8,654.89 |
$8,654.89 |
$8,654.89 |
$4,619.39
|
|
Trmt of fracture (femoral shaft) 27500
|
$974.40 |
$974.40 |
$974.40 |
$754.80
|
|
Trnscath plc stent crv crtd without prtct
|
$2,047.80 |
$2,047.80 |
$2,047.80 |
$7,795.71
|
|
Trnscath plc stent crv crtd w/prtct
|
$1,428.00 |
$1,428.00 |
$1,428.00 |
$9,767.25
|
|
Trnscath plc stnt ante carotid art
|
$1,795.80 |
$1,795.80 |
$1,795.80 |
$6,046.25
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$3,943.20 |
$3,943.20 |
$3,943.20 |
$8,790.54
|
|
Trnscath plc vas stent w/s&i ini vein
|
$504.00 |
$504.00 |
$504.00 |
$14,558.70
|
|
Trnscath retrv pq vasc fb w/guide
|
$2,812.20 |
$2,812.20 |
$2,812.20 |
$4,766.40
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$658.80 |
$658.80 |
$658.80 |
$5,139.20
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$352.20 |
$352.20 |
$352.20 |
$4,350.00
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$174.60 |
$174.60 |
$174.60 |
$4,379.34
|
|
Trnscath tx thromblytc vein ini day
|
$509.40 |
$509.40 |
$509.40 |
$3,866.70
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$2,085.60 |
$2,085.60 |
$2,085.60 |
$4,727.52
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$435.00 |
$435.00 |
$435.00 |
$2,377.62
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$1,493.40 |
$1,493.40 |
$1,493.40 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$1,948.80 |
$1,948.80 |
$1,948.80 |
$3,091.20
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$1,672.20 |
$1,672.20 |
$1,672.20 |
$2,527.20
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$1,529.40 |
$1,529.40 |
$1,529.40 |
$2,486.75
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$1,189.20 |
$1,189.20 |
$1,189.20 |
$2,406.77
|
|
Troponin quantitative
|
$112.80 |
$112.80 |
$112.80 |
$127.20
|
|
Tubal Ligation (Laparoscopic)
|
$711.00 |
$711.00 |
$711.00 |
$4,323.20
|
|
Tube drain vert dev st 5-40f
|
$198.00 |
$198.00 |
$198.00 |
$27.60
|
|
Tube trach disp innr can 5 xlt
|
$146.40 |
$146.40 |
$146.40 |
$445.99
|
|
Tube trach disp innr can 6 xlt
|
$9.60 |
$9.60 |
$9.60 |
$16.80
|
|
Tube trach fen sz 6 uncuffed
|
$132.00 |
$132.00 |
$132.00 |
$155.98
|
|
Tubing (oxygen) per foot
|
$20.40 |
$20.40 |
$20.40 |
$0.40
|
|
Tvh >250 gms 58290
|
$2,244.00 |
$2,244.00 |
$2,244.00 |
$6,872.92
|
|
Tvh w/mmk 58267
|
$2,058.60 |
$2,058.60 |
$2,058.60 |
$1,747.20
|
|
Tx closed hip disl traumatic without anes
|
$726.60 |
$726.60 |
$726.60 |
$586.80
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$1,236.60 |
$1,236.60 |
$1,236.60 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$648.00 |
$648.00 |
$648.00 |
$535.60
|
|
Tx contour defects 1.1-5.0cc 11951
|
$110.40 |
$110.40 |
$110.40 |
$849.50
|
|
Tx ectopic pregnancy abdl pregnancy 59130
|
$1,776.60 |
$1,776.60 |
$1,776.60 |
$2,277.60
|
|
Tx ectopic pregnancy ntrstl prtl rescj uter 59136
|
$1,792.20 |
$1,792.20 |
$1,792.20 |
$2,159.20
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$1,038.60 |
$1,038.60 |
$1,038.60 |
$4,499.12
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$937.20 |
$937.20 |
$937.20 |
$4,499.12
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$1,020.60 |
$1,020.60 |
$1,020.60 |
$4,499.12
|
|
Tx open nsl fx uncomp
|
$910.80 |
$910.80 |
$910.80 |
$3,837.72
|
|
Tx open nsl sptl fx
|
$1,261.20 |
$1,261.20 |
$1,261.20 |
$4,308.40
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$1,123.80 |
$1,123.80 |
$1,123.80 |
$4,529.60
|
|
Tx septic abortion surgical 59830
|
$896.40 |
$896.40 |
$896.40 |
$896.40
|
|
Tx tarsal bone fx without manip 28450
|
$410.40 |
$410.40 |
$410.40 |
$419.73
|
|
Tympanic membrane repair
|
$759.00 |
$759.00 |
$759.00 |
$2,638.87
|
|
Tympanolysis transcanal 69450
|
$1,069.80 |
$1,069.80 |
$1,069.80 |
$3,837.72
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$779.40 |
$779.40 |
$779.40 |
$911.43
|
|
Tympp antrt/mastoidotomy prosthesis torp 69637
|
$2,705.40 |
$2,705.40 |
$2,705.40 |
$6,740.80
|
|
Tympp antrt/mastoid without ossic chain recnst 69635
|
$2,403.60 |
$2,403.60 |
$2,403.60 |
$7,000.36
|
|
Ua w/micro/comp poc
|
$8.40 |
$8.40 |
$8.40 |
$23.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$516.60 |
$516.60 |
$516.60 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$272.40 |
$272.40 |
$272.40 |
$338.00
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$324.00 |
$324.00 |
$324.00 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$844.20 |
$844.20 |
$844.20 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$72.60 |
$72.60 |
$72.60 |
$388.08
|
|
Ultrasound guide intraoperative
|
$411.00 |
$411.00 |
$411.00 |
$632.85
|
|
Ultrasound joint complete left
|
$238.80 |
$238.80 |
$238.80 |
$557.99
|
|
Ultrasound ob >=14wks ea addl gest
|
$305.40 |
$305.40 |
$305.40 |
$409.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$210.00 |
$210.00 |
$210.00 |
$335.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$361.80 |
$361.80 |
$361.80 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$275.40 |
$275.40 |
$275.40 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$318.60 |
$318.60 |
$318.60 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$398.40 |
$398.40 |
$398.40 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$233.40 |
$233.40 |
$233.40 |
$421.00
|
|
Umbilical artery cath newborn 36660
|
$144.00 |
$144.00 |
$144.00 |
$223.80
|
|
Umbilicoplasty 15847
|
$655.80 |
$655.80 |
$655.80 |
$4,172.97
|
|
Unlisted dialysis procedure
|
$522.00 |
$522.00 |
$522.00 |
$1,144.00
|
|
Unlisted laparoscopic liver biopy 47379
|
$654.60 |
$654.60 |
$654.60 |
$6,307.38
|
|
Unlisted laparoscopic procedure 49659
|
$3,293.40 |
$3,293.40 |
$3,293.40 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$2,545.20 |
$2,545.20 |
$2,545.20 |
$5,419.00
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$1,219.20 |
$1,219.20 |
$1,219.20 |
$6,463.42
|
|
Unlisted procedure urinary 58750
|
$1,758.60 |
$1,758.60 |
$1,758.60 |
$926.40
|
|
Unlisted psychiatric service/proc 90899
|
$121.20 |
$121.20 |
$121.20 |
$277.76
|
|
Unlisted special svc px/rprt
|
$9.00 |
$9.00 |
$9.00 |
$90.00
|
|
Unlisted ultrasound procedure
|
$157.80 |
$157.80 |
$157.80 |
$335.00
|
|
Unsched dialysis esrd pt hos
|
$822.60 |
$822.60 |
$822.60 |
$1,296.00
|
|
Upgrade pm system
|
$932.40 |
$932.40 |
$932.40 |
$12,077.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$281.40 |
$281.40 |
$281.40 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$1,443.00 |
$1,443.00 |
$1,443.00 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,381.20 |
$1,381.20 |
$1,381.20 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,361.60 |
$2,361.60 |
$2,361.60 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,275.60 |
$1,275.60 |
$1,275.60 |
$2,392.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,741.80 |
$1,741.80 |
$1,741.80 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$223.20 |
$223.20 |
$223.20 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$246.00 |
$246.00 |
$246.00 |
$381.60
|
|
Upper Endoscopy (EGD, diagnostic)
|
$181.20 |
$181.20 |
$181.20 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$204.60 |
$204.60 |
$204.60 |
$1,768.00
|
|
Upper ext harvest for cabg1 seg 35600
|
$504.00 |
$504.00 |
$504.00 |
$627.20
|
|
Upper GI Barium X-ray (barium and gas)
|
$363.60 |
$363.60 |
$363.60 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$346.80 |
$346.80 |
$346.80 |
$607.20
|
|
Uppr gi scope w/submuc inj
|
$661.80 |
$661.80 |
$661.80 |
$1,872.00
|
|
Urachal cyst/sinus excision 51500
|
$1,317.60 |
$1,317.60 |
$1,317.60 |
$6,082.67
|
|
Urea nitrogen
|
$34.80 |
$34.80 |
$34.80 |
$42.01
|
|
Urea nitrogen 24 hour urine
|
$56.40 |
$56.40 |
$56.40 |
$51.84
|
|
Ureteral reflux study
|
$802.80 |
$802.80 |
$802.80 |
$952.50
|
|
Ureteroneocystostomy 50780
|
$2,313.60 |
$2,313.60 |
$2,313.60 |
$4,457.05
|
|
Ureteroureterostomy 50760
|
$2,200.20 |
$2,200.20 |
$2,200.20 |
$2,773.01
|
|
Urethrocystography void s&i
|
$480.60 |
$480.60 |
$480.60 |
$634.50
|
|
Uric acid blood
|
$31.20 |
$31.20 |
$31.20 |
$49.32
|
|
Uric acid urine
|
$32.40 |
$32.40 |
$32.40 |
$44.52
|