|
Triglycerides
|
$92.40 |
$92.40 |
$92.40 |
$58.05
|
|
Trimethobenzamide hcl inj
|
$301.70 |
$301.70 |
$301.70 |
$117.49
|
|
Trim nondyst nails
|
$113.40 |
$113.40 |
$113.40 |
$113.40
|
|
Trml dstrj ios bvn 1st 2 l/s
|
$26,989.20 |
$26,989.20 |
$26,989.20 |
$15,226.08
|
|
Trml dstrj ios bvn ea addl
|
$13,493.90 |
$13,493.90 |
$13,493.90 |
$7,354.00
|
|
Trnscath plc stnt ante carotid art
|
$1,249.50 |
$1,249.50 |
$1,249.50 |
$6,069.00
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$94,271.08 |
$94,271.08 |
$94,271.08 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$122,288.15 |
$122,288.15 |
$122,288.15 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$70,853.07 |
$70,853.07 |
$70,853.07 |
$15,330.11
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$7,900.20 |
$7,900.20 |
$7,900.20 |
$5,069.50
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$11,054.40 |
$11,054.40 |
$11,054.40 |
$4,250.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$8,685.60 |
$8,685.60 |
$8,685.60 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$920.50 |
$920.50 |
$920.50 |
$3,866.70
|
|
Troponin quantitative
|
$170.80 |
$170.80 |
$170.80 |
$127.20
|
|
Tte w or without contr, cont ecg
|
$4,760.00 |
$4,760.00 |
$4,760.00 |
$2,012.40
|
|
Tubal Ligation (Laparoscopic)
|
$43,722.05 |
$43,722.05 |
$43,722.05 |
$4,323.20
|
|
Tube trach disp innr can 5 xlt
|
$148.78 |
$148.78 |
$148.78 |
$445.99
|
|
Tx atrial fib pulm vein isol
|
$21,205.10 |
$21,205.10 |
$21,205.10 |
$29,030.54
|
|
Tx closed hip disl traumatic without anes
|
$808.50 |
$808.50 |
$808.50 |
$581.07
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$5,628.70 |
$5,628.70 |
$5,628.70 |
$3,977.49
|
|
Tx l/r atrial fib addl
|
$4,109.00 |
$4,109.00 |
$4,109.00 |
$6,769.00
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$5,224.80 |
$5,224.80 |
$5,224.80 |
$4,421.00
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$8,633.80 |
$8,633.80 |
$8,633.80 |
$4,499.12
|
|
Tympanic membrane repair
|
$9,566.09 |
$9,566.09 |
$9,566.09 |
$2,638.87
|
|
Tympanolysis transcanal 69450
|
$33,635.40 |
$33,635.40 |
$33,635.40 |
$3,837.72
|
|
Tympanometry & reflex thresh
|
$116.90 |
$116.90 |
$116.90 |
$170.00
|
|
Ugt1a1 gene analy common variants
|
$717.50 |
$717.50 |
$717.50 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$852.60 |
$852.60 |
$852.60 |
$394.20
|
|
Ultrasound breast complete
|
$532.00 |
$532.00 |
$532.00 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$438.90 |
$438.90 |
$438.90 |
$449.35
|
|
Ultrasound chest
|
$1,039.50 |
$1,039.50 |
$1,039.50 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$969.50 |
$969.50 |
$969.50 |
$338.00
|
|
Ultrasound elastography ea l target les
|
$434.00 |
$434.00 |
$434.00 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$482.30 |
$482.30 |
$482.30 |
$307.00
|
|
Ultrasound encephalogram
|
$1,406.30 |
$1,406.30 |
$1,406.30 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$1,237.60 |
$1,237.60 |
$1,237.60 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$1,120.70 |
$1,120.70 |
$1,120.70 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$1,292.20 |
$1,292.20 |
$1,292.20 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$1,705.20 |
$1,705.20 |
$1,705.20 |
$720.15
|
|
Ultrasound guide intraoperative
|
$2,104.20 |
$2,104.20 |
$2,104.20 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$2,603.30 |
$2,603.30 |
$2,603.30 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$1,275.40 |
$1,275.40 |
$1,275.40 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$1,087.80 |
$1,087.80 |
$1,087.80 |
$311.25
|
|
Ultrasound joint complete left
|
$1,269.80 |
$1,269.80 |
$1,269.80 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$774.90 |
$774.90 |
$774.90 |
$425.45
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$245.70 |
$245.70 |
$245.70 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$1,598.10 |
$1,598.10 |
$1,598.10 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$819.70 |
$819.70 |
$819.70 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,360.80 |
$1,360.80 |
$1,360.80 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$830.90 |
$830.90 |
$830.90 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$718.90 |
$718.90 |
$718.90 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$749.00 |
$749.00 |
$749.00 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$1,085.00 |
$1,085.00 |
$1,085.00 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$1,313.20 |
$1,313.20 |
$1,313.20 |
$486.50
|
|
Ultrasound scrotum and contents
|
$1,376.90 |
$1,376.90 |
$1,376.90 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$1,559.60 |
$1,559.60 |
$1,559.60 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$1,157.10 |
$1,157.10 |
$1,157.10 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$1,079.40 |
$1,079.40 |
$1,079.40 |
$558.35
|
|
Ultrasound trgt dyn mbubb 1st les
|
$3,213.00 |
$3,213.00 |
$3,213.00 |
$568.32
|
|
Ultrasound trgt dyn mbubb ea addl
|
$4,034.80 |
$4,034.80 |
$4,034.80 |
$348.00
|
|
Umbilical artery cath newborn 36660
|
$851.20 |
$851.20 |
$851.20 |
$206.64
|
|
Unlisted chemotherapy px
|
$540.40 |
$540.40 |
$540.40 |
$150.00
|
|
Unlisted CT procedure
|
$1,941.10 |
$1,941.10 |
$1,941.10 |
$732.70
|
|
Unlisted dx gi procedure
|
$1,908.20 |
$1,908.20 |
$1,908.20 |
$649.22
|
|
Unlisted fetal invas px w/us
|
$606.90 |
$606.90 |
$606.90 |
$498.40
|
|
Unlisted fluoroscopic px
|
$26,511.80 |
$26,511.80 |
$26,511.80 |
$305.76
|
|
Unlisted hematology&coagj px
|
$123.90 |
$123.90 |
$123.90 |
$39.52
|
|
Unlisted hystsc px uterus
|
$24,891.31 |
$24,891.31 |
$24,891.31 |
$2,803.60
|
|
Unlisted laparoscopic liver biopy 47379
|
$32,138.30 |
$32,138.30 |
$32,138.30 |
$5,419.00
|
|
Unlisted laparoscopic procedure 49659
|
$45,082.73 |
$45,082.73 |
$45,082.73 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$31,288.27 |
$31,288.27 |
$31,288.27 |
$5,419.00
|
|
Unlisted laps px appendix
|
$48,925.57 |
$48,925.57 |
$48,925.57 |
$3,617.40
|
|
Unlisted laps px bladder
|
$46,359.10 |
$46,359.10 |
$46,359.10 |
$5,082.74
|
|
Unlisted laps px lymphtc sys
|
$132,655.90 |
$132,655.90 |
$132,655.90 |
$6,870.89
|
|
Unlisted laps px spleen
|
$56,860.03 |
$56,860.03 |
$56,860.03 |
$4,627.00
|
|
Unlisted laps px uterus
|
$48,800.66 |
$48,800.66 |
$48,800.66 |
$4,627.00
|
|
Unlisted maaa
|
$284.90 |
$284.90 |
$284.90 |
$235.20
|
|
Unlisted mr procedure
|
$2,110.50 |
$2,110.50 |
$2,110.50 |
$1,163.00
|
|
Unlisted procedure colon
|
$10,896.20 |
$10,896.20 |
$10,896.20 |
$1,702.50
|
|
Unlisted procedure esophagus
|
$15,993.60 |
$15,993.60 |
$15,993.60 |
$1,998.88
|
|
Unlisted procedure eyelids
|
$154,562.90 |
$154,562.90 |
$154,562.90 |
$833.00
|
|
Unlisted procedure larynx
|
$29,138.14 |
$29,138.14 |
$29,138.14 |
$924.00
|
|
Unlisted procedure liver
|
$26,043.50 |
$26,043.50 |
$26,043.50 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$490.70 |
$490.70 |
$490.70 |
$523.50
|
|
Unlisted procedure pancreas
|
$8,447.60 |
$8,447.60 |
$8,447.60 |
$3,986.00
|
|
Unlisted procedure rectum
|
$12,129.60 |
$12,129.60 |
$12,129.60 |
$1,220.35
|
|
Unlisted px abdomen muscskel
|
$3,161.20 |
$3,161.20 |
$3,161.20 |
$1,848.60
|
|
Unlisted px accessory sinus
|
$122,103.02 |
$122,103.02 |
$122,103.02 |
$3,335.28
|
|
Unlisted px arthroscopy
|
$15,766.10 |
$15,766.10 |
$15,766.10 |
$2,765.60
|
|
Unlisted px biliary tract
|
$23,227.40 |
$23,227.40 |
$23,227.40 |
$2,718.10
|
|
Unlisted px leg/ankle
|
$13,652.80 |
$13,652.80 |
$13,652.80 |
$811.00
|
|
Unlisted px med radj physics
|
$1,124.20 |
$1,124.20 |
$1,124.20 |
$462.35
|
|
Unlisted px middle ear
|
$16,700.18 |
$16,700.18 |
$16,700.18 |
$343.50
|
|
Unlisted px palate uvula
|
$17,105.28 |
$17,105.28 |
$17,105.28 |
$274.80
|
|
Unlisted px posterior segmnt
|
$8,799.70 |
$8,799.70 |
$8,799.70 |
$3,173.34
|
|
Unlisted px salivry glnd/dux
|
$33,824.94 |
$33,824.94 |
$33,824.94 |
$1,265.16
|
|
Unlisted px small intestine
|
$12,495.70 |
$12,495.70 |
$12,495.70 |
$2,102.10
|
|
Unlisted surgical path px
|
$81.20 |
$81.20 |
$81.20 |
$217.75
|
|
Unlisted ultrasound procedure
|
$105.00 |
$105.00 |
$105.00 |
$321.20
|
|
Unlisted urinalysis px
|
$114.10 |
$114.10 |
$114.10 |
$25.72
|
