|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$2,128.80 |
$2,128.80 |
$18,038.08 |
$2,551.20
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$1,954.40 |
$1,954.40 |
$28,109.71 |
$2,486.75
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$1,534.40 |
$1,534.40 |
$1,534.40 |
$2,486.75
|
|
Trnsplj pd lvr&bwl cd154+cll
|
$615.11 |
$615.11 |
$615.11 |
$704.80
|
|
Trnspl rej kdn mrna qpcr 139
|
$6,480.00 |
$6,480.00 |
$6,480.00 |
$3,232.32
|
|
Troponin quantitative
|
$64.28 |
$64.28 |
$21,503.65 |
$125.00
|
|
Tr retinal les preterm inf
|
$5,792.00 |
$5,792.00 |
$5,792.00 |
$1,794.00
|
|
Trurl dstrj prst8 tiss rf wv
|
$4,385.60 |
$4,385.60 |
$4,385.60 |
$4,228.00
|
|
Tte w or without contr, cont ecg
|
$1,432.60 |
$1,432.60 |
$2,717.25 |
$2,196.00
|
|
Tte w or without fol w/con,stres
|
$2,176.20 |
$2,176.20 |
$2,717.25 |
$1,643.14
|
|
Tte w or without fol w/cont, com
|
$2,056.60 |
$2,056.60 |
$2,056.60 |
$1,266.50
|
|
Tte w or without fol w/cont, f/u
|
$2,298.40 |
$2,298.40 |
$2,298.40 |
$1,178.00
|
|
Tubal Ligation (Laparoscopic)
|
$920.80 |
$920.80 |
$920.80 |
$4,323.20
|
|
Tube drain vert dev st 5-40f
|
$17.68 |
$17.68 |
$17.68 |
$27.60
|
|
Tube trach disp innr can 5 xlt
|
$416.99 |
$416.99 |
$416.99 |
$445.99
|
|
Tube trach disp innr can 6 xlt
|
$2.78 |
$2.78 |
$2.78 |
$16.80
|
|
Tube trach fen sz 6 uncuffed
|
$128.12 |
$128.12 |
$128.12 |
$155.98
|
|
Tubing (oxygen) per foot
|
$0.40 |
$0.40 |
$0.40 |
$0.40
|
|
Tvh >250 gms 58290
|
$2,885.60 |
$2,885.60 |
$2,885.60 |
$6,872.92
|
|
Tvh w/mmk 58267
|
$2,665.60 |
$2,665.60 |
$2,665.60 |
$1,747.20
|
|
Tx atrial fib pulm vein isol
|
$20,038.20 |
$20,038.20 |
$36,947.29 |
$29,030.54
|
|
Tx closed distal humerus fx
|
$382.44 |
$382.44 |
$382.44 |
$589.00
|
|
Tx closed hip disl traumatic without anes
|
$905.60 |
$905.60 |
$905.60 |
$586.80
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$4,668.23 |
$4,668.23 |
$4,668.23 |
$4,043.32
|
|
Tx closed tib shaft fx without manip
|
$1,692.80 |
$1,692.80 |
$1,692.80 |
$535.60
|
|
Tx contour defects >10.0 cc
|
$388.80 |
$388.80 |
$388.80 |
$918.06
|
|
Tx contour defects 1.1-5.0cc 11951
|
$262.40 |
$262.40 |
$262.40 |
$849.50
|
|
Tx ectopic pregnancy abdl pregnancy 59130
|
$2,277.60 |
$2,277.60 |
$2,277.60 |
$2,277.60
|
|
Tx ectopic pregnancy ntrstl prtl rescj uter 59136
|
$2,159.20 |
$2,159.20 |
$2,159.20 |
$2,159.20
|
|
Tx l/r atrial fib addl
|
$13,501.94 |
$13,501.94 |
$80,907.67 |
$6,986.85
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$1,828.80 |
$1,828.80 |
$1,828.80 |
$4,521.61
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$6,360.55 |
$6,360.55 |
$6,360.55 |
$4,537.59
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$4,805.08 |
$4,805.08 |
$4,805.08 |
$4,595.50
|
|
Tx open nsl fx uncomp
|
$1,072.80 |
$1,072.80 |
$1,072.80 |
$3,837.72
|
|
Tx open nsl sptl fx
|
$1,567.20 |
$1,567.20 |
$1,567.20 |
$4,308.40
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$1,463.20 |
$1,463.20 |
$1,463.20 |
$4,529.60
|
|
Tx septic abortion surgical 59830
|
$1,094.40 |
$1,094.40 |
$1,094.40 |
$896.40
|
|
Tx tarsal bone fx without manip 28450
|
$523.20 |
$523.20 |
$523.20 |
$423.15
|
|
Tympanic membrane repair
|
$1,856.00 |
$1,856.00 |
$17,258.40 |
$2,133.48
|
|
Tympanolysis transcanal 69450
|
$2,659.20 |
$2,659.20 |
$2,659.20 |
$3,837.72
|
|
Tympanometry & reflex thresh
|
$121.47 |
$121.47 |
$121.47 |
$173.18
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$966.40 |
$966.40 |
$966.40 |
$911.43
|
|
Tympp antrt/mastoidotomy prosthesis torp 69637
|
$6,740.80 |
$6,740.80 |
$6,740.80 |
$6,740.80
|
|
Tympp antrt/mastoid without ossic chain recnst 69635
|
$6,043.20 |
$6,043.20 |
$6,043.20 |
$7,000.36
|
|
Tyms gene com variants
|
$350.40 |
$350.40 |
$350.40 |
$192.29
|
|
Typhoid vaccine oral
|
$100.00 |
$100.00 |
$100.00 |
$63.28
|
|
Ua w/micro/comp poc
|
$25.72 |
$25.72 |
$25.72 |
$23.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$107,599.30 |
$107,599.30 |
$107,599.30 |
$21,992.26
|
|
Ugt1a1 gene analy common variants
|
$271.70 |
$271.70 |
$468.00 |
$438.75
|
|
Ultrasound bone density measure
|
$29.60 |
$29.60 |
$29.60 |
$143.75
|
|
Ultrasound breast complete
|
$1,319.16 |
$1,319.16 |
$1,319.16 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$1,004.68 |
$1,004.68 |
$2,387.00 |
$452.00
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$401.05 |
$401.05 |
$682.45 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$241.56 |
$241.56 |
$241.56 |
$296.80
|
|
Ultrasound elastography ea l target les
|
$408.76 |
$408.76 |
$408.76 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$408.76 |
$408.76 |
$600.60 |
$307.00
|
|
Ultrasound encephalogram
|
$503.20 |
$503.20 |
$738.40 |
$485.48
|
|
Ultrasound exam k transpl w/doppler
|
$830.83 |
$830.83 |
$969.80 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$723.42 |
$723.42 |
$2,502.00 |
$477.10
|
|
Ultrasound Guidance for a Needle Procedure
|
$756.76 |
$756.76 |
$2,227.90 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$722.54 |
$722.54 |
$20,999.16 |
$388.08
|
|
Ultrasound guide intraoperative
|
$964.13 |
$964.13 |
$1,170.65 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$654.76 |
$654.76 |
$654.76 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$332.15 |
$332.15 |
$1,052.04 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$332.15 |
$332.15 |
$506.15 |
$304.00
|
|
Ultrasound joint complete left
|
$193.70 |
$193.70 |
$783.97 |
$560.92
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$191.20 |
$191.20 |
$191.20 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$639.76 |
$639.76 |
$988.00 |
$406.44
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$410.80 |
$410.80 |
$529.76 |
$333.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$830.05 |
$830.05 |
$1,048.25 |
$698.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$461.50 |
$461.50 |
$578.36 |
$428.25
|
|
Ultrasound prostate/transrectal
|
$729.30 |
$729.30 |
$779.15 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$417.95 |
$417.95 |
$640.80 |
$459.00
|
|
Ultrasound transabd ea addl gest
|
$618.32 |
$618.32 |
$714.35 |
$417.15
|
|
Ultrasound trgt dyn mbubb 1st les
|
$516.00 |
$516.00 |
$516.00 |
$568.32
|
|
Ultrasound trgt dyn mbubb ea addl
|
$348.00 |
$348.00 |
$348.00 |
$348.00
|
|
Ultraviolet therapy
|
$119.59 |
$119.59 |
$119.59 |
$39.76
|
|
Umbilical artery cath newborn 36660
|
$220.68 |
$220.68 |
$220.68 |
$223.80
|
|
Umbilical cord occlud w/us
|
$1,262.40 |
$1,262.40 |
$1,262.40 |
$754.00
|
|
Umbilicoplasty 15847
|
$834.40 |
$834.40 |
$834.40 |
$4,172.97
|
|
Unit mobile power mpu
|
$11,821.68 |
$11,821.68 |
$11,821.68 |
$14,359.52
|
|
Unlisted chemotherapy px
|
$83.85 |
$83.85 |
$83.85 |
$149.15
|
|
Unlisted hematology&coagj px
|
$33.57 |
$33.57 |
$33.57 |
$39.52
|
|
Unlisted laparoscopic liver biopy 47379
|
$1,218.40 |
$1,218.40 |
$6,504.00 |
$6,307.38
|
|
Unlisted laparoscopic procedure 49659
|
$1,977.60 |
$1,977.60 |
$1,977.60 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$1,755.20 |
$1,755.20 |
$1,755.20 |
$5,419.00
|
|
Unlisted laps px bladder
|
$1,531.20 |
$1,531.20 |
$1,531.20 |
$5,082.74
|
|
Unlisted laps px ovidct ovry
|
$1,158.40 |
$1,158.40 |
$1,158.40 |
$6,904.15
|
|
Unlisted laps px uterus
|
$768.00 |
$768.00 |
$768.00 |
$4,627.00
|
|
Unlisted maaa
|
$127.86 |
$127.86 |
$127.86 |
$235.20
|
|
Unlisted mr procedure
|
$3,906.78 |
$3,906.78 |
$3,906.78 |
$1,165.00
|
|
Unlisted procedure colon
|
$1,580.44 |
$1,580.44 |
$1,580.44 |
$1,839.55
|
|
Unlisted procedure microbiology
|
$38.58 |
$38.58 |
$422.50 |
$530.00
|
|
Unlisted procedure pancreas
|
$1,849.60 |
$1,849.60 |
$1,849.60 |
$4,810.00
|
|
Unlisted procedure rectum
|
$892.17 |
$892.17 |
$86,785.96 |
$1,278.72
|
|
Unlisted psychiatric service/proc 90899
|
$1,866.34 |
$1,866.34 |
$1,866.34 |
$277.76
|
|
Unlisted px abdomen muscskel
|
$19,939.00 |
$19,939.00 |
$19,939.00 |
$2,053.50
|
|
Unlisted px arthroscopy
|
$2,765.60 |
$2,765.60 |
$2,765.60 |
$2,765.60
|
|
Unlisted px biliary tract
|
$3,598.64 |
$3,598.64 |
$3,598.64 |
$3,055.00
|
|
Unlisted px casting/strpg
|
$78.40 |
$78.40 |
$78.40 |
$222.00
|
