|
Tx atrial fib pulm vein isol
|
$2,755.20 |
$28,245.40 |
$37,008.40 |
|
|
Tx closed distal humerus fx
|
$237.88 |
$1,844.48 |
$1,936.90 |
|
|
Tx closed hip disl traumatic without anes
|
$232.32 |
$905.60 |
$905.60 |
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$1,004.16 |
$3,027.20 |
$5,804.96 |
|
|
Tx closed tib shaft fx without manip
|
$321.75 |
$1,692.80 |
$1,692.80 |
|
|
Tx contour defects >10.0 cc
|
$388.80 |
$388.80 |
$867.00 |
|
|
Tx contour defects 1.1-5.0cc 11951
|
$105.00 |
$262.40 |
$262.40 |
|
|
Tx ectopic pregnancy abdl pregnancy 59130
|
$1,692.00 |
$2,277.60 |
$2,277.60 |
|
|
Tx ectopic pregnancy ntrstl prtl rescj uter 59136
|
$1,707.00 |
$2,159.20 |
$2,159.20 |
|
|
Tx l/r atrial fib addl
|
$1,044.80 |
$9,995.45 |
$80,907.67 |
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$1,038.60 |
$1,828.80 |
$8,117.40 |
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$892.80 |
$3,977.08 |
$51,856.87 |
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$972.00 |
$1,342.40 |
$6,279.67 |
|
|
Tx open nsl fx uncomp
|
$867.60 |
$1,072.80 |
$1,072.80 |
|
|
Tx open nsl sptl fx
|
$1,201.20 |
$1,567.20 |
$1,567.20 |
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$1,070.40 |
$1,463.20 |
$34,798.95 |
|
|
Tx septic abortion surgical 59830
|
$853.80 |
$1,094.40 |
$1,094.40 |
|
|
Tx tarsal bone fx without manip 28450
|
$328.80 |
$523.20 |
$672.00 |
|
|
Tympanic membrane repair
|
$723.00 |
$1,856.00 |
$21,409.08 |
|
|
Tympanolysis transcanal 69450
|
$1,018.80 |
$2,659.20 |
$2,659.20 |
|
|
Tympanometry & reflex thresh
|
$49.60 |
$49.60 |
$121.47 |
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$146.40 |
$966.40 |
$2,323.75 |
|
|
Tympp antrt/mastoidotomy prosthesis torp 69637
|
$2,576.40 |
$6,740.80 |
$6,740.80 |
|
|
Tympp antrt/mastoid without ossic chain recnst 69635
|
$2,289.00 |
$6,043.20 |
$6,043.20 |
|
|
Tyms gene com variants
|
$350.40 |
$350.40 |
$350.40 |
|
|
Typhoid vaccine oral
|
$100.00 |
$100.00 |
$100.00 |
|
|
Ua w/micro/comp poc
|
$7.80 |
$25.72 |
$148.20 |
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$111.87 |
$35,496.45 |
$107,599.30 |
|
|
Ugt1a1 gene analy common variants
|
$271.70 |
$468.00 |
$468.00 |
|
|
Ultrasound bone density measure
|
$29.60 |
$29.60 |
$29.60 |
|
|
Ultrasound breast complete
|
$102.72 |
$570.61 |
$1,319.16 |
|
|
Ultrasound breast unilateral limited (both sides)
|
$102.72 |
$691.60 |
$2,387.00 |
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$104.80 |
$272.40 |
$682.45 |
|
|
Ultrasound dx ophth b-scan
|
$27.30 |
$158.40 |
$254.62 |
|
|
Ultrasound elastography ea l target les
|
$108.00 |
$108.00 |
$568.55 |
|
|
Ultrasound elastography parenchyma
|
$119.70 |
$189.60 |
$1,625.00 |
|
|
Ultrasound encephalogram
|
$230.40 |
$385.14 |
$1,136.00 |
|
|
Ultrasound exam follow-up
|
$200.16 |
$204.33 |
$226.38 |
|
|
Ultrasound exam k transpl w/doppler
|
$60.48 |
$724.17 |
$1,492.00 |
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$207.44 |
$466.70 |
$2,502.00 |
|
|
Ultrasound Guidance for a Needle Procedure
|
$366.13 |
$716.68 |
$14,707.39 |
|
|
Ultrasound guidance for vascular access
|
$72.60 |
$429.12 |
$20,999.16 |
|
|
Ultrasound guide intraoperative
|
$306.24 |
$614.83 |
$1,801.00 |
|
|
Ultrasound guide tissue ablation
|
$238.98 |
$401.60 |
$654.76 |
|
|
Ultrasound hips infant dynamic
|
$179.52 |
$332.15 |
$1,052.04 |
|
|
Ultrasound infant hips ltd without stress
|
$163.80 |
$292.74 |
$531.80 |
|
|
Ultrasound joint complete left
|
$193.70 |
$392.49 |
$825.50 |
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$191.20 |
$191.20 |
$402.36 |
|
|
Ultrasound ob >=14wks ea addl gest
|
$225.60 |
$368.29 |
$988.00 |
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$151.20 |
$234.65 |
$529.76 |
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$331.20 |
$490.98 |
$1,277.00 |
|
|
Ultrasound pregnant uterus follow up per fetus
|
$174.72 |
$429.00 |
$2,096.00 |
|
|
Ultrasound prostate/transrectal
|
$87.10 |
$531.80 |
$1,823.94 |
|
|
Ultrasound spinal canal and contents
|
$290.64 |
$417.95 |
$893.88 |
|
|
Ultrasound transabd ea addl gest
|
$213.60 |
$424.80 |
$724.22 |
|
|
Ultrasound trgt dyn mbubb 1st les
|
$516.00 |
$516.00 |
$758.04 |
|
|
Ultrasound trgt dyn mbubb ea addl
|
$348.00 |
$348.00 |
$568.55 |
|
|
Ultraviolet therapy
|
$15.20 |
$15.20 |
$119.59 |
|
|
Umbilical artery cath newborn 36660
|
$137.40 |
$176.80 |
$274.40 |
|
|
Umbilical cord occlud w/us
|
$1,262.40 |
$1,262.40 |
$1,262.40 |
|
|
Umbilicoplasty 15847
|
$624.60 |
$834.40 |
$80,127.30 |
|
|
Unit mobile power mpu
|
$11,232.00 |
$11,821.68 |
$18,187.20 |
|
|
Unlistd noninvas vasc dx std
|
$44.80 |
$44.80 |
$44.80 |
|
|
Unlisted chemotherapy px
|
$83.85 |
$85.80 |
$92.20 |
|
|
Unlisted CT procedure
|
$285.14 |
$285.14 |
$298.79 |
|
|
Unlisted cv px dx nuc med
|
$1,020.36 |
$1,020.36 |
$1,384.34 |
|
|
Unlisted dialysis procedure
|
$33,066.51 |
$33,066.51 |
$33,066.51 |
|
|
Unlisted dx gi procedure
|
$1,598.52 |
$1,598.52 |
$1,598.52 |
|
|
Unlisted endocrine px dx nuc
|
$478.37 |
$1,020.36 |
$1,066.00 |
|
|
Unlisted fluoroscopic px
|
$200.75 |
$200.75 |
$285.60 |
|
|
Unlisted gi px dx nuc med
|
$1,020.36 |
$1,020.36 |
$1,539.67 |
|
|
Unlisted gu px dx nuc med
|
$1,020.36 |
$1,020.36 |
$1,384.34 |
|
|
Unlisted hematology&coagj px
|
$33.57 |
$33.57 |
$33.57 |
|
|
Unlisted laparoscopic liver biopy 47379
|
$623.40 |
$1,218.40 |
$78,897.61 |
|
|
Unlisted laparoscopic procedure 49659
|
$1,977.60 |
$1,977.60 |
$3,293.40 |
|
|
Unlisted laparoscopic reduction intestine 44238
|
$1,755.20 |
$1,755.20 |
$2,545.20 |
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$1,161.00 |
$1,219.20 |
$1,219.20 |
|
|
Unlisted laps px bladder
|
$1,531.20 |
$1,531.20 |
$49,492.83 |
|
|
Unlisted laps px ovidct ovry
|
$1,158.40 |
$1,158.40 |
$1,158.40 |
|
|
Unlisted laps px uterus
|
$768.00 |
$768.00 |
$768.00 |
|
|
Unlisted maaa
|
$127.86 |
$127.86 |
$127.86 |
|
|
Unlisted mr procedure
|
$67.20 |
$1,158.67 |
$3,906.78 |
|
|
Unlisted muscskel px dx nuc
|
$1,020.36 |
$1,020.36 |
$1,384.34 |
|
|
Unlisted nrvs sys px dx nuc
|
$891.41 |
$891.41 |
$1,410.40 |
|
|
Unlisted orl service/px
|
$40.32 |
$61.44 |
$62.72 |
|
|
Unlisted procedure colon
|
$1,580.44 |
$1,580.44 |
$2,701.17 |
|
|
Unlisted procedure liver
|
$371.70 |
$371.70 |
$2,118.31 |
|
|
Unlisted procedure microbiology
|
$38.58 |
$422.50 |
$3,675.00 |
|
|
Unlisted procedure pancreas
|
$1,849.60 |
$1,849.60 |
$1,849.60 |
|
|
Unlisted procedure rectum
|
$892.17 |
$1,964.08 |
$86,785.96 |
|
|
Unlisted procedure urinary 58750
|
$1,674.60 |
$1,758.60 |
$1,758.60 |
|
|
Unlisted psychiatric service/proc 90899
|
$115.20 |
$992.16 |
$1,919.81 |
|
|
Unlisted px abdomen muscskel
|
$19,939.00 |
$19,939.00 |
$19,939.00 |
|
|
Unlisted px accessory sinus
|
$39,198.64 |
$39,198.64 |
$39,198.64 |
|
|
Unlisted px arthroscopy
|
$2,765.60 |
$2,765.60 |
$39,950.70 |
|
|
Unlisted px biliary tract
|
$599.76 |
$599.76 |
$3,598.64 |
|
|
Unlisted px casting/strpg
|
$78.40 |
$78.40 |
$161.21 |
|
|
Unlisted px external ear
|
$158.34 |
$158.34 |
$158.34 |
|
|
Unlisted px foot/toes
|
$1,740.80 |
$1,740.80 |
$25,903.00 |
|
|
Unlisted px hands/fingers
|
$113.28 |
$115.64 |
$213.36 |
|
