|
Tx open nsl sptl fx
|
$4,499.12 |
$4,499.12 |
$4,499.12 |
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$4,499.12 |
$11,705.00 |
$11,705.00 |
|
|
Tx septic abortion surgical 59830
|
$637.06 |
$637.06 |
$637.06 |
|
|
Tx tarsal bone fx without manip 28450
|
$339.18 |
$414.00 |
$599.00 |
|
|
Tympanic membrane repair
|
$782.00 |
$782.00 |
$2,133.48 |
|
|
Tympanolysis transcanal 69450
|
$4,558.89 |
$4,558.89 |
$4,558.89 |
|
|
Tympanometry & reflex thresh
|
$114.24 |
$170.00 |
$296.91 |
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$741.60 |
$741.60 |
$741.60 |
|
|
Tympp antrt/mastoidotomy prosthesis torp 69637
|
$8,139.99 |
$8,139.99 |
$8,139.99 |
|
|
Tympp antrt/mastoid without ossic chain recnst 69635
|
$8,139.99 |
$8,139.99 |
$8,139.99 |
|
|
Tyms gene com variants
|
$82.25 |
$241.24 |
$241.24 |
|
|
Typhoid vaccine oral
|
$151.80 |
$151.80 |
$151.80 |
|
|
U2af1 gene common variants
|
$266.69 |
$266.69 |
$266.69 |
|
|
Ua w/micro/comp poc
|
$3.76 |
$15.00 |
$139.20 |
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$96.85 |
$96.85 |
$96.85 |
|
|
Ue triple control harness
|
$504.06 |
$504.06 |
$504.06 |
|
|
Ugt1a1 gene analy common variants
|
$109.98 |
$238.32 |
$322.92 |
|
|
Ultrasound bone density measure
|
$143.75 |
$143.75 |
$143.75 |
|
|
Ultrasound breast complete
|
$143.75 |
$459.00 |
$1,641.00 |
|
|
Ultrasound breast unilateral limited (both sides)
|
$119.66 |
$369.04 |
$1,586.40 |
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$90.72 |
$603.00 |
$782.00 |
|
|
Ultrasound dx ophth b-scan
|
$143.75 |
$470.00 |
$623.00 |
|
|
Ultrasound elastography ea l target les
|
$49.27 |
$49.27 |
$129.72 |
|
|
Ultrasound elastography parenchyma
|
$129.72 |
$453.00 |
$1,240.00 |
|
|
Ultrasound encephalogram
|
$143.75 |
$608.00 |
$1,024.00 |
|
|
Ultrasound exam k transpl w/doppler
|
$143.75 |
$774.00 |
$1,365.60 |
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$133.48 |
$814.00 |
$1,240.00 |
|
|
Ultrasound Guidance for a Needle Procedure
|
$43.93 |
$930.00 |
$1,424.00 |
|
|
Ultrasound guidance for vascular access
|
$35.92 |
$221.00 |
$792.00 |
|
|
Ultrasound guide intraoperative
|
$71.69 |
$851.00 |
$1,488.00 |
|
|
Ultrasound guide tissue ablation
|
$149.34 |
$468.00 |
$468.00 |
|
|
Ultrasound hips infant dynamic
|
$119.66 |
$320.88 |
$668.80 |
|
|
Ultrasound infant hips ltd without stress
|
$119.66 |
$285.00 |
$1,196.00 |
|
|
Ultrasound joint complete left
|
$143.75 |
$904.00 |
$1,604.80 |
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$143.75 |
$363.00 |
$723.00 |
|
|
Ultrasound ob >=14wks ea addl gest
|
$65.92 |
$301.00 |
$2,965.60 |
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$55.12 |
$530.00 |
$914.40 |
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$214.48 |
$1,276.00 |
$1,896.00 |
|
|
Ultrasound pregnant uterus follow up per fetus
|
$95.20 |
$567.00 |
$1,240.00 |
|
|
Ultrasound prostate/transrectal
|
$143.75 |
$514.00 |
$1,568.80 |
|
|
Ultrasound spinal canal and contents
|
$93.52 |
$723.00 |
$1,010.40 |
|
|
Ultrasound transabd ea addl gest
|
$145.67 |
$702.00 |
$914.40 |
|
|
Ultrasound trgt dyn mbubb 1st les
|
$479.72 |
$479.72 |
$479.72 |
|
|
Ultrasound trgt dyn mbubb ea addl
|
$90.18 |
$90.18 |
$90.18 |
|
|
Ultraviolet therapy
|
$11.58 |
$11.58 |
$36.80 |
|
|
Umbilical artery cath newborn 36660
|
$81.05 |
$172.00 |
$177.00 |
|
|
Umbilical cord occlud w/us
|
$724.03 |
$724.03 |
$724.03 |
|
|
Unit mobile power mpu
|
$20,397.63 |
$20,397.63 |
$31,229.60 |
|
|
Unlistd noninvas vasc dx std
|
$39.77 |
$39.77 |
$39.77 |
|
|
Unlisted all/immlg svc/px
|
$39.77 |
$39.77 |
$39.77 |
|
|
Unlisted chemotherapy px
|
$64.39 |
$292.00 |
$401.00 |
|
|
Unlisted cranfcl&maxlfcl px
|
$325.68 |
$325.68 |
$325.68 |
|
|
Unlisted CT procedure
|
$119.66 |
$175.00 |
$1,258.00 |
|
|
Unlisted cv px dx nuc med
|
$549.70 |
$549.70 |
$549.70 |
|
|
Unlisted cytogenetic study
|
$71.65 |
$71.65 |
$2,388.80 |
|
|
Unlisted cytopathology px
|
$71.65 |
$71.65 |
$71.65 |
|
|
Unlisted dialysis procedure
|
$906.00 |
$1,007.00 |
$1,007.00 |
|
|
Unlisted dx gi procedure
|
$176.93 |
$176.93 |
$176.93 |
|
|
Unlisted endocrine px dx nuc
|
$549.70 |
$549.70 |
$549.70 |
|
|
Unlisted fetal invas px w/us
|
$277.99 |
$277.99 |
$277.99 |
|
|
Unlisted fluoroscopic px
|
$82.72 |
$317.00 |
$507.00 |
|
|
Unlisted gi px dx nuc med
|
$549.70 |
$549.70 |
$549.70 |
|
|
Unlisted gu px dx nuc med
|
$549.70 |
$549.70 |
$549.70 |
|
|
Unlisted hystsc px uterus
|
$277.99 |
$277.99 |
$277.99 |
|
|
Unlisted laparoscopic liver biopy 47379
|
$8,312.83 |
$8,312.83 |
$8,312.83 |
|
|
Unlisted laparoscopic procedure 49659
|
$8,312.83 |
$8,312.83 |
$8,312.83 |
|
|
Unlisted laparoscopic reduction intestine 44238
|
$8,312.83 |
$8,312.83 |
$8,312.83 |
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$8,312.83 |
$8,312.83 |
$8,312.83 |
|
|
Unlisted laps px appendix
|
$8,312.83 |
$8,312.83 |
$8,312.83 |
|
|
Unlisted laps px bladder
|
$8,312.83 |
$8,312.83 |
$8,312.83 |
|
|
Unlisted laps px endoc sys
|
$8,312.83 |
$8,312.83 |
$8,312.83 |
|
|
Unlisted laps px esoph
|
$8,312.83 |
$8,312.83 |
$8,312.83 |
|
|
Unlisted laps px lymphtc sys
|
$8,312.83 |
$8,312.83 |
$8,312.83 |
|
|
Unlisted laps px ovidct ovry
|
$8,312.83 |
$8,312.83 |
$8,312.83 |
|
|
Unlisted laps px renal
|
$8,312.83 |
$8,312.83 |
$8,312.83 |
|
|
Unlisted laps px spleen
|
$8,312.83 |
$8,312.83 |
$8,312.83 |
|
|
Unlisted laps px testis
|
$8,312.83 |
$8,312.83 |
$8,312.83 |
|
|
Unlisted laps px ureter
|
$8,312.83 |
$8,312.83 |
$8,312.83 |
|
|
Unlisted laps px uterus
|
$8,312.83 |
$8,312.83 |
$8,312.83 |
|
|
Unlisted maaa
|
$589.60 |
$589.60 |
$589.60 |
|
|
Unlisted maxlfcl prosth px
|
$325.68 |
$325.68 |
$325.68 |
|
|
Unlisted misc path test
|
$71.65 |
$71.65 |
$71.65 |
|
|
Unlisted mr procedure
|
$119.66 |
$3,737.00 |
$4,440.00 |
|
|
Unlisted muscskel px dx nuc
|
$549.70 |
$549.70 |
$549.70 |
|
|
Unlisted muscskel px head
|
$325.68 |
$325.68 |
$325.68 |
|
|
Unlisted neurological dx px
|
$160.00 |
$176.93 |
$176.93 |
|
|
Unlisted nrvs sys px dx nuc
|
$549.70 |
$549.70 |
$549.70 |
|
|
Unlisted oph svc/procedure
|
$39.77 |
$39.77 |
$39.77 |
|
|
Unlisted orl service/px
|
$39.77 |
$39.77 |
$49.84 |
|
|
Unlisted procedure colon
|
$1,278.72 |
$8,350.00 |
$8,395.00 |
|
|
Unlisted procedure esophagus
|
$1,247.13 |
$1,247.13 |
$1,247.13 |
|
|
Unlisted procedure eyelids
|
$436.44 |
$436.44 |
$436.44 |
|
|
Unlisted procedure larynx
|
$325.68 |
$325.68 |
$325.68 |
|
|
Unlisted procedure liver
|
$973.71 |
$5,372.00 |
$5,401.00 |
|
|
Unlisted procedure microbiology
|
$2,279.20 |
$2,279.20 |
$2,279.20 |
|
|
Unlisted procedure orbit
|
$436.44 |
$436.44 |
$436.44 |
|
|
Unlisted procedure pancreas
|
$973.71 |
$17,503.00 |
$17,503.00 |
|
|
Unlisted procedure rectum
|
$1,278.72 |
$2,657.00 |
$4,905.00 |
|
|
Unlisted procedure spine
|
$339.18 |
$339.18 |
$7,459.00 |
|
|
Unlisted procedure urinary 58750
|
$1,181.29 |
$1,181.29 |
$1,181.29 |
|