|
Trnscath tx thromblytc vein ini day
|
$3,439.84 |
$3,439.84 |
$3,439.84 |
$4,329.36
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$4,001.00 |
$4,001.00 |
$4,001.00 |
$4,805.85
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$1,999.13 |
$1,999.13 |
$1,999.13 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$1,999.13 |
$1,999.13 |
$1,999.13 |
$3,322.20
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$1,999.13 |
$1,999.13 |
$1,999.13 |
$2,355.65
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$1,999.13 |
$1,999.13 |
$1,999.13 |
$2,328.30
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$1,999.13 |
$1,999.13 |
$1,999.13 |
$2,190.24
|
|
Troponin quantitative
|
$12.47 |
$12.47 |
$12.47 |
$123.75
|
|
Tr retinal les preterm inf
|
$599.55 |
$599.55 |
$599.55 |
$1,736.63
|
|
Trurl dstrj prst8 tiss rf wv
|
$3,769.31 |
$3,769.31 |
$3,769.31 |
$4,385.60
|
|
Tte w or without contr, cont ecg
|
$863.44 |
$863.44 |
$863.44 |
$1,608.73
|
|
Tte w or without fol w/con,stres
|
$863.44 |
$863.44 |
$863.44 |
$1,446.48
|
|
Tte w or without fol w/cont, com
|
$863.44 |
$863.44 |
$863.44 |
$1,453.15
|
|
Tte w or without fol w/cont, f/u
|
$863.44 |
$863.44 |
$863.44 |
$934.93
|
|
Tubal Ligation (Laparoscopic)
|
$6,376.26 |
$6,376.26 |
$6,376.26 |
$4,948.77
|
|
Tumor cell deplete of harvst
|
$477.79 |
$477.79 |
$477.79 |
$547.20
|
|
Tvh >250 gms 58290
|
$8,081.64 |
$8,081.64 |
$8,081.64 |
$6,839.00
|
|
Tx atrial fib pulm vein isol
|
$26,810.86 |
$26,810.86 |
$26,810.86 |
$32,426.20
|
|
Tx closed distal humerus fx
|
$262.16 |
$262.16 |
$262.16 |
$786.00
|
|
Tx closed hip disl traumatic without anes
|
$262.16 |
$262.16 |
$262.16 |
$657.28
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$3,545.97 |
$3,545.97 |
$3,545.97 |
$3,874.79
|
|
Tx closed tib shaft fx without manip
|
$262.16 |
$262.16 |
$262.16 |
$635.46
|
|
Tx contour defects >10.0 cc
|
$668.98 |
$668.98 |
$668.98 |
$755.08
|
|
Tx contour defects 1.1-5.0cc 11951
|
$668.98 |
$668.98 |
$668.98 |
$724.37
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$3,545.97 |
$3,545.97 |
$3,545.97 |
$4,449.44
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$3,545.97 |
$3,545.97 |
$3,545.97 |
$4,499.12
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$3,545.97 |
$3,545.97 |
$3,545.97 |
$4,281.00
|
|
Tx open nsl fx uncomp
|
$3,544.29 |
$3,544.29 |
$3,544.29 |
$4,007.22
|
|
Tx open nsl sptl fx
|
$3,545.97 |
$3,545.97 |
$3,545.97 |
$4,289.04
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$3,545.97 |
$3,545.97 |
$3,545.97 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$262.16 |
$262.16 |
$262.16 |
$469.20
|
|
Tympanic membrane repair
|
$1,618.86 |
$1,618.86 |
$1,618.86 |
$1,856.00
|
|
Tympanolysis transcanal 69450
|
$3,544.29 |
$3,544.29 |
$3,544.29 |
$3,837.72
|
|
Tympanometry & reflex thresh
|
$170.99 |
$170.99 |
$170.99 |
$173.18
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$556.55 |
$556.55 |
$556.55 |
$911.43
|
|
Tympp antrt/mastoidotomy prosthesis torp 69637
|
$6,465.11 |
$6,465.11 |
$6,465.11 |
$6,740.80
|
|
Tympp antrt/mastoid without ossic chain recnst 69635
|
$6,465.11 |
$6,465.11 |
$6,465.11 |
$6,547.81
|
|
Ua w/micro/comp poc
|
$4.02 |
$4.02 |
$4.02 |
$24.45
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$71.90 |
$71.90 |
$71.90 |
$71.90
|
|
Ugt1a1 gene analy common variants
|
$234.00 |
$234.00 |
$234.00 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$116.22 |
$116.22 |
$116.22 |
$403.26
|
|
Ultrasound bone density measure
|
$116.22 |
$116.22 |
$116.22 |
$117.81
|
|
Ultrasound breast complete
|
$116.22 |
$116.22 |
$116.22 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$96.23 |
$96.23 |
$96.23 |
$449.35
|
|
Ultrasound chest
|
$116.22 |
$116.22 |
$116.22 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$116.22 |
$116.22 |
$116.22 |
$340.14
|
|
Ultrasound dx ophth b-scan
|
$116.22 |
$116.22 |
$116.22 |
$330.40
|
|
Ultrasound elastography parenchyma
|
$116.22 |
$116.22 |
$116.22 |
$284.25
|
|
Ultrasound encephalogram
|
$116.22 |
$116.22 |
$116.22 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$116.22 |
$116.22 |
$116.22 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$116.22 |
$116.22 |
$116.22 |
$477.88
|
|
Ultrasound hips infant dynamic
|
$96.23 |
$96.23 |
$96.23 |
$403.00
|
|
Ultrasound infant hips ltd without stress
|
$96.23 |
$96.23 |
$96.23 |
$321.35
|
|
Ultrasound joint complete left
|
$116.22 |
$116.22 |
$116.22 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$116.22 |
$116.22 |
$116.22 |
$448.50
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$116.22 |
$116.22 |
$116.22 |
$280.02
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$264.17 |
$264.17 |
$264.17 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$116.22 |
$116.22 |
$116.22 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$116.22 |
$116.22 |
$116.22 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$116.22 |
$116.22 |
$116.22 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$116.22 |
$116.22 |
$116.22 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$116.22 |
$116.22 |
$116.22 |
$498.00
|
|
Ultrasound scrotum and contents
|
$116.22 |
$116.22 |
$116.22 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$116.22 |
$116.22 |
$116.22 |
$450.60
|
|
Ultrasound transvaginal non obstetric
|
$116.22 |
$116.22 |
$116.22 |
$567.44
|
|
Ultrasound trgt dyn mbubb 1st les
|
$194.55 |
$194.55 |
$194.55 |
$479.72
|
|
Ultraviolet therapy
|
$10.45 |
$10.45 |
$10.45 |
$42.60
|
|
Umbilical cord occlud w/us
|
$332.44 |
$332.44 |
$332.44 |
$569.50
|
|
Unlistd noninvas vasc dx std
|
$26.76 |
$26.76 |
$26.76 |
$819.65
|
|
Unlisted all/immlg svc/px
|
$26.76 |
$26.76 |
$26.76 |
$28.98
|
|
Unlisted chemotherapy px
|
$50.43 |
$50.43 |
$50.43 |
$153.85
|
|
Unlisted cranfcl&maxlfcl px
|
$253.79 |
$253.79 |
$253.79 |
$3,786.00
|
|
Unlisted CT procedure
|
$96.23 |
$96.23 |
$96.23 |
$1,043.00
|
|
Unlisted cv px dx nuc med
|
$439.15 |
$439.15 |
$439.15 |
$475.51
|
|
Unlisted cytogenetic study
|
$58.39 |
$58.39 |
$58.39 |
$132.48
|
|
Unlisted cytopathology px
|
$58.39 |
$58.39 |
$58.39 |
$71.65
|
|
Unlisted dx gi procedure
|
$170.99 |
$170.99 |
$170.99 |
$482.90
|
|
Unlisted endocrine px dx nuc
|
$439.15 |
$439.15 |
$439.15 |
$475.51
|
|
Unlisted fetal invas px w/us
|
$219.85 |
$219.85 |
$219.85 |
$492.81
|
|
Unlisted fluoroscopic px
|
$96.23 |
$96.23 |
$96.23 |
$324.85
|
|
Unlisted gi px dx nuc med
|
$439.15 |
$439.15 |
$439.15 |
$549.70
|
|
Unlisted gu px dx nuc med
|
$439.15 |
$439.15 |
$439.15 |
$475.51
|
|
Unlisted hystsc px uterus
|
$219.85 |
$219.85 |
$219.85 |
$2,803.60
|
|
Unlisted laparoscopic liver biopy 47379
|
$6,376.26 |
$6,376.26 |
$6,376.26 |
$6,307.38
|
|
Unlisted laparoscopic procedure 49659
|
$6,376.26 |
$6,376.26 |
$6,376.26 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$6,376.26 |
$6,376.26 |
$6,376.26 |
$5,741.00
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$6,376.26 |
$6,376.26 |
$6,376.26 |
$6,904.15
|
|
Unlisted laps px appendix
|
$6,376.26 |
$6,376.26 |
$6,376.26 |
$4,881.00
|
|
Unlisted laps px bladder
|
$6,376.26 |
$6,376.26 |
$6,376.26 |
$6,376.26
|
|
Unlisted laps px endoc sys
|
$6,376.26 |
$6,376.26 |
$6,376.26 |
$6,548.98
|
|
Unlisted laps px esoph
|
$6,376.26 |
$6,376.26 |
$6,376.26 |
$6,429.80
|
|
Unlisted laps px lymphtc sys
|
$6,376.26 |
$6,376.26 |
$6,376.26 |
$6,904.15
|
|
Unlisted laps px ovidct ovry
|
$6,376.26 |
$6,376.26 |
$6,376.26 |
$5,339.00
|
|
Unlisted laps px renal
|
$6,376.26 |
$6,376.26 |
$6,376.26 |
$6,839.00
|
|
Unlisted laps px spleen
|
$6,376.26 |
$6,376.26 |
$6,376.26 |
$6,463.42
|
|
Unlisted laps px testis
|
$6,376.26 |
$6,376.26 |
$6,376.26 |
$6,457.82
|
|
Unlisted laps px ureter
|
$6,376.26 |
$6,376.26 |
$6,376.26 |
$6,376.26
|
|
Unlisted laps px uterus
|
$6,376.26 |
$6,376.26 |
$6,376.26 |
$6,457.82
|
|
Unlisted maxlfcl prosth px
|
$253.79 |
$253.79 |
$253.79 |
$1,432.65
|
|
Unlisted misc path test
|
$58.39 |
$58.39 |
$58.39 |
$89.40
|
