|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$3,322.20
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,355.65
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,328.30
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,190.24
|
|
Trnsplj pd lvr&bwl cd154+cll
|
$704.80 |
$704.80 |
$704.80 |
$640.73
|
|
Trnspl rej kdn mrna qpcr 139
|
$1,727.94 |
$1,727.94 |
$1,727.94 |
$3,240.00
|
|
Troponin quantitative
|
$13.72 |
$13.72 |
$13.72 |
$123.75
|
|
Tr retinal les preterm inf
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$1,736.63
|
|
Trurl dstrj prst8 tiss rf wv
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$4,385.60
|
|
Tubal Ligation (Laparoscopic)
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$4,948.77
|
|
Tumor cell deplete of harvst
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$547.20
|
|
Tvh >250 gms 58290
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$6,839.00
|
|
Tx atrial fib pulm vein isol
|
$10,182.94 |
$10,182.94 |
$10,182.94 |
$32,426.20
|
|
Tx closed distal humerus fx
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$786.00
|
|
Tx closed hip disl traumatic without anes
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$657.28
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$3,874.79
|
|
Tx closed tib shaft fx without manip
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$635.46
|
|
Tx contour defects >10.0 cc
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$755.08
|
|
Tx contour defects 1.1-5.0cc 11951
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$724.37
|
|
Tx l/r atrial fib addl
|
$2,028.48 |
$2,028.48 |
$2,028.48 |
$7,717.80
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$4,449.44
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$4,499.12
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$4,281.00
|
|
Tx open nsl fx uncomp
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$4,007.22
|
|
Tx open nsl sptl fx
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$4,289.04
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$469.20
|
|
Tympanic membrane repair
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$1,856.00
|
|
Tympanolysis transcanal 69450
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$3,837.72
|
|
Tympanometry & reflex thresh
|
$74.01 |
$74.01 |
$74.01 |
$173.18
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$911.43
|
|
Tympp antrt/mastoidotomy prosthesis torp 69637
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$6,740.80
|
|
Tympp antrt/mastoid without ossic chain recnst 69635
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$6,547.81
|
|
Tyms gene com variants
|
$192.29 |
$192.29 |
$192.29 |
$192.29
|
|
U2af1 gene common variants
|
$212.58 |
$212.58 |
$212.58 |
$193.25
|
|
Ua w/micro/comp poc
|
$4.42 |
$4.42 |
$4.42 |
$24.45
|
|
Ugt1a1 gene analy common variants
|
$257.40 |
$257.40 |
$257.40 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$194.95 |
$194.95 |
$194.95 |
$403.26
|
|
Ultrasound chest
|
$209.67 |
$209.67 |
$209.67 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$118.16 |
$118.16 |
$118.16 |
$340.14
|
|
Ultrasound elastography ea l target les
|
$77.85 |
$77.85 |
$77.85 |
$136.11
|
|
Ultrasound elastography parenchyma
|
$200.71 |
$200.71 |
$200.71 |
$284.25
|
|
Ultrasound encephalogram
|
$141.84 |
$141.84 |
$141.84 |
$481.60
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$169.36 |
$169.36 |
$169.36 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$130.53 |
$130.53 |
$130.53 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$193.88 |
$193.88 |
$193.88 |
$701.35
|
|
Ultrasound guide intraoperative
|
$211.59 |
$211.59 |
$211.59 |
$632.90
|
|
Ultrasound guide tissue ablation
|
$133.52 |
$133.52 |
$133.52 |
$498.40
|
|
Ultrasound hips infant dynamic
|
$213.08 |
$213.08 |
$213.08 |
$403.00
|
|
Ultrasound infant hips ltd without stress
|
$147.60 |
$147.60 |
$147.60 |
$321.35
|
|
Ultrasound ob >=14wks ea addl gest
|
$107.28 |
$107.28 |
$107.28 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$73.58 |
$73.58 |
$73.58 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$196.87 |
$196.87 |
$196.87 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$152.29 |
$152.29 |
$152.29 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$185.99 |
$185.99 |
$185.99 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$166.58 |
$166.58 |
$166.58 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$122.43 |
$122.43 |
$122.43 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$188.55 |
$188.55 |
$188.55 |
$498.00
|
|
Ultrasound scrotum and contents
|
$193.67 |
$193.67 |
$193.67 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$153.36 |
$153.36 |
$153.36 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$101.10 |
$101.10 |
$101.10 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$228.01 |
$228.01 |
$228.01 |
$567.44
|
|
Umbilical cord occlud w/us
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$569.50
|
|
Unlisted cranfcl&maxlfcl px
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$3,786.00
|
|
Unlisted fetal invas px w/us
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$492.81
|
|
Unlisted fluoroscopic px
|
$147.39 |
$147.39 |
$147.39 |
$324.85
|
|
Unlisted hystsc px uterus
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,803.60
|
|
Unlisted laparoscopic liver biopy 47379
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$6,307.38
|
|
Unlisted laparoscopic procedure 49659
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$5,741.00
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$6,904.15
|
|
Unlisted laps px appendix
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$4,881.00
|
|
Unlisted laps px bladder
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$6,376.26
|
|
Unlisted laps px endoc sys
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$6,548.98
|
|
Unlisted laps px esoph
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$6,429.80
|
|
Unlisted laps px lymphtc sys
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$6,904.15
|
|
Unlisted laps px ovidct ovry
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$5,339.00
|
|
Unlisted laps px renal
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$6,839.00
|
|
Unlisted laps px spleen
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$6,463.42
|
|
Unlisted laps px testis
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$6,457.82
|
|
Unlisted laps px ureter
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$6,376.26
|
|
Unlisted laps px uterus
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$6,457.82
|
|
Unlisted maxlfcl prosth px
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$1,432.65
|
|
Unlisted mr procedure
|
$1,096.57 |
$1,096.57 |
$1,096.57 |
$1,032.20
|
|
Unlisted muscskel px head
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$274.80
|
|
Unlisted neurological dx px
|
$87.23 |
$87.23 |
$87.23 |
$185.15
|
|
Unlisted orl service/px
|
$84.25 |
$84.25 |
$84.25 |
$121.50
|
|
Unlisted procedure colon
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$1,580.44
|
|
Unlisted procedure esophagus
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$1,215.50
|
|
Unlisted procedure eyelids
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$479.62
|
|
Unlisted procedure larynx
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$4,350.00
|
|
Unlisted procedure liver
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,694.00
|
|
Unlisted procedure microbiology
|
$23.67 |
$23.67 |
$23.67 |
$487.50
|
|
Unlisted procedure orbit
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$353.74
|
|
Unlisted procedure pancreas
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,967.75
|
|
Unlisted procedure rectum
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$1,278.72
|
|
Unlisted procedure spine
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$4,706.35
|
|
Unlisted px abdomen muscskel
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,633.80
|
|
Unlisted px accessory sinus
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$257.26
|
