|
Tx atrial fib pulm vein isol
|
$9,944.24 |
$9,944.24 |
$9,944.24 |
$32,426.20
|
|
Tx closed distal humerus fx
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$786.00
|
|
Tx closed hip disl traumatic without anes
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$657.28
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,874.79
|
|
Tx closed tib shaft fx without manip
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$635.46
|
|
Tx contour defects >10.0 cc
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$755.08
|
|
Tx contour defects 1.1-5.0cc 11951
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$724.37
|
|
Tx l/r atrial fib addl
|
$1,980.93 |
$1,980.93 |
$1,980.93 |
$7,717.80
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$4,449.44
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$4,499.12
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$4,281.00
|
|
Tx open nsl fx uncomp
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$4,007.22
|
|
Tx open nsl sptl fx
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$4,289.04
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$469.20
|
|
Tympanic membrane repair
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,856.00
|
|
Tympanolysis transcanal 69450
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,837.72
|
|
Tympanometry & reflex thresh
|
$72.28 |
$72.28 |
$72.28 |
$173.18
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$911.43
|
|
Tympp antrt/mastoidotomy prosthesis torp 69637
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$6,740.80
|
|
Tympp antrt/mastoid without ossic chain recnst 69635
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$6,547.81
|
|
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
|
$190.38 |
$190.38 |
$190.38 |
$403.26
|
|
Ultrasound chest
|
$204.75 |
$204.75 |
$204.75 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$115.39 |
$115.39 |
$115.39 |
$340.14
|
|
Ultrasound elastography parenchyma
|
$196.01 |
$196.01 |
$196.01 |
$284.25
|
|
Ultrasound encephalogram
|
$138.51 |
$138.51 |
$138.51 |
$481.60
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$165.39 |
$165.39 |
$165.39 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$127.47 |
$127.47 |
$127.47 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$189.34 |
$189.34 |
$189.34 |
$701.35
|
|
Ultrasound guide intraoperative
|
$206.63 |
$206.63 |
$206.63 |
$632.90
|
|
Ultrasound guide tissue ablation
|
$130.39 |
$130.39 |
$130.39 |
$498.40
|
|
Ultrasound hips infant dynamic
|
$208.09 |
$208.09 |
$208.09 |
$403.00
|
|
Ultrasound infant hips ltd without stress
|
$144.14 |
$144.14 |
$144.14 |
$321.35
|
|
Ultrasound ob >=14wks ea addl gest
|
$104.77 |
$104.77 |
$104.77 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$71.86 |
$71.86 |
$71.86 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$192.26 |
$192.26 |
$192.26 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$148.72 |
$148.72 |
$148.72 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$181.63 |
$181.63 |
$181.63 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$162.68 |
$162.68 |
$162.68 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$119.56 |
$119.56 |
$119.56 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$184.13 |
$184.13 |
$184.13 |
$498.00
|
|
Ultrasound scrotum and contents
|
$189.13 |
$189.13 |
$189.13 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$149.76 |
$149.76 |
$149.76 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$98.73 |
$98.73 |
$98.73 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$222.67 |
$222.67 |
$222.67 |
$567.44
|
|
Umbilical cord occlud w/us
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$569.50
|
|
Unlisted cranfcl&maxlfcl px
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,786.00
|
|
Unlisted fetal invas px w/us
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$492.81
|
|
Unlisted hystsc px uterus
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,803.60
|
|
Unlisted laparoscopic liver biopy 47379
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$6,307.38
|
|
Unlisted laparoscopic procedure 49659
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,741.00
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$6,904.15
|
|
Unlisted laps px appendix
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$4,881.00
|
|
Unlisted laps px bladder
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$6,376.26
|
|
Unlisted laps px endoc sys
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$6,548.98
|
|
Unlisted laps px esoph
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$6,429.80
|
|
Unlisted laps px lymphtc sys
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$6,904.15
|
|
Unlisted laps px ovidct ovry
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$5,339.00
|
|
Unlisted laps px renal
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$6,839.00
|
|
Unlisted laps px spleen
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$6,463.42
|
|
Unlisted laps px testis
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$6,457.82
|
|
Unlisted laps px ureter
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$6,376.26
|
|
Unlisted laps px uterus
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$6,457.82
|
|
Unlisted maxlfcl prosth px
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,432.65
|
|
Unlisted misc path test
|
$7.29 |
$7.29 |
$7.29 |
$89.40
|
|
Unlisted muscskel px head
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$274.80
|
|
Unlisted procedure colon
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,580.44
|
|
Unlisted procedure esophagus
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,215.50
|
|
Unlisted procedure eyelids
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$479.62
|
|
Unlisted procedure larynx
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$4,350.00
|
|
Unlisted procedure liver
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,694.00
|
|
Unlisted procedure microbiology
|
$23.12 |
$23.12 |
$23.12 |
$487.50
|
|
Unlisted procedure orbit
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$353.74
|
|
Unlisted procedure pancreas
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,967.75
|
|
Unlisted procedure rectum
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,278.72
|
|
Unlisted procedure spine
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$4,706.35
|
|
Unlisted px abdomen muscskel
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,633.80
|
|
Unlisted px accessory sinus
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$257.26
|
|
Unlisted px ant segment eye
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,698.92
|
|
Unlisted px arthroscopy
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$4,087.20
|
|
Unlisted px biliary tract
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,718.10
|
|
Unlisted px casting/strpg
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$224.93
|
|
Unlisted px conjunctiva
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$353.74
|
|
Unlisted px exc pressure ulc
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$832.60
|
|
Unlisted px external ear
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$354.00
|
|
Unlisted px extraocular musc
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$352.04
|
|
Unlisted px foot/toes
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,105.70
|
|
Unlisted px forearm/wrist
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$3,521.60
|
|
Unlisted px hands/fingers
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$379.44
|
|
Unlisted px inner ear
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$4,881.00
|
|
Unlisted px lacrimal system
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$359.15
|
|
Unlisted px leg/ankle
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$811.00
|
|
Unlisted px male genital sys
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$897.95
|
|
Unlisted px middle ear
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,975.05
|
|
Unlisted px neck/thorax
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,680.22
|
|
Unlisted px palate uvula
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$257.04
|
|
Unlisted px pelvis/hip joint
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,108.82
|
