|
Treat metatarsal fracture
|
$2,488.00 |
$2,488.00 |
$2,488.00 |
$8,453.60
|
|
Treat midfoot fracture each
|
$1,848.00 |
$1,848.00 |
$1,848.00 |
$1,851.78
|
|
Treat midfoot fracture each
|
$1,727.88 |
$1,727.88 |
$1,727.88 |
$6,192.78
|
|
Treat thigh fracture
|
$283.50 |
$283.50 |
$283.50 |
$661.00
|
|
Treat thigh fracture
|
$1,848.00 |
$1,848.00 |
$1,848.00 |
$1,893.86
|
|
Treat thigh fracture
|
$3,127.50 |
$3,127.50 |
$3,127.50 |
$4,726.80
|
|
Treat thigh fracture
|
$283.50 |
$283.50 |
$283.50 |
$618.80
|
|
Treat thumb fracture
|
$2,448.50 |
$2,448.50 |
$2,448.50 |
$2,508.80
|
|
Treat ulnar fracture
|
$2,113.00 |
$2,113.00 |
$2,113.00 |
$1,662.00
|
|
Treat ulnar fracture
|
$7,747.50 |
$7,747.50 |
$7,747.50 |
$5,926.25
|
|
Treat wrist bone fracture
|
$1,848.00 |
$1,848.00 |
$1,848.00 |
$1,548.40
|
|
Treponema pallidum antibody
|
$48.50 |
$48.50 |
$48.50 |
$70.40
|
|
Trg gene rearrangement anal
|
$699.00 |
$699.00 |
$699.00 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$6.75 |
$6.75 |
$6.75 |
$43.21
|
|
Triamcinolone a inj prs-free
|
$53.50 |
$53.50 |
$53.50 |
$223.56
|
|
Trichinella antibody
|
$39.00 |
$39.00 |
$39.00 |
$70.20
|
|
Trichomonas assay w/optic
|
$39.50 |
$39.50 |
$39.50 |
$55.50
|
|
#tricyclicantidprssnt
|
$5.00 |
$5.00 |
$5.00 |
$50.86
|
|
Triglycerides
|
$51.00 |
$51.00 |
$51.00 |
$58.05
|
|
Triptorelin pamoate
|
$1,737.00 |
$1,737.00 |
$1,737.00 |
$4,619.39
|
|
Trnscath plc stnt ante carotid art
|
$14,686.50 |
$14,686.50 |
$14,686.50 |
$6,069.00
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$361.00 |
$361.00 |
$361.00 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$361.00 |
$361.00 |
$361.00 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$7,110.50 |
$7,110.50 |
$7,110.50 |
$15,330.11
|
|
Trnscath retrv pq vasc fb w/guide
|
$2,669.50 |
$2,669.50 |
$2,669.50 |
$4,523.96
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$4,687.50 |
$4,687.50 |
$4,687.50 |
$5,069.50
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$2,669.50 |
$2,669.50 |
$2,669.50 |
$4,250.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$2,669.50 |
$2,669.50 |
$2,669.50 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$2,669.50 |
$2,669.50 |
$2,669.50 |
$3,866.70
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$4,073.00 |
$4,073.00 |
$4,073.00 |
$4,713.66
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$2,079.50 |
$2,079.50 |
$2,079.50 |
$2,357.04
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$2,371.50 |
$2,371.50 |
$2,371.50 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$2,371.50 |
$2,371.50 |
$2,371.50 |
$2,371.50
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$2,371.50 |
$2,371.50 |
$2,371.50 |
$2,371.50
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$2,371.50 |
$2,371.50 |
$2,371.50 |
$2,406.77
|
|
Troponin quantitative
|
$96.00 |
$96.00 |
$96.00 |
$127.20
|
|
Trurl dstrj prst8 tiss rf wv
|
$976.00 |
$976.00 |
$976.00 |
$4,228.00
|
|
Tte w or without contr, cont ecg
|
$1,630.00 |
$1,630.00 |
$1,630.00 |
$2,012.40
|
|
Tube trach disp innr can 5 xlt
|
$130.50 |
$130.50 |
$130.50 |
$445.99
|
|
Tx closed hip disl traumatic without anes
|
$308.00 |
$308.00 |
$308.00 |
$581.07
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$3,760.50 |
$3,760.50 |
$3,760.50 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$378.00 |
$378.00 |
$378.00 |
$535.60
|
|
Tx contour defects >10.0 cc
|
$849.50 |
$849.50 |
$849.50 |
$944.00
|
|
Tx contour defects 1.1-5.0cc 11951
|
$849.50 |
$849.50 |
$849.50 |
$804.23
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$4,447.00 |
$4,447.00 |
$4,447.00 |
$4,468.55
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$4,421.00 |
$4,421.00 |
$4,421.00 |
$4,421.00
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$3,760.50 |
$3,760.50 |
$3,760.50 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$283.50 |
$283.50 |
$283.50 |
$416.16
|
|
Tympanic membrane repair
|
$1,783.50 |
$1,783.50 |
$1,783.50 |
$2,638.87
|
|
Ua w/micro/comp poc
|
$24.50 |
$24.50 |
$24.50 |
$23.00
|
|
Ugt1a1 gene analy common variants
|
$180.00 |
$180.00 |
$180.00 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$279.50 |
$279.50 |
$279.50 |
$394.20
|
|
Ultrasound breast complete
|
$499.00 |
$499.00 |
$499.00 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$270.00 |
$270.00 |
$270.00 |
$449.35
|
|
Ultrasound chest
|
$279.50 |
$279.50 |
$279.50 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$174.00 |
$174.00 |
$174.00 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$389.00 |
$389.00 |
$389.00 |
$296.80
|
|
Ultrasound encephalogram
|
$249.50 |
$249.50 |
$249.50 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$249.50 |
$249.50 |
$249.50 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$279.50 |
$279.50 |
$279.50 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$490.00 |
$490.00 |
$490.00 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$824.50 |
$824.50 |
$824.50 |
$720.15
|
|
Ultrasound guide intraoperative
|
$512.00 |
$512.00 |
$512.00 |
$632.85
|
|
Ultrasound hips infant dynamic
|
$153.50 |
$153.50 |
$153.50 |
$403.88
|
|
Ultrasound joint complete left
|
$499.50 |
$499.50 |
$499.50 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$999.00 |
$999.00 |
$999.00 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$188.50 |
$188.50 |
$188.50 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$188.50 |
$188.50 |
$188.50 |
$331.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$249.50 |
$249.50 |
$249.50 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$272.00 |
$272.00 |
$272.00 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$279.50 |
$279.50 |
$279.50 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$329.50 |
$329.50 |
$329.50 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$279.50 |
$279.50 |
$279.50 |
$486.50
|
|
Ultrasound scrotum and contents
|
$279.50 |
$279.50 |
$279.50 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$249.50 |
$249.50 |
$249.50 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$188.50 |
$188.50 |
$188.50 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$279.50 |
$279.50 |
$279.50 |
$558.35
|
|
Unlisted chemotherapy px
|
$571.50 |
$571.50 |
$571.50 |
$150.00
|
|
Unlisted dialysis procedure
|
$711.50 |
$711.50 |
$711.50 |
$1,144.00
|
|
Unlisted hematology&coagj px
|
$91.00 |
$91.00 |
$91.00 |
$39.52
|
|
Unlisted laparoscopic liver biopy 47379
|
$4,549.67 |
$4,549.67 |
$4,549.67 |
$5,419.00
|
|
Unlisted maaa
|
$587.00 |
$587.00 |
$587.00 |
$235.20
|
|
Unlisted neurological dx px
|
$192.00 |
$192.00 |
$192.00 |
$242.50
|
|
Unlisted procedure colon
|
$1,235.00 |
$1,235.00 |
$1,235.00 |
$1,702.50
|
|
Unlisted procedure larynx
|
$272.00 |
$272.00 |
$272.00 |
$924.00
|
|
Unlisted procedure microbiology
|
$6.50 |
$6.50 |
$6.50 |
$523.50
|
|
Unlisted procedure rectum
|
$1,235.00 |
$1,235.00 |
$1,235.00 |
$1,220.35
|
|
Unlisted procedure spine
|
$283.50 |
$283.50 |
$283.50 |
$4,659.85
|
|
Unlisted px abdomen muscskel
|
$2,053.50 |
$2,053.50 |
$2,053.50 |
$1,848.60
|
|
Unlisted px ant segment eye
|
$2,652.50 |
$2,652.50 |
$2,652.50 |
$2,698.92
|
|
Unlisted px arthroscopy
|
$1,354.00 |
$1,354.00 |
$1,354.00 |
$2,765.60
|
|
Unlisted px casting/strpg
|
$216.00 |
$216.00 |
$216.00 |
$219.70
|
|
Unlisted px foot/toes
|
$1,199.88 |
$1,199.88 |
$1,199.88 |
$1,225.50
|
|
Unlisted px hands/fingers
|
$295.00 |
$295.00 |
$295.00 |
$354.20
|
|
Unlisted px lacrimal system
|
$365.00 |
$365.00 |
$365.00 |
$416.50
|
|
Unlisted px leg/ankle
|
$324.00 |
$324.00 |
$324.00 |
$811.00
|
|
Unlisted px middle ear
|
$272.00 |
$272.00 |
$272.00 |
$343.50
|
|
Unlisted px posterior segmnt
|
$2,652.50 |
$2,652.50 |
$2,652.50 |
$3,173.34
|
|
Unlisted px small intestine
|
$1,042.50 |
$1,042.50 |
$1,042.50 |
$2,102.10
|
|
Unlisted px tongue flr mouth
|
$272.00 |
$272.00 |
$272.00 |
$282.50
|
