|
Trnscath plc stnt ante carotid art
|
$6,091.50 |
$6,091.50 |
$6,091.50 |
$6,069.00
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$6,041.00 |
$6,041.00 |
$6,041.00 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$6,637.00 |
$6,637.00 |
$6,637.00 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$13,723.00 |
$13,723.00 |
$13,723.00 |
$15,330.11
|
|
Trnscath retrv pq vasc fb w/guide
|
$4,205.50 |
$4,205.50 |
$4,205.50 |
$4,523.96
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$1,814.00 |
$1,814.00 |
$1,814.00 |
$5,069.50
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$3,116.50 |
$3,116.50 |
$3,116.50 |
$4,250.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$3,116.50 |
$3,116.50 |
$3,116.50 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$1,589.00 |
$1,589.00 |
$1,589.00 |
$3,866.70
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$3,215.50 |
$3,215.50 |
$3,215.50 |
$4,713.66
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$3,169.00 |
$3,169.00 |
$3,169.00 |
$2,357.04
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$1,564.00 |
$1,564.00 |
$1,564.00 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$1,761.50 |
$1,761.50 |
$1,761.50 |
$3,078.00
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$2,145.00 |
$2,145.00 |
$2,145.00 |
$2,371.50
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$1,707.00 |
$1,707.00 |
$1,707.00 |
$2,371.50
|
|
Troponin quantitative
|
$93.00 |
$93.00 |
$93.00 |
$127.20
|
|
Tte w or without fol w/cont, com
|
$1,177.00 |
$1,177.00 |
$1,177.00 |
$1,220.31
|
|
Tte w or without fol w/cont, f/u
|
$901.00 |
$901.00 |
$901.00 |
$1,077.92
|
|
Tube trach fen sz 6 uncuffed
|
$101.00 |
$101.00 |
$101.00 |
$155.98
|
|
Tx atrial fib pulm vein isol
|
$15,265.00 |
$15,265.00 |
$15,265.00 |
$29,030.54
|
|
Tx closed hip disl traumatic without anes
|
$218.00 |
$218.00 |
$218.00 |
$581.07
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$1,615.00 |
$1,615.00 |
$1,615.00 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$285.00 |
$285.00 |
$285.00 |
$535.60
|
|
Tx l/r atrial fib addl
|
$4,041.50 |
$4,041.50 |
$4,041.50 |
$6,769.00
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$2,143.50 |
$2,143.50 |
$2,143.50 |
$4,468.55
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$3,116.00 |
$3,116.00 |
$3,116.00 |
$4,421.00
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$3,636.50 |
$3,636.50 |
$3,636.50 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$256.50 |
$256.50 |
$256.50 |
$416.16
|
|
Tympanic membrane repair
|
$2,900.50 |
$2,900.50 |
$2,900.50 |
$2,638.87
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$929.00 |
$929.00 |
$929.00 |
$911.43
|
|
Ua w/micro/comp poc
|
$16.00 |
$16.00 |
$16.00 |
$23.00
|
|
Ugt1a1 gene analy common variants
|
$912.50 |
$912.50 |
$912.50 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$114.00 |
$114.00 |
$114.00 |
$394.20
|
|
Ultrasound breast complete
|
$448.00 |
$448.00 |
$448.00 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$424.00 |
$424.00 |
$424.00 |
$449.35
|
|
Ultrasound chest
|
$294.00 |
$294.00 |
$294.00 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$261.50 |
$261.50 |
$261.50 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$209.50 |
$209.50 |
$209.50 |
$296.80
|
|
Ultrasound elastography ea l target les
|
$84.00 |
$84.00 |
$84.00 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$112.00 |
$112.00 |
$112.00 |
$307.00
|
|
Ultrasound encephalogram
|
$364.50 |
$364.50 |
$364.50 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$233.00 |
$233.00 |
$233.00 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$225.00 |
$225.00 |
$225.00 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$202.00 |
$202.00 |
$202.00 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$446.00 |
$446.00 |
$446.00 |
$720.15
|
|
Ultrasound guide intraoperative
|
$468.50 |
$468.50 |
$468.50 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$154.00 |
$154.00 |
$154.00 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$177.00 |
$177.00 |
$177.00 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$154.00 |
$154.00 |
$154.00 |
$311.25
|
|
Ultrasound joint complete left
|
$126.50 |
$126.50 |
$126.50 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$82.50 |
$82.50 |
$82.50 |
$425.45
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$132.50 |
$132.50 |
$132.50 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$550.00 |
$550.00 |
$550.00 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$189.00 |
$189.00 |
$189.00 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$298.50 |
$298.50 |
$298.50 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$282.00 |
$282.00 |
$282.00 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$231.00 |
$231.00 |
$231.00 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$202.50 |
$202.50 |
$202.50 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$216.00 |
$216.00 |
$216.00 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$230.00 |
$230.00 |
$230.00 |
$486.50
|
|
Ultrasound scrotum and contents
|
$388.00 |
$388.00 |
$388.00 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$263.00 |
$263.00 |
$263.00 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$233.00 |
$233.00 |
$233.00 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$338.00 |
$338.00 |
$338.00 |
$558.35
|
|
Ultrasound trgt dyn mbubb 1st les
|
$200.00 |
$200.00 |
$200.00 |
$568.32
|
|
Ultrasound trgt dyn mbubb ea addl
|
$150.00 |
$150.00 |
$150.00 |
$348.00
|
|
Umbilical artery cath newborn 36660
|
$959.00 |
$959.00 |
$959.00 |
$206.64
|
|
Unit mobile power mpu
|
$12,973.00 |
$12,973.00 |
$12,973.00 |
$14,612.80
|
|
Unlisted chemotherapy px
|
$11.50 |
$11.50 |
$11.50 |
$150.00
|
|
Unlisted CT procedure
|
$563.50 |
$563.50 |
$563.50 |
$732.70
|
|
Unlisted endocrine px dx nuc
|
$249.50 |
$249.50 |
$249.50 |
$569.91
|
|
Unlisted fluoroscopic px
|
$1,290.00 |
$1,290.00 |
$1,290.00 |
$305.76
|
|
Unlisted mr procedure
|
$448.00 |
$448.00 |
$448.00 |
$1,163.00
|
|
Unlisted oph svc/procedure
|
$83.00 |
$83.00 |
$83.00 |
$40.26
|
|
Unlisted procedure colon
|
$1,254.00 |
$1,254.00 |
$1,254.00 |
$1,702.50
|
|
Unlisted procedure liver
|
$5,342.00 |
$5,342.00 |
$5,342.00 |
$2,287.20
|
|
Unlisted procedure pancreas
|
$7,209.50 |
$7,209.50 |
$7,209.50 |
$3,986.00
|
|
Unlisted procedure rectum
|
$813.00 |
$813.00 |
$813.00 |
$1,220.35
|
|
Unlisted procedure spine
|
$3,819.00 |
$3,819.00 |
$3,819.00 |
$4,659.85
|
|
Unlisted psychiatric service/proc 90899
|
$196.00 |
$196.00 |
$196.00 |
$277.76
|
|
Unlisted px accessory sinus
|
$209.00 |
$209.00 |
$209.00 |
$3,335.28
|
|
Unlisted px ant segment eye
|
$1,697.50 |
$1,697.50 |
$1,697.50 |
$2,698.92
|
|
Unlisted px biliary tract
|
$13,267.00 |
$13,267.00 |
$13,267.00 |
$2,718.10
|
|
Unlisted px inner ear
|
$104.00 |
$104.00 |
$104.00 |
$571.20
|
|
Unlisted px lacrimal system
|
$331.00 |
$331.00 |
$331.00 |
$416.50
|
|
Unlisted px male genital sys
|
$5,363.50 |
$5,363.50 |
$5,363.50 |
$343.55
|
|
Unlisted px neck/thorax
|
$6,337.50 |
$6,337.50 |
$6,337.50 |
$571.20
|
|
Unlisted px palate uvula
|
$666.00 |
$666.00 |
$666.00 |
$274.80
|
|
Unlisted px pelvis/hip joint
|
$4,683.00 |
$4,683.00 |
$4,683.00 |
$3,118.44
|
|
Unlisted px salivry glnd/dux
|
$268.50 |
$268.50 |
$268.50 |
$1,265.16
|
|
Unlisted px small intestine
|
$3,630.00 |
$3,630.00 |
$3,630.00 |
$2,102.10
|
|
Unlisted px tongue flr mouth
|
$1,324.50 |
$1,324.50 |
$1,324.50 |
$282.50
|
|
Unlisted resp px dx nuc med
|
$405.00 |
$405.00 |
$405.00 |
$670.60
|
|
Unsched dialysis esrd pt hos
|
$497.00 |
$497.00 |
$497.00 |
$1,268.17
|
|
Upgrade pm system
|
$2,275.50 |
$2,275.50 |
$2,275.50 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,187.00 |
$1,187.00 |
$1,187.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$935.00 |
$935.00 |
$935.00 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$830.50 |
$830.50 |
$830.50 |
$2,034.41
|
|
Urea nitrogen
|
$24.00 |
$24.00 |
$24.00 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$22.00 |
$22.00 |
$22.00 |
$51.75
|
