|
Trmt of fracture (femoral shaft) 27500
|
$380.50 |
$526.50 |
$526.50 |
|
|
Trnscath plc stent crv crtd without prtct
|
$5,204.40 |
$10,170.00 |
$14,905.00 |
|
|
Trnscath plc stent crv crtd w/prtct
|
$5,412.00 |
$8,506.50 |
$10,793.00 |
|
|
Trnscath plc stnt ante carotid art
|
$6,091.50 |
$7,520.50 |
$8,272.00 |
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$6,041.00 |
$7,458.00 |
$25,961.50 |
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$6,106.00 |
$8,194.00 |
$25,961.50 |
|
|
Trnscath plc vas stent w/s&i ini vein
|
$7,840.00 |
$16,583.40 |
$25,961.50 |
|
|
Trnscath retrv pq vasc fb w/guide
|
$2,195.00 |
$5,708.50 |
$11,575.00 |
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$1,253.00 |
$2,462.50 |
$4,778.00 |
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$2,723.00 |
$4,230.00 |
$16,107.00 |
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$2,723.00 |
$4,230.00 |
$16,107.00 |
|
|
Trnscath tx thromblytc vein ini day
|
$1,252.00 |
$2,157.00 |
$4,778.00 |
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$3,215.50 |
$4,366.00 |
$4,366.00 |
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$3,169.00 |
$4,302.00 |
$4,302.00 |
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$1,564.00 |
$2,427.50 |
$18,200.73 |
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$1,761.50 |
$2,392.00 |
$2,564.50 |
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$2,145.00 |
$2,912.00 |
$2,912.00 |
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$1,707.00 |
$2,318.00 |
$2,318.00 |
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$9,655.27 |
$9,655.27 |
$9,655.27 |
|
|
Troponin quantitative
|
$85.80 |
$129.00 |
$409.00 |
|
|
Trurl dstrj prst8 tiss rf wv
|
$3,056.50 |
$3,056.50 |
$23,763.26 |
|
|
Tte w or without fol w/con,stres
|
$1,503.00 |
$1,503.00 |
$1,503.00 |
|
|
Tte w or without fol w/cont, com
|
$1,111.50 |
$1,111.50 |
$1,177.00 |
|
|
Tte w or without fol w/cont, f/u
|
$851.50 |
$851.50 |
$901.00 |
|
|
Tube trach disp innr can 5 xlt
|
$296.40 |
$1,065.59 |
$1,065.59 |
|
|
Tube trach disp innr can 6 xlt
|
$9.75 |
$9.75 |
$9.75 |
|
|
Tube trach fen sz 6 uncuffed
|
$70.00 |
$101.00 |
$1,381.90 |
|
|
Tubular dressing
|
$144.95 |
$144.95 |
$144.95 |
|
|
Tx atrial fib pulm vein isol
|
$13,320.50 |
$18,845.50 |
$105,901.00 |
|
|
Tx closed hip disl traumatic without anes
|
$218.00 |
$370.00 |
$463.50 |
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$1,615.00 |
$2,233.50 |
$7,289.40 |
|
|
Tx closed tib shaft fx without manip
|
$285.00 |
$393.50 |
$530.40 |
|
|
Tx contour defects 1.1-5.0cc 11951
|
$568.50 |
$568.50 |
$568.50 |
|
|
Tx l/r atrial fib addl
|
$4,041.50 |
$5,139.00 |
$33,168.00 |
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$2,143.50 |
$2,963.50 |
$12,808.68 |
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$3,116.00 |
$4,049.00 |
$4,308.00 |
|
|
Tx open nsl sptl fx
|
$9,837.80 |
$9,837.80 |
$9,837.80 |
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$3,636.50 |
$5,028.00 |
$33,129.20 |
|
|
Tx tarsal bone fx without manip 28450
|
$256.50 |
$354.50 |
$354.50 |
|
|
Tympanic membrane repair
|
$2,900.50 |
$3,938.00 |
$13,399.31 |
|
|
Tympanometry & reflex thresh
|
$108.00 |
$108.00 |
$108.00 |
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$929.00 |
$1,284.50 |
$1,284.50 |
|
|
Ua w/micro/comp poc
|
$13.20 |
$16.00 |
$20.00 |
|
|
Ugt1a1 gene analy common variants
|
$679.20 |
$1,131.00 |
$1,454.50 |
|
|
Ultrasound breast complete
|
$367.50 |
$498.00 |
$852.50 |
|
|
Ultrasound breast unilateral limited (both sides)
|
$276.50 |
$520.50 |
$745.00 |
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$165.60 |
$261.50 |
$434.50 |
|
|
Ultrasound dx ophth b-scan
|
$209.50 |
$233.00 |
$14,077.85 |
|
|
Ultrasound elastography ea l target les
|
$84.00 |
$94.00 |
$94.00 |
|
|
Ultrasound elastography parenchyma
|
$92.50 |
$112.00 |
$124.50 |
|
|
Ultrasound encephalogram
|
$178.00 |
$405.00 |
$2,614.00 |
|
|
Ultrasound exam k transpl w/doppler
|
$176.50 |
$259.00 |
$1,904.00 |
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$151.00 |
$250.50 |
$1,481.00 |
|
|
Ultrasound Guidance for a Needle Procedure
|
$446.00 |
$687.50 |
$990.60 |
|
|
Ultrasound guidance for vascular access
|
$202.00 |
$459.50 |
$1,772.50 |
|
|
Ultrasound guide intraoperative
|
$468.50 |
$539.00 |
$1,513.00 |
|
|
Ultrasound guide tissue ablation
|
$154.00 |
$172.00 |
$504.60 |
|
|
Ultrasound hips infant dynamic
|
$177.00 |
$197.00 |
$1,414.50 |
|
|
Ultrasound infant hips ltd without stress
|
$154.00 |
$207.60 |
$707.50 |
|
|
Ultrasound joint complete left
|
$110.00 |
$435.00 |
$4,789.00 |
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$132.50 |
$147.00 |
$147.00 |
|
|
Ultrasound ob >=14wks ea addl gest
|
$195.50 |
$611.00 |
$2,103.00 |
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$124.00 |
$211.00 |
$2,103.00 |
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$253.50 |
$332.00 |
$2,848.00 |
|
|
Ultrasound pregnant uterus follow up per fetus
|
$127.50 |
$313.50 |
$973.00 |
|
|
Ultrasound prostate/transrectal
|
$216.00 |
$240.00 |
$1,041.95 |
|
|
Ultrasound spinal canal and contents
|
$263.00 |
$420.00 |
$2,554.00 |
|
|
Ultrasound transabd ea addl gest
|
$109.00 |
$259.00 |
$2,848.00 |
|
|
Ultrasound trgt dyn mbubb 1st les
|
$200.00 |
$223.00 |
$223.00 |
|
|
Ultrasound trgt dyn mbubb ea addl
|
$150.00 |
$167.00 |
$167.00 |
|
|
Umbilical artery cath newborn 36660
|
$959.00 |
$1,193.50 |
$1,540.80 |
|
|
Umbilicoplasty 15847
|
$34,935.96 |
$34,935.96 |
$34,935.96 |
|
|
Unit mobile power mpu
|
$10,557.00 |
$12,973.00 |
$15,672.50 |
|
|
Unlisted chemotherapy px
|
$11.50 |
$17.50 |
$72.00 |
|
|
Unlisted cranfcl&maxlfcl px
|
$16,395.02 |
$16,395.02 |
$16,395.02 |
|
|
Unlisted CT procedure
|
$460.00 |
$460.00 |
$586.00 |
|
|
Unlisted dialysis procedure
|
$585.00 |
$585.00 |
$585.00 |
|
|
Unlisted dx gi procedure
|
$4,893.23 |
$4,893.23 |
$4,893.23 |
|
|
Unlisted endocrine px dx nuc
|
$249.50 |
$328.00 |
$328.00 |
|
|
Unlisted fluoroscopic px
|
$160.00 |
$1,290.00 |
$2,139.00 |
|
|
Unlisted hematology&coagj px
|
$96.60 |
$96.60 |
$96.60 |
|
|
Unlisted laparoscopic liver biopy 47379
|
$21,491.70 |
$21,491.70 |
$23,400.68 |
|
|
Unlisted laparoscopic procedure 49659
|
$23,526.02 |
$23,526.02 |
$23,526.02 |
|
|
Unlisted maaa
|
$135.00 |
$135.00 |
$1,411.00 |
|
|
Unlisted maxlfcl prosth px
|
$5,596.00 |
$5,596.00 |
$5,596.00 |
|
|
Unlisted mr procedure
|
$368.50 |
$448.00 |
$482.00 |
|
|
Unlisted oph svc/procedure
|
$83.00 |
$122.50 |
$122.50 |
|
|
Unlisted orl service/px
|
$133.00 |
$133.00 |
$133.00 |
|
|
Unlisted procedure colon
|
$1,254.00 |
$1,702.50 |
$1,702.50 |
|
|
Unlisted procedure larynx
|
$5,863.00 |
$5,863.00 |
$5,863.00 |
|
|
Unlisted procedure liver
|
$5,342.00 |
$7,252.50 |
$22,887.38 |
|
|
Unlisted procedure pancreas
|
$7,209.50 |
$9,788.00 |
$10,081.55 |
|
|
Unlisted procedure rectum
|
$813.00 |
$1,103.50 |
$1,103.50 |
|
|
Unlisted procedure spine
|
$1,293.00 |
$3,819.00 |
$5,185.00 |
|
|
Unlisted psychiatric service/proc 90899
|
$196.00 |
$270.50 |
$270.50 |
|
|
Unlisted px abdomen muscskel
|
$35,628.08 |
$35,628.08 |
$35,628.08 |
|
|
Unlisted px accessory sinus
|
$209.00 |
$284.00 |
$284.00 |
|
|
Unlisted px ant segment eye
|
$1,697.50 |
$2,514.50 |
$21,394.55 |
|
|
Unlisted px arthroscopy
|
$20,205.53 |
$20,205.53 |
$20,205.53 |
|
|
Unlisted px biliary tract
|
$13,267.00 |
$18,011.00 |
$18,011.00 |
|
