|
Triptorelin pamoate
|
$1,706.82 |
$1,706.82 |
$1,706.82 |
$4,619.39
|
|
Trml dstrj ios bvn 1st 2 l/s
|
$15,111.95 |
$15,111.95 |
$21,248.85 |
$15,258.00
|
|
Trml dstrj ios bvn ea addl
|
$10,353.85 |
$10,353.85 |
$10,624.65 |
$7,354.00
|
|
Trmt of fracture (femoral shaft) 27500
|
$520.80 |
$520.80 |
$1,322.09 |
$754.80
|
|
Trnscath plc stent crv crtd without prtct
|
$9,687.14 |
$9,687.14 |
$19,103.10 |
$7,795.71
|
|
Trnscath plc stent crv crtd w/prtct
|
$13,302.73 |
$13,302.73 |
$19,103.10 |
$9,767.25
|
|
Trnscath plc stnt ante carotid art
|
$10,132.11 |
$10,132.11 |
$19,103.10 |
$6,046.25
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$9,418.42 |
$9,418.42 |
$11,631.90 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$10,946.25 |
$10,946.25 |
$11,631.90 |
$8,790.54
|
|
Trnscath plc vas stent w/s&i ini vein
|
$11,631.90 |
$11,631.90 |
$16,687.70 |
$14,558.70
|
|
Trnscath retrv pq vasc fb w/guide
|
$5,398.35 |
$5,398.35 |
$5,602.90 |
$4,766.40
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$3,267.30 |
$3,267.30 |
$5,361.72 |
$5,139.20
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$4,250.25 |
$4,250.25 |
$4,960.05 |
$4,350.00
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$4,250.25 |
$4,250.25 |
$5,428.93 |
$4,379.34
|
|
Trnscath tx thromblytc vein ini day
|
$3,866.70 |
$3,866.70 |
$4,522.76 |
$3,866.70
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$3,840.60 |
$3,840.60 |
$5,938.20 |
$4,727.52
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$2,239.50 |
$2,239.50 |
$3,110.10 |
$2,377.62
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$1,626.30 |
$1,626.30 |
$2,986.34 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$7,371.75 |
$7,371.75 |
$7,371.75 |
$3,091.20
|
|
Troponin quantitative
|
$241.65 |
$339.75 |
$353.40 |
$127.20
|
|
Tr retinal les preterm inf
|
$1,736.63 |
$1,736.63 |
$1,736.63 |
$1,794.00
|
|
Truskin, per sq centimeter
|
$230.63 |
$230.63 |
$230.63 |
$1.00
|
|
Tte w or without contr, cont ecg
|
$1,802.10 |
$1,802.10 |
$2,198.34 |
$2,075.90
|
|
Tte w or without fol w/con,stres
|
$1,375.35 |
$1,375.35 |
$1,375.35 |
$1,632.80
|
|
Tube drain vert dev st 5-40f
|
$27.60 |
$27.60 |
$27.60 |
$27.60
|
|
Tube trach disp innr can 5 xlt
|
$667.76 |
$1,217.70 |
$1,217.70 |
$445.99
|
|
Tube trach disp innr can 6 xlt
|
$329.64 |
$329.64 |
$329.64 |
$16.80
|
|
Tube trach fen sz 6 uncuffed
|
$846.24 |
$846.24 |
$846.24 |
$155.98
|
|
Tubular dressing
|
$139.53 |
$139.53 |
$139.53 |
$28.46
|
|
Tx atrial fib pulm vein isol
|
$14,791.50 |
$14,791.50 |
$36,478.99 |
$29,030.54
|
|
Tx closed distal humerus fx
|
$4,298.11 |
$4,298.11 |
$4,298.11 |
$594.88
|
|
Tx closed hip disl traumatic without anes
|
$279.90 |
$279.90 |
$649.67 |
$586.80
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$3,406.82 |
$3,406.82 |
$4,829.55 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$256.95 |
$256.95 |
$757.39 |
$535.60
|
|
Tx l/r atrial fib addl
|
$7,396.05 |
$7,396.05 |
$12,204.38 |
$6,986.85
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$3,331.35 |
$3,331.35 |
$5,003.40 |
$4,499.12
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$3,331.35 |
$3,331.35 |
$5,737.64 |
$4,499.12
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$3,476.21 |
$3,476.21 |
$3,476.21 |
$4,499.12
|
|
Tx open nsl fx uncomp
|
$5,143.95 |
$5,143.95 |
$5,143.95 |
$3,837.72
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$2,911.20 |
$2,911.20 |
$5,175.49 |
$4,529.60
|
|
Tx tarsal bone fx without manip 28450
|
$256.95 |
$256.95 |
$256.95 |
$419.73
|
|
Ua w/micro/comp poc
|
$39.33 |
$39.33 |
$39.33 |
$23.00
|
|
Ugt1a1 gene analy common variants
|
$1,476.60 |
$1,476.60 |
$1,476.60 |
$438.75
|
|
Ultrasound breast complete
|
$383.10 |
$442.26 |
$766.05 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$346.19 |
$383.10 |
$766.05 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$340.14 |
$340.14 |
$340.14 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$366.50 |
$366.50 |
$366.50 |
$296.80
|
|
Ultrasound elastography ea l target les
|
$545.55 |
$545.55 |
$545.55 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$232.30 |
$232.30 |
$545.55 |
$313.95
|
|
Ultrasound encephalogram
|
$496.36 |
$762.60 |
$762.60 |
$494.92
|
|
Ultrasound exam follow-up
|
$189.00 |
$189.00 |
$189.00 |
$226.38
|
|
Ultrasound exam k transpl w/doppler
|
$545.55 |
$545.55 |
$684.31 |
$575.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$404.98 |
$404.98 |
$469.50 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$720.15 |
$720.15 |
$909.17 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$532.95 |
$532.95 |
$631.95 |
$388.08
|
|
Ultrasound guide intraoperative
|
$632.85 |
$632.85 |
$632.90 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$422.75 |
$422.75 |
$422.75 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$403.88 |
$484.95 |
$484.95 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$220.50 |
$220.50 |
$359.55 |
$311.25
|
|
Ultrasound joint complete left
|
$484.95 |
$484.95 |
$623.67 |
$557.99
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$265.61 |
$277.80 |
$277.80 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$317.85 |
$317.85 |
$470.69 |
$409.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$317.85 |
$317.85 |
$362.59 |
$335.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$641.40 |
$641.40 |
$690.48 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$254.70 |
$254.70 |
$393.32 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$545.16 |
$557.40 |
$557.40 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$450.60 |
$545.55 |
$545.55 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$397.03 |
$417.15 |
$417.15 |
$421.00
|
|
Ultrasound trgt dyn mbubb 1st les
|
$622.88 |
$622.88 |
$622.88 |
$568.32
|
|
Ultrasound trgt dyn mbubb ea addl
|
$294.97 |
$294.97 |
$294.97 |
$348.00
|
|
Umbilical artery cath newborn 36660
|
$973.63 |
$973.63 |
$973.63 |
$223.80
|
|
Unit mobile power mpu
|
$16,315.20 |
$16,315.20 |
$16,315.20 |
$14,359.52
|
|
Unlistd noninvas vasc dx std
|
$1,012.44 |
$1,012.44 |
$1,105.80 |
$564.60
|
|
Unlisted chemotherapy px
|
$507.17 |
$507.17 |
$507.17 |
$143.75
|
|
Unlisted cranfcl&maxlfcl px
|
$6,289.53 |
$6,289.53 |
$6,289.53 |
$571.20
|
|
Unlisted CT procedure
|
$3,852.68 |
$3,852.68 |
$3,852.68 |
$732.70
|
|
Unlisted cytogenetic study
|
$310.46 |
$310.46 |
$310.46 |
$160.00
|
|
Unlisted dialysis procedure
|
$3,148.74 |
$3,148.74 |
$3,148.74 |
$1,144.00
|
|
Unlisted fetal invas px w/us
|
$492.81 |
$492.81 |
$492.81 |
$498.40
|
|
Unlisted fluoroscopic px
|
$3,433.99 |
$3,433.99 |
$3,433.99 |
$305.76
|
|
Unlisted laparoscopic liver biopy 47379
|
$3,495.74 |
$3,495.74 |
$3,495.74 |
$6,307.38
|
|
Unlisted laparoscopic procedure 49659
|
$6,838.32 |
$6,838.32 |
$6,838.32 |
$6,838.32
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$9,492.80 |
$9,492.80 |
$9,492.80 |
$6,463.42
|
|
Unlisted laps px appendix
|
$2,890.09 |
$2,890.09 |
$2,890.09 |
$3,617.40
|
|
Unlisted laps px endoc sys
|
$6,548.98 |
$6,548.98 |
$6,548.98 |
$5,855.00
|
|
Unlisted laps px lymphtc sys
|
$10,488.59 |
$10,488.59 |
$10,488.59 |
$6,870.89
|
|
Unlisted laps px renal
|
$3,891.34 |
$3,891.34 |
$3,891.34 |
$5,110.00
|
|
Unlisted maxlfcl prosth px
|
$1,607.44 |
$1,607.44 |
$1,607.44 |
$571.20
|
|
Unlisted misc path test
|
$89.40 |
$89.40 |
$89.40 |
$89.40
|
|
Unlisted mr procedure
|
$1,728.00 |
$1,728.00 |
$1,728.00 |
$1,163.00
|
|
Unlisted neurological dx px
|
$243.15 |
$243.15 |
$243.15 |
$242.50
|
|
Unlisted orl service/px
|
$343.84 |
$343.84 |
$343.84 |
$132.60
|
|
Unlisted procedure colon
|
$1,569.10 |
$1,569.10 |
$1,569.10 |
$1,839.55
|
|
Unlisted procedure esophagus
|
$442.53 |
$442.53 |
$442.53 |
$1,998.88
|
|
Unlisted procedure larynx
|
$221.40 |
$221.40 |
$5,107.38 |
$924.00
|
|
Unlisted procedure liver
|
$3,003.11 |
$3,003.11 |
$3,003.11 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$837.00 |
$837.00 |
$1,069.61 |
$530.00
|
|
Unlisted procedure orbit
|
$334.84 |
$334.84 |
$334.84 |
$437.00
|
|
Unlisted procedure pancreas
|
$6,597.79 |
$6,597.79 |
$6,597.79 |
$4,810.00
|
|
Unlisted procedure rectum
|
$1,603.06 |
$1,603.06 |
$2,510.70 |
$1,223.20
|
