|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$5,719.01 |
$5,719.01 |
$5,719.01 |
$4,727.52
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$2,124.68 |
$2,124.68 |
$2,124.68 |
$2,377.62
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$4,549.10 |
$4,549.10 |
$4,549.10 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$4,167.42 |
$4,167.42 |
$4,167.42 |
$3,091.20
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$4,548.51 |
$4,548.51 |
$4,548.51 |
$2,551.20
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$3,174.23 |
$3,174.23 |
$3,174.23 |
$2,486.75
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$2,931.76 |
$2,931.76 |
$2,931.76 |
$2,486.75
|
|
Troponin quantitative
|
$241.65 |
$241.65 |
$241.65 |
$125.00
|
|
Tr retinal les preterm inf
|
$884.17 |
$884.17 |
$884.17 |
$1,794.00
|
|
Trurl dstrj prst8 tiss rf wv
|
$2,656.28 |
$2,656.28 |
$2,656.28 |
$4,228.00
|
|
Tte w or without contr, cont ecg
|
$1,393.28 |
$1,393.28 |
$1,393.28 |
$2,196.00
|
|
Tubal Ligation (Laparoscopic)
|
$4,948.77 |
$4,948.77 |
$4,948.77 |
$4,323.20
|
|
Tube drain vert dev st 5-40f
|
$72.21 |
$72.21 |
$72.21 |
$27.60
|
|
Tube trach disp innr can 5 xlt
|
$667.76 |
$667.76 |
$667.76 |
$445.99
|
|
Tube trach fen sz 6 uncuffed
|
$464.89 |
$464.89 |
$464.89 |
$155.98
|
|
Tubular dressing
|
$20.93 |
$20.93 |
$20.93 |
$28.46
|
|
Tvh >250 gms 58290
|
$6,872.92 |
$6,872.92 |
$6,872.92 |
$6,872.92
|
|
Tx atrial fib pulm vein isol
|
$36,478.99 |
$36,478.99 |
$36,478.99 |
$29,030.54
|
|
Tx closed distal humerus fx
|
$6,339.84 |
$6,339.84 |
$6,339.84 |
$589.00
|
|
Tx closed hip disl traumatic without anes
|
$763.79 |
$763.79 |
$763.79 |
$586.80
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$3,874.79 |
$3,874.79 |
$3,874.79 |
$4,043.32
|
|
Tx closed tib shaft fx without manip
|
$575.33 |
$575.33 |
$575.33 |
$535.60
|
|
Tx contour defects >10.0 cc
|
$1,827.21 |
$1,827.21 |
$1,827.21 |
$918.06
|
|
Tx contour defects 1.1-5.0cc 11951
|
$695.84 |
$695.84 |
$695.84 |
$849.50
|
|
Tx l/r atrial fib addl
|
$6,395.20 |
$6,395.20 |
$6,395.20 |
$6,986.85
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$5,167.55 |
$5,167.55 |
$5,167.55 |
$4,521.61
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$3,636.23 |
$3,636.23 |
$3,636.23 |
$4,537.59
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$3,364.80 |
$3,364.80 |
$3,364.80 |
$4,595.50
|
|
Tx open nsl fx uncomp
|
$4,173.52 |
$4,173.52 |
$4,173.52 |
$3,837.72
|
|
Tx open nsl sptl fx
|
$4,308.40 |
$4,308.40 |
$4,308.40 |
$4,308.40
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$5,585.50 |
$5,585.50 |
$5,585.50 |
$4,529.60
|
|
Tx tarsal bone fx without manip 28450
|
$532.46 |
$532.46 |
$532.46 |
$423.15
|
|
Tympanic membrane repair
|
$2,836.60 |
$2,836.60 |
$2,836.60 |
$2,133.48
|
|
Tympanolysis transcanal 69450
|
$5,550.20 |
$5,550.20 |
$5,550.20 |
$3,837.72
|
|
Tympanometry & reflex thresh
|
$227.29 |
$227.29 |
$227.29 |
$173.18
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$780.46 |
$780.46 |
$780.46 |
$911.43
|
|
Tympp antrt/mastoidotomy prosthesis torp 69637
|
$11,063.54 |
$11,063.54 |
$11,063.54 |
$6,740.80
|
|
Tympp antrt/mastoid without ossic chain recnst 69635
|
$9,481.40 |
$9,481.40 |
$9,481.40 |
$7,000.36
|
|
Tyms gene com variants
|
$1,192.80 |
$1,192.80 |
$1,192.80 |
$192.29
|
|
Ua w/micro/comp poc
|
$34.20 |
$34.20 |
$34.20 |
$23.00
|
|
Ugt1a1 gene analy common variants
|
$1,476.60 |
$1,476.60 |
$1,476.60 |
$438.75
|
|
Ultrasound breast complete
|
$442.26 |
$442.26 |
$442.26 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$346.09 |
$346.09 |
$346.09 |
$452.00
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$322.20 |
$322.20 |
$322.20 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$393.89 |
$393.89 |
$393.89 |
$296.80
|
|
Ultrasound elastography parenchyma
|
$399.40 |
$399.40 |
$399.40 |
$307.00
|
|
Ultrasound encephalogram
|
$456.60 |
$456.60 |
$456.60 |
$485.48
|
|
Ultrasound exam follow-up
|
$274.87 |
$274.87 |
$274.87 |
$226.38
|
|
Ultrasound exam k transpl w/doppler
|
$618.88 |
$618.88 |
$618.88 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$428.68 |
$428.68 |
$428.68 |
$477.10
|
|
Ultrasound Guidance for a Needle Procedure
|
$799.40 |
$799.40 |
$799.40 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$621.95 |
$621.95 |
$621.95 |
$388.08
|
|
Ultrasound guide intraoperative
|
$656.12 |
$656.12 |
$656.12 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$474.95 |
$474.95 |
$474.95 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$474.87 |
$474.87 |
$474.87 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$412.92 |
$412.92 |
$412.92 |
$304.00
|
|
Ultrasound joint complete left
|
$544.62 |
$544.62 |
$544.62 |
$560.92
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$376.57 |
$376.57 |
$376.57 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$567.63 |
$567.63 |
$567.63 |
$406.44
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$352.15 |
$352.15 |
$352.15 |
$333.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$680.71 |
$680.71 |
$680.71 |
$698.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$355.63 |
$355.63 |
$355.63 |
$428.25
|
|
Ultrasound prostate/transrectal
|
$441.88 |
$441.88 |
$441.88 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$529.99 |
$529.99 |
$529.99 |
$459.00
|
|
Ultrasound transabd ea addl gest
|
$437.17 |
$437.17 |
$437.17 |
$417.15
|
|
Ultrasound trgt dyn mbubb 1st les
|
$237.74 |
$237.74 |
$237.74 |
$568.32
|
|
Ultraviolet therapy
|
$52.03 |
$52.03 |
$52.03 |
$39.76
|
|
Umbilical artery cath newborn 36660
|
$807.86 |
$807.86 |
$807.86 |
$223.80
|
|
Umbilical cord occlud w/us
|
$374.48 |
$374.48 |
$374.48 |
$754.00
|
|
Umbilicoplasty 15847
|
$4,172.97 |
$4,172.97 |
$4,172.97 |
$4,172.97
|
|
Unit mobile power mpu
|
$18,528.00 |
$18,528.00 |
$18,528.00 |
$14,359.52
|
|
Unlistd noninvas vasc dx std
|
$1,133.57 |
$1,133.57 |
$1,133.57 |
$564.60
|
|
Unlisted chemotherapy px
|
$475.70 |
$475.70 |
$475.70 |
$149.15
|
|
Unlisted cranfcl&maxlfcl px
|
$5,876.98 |
$5,876.98 |
$5,876.98 |
$571.20
|
|
Unlisted CT procedure
|
$3,679.86 |
$3,679.86 |
$3,679.86 |
$740.43
|
|
Unlisted dialysis procedure
|
$3,975.37 |
$3,975.37 |
$3,975.37 |
$1,144.00
|
|
Unlisted dx gi procedure
|
$1,256.74 |
$1,256.74 |
$1,256.74 |
$649.22
|
|
Unlisted fetal invas px w/us
|
$575.54 |
$575.54 |
$575.54 |
$498.40
|
|
Unlisted fluoroscopic px
|
$3,501.00 |
$3,501.00 |
$3,501.00 |
$305.76
|
|
Unlisted hystsc px uterus
|
$3,027.89 |
$3,027.89 |
$3,027.89 |
$3,027.89
|
|
Unlisted laparoscopic liver biopy 47379
|
$6,307.38 |
$6,307.38 |
$6,307.38 |
$6,307.38
|
|
Unlisted laparoscopic procedure 49659
|
$6,838.32 |
$6,838.32 |
$6,838.32 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$3,795.52 |
$3,795.52 |
$3,795.52 |
$5,419.00
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$7,299.35 |
$7,299.35 |
$7,299.35 |
$6,463.42
|
|
Unlisted laps px appendix
|
$3,617.40 |
$3,617.40 |
$3,617.40 |
$3,617.40
|
|
Unlisted laps px bladder
|
$5,082.74 |
$5,082.74 |
$5,082.74 |
$5,082.74
|
|
Unlisted laps px endoc sys
|
$5,783.48 |
$5,783.48 |
$5,783.48 |
$5,855.00
|
|
Unlisted laps px esoph
|
$5,042.16 |
$5,042.16 |
$5,042.16 |
$5,741.00
|
|
Unlisted laps px lymphtc sys
|
$10,488.59 |
$10,488.59 |
$10,488.59 |
$6,870.89
|
|
Unlisted laps px ovidct ovry
|
$4,713.11 |
$4,713.11 |
$4,713.11 |
$6,904.15
|
|
Unlisted laps px renal
|
$8,914.07 |
$8,914.07 |
$8,914.07 |
$5,110.00
|
|
Unlisted laps px testis
|
$5,628.67 |
$5,628.67 |
$5,628.67 |
$5,628.67
|
|
Unlisted laps px ureter
|
$4,904.96 |
$4,904.96 |
$4,904.96 |
$6,376.26
|
|
Unlisted laps px uterus
|
$8,803.87 |
$8,803.87 |
$8,803.87 |
$4,627.00
|
|
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
|
$2,052.00 |
$2,052.00 |
$2,052.00 |
$1,165.00
|
|
Unlisted muscskel px head
|
$155.13 |
$155.13 |
$155.13 |
$1,224.08
|
|
Unlisted oph svc/procedure
|
$213.51 |
$213.51 |
$213.51 |
$40.26
|
|
Unlisted orl service/px
|
$343.84 |
$343.84 |
$343.84 |
$132.60
|
