|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$67.50 |
$67.50 |
$67.50 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$106.50 |
$106.50 |
$106.50 |
$203.35
|
|
Treatment missed abortion completed surgically 1st trimester
|
$2,111.00 |
$2,111.00 |
$2,111.00 |
$3,982.44
|
|
Treatment of ankle fracture 27786
|
$336.50 |
$336.50 |
$336.50 |
$520.80
|
|
Treatment of fibula fracture 27780
|
$106.50 |
$106.50 |
$106.50 |
$491.50
|
|
Treatment of heel fracture 28400
|
$106.50 |
$106.50 |
$106.50 |
$473.00
|
|
Treatment of miscarriage
|
$2,111.00 |
$2,111.00 |
$2,111.00 |
$4,146.69
|
|
Treatment of thigh fracture
|
$912.50 |
$912.50 |
$912.50 |
$476.16
|
|
Treatment of thigh fracture
|
$2,384.00 |
$2,384.00 |
$2,384.00 |
$1,748.40
|
|
Treatment of thigh fracture
|
$374.50 |
$374.50 |
$374.50 |
$548.90
|
|
Treatment of thigh fracture
|
$1,164.50 |
$1,164.50 |
$1,164.50 |
$1,772.97
|
|
Treatment of toe fracture 28510
|
$300.00 |
$300.00 |
$300.00 |
$369.70
|
|
Treatment radiation delivery level 2
|
$405.00 |
$405.00 |
$405.00 |
$767.65
|
|
Treat midfoot fracture each
|
$1,705.00 |
$1,705.00 |
$1,705.00 |
$1,851.78
|
|
Treat spinal cord lesion
|
$1,182.00 |
$1,182.00 |
$1,182.00 |
$1,142.50
|
|
Treat spinal cord lesion
|
$1,237.00 |
$1,237.00 |
$1,237.00 |
$1,337.00
|
|
Treat thigh fracture
|
$406.50 |
$406.50 |
$406.50 |
$661.00
|
|
Treat thigh fracture
|
$2,093.50 |
$2,093.50 |
$2,093.50 |
$1,893.86
|
|
Treat thigh fracture
|
$701.50 |
$701.50 |
$701.50 |
$618.80
|
|
Treat thigh fracture
|
$2,082.00 |
$2,082.00 |
$2,082.00 |
$2,032.10
|
|
Treat thumb fracture
|
$1,523.50 |
$1,523.50 |
$1,523.50 |
$2,508.80
|
|
Treat toe dislocation
|
$713.50 |
$713.50 |
$713.50 |
$756.39
|
|
Treat ulnar fracture
|
$783.50 |
$783.50 |
$783.50 |
$1,662.00
|
|
Treat vaginal bleeding
|
$371.50 |
$371.50 |
$371.50 |
$379.60
|
|
Treat wrist bone fracture
|
$741.00 |
$741.00 |
$741.00 |
$1,548.40
|
|
Treat wrist dislocation
|
$268.50 |
$268.50 |
$268.50 |
$656.25
|
|
Treponema pallidum antibody
|
$56.00 |
$56.00 |
$56.00 |
$70.40
|
|
Trg gene rearrangement anal
|
$260.50 |
$260.50 |
$260.50 |
$455.70
|
|
Trichinella antibody
|
$56.00 |
$56.00 |
$56.00 |
$70.20
|
|
Triglycerides
|
$28.00 |
$28.00 |
$28.00 |
$58.05
|
|
Trim nondyst nails
|
$101.50 |
$101.50 |
$101.50 |
$113.40
|
|
Trmt of fracture (femoral shaft) 27500
|
$432.00 |
$432.00 |
$432.00 |
$754.80
|
|
Trnscath plc stent crv crtd without prtct
|
$11,524.00 |
$11,524.00 |
$11,524.00 |
$7,795.71
|
|
Trnscath plc stent crv crtd w/prtct
|
$16,590.50 |
$16,590.50 |
$16,590.50 |
$9,767.25
|
|
Trnscath plc stnt ante carotid art
|
$9,524.00 |
$9,524.00 |
$9,524.00 |
$6,069.00
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$6,231.50 |
$6,231.50 |
$6,231.50 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$6,231.50 |
$6,231.50 |
$6,231.50 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$17,369.00 |
$17,369.00 |
$17,369.00 |
$15,330.11
|
|
Trnscath retrv pq vasc fb w/guide
|
$3,300.00 |
$3,300.00 |
$3,300.00 |
$4,523.96
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$2,641.00 |
$2,641.00 |
$2,641.00 |
$5,069.50
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$5,316.50 |
$5,316.50 |
$5,316.50 |
$4,250.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$4,418.00 |
$4,418.00 |
$4,418.00 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$5,016.00 |
$5,016.00 |
$5,016.00 |
$3,866.70
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$3,186.00 |
$3,186.00 |
$3,186.00 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$3,186.00 |
$3,186.00 |
$3,186.00 |
$3,078.00
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$2,383.00 |
$2,383.00 |
$2,383.00 |
$2,406.77
|
|
Troponin quantitative
|
$46.00 |
$46.00 |
$46.00 |
$127.20
|
|
Tte w or without contr, cont ecg
|
$1,064.00 |
$1,064.00 |
$1,064.00 |
$2,012.40
|
|
Tte w or without fol w/con,stres
|
$1,482.50 |
$1,482.50 |
$1,482.50 |
$1,632.80
|
|
Tubular dressing
|
$28.46 |
$28.46 |
$28.46 |
$28.46
|
|
Tx atrial fib pulm vein isol
|
$11,948.00 |
$11,948.00 |
$11,948.00 |
$29,030.54
|
|
Tx closed distal humerus fx
|
$390.00 |
$390.00 |
$390.00 |
$594.88
|
|
Tx closed hip disl traumatic without anes
|
$197.00 |
$197.00 |
$197.00 |
$581.07
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$1,625.00 |
$1,625.00 |
$1,625.00 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$336.50 |
$336.50 |
$336.50 |
$535.60
|
|
Tx l/r atrial fib addl
|
$4,204.00 |
$4,204.00 |
$4,204.00 |
$6,769.00
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$3,552.50 |
$3,552.50 |
$3,552.50 |
$4,499.12
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$3,131.00 |
$3,131.00 |
$3,131.00 |
$4,468.55
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$3,886.00 |
$3,886.00 |
$3,886.00 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$106.50 |
$106.50 |
$106.50 |
$416.16
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$765.00 |
$765.00 |
$765.00 |
$911.43
|
|
Ua w/micro/comp poc
|
$11.00 |
$11.00 |
$11.00 |
$23.00
|
|
Ugt1a1 gene analy common variants
|
$855.50 |
$855.50 |
$855.50 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$302.50 |
$302.50 |
$302.50 |
$394.20
|
|
Ultrasound breast complete
|
$387.00 |
$387.00 |
$387.00 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$351.50 |
$351.50 |
$351.50 |
$449.35
|
|
Ultrasound chest
|
$488.00 |
$488.00 |
$488.00 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$411.00 |
$411.00 |
$411.00 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$275.00 |
$275.00 |
$275.00 |
$296.80
|
|
Ultrasound elastography ea l target les
|
$336.50 |
$336.50 |
$336.50 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$336.50 |
$336.50 |
$336.50 |
$307.00
|
|
Ultrasound encephalogram
|
$375.00 |
$375.00 |
$375.00 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$496.50 |
$496.50 |
$496.50 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$428.00 |
$428.00 |
$428.00 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$116.00 |
$116.00 |
$116.00 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$404.00 |
$404.00 |
$404.00 |
$720.15
|
|
Ultrasound guide intraoperative
|
$475.50 |
$475.50 |
$475.50 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$273.00 |
$273.00 |
$273.00 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$492.00 |
$492.00 |
$492.00 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$171.00 |
$171.00 |
$171.00 |
$311.25
|
|
Ultrasound joint complete left
|
$488.00 |
$488.00 |
$488.00 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$90.50 |
$90.50 |
$90.50 |
$425.45
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$404.00 |
$404.00 |
$404.00 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$785.50 |
$785.50 |
$785.50 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$264.00 |
$264.00 |
$264.00 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$551.00 |
$551.00 |
$551.00 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$218.50 |
$218.50 |
$218.50 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$428.00 |
$428.00 |
$428.00 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$428.00 |
$428.00 |
$428.00 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$392.00 |
$392.00 |
$392.00 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$383.00 |
$383.00 |
$383.00 |
$486.50
|
|
Ultrasound scrotum and contents
|
$495.00 |
$495.00 |
$495.00 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$375.00 |
$375.00 |
$375.00 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$334.00 |
$334.00 |
$334.00 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$423.50 |
$423.50 |
$423.50 |
$558.35
|
|
Ultrasound trgt dyn mbubb 1st les
|
$687.50 |
$687.50 |
$687.50 |
$568.32
|
|
Ultrasound trgt dyn mbubb ea addl
|
$436.00 |
$436.00 |
$436.00 |
$348.00
|
|
Unlisted chemotherapy px
|
$214.00 |
$214.00 |
$214.00 |
$150.00
|
|
Unlisted dialysis procedure
|
$385.00 |
$385.00 |
$385.00 |
$1,144.00
|
|
Unlisted dx gi procedure
|
$283.50 |
$283.50 |
$283.50 |
$649.22
|
