|
Triptorelin pamoate
|
$303.20 |
$303.20 |
$303.20 |
$4,619.39
|
|
Trmt of fracture (femoral shaft) 27500
|
$3,418.40 |
$3,418.40 |
$3,418.40 |
$716.95
|
|
Trnscath plc stent crv crtd without prtct
|
$10,417.55 |
$10,417.55 |
$10,417.55 |
$7,795.71
|
|
Trnscath plc stent crv crtd w/prtct
|
$11,188.65 |
$11,188.65 |
$16,163.20 |
$9,767.25
|
|
Trnscath plc stnt ante carotid art
|
$3,364.90 |
$3,364.90 |
$25,328.20 |
$6,046.25
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$2,671.35 |
$2,671.35 |
$13,541.31 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$2,671.35 |
$2,671.35 |
$12,193.94 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$7,158.25 |
$7,158.25 |
$25,214.19 |
$14,872.52
|
|
Trnscath retrv pq vasc fb w/guide
|
$4,137.10 |
$4,137.10 |
$10,243.32 |
$4,766.40
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$6,476.80 |
$6,476.80 |
$8,064.65 |
$5,139.20
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$6,086.30 |
$6,086.30 |
$6,662.97 |
$4,341.66
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$1,557.05 |
$1,557.05 |
$7,530.84 |
$4,418.00
|
|
Trnscath tx thromblytc vein ini day
|
$2,753.52 |
$2,753.52 |
$6,311.80 |
$3,900.60
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$2,850.40 |
$2,850.40 |
$2,850.40 |
$4,727.52
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$1,906.40 |
$1,906.40 |
$1,906.40 |
$2,377.62
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$3,688.00 |
$3,688.00 |
$3,688.00 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$2,692.80 |
$2,692.80 |
$2,692.80 |
$3,091.20
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$2,551.20 |
$2,551.20 |
$2,551.20 |
$2,551.20
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$2,461.60 |
$2,461.60 |
$2,461.60 |
$2,486.75
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$2,270.40 |
$2,270.40 |
$2,270.40 |
$2,486.75
|
|
Troponin quantitative
|
$131.29 |
$131.29 |
$151.80 |
$125.00
|
|
Tte w or without fol w/con,stres
|
$854.70 |
$854.70 |
$3,717.84 |
$1,643.14
|
|
Tte w or without fol w/cont, com
|
$935.55 |
$935.55 |
$935.55 |
$1,266.50
|
|
Tte w or without fol w/cont, f/u
|
$2,929.28 |
$2,929.28 |
$2,929.28 |
$1,178.00
|
|
Tube trach disp innr can 5 xlt
|
$150.49 |
$150.49 |
$150.49 |
$445.99
|
|
Tube trach disp innr can 6 xlt
|
$99.91 |
$99.91 |
$99.91 |
$16.80
|
|
Tube trach fen sz 6 uncuffed
|
$87.42 |
$87.42 |
$87.42 |
$155.98
|
|
Tx atrial fib pulm vein isol
|
$22,629.75 |
$22,629.75 |
$44,770.17 |
$29,030.54
|
|
Tx closed distal humerus fx
|
$1,036.91 |
$1,036.91 |
$1,036.91 |
$589.00
|
|
Tx closed hip disl traumatic without anes
|
$766.15 |
$766.15 |
$3,066.40 |
$586.80
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$4,955.20 |
$4,955.20 |
$4,955.20 |
$4,043.32
|
|
Tx closed tib shaft fx without manip
|
$2,228.80 |
$2,228.80 |
$2,228.80 |
$535.60
|
|
Tx contour defects >10.0 cc
|
$1,317.60 |
$1,317.60 |
$1,317.60 |
$918.06
|
|
Tx contour defects 1.1-5.0cc 11951
|
$1,144.00 |
$1,144.00 |
$1,144.00 |
$849.50
|
|
Tx l/r atrial fib addl
|
$1,279.85 |
$1,279.85 |
$22,385.09 |
$6,986.85
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$5,497.60 |
$5,497.60 |
$5,497.60 |
$4,521.61
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$10,622.97 |
$10,622.97 |
$10,622.97 |
$4,537.59
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$6,235.20 |
$6,235.20 |
$6,235.20 |
$4,595.50
|
|
Tx open nsl fx uncomp
|
$2,301.60 |
$2,301.60 |
$2,301.60 |
$3,837.72
|
|
Tx open nsl sptl fx
|
$2,614.40 |
$2,614.40 |
$2,614.40 |
$4,308.40
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$9,498.36 |
$9,498.36 |
$9,498.36 |
$4,529.60
|
|
Tx tarsal bone fx without manip 28450
|
$944.00 |
$944.00 |
$944.00 |
$423.15
|
|
Tympanic membrane repair
|
$4,263.20 |
$4,263.20 |
$4,263.20 |
$2,133.48
|
|
Tympanometry & reflex thresh
|
$116.00 |
$116.00 |
$116.00 |
$173.18
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$2,177.57 |
$2,177.57 |
$2,177.57 |
$911.43
|
|
Tympp antrt/mastoidotomy prosthesis torp 69637
|
$8,756.80 |
$8,756.80 |
$8,756.80 |
$6,740.80
|
|
Tympp antrt/mastoid without ossic chain recnst 69635
|
$7,840.80 |
$7,840.80 |
$7,840.80 |
$7,000.36
|
|
Typhoid vaccine oral
|
$74.40 |
$74.40 |
$74.40 |
$63.28
|
|
Ua w/micro/comp poc
|
$43.20 |
$43.20 |
$43.20 |
$23.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$111.87 |
$111.87 |
$111.87 |
$21,992.26
|
|
Ugt1a1 gene analy common variants
|
$618.20 |
$618.20 |
$618.20 |
$438.75
|
|
Ultrasound breast complete
|
$723.80 |
$723.80 |
$2,434.60 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$1,349.70 |
$1,349.70 |
$2,012.34 |
$452.00
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$749.52 |
$749.52 |
$830.50 |
$338.00
|
|
Ultrasound encephalogram
|
$549.45 |
$549.45 |
$919.47 |
$485.48
|
|
Ultrasound exam k transpl w/doppler
|
$717.46 |
$717.46 |
$1,045.55 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$1,018.05 |
$1,018.05 |
$1,415.87 |
$477.10
|
|
Ultrasound Guidance for a Needle Procedure
|
$1,177.00 |
$1,177.00 |
$2,246.35 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$435.05 |
$435.05 |
$1,091.16 |
$388.08
|
|
Ultrasound guide intraoperative
|
$1,318.35 |
$1,318.35 |
$1,834.23 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$927.20 |
$927.20 |
$1,300.75 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$919.47 |
$919.47 |
$1,096.15 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$860.20 |
$860.20 |
$860.20 |
$304.00
|
|
Ultrasound joint complete left
|
$770.55 |
$770.55 |
$1,415.87 |
$560.92
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$278.40 |
$278.40 |
$278.40 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$945.45 |
$945.45 |
$1,415.87 |
$406.44
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$354.64 |
$354.64 |
$491.70 |
$333.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$2,101.55 |
$2,101.55 |
$2,205.77 |
$698.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$644.05 |
$644.05 |
$919.47 |
$428.25
|
|
Ultrasound prostate/transrectal
|
$332.00 |
$332.00 |
$675.95 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$417.45 |
$417.45 |
$1,415.87 |
$459.00
|
|
Ultrasound transabd ea addl gest
|
$832.70 |
$832.70 |
$919.47 |
$417.15
|
|
Umbilical artery cath newborn 36660
|
$575.20 |
$575.20 |
$575.20 |
$223.80
|
|
Unlistd noninvas vasc dx std
|
$37.95 |
$37.95 |
$37.95 |
$564.60
|
|
Unlisted CT procedure
|
$747.40 |
$747.40 |
$747.40 |
$740.43
|
|
Unlisted cv px dx nuc med
|
$1,482.88 |
$1,482.88 |
$1,482.88 |
$1,747.20
|
|
Unlisted dialysis procedure
|
$729.30 |
$729.30 |
$729.30 |
$1,144.00
|
|
Unlisted endocrine px dx nuc
|
$1,226.96 |
$1,226.96 |
$1,226.96 |
$653.31
|
|
Unlisted fluoroscopic px
|
$364.10 |
$364.10 |
$364.10 |
$305.76
|
|
Unlisted gi px dx nuc med
|
$1,482.88 |
$1,482.88 |
$1,482.88 |
$995.00
|
|
Unlisted gu px dx nuc med
|
$1,482.88 |
$1,482.88 |
$1,482.88 |
$805.62
|
|
Unlisted hematology&coagj px
|
$83.55 |
$83.55 |
$83.55 |
$39.52
|
|
Unlisted laparoscopic procedure 49659
|
$5,832.00 |
$5,832.00 |
$5,832.00 |
$6,838.32
|
|
Unlisted laps px spleen
|
$2,667.20 |
$2,667.20 |
$2,667.20 |
$4,627.00
|
|
Unlisted maaa
|
$109.60 |
$109.60 |
$109.60 |
$235.20
|
|
Unlisted mr procedure
|
$2,706.00 |
$2,706.00 |
$2,706.00 |
$1,165.00
|
|
Unlisted orl service/px
|
$52.80 |
$52.80 |
$52.80 |
$132.60
|
|
Unlisted procedure microbiology
|
$107.20 |
$107.20 |
$107.20 |
$530.00
|
|
Unlisted procedure rectum
|
$2,823.51 |
$2,823.51 |
$2,823.51 |
$1,278.72
|
|
Unlisted procedure spine
|
$8,297.61 |
$8,297.61 |
$8,297.61 |
$4,706.35
|
|
Unlisted psychiatric service/proc 90899
|
$480.70 |
$480.70 |
$480.70 |
$277.76
|
|
Unlisted px biliary tract
|
$2,634.16 |
$2,634.16 |
$2,634.16 |
$3,055.00
|
|
Unlisted px casting/strpg
|
$409.75 |
$409.75 |
$409.75 |
$222.00
|
|
Unlisted px diaphragm
|
$5,417.60 |
$5,417.60 |
$5,417.60 |
$6,325.20
|
|
Unlisted px pelvis/hip joint
|
$16,630.40 |
$16,630.40 |
$16,630.40 |
$3,251.90
|
|
Unlisted px salivry glnd/dux
|
$1,048.30 |
$1,048.30 |
$1,048.30 |
$1,173.42
|
|
Unlisted px small intestine
|
$2,649.22 |
$2,649.22 |
$2,649.22 |
$2,118.35
|
|
Unlisted reprod med lab proc
|
$67.63 |
$67.63 |
$67.63 |
$70.00
|
|
Unlisted surgical path px
|
$97.90 |
$97.90 |
$97.90 |
$216.00
|
|
Unlisted transfusion med px
|
$28.05 |
$28.05 |
$28.05 |
$147.50
|
