|
Trnscath tx thromblytc cath rmv sbsq day
|
$9,344.16 |
$9,344.16 |
$9,344.16 |
$4,793.13
|
|
Trnscath tx thromblytc vein ini day
|
$9,344.16 |
$9,344.16 |
$9,344.16 |
$4,329.36
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$6,019.20 |
$6,019.20 |
$6,019.20 |
$4,805.85
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$3,009.60 |
$3,009.60 |
$3,009.60 |
$2,343.60
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$4,722.24 |
$4,722.24 |
$4,722.24 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$3,091.20 |
$3,091.20 |
$3,091.20 |
$3,322.20
|
|
Troponin quantitative
|
$147.36 |
$147.36 |
$147.36 |
$123.75
|
|
Tte w or without contr, cont ecg
|
$1,092.00 |
$1,092.00 |
$1,092.00 |
$1,876.20
|
|
Tte w or without fol w/con,stres
|
$1,210.56 |
$1,210.56 |
$1,210.56 |
$1,582.75
|
|
Tube trach disp innr can 5 xlt
|
$740.58 |
$740.58 |
$740.58 |
$460.58
|
|
Tx atrial fib pulm vein isol
|
$9,712.80 |
$9,712.80 |
$9,712.80 |
$32,426.20
|
|
Tx closed hip disl traumatic without anes
|
$388.32 |
$388.32 |
$388.32 |
$657.28
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$4,307.52 |
$4,307.52 |
$4,307.52 |
$3,874.79
|
|
Tx closed tib shaft fx without manip
|
$615.36 |
$615.36 |
$615.36 |
$635.46
|
|
Tx l/r atrial fib addl
|
$9,712.80 |
$9,712.80 |
$9,712.80 |
$7,717.80
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$4,307.52 |
$4,307.52 |
$4,307.52 |
$4,449.44
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$4,624.32 |
$4,624.32 |
$4,624.32 |
$4,499.12
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$4,953.60 |
$4,953.60 |
$4,953.60 |
$4,281.00
|
|
Tx open nsl fx uncomp
|
$4,121.76 |
$4,121.76 |
$4,121.76 |
$4,007.22
|
|
Tx open nsl sptl fx
|
$5,214.24 |
$5,214.24 |
$5,214.24 |
$4,289.04
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$4,953.60 |
$4,953.60 |
$4,953.60 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$337.92 |
$337.92 |
$337.92 |
$469.20
|
|
Ultrasound abdomen aorta screening study aaa
|
$552.00 |
$552.00 |
$552.00 |
$403.26
|
|
Ultrasound breast complete
|
$365.76 |
$365.76 |
$365.76 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$328.80 |
$328.80 |
$328.80 |
$449.35
|
|
Ultrasound chest
|
$580.80 |
$580.80 |
$580.80 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$352.32 |
$352.32 |
$352.32 |
$340.14
|
|
Ultrasound elastography ea l target les
|
$402.24 |
$402.24 |
$402.24 |
$136.11
|
|
Ultrasound elastography parenchyma
|
$402.24 |
$402.24 |
$402.24 |
$284.25
|
|
Ultrasound encephalogram
|
$1,629.60 |
$1,629.60 |
$1,629.60 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$1,737.60 |
$1,737.60 |
$1,737.60 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$324.48 |
$324.48 |
$324.48 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$1,866.72 |
$1,866.72 |
$1,866.72 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$641.28 |
$641.28 |
$641.28 |
$701.35
|
|
Ultrasound guide intraoperative
|
$1,068.48 |
$1,068.48 |
$1,068.48 |
$632.90
|
|
Ultrasound guide tissue ablation
|
$596.64 |
$596.64 |
$596.64 |
$498.40
|
|
Ultrasound joint complete left
|
$1,150.08 |
$1,150.08 |
$1,150.08 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$716.64 |
$716.64 |
$716.64 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$691.68 |
$691.68 |
$691.68 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$361.92 |
$361.92 |
$361.92 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$850.56 |
$850.56 |
$850.56 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$219.84 |
$219.84 |
$219.84 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$499.20 |
$499.20 |
$499.20 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$479.52 |
$479.52 |
$479.52 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$1,897.92 |
$1,897.92 |
$1,897.92 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$1,507.20 |
$1,507.20 |
$1,507.20 |
$498.00
|
|
Ultrasound scrotum and contents
|
$1,922.88 |
$1,922.88 |
$1,922.88 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$1,384.32 |
$1,384.32 |
$1,384.32 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$405.12 |
$405.12 |
$405.12 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$723.36 |
$723.36 |
$723.36 |
$567.44
|
|
Umbilical artery cath newborn 36660
|
$634.56 |
$634.56 |
$634.56 |
$265.85
|
|
Unlisted chemotherapy px
|
$140.64 |
$140.64 |
$140.64 |
$153.85
|
|
Unlisted fluoroscopic px
|
$487.20 |
$487.20 |
$487.20 |
$324.85
|
|
Unlisted mr procedure
|
$1,198.08 |
$1,198.08 |
$1,198.08 |
$1,032.20
|
|
Unlisted procedure rectum
|
$1,454.88 |
$1,454.88 |
$1,454.88 |
$1,278.72
|
|
Unlisted px hands/fingers
|
$293.76 |
$293.76 |
$293.76 |
$379.44
|
|
Unlisted px neck/thorax
|
$876.96 |
$876.96 |
$876.96 |
$2,680.22
|
|
Unlisted px pelvis/hip joint
|
$876.96 |
$876.96 |
$876.96 |
$2,108.82
|
|
Unlisted px salivry glnd/dux
|
$355.20 |
$355.20 |
$355.20 |
$486.72
|
|
Unlisted px small intestine
|
$3,455.04 |
$3,455.04 |
$3,455.04 |
$2,118.35
|
|
Unlisted transfusion med px
|
$108.00 |
$108.00 |
$108.00 |
$141.35
|
|
Unlisted ultrasound procedure
|
$1,595.04 |
$1,595.04 |
$1,595.04 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$1,469.76 |
$1,469.76 |
$1,469.76 |
$1,469.76
|
|
Upgrade pm system
|
$12,906.72 |
$12,906.72 |
$12,906.72 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$9,328.80 |
$9,328.80 |
$9,328.80 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$7,848.00 |
$7,848.00 |
$7,848.00 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$7,183.68 |
$7,183.68 |
$7,183.68 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,075.68 |
$1,075.68 |
$1,075.68 |
$1,588.59
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,075.68 |
$1,075.68 |
$1,075.68 |
$1,656.60
|
|
Urea nitrogen
|
$62.88 |
$62.88 |
$62.88 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$97.44 |
$97.44 |
$97.44 |
$50.00
|
|
Ureteral embolization/occl
|
$4,790.88 |
$4,790.88 |
$4,790.88 |
$3,041.22
|
|
Urethrcystgrphy rtrgrde s&i
|
$452.16 |
$452.16 |
$452.16 |
$574.40
|
|
Urethrocystography void s&i
|
$507.84 |
$507.84 |
$507.84 |
$634.50
|
|
Uric acid blood
|
$66.24 |
$66.24 |
$66.24 |
$46.64
|
|
Uric acid urine
|
$97.44 |
$97.44 |
$97.44 |
$46.75
|
|
Urinalysis microscopic only
|
$185.28 |
$185.28 |
$185.28 |
$26.35
|
|
Urinalysis (with microscopy)
|
$143.04 |
$143.04 |
$143.04 |
$48.14
|
|
Urinalysis (without microscopy)
|
$96.96 |
$96.96 |
$96.96 |
$38.99
|
|
Urine Culture Test
|
$147.84 |
$147.84 |
$147.84 |
$84.81
|
|
Urine pregnancy test
|
$154.08 |
$154.08 |
$154.08 |
$66.40
|
|
Urography, antegrade
|
$639.36 |
$639.36 |
$639.36 |
$593.37
|
|
Use 1st target lesion
|
$402.24 |
$402.24 |
$402.24 |
$245.30
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$5,061.76 |
$5,061.76 |
$5,061.76 |
$5,521.54
|
|
Vaccine dtap < 7 years im
|
$97.43 |
$97.43 |
$97.43 |
$87.80
|
|
Vaccine dtap-hep b-ipv im
|
$212.28 |
$212.28 |
$212.28 |
$193.83
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$112.25 |
$112.25 |
$112.25 |
$85.00
|
|
Vaccine hepatitis a (hepa) adult im
|
$222.32 |
$222.32 |
$222.32 |
$178.07
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 3 dose im
|
$113.90 |
$113.90 |
$113.90 |
$48.10
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$77.46 |
$77.46 |
$77.46 |
$79.04
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$103.88 |
$103.88 |
$103.88 |
$103.88
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$619.21 |
$619.21 |
$619.21 |
$499.00
|
|
Vaccine mmr live subcutaneous
|
$287.76 |
$287.76 |
$287.76 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$360.57 |
$360.57 |
$360.57 |
$274.95
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$648.18 |
$648.18 |
$648.18 |
$397.18
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$715.41 |
$715.41 |
$715.41 |
$715.41
|
|
Vaccine rabies im
|
$1,075.20 |
$1,075.20 |
$1,075.20 |
$945.46
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$1,507.72 |
$1,507.72 |
$1,507.72 |
$1,196.00
|
|
Vaccine tdap >=7 years im
|
$163.84 |
$163.84 |
$163.84 |
$150.76
|
|
Vad battery clip set hmii 14-v li-ion
|
$1,947.37 |
$1,947.37 |
$1,947.37 |
$1,683.99
|
