|
Tympp antrt/mastoidotomy prosthesis torp 69637
|
$2,652.00 |
$2,652.00 |
$2,652.00 |
$6,839.00
|
|
Typhoid vaccine oral
|
$57.62 |
$57.62 |
$57.62 |
$63.28
|
|
Ua w/micro/comp poc
|
$31.72 |
$31.72 |
$31.72 |
$23.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$16,640.94 |
$16,640.94 |
$16,640.94 |
$20,945.01
|
|
Ugt1a1 gene analy common variants
|
$284.44 |
$284.44 |
$284.44 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$624.00 |
$624.00 |
$624.00 |
$394.20
|
|
Ultrasound bone density measure
|
$249.60 |
$249.60 |
$249.60 |
$143.75
|
|
Ultrasound breast complete
|
$556.40 |
$556.40 |
$556.40 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$327.60 |
$327.60 |
$327.60 |
$449.35
|
|
Ultrasound chest
|
$650.00 |
$650.00 |
$650.00 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$338.00 |
$338.00 |
$338.00 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$421.20 |
$421.20 |
$421.20 |
$296.80
|
|
Ultrasound elastography ea l target les
|
$109.20 |
$109.20 |
$109.20 |
$180.00
|
|
Ultrasound encephalogram
|
$468.00 |
$468.00 |
$468.00 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$1,097.20 |
$1,097.20 |
$1,097.20 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$561.60 |
$561.60 |
$561.60 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$660.40 |
$660.40 |
$660.40 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$967.20 |
$967.20 |
$967.20 |
$720.15
|
|
Ultrasound guide intraoperative
|
$852.80 |
$852.80 |
$852.80 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$644.80 |
$644.80 |
$644.80 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$421.20 |
$421.20 |
$421.20 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$223.60 |
$223.60 |
$223.60 |
$311.25
|
|
Ultrasound joint complete left
|
$707.20 |
$707.20 |
$707.20 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$296.40 |
$296.40 |
$296.40 |
$425.45
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$249.60 |
$249.60 |
$249.60 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$769.60 |
$769.60 |
$769.60 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$358.80 |
$358.80 |
$358.80 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$816.40 |
$816.40 |
$816.40 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$447.20 |
$447.20 |
$447.20 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$504.40 |
$504.40 |
$504.40 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$577.20 |
$577.20 |
$577.20 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$681.20 |
$681.20 |
$681.20 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$686.40 |
$686.40 |
$686.40 |
$486.50
|
|
Ultrasound scrotum and contents
|
$894.40 |
$894.40 |
$894.40 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$494.00 |
$494.00 |
$494.00 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$478.40 |
$478.40 |
$478.40 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$514.80 |
$514.80 |
$514.80 |
$558.35
|
|
Ultraviolet therapy
|
$70.72 |
$70.72 |
$70.72 |
$39.76
|
|
Umbilical cord occlud w/us
|
$754.00 |
$754.00 |
$754.00 |
$754.00
|
|
Unit mobile power mpu
|
$6,240.00 |
$6,240.00 |
$6,240.00 |
$14,612.80
|
|
Unlistd noninvas vasc dx std
|
$131.04 |
$131.04 |
$131.04 |
$528.80
|
|
Unlisted chemotherapy px
|
$113.36 |
$113.36 |
$113.36 |
$150.00
|
|
Unlisted CT procedure
|
$884.00 |
$884.00 |
$884.00 |
$732.70
|
|
Unlisted cv px dx nuc med
|
$1,747.20 |
$1,747.20 |
$1,747.20 |
$1,200.00
|
|
Unlisted cytogenetic study
|
$179.40 |
$179.40 |
$179.40 |
$160.18
|
|
Unlisted cytopathology px
|
$224.12 |
$224.12 |
$224.12 |
$132.08
|
|
Unlisted dialysis procedure
|
$1,144.00 |
$1,144.00 |
$1,144.00 |
$1,144.00
|
|
Unlisted endocrine px dx nuc
|
$889.20 |
$889.20 |
$889.20 |
$569.91
|
|
Unlisted gi px dx nuc med
|
$1,528.80 |
$1,528.80 |
$1,528.80 |
$995.00
|
|
Unlisted hematology&coagj px
|
$39.52 |
$39.52 |
$39.52 |
$39.52
|
|
Unlisted hystsc px uterus
|
$7,630.48 |
$7,630.48 |
$7,630.48 |
$2,803.60
|
|
Unlisted laparoscopic liver biopy 47379
|
$5,323.76 |
$5,323.76 |
$5,323.76 |
$5,419.00
|
|
Unlisted laps px ovidct ovry
|
$7,796.88 |
$7,796.88 |
$7,796.88 |
$6,904.15
|
|
Unlisted misc path test
|
$131.04 |
$131.04 |
$131.04 |
$89.40
|
|
Unlisted mr procedure
|
$1,560.00 |
$1,560.00 |
$1,560.00 |
$1,163.00
|
|
Unlisted muscskel px dx nuc
|
$1,554.80 |
$1,554.80 |
$1,554.80 |
$1,279.98
|
|
Unlisted muscskel px head
|
$1,224.08 |
$1,224.08 |
$1,224.08 |
$478.46
|
|
Unlisted neurological dx px
|
$238.16 |
$238.16 |
$238.16 |
$242.50
|
|
Unlisted orl service/px
|
$99.32 |
$99.32 |
$99.32 |
$132.60
|
|
Unlisted procedure colon
|
$2,069.60 |
$2,069.60 |
$2,069.60 |
$1,702.50
|
|
Unlisted procedure esophagus
|
$1,998.88 |
$1,998.88 |
$1,998.88 |
$1,998.88
|
|
Unlisted procedure larynx
|
$1,128.40 |
$1,128.40 |
$1,128.40 |
$924.00
|
|
Unlisted procedure liver
|
$1,294.80 |
$1,294.80 |
$1,294.80 |
$2,287.20
|
|
Unlisted procedure pancreas
|
$13,019.76 |
$13,019.76 |
$13,019.76 |
$3,986.00
|
|
Unlisted procedure rectum
|
$4,076.28 |
$4,076.28 |
$4,076.28 |
$1,220.35
|
|
Unlisted procedure spine
|
$4,876.04 |
$4,876.04 |
$4,876.04 |
$4,659.85
|
|
Unlisted px abdomen muscskel
|
$1,848.60 |
$1,848.60 |
$1,848.60 |
$1,848.60
|
|
Unlisted px accessory sinus
|
$3,335.28 |
$3,335.28 |
$3,335.28 |
$3,335.28
|
|
Unlisted px ant segment eye
|
$1,794.00 |
$1,794.00 |
$1,794.00 |
$2,698.92
|
|
Unlisted px biliary tract
|
$5,079.88 |
$5,079.88 |
$5,079.88 |
$2,718.10
|
|
Unlisted px casting/strpg
|
$296.40 |
$296.40 |
$296.40 |
$219.70
|
|
Unlisted px foot/toes
|
$426.40 |
$426.40 |
$426.40 |
$1,225.50
|
|
Unlisted px lacrimal system
|
$4,038.84 |
$4,038.84 |
$4,038.84 |
$416.50
|
|
Unlisted px leg/ankle
|
$1,023.88 |
$1,023.88 |
$1,023.88 |
$811.00
|
|
Unlisted px male genital sys
|
$447.20 |
$447.20 |
$447.20 |
$343.55
|
|
Unlisted px pelvis/hip joint
|
$3,118.44 |
$3,118.44 |
$3,118.44 |
$3,118.44
|
|
Unlisted px salivry glnd/dux
|
$4,319.64 |
$4,319.64 |
$4,319.64 |
$1,265.16
|
|
Unlisted px small intestine
|
$4,576.00 |
$4,576.00 |
$4,576.00 |
$2,102.10
|
|
Unlisted px tongue flr mouth
|
$667.16 |
$667.16 |
$667.16 |
$282.50
|
|
Unlisted spec derm svc/px
|
$223.08 |
$223.08 |
$223.08 |
$223.08
|
|
Unlisted special svc px/rprt
|
$289.12 |
$289.12 |
$289.12 |
$90.00
|
|
Unlisted surgical path px
|
$224.12 |
$224.12 |
$224.12 |
$217.75
|
|
Unlisted ultrasound procedure
|
$478.40 |
$478.40 |
$478.40 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$1,248.00 |
$1,248.00 |
$1,248.00 |
$1,268.17
|
|
Upgrade pm system
|
$17,888.00 |
$17,888.00 |
$17,888.00 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,224.00 |
$3,224.00 |
$3,224.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,860.00 |
$2,860.00 |
$2,860.00 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,392.00 |
$2,392.00 |
$2,392.00 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,872.00 |
$1,872.00 |
$1,872.00 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,768.00 |
$1,768.00 |
$1,768.00 |
$1,768.00
|
|
Upper ext fx orthosis rad/ul
|
$713.44 |
$713.44 |
$713.44 |
$619.49
|
|
Uppr gi scope w/submuc inj
|
$1,872.00 |
$1,872.00 |
$1,872.00 |
$1,872.00
|
|
Urea nitrogen
|
$36.92 |
$36.92 |
$36.92 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$42.12 |
$42.12 |
$42.12 |
$51.75
|
|
Urea nitrogen clearance
|
$76.96 |
$76.96 |
$76.96 |
$42.25
|
|
Urea nitrogen semi-quant
|
$34.84 |
$34.84 |
$34.84 |
$10.40
|
|
Ureteral embolization/occl
|
$369.20 |
$369.20 |
$369.20 |
$2,181.40
|
|
Ureteral reflux study
|
$1,216.80 |
$1,216.80 |
$1,216.80 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$899.60 |
$899.60 |
$899.60 |
$579.73
|
|
Urethrocystography void s&i
|
$899.60 |
$899.60 |
$899.60 |
$622.35
|
