|
Tx tarsal bone fx without manip 28450
|
$896.35 |
$896.35 |
$896.35 |
$423.15
|
|
Tympanometry & reflex thresh
|
$100.10 |
$100.10 |
$100.10 |
$173.18
|
|
Typhoid vaccine oral
|
$45.75 |
$45.75 |
$45.75 |
$63.28
|
|
Ua w/micro/comp poc
|
$16.90 |
$16.90 |
$16.90 |
$23.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$4,332.90 |
$4,332.90 |
$4,332.90 |
$21,992.26
|
|
Ugt1a1 gene analy common variants
|
$1,049.75 |
$1,049.75 |
$1,049.75 |
$438.75
|
|
Ultrasound breast complete
|
$596.70 |
$596.70 |
$596.70 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$494.00 |
$494.00 |
$494.00 |
$452.00
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$596.70 |
$596.70 |
$596.70 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$159.90 |
$159.90 |
$159.90 |
$296.80
|
|
Ultrasound elastography ea l target les
|
$122.20 |
$122.20 |
$122.20 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$169.00 |
$169.00 |
$169.00 |
$318.45
|
|
Ultrasound encephalogram
|
$596.70 |
$596.70 |
$596.70 |
$496.36
|
|
Ultrasound exam k transpl w/doppler
|
$596.70 |
$596.70 |
$596.70 |
$578.70
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$596.70 |
$596.70 |
$596.70 |
$477.10
|
|
Ultrasound Guidance for a Needle Procedure
|
$701.35 |
$701.35 |
$701.35 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$216.45 |
$216.45 |
$216.45 |
$388.08
|
|
Ultrasound guide intraoperative
|
$685.10 |
$685.10 |
$685.10 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$567.45 |
$567.45 |
$567.45 |
$560.00
|
|
Ultrasound infant hips ltd without stress
|
$161.20 |
$161.20 |
$161.20 |
$311.25
|
|
Ultrasound joint complete left
|
$596.70 |
$596.70 |
$596.70 |
$560.25
|
|
Ultrasound ob >=14wks ea addl gest
|
$577.85 |
$577.85 |
$577.85 |
$409.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$577.85 |
$577.85 |
$577.85 |
$336.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,355.25 |
$1,355.25 |
$1,355.25 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$596.70 |
$596.70 |
$596.70 |
$428.25
|
|
Ultrasound prostate/transrectal
|
$596.70 |
$596.70 |
$596.70 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$596.70 |
$596.70 |
$596.70 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$531.70 |
$531.70 |
$531.70 |
$423.36
|
|
Ultrasound trgt dyn mbubb 1st les
|
$421.20 |
$421.20 |
$421.20 |
$568.32
|
|
Ultrasound trgt dyn mbubb ea addl
|
$221.00 |
$221.00 |
$221.00 |
$348.00
|
|
Umbilical artery cath newborn 36660
|
$204.75 |
$204.75 |
$204.75 |
$223.80
|
|
Umbilicoplasty 15847
|
$3,788.20 |
$3,788.20 |
$3,788.20 |
$4,172.97
|
|
Unlistd noninvas vasc dx std
|
$1,025.05 |
$1,025.05 |
$1,025.05 |
$564.60
|
|
Unlisted cranfcl&maxlfcl px
|
$3,187.60 |
$3,187.60 |
$3,187.60 |
$571.20
|
|
Unlisted CT procedure
|
$8,697.00 |
$8,697.00 |
$8,697.00 |
$732.70
|
|
Unlisted fluoroscopic px
|
$30,872.40 |
$30,872.40 |
$30,872.40 |
$305.76
|
|
Unlisted laparoscopic liver biopy 47379
|
$16,602.30 |
$16,602.30 |
$16,602.30 |
$6,307.38
|
|
Unlisted laparoscopic procedure 49659
|
$7,044.05 |
$7,044.05 |
$7,044.05 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$8,529.95 |
$8,529.95 |
$8,529.95 |
$5,419.00
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$9,700.60 |
$9,700.60 |
$9,700.60 |
$6,463.42
|
|
Unlisted laps px appendix
|
$3,513.25 |
$3,513.25 |
$3,513.25 |
$3,617.40
|
|
Unlisted laps px bladder
|
$10,743.20 |
$10,743.20 |
$10,743.20 |
$5,082.74
|
|
Unlisted laps px esoph
|
$6,429.80 |
$6,429.80 |
$6,429.80 |
$5,741.00
|
|
Unlisted laps px lymphtc sys
|
$4,560.40 |
$4,560.40 |
$4,560.40 |
$6,870.89
|
|
Unlisted laps px ovidct ovry
|
$4,290.00 |
$4,290.00 |
$4,290.00 |
$6,904.15
|
|
Unlisted laps px renal
|
$7,046.00 |
$7,046.00 |
$7,046.00 |
$5,110.00
|
|
Unlisted laps px ureter
|
$6,212.70 |
$6,212.70 |
$6,212.70 |
$6,376.26
|
|
Unlisted laps px uterus
|
$4,524.00 |
$4,524.00 |
$4,524.00 |
$4,627.00
|
|
Unlisted maaa
|
$68.90 |
$68.90 |
$68.90 |
$235.20
|
|
Unlisted mr procedure
|
$8,762.65 |
$8,762.65 |
$8,762.65 |
$1,165.00
|
|
Unlisted procedure colon
|
$6,869.20 |
$6,869.20 |
$6,869.20 |
$1,839.55
|
|
Unlisted procedure esophagus
|
$12,597.00 |
$12,597.00 |
$12,597.00 |
$1,998.88
|
|
Unlisted procedure eyelids
|
$2,174.90 |
$2,174.90 |
$2,174.90 |
$2,174.90
|
|
Unlisted procedure larynx
|
$5,031.65 |
$5,031.65 |
$5,031.65 |
$924.00
|
|
Unlisted procedure liver
|
$4,366.70 |
$4,366.70 |
$4,366.70 |
$2,287.20
|
|
Unlisted procedure pancreas
|
$14,754.35 |
$14,754.35 |
$14,754.35 |
$4,810.00
|
|
Unlisted procedure rectum
|
$9,100.00 |
$9,100.00 |
$9,100.00 |
$1,278.72
|
|
Unlisted procedure spine
|
$10,826.40 |
$10,826.40 |
$10,826.40 |
$4,706.35
|
|
Unlisted px abdomen muscskel
|
$2,067.00 |
$2,067.00 |
$2,067.00 |
$2,053.50
|
|
Unlisted px accessory sinus
|
$6,248.45 |
$6,248.45 |
$6,248.45 |
$3,335.28
|
|
Unlisted px arthroscopy
|
$4,087.20 |
$4,087.20 |
$4,087.20 |
$2,765.60
|
|
Unlisted px biliary tract
|
$34,425.95 |
$34,425.95 |
$34,425.95 |
$3,055.00
|
|
Unlisted px casting/strpg
|
$219.70 |
$219.70 |
$219.70 |
$222.00
|
|
Unlisted px diaphragm
|
$28,316.60 |
$28,316.60 |
$28,316.60 |
$6,325.20
|
|
Unlisted px external ear
|
$2,056.60 |
$2,056.60 |
$2,056.60 |
$325.68
|
|
Unlisted px foot/toes
|
$3,881.80 |
$3,881.80 |
$3,881.80 |
$1,225.50
|
|
Unlisted px forearm/wrist
|
$3,192.15 |
$3,192.15 |
$3,192.15 |
$859.50
|
|
Unlisted px hands/fingers
|
$423.80 |
$423.80 |
$423.80 |
$349.70
|
|
Unlisted px leg/ankle
|
$1,931.80 |
$1,931.80 |
$1,931.80 |
$813.24
|
|
Unlisted px male genital sys
|
$10,795.85 |
$10,795.85 |
$10,795.85 |
$362.00
|
|
Unlisted px pelvis/hip joint
|
$10,826.40 |
$10,826.40 |
$10,826.40 |
$3,251.90
|
|
Unlisted px salivry glnd/dux
|
$1,607.45 |
$1,607.45 |
$1,607.45 |
$1,265.16
|
|
Unlisted px small intestine
|
$7,163.00 |
$7,163.00 |
$7,163.00 |
$2,118.35
|
|
Unlisted px ther rad tx plng
|
$228.80 |
$228.80 |
$228.80 |
$182.00
|
|
Unlisted px tongue flr mouth
|
$405.60 |
$405.60 |
$405.60 |
$282.50
|
|
Unlisted px vestibule mouth
|
$1,409.20 |
$1,409.20 |
$1,409.20 |
$456.96
|
|
Unlisted ultrasound procedure
|
$124.15 |
$124.15 |
$124.15 |
$335.00
|
|
Unlstd laps px sprmatic cord
|
$1,731.60 |
$1,731.60 |
$1,731.60 |
$4,713.11
|
|
Unsched dialysis esrd pt hos
|
$2,274.35 |
$2,274.35 |
$2,274.35 |
$1,316.90
|
|
Upgrade pm system
|
$20,950.15 |
$20,950.15 |
$20,950.15 |
$12,087.24
|
|
Upper Arm (Humerus) X-ray (left side)
|
$494.00 |
$494.00 |
$494.00 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$997.75 |
$997.75 |
$997.75 |
$1,680.60
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$596.70 |
$596.70 |
$596.70 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,002.00 |
$2,002.00 |
$2,002.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,002.00 |
$2,002.00 |
$2,002.00 |
$2,410.98
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,355.25 |
$1,355.25 |
$1,355.25 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$653.90 |
$653.90 |
$653.90 |
$322.50
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$596.70 |
$596.70 |
$596.70 |
$381.75
|
|
Upper Endoscopy (EGD, diagnostic)
|
$3,504.15 |
$3,504.15 |
$3,504.15 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$683.80 |
$683.80 |
$683.80 |
$1,768.00
|
|
Upper ext harvest for cabg1 seg 35600
|
$1,027.00 |
$1,027.00 |
$1,027.00 |
$627.20
|
|
Upper GI Barium X-ray (barium and gas)
|
$997.75 |
$997.75 |
$997.75 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$997.75 |
$997.75 |
$997.75 |
$612.00
|
|
Uppr gi scope w/submuc inj
|
$683.80 |
$683.80 |
$683.80 |
$1,872.00
|
|
Urea nitrogen
|
$52.00 |
$52.00 |
$52.00 |
$42.00
|
|
Urea nitrogen 24 hour urine
|
$85.15 |
$85.15 |
$85.15 |
$51.77
|
|
Ureteral embolization/occl
|
$1,047.80 |
$1,047.80 |
$1,047.80 |
$2,079.31
|
|
Ureteral reflux study
|
$2,252.90 |
$2,252.90 |
$2,252.90 |
$952.50
|
|
Ureteroneocystostomy 50780
|
$5,705.70 |
$5,705.70 |
$5,705.70 |
$4,457.05
|
|
Ureteroureterostomy 50760
|
$5,218.20 |
$5,218.20 |
$5,218.20 |
$2,773.01
|
