|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$963.60 |
$963.60 |
$963.60 |
$2,357.04
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$6,433.80 |
$6,433.80 |
$6,433.80 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$1,152.60 |
$1,152.60 |
$1,152.60 |
$3,078.00
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$1,152.60 |
$1,152.60 |
$1,152.60 |
$2,371.50
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$1,152.60 |
$1,152.60 |
$1,152.60 |
$2,371.50
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$1,152.60 |
$1,152.60 |
$1,152.60 |
$2,406.77
|
|
Troponin quantitative
|
$231.60 |
$231.60 |
$231.60 |
$127.20
|
|
Tx atrial fib pulm vein isol
|
$19,113.60 |
$19,113.60 |
$19,113.60 |
$29,030.54
|
|
Tx closed distal humerus fx
|
$348.60 |
$348.60 |
$348.60 |
$594.88
|
|
Tx closed hip disl traumatic without anes
|
$514.20 |
$514.20 |
$514.20 |
$581.07
|
|
Tx l/r atrial fib addl
|
$9,548.40 |
$9,548.40 |
$9,548.40 |
$6,769.00
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$9,571.20 |
$9,571.20 |
$9,571.20 |
$4,468.55
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$2,044.20 |
$2,044.20 |
$2,044.20 |
$4,499.12
|
|
Tympanometry & reflex thresh
|
$210.00 |
$210.00 |
$210.00 |
$170.00
|
|
Ultrasound abdomen aorta screening study aaa
|
$782.40 |
$782.40 |
$782.40 |
$394.20
|
|
Ultrasound breast complete
|
$808.20 |
$808.20 |
$808.20 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$728.40 |
$728.40 |
$728.40 |
$449.35
|
|
Ultrasound chest
|
$531.00 |
$531.00 |
$531.00 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$456.60 |
$456.60 |
$456.60 |
$338.00
|
|
Ultrasound elastography ea l target les
|
$148.20 |
$148.20 |
$148.20 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$338.40 |
$338.40 |
$338.40 |
$307.00
|
|
Ultrasound exam k transpl w/doppler
|
$1,095.60 |
$1,095.60 |
$1,095.60 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$705.00 |
$705.00 |
$705.00 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$967.80 |
$967.80 |
$967.80 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$967.80 |
$967.80 |
$967.80 |
$720.15
|
|
Ultrasound guide intraoperative
|
$1,276.20 |
$1,276.20 |
$1,276.20 |
$632.85
|
|
Ultrasound joint complete left
|
$1,071.60 |
$1,071.60 |
$1,071.60 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$605.40 |
$605.40 |
$605.40 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$1,389.00 |
$1,389.00 |
$1,389.00 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$555.60 |
$555.60 |
$555.60 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$791.40 |
$791.40 |
$791.40 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$630.60 |
$630.60 |
$630.60 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$705.00 |
$705.00 |
$705.00 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$520.80 |
$520.80 |
$520.80 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$1,463.40 |
$1,463.40 |
$1,463.40 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$810.60 |
$810.60 |
$810.60 |
$486.50
|
|
Ultrasound scrotum and contents
|
$564.00 |
$564.00 |
$564.00 |
$608.90
|
|
Ultrasound transabd ea addl gest
|
$463.80 |
$463.80 |
$463.80 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$520.80 |
$520.80 |
$520.80 |
$558.35
|
|
Ultraviolet therapy
|
$27.60 |
$27.60 |
$27.60 |
$39.76
|
|
Umbilical artery cath newborn 36660
|
$247.80 |
$247.80 |
$247.80 |
$206.64
|
|
Unlisted cytogenetic study
|
$1,631.40 |
$1,631.40 |
$1,631.40 |
$160.18
|
|
Unlisted maaa
|
$370.20 |
$370.20 |
$370.20 |
$235.20
|
|
Unlisted mr procedure
|
$2,694.60 |
$2,694.60 |
$2,694.60 |
$1,163.00
|
|
Unlisted orl service/px
|
$138.00 |
$138.00 |
$138.00 |
$132.60
|
|
Unlisted procedure liver
|
$1,662.00 |
$1,662.00 |
$1,662.00 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$1,692.60 |
$1,692.60 |
$1,692.60 |
$523.50
|
|
Unlisted px casting/strpg
|
$434.40 |
$434.40 |
$434.40 |
$219.70
|
|
Unlisted px male genital sys
|
$174.60 |
$174.60 |
$174.60 |
$343.55
|
|
Unlisted px med radj physics
|
$498.60 |
$498.60 |
$498.60 |
$462.35
|
|
Unlisted px small intestine
|
$2,674.20 |
$2,674.20 |
$2,674.20 |
$2,102.10
|
|
Unlisted ultrasound procedure
|
$550.80 |
$550.80 |
$550.80 |
$321.20
|
|
Upgrade pm system
|
$9,774.00 |
$9,774.00 |
$9,774.00 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,022.80 |
$3,022.80 |
$3,022.80 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,643.00 |
$2,643.00 |
$2,643.00 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,425.80 |
$2,425.80 |
$2,425.80 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$3,049.80 |
$3,049.80 |
$3,049.80 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$3,504.60 |
$3,504.60 |
$3,504.60 |
$1,768.00
|
|
Urea nitrogen
|
$110.40 |
$110.40 |
$110.40 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$145.80 |
$145.80 |
$145.80 |
$51.75
|
|
Ureteral reflux study
|
$738.60 |
$738.60 |
$738.60 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$750.60 |
$750.60 |
$750.60 |
$579.73
|
|
Urethrocystography void s&i
|
$693.60 |
$693.60 |
$693.60 |
$622.35
|
|
Uric acid blood
|
$102.60 |
$102.60 |
$102.60 |
$48.75
|
|
Uric acid urine
|
$175.80 |
$175.80 |
$175.80 |
$44.33
|
|
Urinalysis microscopic only
|
$81.60 |
$81.60 |
$81.60 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$31.20 |
$31.20 |
$31.20 |
$25.72
|
|
Urinalysis (with microscopy)
|
$112.20 |
$112.20 |
$112.20 |
$55.00
|
|
Urinalysis (without microscopy)
|
$77.40 |
$77.40 |
$77.40 |
$35.75
|
|
Urine Culture Test
|
$68.40 |
$68.40 |
$68.40 |
$81.50
|
|
Urine pregnancy test
|
$137.40 |
$137.40 |
$137.40 |
$67.20
|
|
Use 1st target lesion
|
$268.20 |
$268.20 |
$268.20 |
$332.00
|
|
Vad battery clip set hmii 14-v li-ion
|
$3,481.20 |
$3,481.20 |
$3,481.20 |
$2,002.00
|
|
Valproic acid total therapeutic drug level
|
$209.40 |
$209.40 |
$209.40 |
$114.72
|
|
Vancomycin peak therapeutic drug level
|
$192.60 |
$192.60 |
$192.60 |
$136.13
|
|
Varicella zoster antibody igg
|
$231.00 |
$231.00 |
$231.00 |
$86.80
|
|
Veeg cont 2-12 hrs
|
$2,922.60 |
$2,922.60 |
$2,922.60 |
$1,540.00
|
|
Veeg ea 12-26hr cont mntr
|
$4,125.60 |
$4,125.60 |
$4,125.60 |
$3,225.60
|
|
Veeg intrmnt 2-12 hrs
|
$3,360.60 |
$3,360.60 |
$3,360.60 |
$961.00
|
|
Veeg unmon 12-26 hrs
|
$4,744.80 |
$4,744.80 |
$4,744.80 |
$1,671.09
|
|
Veeg unmon 2-12 hrs
|
$3,360.60 |
$3,360.60 |
$3,360.60 |
$826.15
|
|
Vein x-ray liver w/hemodynam
|
$1,957.20 |
$1,957.20 |
$1,957.20 |
$3,486.86
|
|
Vein x-ray liver w/hemodynam
|
$3,784.20 |
$3,784.20 |
$3,784.20 |
$3,483.84
|
|
Vein x-ray liver without hemodyn
|
$1,957.20 |
$1,957.20 |
$1,957.20 |
$2,452.80
|
|
Vemp test i&r cervical
|
$400.20 |
$400.20 |
$400.20 |
$313.00
|
|
Vemp test i&r ocular
|
$400.20 |
$400.20 |
$400.20 |
$266.00
|
|
Vemp tst i&r cervical&ocular
|
$759.60 |
$759.60 |
$759.60 |
$591.50
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$111.60 |
$111.60 |
$111.60 |
$202.80
|
|
Venogram ext bil s&i
|
$2,315.40 |
$2,315.40 |
$2,315.40 |
$1,797.50
|
|
Venogram extremity supervision & interpretation unilateral
|
$1,315.20 |
$1,315.20 |
$1,315.20 |
$1,366.20
|
|
Venous mech thrombectomy
|
$8,707.20 |
$8,707.20 |
$8,707.20 |
$7,965.00
|
|
Venous m-thrombectomy add-on
|
$5,011.80 |
$5,011.80 |
$5,011.80 |
$5,094.75
|
|
Ventilator each subsequent day
|
$765.00 |
$765.00 |
$765.00 |
$1,204.00
|
|
Ventilator initial day
|
$943.80 |
$943.80 |
$943.80 |
$1,431.43
|
|
Version cephalic external
|
$1,617.60 |
$1,617.60 |
$1,617.60 |
$2,361.75
|
|
Very long chain fatty acids
|
$751.80 |
$751.80 |
$751.80 |
$139.88
|
|
Vest large holster
|
$1,838.40 |
$1,838.40 |
$1,838.40 |
$1,078.25
|
|
Virus isolation addl studies ea
|
$112.80 |
$112.80 |
$112.80 |
$77.50
|
|
Visual audiometry (vra)
|
$260.40 |
$260.40 |
$260.40 |
$215.25
|
|
Vital capacity test
|
$98.40 |
$98.40 |
$98.40 |
$170.00
|
