|
Trnscath plc stnt ante carotid art
|
$1,249.50 |
$1,249.50 |
$1,249.50 |
$6,069.00
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$6,876.80 |
$6,876.80 |
$6,876.80 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$5,530.00 |
$5,530.00 |
$5,530.00 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$44,101.04 |
$44,101.04 |
$44,101.04 |
$15,330.11
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$7,900.20 |
$7,900.20 |
$7,900.20 |
$5,069.50
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$11,054.40 |
$11,054.40 |
$11,054.40 |
$4,250.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$8,685.60 |
$8,685.60 |
$8,685.60 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$920.50 |
$920.50 |
$920.50 |
$3,866.70
|
|
Troponin quantitative
|
$170.80 |
$170.80 |
$170.80 |
$127.20
|
|
Tte w or without contr, cont ecg
|
$4,760.00 |
$4,760.00 |
$4,760.00 |
$2,012.40
|
|
Tubal Ligation (Laparoscopic)
|
$26,986.10 |
$26,986.10 |
$26,986.10 |
$4,323.20
|
|
Tube trach disp innr can 5 xlt
|
$784.78 |
$784.78 |
$784.78 |
$445.99
|
|
Tube trach fen sz 6 uncuffed
|
$84.52 |
$84.52 |
$84.52 |
$155.98
|
|
Tx atrial fib pulm vein isol
|
$21,205.10 |
$21,205.10 |
$21,205.10 |
$29,030.54
|
|
Tx closed hip disl traumatic without anes
|
$808.50 |
$808.50 |
$808.50 |
$581.07
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$5,628.70 |
$5,628.70 |
$5,628.70 |
$3,977.49
|
|
Tx l/r atrial fib addl
|
$4,109.00 |
$4,109.00 |
$4,109.00 |
$6,769.00
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$5,224.80 |
$5,224.80 |
$5,224.80 |
$4,421.00
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$8,633.80 |
$8,633.80 |
$8,633.80 |
$4,499.12
|
|
Tympanometry & reflex thresh
|
$116.90 |
$116.90 |
$116.90 |
$170.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$52,509.10 |
$52,509.10 |
$52,509.10 |
$20,945.01
|
|
Ugt1a1 gene analy common variants
|
$718.90 |
$718.90 |
$718.90 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$852.60 |
$852.60 |
$852.60 |
$394.20
|
|
Ultrasound breast complete
|
$532.00 |
$532.00 |
$532.00 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$438.90 |
$438.90 |
$438.90 |
$449.35
|
|
Ultrasound chest
|
$1,039.50 |
$1,039.50 |
$1,039.50 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$969.50 |
$969.50 |
$969.50 |
$338.00
|
|
Ultrasound elastography ea l target les
|
$434.00 |
$434.00 |
$434.00 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$482.30 |
$482.30 |
$482.30 |
$307.00
|
|
Ultrasound encephalogram
|
$1,406.30 |
$1,406.30 |
$1,406.30 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$1,237.60 |
$1,237.60 |
$1,237.60 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$1,120.70 |
$1,120.70 |
$1,120.70 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$1,292.20 |
$1,292.20 |
$1,292.20 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$1,705.20 |
$1,705.20 |
$1,705.20 |
$720.15
|
|
Ultrasound guide intraoperative
|
$2,104.20 |
$2,104.20 |
$2,104.20 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$2,603.30 |
$2,603.30 |
$2,603.30 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$1,275.40 |
$1,275.40 |
$1,275.40 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$1,087.80 |
$1,087.80 |
$1,087.80 |
$311.25
|
|
Ultrasound joint complete left
|
$1,269.80 |
$1,269.80 |
$1,269.80 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$774.90 |
$774.90 |
$774.90 |
$425.45
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$245.70 |
$245.70 |
$245.70 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$1,598.10 |
$1,598.10 |
$1,598.10 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$819.70 |
$819.70 |
$819.70 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,360.80 |
$1,360.80 |
$1,360.80 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$830.90 |
$830.90 |
$830.90 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$718.90 |
$718.90 |
$718.90 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$749.00 |
$749.00 |
$749.00 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$1,085.00 |
$1,085.00 |
$1,085.00 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$1,313.20 |
$1,313.20 |
$1,313.20 |
$486.50
|
|
Ultrasound scrotum and contents
|
$1,376.90 |
$1,376.90 |
$1,376.90 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$1,559.60 |
$1,559.60 |
$1,559.60 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$1,157.10 |
$1,157.10 |
$1,157.10 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$1,079.40 |
$1,079.40 |
$1,079.40 |
$558.35
|
|
Ultrasound trgt dyn mbubb 1st les
|
$3,213.00 |
$3,213.00 |
$3,213.00 |
$568.32
|
|
Ultrasound trgt dyn mbubb ea addl
|
$4,034.80 |
$4,034.80 |
$4,034.80 |
$348.00
|
|
Umbilical artery cath newborn 36660
|
$851.20 |
$851.20 |
$851.20 |
$206.64
|
|
Unlisted chemotherapy px
|
$540.40 |
$540.40 |
$540.40 |
$150.00
|
|
Unlisted CT procedure
|
$1,941.10 |
$1,941.10 |
$1,941.10 |
$732.70
|
|
Unlisted dx gi procedure
|
$1,908.20 |
$1,908.20 |
$1,908.20 |
$649.22
|
|
Unlisted fetal invas px w/us
|
$606.90 |
$606.90 |
$606.90 |
$498.40
|
|
Unlisted fluoroscopic px
|
$26,511.80 |
$26,511.80 |
$26,511.80 |
$305.76
|
|
Unlisted hematology&coagj px
|
$65.10 |
$65.10 |
$65.10 |
$39.52
|
|
Unlisted hystsc px uterus
|
$17,169.00 |
$17,169.00 |
$17,169.00 |
$2,803.60
|
|
Unlisted laparoscopic liver biopy 47379
|
$33,277.42 |
$33,277.42 |
$33,277.42 |
$5,419.00
|
|
Unlisted laparoscopic procedure 49659
|
$34,720.87 |
$34,720.87 |
$34,720.87 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$29,740.02 |
$29,740.02 |
$29,740.02 |
$5,419.00
|
|
Unlisted maaa
|
$284.90 |
$284.90 |
$284.90 |
$235.20
|
|
Unlisted mr procedure
|
$2,110.50 |
$2,110.50 |
$2,110.50 |
$1,163.00
|
|
Unlisted procedure colon
|
$10,896.20 |
$10,896.20 |
$10,896.20 |
$1,702.50
|
|
Unlisted procedure esophagus
|
$15,993.60 |
$15,993.60 |
$15,993.60 |
$1,998.88
|
|
Unlisted procedure liver
|
$26,043.50 |
$26,043.50 |
$26,043.50 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$2,748.20 |
$2,748.20 |
$2,748.20 |
$523.50
|
|
Unlisted procedure pancreas
|
$8,447.60 |
$8,447.60 |
$8,447.60 |
$3,986.00
|
|
Unlisted procedure rectum
|
$12,129.60 |
$12,129.60 |
$12,129.60 |
$1,220.35
|
|
Unlisted px abdomen muscskel
|
$3,161.20 |
$3,161.20 |
$3,161.20 |
$1,848.60
|
|
Unlisted px accessory sinus
|
$35,512.48 |
$35,512.48 |
$35,512.48 |
$3,335.28
|
|
Unlisted px arthroscopy
|
$48,747.04 |
$48,747.04 |
$48,747.04 |
$2,765.60
|
|
Unlisted px biliary tract
|
$23,227.40 |
$23,227.40 |
$23,227.40 |
$2,718.10
|
|
Unlisted px leg/ankle
|
$13,652.80 |
$13,652.80 |
$13,652.80 |
$811.00
|
|
Unlisted px male genital sys
|
$16,062.75 |
$16,062.75 |
$16,062.75 |
$343.55
|
|
Unlisted px med radj physics
|
$30,484.82 |
$30,484.82 |
$30,484.82 |
$462.35
|
|
Unlisted px posterior segmnt
|
$8,799.70 |
$8,799.70 |
$8,799.70 |
$3,173.34
|
|
Unlisted px small intestine
|
$12,495.70 |
$12,495.70 |
$12,495.70 |
$2,102.10
|
|
Unlisted surgical path px
|
$249.20 |
$249.20 |
$249.20 |
$217.75
|
|
Unlisted ultrasound procedure
|
$105.00 |
$105.00 |
$105.00 |
$321.20
|
|
Unlisted urinalysis px
|
$114.10 |
$114.10 |
$114.10 |
$25.72
|
|
Unlstd laps px sprmatic cord
|
$36,512.00 |
$36,512.00 |
$36,512.00 |
$4,713.11
|
|
Unsched dialysis esrd pt hos
|
$1,844.50 |
$1,844.50 |
$1,844.50 |
$1,268.17
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,696.30 |
$4,696.30 |
$4,696.30 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$4,101.30 |
$4,101.30 |
$4,101.30 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,809.40 |
$3,809.40 |
$3,809.40 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$4,920.72 |
$4,920.72 |
$4,920.72 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$11,107.61 |
$11,107.61 |
$11,107.61 |
$1,768.00
|
|
Uppr gi scope w/submuc inj
|
$19,048.06 |
$19,048.06 |
$19,048.06 |
$1,872.00
|
|
Urea nitrogen
|
$84.00 |
$84.00 |
$84.00 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$205.10 |
$205.10 |
$205.10 |
$51.75
|
|
Ureteroureterostomy 50760
|
$93,267.34 |
$93,267.34 |
$93,267.34 |
$2,999.40
|
|
Urethrcystgrphy rtrgrde s&i
|
$839.30 |
$839.30 |
$839.30 |
$579.73
|
|
Urethrocystography void s&i
|
$897.40 |
$897.40 |
$897.40 |
$622.35
|
|
Uric acid blood
|
$79.10 |
$79.10 |
$79.10 |
$48.75
|
