|
Tx septic abortion surgical 59830
|
$1,094.40 |
$1,094.40 |
$1,094.40 |
$896.40
|
|
Tx tarsal bone fx without manip 28450
|
$523.20 |
$523.20 |
$523.20 |
$423.15
|
|
Tympanic membrane repair
|
$1,856.00 |
$1,856.00 |
$1,856.00 |
$2,133.48
|
|
Tympanolysis transcanal 69450
|
$2,659.20 |
$2,659.20 |
$2,659.20 |
$3,837.72
|
|
Tympanometry & reflex thresh
|
$49.60 |
$49.60 |
$49.60 |
$173.18
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$966.40 |
$966.40 |
$966.40 |
$911.43
|
|
Tympp antrt/mastoidotomy prosthesis torp 69637
|
$6,740.80 |
$6,740.80 |
$6,740.80 |
$6,740.80
|
|
Tympp antrt/mastoid without ossic chain recnst 69635
|
$6,043.20 |
$6,043.20 |
$6,043.20 |
$7,000.36
|
|
Tyms gene com variants
|
$350.40 |
$350.40 |
$350.40 |
$192.29
|
|
Typhoid vaccine oral
|
$100.00 |
$100.00 |
$100.00 |
$63.28
|
|
Ua w/micro/comp poc
|
$25.72 |
$25.72 |
$25.72 |
$23.00
|
|
Ugt1a1 gene analy common variants
|
$468.00 |
$468.00 |
$468.00 |
$438.75
|
|
Ultrasound bone density measure
|
$29.60 |
$29.60 |
$29.60 |
$143.75
|
|
Ultrasound breast complete
|
$730.05 |
$730.05 |
$730.05 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$730.05 |
$730.05 |
$730.05 |
$452.00
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$233.61 |
$233.61 |
$233.61 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$249.46 |
$249.46 |
$249.46 |
$296.80
|
|
Ultrasound elastography ea l target les
|
$568.55 |
$568.55 |
$568.55 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$189.60 |
$189.60 |
$189.60 |
$307.00
|
|
Ultrasound encephalogram
|
$230.40 |
$230.40 |
$230.40 |
$485.48
|
|
Ultrasound exam k transpl w/doppler
|
$667.64 |
$667.64 |
$667.64 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$885.87 |
$885.87 |
$885.87 |
$477.10
|
|
Ultrasound Guidance for a Needle Procedure
|
$479.13 |
$479.13 |
$479.13 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$425.97 |
$425.97 |
$425.97 |
$388.08
|
|
Ultrasound guide intraoperative
|
$758.04 |
$758.04 |
$758.04 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$401.60 |
$401.60 |
$401.60 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$271.20 |
$271.20 |
$271.20 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$202.40 |
$202.40 |
$202.40 |
$304.00
|
|
Ultrasound joint complete left
|
$544.98 |
$544.98 |
$544.98 |
$560.92
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$191.20 |
$191.20 |
$191.20 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$368.29 |
$368.29 |
$368.29 |
$406.44
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$354.54 |
$354.54 |
$354.54 |
$333.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$827.72 |
$827.72 |
$827.72 |
$698.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$521.50 |
$521.50 |
$521.50 |
$428.25
|
|
Ultrasound prostate/transrectal
|
$532.11 |
$532.11 |
$532.11 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$332.80 |
$332.80 |
$332.80 |
$459.00
|
|
Ultrasound transabd ea addl gest
|
$481.61 |
$481.61 |
$481.61 |
$417.15
|
|
Ultrasound trgt dyn mbubb 1st les
|
$758.04 |
$758.04 |
$758.04 |
$568.32
|
|
Ultrasound trgt dyn mbubb ea addl
|
$568.55 |
$568.55 |
$568.55 |
$348.00
|
|
Ultraviolet therapy
|
$15.20 |
$15.20 |
$15.20 |
$39.76
|
|
Umbilical artery cath newborn 36660
|
$176.80 |
$176.80 |
$176.80 |
$223.80
|
|
Umbilical cord occlud w/us
|
$1,262.40 |
$1,262.40 |
$1,262.40 |
$754.00
|
|
Umbilicoplasty 15847
|
$834.40 |
$834.40 |
$834.40 |
$4,172.97
|
|
Unlisted CT procedure
|
$285.14 |
$285.14 |
$285.14 |
$740.43
|
|
Unlisted hematology&coagj px
|
$33.57 |
$33.57 |
$33.57 |
$39.52
|
|
Unlisted laparoscopic liver biopy 47379
|
$1,218.40 |
$1,218.40 |
$1,218.40 |
$6,307.38
|
|
Unlisted laparoscopic procedure 49659
|
$1,977.60 |
$1,977.60 |
$1,977.60 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$1,755.20 |
$1,755.20 |
$1,755.20 |
$5,419.00
|
|
Unlisted laps px bladder
|
$1,531.20 |
$1,531.20 |
$1,531.20 |
$5,082.74
|
|
Unlisted laps px ovidct ovry
|
$1,158.40 |
$1,158.40 |
$1,158.40 |
$6,904.15
|
|
Unlisted laps px uterus
|
$768.00 |
$768.00 |
$768.00 |
$4,627.00
|
|
Unlisted maaa
|
$127.86 |
$127.86 |
$127.86 |
$235.20
|
|
Unlisted procedure microbiology
|
$38.58 |
$38.58 |
$38.58 |
$530.00
|
|
Unlisted procedure pancreas
|
$1,849.60 |
$1,849.60 |
$1,849.60 |
$4,810.00
|
|
Unlisted psychiatric service/proc 90899
|
$157.65 |
$157.65 |
$157.65 |
$277.76
|
|
Unlisted px arthroscopy
|
$2,765.60 |
$2,765.60 |
$2,765.60 |
$2,765.60
|
|
Unlisted px casting/strpg
|
$78.40 |
$78.40 |
$78.40 |
$222.00
|
|
Unlisted px foot/toes
|
$1,740.80 |
$1,740.80 |
$1,740.80 |
$1,225.50
|
|
Unlisted px pelvis/hip joint
|
$1,415.20 |
$1,415.20 |
$1,415.20 |
$3,251.90
|
|
Unlisted px small intestine
|
$2,636.80 |
$2,636.80 |
$2,636.80 |
$2,118.35
|
|
Unlisted px tongue flr mouth
|
$208.00 |
$208.00 |
$208.00 |
$282.50
|
|
Unlisted reprod med lab proc
|
$70.00 |
$70.00 |
$70.00 |
$70.00
|
|
Unlisted special svc px/rprt
|
$25.60 |
$25.60 |
$25.60 |
$90.00
|
|
Unlisted transfusion med px
|
$57.14 |
$57.14 |
$57.14 |
$147.50
|
|
Unlisted ultrasound procedure
|
$369.60 |
$369.60 |
$369.60 |
$335.00
|
|
Unlisted urinalysis px
|
$25.72 |
$25.72 |
$25.72 |
$25.72
|
|
Upgrade pm system
|
$1,174.40 |
$1,174.40 |
$1,174.40 |
$12,087.24
|
|
Upper Arm (Humerus) X-ray (left side)
|
$291.80 |
$291.80 |
$291.80 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$2,059.09 |
$2,059.09 |
$2,059.09 |
$1,652.95
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,234.96 |
$1,234.96 |
$1,234.96 |
$1,422.05
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,865.19 |
$4,865.19 |
$4,865.19 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,946.47 |
$3,946.47 |
$3,946.47 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,960.10 |
$2,960.10 |
$2,960.10 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$271.10 |
$271.10 |
$271.10 |
$320.45
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$271.10 |
$271.10 |
$271.10 |
$380.82
|
|
Upper Endoscopy (EGD, diagnostic)
|
$687.20 |
$687.20 |
$687.20 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$914.40 |
$914.40 |
$914.40 |
$1,768.00
|
|
Upper ext fx orthosis rad/ul
|
$857.60 |
$857.60 |
$857.60 |
$619.49
|
|
Upper ext harvest for cabg1 seg 35600
|
$627.20 |
$627.20 |
$627.20 |
$627.20
|
|
Upper GI Barium X-ray (barium and gas)
|
$582.92 |
$582.92 |
$582.92 |
$657.77
|
|
Upper GI Barium X-ray (barium only)
|
$432.09 |
$432.09 |
$432.09 |
$603.20
|
|
Uppr gi scope w/submuc inj
|
$916.80 |
$916.80 |
$916.80 |
$1,872.00
|
|
Urachal cyst/sinus excision 51500
|
$1,605.60 |
$1,605.60 |
$1,605.60 |
$6,082.67
|
|
Urea nitrogen
|
$33.57 |
$33.57 |
$33.57 |
$42.00
|
|
Urea nitrogen 24 hour urine
|
$33.57 |
$33.57 |
$33.57 |
$51.77
|
|
Urea nitrogen clearance
|
$33.57 |
$33.57 |
$33.57 |
$34.02
|
|
Urea nitrogen semi-quant
|
$10.40 |
$10.40 |
$10.40 |
$10.40
|
|
Ureteral embolization/occl
|
$9,249.60 |
$9,249.60 |
$9,249.60 |
$2,079.31
|
|
Ureteral reflux study
|
$730.98 |
$730.98 |
$730.98 |
$952.50
|
|
Ureter endoscopy
|
$1,875.20 |
$1,875.20 |
$1,875.20 |
$3,326.40
|
|
Ureter endoscopy & biopsy
|
$2,140.80 |
$2,140.80 |
$2,140.80 |
$5,696.72
|
|
Ureter endoscopy & biopsy
|
$2,392.00 |
$2,392.00 |
$2,392.00 |
$5,986.78
|
|
Ureter endoscopy & catheter
|
$1,812.80 |
$1,812.80 |
$1,812.80 |
$3,326.40
|
|
Ureter endoscopy & treatment
|
$2,161.60 |
$2,161.60 |
$2,161.60 |
$6,015.75
|
|
Ureter endoscopy & treatment
|
$1,947.20 |
$1,947.20 |
$1,947.20 |
$5,631.74
|
|
Ureter endoscopy & treatment
|
$2,358.40 |
$2,358.40 |
$2,358.40 |
$5,986.78
|
|
Ureter endoscopy & treatment
|
$1,803.20 |
$1,803.20 |
$1,803.20 |
$5,631.74
|
|
Ureteroneocystostomy 50780
|
$5,564.80 |
$5,564.80 |
$5,564.80 |
$4,457.05
|
|
Ureteroureterostomy 50760
|
$5,649.60 |
$5,649.60 |
$5,649.60 |
$2,773.01
|
|
Urethrcystgrphy rtrgrde s&i
|
$574.40 |
$574.40 |
$574.40 |
$592.80
|
