|
Transcath mv repair addl prosthesis
|
$3,036.80 |
$3,036.80 |
$3,036.80 |
$4,385.00
|
|
Transcath mv repair init prosthesis
|
$4,386.00 |
$4,386.00 |
$4,386.00 |
$12,418.00
|
|
Transcath occlusion cns
|
$4,520.00 |
$4,520.00 |
$4,520.00 |
$7,157.76
|
|
Transcath occlusion non-cns
|
$5,897.60 |
$5,897.60 |
$5,897.60 |
$10,031.28
|
|
Transcath rmvl perm ldss pmkr rv
|
$24,827.20 |
$24,827.20 |
$24,827.20 |
$4,775.16
|
|
Transferrin
|
$32.00 |
$32.00 |
$32.00 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$1,150.00 |
$1,150.00 |
$1,150.00 |
$983.00
|
|
Transperi needle place pros
|
$8,209.60 |
$8,209.60 |
$8,209.60 |
$6,015.75
|
|
Transplt autol hct/donor
|
$4,472.80 |
$4,472.80 |
$4,472.80 |
$3,786.00
|
|
Trans shoe solid stirrup exi
|
$46.80 |
$46.80 |
$46.80 |
$141.41
|
|
Trauma partial team response w/critical care services level 4
|
$6,783.20 |
$6,783.20 |
$6,783.20 |
$4,523.04
|
|
Tray bonemarrw oncontrol 102mm
|
$1,214.80 |
$1,214.80 |
$1,214.80 |
$940.80
|
|
Treatment incomplete abortion completed surgically any trimester
|
$4,176.80 |
$4,176.80 |
$4,176.80 |
$3,916.04
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$252.40 |
$252.40 |
$252.40 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$169.60 |
$169.60 |
$169.60 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$479.20 |
$479.20 |
$479.20 |
$203.35
|
|
Treatment radiation delivery level 2
|
$1,404.80 |
$1,404.80 |
$1,404.80 |
$767.65
|
|
Treatment x10sv retinopathy
|
$1,475.20 |
$1,475.20 |
$1,475.20 |
$1,513.20
|
|
Treponema pallidum antibody
|
$32.40 |
$32.40 |
$32.40 |
$70.40
|
|
Trg gene rearrangement anal
|
$352.00 |
$352.00 |
$352.00 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$8.38 |
$8.38 |
$8.38 |
$43.21
|
|
Trichinella antibody
|
$32.00 |
$32.00 |
$32.00 |
$70.20
|
|
Trichomonas assay w/optic
|
$29.20 |
$29.20 |
$29.20 |
$55.50
|
|
#tricyclicantidprssnt
|
$122.00 |
$122.00 |
$122.00 |
$50.86
|
|
Triglycerides
|
$14.40 |
$14.40 |
$14.40 |
$58.05
|
|
Trim nondyst nails
|
$50.40 |
$50.40 |
$50.40 |
$113.40
|
|
Trnscath plc stent crv crtd without prtct
|
$2,805.60 |
$2,805.60 |
$2,805.60 |
$7,795.71
|
|
Trnscath plc stent crv crtd w/prtct
|
$6,790.00 |
$6,790.00 |
$6,790.00 |
$9,767.25
|
|
Trnscath plc stnt ante carotid art
|
$5,551.60 |
$5,551.60 |
$5,551.60 |
$6,069.00
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$4,376.80 |
$4,376.80 |
$4,376.80 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$3,346.00 |
$3,346.00 |
$3,346.00 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$10,439.20 |
$10,439.20 |
$10,439.20 |
$15,330.11
|
|
Trnscath retrv pq vasc fb w/guide
|
$3,636.00 |
$3,636.00 |
$3,636.00 |
$4,523.96
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$2,821.60 |
$2,821.60 |
$2,821.60 |
$5,069.50
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$1,782.40 |
$1,782.40 |
$1,782.40 |
$4,250.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$1,782.40 |
$1,782.40 |
$1,782.40 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$1,782.40 |
$1,782.40 |
$1,782.40 |
$3,866.70
|
|
Troponin quantitative
|
$35.60 |
$35.60 |
$35.60 |
$127.20
|
|
Tube trach disp innr can 5 xlt
|
$518.40 |
$518.40 |
$518.40 |
$445.99
|
|
Tube trach fen sz 6 uncuffed
|
$366.40 |
$366.40 |
$366.40 |
$155.98
|
|
Tx atrial fib pulm vein isol
|
$21,050.80 |
$21,050.80 |
$21,050.80 |
$29,030.54
|
|
Tx l/r atrial fib addl
|
$2,378.00 |
$2,378.00 |
$2,378.00 |
$6,769.00
|
|
Ua w/micro/comp poc
|
$9.20 |
$9.20 |
$9.20 |
$23.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$118.58 |
$118.58 |
$118.58 |
$20,945.01
|
|
Ugt1a1 gene analy common variants
|
$282.00 |
$282.00 |
$282.00 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$359.20 |
$359.20 |
$359.20 |
$394.20
|
|
Ultrasound breast complete
|
$347.20 |
$347.20 |
$347.20 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$255.60 |
$255.60 |
$255.60 |
$449.35
|
|
Ultrasound chest
|
$353.60 |
$353.60 |
$353.60 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$300.00 |
$300.00 |
$300.00 |
$338.00
|
|
Ultrasound elastography parenchyma
|
$327.20 |
$327.20 |
$327.20 |
$307.00
|
|
Ultrasound encephalogram
|
$359.20 |
$359.20 |
$359.20 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$464.40 |
$464.40 |
$464.40 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$359.20 |
$359.20 |
$359.20 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$84.40 |
$84.40 |
$84.40 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$579.20 |
$579.20 |
$579.20 |
$720.15
|
|
Ultrasound guide intraoperative
|
$339.60 |
$339.60 |
$339.60 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$335.60 |
$335.60 |
$335.60 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$305.60 |
$305.60 |
$305.60 |
$403.88
|
|
Ultrasound joint complete left
|
$407.20 |
$407.20 |
$407.20 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$304.40 |
$304.40 |
$304.40 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$407.20 |
$407.20 |
$407.20 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$266.00 |
$266.00 |
$266.00 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$707.20 |
$707.20 |
$707.20 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$346.00 |
$346.00 |
$346.00 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$355.60 |
$355.60 |
$355.60 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$399.20 |
$399.20 |
$399.20 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$435.20 |
$435.20 |
$435.20 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$359.20 |
$359.20 |
$359.20 |
$486.50
|
|
Ultrasound scrotum and contents
|
$426.00 |
$426.00 |
$426.00 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$391.20 |
$391.20 |
$391.20 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$323.20 |
$323.20 |
$323.20 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$488.00 |
$488.00 |
$488.00 |
$558.35
|
|
Umbilical artery cath newborn 36660
|
$461.20 |
$461.20 |
$461.20 |
$206.64
|
|
Unit mobile power mpu
|
$14,612.80 |
$14,612.80 |
$14,612.80 |
$14,612.80
|
|
Unlisted chemotherapy px
|
$108.40 |
$108.40 |
$108.40 |
$150.00
|
|
Unlisted fluoroscopic px
|
$275.20 |
$275.20 |
$275.20 |
$305.76
|
|
Unlisted maaa
|
$280.00 |
$280.00 |
$280.00 |
$235.20
|
|
Unlisted mr procedure
|
$6,891.60 |
$6,891.60 |
$6,891.60 |
$1,163.00
|
|
Unlisted procedure larynx
|
$2,210.40 |
$2,210.40 |
$2,210.40 |
$924.00
|
|
Unlisted procedure microbiology
|
$22.40 |
$22.40 |
$22.40 |
$523.50
|
|
Unlisted px abdomen muscskel
|
$2,210.80 |
$2,210.80 |
$2,210.80 |
$1,848.60
|
|
Unlisted px foot/toes
|
$1,239.20 |
$1,239.20 |
$1,239.20 |
$1,225.50
|
|
Unlisted px med radj physics
|
$363.60 |
$363.60 |
$363.60 |
$462.35
|
|
Unlisted px small intestine
|
$2,210.40 |
$2,210.40 |
$2,210.40 |
$2,102.10
|
|
Unsched dialysis esrd pt hos
|
$774.00 |
$774.00 |
$774.00 |
$1,268.17
|
|
Upgrade pm system
|
$11,642.40 |
$11,642.40 |
$11,642.40 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,928.40 |
$1,928.40 |
$1,928.40 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,990.00 |
$1,990.00 |
$1,990.00 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,753.60 |
$1,753.60 |
$1,753.60 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$4,088.80 |
$4,088.80 |
$4,088.80 |
$1,751.66
|
|
Urea nitrogen
|
$11.20 |
$11.20 |
$11.20 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$11.60 |
$11.60 |
$11.60 |
$51.75
|
|
Urea nitrogen clearance
|
$16.00 |
$16.00 |
$16.00 |
$42.25
|
|
Ureteral reflux study
|
$1,249.20 |
$1,249.20 |
$1,249.20 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$382.40 |
$382.40 |
$382.40 |
$579.73
|
|
Urethrocystography void s&i
|
$714.40 |
$714.40 |
$714.40 |
$622.35
|
|
Uric acid blood
|
$11.60 |
$11.60 |
$11.60 |
$48.75
|
|
Uric acid urine
|
$12.00 |
$12.00 |
$12.00 |
$44.33
|
|
Urinalysis microscopic only
|
$8.40 |
$8.40 |
$8.40 |
$26.35
|
