,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, University Hospital,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Shoppable Services,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Filename: 221775306_UniversityHospital_ShoppableServices.pdf,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, "Updated 9/16/2022, using 8/4/2022 CDM",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Notes:,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Inpatient charges are not separately billable and are included in the DRG rate.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, The gross charges for the DRG based billing codes are average charge per case.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Discounted prices that are not currently available are noted as T.B.D.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Prices not directly translated on a contract or service group are noted as Contact UH.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Shoppable ID,N/A Indicator,Billing Code,Description,Location Provided,Gross Charge,Aetna Health Plan: Better Health,Aetna Health Plan: Commercial,Aetna Health Plan: Medicare,Devon Health Services (FKA Americare),Amerigroup,Amerihealth: HMO and PPO,Amerihealth: Medicare,Consumer Health Network: PPO,"Correctional Medical Services, In.",Coventry Health Care (FKA CCN and FirstHealth),First Trenton Indemnity,Horizon Plan: Indemnity,Horizon Plan: Medicare Blue,Horizon Plan: Managed,Horizon Plan: NJ Health,Horizon Plan: PPO,Managed Care Incorporated,"Multiplan, Inc",QualCare,Three Rivers Provider Network,United Healthcare Community Plan: Medicaid,United Healthcare Community Plan: Medicare,United HealthCare: Commercial,United HealthCare: Oxford,United HealthCare: PPO,Wellcare: Medicaid,Wellcare: Medicare,Minimum Negotiated Rate,Maximum Negotiated Rate,Discounted Cash Price 1,,85027,"Complete Blood Count, Automated ",IP/OP,32.00,8.31,12.16,6.47,24.00,8.89,Contact UH,6.47,30.40,25.60,22.40,28.80,12.25,9.60,12.25,N/A,12.25,28.80,25.60,24.00,30.40,4.80,6.47,Contact UH,Contact UH,Contact UH,4.80,6.47,4.80,30.40,7.44 2,,80053,"Blood Test, Comprehensive Group Of Blood Chemicals ",IP/OP,51.00,13.24,19.38,10.56,38.25,14.17,Contact UH,10.56,48.45,40.80,35.70,45.90,19.52,15.30,19.52,N/A,19.52,45.90,40.80,38.25,48.45,10.50,10.56,Contact UH,Contact UH,Contact UH,10.50,10.56,10.50,48.45,12.14 3,,80061,"Blood Test, Lipids (Cholesterol And Triglycerides) ",IP/OP,119.00,30.90,45.22,13.39,89.25,33.06,Contact UH,13.39,113.05,95.20,83.30,107.10,45.55,35.70,45.55,N/A,45.55,107.10,95.20,89.25,113.05,15.00,13.39,Contact UH,Contact UH,Contact UH,15.00,13.39,13.39,113.05,15.40 4,,84153,Psa (Prostate Specific Antigen) ,IP/OP,156.00,40.51,59.28,18.39,117.00,43.34,Contact UH,18.39,148.20,124.80,109.20,140.40,59.72,46.80,59.72,N/A,59.72,140.40,124.80,117.00,148.20,24.50,18.39,Contact UH,Contact UH,Contact UH,24.50,18.39,18.39,148.20,21.15 5,,80076,Liver Function Blood Test Panel ,IP/OP,66.00,17.14,25.08,8.17,49.50,18.33,Contact UH,8.17,62.70,52.80,46.20,59.40,25.26,19.80,25.26,N/A,25.26,59.40,52.80,49.50,62.70,7.00,8.17,Contact UH,Contact UH,Contact UH,7.00,8.17,7.00,62.70,9.40 6,,70450,"Ct Scan, Head Or Brain, Without Contrast ",IP/OP,2425.00,629.77,184.41,131.72,1818.75,673.67,Contact UH,131.72,2303.75,1940.00,1697.50,2182.50,248.82,131.72,248.82,N/A,248.82,2182.50,1940.00,1818.75,2303.75,629.77,131.72,Contact UH,Contact UH,Contact UH,629.77,131.72,131.72,2303.75,151.48 7,,74177,Ct Scan Of Abdomen And Pelvis With Contrast ,IP/OP,1500.00,389.55,623.77,445.55,1125.00,416.70,Contact UH,445.55,1425.00,1200.00,1050.00,1350.00,841.64,445.55,841.64,N/A,841.64,1350.00,1200.00,1125.00,1425.00,389.55,445.55,Contact UH,Contact UH,Contact UH,389.55,445.55,389.55,1425.00,512.38 8,,81001,Manual Urinalysis Test With Examination Using Microscope ,IP/OP,34.00,8.83,12.92,3.17,25.50,9.45,Contact UH,3.17,32.30,27.20,23.80,30.60,13.02,10.20,13.02,N/A,13.02,30.60,27.20,25.50,32.30,1.20,3.17,Contact UH,Contact UH,Contact UH,1.20,3.17,1.20,32.30,3.65 9,,76830,Ultrasound Pelvis Through Vagina ,IP/OP,462.00,119.98,184.41,131.72,346.50,128.34,Contact UH,131.72,438.90,369.60,323.40,415.80,248.82,131.72,248.82,N/A,248.82,415.80,369.60,346.50,438.90,119.98,131.72,Contact UH,Contact UH,Contact UH,119.98,131.72,119.98,438.90,151.48 10,,62323,Injection Of Substance Into Spinal Canal Of Lower Back Or Sacrum Using Imaging Guidance ,IP/OP,2311.00,600.17,1075.61,768.29,1733.25,642.00,Contact UH,768.29,2195.45,1848.80,1617.70,2079.90,1451.30,768.29,1451.30,N/A,1451.30,2079.90,1848.80,1733.25,2195.45,600.17,768.29,Contact UH,Contact UH,Contact UH,600.17,768.29,600.17,2195.45,883.53 11,,85610,"Blood Test, Clotting Time ",IP/OP,41.00,10.65,15.58,4.29,30.75,11.39,Contact UH,4.29,38.95,32.80,28.70,36.90,15.69,12.30,15.69,N/A,15.69,36.90,32.80,30.75,38.95,3.00,4.29,Contact UH,Contact UH,Contact UH,3.00,4.29,3.00,38.95,4.93 12,,85730,Coagulation Assessment Blood Test ,IP/OP,49.00,12.73,18.62,6.01,36.75,13.61,Contact UH,6.01,46.55,39.20,34.30,44.10,18.76,14.70,18.76,N/A,18.76,44.10,39.20,36.75,46.55,3.00,6.01,Contact UH,Contact UH,Contact UH,3.00,6.01,3.00,46.55,6.91 13,,80048,Basic Metabolic Panel ,IP/OP,63.00,16.36,23.94,8.46,47.25,17.50,Contact UH,8.46,59.85,50.40,44.10,56.70,24.12,18.90,24.12,N/A,24.12,56.70,50.40,47.25,59.85,9.30,8.46,Contact UH,Contact UH,Contact UH,9.30,8.46,8.46,59.85,9.73 14,,72193,"Ct Scan, Pelvis, With Contrast ",IP/OP,1621.00,420.97,302.57,216.12,1215.75,450.31,Contact UH,216.12,1539.95,1296.80,1134.70,1458.90,408.25,216.12,408.25,N/A,408.25,1458.90,1296.80,1215.75,1539.95,420.97,216.12,Contact UH,Contact UH,Contact UH,420.97,216.12,216.12,1539.95,248.54 15,,93452,Insertion Of Catheter Into Left Heart For Diagnosis ,OP ,13574.00,3525.17,4911.83,3508.45,10180.50,3770.86,Contact UH,3508.45,12895.30,10859.20,9501.80,12216.60,6627.46,3508.45,6627.46,N/A,6627.46,12216.60,10859.20,10180.50,12895.30,3525.17,3508.45,Contact UH,Contact UH,Contact UH,3525.17,3508.45,3508.45,12895.30,4034.72 16,,76700,Ultrasound Of Abdomen ,IP/OP,473.00,122.84,184.41,131.72,354.75,131.40,Contact UH,131.72,449.35,378.40,331.10,425.70,248.82,131.72,248.82,N/A,248.82,425.70,378.40,354.75,449.35,122.84,131.72,Contact UH,Contact UH,Contact UH,122.84,131.72,122.84,449.35,151.48 17,,73721,Mri Scan Of Leg Joint ,IP/OP,1736.00,450.84,389.76,278.40,1302.00,482.26,Contact UH,278.40,1649.20,1388.80,1215.20,1562.40,525.90,278.40,525.90,N/A,525.90,1562.40,1388.80,1302.00,1649.20,450.84,278.40,Contact UH,Contact UH,Contact UH,450.84,278.40,278.40,1649.20,320.16 18,,59400,"Routine Obstetric Care For Vaginal Delivery, Including Pre-And Post-Delivery Care ",IP/OP,7827.00,2032.67,2974.26,2410.72,5870.25,2174.34,Contact UH,N/A,7435.65,6261.60,5478.90,7044.30,2996.18,2348.10,2996.18,N/A,2996.18,7044.30,6261.60,5870.25,7435.65,2032.67,N/A,Contact UH,Contact UH,Contact UH,2032.67,N/A,2032.67,7435.65,T.B.D 19,,77067,"Mammography, Screening, Bilateral ",IP/OP,472.00,122.58,179.36,145.38,354.00,131.12,Contact UH,N/A,448.40,377.60,330.40,424.80,180.68,141.60,180.68,N/A,180.68,424.80,377.60,354.00,448.40,122.58,N/A,Contact UH,Contact UH,Contact UH,122.58,N/A,122.58,448.40,T.B.D 20,,43239,"Biopsy Of The Esophagus, Stomach, And/Or Upper Small Bowel Using An Endoscope ",IP/OP,2757.00,715.99,1370.61,979.01,2067.75,765.89,Contact UH,979.01,2619.15,2205.60,1929.90,2481.30,1849.35,979.01,1849.35,N/A,1849.35,2481.30,2205.60,2067.75,2619.15,715.99,979.01,Contact UH,Contact UH,Contact UH,715.99,979.01,715.99,2619.15,1125.86 21,,43235,"Diagnostic Examination Of Esophagus, Stomach, And/Or Upper Small Bowel Using An Endoscope ",IP/OP,2067.00,536.80,1370.61,979.01,1550.25,574.21,Contact UH,979.01,1963.65,1653.60,1446.90,1860.30,1849.35,979.01,1849.35,N/A,1849.35,1860.30,1653.60,1550.25,1963.65,536.80,979.01,Contact UH,Contact UH,Contact UH,536.80,979.01,536.80,1963.65,1125.86 22,,72110,"X-Ray, Lower Back, Minimum Four Views ",IP/OP,372.00,96.61,184.41,131.72,279.00,103.34,Contact UH,131.72,353.40,297.60,260.40,334.80,248.82,131.72,248.82,N/A,248.82,334.80,297.60,279.00,353.40,96.61,131.72,Contact UH,Contact UH,Contact UH,96.61,131.72,96.61,353.40,151.48 23,,64483,Injections Of Anesthetic And/Or Steroid Drug Into Lower Or Sacral Spine Nerve Root Using Imaging Gui,IP/OP,1125.00,292.16,1394.40,996.00,843.75,312.53,Contact UH,996.00,1068.75,900.00,787.50,1012.50,1881.44,996.00,1881.44,N/A,1881.44,1012.50,900.00,843.75,1068.75,292.16,996.00,Contact UH,Contact UH,Contact UH,292.16,996.00,292.16,1881.44,1145.40 24,,45385,Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope ,IP/OP,2757.00,715.99,1756.51,1254.65,2067.75,765.89,Contact UH,1254.65,2619.15,2205.60,1929.90,2481.30,2370.03,1254.65,2370.03,N/A,2370.03,2481.30,2205.60,2067.75,2619.15,715.99,1254.65,Contact UH,Contact UH,Contact UH,715.99,1254.65,715.99,2619.15,1442.85 25,,77066,Mammography Of Both Breasts ,IP/OP,500.00,129.85,190.00,154.00,375.00,138.90,Contact UH,N/A,475.00,400.00,350.00,450.00,191.40,150.00,191.40,N/A,191.40,450.00,400.00,375.00,475.00,129.85,N/A,Contact UH,Contact UH,Contact UH,129.85,N/A,129.85,475.00,T.B.D 26,,45380,Biopsy Of Large Bowel Using An Endoscope ,OP ,2757.00,715.99,1756.51,1254.65,2067.75,765.89,Contact UH,1254.65,2619.15,2205.60,1929.90,2481.30,2370.03,1254.65,2370.03,N/A,2370.03,2481.30,2205.60,2067.75,2619.15,715.99,1254.65,Contact UH,Contact UH,Contact UH,715.99,1254.65,715.99,2619.15,1442.85 27,,49505,Repair Of Groin Hernia Patient Age 5 Years Or Older ,OP,8310.00,2158.11,5389.22,3849.44,6232.50,2308.52,Contact UH,3849.44,7894.50,6648.00,5817.00,7479.00,7271.59,3849.44,7271.59,N/A,7271.59,7479.00,6648.00,6232.50,7894.50,2158.11,3849.44,Contact UH,Contact UH,Contact UH,2158.11,3849.44,2158.11,7894.50,4426.86 28,,97110,"Physical Therapy, Therapeutic Exercise ",IP/OP,152.00,39.47,57.76,46.82,114.00,42.23,Contact UH,N/A,144.40,121.60,106.40,136.80,58.19,45.60,58.19,N/A,58.19,136.80,121.60,114.00,144.40,39.47,N/A,Contact UH,Contact UH,Contact UH,39.47,N/A,39.47,144.40,T.B.D 29,,70553,Mri Scan Of Brain Before And After Contrast ,IP/OP,9266.00,2406.38,623.77,2853.93,6949.50,2574.09,Contact UH,445.55,8802.70,7412.80,6486.20,8339.40,841.64,445.55,841.64,N/A,841.64,8339.40,7412.80,6949.50,8802.70,2406.38,445.55,Contact UH,Contact UH,Contact UH,2406.38,445.55,445.55,8802.70,512.38 30,,81002,Automated Urinalysis Test ,IP/OP,21.00,5.45,7.98,6.47,15.75,5.83,Contact UH,3.48,19.95,16.80,14.70,18.90,8.04,6.30,8.04,N/A,8.04,18.90,16.80,15.75,19.95,5.45,3.48,Contact UH,Contact UH,Contact UH,5.45,3.48,3.48,19.95,4.00 31,,66821,Removal Of Recurring Cataract In Lens Capsule Using Laser ,OP ,2086.00,541.73,852.46,608.90,1564.50,579.49,Contact UH,608.90,1981.70,1668.80,1460.20,1877.40,1150.21,608.90,1150.21,N/A,1150.21,1877.40,1668.80,1564.50,1981.70,541.73,608.90,Contact UH,Contact UH,Contact UH,541.73,608.90,541.73,1981.70,700.24 32,,72148,Mri Scan Of Lower Spinal Canal ,IP/OP,1335.00,346.70,389.76,411.18,1001.25,370.86,Contact UH,278.40,1268.25,1068.00,934.50,1201.50,525.90,278.40,525.90,N/A,525.90,1201.50,1068.00,1001.25,1268.25,346.70,278.40,Contact UH,Contact UH,Contact UH,346.70,278.40,278.40,1268.25,320.16 33,,90832,"Psychotherapy, 30 Min ",OP,494.00,128.29,226.65,152.15,370.50,137.23,Contact UH,161.89,469.30,395.20,345.80,444.60,305.81,161.89,305.81,N/A,305.81,444.60,395.20,370.50,469.30,128.29,161.89,Contact UH,Contact UH,Contact UH,128.29,161.89,128.29,469.30,186.17 34,,55700,Biopsy Of Prostate Gland ,OP ,6618.00,1718.69,3032.92,2038.34,4963.50,1838.48,Contact UH,2166.37,6287.10,5294.40,4632.60,5956.20,4092.27,2166.37,4092.27,N/A,4092.27,5956.20,5294.40,4963.50,6287.10,1718.69,2166.37,Contact UH,Contact UH,Contact UH,1718.69,2166.37,1718.69,6287.10,2491.33 35,,45391,Ultrasound Examination Of Lower Large Bowel Using An Endoscope ,OP ,2825.00,733.65,1756.51,1254.65,2118.75,784.79,Contact UH,1254.65,2683.75,2260.00,1977.50,2542.50,2370.03,1254.65,2370.03,N/A,2370.03,2542.50,2260.00,2118.75,2683.75,733.65,1254.65,Contact UH,Contact UH,Contact UH,733.65,1254.65,733.65,2683.75,1442.85 36,,77065,Mammography Of One Breast ,IP/OP,449.00,116.61,170.62,138.29,336.75,124.73,Contact UH,N/A,426.55,359.20,314.30,404.10,171.88,134.70,171.88,N/A,171.88,404.10,359.20,336.75,426.55,116.61,N/A,Contact UH,Contact UH,Contact UH,116.61,N/A,116.61,426.55,T.B.D 37,,19120,"Removal Of 1 Or More Breast Growth, Open Procedure ",OP,11655.00,3026.80,5348.83,3820.59,8741.25,3237.76,Contact UH,3820.59,11072.25,9324.00,8158.50,10489.50,7217.09,3820.59,7217.09,N/A,7217.09,10489.50,9324.00,8741.25,11072.25,3026.80,3820.59,Contact UH,Contact UH,Contact UH,3026.80,3820.59,3026.80,11072.25,4393.68 38,,90834,"Psychotherapy, 45 Min ",OP,494.00,128.29,226.65,161.89,370.50,137.23,Contact UH,161.89,469.30,395.20,345.80,444.60,305.81,161.89,305.81,N/A,305.81,444.60,395.20,370.50,469.30,128.29,161.89,Contact UH,Contact UH,Contact UH,128.29,161.89,128.29,469.30,186.17 39,,90837,"Psychotherapy, 60 Min ",OP,494.00,128.29,226.65,152.15,370.50,137.23,Contact UH,161.89,469.30,395.20,345.80,444.60,305.81,161.89,305.81,N/A,305.81,444.60,395.20,370.50,469.30,128.29,161.89,Contact UH,Contact UH,Contact UH,128.29,161.89,128.29,469.30,186.17 40,,85025,"Complete Blood Cell Count, With Differential White Blood Cells, Automated ",IP/OP,40.00,10.39,15.20,7.77,30.00,11.11,Contact UH,7.77,38.00,32.00,28.00,36.00,15.31,12.00,15.31,N/A,15.31,36.00,32.00,30.00,38.00,10.39,7.77,Contact UH,Contact UH,Contact UH,10.39,7.77,7.77,38.00,8.94 41,,84443,"Blood Test, Thyroid Stimulating Hormone (Tsh) ",IP/OP,148.00,38.44,56.24,16.80,111.00,41.11,Contact UH,16.80,140.60,118.40,103.60,133.20,56.65,44.40,56.65,N/A,56.65,133.20,118.40,111.00,140.60,23.00,16.80,Contact UH,Contact UH,Contact UH,23.00,16.80,16.80,140.60,19.32 42,,90853,Group Psychotherapy ,OP,297.00,77.13,126.74,90.53,222.75,82.51,Contact UH,90.53,282.15,237.60,207.90,267.30,171.01,90.53,171.01,N/A,171.01,267.30,237.60,222.75,282.15,77.13,90.53,Contact UH,Contact UH,Contact UH,77.13,90.53,77.13,282.15,104.11 43,,45378,Diagnostic Examination Of Large Bowel Using An Endoscope ,IP/OP,2757.00,715.99,1344.22,960.16,2067.75,765.89,Contact UH,960.16,2619.15,2205.60,1929.90,2481.30,1813.74,960.16,1813.74,N/A,1813.74,2481.30,2205.60,2067.75,2619.15,715.99,960.16,Contact UH,Contact UH,Contact UH,715.99,960.16,715.99,2619.15,1104.18 44,N/A,90846,"Family Psychotherapy, Not Including Patient, 50 Min ",OP,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,Contact UH,Contact UH,N/A,N/A,N/A,N/A,T.B.D 45,N/A,90847,"Family Psychotherapy, Including Patient, 50 Min ",OP,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,Contact UH,Contact UH,N/A,N/A,N/A,N/A,T.B.D 46,N/A,99203,"New Patient Office Or Other Outpatient Visit, Typically 30 Min ",OP,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,Contact UH,Contact UH,N/A,N/A,N/A,N/A,T.B.D 47,N/A,99204,"New Patient Office Of Other Outpatient Visit, Typically 45 Min ",OP,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,Contact UH,Contact UH,N/A,N/A,N/A,N/A,T.B.D 48,N/A,99205,"New Patient Office Of Other Outpatient Visit, Typically 60 Min ",OP,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,Contact UH,Contact UH,N/A,N/A,N/A,N/A,T.B.D 49,N/A,99243,"Patient Office Consultation, Typically 40 Min ",OP,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,Contact UH,Contact UH,N/A,N/A,N/A,N/A,T.B.D 50,N/A,42820,Removal Of Tonsils And Adenoid Glands Patient Younger Than Age 12 ,OP,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,Contact UH,Contact UH,N/A,N/A,N/A,N/A,T.B.D 51,N/A,47562,Removal Of Gallbladder Using An Endoscope ,OP,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,Contact UH,Contact UH,N/A,N/A,N/A,N/A,T.B.D 52,N/A,55866,Surgical Removal Of Prostate And Surrounding Lymph Nodes Using An Endoscope ,OP,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,Contact UH,Contact UH,N/A,N/A,N/A,N/A,T.B.D 53,N/A,59510,"Routine Obstetric Care For Cesarean Delivery, Including Pre-And Post-Delivery Care ",IP/OP,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,Contact UH,Contact UH,N/A,N/A,N/A,N/A,T.B.D 54,N/A,59610,Routine Obstetric Care For Vaginal Delivery After Prior Cesarean Delivery Including Pre-And Post-Del,IP/OP,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,Contact UH,Contact UH,N/A,N/A,N/A,N/A,T.B.D 55,N/A,66984,Removal Of Cataract With Insertion Of Lens ,OP,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,Contact UH,Contact UH,N/A,N/A,N/A,N/A,T.B.D 56,,DRG - 460,Spinal Fusion Except Cervical Without Major Comorbid Conditions Or Complications (Mcc) ,IP,N/A,N/A,61932.11,56236.07,N/A,N/A,46427.54,56236.07,N/A,N/A,N/A,N/A,142867.00,56236.07,63058.00,39871.84,66776.00,N/A,N/A,Contact UH,N/A,N/A,56236.07,56602.08,55029.80,58508.47,N/A,56236.07,39871.84,142867.00,64671.48 57,,DRG - 470,Major Joint Replacement Or Reattachment Of Lower Extremity Without Major Comorbid Conditions Or Comp,IP,N/A,N/A,29941.13,32690.93,N/A,N/A,22445.43,32690.93,N/A,N/A,N/A,N/A,70409.00,32690.93,31077.00,19650.03,32909.00,N/A,N/A,Contact UH,N/A,N/A,32690.93,27364.32,26604.20,28285.97,N/A,32690.93,19650.03,70409.00,37594.57 58,,DRG - 473,Cervical Spinal Fusion Without Comorbid Conditions (Cc) Or Major Comorbid Conditions Or Complication,IP,N/A,N/A,40004.48,40097.49,N/A,N/A,29989.45,40097.49,N/A,N/A,N/A,N/A,83965.00,40097.49,37060.00,23433.28,39245.00,N/A,N/A,Contact UH,N/A,N/A,40097.49,36561.60,35546.00,37793.02,N/A,40097.49,23433.28,83965.00,46112.12 59,,DRG - 743,Uterine And Adnexa Procedures For Non-Malignancy Without Comorbid Conditions (Cc) Or Major Comorbid ,IP,N/A,N/A,17848.40,23790.77,N/A,N/A,13380.09,23790.77,N/A,N/A,N/A,N/A,39476.00,23790.77,17423.00,11016.97,18451.00,N/A,N/A,Contact UH,N/A,N/A,23790.77,16312.32,15859.20,16861.73,N/A,23790.77,11016.97,39476.00,27359.38 60,N/A,29826,Shaving Of Shoulder Bone Using An Endoscope ,OP,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,Contact UH,Contact UH,N/A,N/A,N/A,N/A,T.B.D 61,N/A,29881,Removal Of One Knee Cartilage Using An Endoscope ,OP,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,Contact UH,Contact UH,N/A,N/A,N/A,N/A,T.B.D 62,N/A,99244,"Patient Office Consultation, Typically 60 Min ",OP,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,Contact UH,Contact UH,N/A,N/A,N/A,N/A,T.B.D 63,N/A,99385,Initial New Patient Preventive Medicine Evaluation (18-39 Years) ,OP,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,Contact UH,Contact UH,N/A,N/A,N/A,N/A,T.B.D 64,N/A,99386,Initial New Patient Preventive Medicine Evaluation (40-64 Years) ,OP,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,Contact UH,Contact UH,N/A,N/A,N/A,N/A,T.B.D 65,N/A,80055,Obstetric Blood Test Panel ,OP,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,Contact UH,Contact UH,N/A,N/A,N/A,N/A,T.B.D 66,N/A,80069,Kidney Function Panel Test ,OP,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,Contact UH,Contact UH,N/A,N/A,N/A,N/A,T.B.D 67,,DRG - 216,Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Major Comp,IP,N/A,N/A,158179.21,127073.27,N/A,N/A,118579.39,127073.27,N/A,N/A,N/A,N/A,347513.00,127073.27,153383.00,96985.10,162428.00,N/A,N/A,78485.00,N/A,N/A,127073.27,144565.92,140550.20,149434.98,N/A,127073.27,78485.00,347513.00,146134.25 68,N/A,93000,"Electrocardiogram, Routine, With Interpretation And Report ",OP,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,Contact UH,Contact UH,N/A,N/A,N/A,N/A,T.B.D 69,N/A,95810,Sleep Study ,OP,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,N/A,Contact UH,Contact UH,Contact UH,N/A,N/A,N/A,N/A,T.B.D 70,,76805,Abdominal Ultrasound Of Pregnant Uterus (Greater Or Equal To 14 Weeks 0 Days) Single Or First Fetus ,IP/OP,472.00,122.58,184.41,145.38,354.00,131.12,Contact UH,131.72,448.40,377.60,330.40,424.80,248.82,131.72,248.82,N/A,248.82,424.80,377.60,354.00,448.40,122.58,131.72,Contact UH,Contact UH,Contact UH,122.58,131.72,122.58,448.40,151.48 71,,86480,Tuberculosis Test ,IP/OP,229.00,59.47,87.02,61.98,171.75,63.62,Contact UH,61.98,217.55,183.20,160.30,206.10,87.66,68.70,87.66,N/A,87.66,206.10,183.20,171.75,217.55,49.58,61.98,Contact UH,Contact UH,Contact UH,49.58,61.98,49.58,217.55,71.28 72,,83735,"Blood Test, Magnesium",IP/OP,45.00,11.69,17.10,13.86,33.75,12.50,Contact UH,6.70,42.75,36.00,31.50,40.50,17.23,13.50,17.23,N/A,17.23,40.50,36.00,33.75,42.75,11.69,6.70,Contact UH,Contact UH,Contact UH,11.69,6.70,6.70,42.75,7.71 73,,DRG - 115,Extraocular Procedures Except Orbit,IP,N/A,N/A,22950.19,27545.65,N/A,N/A,17204.66,27545.65,N/A,N/A,N/A,N/A,48198.00,27545.65,21273.00,13451.25,22528.00,N/A,N/A,Contact UH,N/A,N/A,27545.65,20975.04,20392.40,21681.49,N/A,27545.65,13451.25,48198.00,31677.50 74,,DRG - 117,Intraocular Procedures Without Complications,IP,N/A,N/A,16405.15,22728.55,N/A,N/A,12298.15,22728.55,N/A,N/A,N/A,N/A,35473.00,22728.55,15657.00,9900.07,16580.00,N/A,N/A,Contact UH,N/A,N/A,22728.55,14993.28,14576.80,15498.26,N/A,22728.55,9900.07,35473.00,26137.83 75,,DRG - 788,Cesarean Section Without Sterilization Without Complications,IP,N/A,N/A,13981.87,20945.04,N/A,N/A,N/A,20945.04,N/A,N/A,N/A,N/A,31871.00,20945.04,14067.00,6969.05,14897.00,N/A,N/A,Contact UH,N/A,N/A,20945.04,N/A,N/A,N/A,N/A,20945.04,6969.05,31871.00,24086.79 76,,DRG - 906,Hand Procedures For Injuries,IP,N/A,N/A,28420.67,31571.89,N/A,N/A,21305.62,31571.89,N/A,N/A,N/A,N/A,65222.00,31571.89,28787.00,18202.30,30485.00,N/A,N/A,Contact UH,N/A,N/A,31571.89,25974.72,25253.20,26849.56,N/A,31571.89,18202.30,65222.00,36307.67 77,,DRG - 482,Hipand Femur Procedures Except Major Joint Without Complications,IP,N/A,N/A,25931.22,29739.67,N/A,N/A,19439.40,29739.67,N/A,N/A,N/A,N/A,58898.00,29739.67,25996.00,16437.57,27529.00,N/A,N/A,Contact UH,N/A,N/A,29739.67,23699.52,23041.20,24497.73,N/A,29739.67,16437.57,58898.00,34200.63 78,,DRG - 494,"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Complications",IP,N/A,N/A,29175.39,32127.35,N/A,N/A,21871.39,32127.35,N/A,N/A,N/A,N/A,62062.00,32127.35,27392.00,17320.43,29008.00,N/A,N/A,Contact UH,N/A,N/A,32127.35,26664.48,25923.80,27562.55,N/A,32127.35,17320.43,62062.00,36946.46 79,,DRG - 502,Soft Tissue Procedures Without Complications,IP,N/A,N/A,20999.60,26110.03,N/A,N/A,15742.39,26110.03,N/A,N/A,N/A,N/A,45686.00,26110.03,20164.00,12750.10,21354.00,N/A,N/A,Contact UH,N/A,N/A,26110.03,19192.32,18659.20,19838.73,N/A,26110.03,12750.10,45686.00,30026.54 80,,DRG - 505,Foot Procedures W/O Cc/Mcc,IP,N/A,N/A,27966.90,31237.92,N/A,N/A,20965.45,31237.92,N/A,N/A,N/A,N/A,55901.00,31237.92,24673.00,15601.12,26128.00,N/A,N/A,Contact UH,N/A,N/A,31237.92,25560.00,24850.00,26420.88,N/A,31237.92,15601.12,55901.00,35923.60 81,,DRG - 512,"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Complications",IP,N/A,N/A,24492.70,28680.93,N/A,N/A,18361.01,28680.93,N/A,N/A,N/A,N/A,53860.00,28680.93,23772.00,15031.31,25174.00,N/A,N/A,Contact UH,N/A,N/A,28680.93,22384.80,21763.00,23138.73,N/A,28680.93,15031.31,53860.00,32983.07 82,,DRG - 660,Kidney And Ureter Procedures For Non-Neoplasm With Complications,IP,N/A,N/A,22737.48,27389.10,N/A,N/A,17045.20,27389.10,N/A,N/A,N/A,N/A,51223.00,27389.10,22609.00,14295.60,23942.00,N/A,N/A,Contact UH,N/A,N/A,27389.10,20780.64,20203.40,21480.54,N/A,27389.10,14295.60,51223.00,31497.47 83,,DRG - 142,Major Head And Neck Procedures Without Complications,IP,N/A,N/A,25289.96,29267.70,N/A,N/A,18958.67,29267.70,N/A,N/A,N/A,N/A,N/A,29267.70,N/A,N/A,N/A,N/A,N/A,Contact UH,N/A,N/A,29267.70,23113.44,22471.40,23891.91,N/A,29267.70,18958.67,29267.70,33657.86 84,,DRG - 247,Percutaneous Cardiovascular Procedures With Coronary Artery Stent,IP,N/A,N/A,31089.74,33536.30,N/A,N/A,23306.49,33536.30,N/A,N/A,N/A,N/A,73498.00,33536.30,32440.00,20512.15,34353.00,N/A,N/A,31313.00,N/A,N/A,33536.30,28414.08,27624.80,29371.08,N/A,33536.30,20512.15,73498.00,38566.75 85,,DRG - 329,Major Small And Large Bowel Procedures With Major Comp,IP,N/A,N/A,76986.97,67316.34,N/A,N/A,57713.45,67316.34,N/A,N/A,N/A,N/A,176667.00,67316.34,77976.00,49304.80,82574.00,N/A,N/A,Contact UH,N/A,N/A,67316.34,70361.28,68406.80,72731.09,N/A,67316.34,49304.80,176667.00,77413.79 86,,DRG - 355,Hernia Procedures Except Inguinal And Femoral Without Complications,IP,N/A,N/A,21431.31,26427.77,N/A,N/A,16066.03,26427.77,N/A,N/A,N/A,N/A,47940.00,26427.77,21159.00,13379.16,22407.00,N/A,N/A,Contact UH,N/A,N/A,26427.77,19586.88,19042.80,20246.58,N/A,26427.77,13379.16,47940.00,30391.93 87,,DRG - 419,Laparoscopic Cholecystectomy Without C.D.E. Without Complications,IP,N/A,N/A,20723.87,25907.10,N/A,N/A,15535.69,25907.10,N/A,N/A,N/A,N/A,46149.00,25907.10,20369.00,12879.47,21570.00,N/A,N/A,Contact UH,N/A,N/A,25907.10,18940.32,18414.20,19578.24,N/A,25907.10,12879.47,46149.00,29793.16 88,,DRG - 479,Biopsies Of Musculoskeletal System And Connective Tissue Without Complications,IP,N/A,N/A,28510.48,31637.99,N/A,N/A,21372.95,31637.99,N/A,N/A,N/A,N/A,63622.00,31637.99,28081.00,17755.93,29737.00,N/A,N/A,Contact UH,N/A,N/A,31637.99,26056.80,25333.00,26934.41,N/A,31637.99,17755.93,63622.00,36383.69 89,,72131,"Ct Scan, Lumbar Spine",IP/OP,265.00,68.82,184.41,131.72,198.75,73.62,Contact UH,131.72,251.75,212.00,185.50,238.50,248.82,131.72,248.82,N/A,248.82,238.50,212.00,198.75,251.75,68.82,131.72,Contact UH,Contact UH,Contact UH,68.82,131.72,68.82,251.75,151.48 90,,87491,"Infectious Agent Detection, Chlamydia Trachomatis",IP/OP,155.00,40.25,58.90,35.09,116.25,43.06,Contact UH,35.09,147.25,124.00,108.50,139.50,59.33,46.50,59.33,N/A,59.33,139.50,124.00,116.25,147.25,38.00,35.09,Contact UH,Contact UH,Contact UH,38.00,35.09,35.09,147.25,40.35 91,,73700,"Ct Scan, Lower Extremities",IP/OP,265.00,68.82,184.41,131.72,198.75,73.62,Contact UH,131.72,251.75,212.00,185.50,238.50,248.82,131.72,248.82,N/A,248.82,238.50,212.00,198.75,251.75,68.82,131.72,Contact UH,Contact UH,Contact UH,68.82,131.72,68.82,251.75,151.48 92,,73630,"X-Ray, Foot",IP/OP,568.00,147.51,137.02,97.87,426.00,157.79,Contact UH,97.87,539.60,454.40,397.60,511.20,184.88,97.87,184.88,N/A,184.88,511.20,454.40,426.00,539.60,147.51,97.87,Contact UH,Contact UH,Contact UH,147.51,97.87,97.87,539.60,112.55 93,,73560,"X-Ray, Knee",IP/OP,590.00,153.22,137.02,181.72,442.50,163.90,Contact UH,97.87,560.50,472.00,413.00,531.00,184.88,97.87,184.88,N/A,184.88,531.00,472.00,442.50,560.50,153.22,97.87,Contact UH,Contact UH,Contact UH,153.22,97.87,97.87,560.50,112.55 94,,72190,"X-Ray, Pelvis, 3 Views",IP/OP,232.00,60.25,184.41,131.72,174.00,64.45,Contact UH,131.72,220.40,185.60,162.40,208.80,248.82,131.72,248.82,N/A,248.82,208.80,185.60,174.00,220.40,60.25,131.72,Contact UH,Contact UH,Contact UH,60.25,131.72,60.25,248.82,151.48 95,,92557,Comprehensive Audiometry Threshold Evaluation And Speech Recognition,IP/OP,866.00,224.90,236.49,168.92,649.50,240.57,Contact UH,168.92,822.70,692.80,606.20,779.40,319.09,168.92,319.09,N/A,319.09,779.40,692.80,649.50,822.70,224.90,168.92,Contact UH,Contact UH,Contact UH,224.90,168.92,168.92,822.70,194.26 96,,76512,"Ophthalmic Ultrasound, Diagnostic, B-Scan With And Without Quant. A",IP/OP,472.00,122.58,184.41,131.72,354.00,131.12,Contact UH,131.72,448.40,377.60,330.40,424.80,248.82,131.72,248.82,N/A,248.82,424.80,377.60,354.00,448.40,122.58,131.72,Contact UH,Contact UH,Contact UH,122.58,131.72,122.58,448.40,151.48 97,,70355,"X-Ray, Jaws, Panoramic",IP/OP,299.00,77.65,137.02,97.87,224.25,83.06,Contact UH,97.87,284.05,239.20,209.30,269.10,184.88,97.87,184.88,N/A,184.88,269.10,239.20,224.25,284.05,77.65,97.87,Contact UH,Contact UH,Contact UH,77.65,97.87,77.65,284.05,112.55 98,,96415,"Chemotherapy Administration, Intravenous Infusion Technique ",IP/OP,192.00,49.86,105.01,75.01,144.00,53.34,Contact UH,75.01,182.40,153.60,134.40,172.80,141.69,75.01,141.69,N/A,141.69,172.80,153.60,144.00,182.40,49.86,75.01,Contact UH,Contact UH,Contact UH,49.86,75.01,49.86,182.40,86.26 99,,96367,"Intravenous Infusion, For Therapy, Prophylaxis, Or Diagnosis; Additional Sequential Infusion Of A New Drug/Substance, Up To 1 Hour ",IP/OP,192.00,49.86,105.01,75.01,144.00,53.34,Contact UH,75.01,182.40,153.60,134.40,172.80,141.69,75.01,141.69,N/A,141.69,172.80,153.60,144.00,182.40,49.86,75.01,Contact UH,Contact UH,Contact UH,49.86,75.01,49.86,182.40,86.26 100,,70498,"Ct Scan, Neck",IP/OP,2319.00,602.24,302.57,216.12,1739.25,644.22,Contact UH,216.12,2203.05,1855.20,1623.30,2087.10,408.25,216.12,408.25,N/A,408.25,2087.10,1855.20,1739.25,2203.05,602.24,216.12,Contact UH,Contact UH,Contact UH,602.24,216.12,216.12,2203.05,248.54 101,,76376,3D Rendering With Interpretation And Post Process Supervision,IP/OP,265.00,68.82,100.70,81.62,198.75,73.62,Contact UH,N/A,251.75,212.00,185.50,238.50,101.44,79.50,101.44,N/A,101.44,238.50,212.00,198.75,251.75,68.82,N/A,Contact UH,Contact UH,Contact UH,68.82,N/A,68.82,251.75,T.B.D 102,,92567,Tympanometry ,OP ,196.00,50.90,57.33,40.95,147.00,54.45,Contact UH,40.95,186.20,156.80,137.20,176.40,77.35,40.95,77.35,N/A,77.35,176.40,156.80,147.00,186.20,50.90,40.95,Contact UH,Contact UH,Contact UH,50.90,40.95,40.95,186.20,47.09 103,,92235,Fluorescein Angiography,OP ,903.00,234.51,448.29,320.21,677.25,250.85,Contact UH,320.21,857.85,722.40,632.10,812.70,604.88,320.21,604.88,N/A,604.88,812.70,722.40,677.25,857.85,234.51,320.21,Contact UH,Contact UH,Contact UH,234.51,320.21,234.51,857.85,368.24 104,,76815,Abdominal Ultrasound Of Pregnant Uterus,IP/OP,403.00,104.66,184.41,131.72,302.25,111.95,Contact UH,131.72,382.85,322.40,282.10,362.70,248.82,131.72,248.82,N/A,248.82,362.70,322.40,302.25,382.85,104.66,131.72,Contact UH,Contact UH,Contact UH,104.66,131.72,104.66,382.85,151.48 105,,96368,"Intravenous Infusion, For Therapy, Prophylaxis, Or Diagnosis; Concurrent Infusion ",IP/OP,135.00,35.06,51.30,41.58,101.25,37.50,Contact UH,N/A,128.25,108.00,94.50,121.50,51.68,40.50,51.68,N/A,51.68,121.50,108.00,101.25,128.25,35.06,N/A,Contact UH,Contact UH,Contact UH,35.06,N/A,35.06,128.25,T.B.D 106,,90472,Immunization Administration,IP/OP,133.00,34.54,50.54,40.96,99.75,36.95,Contact UH,N/A,126.35,106.40,93.10,119.70,50.91,39.90,50.91,N/A,50.91,119.70,106.40,99.75,126.35,34.54,N/A,Contact UH,Contact UH,Contact UH,34.54,N/A,34.54,126.35,T.B.D 107,,92603,"Diagnostic Analysis Of Cochlear Implant, Age 7 Years Or Older; With Programming",OP ,797.00,206.98,236.49,168.92,597.75,221.41,Contact UH,168.92,757.15,637.60,557.90,717.30,319.09,168.92,319.09,N/A,319.09,717.30,637.60,597.75,757.15,206.98,168.92,Contact UH,Contact UH,Contact UH,206.98,168.92,168.92,757.15,194.26 108,,92250,Fundus Photography With Interpretation And Report ,OP ,376.00,97.65,191.00,136.43,282.00,104.45,Contact UH,136.43,357.20,300.80,263.20,338.40,257.72,136.43,257.72,N/A,257.72,338.40,300.80,282.00,357.20,97.65,136.43,Contact UH,Contact UH,Contact UH,97.65,136.43,97.65,357.20,156.89 109,,96523,Irrigation Of Implanted Venous Access Device ,IP/OP,232.00,60.25,94.29,67.35,174.00,64.45,Contact UH,67.35,220.40,185.60,162.40,208.80,127.22,67.35,127.22,N/A,127.22,208.80,185.60,174.00,220.40,60.25,67.35,Contact UH,Contact UH,Contact UH,60.25,67.35,60.25,220.40,77.45 110,,90746,"Hepatitis B Vaccine (Hepb), Adult Dosage, 3 Dose Schedule, For Intramuscular Use",IP/OP,440.00,114.27,167.20,70.38,330.00,122.23,Contact UH,70.38,418.00,352.00,308.00,396.00,168.43,132.00,168.43,N/A,168.43,396.00,352.00,330.00,418.00,114.27,70.38,Contact UH,Contact UH,Contact UH,114.27,70.38,70.38,418.00,80.93 111,,89051,"Cell Count, Miscellaneous Body Fluids ",IP/OP,40.00,10.39,15.20,5.60,30.00,11.11,Contact UH,5.60,38.00,32.00,28.00,36.00,15.31,12.00,15.31,N/A,15.31,36.00,32.00,30.00,38.00,0.90,5.60,Contact UH,Contact UH,Contact UH,0.90,5.60,0.90,38.00,6.44 112,,73590,"X-Ray, Lower Leg",IP/OP,568.00,147.51,137.02,97.87,426.00,157.79,Contact UH,97.87,539.60,454.40,397.60,511.20,184.88,97.87,184.88,N/A,184.88,511.20,454.40,426.00,539.60,147.51,97.87,Contact UH,Contact UH,Contact UH,147.51,97.87,97.87,539.60,112.55 113,,72170,"X-Ray, Pelvis, 1-2 Views",IP/OP,238.00,61.81,184.41,73.30,178.50,66.12,Contact UH,131.72,226.10,190.40,166.60,214.20,248.82,131.72,248.82,N/A,248.82,214.20,190.40,178.50,226.10,61.81,131.72,Contact UH,Contact UH,Contact UH,61.81,131.72,61.81,248.82,151.48 114,,73070,"X-Ray, Elbow",IP/OP,568.00,147.51,137.02,174.94,426.00,157.79,Contact UH,97.87,539.60,454.40,397.60,511.20,184.88,97.87,184.88,N/A,184.88,511.20,454.40,426.00,539.60,147.51,97.87,Contact UH,Contact UH,Contact UH,147.51,97.87,97.87,539.60,112.55 115,,72125,"Ct Scan, Neck Spine Without Contrast",IP/OP,1240.00,322.03,184.41,131.72,930.00,344.47,Contact UH,131.72,1178.00,992.00,868.00,1116.00,248.82,131.72,248.82,N/A,248.82,1116.00,992.00,930.00,1178.00,322.03,131.72,Contact UH,Contact UH,Contact UH,322.03,131.72,131.72,1178.00,151.48 116,,73030,"X-Ray, Shoulder",IP/OP,568.00,147.51,137.02,97.87,426.00,157.79,Contact UH,97.87,539.60,454.40,397.60,511.20,184.88,97.87,184.88,N/A,184.88,511.20,454.40,426.00,539.60,147.51,97.87,Contact UH,Contact UH,Contact UH,147.51,97.87,97.87,539.60,112.55 117,,73060,"X-Ray, Humerus",IP/OP,568.00,147.51,137.02,97.87,426.00,157.79,Contact UH,97.87,539.60,454.40,397.60,511.20,184.88,97.87,184.88,N/A,184.88,511.20,454.40,426.00,539.60,147.51,97.87,Contact UH,Contact UH,Contact UH,147.51,97.87,97.87,539.60,112.55 118,,72100,"X-Ray, Lumbar Spine, 2-3 Views",IP/OP,437.00,113.49,184.41,131.72,327.75,121.40,Contact UH,131.72,415.15,349.60,305.90,393.30,248.82,131.72,248.82,N/A,248.82,393.30,349.60,327.75,415.15,113.49,131.72,Contact UH,Contact UH,Contact UH,113.49,131.72,113.49,415.15,151.48 119,,73120,Hepatitis B Surface Antibody (Hbsab) ,IP/OP,326.00,84.66,184.41,131.72,244.50,90.56,Contact UH,131.72,309.70,260.80,228.20,293.40,248.82,131.72,248.82,N/A,248.82,293.40,260.80,244.50,309.70,84.66,131.72,Contact UH,Contact UH,Contact UH,84.66,131.72,84.66,309.70,151.48 120,,73610,"X-Ray, Ankle",IP/OP,222.00,57.65,137.02,97.87,166.50,61.67,Contact UH,97.87,210.90,177.60,155.40,199.80,184.88,97.87,184.88,N/A,184.88,199.80,177.60,166.50,210.90,57.65,97.87,Contact UH,Contact UH,Contact UH,57.65,97.87,57.65,210.90,112.55 121,,73110,"X-Ray, Wrist",IP/OP,336.00,87.26,137.02,97.87,252.00,93.34,Contact UH,97.87,319.20,268.80,235.20,302.40,184.88,97.87,184.88,N/A,184.88,302.40,268.80,252.00,319.20,87.26,97.87,Contact UH,Contact UH,Contact UH,87.26,97.87,87.26,319.20,112.55 122,,73090,"X-Ray, Forearm",IP/OP,568.00,147.51,137.02,97.87,426.00,157.79,Contact UH,97.87,539.60,454.40,397.60,511.20,184.88,97.87,184.88,N/A,184.88,511.20,454.40,426.00,539.60,147.51,97.87,Contact UH,Contact UH,Contact UH,147.51,97.87,97.87,539.60,112.55 123,,93312,"Echocardiography, Transesophageal",IP/OP,2631.00,683.27,818.47,810.35,1973.25,730.89,Contact UH,584.62,2499.45,2104.80,1841.70,2367.90,1104.35,584.62,1104.35,N/A,1104.35,2367.90,2104.80,1973.25,2499.45,683.27,584.62,Contact UH,Contact UH,Contact UH,683.27,584.62,584.62,2499.45,672.31 124,,97140,"Manual Therapy Techniques, 1 Or More Regions, Each 15 Minutes ",IP/OP,198.00,51.42,75.24,60.98,148.50,55.00,Contact UH,N/A,188.10,158.40,138.60,178.20,75.79,59.40,75.79,N/A,75.79,178.20,158.40,148.50,188.10,51.42,N/A,Contact UH,Contact UH,Contact UH,51.42,N/A,51.42,188.10,T.B.D 125,,92611,Motion Fluoroscopic Evaluation Of Swallowing Function By Cine Or Video Recording,IP/OP,940.00,244.12,357.20,289.52,705.00,261.13,Contact UH,N/A,893.00,752.00,658.00,846.00,359.83,282.00,359.83,N/A,359.83,846.00,752.00,705.00,893.00,244.12,N/A,Contact UH,Contact UH,Contact UH,244.12,N/A,244.12,893.00,T.B.D 126,,73562,"X-Ray, Knee, 3 Views",IP/OP,238.00,61.81,137.02,97.87,178.50,66.12,Contact UH,97.87,226.10,190.40,166.60,214.20,184.88,97.87,184.88,N/A,184.88,214.20,190.40,178.50,226.10,61.81,97.87,Contact UH,Contact UH,Contact UH,61.81,97.87,61.81,226.10,112.55 127,,96374,"Therapeutic, Prophylactic, Or Diagnostic Injection; Intravenous Push, Single Or Initial Substance/Drug",IP/OP,725.00,188.28,346.53,223.30,543.75,201.41,Contact UH,247.52,688.75,580.00,507.50,652.50,467.57,247.52,467.57,N/A,467.57,652.50,580.00,543.75,688.75,188.28,247.52,Contact UH,Contact UH,Contact UH,188.28,247.52,188.28,688.75,284.65 128,,92950,Cardiopulmonary Resuscitation,IP/OP,903.00,234.51,448.29,320.21,677.25,250.85,Contact UH,320.21,857.85,722.40,632.10,812.70,604.88,320.21,604.88,N/A,604.88,812.70,722.40,677.25,857.85,234.51,320.21,Contact UH,Contact UH,Contact UH,234.51,320.21,234.51,857.85,368.24 129,,77386,Intensity Modulated Radiation Therapy Delivery Complex,IP/OP,2248.00,583.81,919.03,656.45,1686.00,624.49,Contact UH,656.45,2135.60,1798.40,1573.60,2023.20,1240.03,656.45,1240.03,N/A,1240.03,2023.20,1798.40,1686.00,2135.60,583.81,656.45,Contact UH,Contact UH,Contact UH,583.81,656.45,583.81,2135.60,754.92 130,,93990,Duplex Scan Of Hemodialysis Access,IP/OP,1979.00,513.95,184.41,131.72,1484.25,549.77,Contact UH,131.72,1880.05,1583.20,1385.30,1781.10,248.82,131.72,248.82,N/A,248.82,1781.10,1583.20,1484.25,1880.05,513.95,131.72,Contact UH,Contact UH,Contact UH,513.95,131.72,131.72,1880.05,151.48 131,,93926,Duplex Scan Of Lower Extremity Arteries Or Arterial Bypass Grafts; Unilateral Or Limited Study,IP/OP,449.00,116.61,184.41,131.72,336.75,124.73,Contact UH,131.72,426.55,359.20,314.30,404.10,248.82,131.72,248.82,N/A,248.82,404.10,359.20,336.75,426.55,116.61,131.72,Contact UH,Contact UH,Contact UH,116.61,131.72,116.61,426.55,151.48 132,,84703,"Blood Test, Human Chorionic Gonadotropin (Hcg)",IP/OP,66.00,17.14,25.08,20.33,49.50,18.33,Contact UH,7.52,62.70,52.80,46.20,59.40,25.26,19.80,25.26,N/A,25.26,59.40,52.80,49.50,62.70,17.14,7.52,Contact UH,Contact UH,Contact UH,17.14,7.52,7.52,62.70,8.65 133,,93978,"Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; Complete Study",IP/OP,706.00,183.35,389.76,278.40,529.50,196.13,Contact UH,278.40,670.70,564.80,494.20,635.40,525.90,278.40,525.90,N/A,525.90,635.40,564.80,529.50,670.70,183.35,278.40,Contact UH,Contact UH,Contact UH,183.35,278.40,183.35,670.70,320.16 134,,93925,Duplex Scan Of Lower Extremity Arteries Or Arterial Bypass Grafts; Complete Bilateral Study,IP/OP,706.00,183.35,389.76,278.40,529.50,196.13,Contact UH,278.40,670.70,564.80,494.20,635.40,525.90,278.40,525.90,N/A,525.90,635.40,564.80,529.50,670.70,183.35,278.40,Contact UH,Contact UH,Contact UH,183.35,278.40,183.35,670.70,320.16 135,,90375,Rabies Immune Globulin (Rig),IP/OP,1412.00,366.70,474.38,308.67,1059.00,392.25,Contact UH,308.67,1341.40,1129.60,988.40,1270.80,640.07,338.84,640.07,N/A,640.07,1270.80,1129.60,1059.00,1341.40,366.70,308.67,Contact UH,Contact UH,Contact UH,366.70,308.67,308.67,1341.40,354.97 136,,92587,Distortion Product Evoked Otoacoustic Emissions,IP/OP,961.00,249.57,448.29,295.99,720.75,266.97,Contact UH,320.21,912.95,768.80,672.70,864.90,604.88,320.21,604.88,N/A,604.88,864.90,768.80,720.75,912.95,249.57,320.21,Contact UH,Contact UH,Contact UH,249.57,320.21,249.57,912.95,368.24 137,,92134,"Scanning Computerized Ophthalmic Diagnostic Imaging, Posterior Segment; Retina ",IP/OP,206.00,53.50,94.29,67.35,154.50,57.23,Contact UH,67.35,195.70,164.80,144.20,185.40,127.22,67.35,127.22,N/A,127.22,185.40,164.80,154.50,195.70,53.50,67.35,Contact UH,Contact UH,Contact UH,53.50,67.35,53.50,195.70,77.45 138,,96411,"Chemotherapy Administration; Intravenous, Push Technique, Each Additional Substance/Drug",OP ,381.00,98.95,105.01,75.01,285.75,105.84,Contact UH,75.01,361.95,304.80,266.70,342.90,141.69,75.01,141.69,N/A,141.69,342.90,304.80,285.75,361.95,98.95,75.01,Contact UH,Contact UH,Contact UH,98.95,75.01,75.01,361.95,86.26 139,,82805,Blood Gasses With O2 Saturation,IP/OP,466.00,121.02,177.08,143.53,349.50,129.45,Contact UH,78.77,442.70,372.80,326.20,419.40,178.38,139.80,178.38,N/A,178.38,419.40,372.80,349.50,442.70,121.02,78.77,Contact UH,Contact UH,Contact UH,121.02,78.77,78.77,442.70,90.59 140,,94664,"Demonstration And/Or Evaluation Of Patient Utilization Of An Aerosol Generator, Nebulizer, Metered Dose Inhaler Or Ippb Device ",IP/OP,742.00,192.70,318.39,228.54,556.50,206.13,Contact UH,227.42,704.90,593.60,519.40,667.80,429.60,227.42,429.60,N/A,429.60,667.80,593.60,556.50,704.90,192.70,227.42,Contact UH,Contact UH,Contact UH,192.70,227.42,192.70,704.90,261.53 141,,94667,Manipulation Chest Wall,IP/OP,376.00,97.65,191.00,136.43,282.00,104.45,Contact UH,136.43,357.20,300.80,263.20,338.40,257.72,136.43,257.72,N/A,257.72,338.40,300.80,282.00,357.20,97.65,136.43,Contact UH,Contact UH,Contact UH,97.65,136.43,97.65,357.20,156.89 142,,94660,Continuous Positive Airway Pressure Ventilation (Cpap) ,IP/OP,613.00,159.20,318.39,227.42,459.75,170.29,Contact UH,227.42,582.35,490.40,429.10,551.70,429.60,227.42,429.60,N/A,429.60,551.70,490.40,459.75,582.35,159.20,227.42,Contact UH,Contact UH,Contact UH,159.20,227.42,159.20,582.35,261.53 143,,95816,Electroencephalogram (Eeg),IP/OP,977.00,253.73,448.29,320.21,732.75,271.41,Contact UH,320.21,928.15,781.60,683.90,879.30,604.88,320.21,604.88,N/A,604.88,879.30,781.60,732.75,928.15,253.73,320.21,Contact UH,Contact UH,Contact UH,253.73,320.21,253.73,928.15,368.24 144,,96521,Refilling And Maintenance Of Portable Pump,IP/OP,710.00,184.39,346.53,247.52,532.50,197.24,Contact UH,247.52,674.50,568.00,497.00,639.00,467.57,247.52,467.57,N/A,467.57,639.00,568.00,532.50,674.50,184.39,247.52,Contact UH,Contact UH,Contact UH,184.39,247.52,184.39,674.50,284.65 145,,97597,Debridement,IP/OP,663.00,172.18,304.18,217.27,497.25,184.18,Contact UH,217.27,629.85,530.40,464.10,596.70,410.42,217.27,410.42,N/A,410.42,596.70,530.40,497.25,629.85,172.18,217.27,Contact UH,Contact UH,Contact UH,172.18,217.27,172.18,629.85,249.86 146,,90651,Hpv Vaccine,IP/OP,606.00,157.38,230.28,186.65,454.50,168.35,Contact UH,N/A,575.70,484.80,424.20,545.40,231.98,181.80,231.98,N/A,231.98,545.40,484.80,454.50,575.70,157.38,N/A,Contact UH,Contact UH,Contact UH,157.38,N/A,157.38,575.70,T.B.D 147,,96413,"Chemotherapy Administration, Intravenous Infusion Technique; Up To 1 Hour",IP/OP,1194.00,310.08,540.09,385.78,895.50,331.69,Contact UH,385.78,1134.30,955.20,835.80,1074.60,728.74,385.78,728.74,N/A,728.74,1074.60,955.20,895.50,1134.30,310.08,385.78,Contact UH,Contact UH,Contact UH,310.08,385.78,310.08,1134.30,443.65 148,,92570,Acoustic Immittance Testing,OP ,533.00,138.42,236.49,168.92,399.75,148.07,Contact UH,168.92,506.35,426.40,373.10,479.70,319.09,168.92,319.09,N/A,319.09,479.70,426.40,399.75,506.35,138.42,168.92,Contact UH,Contact UH,Contact UH,138.42,168.92,138.42,506.35,194.26 149,,92133,"Scanning Computerized Ophthalmic Diagnostic Imaging, Optic Nerve",OP ,206.00,53.50,94.29,63.45,154.50,57.23,Contact UH,67.35,195.70,164.80,144.20,185.40,127.22,67.35,127.22,N/A,127.22,185.40,164.80,154.50,195.70,53.50,67.35,Contact UH,Contact UH,Contact UH,53.50,67.35,53.50,195.70,77.45 150,,90675,"Rabies Vaccine, For Intramuscular Use",IP/OP,954.00,247.75,483.95,341.95,715.50,265.02,Contact UH,341.95,906.30,763.20,667.80,858.60,652.99,345.68,652.99,N/A,652.99,858.60,763.20,715.50,906.30,247.75,341.95,Contact UH,Contact UH,Contact UH,247.75,341.95,247.75,906.30,393.24 151,,96417,"Chemotherapy Administration, Intravenous Infusion Technique",IP/OP,417.00,108.29,105.01,75.01,312.75,115.84,Contact UH,75.01,396.15,333.60,291.90,375.30,141.69,75.01,141.69,N/A,141.69,375.30,333.60,312.75,396.15,108.29,75.01,Contact UH,Contact UH,Contact UH,108.29,75.01,75.01,396.15,86.26 152,,92083,Visual Field Examination,IP/OP,376.00,97.65,191.00,115.81,282.00,104.45,Contact UH,136.43,357.20,300.80,263.20,338.40,257.72,136.43,257.72,N/A,257.72,338.40,300.80,282.00,357.20,97.65,136.43,Contact UH,Contact UH,Contact UH,97.65,136.43,97.65,357.20,156.89 153,,92136,Ophthalmic Biometry ,OP ,414.00,107.52,191.00,136.43,310.50,115.01,Contact UH,136.43,393.30,331.20,289.80,372.60,257.72,136.43,257.72,N/A,257.72,372.60,331.20,310.50,393.30,107.52,136.43,Contact UH,Contact UH,Contact UH,107.52,136.43,107.52,393.30,156.89 154,,96401,"Chemotherapy Administration, Subcutaneous Or Intramuscular; Non-Hormonal Anti-Neoplastic",IP/OP,1720.00,446.68,105.01,75.01,1290.00,477.82,Contact UH,75.01,1634.00,1376.00,1204.00,1548.00,141.69,75.01,141.69,N/A,141.69,1548.00,1376.00,1290.00,1634.00,446.68,75.01,Contact UH,Contact UH,Contact UH,446.68,75.01,75.01,1634.00,86.26 155,,96402,"Chemotherapy Administration, Subcutaneous Or Intramuscular; Hormonal Anti-Neoplastic",OP ,291.00,75.57,105.01,75.01,218.25,80.84,Contact UH,75.01,276.45,232.80,203.70,261.90,141.69,75.01,141.69,N/A,141.69,261.90,232.80,218.25,276.45,75.57,75.01,Contact UH,Contact UH,Contact UH,75.57,75.01,75.01,276.45,86.26 156,,90734,Meningococcal Conjugate Vaccine,IP/OP,519.00,134.78,197.22,159.85,389.25,144.18,Contact UH,N/A,493.05,415.20,363.30,467.10,198.67,155.70,198.67,N/A,198.67,467.10,415.20,389.25,493.05,134.78,N/A,Contact UH,Contact UH,Contact UH,134.78,N/A,134.78,493.05,T.B.D 157,,96365,"Intravenous Infusion, For Therapy, Prophylaxis, Or Diagnosis; Initial, Up To 1 Hour ",IP/OP,725.00,188.28,346.53,247.52,543.75,201.41,Contact UH,247.52,688.75,580.00,507.50,652.50,467.57,247.52,467.57,N/A,467.57,652.50,580.00,543.75,688.75,188.28,247.52,Contact UH,Contact UH,Contact UH,188.28,247.52,188.28,688.75,284.65 158,,90396,"Varicella-Zoster Immune Globulin, Human, For Intramuscular Use",OP ,2998.00,778.58,3438.40,2456.00,2248.50,832.84,Contact UH,2456.00,2848.10,2398.40,2098.60,2698.20,4639.38,2456.00,4639.38,N/A,4639.38,2698.20,2398.40,2248.50,2848.10,778.58,2456.00,Contact UH,Contact UH,Contact UH,778.58,2456.00,778.58,4639.38,2824.40 159,,90670,"Pneumococcal Conjugate Vaccine, 13 Valent (Pcv13), For Intramuscular Use ",IP/OP,568.00,147.51,215.84,241.38,426.00,157.79,Contact UH,241.38,539.60,454.40,397.60,511.20,217.43,170.40,217.43,N/A,217.43,511.20,454.40,426.00,539.60,147.51,241.38,Contact UH,Contact UH,Contact UH,147.51,241.38,147.51,539.60,277.59 160,,77336,Continuing Medical Physics Consultation,IP/OP,1377.00,357.61,214.93,424.12,1032.75,382.53,Contact UH,153.52,1308.15,1101.60,963.90,1239.30,290.00,153.52,290.00,N/A,290.00,1239.30,1101.60,1032.75,1308.15,357.61,153.52,Contact UH,Contact UH,Contact UH,357.61,153.52,153.52,1308.15,176.55 161,,92602,"Diagnostic Analysis Of Cochlear Implant, Patient Younger Than 7 Yrs Of Age; Subsequent Reprogramming",OP ,870.00,225.94,236.49,168.92,652.50,241.69,Contact UH,168.92,826.50,696.00,609.00,783.00,319.09,168.92,319.09,N/A,319.09,783.00,696.00,652.50,826.50,225.94,168.92,Contact UH,Contact UH,Contact UH,225.94,168.92,168.92,826.50,194.26 162,,92025,Computerized Corneal Topography ,OP ,206.00,53.50,94.29,67.35,154.50,57.23,Contact UH,67.35,195.70,164.80,144.20,185.40,127.22,67.35,127.22,N/A,127.22,185.40,164.80,154.50,195.70,53.50,67.35,Contact UH,Contact UH,Contact UH,53.50,67.35,53.50,195.70,77.45 163,,93923,"Complete Bilateral Noninvasive Physiologic Studies Of Upper Or Lower Extremity Arteries, 3 Or More Levels",IP/OP,1399.00,363.32,236.49,430.89,1049.25,388.64,Contact UH,168.92,1329.05,1119.20,979.30,1259.10,319.09,168.92,319.09,N/A,319.09,1259.10,1119.20,1049.25,1329.05,363.32,168.92,Contact UH,Contact UH,Contact UH,363.32,168.92,168.92,1329.05,194.26 164,,82948,Glucose Test,IP/OP,40.00,10.39,15.20,5.04,30.00,11.11,Contact UH,5.04,38.00,32.00,28.00,36.00,15.31,12.00,15.31,N/A,15.31,36.00,32.00,30.00,38.00,1.50,5.04,Contact UH,Contact UH,Contact UH,1.50,5.04,1.50,38.00,5.80 165,,94150,"Vital Capacity, Total (Separate Procedure) ",IP/OP,533.00,138.42,236.49,168.92,399.75,148.07,Contact UH,168.92,506.35,426.40,373.10,479.70,319.09,168.92,319.09,N/A,319.09,479.70,426.40,399.75,506.35,138.42,168.92,Contact UH,Contact UH,Contact UH,138.42,168.92,138.42,506.35,194.26 166,,94060,Bronchodilation Responsiveness,IP/OP,617.00,160.23,448.29,320.21,462.75,171.40,Contact UH,320.21,586.15,493.60,431.90,555.30,604.88,320.21,604.88,N/A,604.88,555.30,493.60,462.75,586.15,160.23,320.21,Contact UH,Contact UH,Contact UH,160.23,320.21,160.23,604.88,368.24 167,,90732,Pneumococcal Polysaccharide Vaccine,IP/OP,116.00,30.13,44.08,35.73,87.00,32.22,Contact UH,133.47,110.20,92.80,81.20,104.40,44.40,34.80,44.40,N/A,44.40,104.40,92.80,87.00,110.20,30.13,133.47,Contact UH,Contact UH,Contact UH,30.13,133.47,30.13,153.49,153.49 168,,92584,Electrocochleography ,OP ,877.00,227.76,236.49,168.92,657.75,243.63,Contact UH,168.92,833.15,701.60,613.90,789.30,319.09,168.92,319.09,N/A,319.09,789.30,701.60,657.75,833.15,227.76,168.92,Contact UH,Contact UH,Contact UH,227.76,168.92,168.92,833.15,194.26 169,,92550,Tympanometry And Reflex Threshold Measurements,OP ,533.00,138.42,236.49,168.92,399.75,148.07,Contact UH,168.92,506.35,426.40,373.10,479.70,319.09,168.92,319.09,N/A,319.09,479.70,426.40,399.75,506.35,138.42,168.92,Contact UH,Contact UH,Contact UH,138.42,168.92,138.42,506.35,194.26 170,,92626,"Evaluation Of Auditory Function, First Hour ",OP ,626.00,162.57,236.49,168.92,469.50,173.90,Contact UH,168.92,594.70,500.80,438.20,563.40,319.09,168.92,319.09,N/A,319.09,563.40,500.80,469.50,594.70,162.57,168.92,Contact UH,Contact UH,Contact UH,162.57,168.92,162.57,594.70,194.26 171,,92579,Visual Reinforcement Audiometry (Vra),IP/OP,533.00,138.42,236.49,168.92,399.75,148.07,Contact UH,168.92,506.35,426.40,373.10,479.70,319.09,168.92,319.09,N/A,319.09,479.70,426.40,399.75,506.35,138.42,168.92,Contact UH,Contact UH,Contact UH,138.42,168.92,138.42,506.35,194.26 172,,92582,Conditioning Play Audiometry,OP ,866.00,224.90,236.49,168.92,649.50,240.57,Contact UH,168.92,822.70,692.80,606.20,779.40,319.09,168.92,319.09,N/A,319.09,779.40,692.80,649.50,822.70,224.90,168.92,Contact UH,Contact UH,Contact UH,224.90,168.92,168.92,822.70,194.26 173,,90686,Influenza Virus Vaccine,IP/OP,78.00,20.26,29.64,24.02,58.50,21.67,Contact UH,20.53,74.10,62.40,54.60,70.20,29.86,23.40,29.86,N/A,29.86,70.20,62.40,58.50,74.10,20.26,20.53,Contact UH,Contact UH,Contact UH,20.26,20.53,20.26,74.10,23.60 174,,92604,"Diagnostic Analysis Of Cochlear Implant, Age 7 Yrs Or Older",OP ,569.00,147.77,236.49,168.92,426.75,158.07,Contact UH,168.92,540.55,455.20,398.30,512.10,319.09,168.92,319.09,N/A,319.09,512.10,455.20,426.75,540.55,147.77,168.92,Contact UH,Contact UH,Contact UH,147.77,168.92,147.77,540.55,194.26 175,,90715,"Tetanus, Diphtheria Toxoids And Acellular Pertussis Vaccine (Tdap), 7 Years+ ",IP/OP,163.00,42.33,61.94,36.16,122.25,45.28,Contact UH,36.16,154.85,130.40,114.10,146.70,62.40,48.90,62.40,N/A,62.40,146.70,130.40,122.25,154.85,42.33,36.16,Contact UH,Contact UH,Contact UH,42.33,36.16,36.16,154.85,41.59 176,,86901,Blood Typing Rhd,IP/OP,133.00,34.54,57.33,2.99,99.75,36.95,Contact UH,2.99,126.35,106.40,93.10,119.70,77.35,40.95,77.35,N/A,77.35,119.70,106.40,99.75,126.35,34.54,2.99,Contact UH,Contact UH,Contact UH,34.54,2.99,2.99,126.35,3.44 177,,93922,Limited Bilateral Noninvasive Physiologic Studies Of Upper Or Lower Extremity Arteries,IP/OP,820.00,212.95,191.00,136.43,615.00,227.80,Contact UH,136.43,779.00,656.00,574.00,738.00,257.72,136.43,257.72,N/A,257.72,738.00,656.00,615.00,779.00,212.95,136.43,Contact UH,Contact UH,Contact UH,212.95,136.43,136.43,779.00,156.89 178,,36415,Routine Venipuncture,IP/OP,56.00,14.54,21.28,3.00,42.00,15.56,Contact UH,3.00,53.20,44.80,39.20,50.40,21.44,16.80,21.44,N/A,21.44,50.40,44.80,42.00,53.20,1.80,3.00,Contact UH,Contact UH,Contact UH,1.80,3.00,1.80,53.20,3.45 179,,92610,Evaluation Of Oral And Pharyngeal Swallowing Function ,IP/OP,243.00,63.11,92.34,74.84,182.25,67.51,Contact UH,N/A,230.85,194.40,170.10,218.70,93.02,72.90,93.02,N/A,93.02,218.70,194.40,182.25,230.85,63.11,N/A,Contact UH,Contact UH,Contact UH,63.11,N/A,63.11,230.85,T.B.D 180,,92522,Evaluation Of Speech Sound Production,IP/OP,534.00,138.68,202.92,164.47,400.50,148.35,Contact UH,N/A,507.30,427.20,373.80,480.60,204.42,160.20,204.42,N/A,204.42,480.60,427.20,400.50,507.30,138.68,N/A,Contact UH,Contact UH,Contact UH,138.68,N/A,138.68,507.30,T.B.D 181,,93880,Duplex Scan Of Extracranial Arteries; Complete Bilateral Study ,IP/OP,891.00,231.39,389.76,278.40,668.25,247.52,Contact UH,278.40,846.45,712.80,623.70,801.90,525.90,278.40,525.90,N/A,525.90,801.90,712.80,668.25,846.45,231.39,278.40,Contact UH,Contact UH,Contact UH,231.39,278.40,231.39,846.45,320.16 182,,97802,Medical Nutrition Therapy,OP ,475.00,123.36,180.50,146.30,356.25,131.96,Contact UH,N/A,451.25,380.00,332.50,427.50,181.83,142.50,181.83,N/A,181.83,427.50,380.00,356.25,451.25,123.36,N/A,Contact UH,Contact UH,Contact UH,123.36,N/A,123.36,451.25,T.B.D 183,,86703,"Antibody; Hiv-1 And Hiv-2, Single Result ",IP/OP,52.00,13.50,19.76,13.71,39.00,14.45,Contact UH,13.71,49.40,41.60,36.40,46.80,19.91,15.60,19.91,N/A,19.91,46.80,41.60,39.00,49.40,18.00,13.71,Contact UH,Contact UH,Contact UH,18.00,13.71,13.50,49.40,15.77 184,,93970,Duplex Scan Of Extremity Veins; Complete Bilateral Study ,IP/OP,2178.00,565.63,389.76,278.40,1633.50,605.05,Contact UH,278.40,2069.10,1742.40,1524.60,1960.20,525.90,278.40,525.90,N/A,525.90,1960.20,1742.40,1633.50,2069.10,565.63,278.40,Contact UH,Contact UH,Contact UH,565.63,278.40,278.40,2069.10,320.16 185,,96376,"Therapeutic, Prophylactic, Or Diagnostic Injection Sequential Intravenous Push Of The Same Substance/Drug ",IP/OP,199.00,51.68,75.62,61.29,149.25,55.28,Contact UH,N/A,189.05,159.20,139.30,179.10,76.18,59.70,76.18,N/A,76.18,179.10,159.20,149.25,189.05,51.68,N/A,Contact UH,Contact UH,Contact UH,51.68,N/A,51.68,189.05,T.B.D 186,,90744,"Hepatitis B Vaccine (Hepb), Pediatric/Adolescent Dosage, 3 Dose Schedule ",IP/OP,161.00,41.81,61.18,49.59,120.75,44.73,Contact UH,28.76,152.95,128.80,112.70,144.90,61.63,48.30,61.63,N/A,61.63,144.90,128.80,120.75,152.95,41.81,28.76,Contact UH,Contact UH,Contact UH,41.81,28.76,28.76,152.95,33.07 187,,93971,Duplex Scan Of Extremity Veins; Unilateral Or Limited Study ,IP/OP,449.00,116.61,184.41,131.72,336.75,124.73,Contact UH,131.72,426.55,359.20,314.30,404.10,248.82,131.72,248.82,N/A,248.82,404.10,359.20,336.75,426.55,116.61,131.72,Contact UH,Contact UH,Contact UH,116.61,131.72,116.61,426.55,151.48 188,,90471,Immunization Administration ,IP/OP,229.00,59.47,105.01,75.01,171.75,63.62,Contact UH,75.01,217.55,183.20,160.30,206.10,141.69,75.01,141.69,N/A,141.69,206.10,183.20,171.75,217.55,59.47,75.01,Contact UH,Contact UH,Contact UH,59.47,75.01,59.47,217.55,86.26 189,,90632,"Hepatitis A Vaccine (Hepa), Adult Dosage, For Intramuscular Use",IP/OP,210.00,54.54,79.80,64.74,157.50,58.34,Contact UH,64.74,199.50,168.00,147.00,189.00,80.39,63.00,80.39,N/A,80.39,189.00,168.00,157.50,199.50,54.54,64.74,Contact UH,Contact UH,Contact UH,54.54,64.74,54.54,199.50,74.45 190,,99153,Mod Sedation Services Provided By The Same Physician,OP ,245.00,63.63,93.10,75.46,183.75,68.06,Contact UH,N/A,232.75,196.00,171.50,220.50,93.79,73.50,93.79,N/A,93.79,220.50,196.00,183.75,232.75,63.63,N/A,Contact UH,Contact UH,Contact UH,63.63,N/A,63.63,232.75,T.B.D 191,,93303,Transthoracic Echocardiography,IP/OP,2631.00,683.27,818.47,584.62,1973.25,730.89,Contact UH,584.62,2499.45,2104.80,1841.70,2367.90,1104.35,584.62,1104.35,N/A,1104.35,2367.90,2104.80,1973.25,2499.45,683.27,584.62,Contact UH,Contact UH,Contact UH,683.27,584.62,584.62,2499.45,672.31 192,,73552,"X-Ray, Femur, 2 Views",IP/OP,261.00,67.78,137.02,97.87,195.75,72.51,Contact UH,97.87,247.95,208.80,182.70,234.90,184.88,97.87,184.88,N/A,184.88,234.90,208.80,195.75,247.95,67.78,97.87,Contact UH,Contact UH,Contact UH,67.78,97.87,67.78,247.95,112.55 193,,96372,"Therapeutic, Prophylactic, Or Diagnostic Injection; Subcutaneous Or Intramuscular ",IP/OP,176.00,45.71,105.01,75.01,132.00,48.89,Contact UH,75.01,167.20,140.80,123.20,158.40,141.69,75.01,141.69,N/A,141.69,158.40,140.80,132.00,167.20,45.71,75.01,Contact UH,Contact UH,Contact UH,45.71,75.01,45.71,167.20,86.26 194,,95851,Range Of Motion Measurements And Report,IP/OP,108.00,28.05,41.04,33.26,81.00,30.00,Contact UH,N/A,102.60,86.40,75.60,97.20,41.34,32.40,41.34,N/A,41.34,97.20,86.40,81.00,102.60,28.05,N/A,Contact UH,Contact UH,Contact UH,28.05,N/A,28.05,102.60,T.B.D 195,,77300,Basic Radiation Dosimetry Calculation,IP/OP,620.00,161.01,214.93,153.52,465.00,172.24,Contact UH,153.52,589.00,496.00,434.00,558.00,290.00,153.52,290.00,N/A,290.00,558.00,496.00,465.00,589.00,161.01,153.52,Contact UH,Contact UH,Contact UH,161.01,153.52,153.52,589.00,176.55 196,,96366,"Intravenous Infusion, For Therapy, Prophylaxis, Or Diagnosis, Each Additional Hour",IP/OP,243.00,63.11,67.79,48.42,182.25,67.51,Contact UH,48.42,230.85,194.40,170.10,218.70,91.47,48.42,91.47,N/A,91.47,218.70,194.40,182.25,230.85,63.11,48.42,Contact UH,Contact UH,Contact UH,63.11,48.42,48.42,230.85,55.68 197,,94761,Noninvasive Ear Or Pulse Oximetry For Oxygen Saturation; Multiple Determinations,IP/OP,360.00,93.49,136.80,110.88,270.00,100.01,Contact UH,N/A,342.00,288.00,252.00,324.00,137.81,108.00,137.81,N/A,137.81,324.00,288.00,270.00,342.00,93.49,N/A,Contact UH,Contact UH,Contact UH,93.49,N/A,93.49,342.00,T.B.D 198,,94640,Inhalation Therapy ,IP/OP,613.00,159.20,318.39,188.80,459.75,170.29,Contact UH,227.42,582.35,490.40,429.10,551.70,429.60,227.42,429.60,N/A,429.60,551.70,490.40,459.75,582.35,159.20,227.42,Contact UH,Contact UH,Contact UH,159.20,227.42,159.20,582.35,261.53 199,,77412,Radiation Therapy Delivery,IP/OP,860.00,223.34,409.44,292.46,645.00,238.91,Contact UH,292.46,817.00,688.00,602.00,774.00,552.46,292.46,552.46,N/A,552.46,774.00,688.00,645.00,817.00,223.34,292.46,Contact UH,Contact UH,Contact UH,223.34,292.46,223.34,817.00,336.33 200,,77063,"Screening Digital Breast Tomosynthesis, Bilateral",IP/OP,500.00,129.85,190.00,154.00,375.00,138.90,Contact UH,N/A,475.00,400.00,350.00,450.00,191.40,150.00,191.40,N/A,191.40,450.00,400.00,375.00,475.00,129.85,N/A,Contact UH,Contact UH,Contact UH,129.85,N/A,129.85,475.00,T.B.D 201,,87591,"Infectious Agent Detection, Neisseria Gonorrhoeae",IP/OP,155.00,40.25,58.90,35.09,116.25,43.06,Contact UH,35.09,147.25,124.00,108.50,139.50,59.33,46.50,59.33,N/A,59.33,139.50,124.00,116.25,147.25,38.00,35.09,Contact UH,Contact UH,Contact UH,38.00,35.09,35.09,147.25,40.35 202,,97535,Self-Care/Home Management Training ,IP/OP,198.00,51.42,75.24,60.98,148.50,55.00,Contact UH,N/A,188.10,158.40,138.60,178.20,75.79,59.40,75.79,N/A,75.79,178.20,158.40,148.50,188.10,51.42,N/A,Contact UH,Contact UH,Contact UH,51.42,N/A,51.42,188.10,T.B.D 203,,70551,"Mri, Brain Without Contrast",IP/OP,5732.00,1488.60,389.76,278.40,4299.00,1592.35,Contact UH,278.40,5445.40,4585.60,4012.40,5158.80,525.90,278.40,525.90,N/A,525.90,5158.80,4585.60,4299.00,5445.40,1488.60,278.40,Contact UH,Contact UH,Contact UH,1488.60,278.40,278.40,5445.40,320.16 204,,97162,"Physical Therapy Evaluation, Complex, 30 Minutes",IP/OP,360.00,93.49,136.80,110.88,270.00,100.01,Contact UH,N/A,342.00,288.00,252.00,324.00,137.81,108.00,137.81,N/A,137.81,324.00,288.00,270.00,342.00,93.49,N/A,Contact UH,Contact UH,Contact UH,93.49,N/A,93.49,342.00,T.B.D 205,,92507,Therapy Speech And/Or Auditory,IP/OP,178.00,46.23,67.64,54.82,133.50,49.45,Contact UH,N/A,169.10,142.40,124.60,160.20,68.14,53.40,68.14,N/A,68.14,160.20,142.40,133.50,169.10,46.23,N/A,Contact UH,Contact UH,Contact UH,46.23,N/A,46.23,169.10,T.B.D 206,,92612,Flexible Endoscopic Evaluation Of Swallowing By Cine Or Video Recording,IP/OP,902.00,234.25,342.76,277.82,676.50,250.58,Contact UH,N/A,856.90,721.60,631.40,811.80,345.29,270.60,345.29,N/A,345.29,811.80,721.60,676.50,856.90,234.25,N/A,Contact UH,Contact UH,Contact UH,234.25,N/A,234.25,856.90,T.B.D 207,,71250,"Ct Scan, Thorax Without Contrast",IP/OP,971.00,252.17,184.41,131.72,728.25,269.74,Contact UH,131.72,922.45,776.80,679.70,873.90,248.82,131.72,248.82,N/A,248.82,873.90,776.80,728.25,922.45,252.17,131.72,Contact UH,Contact UH,Contact UH,252.17,131.72,131.72,922.45,151.48 208,,76705,"Ultrasound Of Abdomen, Limited ",IP/OP,739.00,191.92,184.41,131.72,554.25,205.29,Contact UH,131.72,702.05,591.20,517.30,665.10,248.82,131.72,248.82,N/A,248.82,665.10,591.20,554.25,702.05,191.92,131.72,Contact UH,Contact UH,Contact UH,191.92,131.72,131.72,702.05,151.48 209,,95813,Electroencephalogram (Eeg) Extended Monitoring; 61-119 Minutes,IP/OP,771.00,200.23,448.29,320.21,578.25,214.18,Contact UH,320.21,732.45,616.80,539.70,693.90,604.88,320.21,604.88,N/A,604.88,693.90,616.80,578.25,732.45,200.23,320.21,Contact UH,Contact UH,Contact UH,200.23,320.21,200.23,732.45,368.24 210,,93005,Electrocardiogram,IP/OP,225.00,58.43,94.29,67.35,168.75,62.51,Contact UH,67.35,213.75,180.00,157.50,202.50,127.22,67.35,127.22,N/A,127.22,202.50,180.00,168.75,213.75,58.43,67.35,Contact UH,Contact UH,Contact UH,58.43,67.35,58.43,213.75,77.45 211,,95819,Electroencephalogram (Eeg),IP/OP,977.00,253.73,448.29,300.92,732.75,271.41,Contact UH,320.21,928.15,781.60,683.90,879.30,604.88,320.21,604.88,N/A,604.88,879.30,781.60,732.75,928.15,253.73,320.21,Contact UH,Contact UH,Contact UH,253.73,320.21,253.73,928.15,368.24 212,,94727,Gas Dilution,IP/OP,533.00,138.42,236.49,168.92,399.75,148.07,Contact UH,168.92,506.35,426.40,373.10,479.70,319.09,168.92,319.09,N/A,319.09,479.70,426.40,399.75,506.35,138.42,168.92,Contact UH,Contact UH,Contact UH,138.42,168.92,138.42,506.35,194.26 213,,94760,Noninvasive Ear Or Pulse Oximetry For Oxygen Saturation,IP/OP,128.00,33.24,48.64,39.42,96.00,35.56,Contact UH,N/A,121.60,102.40,89.60,115.20,49.00,38.40,49.00,N/A,49.00,115.20,102.40,96.00,121.60,33.24,N/A,Contact UH,Contact UH,Contact UH,33.24,N/A,33.24,121.60,T.B.D 214,,94644,Continuous Inhalation Therapy With Aerosol Medication For Acute Airway Obstruction; First Hour ,IP/OP,376.00,97.65,191.00,136.43,282.00,104.45,Contact UH,136.43,357.20,300.80,263.20,338.40,257.72,136.43,257.72,N/A,257.72,338.40,300.80,282.00,357.20,97.65,136.43,Contact UH,Contact UH,Contact UH,97.65,136.43,97.65,357.20,156.89 215,,94645,Continuous Inhalation Therapy With Aerosol Medication For Acute Airway Obstruction; Each Additional Hour,IP/OP,386.00,100.24,146.68,118.89,289.50,107.23,Contact UH,N/A,366.70,308.80,270.20,347.40,147.76,115.80,147.76,N/A,147.76,347.40,308.80,289.50,366.70,100.24,N/A,Contact UH,Contact UH,Contact UH,100.24,N/A,100.24,366.70,T.B.D 216,,94003,"Ventilation Assist And Management; Hospital Inpatient/Observation, Each Subsequent Day ",IP/OP,940.00,244.12,825.20,289.52,705.00,261.13,Contact UH,589.43,893.00,752.00,658.00,846.00,1113.43,589.43,1113.43,N/A,1113.43,846.00,752.00,705.00,893.00,244.12,589.43,Contact UH,Contact UH,Contact UH,244.12,589.43,244.12,1113.43,677.84 217,,94002,"Ventilation Assist And Management; Hospital Inpatient/Observation, Initial Day ",IP/OP,1862.00,483.56,825.20,589.43,1396.50,517.26,Contact UH,589.43,1768.90,1489.60,1303.40,1675.80,1113.43,589.43,1113.43,N/A,1113.43,1675.80,1489.60,1396.50,1768.90,483.56,589.43,Contact UH,Contact UH,Contact UH,483.56,589.43,483.56,1768.90,677.84 218,,94681,"Oxygen Uptake, Expired Gas Analysis",IP/OP,903.00,234.51,448.29,320.21,677.25,250.85,Contact UH,320.21,857.85,722.40,632.10,812.70,604.88,320.21,604.88,N/A,604.88,812.70,722.40,677.25,857.85,234.51,320.21,Contact UH,Contact UH,Contact UH,234.51,320.21,234.51,857.85,368.24 219,,94010,Spirometry,IP/OP,533.00,138.42,236.49,168.92,399.75,148.07,Contact UH,168.92,506.35,426.40,373.10,479.70,319.09,168.92,319.09,N/A,319.09,479.70,426.40,399.75,506.35,138.42,168.92,Contact UH,Contact UH,Contact UH,138.42,168.92,138.42,506.35,194.26 220,,93888,Transcranial Doppler Study Of The Intracranial Arteries; Limited Study,IP/OP,836.00,217.11,184.41,257.49,627.00,232.24,Contact UH,131.72,794.20,668.80,585.20,752.40,248.82,131.72,248.82,N/A,248.82,752.40,668.80,627.00,794.20,217.11,131.72,Contact UH,Contact UH,Contact UH,217.11,131.72,131.72,794.20,151.48 221,,77417,Therapeutic Radiology Port Image(S),IP/OP,360.00,93.49,136.80,110.88,270.00,100.01,Contact UH,N/A,342.00,288.00,252.00,324.00,137.81,108.00,137.81,N/A,137.81,324.00,288.00,270.00,342.00,93.49,N/A,Contact UH,Contact UH,Contact UH,93.49,N/A,93.49,342.00,T.B.D 222,,94729,Diffusing Capacity,IP/OP,360.00,93.49,136.80,110.88,270.00,100.01,Contact UH,N/A,342.00,288.00,252.00,324.00,137.81,108.00,137.81,N/A,137.81,324.00,288.00,270.00,342.00,93.49,N/A,Contact UH,Contact UH,Contact UH,93.49,N/A,93.49,342.00,T.B.D 223,,77085,"Bone Density Study, Dual-Energy X-Ray Absorptiometry",IP/OP,411.00,106.74,184.41,131.72,308.25,114.18,Contact UH,131.72,390.45,328.80,287.70,369.90,248.82,131.72,248.82,N/A,248.82,369.90,328.80,308.25,390.45,106.74,131.72,Contact UH,Contact UH,Contact UH,106.74,131.72,106.74,390.45,151.48 224,,77334,"Therapy Devices, Design And Construction; Complex",IP/OP,1387.00,360.20,573.61,409.72,1040.25,385.31,Contact UH,409.72,1317.65,1109.60,970.90,1248.30,773.96,409.72,773.96,N/A,773.96,1248.30,1109.60,1040.25,1317.65,360.20,409.72,Contact UH,Contact UH,Contact UH,360.20,409.72,360.20,1317.65,471.18 225,,94668,Manipulation Of Chest Wall,IP/OP,232.00,60.25,191.00,136.43,174.00,64.45,Contact UH,136.43,220.40,185.60,162.40,208.80,257.72,136.43,257.72,N/A,257.72,208.80,185.60,174.00,220.40,60.25,136.43,Contact UH,Contact UH,Contact UH,60.25,136.43,60.25,257.72,156.89 226,,87536,"Infectious Agent Detection; Hiv-1, Quant",IP/OP,841.00,218.41,319.58,85.10,630.75,233.63,Contact UH,85.10,798.95,672.80,588.70,756.90,321.93,252.30,321.93,N/A,321.93,756.90,672.80,630.75,798.95,92.87,85.10,Contact UH,Contact UH,Contact UH,92.87,85.10,85.10,798.95,97.87 227,,95951,"Eeg Monitoring, Video Recording",IP/OP,4147.00,1076.98,1575.86,1277.28,3110.25,1152.04,Contact UH,N/A,3939.65,3317.60,2902.90,3732.30,1587.47,1244.10,1587.47,N/A,1587.47,3732.30,3317.60,3110.25,3939.65,1076.98,N/A,Contact UH,Contact UH,Contact UH,1076.98,N/A,1076.98,3939.65,T.B.D 228,,76642,Ultrasound Of Breast,IP/OP,409.00,106.22,137.02,125.97,306.75,113.62,Contact UH,97.87,388.55,327.20,286.30,368.10,184.88,97.87,184.88,N/A,184.88,368.10,327.20,306.75,388.55,106.22,97.87,Contact UH,Contact UH,Contact UH,106.22,97.87,97.87,388.55,112.55 229,,96360,"Intravenous Infusion, Hydration; Initial, 31 Minutes To 1 Hour",IP/OP,581.00,150.89,346.53,247.52,435.75,161.40,Contact UH,247.52,551.95,464.80,406.70,522.90,467.57,247.52,467.57,N/A,467.57,522.90,464.80,435.75,551.95,150.89,247.52,Contact UH,Contact UH,Contact UH,150.89,247.52,150.89,551.95,284.65 230,,93458,Catheter Placement In Coronary Artery(S) For Coronary Angiography,IP/OP,13574.00,3525.17,4911.83,4180.79,10180.50,3770.86,Contact UH,3508.45,12895.30,10859.20,9501.80,12216.60,6627.46,3508.45,6627.46,N/A,6627.46,12216.60,10859.20,10180.50,12895.30,3525.17,3508.45,Contact UH,Contact UH,Contact UH,3525.17,3508.45,3508.45,12895.30,4034.72 231,,76770,"Ultrasound Of Retroperitoneal, Complete",IP/OP,473.00,122.84,184.41,131.72,354.75,131.40,Contact UH,131.72,449.35,378.40,331.10,425.70,248.82,131.72,248.82,N/A,248.82,425.70,378.40,354.75,449.35,122.84,131.72,Contact UH,Contact UH,Contact UH,122.84,131.72,122.84,449.35,151.48 232,,93975,Vascular Study,IP/OP,845.00,219.45,389.76,278.40,633.75,234.74,Contact UH,278.40,802.75,676.00,591.50,760.50,525.90,278.40,525.90,N/A,525.90,760.50,676.00,633.75,802.75,219.45,278.40,Contact UH,Contact UH,Contact UH,219.45,278.40,219.45,802.75,320.16 233,,76536,Ultrasound Of Head And Neck,IP/OP,739.00,191.92,184.41,131.72,554.25,205.29,Contact UH,131.72,702.05,591.20,517.30,665.10,248.82,131.72,248.82,N/A,248.82,665.10,591.20,554.25,702.05,191.92,131.72,Contact UH,Contact UH,Contact UH,191.92,131.72,131.72,702.05,151.48 234,,76775,"Ultrasound Of Retroperitoneal, Limited",IP/OP,473.00,122.84,184.41,131.72,354.75,131.40,Contact UH,131.72,449.35,378.40,331.10,425.70,248.82,131.72,248.82,N/A,248.82,425.70,378.40,354.75,449.35,122.84,131.72,Contact UH,Contact UH,Contact UH,122.84,131.72,122.84,449.35,151.48 235,,74018,"X-Ray, Abdomen",IP/OP,248.00,64.41,137.02,76.38,186.00,68.89,Contact UH,97.87,235.60,198.40,173.60,223.20,184.88,97.87,184.88,N/A,184.88,223.20,198.40,186.00,235.60,64.41,97.87,Contact UH,Contact UH,Contact UH,64.41,97.87,64.41,235.60,112.55 236,,86900,Blood Typing Abo,IP/OP,242.00,62.85,191.00,2.99,181.50,67.23,Contact UH,2.99,229.90,193.60,169.40,217.80,257.72,136.43,257.72,N/A,257.72,217.80,193.60,181.50,229.90,62.85,2.99,Contact UH,Contact UH,Contact UH,62.85,2.99,2.99,257.72,3.44 237,,87186,"Susceptibility Studies, Anitmicrobial Agent",IP/OP,357.00,92.71,135.66,8.65,267.75,99.17,Contact UH,8.65,339.15,285.60,249.90,321.30,136.66,107.10,136.66,N/A,136.66,321.30,285.60,267.75,339.15,11.00,8.65,Contact UH,Contact UH,Contact UH,11.00,8.65,8.65,339.15,9.95 238,,96375,"Therapeutic, Prophylactic, Or Diagnostic Injection; Sequential Intravenous Push Of A New Substance/Drug",IP/OP,205.00,53.24,67.79,63.14,153.75,56.95,Contact UH,48.42,194.75,164.00,143.50,184.50,91.47,48.42,91.47,N/A,91.47,184.50,164.00,153.75,194.75,53.24,48.42,Contact UH,Contact UH,Contact UH,53.24,48.42,48.42,194.75,55.68 239,,86923,Compatibility Test Each Unit; Electronic,IP/OP,441.00,114.53,252.63,180.45,330.75,122.51,Contact UH,180.45,418.95,352.80,308.70,396.90,340.87,180.45,340.87,N/A,340.87,396.90,352.80,330.75,418.95,12.00,180.45,Contact UH,Contact UH,Contact UH,12.00,180.45,12.00,418.95,207.52 240,,86920,Compatibility Test Each Unit; Immediate Spin Technique ,IP/OP,424.00,110.11,252.63,180.45,318.00,117.79,Contact UH,180.45,402.80,339.20,296.80,381.60,340.87,180.45,340.87,N/A,340.87,381.60,339.20,318.00,402.80,110.11,180.45,Contact UH,Contact UH,Contact UH,110.11,180.45,110.11,402.80,207.52 241,,99152,Mod Sedation Services Provided By The Same Physician,OP ,281.00,72.98,106.78,86.55,210.75,78.06,Contact UH,N/A,266.95,224.80,196.70,252.90,107.57,84.30,107.57,N/A,107.57,252.90,224.80,210.75,266.95,72.98,N/A,Contact UH,Contact UH,Contact UH,72.98,N/A,72.98,266.95,T.B.D 242,,97161,Physical Therapy Evaluation: Low Complexity 20 Minutes,IP/OP,198.00,51.42,75.24,60.98,148.50,55.00,Contact UH,N/A,188.10,158.40,138.60,178.20,75.79,59.40,75.79,N/A,75.79,178.20,158.40,148.50,188.10,51.42,N/A,Contact UH,Contact UH,Contact UH,51.42,N/A,51.42,188.10,T.B.D 243,,71046,C-Reactive Protein; ,IP/OP,248.00,64.41,137.02,97.87,186.00,68.89,Contact UH,97.87,235.60,198.40,173.60,223.20,184.88,97.87,184.88,N/A,184.88,223.20,198.40,186.00,235.60,64.41,97.87,Contact UH,Contact UH,Contact UH,64.41,97.87,64.41,235.60,112.55 244,,87040,"Culture, Bacterial, Blood",IP/OP,86.00,22.33,32.68,10.32,64.50,23.89,Contact UH,10.32,81.70,68.80,60.20,77.40,32.92,25.80,32.92,N/A,32.92,77.40,68.80,64.50,81.70,9.00,10.32,Contact UH,Contact UH,Contact UH,9.00,10.32,9.00,81.70,11.87 245,,97165,"Occupational Therapy Evaluation, Low Complexity, 30 Minutes",IP/OP,198.00,51.42,75.24,60.98,148.50,55.00,Contact UH,N/A,188.10,158.40,138.60,178.20,75.79,59.40,75.79,N/A,75.79,178.20,158.40,148.50,188.10,51.42,N/A,Contact UH,Contact UH,Contact UH,51.42,N/A,51.42,188.10,T.B.D 246,,97166,"Occupational Therapy Evaluation, Mod Complexity 45 Minutes",IP/OP,360.00,93.49,136.80,110.88,270.00,100.01,Contact UH,N/A,342.00,288.00,252.00,324.00,137.81,108.00,137.81,N/A,137.81,324.00,288.00,270.00,342.00,93.49,N/A,Contact UH,Contact UH,Contact UH,93.49,N/A,93.49,342.00,T.B.D 247,,73502,"X-Ray, Hip, 2-3 Views",IP/OP,261.00,67.78,137.02,97.87,195.75,72.51,Contact UH,97.87,247.95,208.80,182.70,234.90,184.88,97.87,184.88,N/A,184.88,234.90,208.80,195.75,247.95,67.78,97.87,Contact UH,Contact UH,Contact UH,67.78,97.87,67.78,247.95,112.55 248,,86850,"Antibody Screen, Rbc, Each Serum Technique ",IP/OP,167.00,43.37,84.17,9.77,125.25,46.39,Contact UH,9.77,158.65,133.60,116.90,150.30,113.57,60.12,113.57,N/A,113.57,150.30,133.60,125.25,158.65,43.37,9.77,Contact UH,Contact UH,Contact UH,43.37,9.77,9.77,158.65,11.24 249,,72040,"X-Ray, Neck, Spine, 2-3 Views",IP/OP,243.00,63.11,137.02,97.87,182.25,67.51,Contact UH,97.87,230.85,194.40,170.10,218.70,184.88,97.87,184.88,N/A,184.88,218.70,194.40,182.25,230.85,63.11,97.87,Contact UH,Contact UH,Contact UH,63.11,97.87,63.11,230.85,112.55 250,,80307,Drug Tests,IP/OP,91.00,23.63,34.58,62.14,68.25,25.28,Contact UH,62.14,86.45,72.80,63.70,81.90,34.83,27.30,34.83,N/A,34.83,81.90,72.80,68.25,86.45,49.71,62.14,Contact UH,Contact UH,Contact UH,49.71,62.14,23.63,86.45,71.46 251,,83690,"Blood Test, Lipase",IP/OP,55.00,14.28,20.90,6.89,41.25,15.28,Contact UH,6.89,52.25,44.00,38.50,49.50,21.05,16.50,21.05,N/A,21.05,49.50,44.00,41.25,52.25,4.50,6.89,Contact UH,Contact UH,Contact UH,4.50,6.89,4.50,52.25,7.92 252,,82550,"Blood Test, Creatine Kinase (Ck)",IP/OP,45.00,11.69,17.10,6.51,33.75,12.50,Contact UH,6.51,42.75,36.00,31.50,40.50,17.23,13.50,17.23,N/A,17.23,40.50,36.00,33.75,42.75,4.80,6.51,Contact UH,Contact UH,Contact UH,4.80,6.51,4.80,42.75,7.49 253,,93306,"Echocardiography, With Doppler ",IP/OP,1892.00,491.35,818.47,584.62,1419.00,525.60,Contact UH,584.62,1797.40,1513.60,1324.40,1702.80,1104.35,584.62,1104.35,N/A,1104.35,1702.80,1513.60,1419.00,1797.40,491.35,584.62,Contact UH,Contact UH,Contact UH,491.35,584.62,491.35,1797.40,672.31 254,,97018,Application Of A Modality To 1 Or More Areas; Paraffin Bath,OP ,108.00,28.05,41.04,33.26,81.00,30.00,Contact UH,N/A,102.60,86.40,75.60,97.20,41.34,32.40,41.34,N/A,41.34,97.20,86.40,81.00,102.60,28.05,N/A,Contact UH,Contact UH,Contact UH,28.05,N/A,28.05,102.60,T.B.D 255,,77002,"X-Ray, Guidance Of Needle Placement",IP/OP,845.00,219.45,321.10,260.26,633.75,234.74,Contact UH,N/A,802.75,676.00,591.50,760.50,323.47,253.50,323.47,N/A,323.47,760.50,676.00,633.75,802.75,219.45,N/A,Contact UH,Contact UH,Contact UH,219.45,N/A,219.45,802.75,T.B.D 256,,96361,"Intravenous Infusion, Hydration; Each Additional Hour ",IP/OP,298.00,77.39,67.79,48.42,223.50,82.78,Contact UH,48.42,283.10,238.40,208.60,268.20,91.47,48.42,91.47,N/A,91.47,268.20,238.40,223.50,283.10,77.39,48.42,Contact UH,Contact UH,Contact UH,77.39,48.42,48.42,283.10,55.68 257,,71045,"X-Ray, Chest, 1 View",IP/OP,248.00,64.41,137.02,97.87,186.00,68.89,Contact UH,97.87,235.60,198.40,173.60,223.20,184.88,97.87,184.88,N/A,184.88,223.20,198.40,186.00,235.60,64.41,97.87,Contact UH,Contact UH,Contact UH,64.41,97.87,64.41,235.60,112.55 258,,92526,Therapy Swallowing Dysfunction And/Or Oral Function For Feeding ,IP/OP,178.00,46.23,67.64,54.82,133.50,49.45,Contact UH,N/A,169.10,142.40,124.60,160.20,68.14,53.40,68.14,N/A,68.14,160.20,142.40,133.50,169.10,46.23,N/A,Contact UH,Contact UH,Contact UH,46.23,N/A,46.23,169.10,T.B.D 259,,97129,"Therapeutic Interventions, 15 Minutes",IP/OP,178.00,46.23,67.64,54.82,133.50,49.45,Contact UH,N/A,169.10,142.40,124.60,160.20,68.14,53.40,68.14,N/A,68.14,160.20,142.40,133.50,169.10,46.23,N/A,Contact UH,Contact UH,Contact UH,46.23,N/A,46.23,169.10,T.B.D 260,,82248,Bilirubin; Direct ,IP/OP,46.00,11.95,17.48,5.02,34.50,12.78,Contact UH,5.02,43.70,36.80,32.20,41.40,17.61,13.80,17.61,N/A,17.61,41.40,36.80,34.50,43.70,4.50,5.02,Contact UH,Contact UH,Contact UH,4.50,5.02,4.50,43.70,5.77 261,,86706,Hepatitis B Surface Antibody,IP/OP,91.00,23.63,34.58,10.74,68.25,25.28,Contact UH,10.74,86.45,72.80,63.70,81.90,34.83,27.30,34.83,N/A,34.83,81.90,72.80,68.25,86.45,12.00,10.74,Contact UH,Contact UH,Contact UH,12.00,10.74,10.74,86.45,12.35 262,,83036,Hemoglobin; Glycosylated (A1C) ,IP/OP,57.00,14.80,21.66,9.71,42.75,15.83,Contact UH,9.71,54.15,45.60,39.90,51.30,21.82,17.10,21.82,N/A,21.82,51.30,45.60,42.75,54.15,6.60,9.71,Contact UH,Contact UH,Contact UH,6.60,9.71,6.60,54.15,11.17 263,,97164,Re-Evaluation Of Physical Therapy Established Plan Of Care,IP/OP,198.00,51.42,75.24,60.98,148.50,55.00,Contact UH,N/A,188.10,158.40,138.60,178.20,75.79,59.40,75.79,N/A,75.79,178.20,158.40,148.50,188.10,51.42,N/A,Contact UH,Contact UH,Contact UH,51.42,N/A,51.42,188.10,T.B.D 264,,97150,"Therapeutic Procedure, Group",IP/OP,198.00,51.42,75.24,60.98,148.50,55.00,Contact UH,N/A,188.10,158.40,138.60,178.20,75.79,59.40,75.79,N/A,75.79,178.20,158.40,148.50,188.10,51.42,N/A,Contact UH,Contact UH,Contact UH,51.42,N/A,51.42,188.10,T.B.D 265,,97112,"Therapeutic Procedure, 1 Or More Areas, Each 15 Minutes",IP/OP,144.00,37.40,54.72,44.35,108.00,40.00,Contact UH,N/A,136.80,115.20,100.80,129.60,55.12,43.20,55.12,N/A,55.12,129.60,115.20,108.00,136.80,37.40,N/A,Contact UH,Contact UH,Contact UH,37.40,N/A,37.40,136.80,T.B.D 266,,97760,Orthotic(S) Management And Training,IP/OP,152.00,39.47,57.76,46.82,114.00,42.23,Contact UH,N/A,144.40,121.60,106.40,136.80,58.19,45.60,58.19,N/A,58.19,136.80,121.60,114.00,144.40,39.47,N/A,Contact UH,Contact UH,Contact UH,39.47,N/A,39.47,144.40,T.B.D 267,,93454,Catheter Placement In Coronary Artery(S) For Coronary Angiography,IP/OP,13574.00,3525.17,4911.83,3508.45,10180.50,3770.86,Contact UH,3508.45,12895.30,10859.20,9501.80,12216.60,6627.46,3508.45,6627.46,N/A,6627.46,12216.60,10859.20,10180.50,12895.30,3525.17,3508.45,Contact UH,Contact UH,Contact UH,3525.17,3508.45,3508.45,12895.30,4034.72 268,,84702,"Gonadotropin, Chorionic (Hcg); Quantitative ",IP/OP,52.00,13.50,19.76,15.05,39.00,14.45,Contact UH,15.05,49.40,41.60,36.40,46.80,19.91,15.60,19.91,N/A,19.91,46.80,41.60,39.00,49.40,11.39,15.05,Contact UH,Contact UH,Contact UH,11.39,15.05,11.39,49.40,17.31 269,,97163,Physical Therapy Evaluation: High Complexity,IP/OP,706.00,183.35,268.28,217.45,529.50,196.13,Contact UH,N/A,670.70,564.80,494.20,635.40,270.26,211.80,270.26,N/A,270.26,635.40,564.80,529.50,670.70,183.35,N/A,Contact UH,Contact UH,Contact UH,183.35,N/A,183.35,670.70,T.B.D 270,,97530,Therapeutic Activities,IP/OP,198.00,51.42,75.24,60.98,148.50,55.00,Contact UH,N/A,188.10,158.40,138.60,178.20,75.79,59.40,75.79,N/A,75.79,178.20,158.40,148.50,188.10,51.42,N/A,Contact UH,Contact UH,Contact UH,51.42,N/A,51.42,188.10,T.B.D 271,,97168,Re-Evaluation Of Occupational Therapy Established Plan Of Care,IP/OP,198.00,51.42,75.24,60.98,148.50,55.00,Contact UH,N/A,188.10,158.40,138.60,178.20,75.79,59.40,75.79,N/A,75.79,178.20,158.40,148.50,188.10,51.42,N/A,Contact UH,Contact UH,Contact UH,51.42,N/A,51.42,188.10,T.B.D 272,,87086,"Culture, Bacterial, Urine",IP/OP,80.00,20.78,30.40,24.64,60.00,22.22,Contact UH,8.07,76.00,64.00,56.00,72.00,30.62,24.00,30.62,N/A,30.62,72.00,64.00,60.00,76.00,20.78,8.07,Contact UH,Contact UH,Contact UH,20.78,8.07,8.07,76.00,9.28 273,,87150,"Culture Typing, Dna/Rna Probe",IP/OP,2726.00,707.94,1035.88,35.09,2044.50,757.28,Contact UH,35.09,2589.70,2180.80,1908.20,2453.40,1043.51,817.80,1043.51,N/A,1043.51,2453.40,2180.80,2044.50,2589.70,28.07,35.09,Contact UH,Contact UH,Contact UH,28.07,35.09,28.07,2589.70,40.35 274,,72070,"X-Ray, Thoracic Spine, 2 Views",IP/OP,232.00,60.25,184.41,131.72,174.00,64.45,Contact UH,131.72,220.40,185.60,162.40,208.80,248.82,131.72,248.82,N/A,248.82,208.80,185.60,174.00,220.40,60.25,131.72,Contact UH,Contact UH,Contact UH,60.25,131.72,60.25,248.82,151.48 275,,93798,Cardiac Rehabilitation With Ecg Monitor,IP/OP,384.00,99.72,196.62,140.44,288.00,106.68,Contact UH,140.44,364.80,307.20,268.80,345.60,265.29,140.44,265.29,N/A,265.29,345.60,307.20,288.00,364.80,99.72,140.44,Contact UH,Contact UH,Contact UH,99.72,140.44,99.72,364.80,161.51 276,,73564,"X-Ray, Knee, 4 Or More Views",IP/OP,223.00,57.91,184.41,131.72,167.25,61.95,Contact UH,131.72,211.85,178.40,156.10,200.70,248.82,131.72,248.82,N/A,248.82,200.70,178.40,167.25,211.85,57.91,131.72,Contact UH,Contact UH,Contact UH,57.91,131.72,57.91,248.82,151.48 277,,93350,"Echocardiography, Transthoracic",IP/OP,1892.00,491.35,818.47,584.62,1419.00,525.60,Contact UH,584.62,1797.40,1513.60,1324.40,1702.80,1104.35,584.62,1104.35,N/A,1104.35,1702.80,1513.60,1419.00,1797.40,491.35,584.62,Contact UH,Contact UH,Contact UH,491.35,584.62,491.35,1797.40,672.31 278,,97116,"Therapeutic Procedure, Gait Training",IP/OP,294.00,76.35,111.72,90.55,220.50,81.67,Contact UH,N/A,279.30,235.20,205.80,264.60,112.54,88.20,112.54,N/A,112.54,264.60,235.20,220.50,279.30,76.35,N/A,Contact UH,Contact UH,Contact UH,76.35,N/A,76.35,279.30,T.B.D 279,,92523,Evaluation Of Speech Sound Production,IP/OP,534.00,138.68,202.92,164.47,400.50,148.35,Contact UH,N/A,507.30,427.20,373.80,480.60,204.42,160.20,204.42,N/A,204.42,480.60,427.20,400.50,507.30,138.68,N/A,Contact UH,Contact UH,Contact UH,138.68,N/A,138.68,507.30,T.B.D 280,,83540,"Blood Test, Iron",IP/OP,38.00,9.87,14.44,6.47,28.50,10.56,Contact UH,6.47,36.10,30.40,26.60,34.20,14.55,11.40,14.55,N/A,14.55,34.20,30.40,28.50,36.10,4.50,6.47,Contact UH,Contact UH,Contact UH,4.50,6.47,4.50,36.10,7.44 281,,84439,"Blood Test, Free T4",IP/OP,78.00,20.26,29.64,24.02,58.50,21.67,Contact UH,9.02,74.10,62.40,54.60,70.20,29.86,23.40,29.86,N/A,29.86,70.20,62.40,58.50,74.10,20.26,9.02,Contact UH,Contact UH,Contact UH,20.26,9.02,9.02,74.10,10.37 282,,82728,"Blood Test, Ferritin",IP/OP,115.00,29.87,43.70,13.63,86.25,31.95,Contact UH,13.63,109.25,92.00,80.50,103.50,44.02,34.50,44.02,N/A,44.02,103.50,92.00,86.25,109.25,16.00,13.63,Contact UH,Contact UH,Contact UH,16.00,13.63,13.63,109.25,15.67 283,,93308,"Echocardiography, Transthoracic, Follow-Up Or Limited Study ",IP/OP,1113.00,289.05,389.76,342.80,834.75,309.19,Contact UH,278.40,1057.35,890.40,779.10,1001.70,525.90,278.40,525.90,N/A,525.90,1001.70,890.40,834.75,1057.35,289.05,278.40,Contact UH,Contact UH,Contact UH,289.05,278.40,278.40,1057.35,320.16 284,,86592,Syphilis Test,IP/OP,44.00,11.43,16.72,13.55,33.00,12.22,Contact UH,4.27,41.80,35.20,30.80,39.60,16.84,13.20,16.84,N/A,16.84,39.60,35.20,33.00,41.80,11.43,4.27,Contact UH,Contact UH,Contact UH,11.43,4.27,4.27,41.80,4.91 285,,83605,"Blood Test, Lactic Acid",IP/OP,49.00,12.73,18.62,11.57,36.75,13.61,Contact UH,11.57,46.55,39.20,34.30,44.10,18.76,14.70,18.76,N/A,18.76,44.10,39.20,36.75,46.55,13.50,11.57,Contact UH,Contact UH,Contact UH,13.50,11.57,11.57,46.55,13.31 286,,84100,"Blood Test, Phosphorus",IP/OP,45.00,11.69,17.10,4.74,33.75,12.50,Contact UH,4.74,42.75,36.00,31.50,40.50,17.23,13.50,17.23,N/A,17.23,40.50,36.00,33.75,42.75,3.00,4.74,Contact UH,Contact UH,Contact UH,3.00,4.74,3.00,42.75,5.45 287,,93017,Cardiovascular Stress Test,IP/OP,1082.00,281.00,448.29,320.21,811.50,300.58,Contact UH,320.21,1027.90,865.60,757.40,973.80,604.88,320.21,604.88,N/A,604.88,973.80,865.60,811.50,1027.90,281.00,320.21,Contact UH,Contact UH,Contact UH,281.00,320.21,281.00,1027.90,368.24 288,,76856,Ultrasound Of Pelvis,IP/OP,462.00,119.98,184.41,131.72,346.50,128.34,Contact UH,131.72,438.90,369.60,323.40,415.80,248.82,131.72,248.82,N/A,248.82,415.80,369.60,346.50,438.90,119.98,131.72,Contact UH,Contact UH,Contact UH,119.98,131.72,119.98,438.90,151.48 289,,70496,"Ct Scan, Head Or Brain",IP/OP,2319.00,602.24,302.57,216.12,1739.25,644.22,Contact UH,216.12,2203.05,1855.20,1623.30,2087.10,408.25,216.12,408.25,N/A,408.25,2087.10,1855.20,1739.25,2203.05,602.24,216.12,Contact UH,Contact UH,Contact UH,602.24,216.12,216.12,2203.05,248.54 290,,74170,"Ct Scan, Abdomen With And Without Contrast",IP/OP,4344.00,1128.14,302.57,216.12,3258.00,1206.76,Contact UH,216.12,4126.80,3475.20,3040.80,3909.60,408.25,216.12,408.25,N/A,408.25,3909.60,3475.20,3258.00,4126.80,1128.14,216.12,Contact UH,Contact UH,Contact UH,1128.14,216.12,216.12,4126.80,248.54 291,,70486,"Ct Scan, Maxillofacial Without Contrast",IP/OP,1093.00,283.85,184.41,131.72,819.75,303.64,Contact UH,131.72,1038.35,874.40,765.10,983.70,248.82,131.72,248.82,N/A,248.82,983.70,874.40,819.75,1038.35,283.85,131.72,Contact UH,Contact UH,Contact UH,283.85,131.72,131.72,1038.35,151.48 292,,71260,"Ct Scan, Thorax With Contrast",IP/OP,1500.00,389.55,302.57,216.12,1125.00,416.70,Contact UH,216.12,1425.00,1200.00,1050.00,1350.00,408.25,216.12,408.25,N/A,408.25,1350.00,1200.00,1125.00,1425.00,389.55,216.12,Contact UH,Contact UH,Contact UH,389.55,216.12,216.12,1425.00,248.54 293,,88341,"Immunohistochemistry Or Immunocytochemistry, Per Specimen",IP/OP,152.00,39.47,57.76,46.82,114.00,42.23,Contact UH,N/A,144.40,121.60,106.40,136.80,58.19,45.60,58.19,N/A,58.19,136.80,121.60,114.00,144.40,79.42,N/A,Contact UH,Contact UH,Contact UH,79.42,N/A,39.47,144.40,T.B.D 294,,87077,"Culture, Bacterial; Aerobic Isolate",IP/OP,73.00,18.96,27.74,8.08,54.75,20.28,Contact UH,8.08,69.35,58.40,51.10,65.70,27.94,21.90,27.94,N/A,27.94,65.70,58.40,54.75,69.35,9.00,8.08,Contact UH,Contact UH,Contact UH,9.00,8.08,8.08,69.35,9.29 295,,76937,Ultrasound Guided Vascular Access,IP/OP,558.00,144.91,212.04,171.86,418.50,155.01,Contact UH,N/A,530.10,446.40,390.60,502.20,213.60,167.40,213.60,N/A,213.60,502.20,446.40,418.50,530.10,144.91,N/A,Contact UH,Contact UH,Contact UH,144.91,N/A,144.91,530.10,T.B.D 296,,77001,Fluoroscopic Guidance For Vein Dvc,IP/OP,454.00,117.90,172.52,139.83,340.50,126.12,Contact UH,N/A,431.30,363.20,317.80,408.60,173.79,136.20,173.79,N/A,173.79,408.60,363.20,340.50,431.30,117.90,N/A,Contact UH,Contact UH,Contact UH,117.90,N/A,117.90,431.30,T.B.D 297,,83615,"Lactate Dehydrogenase (Ld), (Ldh)",IP/OP,55.00,14.28,20.90,6.04,41.25,15.28,Contact UH,6.04,52.25,44.00,38.50,49.50,21.05,16.50,21.05,N/A,21.05,49.50,44.00,41.25,52.25,4.20,6.04,Contact UH,Contact UH,Contact UH,4.20,6.04,4.20,52.25,6.95 298,,85652,"Sedimentation Rate, Erythrocyte, Automated",IP/OP,23.00,5.97,8.74,2.70,17.25,6.39,Contact UH,2.70,21.85,18.40,16.10,20.70,8.80,6.90,8.80,N/A,8.80,20.70,18.40,17.25,21.85,1.50,2.70,Contact UH,Contact UH,Contact UH,1.50,2.70,1.50,21.85,3.11 299,,82306,"Gonadotropin, Chorionic (Hcg); Quantitative ",IP/OP,166.00,43.11,63.08,29.60,124.50,46.11,Contact UH,29.60,157.70,132.80,116.20,149.40,63.54,49.80,63.54,N/A,63.54,149.40,132.80,124.50,157.70,30.00,29.60,Contact UH,Contact UH,Contact UH,30.00,29.60,29.60,157.70,34.04 300,,86803,Hepatitis C Antibody,IP/OP,118.00,30.64,44.84,14.27,88.50,32.78,Contact UH,14.27,112.10,94.40,82.60,106.20,45.17,35.40,45.17,N/A,45.17,106.20,94.40,88.50,112.10,19.00,14.27,Contact UH,Contact UH,Contact UH,19.00,14.27,14.27,112.10,16.41 301,,80202,"Blood Test, Vancomycin",IP/OP,97.00,25.19,36.86,13.54,72.75,26.95,Contact UH,13.54,92.15,77.60,67.90,87.30,37.13,29.10,37.13,N/A,37.13,87.30,77.60,72.75,92.15,12.00,13.54,Contact UH,Contact UH,Contact UH,12.00,13.54,12.00,92.15,15.57 302,,86704,Hepatitis B Core Antibody (Hbcab); Total ,IP/OP,106.00,27.53,40.28,12.05,79.50,29.45,Contact UH,12.05,100.70,84.80,74.20,95.40,40.58,31.80,40.58,N/A,40.58,95.40,84.80,79.50,100.70,15.00,12.05,Contact UH,Contact UH,Contact UH,15.00,12.05,12.05,100.70,13.86 303,,84484,"Blood Test, Troponin",IP/OP,76.00,19.74,28.88,12.47,57.00,21.11,Contact UH,12.47,72.20,60.80,53.20,68.40,29.09,22.80,29.09,N/A,29.09,68.40,60.80,57.00,72.20,9.51,12.47,Contact UH,Contact UH,Contact UH,9.51,12.47,9.51,72.20,14.34 304,,84145,Procalcitonin (Pct),IP/OP,549.00,142.58,208.62,169.09,411.75,152.51,Contact UH,27.22,521.55,439.20,384.30,494.10,210.16,164.70,210.16,N/A,210.16,494.10,439.20,411.75,521.55,142.58,27.22,Contact UH,Contact UH,Contact UH,142.58,27.22,27.22,521.55,31.30 305,,86140,C-Reactive Protein,IP/OP,34.00,8.83,12.92,10.47,25.50,9.45,Contact UH,5.18,32.30,27.20,23.80,30.60,13.02,10.20,13.02,N/A,13.02,30.60,27.20,25.50,32.30,8.83,5.18,Contact UH,Contact UH,Contact UH,8.83,5.18,5.18,32.30,5.96 306,,87340,"Infectious Agent Antigen Detection, Hep B",IP/OP,90.00,23.37,34.20,10.33,67.50,25.00,Contact UH,10.33,85.50,72.00,63.00,81.00,34.45,27.00,34.45,N/A,34.45,81.00,72.00,67.50,85.50,14.00,10.33,Contact UH,Contact UH,Contact UH,14.00,10.33,10.33,85.50,11.88 307,,84132,"Blood Test, Potatssium",IP/OP,26.00,6.75,9.88,4.76,19.50,7.22,Contact UH,4.76,24.70,20.80,18.20,23.40,9.95,7.80,9.95,N/A,9.95,23.40,20.80,19.50,24.70,3.90,4.76,Contact UH,Contact UH,Contact UH,3.90,4.76,3.90,24.70,5.47 308,,88305,"Level Iv - Surgical Pathology, Gross And Microscopic Examination",IP/OP,105.00,27.27,84.17,60.12,78.75,29.17,Contact UH,60.12,99.75,84.00,73.50,94.50,113.57,60.12,113.57,N/A,113.57,94.50,84.00,78.75,99.75,27.27,60.12,Contact UH,Contact UH,Contact UH,27.27,60.12,27.27,113.57,69.14 309,,83550,Iron Binding Capacity ,IP/OP,27.00,7.01,10.26,8.32,20.25,7.50,Contact UH,8.74,25.65,21.60,18.90,24.30,10.34,8.10,10.34,N/A,10.34,24.30,21.60,20.25,25.65,7.01,8.74,Contact UH,Contact UH,Contact UH,7.01,8.74,7.01,25.65,10.05 310,,87389,"Infectious Agent Antigen Detection, With Hiv",IP/OP,99.00,25.71,37.62,30.49,74.25,27.50,Contact UH,24.08,94.05,79.20,69.30,89.10,37.90,29.70,37.90,N/A,37.90,89.10,79.20,74.25,94.05,25.71,24.08,Contact UH,Contact UH,Contact UH,25.71,24.08,24.08,94.05,27.69 311,,84295,"Blood Test, Sodium",IP/OP,27.00,7.01,10.26,4.81,20.25,7.50,Contact UH,4.81,25.65,21.60,18.90,24.30,10.34,8.10,10.34,N/A,10.34,24.30,21.60,20.25,25.65,3.90,4.81,Contact UH,Contact UH,Contact UH,3.90,4.81,3.90,25.65,5.53 312,,83880,"Blood Test, B-Type Natriuretic Peptide (Bnp)",IP/OP,152.00,39.47,57.76,46.82,114.00,42.23,Contact UH,39.26,144.40,121.60,106.40,136.80,58.19,45.60,58.19,N/A,58.19,136.80,121.60,114.00,144.40,39.47,39.26,Contact UH,Contact UH,Contact UH,39.47,39.26,39.26,144.40,45.15 313,,82570,"Blood Test, Creatine Urine",IP/OP,51.00,13.24,19.38,5.18,38.25,14.17,Contact UH,5.18,48.45,40.80,35.70,45.90,19.52,15.30,19.52,N/A,19.52,45.90,40.80,38.25,48.45,3.00,5.18,Contact UH,Contact UH,Contact UH,3.00,5.18,3.00,48.45,5.96 314,,82247,Bilirubin; Total ,IP/OP,46.00,11.95,17.48,5.02,34.50,12.78,Contact UH,5.02,43.70,36.80,32.20,41.40,17.61,13.80,17.61,N/A,17.61,41.40,36.80,34.50,43.70,3.00,5.02,Contact UH,Contact UH,Contact UH,3.00,5.02,3.00,43.70,5.77 315,,88185,"Flow Cytometry, Cell Surface, Cytoplasmic, Or Nuclear Marker, Technical Component Only",IP/OP,64.00,16.62,24.32,19.71,48.00,17.78,Contact UH,N/A,60.80,51.20,44.80,57.60,24.50,19.20,24.50,N/A,24.50,57.60,51.20,48.00,60.80,16.62,N/A,Contact UH,Contact UH,Contact UH,16.62,N/A,16.62,60.80,T.B.D 316,,87070,"Culture, Bacterial; Any Other Source Except Urine, Blood, Stool Or Aerobic",IP/OP,152.00,39.47,57.76,8.62,114.00,42.23,Contact UH,8.62,144.40,121.60,106.40,136.80,58.19,45.60,58.19,N/A,58.19,136.80,121.60,114.00,144.40,9.00,8.62,Contact UH,Contact UH,Contact UH,9.00,8.62,8.62,144.40,9.91 317,,87205,"Smear, Primary Source With Interpretation; Gram Or Giemsa Stain For Bacteria, Fungi, Or Cell Types ",IP/OP,39.00,10.13,14.82,4.27,29.25,10.83,Contact UH,4.27,37.05,31.20,27.30,35.10,14.93,11.70,14.93,N/A,14.93,35.10,31.20,29.25,37.05,4.20,4.27,Contact UH,Contact UH,Contact UH,4.20,4.27,4.20,37.05,4.91 318,,85007,Blood Count ,IP/OP,20.00,5.19,7.60,3.80,15.00,5.56,Contact UH,3.80,19.00,16.00,14.00,18.00,7.66,6.00,7.66,N/A,7.66,18.00,16.00,15.00,19.00,2.40,3.80,Contact UH,Contact UH,Contact UH,2.40,3.80,2.40,19.00,4.37 319,,87081,"Culture, Presumptive, Pathogenic Organisms, Screening Only",IP/OP,83.00,21.56,31.54,6.63,62.25,23.06,Contact UH,6.63,78.85,66.40,58.10,74.70,31.77,24.90,31.77,N/A,31.77,74.70,66.40,62.25,78.85,9.00,6.63,Contact UH,Contact UH,Contact UH,9.00,6.63,6.63,78.85,7.62 320,,74176,"Ct Scan, Abdomen And Pelvis Without Contrast",IP/OP,971.00,252.17,389.76,278.40,728.25,269.74,Contact UH,278.40,922.45,776.80,679.70,873.90,525.90,278.40,525.90,N/A,525.90,873.90,776.80,728.25,922.45,252.17,278.40,Contact UH,Contact UH,Contact UH,252.17,278.40,252.17,922.45,320.16 321,,82435,"Blood Test, Chloride",IP/OP,26.00,6.75,9.88,8.01,19.50,7.22,Contact UH,4.60,24.70,20.80,18.20,23.40,9.95,7.80,9.95,N/A,9.95,23.40,20.80,19.50,24.70,6.75,4.60,Contact UH,Contact UH,Contact UH,6.75,4.60,4.60,24.70,5.29