|
Ultrasound fetal biophysical profile without non-stress testing
|
$1,030.40 |
$1,030.40 |
$1,030.40 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$1,008.00 |
$1,008.00 |
$1,008.00 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$1,349.60 |
$1,349.60 |
$1,349.60 |
$720.15
|
|
Ultrasound guide intraoperative
|
$476.00 |
$476.00 |
$476.00 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$655.20 |
$655.20 |
$655.20 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$610.40 |
$610.40 |
$610.40 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$610.40 |
$610.40 |
$610.40 |
$311.25
|
|
Ultrasound joint complete left
|
$868.00 |
$868.00 |
$868.00 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$767.20 |
$767.20 |
$767.20 |
$425.45
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$296.80 |
$296.80 |
$296.80 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$380.80 |
$380.80 |
$380.80 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$380.80 |
$380.80 |
$380.80 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$901.60 |
$901.60 |
$901.60 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$543.20 |
$543.20 |
$543.20 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$604.80 |
$604.80 |
$604.80 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$806.40 |
$806.40 |
$806.40 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$750.40 |
$750.40 |
$750.40 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$795.20 |
$795.20 |
$795.20 |
$486.50
|
|
Ultrasound scrotum and contents
|
$890.40 |
$890.40 |
$890.40 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$666.40 |
$666.40 |
$666.40 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$655.20 |
$655.20 |
$655.20 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$716.80 |
$716.80 |
$716.80 |
$558.35
|
|
Ultrasound trgt dyn mbubb 1st les
|
$644.00 |
$644.00 |
$644.00 |
$568.32
|
|
Ultrasound trgt dyn mbubb ea addl
|
$666.40 |
$666.40 |
$666.40 |
$348.00
|
|
Ultraviolet therapy
|
$39.76 |
$39.76 |
$39.76 |
$39.76
|
|
Umbilical artery cath newborn 36660
|
$145.60 |
$145.60 |
$145.60 |
$206.64
|
|
Umbilical cord occlud w/us
|
$1,624.00 |
$1,624.00 |
$1,624.00 |
$754.00
|
|
Umbilicoplasty 15847
|
$7,252.00 |
$7,252.00 |
$7,252.00 |
$4,172.97
|
|
Unit mobile power mpu
|
$14,359.52 |
$14,359.52 |
$14,359.52 |
$14,612.80
|
|
Unlistd noninvas vasc dx std
|
$291.20 |
$291.20 |
$291.20 |
$528.80
|
|
Unlisted all/immlg svc/px
|
$111.44 |
$111.44 |
$111.44 |
$28.98
|
|
Unlisted chemotherapy px
|
$256.48 |
$256.48 |
$256.48 |
$150.00
|
|
Unlisted cranfcl&maxlfcl px
|
$571.20 |
$571.20 |
$571.20 |
$571.20
|
|
Unlisted CT procedure
|
$571.20 |
$571.20 |
$571.20 |
$732.70
|
|
Unlisted cv px dx nuc med
|
$2,536.80 |
$2,536.80 |
$2,536.80 |
$1,200.00
|
|
Unlisted cytogenetic study
|
$91.84 |
$91.84 |
$91.84 |
$160.18
|
|
Unlisted cytopathology px
|
$199.92 |
$199.92 |
$199.92 |
$132.08
|
|
Unlisted dialysis procedure
|
$1,461.60 |
$1,461.60 |
$1,461.60 |
$1,144.00
|
|
Unlisted dx gi procedure
|
$666.40 |
$666.40 |
$666.40 |
$649.22
|
|
Unlisted endocrine px dx nuc
|
$1,400.00 |
$1,400.00 |
$1,400.00 |
$569.91
|
|
Unlisted fetal invas px w/us
|
$498.40 |
$498.40 |
$498.40 |
$498.40
|
|
Unlisted fluoroscopic px
|
$305.76 |
$305.76 |
$305.76 |
$305.76
|
|
Unlisted gi px dx nuc med
|
$2,536.80 |
$2,536.80 |
$2,536.80 |
$995.00
|
|
Unlisted gu px dx nuc med
|
$2,536.80 |
$2,536.80 |
$2,536.80 |
$805.62
|
|
Unlisted hematology&coagj px
|
$19.60 |
$19.60 |
$19.60 |
$39.52
|
|
Unlisted hystsc px uterus
|
$498.40 |
$498.40 |
$498.40 |
$2,803.60
|
|
Unlisted laparoscopic liver biopy 47379
|
$103,852.00 |
$103,852.00 |
$103,852.00 |
$5,419.00
|
|
Unlisted laparoscopic procedure 49659
|
$98,823.20 |
$98,823.20 |
$98,823.20 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$98,823.20 |
$98,823.20 |
$98,823.20 |
$5,419.00
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$3,600.80 |
$3,600.80 |
$3,600.80 |
$6,463.42
|
|
Unlisted laps px appendix
|
$487.20 |
$487.20 |
$487.20 |
$3,617.40
|
|
Unlisted laps px bladder
|
$3,600.80 |
$3,600.80 |
$3,600.80 |
$5,082.74
|
|
Unlisted laps px endoc sys
|
$3,600.80 |
$3,600.80 |
$3,600.80 |
$5,855.00
|
|
Unlisted laps px esoph
|
$3,600.80 |
$3,600.80 |
$3,600.80 |
$5,741.00
|
|
Unlisted laps px lymphtc sys
|
$3,600.80 |
$3,600.80 |
$3,600.80 |
$6,870.89
|
|
Unlisted laps px ovidct ovry
|
$9,553.60 |
$9,553.60 |
$9,553.60 |
$6,904.15
|
|
Unlisted laps px renal
|
$3,600.80 |
$3,600.80 |
$3,600.80 |
$5,110.00
|
|
Unlisted laps px spleen
|
$3,600.80 |
$3,600.80 |
$3,600.80 |
$4,627.00
|
|
Unlisted laps px testis
|
$3,600.80 |
$3,600.80 |
$3,600.80 |
$5,628.67
|
|
Unlisted laps px ureter
|
$3,600.80 |
$3,600.80 |
$3,600.80 |
$6,212.70
|
|
Unlisted laps px uterus
|
$3,600.80 |
$3,600.80 |
$3,600.80 |
$4,627.00
|
|
Unlisted maaa
|
$19.04 |
$19.04 |
$19.04 |
$235.20
|
|
Unlisted maxlfcl prosth px
|
$571.20 |
$571.20 |
$571.20 |
$571.20
|
|
Unlisted misc path test
|
$173.60 |
$173.60 |
$173.60 |
$89.40
|
|
Unlisted mr procedure
|
$367.92 |
$367.92 |
$367.92 |
$1,163.00
|
|
Unlisted muscskel px dx nuc
|
$2,536.80 |
$2,536.80 |
$2,536.80 |
$1,279.98
|
|
Unlisted muscskel px head
|
$1,657.60 |
$1,657.60 |
$1,657.60 |
$478.46
|
|
Unlisted neurological dx px
|
$464.80 |
$464.80 |
$464.80 |
$242.50
|
|
Unlisted nrvs sys px dx nuc
|
$1,764.00 |
$1,764.00 |
$1,764.00 |
$891.41
|
|
Unlisted oph svc/procedure
|
$182.56 |
$182.56 |
$182.56 |
$40.26
|
|
Unlisted orl service/px
|
$324.80 |
$324.80 |
$324.80 |
$132.60
|
|
Unlisted procedure colon
|
$2,251.20 |
$2,251.20 |
$2,251.20 |
$1,702.50
|
|
Unlisted procedure esophagus
|
$3,018.40 |
$3,018.40 |
$3,018.40 |
$1,998.88
|
|
Unlisted procedure eyelids
|
$2,385.60 |
$2,385.60 |
$2,385.60 |
$833.00
|
|
Unlisted procedure larynx
|
$924.00 |
$924.00 |
$924.00 |
$924.00
|
|
Unlisted procedure liver
|
$5,264.00 |
$5,264.00 |
$5,264.00 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$17.92 |
$17.92 |
$17.92 |
$523.50
|
|
Unlisted procedure orbit
|
$739.20 |
$739.20 |
$739.20 |
$436.44
|
|
Unlisted procedure pancreas
|
$5,874.40 |
$5,874.40 |
$5,874.40 |
$3,986.00
|
|
Unlisted procedure rectum
|
$9,979.20 |
$9,979.20 |
$9,979.20 |
$1,220.35
|
|
Unlisted procedure spine
|
$6,064.80 |
$6,064.80 |
$6,064.80 |
$4,659.85
|
|
Unlisted psychiatric service/proc 90899
|
$277.76 |
$277.76 |
$277.76 |
$277.76
|
|
Unlisted px abdomen muscskel
|
$2,318.40 |
$2,318.40 |
$2,318.40 |
$1,848.60
|
|
Unlisted px accessory sinus
|
$9,889.60 |
$9,889.60 |
$9,889.60 |
$3,335.28
|
|
Unlisted px ant segment eye
|
$5,364.80 |
$5,364.80 |
$5,364.80 |
$2,698.92
|
|
Unlisted px arthroscopy
|
$593.60 |
$593.60 |
$593.60 |
$2,765.60
|
|
Unlisted px biliary tract
|
$8,271.20 |
$8,271.20 |
$8,271.20 |
$2,718.10
|
|
Unlisted px casting/strpg
|
$397.60 |
$397.60 |
$397.60 |
$219.70
|
|
Unlisted px conjunctiva
|
$991.20 |
$991.20 |
$991.20 |
$479.62
|
|
Unlisted px diaphragm
|
$397.60 |
$397.60 |
$397.60 |
$6,547.57
|
|
Unlisted px exc pressure ulc
|
$1,736.00 |
$1,736.00 |
$1,736.00 |
$973.71
|
|
Unlisted px external ear
|
$582.40 |
$582.40 |
$582.40 |
$325.68
|
|
Unlisted px extraocular musc
|
$739.20 |
$739.20 |
$739.20 |
$739.20
|
|
Unlisted px foot/toes
|
$1,120.00 |
$1,120.00 |
$1,120.00 |
$1,225.50
|
|
Unlisted px forearm/wrist
|
$593.60 |
$593.60 |
$593.60 |
$593.60
|
|
Unlisted px hands/fingers
|
$593.60 |
$593.60 |
$593.60 |
$354.20
|
|
Unlisted px inner ear
|
$571.20 |
$571.20 |
$571.20 |
$571.20
|
|
Unlisted px lacrimal system
|
$6,871.20 |
$6,871.20 |
$6,871.20 |
$416.50
|
|
Unlisted px leg/ankle
|
$1,271.20 |
$1,271.20 |
$1,271.20 |
$811.00
|
|
Unlisted px male genital sys
|
$896.00 |
$896.00 |
$896.00 |
$343.55
|
