|
Unlisted psychiatric service/proc 90899
|
$51.52 |
$51.52 |
$2,424.80 |
|
|
Unlisted px abdomen muscskel
|
$339.18 |
$6,564.00 |
$7,311.00 |
|
|
Unlisted px accessory sinus
|
$325.68 |
$325.68 |
$325.68 |
|
|
Unlisted px ant segment eye
|
$3,173.34 |
$7,839.00 |
$7,839.00 |
|
|
Unlisted px arthroscopy
|
$339.18 |
$339.18 |
$339.18 |
|
|
Unlisted px biliary tract
|
$1,247.13 |
$1,247.13 |
$1,247.13 |
|
|
Unlisted px casting/strpg
|
$223.45 |
$223.45 |
$223.45 |
|
|
Unlisted px conjunctiva
|
$436.44 |
$436.44 |
$436.44 |
|
|
Unlisted px exc pressure ulc
|
$973.71 |
$973.71 |
$973.71 |
|
|
Unlisted px external ear
|
$325.68 |
$354.00 |
$356.00 |
|
|
Unlisted px extraocular musc
|
$436.44 |
$436.44 |
$436.44 |
|
|
Unlisted px foot/toes
|
$339.18 |
$918.00 |
$918.00 |
|
|
Unlisted px forearm/wrist
|
$339.18 |
$339.18 |
$339.18 |
|
|
Unlisted px hands/fingers
|
$282.00 |
$339.18 |
$1,804.00 |
|
|
Unlisted px inner ear
|
$325.68 |
$325.68 |
$325.68 |
|
|
Unlisted px lacrimal system
|
$436.44 |
$436.44 |
$436.44 |
|
|
Unlisted px leg/ankle
|
$339.18 |
$10,432.00 |
$10,432.00 |
|
|
Unlisted px male genital sys
|
$343.55 |
$22,817.00 |
$22,817.00 |
|
|
Unlisted px med radj physics
|
$184.82 |
$709.00 |
$709.00 |
|
|
Unlisted px middle ear
|
$325.68 |
$325.68 |
$325.68 |
|
|
Unlisted px neck/thorax
|
$325.68 |
$325.68 |
$325.68 |
|
|
Unlisted px palate uvula
|
$325.68 |
$325.68 |
$325.68 |
|
|
Unlisted px pelvis/hip joint
|
$339.18 |
$15,881.00 |
$15,966.00 |
|
|
Unlisted px posterior segmnt
|
$3,173.34 |
$3,173.34 |
$3,173.34 |
|
|
Unlisted px salivry glnd/dux
|
$325.68 |
$325.68 |
$325.68 |
|
|
Unlisted px small intestine
|
$980.00 |
$1,247.13 |
$2,700.00 |
|
|
Unlisted px temporal bone
|
$325.68 |
$325.68 |
$325.68 |
|
|
Unlisted px ther rad tx plng
|
$184.82 |
$184.82 |
$184.82 |
|
|
Unlisted px tongue flr mouth
|
$325.68 |
$1,376.00 |
$1,383.00 |
|
|
Unlisted px vestibule mouth
|
$325.68 |
$325.68 |
$325.68 |
|
|
Unlisted reprod med lab proc
|
$58.86 |
$71.65 |
$71.65 |
|
|
Unlisted resp px dx nuc med
|
$549.70 |
$549.70 |
$549.70 |
|
|
Unlisted spec derm svc/px
|
$275.88 |
$275.88 |
$275.88 |
|
|
Unlisted special svc px/rprt
|
$89.60 |
$89.60 |
$89.60 |
|
|
Unlisted surgical path px
|
$71.65 |
$71.65 |
$71.65 |
|
|
Unlisted transfusion med px
|
$27.30 |
$39.77 |
$39.77 |
|
|
Unlisted ultrasound procedure
|
$75.04 |
$119.66 |
$762.40 |
|
|
Unlisted vasc endoscopy px
|
$862.57 |
$862.57 |
$862.57 |
|
|
Unlstd hematop ret/endo lymp
|
$549.70 |
$549.70 |
$549.70 |
|
|
Unlstd laps px mat care&dlvr
|
$8,312.83 |
$8,312.83 |
$8,312.83 |
|
|
Unlstd laps px sprmatic cord
|
$8,312.83 |
$8,312.83 |
$8,312.83 |
|
|
Unsched dialysis esrd pt hos
|
$426.72 |
$1,043.00 |
$3,300.00 |
|
|
Upgrade pm system
|
$10,010.00 |
$14,371.89 |
$41,691.00 |
|
|
Upper Arm (Humerus) X-ray (left side)
|
$72.80 |
$378.00 |
$767.20 |
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$241.18 |
$1,786.00 |
$3,547.00 |
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$143.75 |
$1,151.00 |
$2,304.00 |
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$360.49 |
$3,520.00 |
$5,984.00 |
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$287.17 |
$2,949.00 |
$4,715.20 |
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$233.59 |
$1,902.00 |
$4,715.20 |
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$54.88 |
$225.00 |
$459.20 |
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$75.04 |
$288.00 |
$527.20 |
|
|
Upper Endoscopy (EGD, diagnostic)
|
$866.79 |
$866.79 |
$1,247.13 |
|
|
Upper Endoscopy (EGD, with biopsy)
|
$866.79 |
$866.79 |
$1,247.13 |
|
|
Upper ext fx orthosis rad/ul
|
$247.38 |
$1,186.76 |
$1,186.78 |
|
|
Upper ext harvest for cabg1 seg 35600
|
$259.30 |
$259.30 |
$259.30 |
|
|
Upper GI Barium X-ray (barium and gas)
|
$168.00 |
$370.72 |
$1,627.20 |
|
|
Upper GI Barium X-ray (barium only)
|
$64.96 |
$514.00 |
$1,440.80 |
|
|
Uppr gi scope w/submuc inj
|
$1,247.13 |
$1,247.13 |
$1,247.13 |
|
|
Urachal cyst/sinus excision 51500
|
$8,312.83 |
$8,312.83 |
$8,312.83 |
|
|
Urea nitrogen
|
$5.45 |
$17.00 |
$67.20 |
|
|
Urea nitrogen 24 hour urine
|
$7.67 |
$18.00 |
$108.00 |
|
|
Urea nitrogen clearance
|
$9.94 |
$22.00 |
$30.24 |
|
|
Urea nitrogen semi-quant
|
$2.35 |
$7.08 |
$7.08 |
|
|
Ureteral embolization/occl
|
$235.23 |
$1,460.00 |
$1,468.00 |
|
|
Ureteral reflux study
|
$402.78 |
$549.70 |
$1,386.00 |
|
|
Ureter endoscopy
|
$4,846.99 |
$4,846.99 |
$4,846.99 |
|
|
Ureter endoscopy & biopsy
|
$7,372.68 |
$7,372.68 |
$7,372.68 |
|
|
Ureter endoscopy & biopsy
|
$7,372.68 |
$7,372.68 |
$7,372.68 |
|
|
Ureter endoscopy & catheter
|
$4,846.99 |
$4,846.99 |
$4,846.99 |
|
|
Ureter endoscopy & treatment
|
$7,372.68 |
$7,372.68 |
$7,372.68 |
|
|
Ureter endoscopy & treatment
|
$7,372.68 |
$7,372.68 |
$7,372.68 |
|
|
Ureter endoscopy & treatment
|
$7,372.68 |
$7,372.68 |
$7,372.68 |
|
|
Ureter endoscopy & treatment
|
$7,372.68 |
$7,372.68 |
$7,372.68 |
|
|
Ureteroneocystostomy 50780
|
$1,473.37 |
$1,473.37 |
$1,473.37 |
|
|
Ureteroureterostomy 50760
|
$1,509.66 |
$1,509.66 |
$1,509.66 |
|
|
Urethrcystgrphy rtrgrde s&i
|
$122.20 |
$437.00 |
$1,168.00 |
|
|
Urethrlys transvag with scope
|
$4,846.99 |
$4,846.99 |
$4,846.99 |
|
|
Urethrocystography void s&i
|
$171.55 |
$893.00 |
$1,326.40 |
|
|
Uric acid blood
|
$6.24 |
$18.00 |
$72.80 |
|
|
Uric acid urine
|
$7.01 |
$19.00 |
$108.80 |
|
|
Urinalysis glass test
|
$6.49 |
$6.49 |
$6.49 |
|
|
Urinalysis microscopic only
|
$2.82 |
$4.21 |
$106.40 |
|
|
Urinalysis qual/semiquant excpt ia
|
$2.99 |
$8.27 |
$96.00 |
|
|
Urinalysis (with microscopy)
|
$4.37 |
$20.00 |
$111.20 |
|
|
Urinalysis (without microscopy)
|
$3.11 |
$13.00 |
$66.40 |
|
|
Urinary bldr retent nuc study
|
$87.52 |
$87.52 |
$576.80 |
|
|
Urinary pouch on barr w/flng
|
$6.25 |
$6.25 |
$6.25 |
|
|
Urinary pouch w/barrier
|
$11.83 |
$11.83 |
$11.83 |
|
|
Urinary reflex study
|
$81.77 |
$152.00 |
$169.00 |
|
|
Urinary suspensory
|
$80.19 |
$80.19 |
$80.19 |
|
|
Urine Culture Test
|
$11.14 |
$55.00 |
$83.00 |
|
|
Urine flow measurement 51736
|
$182.95 |
$182.95 |
$182.95 |
|
|
Urine ost pouch w faucet/tap
|
$12.82 |
$12.82 |
$12.82 |
|
|
Urine pregnancy test
|
$9.40 |
$21.00 |
$157.60 |
|
|
Urine screen for bacteria
|
$14.10 |
$41.37 |
$41.37 |
|
|
Urine shunt to intestine
|
$1,588.56 |
$1,588.56 |
$1,588.56 |
|
|
Urine specimen collect mult
|
$12.89 |
$12.89 |
$12.89 |
|
|
Urography, antegrade
|
$301.28 |
$607.00 |
$1,319.00 |
|
|
Urography inf drip &/or bolus
|
$241.18 |
$241.18 |
$241.18 |
|
|
Use 1st target lesion
|
$129.72 |
$494.00 |
$494.00 |
|