|
Ultrasound elastography parenchyma
|
$145.28 |
$145.28 |
$145.28 |
$284.25
|
|
Ultrasound encephalogram
|
$188.38 |
$188.38 |
$188.38 |
$481.60
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$173.72 |
$173.72 |
$173.72 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$134.78 |
$134.78 |
$134.78 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$198.88 |
$198.88 |
$198.88 |
$701.35
|
|
Ultrasound guide intraoperative
|
$227.98 |
$227.98 |
$227.98 |
$632.90
|
|
Ultrasound guide tissue ablation
|
$199.10 |
$199.10 |
$199.10 |
$498.40
|
|
Ultrasound hips infant dynamic
|
$231.05 |
$231.05 |
$231.05 |
$403.00
|
|
Ultrasound infant hips ltd without stress
|
$161.69 |
$161.69 |
$161.69 |
$321.35
|
|
Ultrasound ob >=14wks ea addl gest
|
$110.05 |
$110.05 |
$110.05 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$75.48 |
$75.48 |
$75.48 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$201.95 |
$201.95 |
$201.95 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$158.41 |
$158.41 |
$158.41 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$193.41 |
$193.41 |
$193.41 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$170.88 |
$170.88 |
$170.88 |
$485.48
|
|
Ultrasound retroperitoneal limited
|
$193.41 |
$193.41 |
$193.41 |
$498.00
|
|
Ultrasound scrotum and contents
|
$198.67 |
$198.67 |
$198.67 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$199.76 |
$199.76 |
$199.76 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$103.71 |
$103.71 |
$103.71 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$233.89 |
$233.89 |
$233.89 |
$567.44
|
|
Umbilical cord occlud w/us
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$569.50
|
|
Unlisted cranfcl&maxlfcl px
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$3,786.00
|
|
Unlisted fetal invas px w/us
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$492.81
|
|
Unlisted hystsc px uterus
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,803.60
|
|
Unlisted laparoscopic liver biopy 47379
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$6,307.38
|
|
Unlisted laparoscopic procedure 49659
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$5,741.00
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$6,904.15
|
|
Unlisted laps px appendix
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$4,881.00
|
|
Unlisted laps px bladder
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$6,376.26
|
|
Unlisted laps px endoc sys
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$6,548.98
|
|
Unlisted laps px esoph
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$6,429.80
|
|
Unlisted laps px lymphtc sys
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$6,904.15
|
|
Unlisted laps px ovidct ovry
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$5,339.00
|
|
Unlisted laps px renal
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$6,839.00
|
|
Unlisted laps px spleen
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$6,463.42
|
|
Unlisted laps px testis
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$6,457.82
|
|
Unlisted laps px ureter
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$6,376.26
|
|
Unlisted laps px uterus
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$6,457.82
|
|
Unlisted maxlfcl prosth px
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,432.65
|
|
Unlisted mr procedure
|
$1,124.85 |
$1,124.85 |
$1,124.85 |
$1,032.20
|
|
Unlisted muscskel px head
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$274.80
|
|
Unlisted procedure colon
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,580.44
|
|
Unlisted procedure esophagus
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,215.50
|
|
Unlisted procedure eyelids
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$479.62
|
|
Unlisted procedure larynx
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$4,350.00
|
|
Unlisted procedure liver
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,694.00
|
|
Unlisted procedure microbiology
|
$24.28 |
$24.28 |
$24.28 |
$487.50
|
|
Unlisted procedure orbit
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$353.74
|
|
Unlisted procedure pancreas
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,967.75
|
|
Unlisted procedure rectum
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,278.72
|
|
Unlisted procedure spine
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$4,706.35
|
|
Unlisted px abdomen muscskel
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,633.80
|
|
Unlisted px accessory sinus
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$257.26
|
|
Unlisted px ant segment eye
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,698.92
|
|
Unlisted px arthroscopy
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$4,087.20
|
|
Unlisted px biliary tract
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,718.10
|
|
Unlisted px casting/strpg
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$224.93
|
|
Unlisted px conjunctiva
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$353.74
|
|
Unlisted px exc pressure ulc
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$832.60
|
|
Unlisted px external ear
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$354.00
|
|
Unlisted px extraocular musc
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$352.04
|
|
Unlisted px foot/toes
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$3,105.70
|
|
Unlisted px forearm/wrist
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$3,521.60
|
|
Unlisted px hands/fingers
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$379.44
|
|
Unlisted px inner ear
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$4,881.00
|
|
Unlisted px lacrimal system
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$359.15
|
|
Unlisted px leg/ankle
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$811.00
|
|
Unlisted px male genital sys
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$897.95
|
|
Unlisted px middle ear
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,975.05
|
|
Unlisted px neck/thorax
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,680.22
|
|
Unlisted px palate uvula
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$257.04
|
|
Unlisted px pelvis/hip joint
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,108.82
|
|
Unlisted px posterior segmnt
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$3,997.80
|
|
Unlisted px salivry glnd/dux
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$486.72
|
|
Unlisted px small intestine
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$2,118.35
|
|
Unlisted px temporal bone
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$274.80
|
|
Unlisted px tongue flr mouth
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$274.80
|
|
Unlisted px vestibule mouth
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$274.80
|
|
Unlisted vasc endoscopy px
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$862.57
|
|
Unlstd laps px mat care&dlvr
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$6,463.42
|
|
Unlstd laps px sprmatic cord
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$4,881.00
|
|
Unsched dialysis esrd pt hos
|
$423.37 |
$423.37 |
$423.37 |
$1,469.76
|
|
Upgrade pm system
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,094.21 |
$1,094.21 |
$1,094.21 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$825.31 |
$825.31 |
$825.31 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$655.52 |
$655.52 |
$655.52 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,588.59
|
|
Upper Endoscopy (EGD, with biopsy)
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,656.60
|
|
Upper ext fx orthosis rad/ul
|
$54.70 |
$54.70 |
$54.70 |
$619.49
|
|
Uppr gi scope w/submuc inj
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$1,773.85
|
|
Urachal cyst/sinus excision 51500
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$6,082.67
|
|
Urea nitrogen
|
$4.35 |
$4.35 |
$4.35 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$6.12 |
$6.12 |
$6.12 |
$50.00
|
|
Urea nitrogen clearance
|
$7.92 |
$7.92 |
$7.92 |
$33.57
|
|
Urea nitrogen semi-quant
|
$5.64 |
$5.64 |
$5.64 |
$5.64
|
|
Ureteral reflux study
|
$421.40 |
$421.40 |
$421.40 |
$961.20
|
|
Ureter endoscopy
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$3,820.84
|
|
Ureter endoscopy & biopsy
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$5,626.86
|
|
Ureter endoscopy & biopsy
|
$5,419.00 |
$5,419.00 |
$5,419.00 |
$5,626.86
|
