|
Tx contour defects >10.0 cc
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$755.08
|
|
Tx contour defects 1.1-5.0cc 11951
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$724.37
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,449.44
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,499.12
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,281.00
|
|
Tx open nsl fx uncomp
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,007.22
|
|
Tx open nsl sptl fx
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,289.04
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$469.20
|
|
Tympanic membrane repair
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,856.00
|
|
Tympanolysis transcanal 69450
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,837.72
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$911.43
|
|
Tympp antrt/mastoidotomy prosthesis torp 69637
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,740.80
|
|
Tympp antrt/mastoid without ossic chain recnst 69635
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,547.81
|
|
Tyms gene com variants
|
$192.29 |
$192.29 |
$192.29 |
$192.29
|
|
U2af1 gene common variants
|
$212.58 |
$212.58 |
$212.58 |
$193.25
|
|
Ua w/micro/comp poc
|
$4.42 |
$4.42 |
$4.42 |
$24.45
|
|
Ugt1a1 gene analy common variants
|
$257.40 |
$257.40 |
$257.40 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$115.97 |
$115.97 |
$115.97 |
$403.26
|
|
Ultrasound chest
|
$52.89 |
$52.89 |
$52.89 |
$459.55
|
|
Ultrasound encephalogram
|
$80.36 |
$80.36 |
$80.36 |
$481.60
|
|
Ultrasound guidance for vascular access
|
$81.91 |
$81.91 |
$81.91 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$161.89 |
$161.89 |
$161.89 |
$701.35
|
|
Ultrasound guide intraoperative
|
$91.84 |
$91.84 |
$91.84 |
$632.90
|
|
Ultrasound hips infant dynamic
|
$99.97 |
$99.97 |
$99.97 |
$403.00
|
|
Ultrasound ob >=14wks ea addl gest
|
$64.88 |
$64.88 |
$64.88 |
$454.11
|
|
Ultrasound pregnant uterus follow up per fetus
|
$123.32 |
$123.32 |
$123.32 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$138.93 |
$138.93 |
$138.93 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$129.51 |
$129.51 |
$129.51 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$106.03 |
$106.03 |
$106.03 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$129.64 |
$129.64 |
$129.64 |
$498.00
|
|
Ultrasound scrotum and contents
|
$177.50 |
$177.50 |
$177.50 |
$617.28
|
|
Ultrasound transvaginal non obstetric
|
$137.90 |
$137.90 |
$137.90 |
$567.44
|
|
Umbilical cord occlud w/us
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$569.50
|
|
Unlisted cranfcl&maxlfcl px
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,786.00
|
|
Unlisted fetal invas px w/us
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$492.81
|
|
Unlisted hystsc px uterus
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,803.60
|
|
Unlisted laparoscopic liver biopy 47379
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,307.38
|
|
Unlisted laparoscopic procedure 49659
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,741.00
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,904.15
|
|
Unlisted laps px appendix
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,881.00
|
|
Unlisted laps px bladder
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,376.26
|
|
Unlisted laps px endoc sys
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,548.98
|
|
Unlisted laps px esoph
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,429.80
|
|
Unlisted laps px lymphtc sys
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,904.15
|
|
Unlisted laps px ovidct ovry
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,339.00
|
|
Unlisted laps px renal
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,839.00
|
|
Unlisted laps px spleen
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,463.42
|
|
Unlisted laps px testis
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,457.82
|
|
Unlisted laps px ureter
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,376.26
|
|
Unlisted laps px uterus
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,457.82
|
|
Unlisted maxlfcl prosth px
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,432.65
|
|
Unlisted muscskel px head
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$274.80
|
|
Unlisted procedure colon
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,580.44
|
|
Unlisted procedure esophagus
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,215.50
|
|
Unlisted procedure eyelids
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$479.62
|
|
Unlisted procedure larynx
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,350.00
|
|
Unlisted procedure liver
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,694.00
|
|
Unlisted procedure microbiology
|
$14.31 |
$14.31 |
$14.31 |
$487.50
|
|
Unlisted procedure orbit
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$353.74
|
|
Unlisted procedure pancreas
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,967.75
|
|
Unlisted procedure rectum
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,278.72
|
|
Unlisted procedure spine
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,706.35
|
|
Unlisted px abdomen muscskel
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,633.80
|
|
Unlisted px accessory sinus
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$257.26
|
|
Unlisted px ant segment eye
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,698.92
|
|
Unlisted px arthroscopy
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,087.20
|
|
Unlisted px biliary tract
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,718.10
|
|
Unlisted px casting/strpg
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$224.93
|
|
Unlisted px conjunctiva
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$353.74
|
|
Unlisted px exc pressure ulc
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$832.60
|
|
Unlisted px external ear
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$354.00
|
|
Unlisted px extraocular musc
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$352.04
|
|
Unlisted px foot/toes
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,105.70
|
|
Unlisted px forearm/wrist
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,521.60
|
|
Unlisted px hands/fingers
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$379.44
|
|
Unlisted px inner ear
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,881.00
|
|
Unlisted px lacrimal system
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$359.15
|
|
Unlisted px leg/ankle
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$811.00
|
|
Unlisted px male genital sys
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$897.95
|
|
Unlisted px middle ear
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,975.05
|
|
Unlisted px neck/thorax
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,680.22
|
|
Unlisted px palate uvula
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$257.04
|
|
Unlisted px pelvis/hip joint
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,108.82
|
|
Unlisted px posterior segmnt
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,997.80
|
|
Unlisted px salivry glnd/dux
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$486.72
|
|
Unlisted px small intestine
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,118.35
|
|
Unlisted px temporal bone
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$274.80
|
|
Unlisted px tongue flr mouth
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$274.80
|
|
Unlisted px vestibule mouth
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$274.80
|
|
Unlisted vasc endoscopy px
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$862.57
|
|
Unlstd laps px mat care&dlvr
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,463.42
|
|
Unlstd laps px sprmatic cord
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,881.00
|
|
Unsched dialysis esrd pt hos
|
$414.47 |
$414.47 |
$414.47 |
$1,469.76
|
|
Upgrade pm system
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$645.12 |
$645.12 |
$645.12 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$486.58 |
$486.58 |
$486.58 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$386.48 |
$386.48 |
$386.48 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,588.59
|
