|
Unlisted chemotherapy px
|
$50.43 |
$51.07 |
$54.34 |
|
|
Unlisted cranfcl&maxlfcl px
|
$253.79 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted CT procedure
|
$96.23 |
$97.46 |
$103.69 |
|
|
Unlisted cv px dx nuc med
|
$439.15 |
$444.77 |
$473.22 |
|
|
Unlisted cytogenetic study
|
$58.39 |
$59.14 |
$62.92 |
|
|
Unlisted cytopathology px
|
$58.39 |
$59.14 |
$62.92 |
|
|
Unlisted dx gi procedure
|
$170.99 |
$173.18 |
$184.26 |
|
|
Unlisted endocrine px dx nuc
|
$439.15 |
$444.77 |
$473.22 |
|
|
Unlisted fetal invas px w/us
|
$219.85 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted fluoroscopic px
|
$33.76 |
$97.46 |
$1,278.62 |
|
|
Unlisted gi px dx nuc med
|
$439.15 |
$444.77 |
$473.22 |
|
|
Unlisted gu px dx nuc med
|
$439.15 |
$444.77 |
$473.22 |
|
|
Unlisted hematology&coagj px
|
$3.71 |
$14.82 |
$16.74 |
|
|
Unlisted hystsc px uterus
|
$219.85 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted laparoscopic liver biopy 47379
|
$3,786.00 |
$6,311.00 |
$6,870.89 |
|
|
Unlisted laparoscopic procedure 49659
|
$3,786.00 |
$6,311.00 |
$6,870.89 |
|
|
Unlisted laparoscopic reduction intestine 44238
|
$3,786.00 |
$6,311.00 |
$6,870.89 |
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$3,786.00 |
$6,311.00 |
$6,870.89 |
|
|
Unlisted laps px appendix
|
$3,786.00 |
$6,311.00 |
$6,870.89 |
|
|
Unlisted laps px bladder
|
$3,786.00 |
$6,311.00 |
$6,870.89 |
|
|
Unlisted laps px endoc sys
|
$3,786.00 |
$6,311.00 |
$6,870.89 |
|
|
Unlisted laps px esoph
|
$3,786.00 |
$6,311.00 |
$6,870.89 |
|
|
Unlisted laps px lymphtc sys
|
$3,786.00 |
$6,311.00 |
$6,870.89 |
|
|
Unlisted laps px ovidct ovry
|
$3,786.00 |
$6,311.00 |
$6,870.89 |
|
|
Unlisted laps px renal
|
$3,786.00 |
$6,311.00 |
$6,870.89 |
|
|
Unlisted laps px spleen
|
$3,786.00 |
$6,311.00 |
$6,870.89 |
|
|
Unlisted laps px testis
|
$3,786.00 |
$6,311.00 |
$6,870.89 |
|
|
Unlisted laps px ureter
|
$3,786.00 |
$6,311.00 |
$6,870.89 |
|
|
Unlisted laps px uterus
|
$3,786.00 |
$6,311.00 |
$6,870.89 |
|
|
Unlisted maxlfcl prosth px
|
$253.79 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted misc path test
|
$6.96 |
$59.14 |
$62.92 |
|
|
Unlisted mr procedure
|
$96.23 |
$97.54 |
$1,124.85 |
|
|
Unlisted muscskel px dx nuc
|
$439.15 |
$444.77 |
$473.22 |
|
|
Unlisted muscskel px head
|
$253.79 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted neurological dx px
|
$87.23 |
$173.18 |
$184.26 |
|
|
Unlisted nrvs sys px dx nuc
|
$439.15 |
$444.77 |
$473.22 |
|
|
Unlisted oph svc/procedure
|
$26.76 |
$27.11 |
$28.84 |
|
|
Unlisted orl service/px
|
$26.76 |
$27.13 |
$84.25 |
|
|
Unlisted procedure colon
|
$996.39 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted procedure esophagus
|
$1,024.64 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted procedure eyelids
|
$326.69 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted procedure larynx
|
$253.79 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted procedure liver
|
$768.94 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted procedure microbiology
|
$14.31 |
$23.06 |
$26.38 |
|
|
Unlisted procedure orbit
|
$326.69 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted procedure pancreas
|
$768.94 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted procedure rectum
|
$996.39 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted procedure spine
|
$262.16 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted psychiatric service/proc 90899
|
$32.56 |
$32.97 |
$35.08 |
|
|
Unlisted px abdomen muscskel
|
$262.16 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px accessory sinus
|
$253.79 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px ant segment eye
|
$2,492.56 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px arthroscopy
|
$262.16 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px biliary tract
|
$1,024.64 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px casting/strpg
|
$172.45 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px conjunctiva
|
$326.69 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px exc pressure ulc
|
$768.94 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px external ear
|
$253.79 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px extraocular musc
|
$326.69 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px foot/toes
|
$262.16 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px forearm/wrist
|
$262.16 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px hands/fingers
|
$262.16 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px inner ear
|
$253.79 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px lacrimal system
|
$326.69 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px leg/ankle
|
$262.16 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px male genital sys
|
$265.80 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px med radj physics
|
$145.10 |
$146.96 |
$156.36 |
|
|
Unlisted px middle ear
|
$253.79 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px neck/thorax
|
$253.79 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px palate uvula
|
$253.79 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px pelvis/hip joint
|
$262.16 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px posterior segmnt
|
$2,492.56 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px salivry glnd/dux
|
$253.79 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px small intestine
|
$1,024.64 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px temporal bone
|
$253.79 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px ther rad tx plng
|
$145.10 |
$146.96 |
$156.36 |
|
|
Unlisted px tongue flr mouth
|
$253.79 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted px vestibule mouth
|
$253.79 |
$3,986.00 |
$6,839.00 |
|
|
Unlisted reprod med lab proc
|
$58.39 |
$59.14 |
$62.92 |
|
|
Unlisted resp px dx nuc med
|
$439.15 |
$444.77 |
$473.22 |
|
|
Unlisted spec derm svc/px
|
$217.16 |
$219.93 |
$234.00 |
|
|
Unlisted surgical path px
|
$58.39 |
$59.14 |
$62.92 |
|
|
Unlisted transfusion med px
|
$24.10 |
$27.13 |
$159.13 |
|
|
Unlisted ultrasound procedure
|
$96.23 |
$97.46 |
$103.69 |
|
|
Unlisted vasc endoscopy px
|
$675.68 |
$3,986.00 |
$6,839.00 |
|
|
Unlstd hematop ret/endo lymp
|
$439.15 |
$444.77 |
$473.22 |
|
|
Unlstd laps px mat care&dlvr
|
$3,786.00 |
$6,311.00 |
$6,870.89 |
|
|
Unlstd laps px sprmatic cord
|
$3,786.00 |
$6,311.00 |
$6,870.89 |
|
|
Unsched dialysis esrd pt hos
|
$363.19 |
$735.92 |
$824.03 |
|
|
Upgrade pm system
|
$3,786.00 |
$6,311.00 |
$12,324.60 |
|
|
Upper Arm (Humerus) X-ray (left side)
|
$96.23 |
$97.46 |
$121.50 |
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$194.55 |
$498.84 |
$922.49 |
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$116.22 |
$376.90 |
$679.84 |
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$390.30 |
$819.66 |
$1,188.73 |
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$390.30 |
$618.23 |
$896.60 |
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$264.17 |
$491.04 |
$712.14 |
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$100.60 |
$117.81 |
$258.80 |
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$104.49 |
$121.35 |
$269.60 |
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,024.64 |
$3,986.00 |
$6,839.00 |
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,024.64 |
$3,986.00 |
$6,839.00 |
|