|
Unlisted neurological dx px
|
$185.15 |
$185.15 |
$185.15 |
$242.50
|
|
Unlisted nrvs sys px dx nuc
|
$475.51 |
$475.51 |
$475.51 |
$891.41
|
|
Unlisted oph svc/procedure
|
$28.98 |
$28.98 |
$28.98 |
$40.26
|
|
Unlisted orl service/px
|
$28.98 |
$28.98 |
$28.98 |
$132.60
|
|
Unlisted procedure colon
|
$1,078.88 |
$1,078.88 |
$1,078.88 |
$1,839.55
|
|
Unlisted procedure esophagus
|
$1,109.47 |
$1,109.47 |
$1,109.47 |
$1,998.88
|
|
Unlisted procedure eyelids
|
$353.74 |
$353.74 |
$353.74 |
$2,174.90
|
|
Unlisted procedure larynx
|
$274.80 |
$274.80 |
$274.80 |
$924.00
|
|
Unlisted procedure liver
|
$832.60 |
$832.60 |
$832.60 |
$2,287.20
|
|
Unlisted procedure orbit
|
$353.74 |
$353.74 |
$353.74 |
$437.00
|
|
Unlisted procedure pancreas
|
$832.60 |
$832.60 |
$832.60 |
$4,810.00
|
|
Unlisted procedure rectum
|
$1,078.88 |
$1,078.88 |
$1,078.88 |
$1,278.72
|
|
Unlisted procedure spine
|
$283.86 |
$283.86 |
$283.86 |
$4,706.35
|
|
Unlisted psychiatric service/proc 90899
|
$35.25 |
$35.25 |
$35.25 |
$277.76
|
|
Unlisted px abdomen muscskel
|
$283.86 |
$283.86 |
$283.86 |
$2,053.50
|
|
Unlisted px accessory sinus
|
$274.80 |
$274.80 |
$274.80 |
$3,335.28
|
|
Unlisted px ant segment eye
|
$2,698.92 |
$2,698.92 |
$2,698.92 |
$2,698.92
|
|
Unlisted px arthroscopy
|
$283.86 |
$283.86 |
$283.86 |
$2,765.60
|
|
Unlisted px biliary tract
|
$1,109.47 |
$1,109.47 |
$1,109.47 |
$3,055.00
|
|
Unlisted px casting/strpg
|
$186.72 |
$186.72 |
$186.72 |
$222.00
|
|
Unlisted px conjunctiva
|
$353.74 |
$353.74 |
$353.74 |
$479.62
|
|
Unlisted px exc pressure ulc
|
$832.60 |
$832.60 |
$832.60 |
$973.71
|
|
Unlisted px external ear
|
$274.80 |
$274.80 |
$274.80 |
$325.68
|
|
Unlisted px extraocular musc
|
$353.74 |
$353.74 |
$353.74 |
$739.20
|
|
Unlisted px foot/toes
|
$283.86 |
$283.86 |
$283.86 |
$1,225.50
|
|
Unlisted px forearm/wrist
|
$283.86 |
$283.86 |
$283.86 |
$859.50
|
|
Unlisted px hands/fingers
|
$283.86 |
$283.86 |
$283.86 |
$349.70
|
|
Unlisted px inner ear
|
$274.80 |
$274.80 |
$274.80 |
$571.20
|
|
Unlisted px lacrimal system
|
$353.74 |
$353.74 |
$353.74 |
$416.50
|
|
Unlisted px leg/ankle
|
$283.86 |
$283.86 |
$283.86 |
$813.24
|
|
Unlisted px male genital sys
|
$287.81 |
$287.81 |
$287.81 |
$362.00
|
|
Unlisted px med radj physics
|
$157.11 |
$157.11 |
$157.11 |
$462.35
|
|
Unlisted px middle ear
|
$274.80 |
$274.80 |
$274.80 |
$343.50
|
|
Unlisted px neck/thorax
|
$274.80 |
$274.80 |
$274.80 |
$571.20
|
|
Unlisted px palate uvula
|
$274.80 |
$274.80 |
$274.80 |
$274.80
|
|
Unlisted px pelvis/hip joint
|
$283.86 |
$283.86 |
$283.86 |
$3,251.90
|
|
Unlisted px posterior segmnt
|
$2,698.92 |
$2,698.92 |
$2,698.92 |
$3,173.34
|
|
Unlisted px salivry glnd/dux
|
$274.80 |
$274.80 |
$274.80 |
$1,173.42
|
|
Unlisted px small intestine
|
$1,109.47 |
$1,109.47 |
$1,109.47 |
$2,118.35
|
|
Unlisted px temporal bone
|
$274.80 |
$274.80 |
$274.80 |
$571.20
|
|
Unlisted px ther rad tx plng
|
$157.11 |
$157.11 |
$157.11 |
$182.00
|
|
Unlisted px tongue flr mouth
|
$274.80 |
$274.80 |
$274.80 |
$282.50
|
|
Unlisted px vestibule mouth
|
$274.80 |
$274.80 |
$274.80 |
$456.96
|
|
Unlisted reprod med lab proc
|
$63.23 |
$63.23 |
$63.23 |
$70.00
|
|
Unlisted resp px dx nuc med
|
$475.51 |
$475.51 |
$475.51 |
$670.60
|
|
Unlisted spec derm svc/px
|
$235.13 |
$235.13 |
$235.13 |
$223.08
|
|
Unlisted surgical path px
|
$63.23 |
$63.23 |
$63.23 |
$216.00
|
|
Unlisted transfusion med px
|
$28.98 |
$28.98 |
$28.98 |
$147.50
|
|
Unlisted ultrasound procedure
|
$104.19 |
$104.19 |
$104.19 |
$335.00
|
|
Unlisted vasc endoscopy px
|
$731.62 |
$731.62 |
$731.62 |
$1,523.20
|
|
Unlstd hematop ret/endo lymp
|
$475.51 |
$475.51 |
$475.51 |
$473.22
|
|
Unlstd laps px mat care&dlvr
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
$5,741.00
|
|
Unlstd laps px sprmatic cord
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
$4,713.11
|
|
Unsched dialysis esrd pt hos
|
$828.02 |
$828.02 |
$828.02 |
$1,316.90
|
|
Upgrade pm system
|
$12,384.25 |
$12,384.25 |
$12,384.25 |
$12,087.24
|
|
Upper Arm (Humerus) X-ray (left side)
|
$104.19 |
$104.19 |
$104.19 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$210.66 |
$210.66 |
$210.66 |
$1,652.95
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$125.84 |
$125.84 |
$125.84 |
$1,422.05
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$422.61 |
$422.61 |
$422.61 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$422.61 |
$422.61 |
$422.61 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$286.04 |
$286.04 |
$286.04 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$125.84 |
$125.84 |
$125.84 |
$320.45
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$125.84 |
$125.84 |
$125.84 |
$380.82
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,109.47 |
$1,109.47 |
$1,109.47 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,109.47 |
$1,109.47 |
$1,109.47 |
$1,768.00
|
|
Upper GI Barium X-ray (barium and gas)
|
$210.66 |
$210.66 |
$210.66 |
$657.77
|
|
Upper GI Barium X-ray (barium only)
|
$210.66 |
$210.66 |
$210.66 |
$603.20
|
|
Uppr gi scope w/submuc inj
|
$1,109.47 |
$1,109.47 |
$1,109.47 |
$1,872.00
|
|
Urachal cyst/sinus excision 51500
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
$6,082.67
|
|
Urea nitrogen
|
$3.95 |
$3.95 |
$3.95 |
$42.00
|
|
Urea nitrogen 24 hour urine
|
$5.56 |
$5.56 |
$5.56 |
$51.77
|
|
Urea nitrogen clearance
|
$7.20 |
$7.20 |
$7.20 |
$34.02
|
|
Urea nitrogen semi-quant
|
$5.13 |
$5.13 |
$5.13 |
$10.40
|
|
Ureteral reflux study
|
$475.51 |
$475.51 |
$475.51 |
$952.50
|
|
Ureter endoscopy
|
$4,081.37 |
$4,081.37 |
$4,081.37 |
$3,326.40
|
|
Ureter endoscopy & biopsy
|
$6,015.75 |
$6,015.75 |
$6,015.75 |
$5,696.72
|
|
Ureter endoscopy & biopsy
|
$6,015.75 |
$6,015.75 |
$6,015.75 |
$5,986.78
|
|
Ureter endoscopy & catheter
|
$4,081.37 |
$4,081.37 |
$4,081.37 |
$3,326.40
|
|
Ureter endoscopy & treatment
|
$6,015.75 |
$6,015.75 |
$6,015.75 |
$6,015.75
|
|
Ureter endoscopy & treatment
|
$6,015.75 |
$6,015.75 |
$6,015.75 |
$5,631.74
|
|
Ureter endoscopy & treatment
|
$6,015.75 |
$6,015.75 |
$6,015.75 |
$5,986.78
|
|
Ureter endoscopy & treatment
|
$6,015.75 |
$6,015.75 |
$6,015.75 |
$5,631.74
|
|
Urethrcystgrphy rtrgrde s&i
|
$286.04 |
$286.04 |
$286.04 |
$592.80
|
|
Urethrlys transvag with scope
|
$4,081.37 |
$4,081.37 |
$4,081.37 |
$4,081.37
|
|
Urethrocystography void s&i
|
$286.04 |
$286.04 |
$286.04 |
$631.75
|
|
Uric acid blood
|
$4.52 |
$4.52 |
$4.52 |
$48.96
|
|
Uric acid urine
|
$5.08 |
$5.08 |
$5.08 |
$44.14
|
|
Urinalysis glass test
|
$4.70 |
$4.70 |
$4.70 |
$11.20
|
|
Urinalysis microscopic only
|
$3.05 |
$3.05 |
$3.05 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$2.17 |
$2.17 |
$2.17 |
$25.72
|
|
Urinalysis (with microscopy)
|
$3.17 |
$3.17 |
$3.17 |
$54.60
|
|
Urinalysis (without microscopy)
|
$2.25 |
$2.25 |
$2.25 |
$35.15
|
|
Urinary reflex study
|
$70.29 |
$70.29 |
$70.29 |
$216.05
|
|
Urine Culture Test
|
$8.07 |
$8.07 |
$8.07 |
$81.00
|
|
Urine flow measurement 51736
|
$152.54 |
$152.54 |
$152.54 |
$210.00
|
|
Urine pregnancy test
|
$8.61 |
$8.61 |
$8.61 |
$66.87
|
|
Urine screen for bacteria
|
$29.98 |
$29.98 |
$29.98 |
$55.64
|
|
Urography, antegrade
|
$422.61 |
$422.61 |
$422.61 |
$622.35
|
|
Urography inf drip &/or bolus
|
$210.66 |
$210.66 |
$210.66 |
$642.50
|
|
Use 1st target lesion
|
$125.84 |
$125.84 |
$125.84 |
$332.00
|