|
Ultrasound joint complete left
|
$125.84 |
$125.84 |
$125.84 |
$560.92
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$125.84 |
$125.84 |
$125.84 |
$277.80
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$286.04 |
$286.04 |
$286.04 |
$698.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$125.84 |
$125.84 |
$125.84 |
$428.25
|
|
Ultrasound prostate/transrectal
|
$125.84 |
$125.84 |
$125.84 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$125.84 |
$125.84 |
$125.84 |
$459.00
|
|
Ultrasound trgt dyn mbubb 1st les
|
$210.66 |
$210.66 |
$210.66 |
$568.32
|
|
Ultraviolet therapy
|
$9.41 |
$9.41 |
$9.41 |
$39.76
|
|
Umbilical cord occlud w/us
|
$359.97 |
$359.97 |
$359.97 |
$754.00
|
|
Unlistd noninvas vasc dx std
|
$28.98 |
$28.98 |
$28.98 |
$564.60
|
|
Unlisted all/immlg svc/px
|
$28.98 |
$28.98 |
$28.98 |
$28.98
|
|
Unlisted chemotherapy px
|
$54.60 |
$54.60 |
$54.60 |
$149.15
|
|
Unlisted cranfcl&maxlfcl px
|
$274.80 |
$274.80 |
$274.80 |
$571.20
|
|
Unlisted CT procedure
|
$104.19 |
$104.19 |
$104.19 |
$740.43
|
|
Unlisted cv px dx nuc med
|
$475.51 |
$475.51 |
$475.51 |
$1,747.20
|
|
Unlisted cytogenetic study
|
$63.23 |
$63.23 |
$63.23 |
$160.00
|
|
Unlisted cytopathology px
|
$63.23 |
$63.23 |
$63.23 |
$132.08
|
|
Unlisted dx gi procedure
|
$185.15 |
$185.15 |
$185.15 |
$649.22
|
|
Unlisted endocrine px dx nuc
|
$475.51 |
$475.51 |
$475.51 |
$653.31
|
|
Unlisted fetal invas px w/us
|
$238.06 |
$238.06 |
$238.06 |
$498.40
|
|
Unlisted fluoroscopic px
|
$104.19 |
$104.19 |
$104.19 |
$305.76
|
|
Unlisted gi px dx nuc med
|
$475.51 |
$475.51 |
$475.51 |
$995.00
|
|
Unlisted gu px dx nuc med
|
$475.51 |
$475.51 |
$475.51 |
$805.62
|
|
Unlisted hystsc px uterus
|
$238.06 |
$238.06 |
$238.06 |
$3,027.89
|
|
Unlisted laparoscopic liver biopy 47379
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
$6,307.38
|
|
Unlisted laparoscopic procedure 49659
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
$5,419.00
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
$6,463.42
|
|
Unlisted laps px appendix
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
$3,617.40
|
|
Unlisted laps px bladder
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
$5,082.74
|
|
Unlisted laps px endoc sys
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
$5,855.00
|
|
Unlisted laps px esoph
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
$5,741.00
|
|
Unlisted laps px lymphtc sys
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
$6,870.89
|
|
Unlisted laps px ovidct ovry
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
$6,904.15
|
|
Unlisted laps px renal
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
$5,110.00
|
|
Unlisted laps px spleen
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
$4,627.00
|
|
Unlisted laps px testis
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
$5,628.67
|
|
Unlisted laps px ureter
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
$6,376.26
|
|
Unlisted laps px uterus
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
$4,627.00
|
|
Unlisted maxlfcl prosth px
|
$274.80 |
$274.80 |
$274.80 |
$571.20
|
|
Unlisted misc path test
|
$63.23 |
$63.23 |
$63.23 |
$89.40
|
|
Unlisted mr procedure
|
$104.19 |
$104.19 |
$104.19 |
$1,165.00
|
|
Unlisted muscskel px dx nuc
|
$475.51 |
$475.51 |
$475.51 |
$1,279.98
|
|
Unlisted muscskel px head
|
$274.80 |
$274.80 |
$274.80 |
$1,224.08
|
|
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
|