|
Ultrasound ob >=14wks ea addl gest
|
$222.74 |
$360.83 |
$1,693.20 |
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$108.00 |
$350.22 |
$873.00 |
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$257.40 |
$286.04 |
$1,721.00 |
|
|
Ultrasound pregnant uterus follow up per fetus
|
$94.80 |
$125.84 |
$1,147.00 |
|
|
Ultrasound prostate/transrectal
|
$19.80 |
$125.84 |
$1,352.00 |
|
|
Ultrasound spinal canal and contents
|
$122.40 |
$125.84 |
$1,572.00 |
|
|
Ultrasound transabd ea addl gest
|
$144.51 |
$569.00 |
$795.60 |
|
|
Ultrasound trgt dyn mbubb 1st les
|
$47.30 |
$210.66 |
$1,310.00 |
|
|
Ultrasound trgt dyn mbubb ea addl
|
$24.86 |
$435.65 |
$607.00 |
|
|
Ultraviolet therapy
|
$9.33 |
$9.58 |
$9.82 |
|
|
Umbilical artery cath newborn 36660
|
$41.58 |
$41.58 |
$41.58 |
|
|
Umbilical cord occlud w/us
|
$320.76 |
$359.97 |
$1,078.00 |
|
|
Umbilicoplasty 15847
|
$291.72 |
$291.72 |
$291.72 |
|
|
Unit mobile power mpu
|
$15,600.00 |
$15,600.00 |
$15,600.00 |
|
|
Unlistd noninvas vasc dx std
|
$22.00 |
$28.98 |
$28.98 |
|
|
Unlisted all/immlg svc/px
|
$28.98 |
$28.98 |
$28.98 |
|
|
Unlisted chemotherapy px
|
$19.58 |
$54.60 |
$164.00 |
|
|
Unlisted cranfcl&maxlfcl px
|
$274.80 |
$274.80 |
$274.80 |
|
|
Unlisted CT procedure
|
$104.19 |
$104.19 |
$2,018.00 |
|
|
Unlisted cv px dx nuc med
|
$475.51 |
$475.51 |
$475.51 |
|
|
Unlisted cytogenetic study
|
$63.23 |
$63.23 |
$4,244.69 |
|
|
Unlisted cytopathology px
|
$63.23 |
$63.23 |
$63.23 |
|
|
Unlisted dialysis procedure
|
$1,033.55 |
$1,033.55 |
$1,272.06 |
|
|
Unlisted dx gi procedure
|
$185.15 |
$185.15 |
$185.15 |
|
|
Unlisted endocrine px dx nuc
|
$475.51 |
$475.51 |
$475.51 |
|
|
Unlisted fetal invas px w/us
|
$238.06 |
$238.06 |
$2,052.81 |
|
|
Unlisted fluoroscopic px
|
$24.20 |
$104.19 |
$222.56 |
|
|
Unlisted gi px dx nuc med
|
$475.51 |
$475.51 |
$475.51 |
|
|
Unlisted gu px dx nuc med
|
$475.51 |
$475.51 |
$475.51 |
|
|
Unlisted hematology&coagj px
|
$43.80 |
$43.80 |
$76.44 |
|
|
Unlisted hystsc px uterus
|
$238.06 |
$238.06 |
$238.06 |
|
|
Unlisted laparoscopic liver biopy 47379
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
|
|
Unlisted laparoscopic procedure 49659
|
$262.68 |
$6,904.15 |
$6,904.15 |
|
|
Unlisted laparoscopic reduction intestine 44238
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
|
|
Unlisted laps px appendix
|
$6,904.15 |
$6,904.15 |
$14,223.16 |
|
|
Unlisted laps px bladder
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
|
|
Unlisted laps px endoc sys
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
|
|
Unlisted laps px esoph
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
|
|
Unlisted laps px lymphtc sys
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
|
|
Unlisted laps px ovidct ovry
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
|
|
Unlisted laps px renal
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
|
|
Unlisted laps px spleen
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
|
|
Unlisted laps px testis
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
|
|
Unlisted laps px ureter
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
|
|
Unlisted laps px uterus
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
|
|
Unlisted maxlfcl prosth px
|
$274.80 |
$274.80 |
$274.80 |
|
|
Unlisted misc path test
|
$63.23 |
$63.23 |
$160.18 |
|
|
Unlisted mr procedure
|
$34.54 |
$104.19 |
$8,101.00 |
|
|
Unlisted muscskel px dx nuc
|
$475.51 |
$475.51 |
$475.51 |
|
|
Unlisted muscskel px head
|
$274.80 |
$274.80 |
$274.80 |
|
|
Unlisted neurological dx px
|
$185.15 |
$185.15 |
$848.11 |
|
|
Unlisted nrvs sys px dx nuc
|
$475.51 |
$475.51 |
$475.51 |
|
|
Unlisted oph svc/procedure
|
$28.98 |
$28.98 |
$28.98 |
|
|
Unlisted orl service/px
|
$28.98 |
$28.98 |
$28.98 |
|
|
Unlisted procedure colon
|
$1,078.88 |
$1,078.88 |
$1,078.88 |
|
|
Unlisted procedure esophagus
|
$1,109.47 |
$1,109.47 |
$1,109.47 |
|
|
Unlisted procedure eyelids
|
$353.74 |
$353.74 |
$389.40 |
|
|
Unlisted procedure larynx
|
$274.80 |
$274.80 |
$274.80 |
|
|
Unlisted procedure liver
|
$832.60 |
$832.60 |
$1,705.31 |
|
|
Unlisted procedure microbiology
|
$128.40 |
$1,043.48 |
$1,284.28 |
|
|
Unlisted procedure orbit
|
$353.74 |
$353.74 |
$353.74 |
|
|
Unlisted procedure pancreas
|
$832.60 |
$832.60 |
$832.60 |
|
|
Unlisted procedure rectum
|
$383.40 |
$1,078.88 |
$2,393.41 |
|
|
Unlisted procedure spine
|
$283.86 |
$283.86 |
$939.60 |
|
|
Unlisted procedure urinary 58750
|
$561.88 |
$561.88 |
$561.88 |
|
|
Unlisted psychiatric service/proc 90899
|
$35.25 |
$35.25 |
$35.25 |
|
|
Unlisted px abdomen muscskel
|
$283.86 |
$283.86 |
$22,981.94 |
|
|
Unlisted px accessory sinus
|
$274.80 |
$274.80 |
$274.80 |
|
|
Unlisted px ant segment eye
|
$103.80 |
$2,698.92 |
$2,698.92 |
|
|
Unlisted px arthroscopy
|
$283.86 |
$283.86 |
$283.86 |
|
|
Unlisted px biliary tract
|
$1,109.47 |
$1,109.47 |
$2,195.76 |
|
|
Unlisted px casting/strpg
|
$103.20 |
$186.72 |
$453.32 |
|
|
Unlisted px conjunctiva
|
$353.74 |
$353.74 |
$353.74 |
|
|
Unlisted px diaphragm
|
$18,105.47 |
$18,105.47 |
$22,283.66 |
|
|
Unlisted px exc pressure ulc
|
$832.60 |
$832.60 |
$832.60 |
|
|
Unlisted px external ear
|
$274.80 |
$274.80 |
$274.80 |
|
|
Unlisted px extraocular musc
|
$353.74 |
$353.74 |
$353.74 |
|
|
Unlisted px foot/toes
|
$283.86 |
$283.86 |
$805.25 |
|
|
Unlisted px forearm/wrist
|
$283.86 |
$283.86 |
$283.86 |
|
|
Unlisted px hands/fingers
|
$283.86 |
$283.86 |
$4,707.60 |
|
|
Unlisted px inner ear
|
$274.80 |
$274.80 |
$274.80 |
|
|
Unlisted px lacrimal system
|
$353.74 |
$353.74 |
$918.99 |
|
|
Unlisted px leg/ankle
|
$283.86 |
$283.86 |
$283.86 |
|
|
Unlisted px male genital sys
|
$287.81 |
$287.81 |
$287.81 |
|
|
Unlisted px med radj physics
|
$157.11 |
$157.11 |
$157.11 |
|
|
Unlisted px middle ear
|
$274.80 |
$274.80 |
$274.80 |
|
|
Unlisted px neck/thorax
|
$274.80 |
$274.80 |
$274.80 |
|
|
Unlisted px palate uvula
|
$274.80 |
$274.80 |
$274.80 |
|
|
Unlisted px pelvis/hip joint
|
$283.86 |
$283.86 |
$4,002.34 |
|
|
Unlisted px posterior segmnt
|
$2,698.92 |
$2,698.92 |
$3,949.20 |
|
|
Unlisted px salivry glnd/dux
|
$274.80 |
$274.80 |
$274.80 |
|
|
Unlisted px small intestine
|
$1,109.47 |
$1,109.47 |
$2,664.20 |
|
|
Unlisted px temporal bone
|
$274.80 |
$274.80 |
$274.80 |
|
|
Unlisted px ther rad tx plng
|
$157.11 |
$157.11 |
$157.11 |
|
|
Unlisted px tongue flr mouth
|
$97.20 |
$274.80 |
$618.08 |
|
|
Unlisted px vestibule mouth
|
$274.80 |
$274.80 |
$274.80 |
|
|
Unlisted reprod med lab proc
|
$63.23 |
$63.23 |
$63.23 |
|
|
Unlisted resp px dx nuc med
|
$475.51 |
$475.51 |
$1,146.14 |
|
|
Unlisted spec derm svc/px
|
$235.13 |
$235.13 |
$627.20 |
|