|
Unlisted cv px dx nuc med
|
$1,864.20 |
$1,864.20 |
$2,254.40 |
|
|
Unlisted cytogenetic study
|
$27.60 |
$27.60 |
$27.60 |
|
|
Unlisted dialysis procedure
|
$711.50 |
$711.50 |
$711.50 |
|
|
Unlisted dx gi procedure
|
$158.40 |
$613.20 |
$613.20 |
|
|
Unlisted endocrine px dx nuc
|
$1,028.72 |
$1,028.72 |
$1,028.72 |
|
|
Unlisted fetal invas px w/us
|
$348.60 |
$348.60 |
$357.60 |
|
|
Unlisted fluoroscopic px
|
$25.30 |
$226.20 |
$400.00 |
|
|
Unlisted gi px dx nuc med
|
$550.80 |
$736.80 |
$944.00 |
|
|
Unlisted gu px dx nuc med
|
$694.80 |
$694.80 |
$694.80 |
|
|
Unlisted hematology&coagj px
|
$14.40 |
$56.40 |
$2,942.40 |
|
|
Unlisted laparoscopic liver biopy 47379
|
$3,289.80 |
$3,289.80 |
$4,549.67 |
|
|
Unlisted laparoscopic procedure 49659
|
$274.62 |
$274.62 |
$310.44 |
|
|
Unlisted laparoscopic reduction intestine 44238
|
$3,467.40 |
$3,467.40 |
$3,467.40 |
|
|
Unlisted maaa
|
$587.00 |
$587.00 |
$587.00 |
|
|
Unlisted misc path test
|
$93.00 |
$213.60 |
$351.89 |
|
|
Unlisted mr procedure
|
$36.11 |
$568.20 |
$6,868.80 |
|
|
Unlisted muscskel px dx nuc
|
$545.40 |
$660.00 |
$779.40 |
|
|
Unlisted neurological dx px
|
$96.00 |
$96.00 |
$192.00 |
|
|
Unlisted nrvs sys px dx nuc
|
$1,006.20 |
$1,006.20 |
$1,006.20 |
|
|
Unlisted orl service/px
|
$42.60 |
$111.60 |
$357.60 |
|
|
Unlisted procedure colon
|
$1,235.00 |
$2,449.20 |
$3,264.60 |
|
|
Unlisted procedure esophagus
|
$152.40 |
$152.40 |
$152.40 |
|
|
Unlisted procedure eyelids
|
$407.10 |
$407.10 |
$460.20 |
|
|
Unlisted procedure larynx
|
$104.40 |
$134.40 |
$272.00 |
|
|
Unlisted procedure liver
|
$1,978.02 |
$2,287.20 |
$3,186.00 |
|
|
Unlisted procedure microbiology
|
$6.50 |
$151.20 |
$3,250.82 |
|
|
Unlisted procedure orbit
|
$911.40 |
$911.40 |
$911.40 |
|
|
Unlisted procedure pancreas
|
$152.40 |
$152.40 |
$152.40 |
|
|
Unlisted procedure rectum
|
$121.80 |
$554.40 |
$3,816.80 |
|
|
Unlisted procedure spine
|
$283.50 |
$283.50 |
$283.50 |
|
|
Unlisted procedure urinary 58750
|
$587.42 |
$587.42 |
$664.04 |
|
|
Unlisted px abdomen muscskel
|
$2,053.50 |
$2,053.50 |
$2,053.50 |
|
|
Unlisted px ant segment eye
|
$89.40 |
$717.60 |
$3,823.80 |
|
|
Unlisted px arthroscopy
|
$1,354.00 |
$1,354.00 |
$1,354.00 |
|
|
Unlisted px biliary tract
|
$1,788.00 |
$1,788.00 |
$2,636.40 |
|
|
Unlisted px casting/strpg
|
$72.60 |
$126.00 |
$292.80 |
|
|
Unlisted px conjunctiva
|
$888.60 |
$888.60 |
$888.60 |
|
|
Unlisted px external ear
|
$75.60 |
$103.20 |
$949.20 |
|
|
Unlisted px foot/toes
|
$1,199.88 |
$1,199.88 |
$1,199.88 |
|
|
Unlisted px forearm/wrist
|
$102.60 |
$109.20 |
$382.20 |
|
|
Unlisted px hands/fingers
|
$295.00 |
$4,387.20 |
$6,231.60 |
|
|
Unlisted px lacrimal system
|
$365.00 |
$365.00 |
$365.00 |
|
|
Unlisted px leg/ankle
|
$97.20 |
$118.20 |
$393.00 |
|
|
Unlisted px male genital sys
|
$75.60 |
$104.40 |
$165.00 |
|
|
Unlisted px mediastinum
|
$76.80 |
$76.80 |
$114.40 |
|
|
Unlisted px med radj physics
|
$404.40 |
$404.40 |
$404.40 |
|
|
Unlisted px middle ear
|
$272.00 |
$272.00 |
$272.00 |
|
|
Unlisted px posterior segmnt
|
$2,652.50 |
$4,036.20 |
$5,381.40 |
|
|
Unlisted px salivry glnd/dux
|
$93.60 |
$104.40 |
$464.40 |
|
|
Unlisted px small intestine
|
$130.80 |
$2,511.60 |
$4,264.00 |
|
|
Unlisted px tongue flr mouth
|
$86.40 |
$117.00 |
$653.42 |
|
|
Unlisted resp px dx nuc med
|
$988.64 |
$1,028.72 |
$1,750.80 |
|
|
Unlisted spec derm svc/px
|
$230.50 |
$230.50 |
$230.50 |
|
|
Unlisted surgical path px
|
$68.40 |
$150.22 |
$13,368.60 |
|
|
Unlisted transfusion med px
|
$32.40 |
$160.93 |
$2,944.20 |
|
|
Unlisted ultrasound procedure
|
$78.60 |
$280.20 |
$482.79 |
|
|
Unlisted urinalysis px
|
$21.00 |
$21.00 |
$72.00 |
|
|
Unlstd hematop ret/endo lymp
|
$607.20 |
$734.40 |
$814.80 |
|
|
Unlstd laps px sprmatic cord
|
$4,524.83 |
$4,524.83 |
$4,524.83 |
|
|
Unsched dialysis esrd pt hos
|
$415.80 |
$1,560.60 |
$6,177.60 |
|
|
Upgrade pm system
|
$303.83 |
$15,540.60 |
$54,780.00 |
|
|
Upper Arm (Humerus) X-ray (left side)
|
$108.00 |
$266.40 |
$686.40 |
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$472.00 |
$1,636.80 |
$4,599.60 |
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$286.50 |
$1,084.10 |
$2,937.00 |
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$700.50 |
$2,916.00 |
$9,808.20 |
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$633.50 |
$2,713.80 |
$8,004.00 |
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$454.00 |
$1,699.20 |
$6,214.20 |
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$130.20 |
$419.40 |
$776.00 |
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$125.40 |
$419.40 |
$686.40 |
|
|
Upper Endoscopy (EGD, diagnostic)
|
$78.43 |
$1,872.60 |
$4,264.00 |
|
|
Upper Endoscopy (EGD, with biopsy)
|
$88.09 |
$2,083.20 |
$4,330.80 |
|
|
Upper ext harvest for cabg1 seg 35600
|
$117.53 |
$117.53 |
$132.86 |
|
|
Upper GI Barium X-ray (barium and gas)
|
$349.20 |
$674.40 |
$1,312.80 |
|
|
Upper GI Barium X-ray (barium only)
|
$321.00 |
$674.40 |
$1,312.80 |
|
|
Uppr gi scope w/submuc inj
|
$88.09 |
$2,978.40 |
$4,856.40 |
|
|
Urachal cyst/sinus excision 51500
|
$413.08 |
$413.08 |
$466.96 |
|
|
Urea nitrogen
|
$11.50 |
$27.00 |
$173.40 |
|
|
Urea nitrogen 24 hour urine
|
$20.00 |
$36.96 |
$322.80 |
|
|
Urea nitrogen clearance
|
$5.06 |
$87.00 |
$214.80 |
|
|
Urea nitrogen semi-quant
|
$3.68 |
$3.68 |
$4.16 |
|
|
Ureteral embolization/occl
|
$114.08 |
$6,966.60 |
$10,911.00 |
|
|
Ureteral reflux study
|
$397.20 |
$1,228.80 |
$2,370.00 |
|
|
Ureter endoscopy
|
$236.90 |
$236.90 |
$267.80 |
|
|
Ureter endoscopy & biopsy
|
$225.40 |
$225.40 |
$254.80 |
|
|
Ureter endoscopy & biopsy
|
$301.99 |
$301.99 |
$341.38 |
|
|
Ureter endoscopy & catheter
|
$228.85 |
$228.85 |
$258.70 |
|
|
Ureter endoscopy & treatment
|
$226.55 |
$226.55 |
$256.10 |
|
|
Ureter endoscopy & treatment
|
$201.71 |
$201.71 |
$228.02 |
|
|
Ureter endoscopy & treatment
|
$298.08 |
$298.08 |
$336.96 |
|
|
Ureter endoscopy & treatment
|
$227.24 |
$227.24 |
$256.88 |
|
|
Ureteroneocystostomy 50780
|
$717.83 |
$717.83 |
$811.46 |
|
|
Ureteroureterostomy 50760
|
$727.26 |
$727.26 |
$822.12 |
|
|
Urethrcystgrphy rtrgrde s&i
|
$244.00 |
$624.00 |
$2,813.40 |
|
|
Urethrlys transvag with scope
|
$483.23 |
$483.23 |
$546.26 |
|
|
Urethrocystography void s&i
|
$244.00 |
$547.80 |
$2,813.40 |
|
|
Uric acid blood
|
$12.00 |
$30.03 |
$155.40 |
|
|
Uric acid urine
|
$17.00 |
$28.20 |
$375.00 |
|
|
Urinalysis glass test
|
$3.22 |
$3.22 |
$3.64 |
|
|
Urinalysis microscopic only
|
$9.60 |
$19.24 |
$666.00 |
|
|
Urinalysis qual/semiquant excpt ia
|
$1.38 |
$8.40 |
$378.00 |
|
