|
Ultrasound breast unilateral limited (both sides)
|
$221.20 |
$221.20 |
$346.09 |
$452.00
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$322.20 |
$322.20 |
$322.20 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$393.89 |
$393.89 |
$393.89 |
$296.80
|
|
Ultrasound elastography parenchyma
|
$399.40 |
$399.40 |
$399.40 |
$307.00
|
|
Ultrasound encephalogram
|
$177.28 |
$177.28 |
$456.60 |
$485.48
|
|
Ultrasound exam follow-up
|
$274.87 |
$274.87 |
$274.87 |
$226.38
|
|
Ultrasound exam k transpl w/doppler
|
$618.88 |
$618.88 |
$618.88 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$301.53 |
$301.53 |
$428.68 |
$477.10
|
|
Ultrasound Guidance for a Needle Procedure
|
$763.88 |
$763.88 |
$799.40 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$192.85 |
$192.85 |
$621.95 |
$388.08
|
|
Ultrasound guide intraoperative
|
$163.28 |
$163.28 |
$656.12 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$474.95 |
$474.95 |
$474.95 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$183.93 |
$183.93 |
$474.87 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$412.92 |
$412.92 |
$412.92 |
$304.00
|
|
Ultrasound joint complete left
|
$203.53 |
$203.53 |
$544.62 |
$560.92
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$376.57 |
$376.57 |
$376.57 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$210.70 |
$210.70 |
$567.63 |
$406.44
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$144.90 |
$144.90 |
$352.15 |
$333.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$680.71 |
$680.71 |
$680.71 |
$698.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$339.68 |
$339.68 |
$355.63 |
$428.25
|
|
Ultrasound prostate/transrectal
|
$441.88 |
$441.88 |
$441.88 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$103.25 |
$103.25 |
$529.99 |
$459.00
|
|
Ultrasound transabd ea addl gest
|
$437.17 |
$437.17 |
$437.17 |
$417.15
|
|
Ultrasound trgt dyn mbubb 1st les
|
$237.74 |
$237.74 |
$237.74 |
$568.32
|
|
Ultraviolet therapy
|
$52.03 |
$52.03 |
$52.03 |
$39.76
|
|
Umbilical artery cath newborn 36660
|
$807.86 |
$807.86 |
$807.86 |
$223.80
|
|
Umbilical cord occlud w/us
|
$374.48 |
$374.48 |
$374.48 |
$754.00
|
|
Umbilicoplasty 15847
|
$4,172.97 |
$4,172.97 |
$4,172.97 |
$4,172.97
|
|
Unit mobile power mpu
|
$18,528.00 |
$18,528.00 |
$18,528.00 |
$14,359.52
|
|
Unlistd noninvas vasc dx std
|
$1,133.57 |
$1,133.57 |
$1,133.57 |
$564.60
|
|
Unlisted all/immlg svc/px
|
$9.45 |
$9.45 |
$9.45 |
$28.98
|
|
Unlisted chemotherapy px
|
$84.18 |
$84.18 |
$475.70 |
$149.15
|
|
Unlisted cranfcl&maxlfcl px
|
$5,876.98 |
$5,876.98 |
$5,876.98 |
$571.20
|
|
Unlisted CT procedure
|
$39.03 |
$39.03 |
$3,679.86 |
$740.43
|
|
Unlisted dialysis procedure
|
$3,975.37 |
$3,975.37 |
$3,975.37 |
$1,144.00
|
|
Unlisted dx gi procedure
|
$1,256.74 |
$1,256.74 |
$1,256.74 |
$649.22
|
|
Unlisted fetal invas px w/us
|
$575.54 |
$575.54 |
$575.54 |
$498.40
|
|
Unlisted fluoroscopic px
|
$3,501.00 |
$3,501.00 |
$3,501.00 |
$305.76
|
|
Unlisted hystsc px uterus
|
$3,027.89 |
$3,027.89 |
$3,027.89 |
$3,027.89
|
|
Unlisted laparoscopic liver biopy 47379
|
$6,307.38 |
$6,307.38 |
$6,307.38 |
$6,307.38
|
|
Unlisted laparoscopic procedure 49659
|
$6,838.32 |
$6,838.32 |
$6,838.32 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$3,795.52 |
$3,795.52 |
$3,795.52 |
$5,419.00
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$7,299.35 |
$7,299.35 |
$7,299.35 |
$6,463.42
|
|
Unlisted laps px appendix
|
$3,617.40 |
$3,617.40 |
$3,617.40 |
$3,617.40
|
|
Unlisted laps px bladder
|
$5,082.74 |
$5,082.74 |
$5,082.74 |
$5,082.74
|
|
Unlisted laps px endoc sys
|
$5,783.48 |
$5,783.48 |
$5,783.48 |
$5,855.00
|
|
Unlisted laps px esoph
|
$5,042.16 |
$5,042.16 |
$5,042.16 |
$5,741.00
|
|
Unlisted laps px lymphtc sys
|
$10,488.59 |
$10,488.59 |
$10,488.59 |
$6,870.89
|
|
Unlisted laps px ovidct ovry
|
$4,713.11 |
$4,713.11 |
$4,713.11 |
$6,904.15
|
|
Unlisted laps px renal
|
$8,914.07 |
$8,914.07 |
$8,914.07 |
$5,110.00
|
|
Unlisted laps px testis
|
$5,628.67 |
$5,628.67 |
$5,628.67 |
$5,628.67
|
|
Unlisted laps px ureter
|
$4,904.96 |
$4,904.96 |
$4,904.96 |
$6,376.26
|
|
Unlisted laps px uterus
|
$8,803.87 |
$8,803.87 |
$8,803.87 |
$4,627.00
|
|
Unlisted maxlfcl prosth px
|
$1,607.44 |
$1,607.44 |
$1,607.44 |
$571.20
|
|
Unlisted misc path test
|
$89.40 |
$89.40 |
$89.40 |
$89.40
|
|
Unlisted mr procedure
|
$35.18 |
$35.18 |
$2,052.00 |
$1,165.00
|
|
Unlisted muscskel px head
|
$155.13 |
$155.13 |
$155.13 |
$1,224.08
|
|
Unlisted oph svc/procedure
|
$213.51 |
$213.51 |
$213.51 |
$40.26
|
|
Unlisted orl service/px
|
$343.84 |
$343.84 |
$343.84 |
$132.60
|
|
Unlisted procedure colon
|
$1,983.83 |
$1,983.83 |
$1,983.83 |
$1,839.55
|
|
Unlisted procedure esophagus
|
$7,348.20 |
$7,348.20 |
$7,348.20 |
$1,998.88
|
|
Unlisted procedure eyelids
|
$479.62 |
$479.62 |
$479.62 |
$2,174.90
|
|
Unlisted procedure larynx
|
$5,023.51 |
$5,023.51 |
$5,023.51 |
$924.00
|
|
Unlisted procedure liver
|
$3,071.62 |
$3,071.62 |
$3,071.62 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$2,118.52 |
$2,118.52 |
$2,118.52 |
$530.00
|
|
Unlisted procedure orbit
|
$479.62 |
$479.62 |
$479.62 |
$437.00
|
|
Unlisted procedure pancreas
|
$6,597.79 |
$6,597.79 |
$6,597.79 |
$4,810.00
|
|
Unlisted procedure rectum
|
$875.12 |
$875.12 |
$875.12 |
$1,278.72
|
|
Unlisted procedure spine
|
$9,924.31 |
$9,924.31 |
$9,924.31 |
$4,706.35
|
|
Unlisted px abdomen muscskel
|
$290.15 |
$290.15 |
$7,349.98 |
$2,053.50
|
|
Unlisted px accessory sinus
|
$167.79 |
$167.79 |
$167.79 |
$3,335.28
|
|
Unlisted px ant segment eye
|
$3,110.31 |
$3,110.31 |
$3,110.31 |
$2,698.92
|
|
Unlisted px arthroscopy
|
$11,433.76 |
$11,433.76 |
$11,433.76 |
$2,765.60
|
|
Unlisted px biliary tract
|
$15,476.87 |
$15,476.87 |
$15,476.87 |
$3,055.00
|
|
Unlisted px casting/strpg
|
$42.00 |
$42.00 |
$224.93 |
$222.00
|
|
Unlisted px conjunctiva
|
$479.62 |
$479.62 |
$479.62 |
$479.62
|
|
Unlisted px diaphragm
|
$4,846.78 |
$4,846.78 |
$4,846.78 |
$6,325.20
|
|
Unlisted px exc pressure ulc
|
$626.83 |
$626.83 |
$626.83 |
$973.71
|
|
Unlisted px external ear
|
$7,359.08 |
$7,359.08 |
$7,359.08 |
$325.68
|
|
Unlisted px extraocular musc
|
$3,718.79 |
$3,718.79 |
$3,718.79 |
$739.20
|
|
Unlisted px foot/toes
|
$6,994.18 |
$6,994.18 |
$6,994.18 |
$1,225.50
|
|
Unlisted px forearm/wrist
|
$4,964.24 |
$4,964.24 |
$4,964.24 |
$859.50
|
|
Unlisted px hands/fingers
|
$6,841.45 |
$6,841.45 |
$6,841.45 |
$349.70
|
|
Unlisted px inner ear
|
$10,216.64 |
$10,216.64 |
$10,216.64 |
$571.20
|
|
Unlisted px lacrimal system
|
$479.62 |
$479.62 |
$479.62 |
$416.50
|
|
Unlisted px leg/ankle
|
$6,818.24 |
$6,818.24 |
$6,818.24 |
$813.24
|
|
Unlisted px male genital sys
|
$4,942.08 |
$4,942.08 |
$4,942.08 |
$362.00
|
|
Unlisted px med radj physics
|
$376.03 |
$376.03 |
$376.03 |
$462.35
|
|
Unlisted px middle ear
|
$2,162.16 |
$2,162.16 |
$2,162.16 |
$343.50
|
|
Unlisted px neck/thorax
|
$2,680.22 |
$2,680.22 |
$2,680.22 |
$571.20
|
|
Unlisted px palate uvula
|
$167.79 |
$167.79 |
$167.79 |
$274.80
|
|
Unlisted px pelvis/hip joint
|
$9,872.02 |
$9,872.02 |
$9,872.02 |
$3,251.90
|
|
Unlisted px salivry glnd/dux
|
$4,032.00 |
$4,032.00 |
$4,032.00 |
$1,173.42
|
|
Unlisted px small intestine
|
$3,029.95 |
$3,029.95 |
$3,029.95 |
$2,118.35
|
|
Unlisted px ther rad tx plng
|
$398.11 |
$398.11 |
$398.11 |
$182.00
|
|
Unlisted px tongue flr mouth
|
$203.98 |
$203.98 |
$203.98 |
$282.50
|
|
Unlisted px vestibule mouth
|
$167.79 |
$167.79 |
$167.79 |
$456.96
|
|
Unlisted resp px dx nuc med
|
$389.03 |
$389.03 |
$389.03 |
$670.60
|
|
Unlisted spec derm svc/px
|
$139.21 |
$139.21 |
$139.21 |
$223.08
|
|
Unlisted special svc px/rprt
|
$210.00 |
$210.00 |
$210.00 |
$90.00
|