|
Tr retinal les preterm inf
|
$1,736.63 |
$1,736.63 |
$1,736.63 |
$1,794.00
|
|
Tte w or without contr, cont ecg
|
$2,198.34 |
$2,198.34 |
$17,544.74 |
$2,075.90
|
|
Tte w or without fol w/cont, com
|
$15,598.72 |
$15,598.72 |
$15,598.72 |
$1,254.50
|
|
Tte w or without fol w/cont, f/u
|
$3,949.58 |
$3,949.58 |
$3,949.58 |
$1,178.00
|
|
Tube trach disp innr can 5 xlt
|
$667.76 |
$667.76 |
$667.76 |
$445.99
|
|
Tx atrial fib pulm vein isol
|
$36,478.99 |
$36,478.99 |
$106,165.53 |
$29,030.54
|
|
Tx closed distal humerus fx
|
$4,298.11 |
$4,298.11 |
$4,298.11 |
$594.88
|
|
Tx closed hip disl traumatic without anes
|
$649.67 |
$649.67 |
$649.67 |
$586.80
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$3,406.82 |
$3,406.82 |
$3,406.82 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$757.39 |
$757.39 |
$757.39 |
$535.60
|
|
Tx l/r atrial fib addl
|
$12,204.38 |
$12,204.38 |
$19,547.03 |
$6,986.85
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$5,003.40 |
$5,003.40 |
$5,003.40 |
$4,499.12
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$5,737.64 |
$5,737.64 |
$5,737.64 |
$4,499.12
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$3,476.21 |
$3,476.21 |
$3,476.21 |
$4,499.12
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$5,175.49 |
$5,175.49 |
$5,175.49 |
$4,529.60
|
|
Ua w/micro/comp poc
|
$39.33 |
$39.33 |
$766.23 |
$23.00
|
|
Ugt1a1 gene analy common variants
|
$1,476.60 |
$1,476.60 |
$1,476.60 |
$438.75
|
|
Ultrasound breast complete
|
$442.26 |
$442.26 |
$442.26 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$346.19 |
$346.19 |
$346.19 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$340.14 |
$340.14 |
$340.14 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$366.50 |
$366.50 |
$366.50 |
$296.80
|
|
Ultrasound elastography parenchyma
|
$232.30 |
$232.30 |
$232.30 |
$313.95
|
|
Ultrasound encephalogram
|
$496.36 |
$496.36 |
$496.36 |
$494.92
|
|
Ultrasound exam follow-up
|
$189.00 |
$189.00 |
$189.00 |
$226.38
|
|
Ultrasound exam k transpl w/doppler
|
$684.31 |
$684.31 |
$684.31 |
$575.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$404.98 |
$404.98 |
$2,524.97 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$909.17 |
$909.17 |
$909.17 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$631.95 |
$631.95 |
$631.95 |
$388.08
|
|
Ultrasound guide intraoperative
|
$632.90 |
$632.90 |
$2,937.23 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$422.75 |
$422.75 |
$422.75 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$403.88 |
$403.88 |
$403.88 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$220.50 |
$220.50 |
$2,155.18 |
$311.25
|
|
Ultrasound joint complete left
|
$623.67 |
$623.67 |
$623.67 |
$557.99
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$265.61 |
$265.61 |
$265.61 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$470.69 |
$470.69 |
$470.69 |
$409.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$362.59 |
$362.59 |
$362.59 |
$335.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$690.48 |
$690.48 |
$690.48 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$393.32 |
$393.32 |
$1,852.05 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$545.16 |
$545.16 |
$545.16 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$450.60 |
$450.60 |
$450.60 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$397.03 |
$397.03 |
$397.03 |
$421.00
|
|
Ultrasound trgt dyn mbubb 1st les
|
$622.88 |
$622.88 |
$622.88 |
$568.32
|
|
Ultrasound trgt dyn mbubb ea addl
|
$294.97 |
$294.97 |
$294.97 |
$348.00
|
|
Umbilical artery cath newborn 36660
|
$973.63 |
$973.63 |
$973.63 |
$223.80
|
|
Unit mobile power mpu
|
$16,315.20 |
$16,315.20 |
$16,315.20 |
$14,359.52
|
|
Unlistd noninvas vasc dx std
|
$1,012.44 |
$1,012.44 |
$1,012.44 |
$564.60
|
|
Unlisted chemotherapy px
|
$507.17 |
$507.17 |
$507.17 |
$143.75
|
|
Unlisted cranfcl&maxlfcl px
|
$6,289.53 |
$6,289.53 |
$6,289.53 |
$571.20
|
|
Unlisted CT procedure
|
$3,852.68 |
$3,852.68 |
$3,852.68 |
$732.70
|
|
Unlisted cytogenetic study
|
$310.46 |
$310.46 |
$310.46 |
$160.00
|
|
Unlisted dialysis procedure
|
$3,148.74 |
$3,148.74 |
$3,148.74 |
$1,144.00
|
|
Unlisted fetal invas px w/us
|
$492.81 |
$492.81 |
$492.81 |
$498.40
|
|
Unlisted fluoroscopic px
|
$3,433.99 |
$3,433.99 |
$3,433.99 |
$305.76
|
|
Unlisted laparoscopic liver biopy 47379
|
$3,495.74 |
$3,495.74 |
$3,495.74 |
$6,307.38
|
|
Unlisted laparoscopic procedure 49659
|
$6,838.32 |
$6,838.32 |
$6,838.32 |
$6,838.32
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$9,492.80 |
$9,492.80 |
$9,492.80 |
$6,463.42
|
|
Unlisted laps px appendix
|
$2,890.09 |
$2,890.09 |
$2,890.09 |
$3,617.40
|
|
Unlisted laps px endoc sys
|
$6,548.98 |
$6,548.98 |
$6,548.98 |
$5,855.00
|
|
Unlisted laps px lymphtc sys
|
$10,488.59 |
$10,488.59 |
$10,488.59 |
$6,870.89
|
|
Unlisted laps px renal
|
$3,891.34 |
$3,891.34 |
$3,891.34 |
$5,110.00
|
|
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
|
$1,728.00 |
$1,728.00 |
$1,728.00 |
$1,163.00
|
|
Unlisted orl service/px
|
$343.84 |
$343.84 |
$343.84 |
$132.60
|
|
Unlisted procedure colon
|
$1,569.10 |
$1,569.10 |
$1,569.10 |
$1,839.55
|
|
Unlisted procedure esophagus
|
$442.53 |
$442.53 |
$442.53 |
$1,998.88
|
|
Unlisted procedure larynx
|
$5,107.38 |
$5,107.38 |
$5,107.38 |
$924.00
|
|
Unlisted procedure liver
|
$3,003.11 |
$3,003.11 |
$3,003.11 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$1,069.61 |
$1,069.61 |
$1,069.61 |
$530.00
|
|
Unlisted procedure orbit
|
$334.84 |
$334.84 |
$334.84 |
$437.00
|
|
Unlisted procedure pancreas
|
$6,597.79 |
$6,597.79 |
$6,597.79 |
$4,810.00
|
|
Unlisted procedure rectum
|
$1,603.06 |
$1,603.06 |
$1,603.06 |
$1,223.20
|
|
Unlisted procedure spine
|
$8,245.45 |
$8,245.45 |
$8,245.45 |
$4,659.85
|
|
Unlisted px abdomen muscskel
|
$11,582.59 |
$11,582.59 |
$11,582.59 |
$1,956.50
|
|
Unlisted px ant segment eye
|
$2,264.15 |
$2,264.15 |
$2,264.15 |
$2,698.92
|
|
Unlisted px arthroscopy
|
$13,708.47 |
$13,708.47 |
$13,708.47 |
$2,765.60
|
|
Unlisted px biliary tract
|
$15,692.77 |
$15,692.77 |
$15,692.77 |
$3,055.00
|
|
Unlisted px casting/strpg
|
$442.48 |
$442.48 |
$442.48 |
$222.00
|
|
Unlisted px diaphragm
|
$6,547.57 |
$6,547.57 |
$6,547.57 |
$6,325.20
|
|
Unlisted px external ear
|
$433.65 |
$433.65 |
$433.65 |
$325.68
|
|
Unlisted px foot/toes
|
$7,763.00 |
$7,763.00 |
$7,763.00 |
$1,239.20
|
|
Unlisted px forearm/wrist
|
$6,515.57 |
$6,515.57 |
$6,515.57 |
$859.50
|
|
Unlisted px hands/fingers
|
$7,183.52 |
$7,183.52 |
$7,183.52 |
$354.20
|
|
Unlisted px inner ear
|
$17,114.99 |
$17,114.99 |
$17,114.99 |
$571.20
|
|
Unlisted px leg/ankle
|
$6,818.24 |
$6,818.24 |
$6,818.24 |
$882.30
|
|
Unlisted px male genital sys
|
$6,664.68 |
$6,664.68 |
$6,664.68 |
$387.84
|
|
Unlisted px med radj physics
|
$376.03 |
$376.03 |
$376.03 |
$462.35
|
|
Unlisted px neck/thorax
|
$3,385.58 |
$3,385.58 |
$3,385.58 |
$571.20
|
|
Unlisted px palate uvula
|
$243.44 |
$243.44 |
$243.44 |
$274.80
|
|
Unlisted px pelvis/hip joint
|
$10,031.98 |
$10,031.98 |
$10,031.98 |
$3,251.90
|
|
Unlisted px salivry glnd/dux
|
$2,838.66 |
$2,838.66 |
$2,838.66 |
$1,265.16
|
|
Unlisted px small intestine
|
$3,029.95 |
$3,029.95 |
$3,029.95 |
$2,118.35
|
|
Unlisted px tongue flr mouth
|
$243.44 |
$243.44 |
$243.44 |
$282.50
|
|
Unlisted special svc px/rprt
|
$210.00 |
$210.00 |
$210.00 |
$90.00
|
|
Unlisted ultrasound procedure
|
$2,231.09 |
$2,231.09 |
$2,247.61 |
$335.00
|
|
Unlstd laps px sprmatic cord
|
$3,961.44 |
$3,961.44 |
$3,961.44 |
$4,713.11
|
|
Unsched dialysis esrd pt hos
|
$1,951.63 |
$1,951.63 |
$3,884.50 |
$1,296.00
|
|
Upgrade pm system
|
$8,856.75 |
$8,856.75 |
$13,940.67 |
$12,077.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$309.31 |
$309.31 |
$309.31 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$2,274.17 |
$2,274.17 |
$2,274.17 |
$1,669.00
|
