|
Tympanostomy/ven tube/loc/top anes 69433
|
$1,606.00 |
$1,606.00 |
$1,606.00 |
$911.43
|
|
Ua w/micro/comp poc
|
$17.50 |
$17.50 |
$17.50 |
$23.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$54,980.64 |
$54,980.64 |
$54,980.64 |
$20,945.01
|
|
Ugt1a1 gene analy common variants
|
$1,034.50 |
$1,034.50 |
$1,034.50 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$443.50 |
$443.50 |
$443.50 |
$394.20
|
|
Ultrasound breast complete
|
$488.00 |
$488.00 |
$488.00 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$565.00 |
$565.00 |
$565.00 |
$449.35
|
|
Ultrasound chest
|
$304.00 |
$304.00 |
$304.00 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$341.00 |
$341.00 |
$341.00 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$585.00 |
$585.00 |
$585.00 |
$296.80
|
|
Ultrasound elastography parenchyma
|
$233.50 |
$233.50 |
$233.50 |
$307.00
|
|
Ultrasound encephalogram
|
$483.00 |
$483.00 |
$483.00 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$470.50 |
$470.50 |
$470.50 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$304.50 |
$304.50 |
$304.50 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$780.00 |
$780.00 |
$780.00 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$5,482.33 |
$5,482.33 |
$5,482.33 |
$720.15
|
|
Ultrasound guide intraoperative
|
$9,219.63 |
$9,219.63 |
$9,219.63 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$1,073.00 |
$1,073.00 |
$1,073.00 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$319.50 |
$319.50 |
$319.50 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$304.00 |
$304.00 |
$304.00 |
$311.25
|
|
Ultrasound joint complete left
|
$533.00 |
$533.00 |
$533.00 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$900.00 |
$900.00 |
$900.00 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$1,044.50 |
$1,044.50 |
$1,044.50 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$422.00 |
$422.00 |
$422.00 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$749.00 |
$749.00 |
$749.00 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$671.00 |
$671.00 |
$671.00 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$304.00 |
$304.00 |
$304.00 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$293.50 |
$293.50 |
$293.50 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$470.50 |
$470.50 |
$470.50 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$869.00 |
$869.00 |
$869.00 |
$486.50
|
|
Ultrasound scrotum and contents
|
$513.50 |
$513.50 |
$513.50 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$492.00 |
$492.00 |
$492.00 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$315.00 |
$315.00 |
$315.00 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$1,040.00 |
$1,040.00 |
$1,040.00 |
$558.35
|
|
Ultrasound trgt dyn mbubb 1st les
|
$574.00 |
$574.00 |
$574.00 |
$568.32
|
|
Ultrasound trgt dyn mbubb ea addl
|
$402.50 |
$402.50 |
$402.50 |
$348.00
|
|
Umbilicoplasty 15847
|
$16,815.00 |
$16,815.00 |
$16,815.00 |
$4,172.97
|
|
Unlisted all/immlg svc/px
|
$46.50 |
$46.50 |
$46.50 |
$28.98
|
|
Unlisted chemotherapy px
|
$618.50 |
$618.50 |
$618.50 |
$150.00
|
|
Unlisted cranfcl&maxlfcl px
|
$10,927.50 |
$10,927.50 |
$10,927.50 |
$571.20
|
|
Unlisted dialysis procedure
|
$1,704.00 |
$1,704.00 |
$1,704.00 |
$1,144.00
|
|
Unlisted dx gi procedure
|
$659.00 |
$659.00 |
$659.00 |
$649.22
|
|
Unlisted fluoroscopic px
|
$123.50 |
$123.50 |
$123.50 |
$305.76
|
|
Unlisted hematology&coagj px
|
$127.50 |
$127.50 |
$127.50 |
$39.52
|
|
Unlisted laparoscopic liver biopy 47379
|
$18,641.34 |
$18,641.34 |
$18,641.34 |
$5,419.00
|
|
Unlisted laparoscopic procedure 49659
|
$20,458.00 |
$20,458.00 |
$20,458.00 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$15,952.50 |
$15,952.50 |
$15,952.50 |
$5,419.00
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$1,971.00 |
$1,971.00 |
$1,971.00 |
$6,463.42
|
|
Unlisted laps px bladder
|
$4,184.75 |
$4,184.75 |
$4,184.75 |
$5,082.74
|
|
Unlisted laps px esoph
|
$15,346.00 |
$15,346.00 |
$15,346.00 |
$5,741.00
|
|
Unlisted laps px lymphtc sys
|
$18,368.17 |
$18,368.17 |
$18,368.17 |
$6,870.89
|
|
Unlisted laps px ovidct ovry
|
$11,102.25 |
$11,102.25 |
$11,102.25 |
$6,904.15
|
|
Unlisted laps px ureter
|
$33,555.00 |
$33,555.00 |
$33,555.00 |
$6,212.70
|
|
Unlisted laps px uterus
|
$22,533.50 |
$22,533.50 |
$22,533.50 |
$4,627.00
|
|
Unlisted maaa
|
$675.00 |
$675.00 |
$675.00 |
$235.20
|
|
Unlisted mr procedure
|
$2,009.00 |
$2,009.00 |
$2,009.00 |
$1,163.00
|
|
Unlisted muscskel px head
|
$8,155.50 |
$8,155.50 |
$8,155.50 |
$478.46
|
|
Unlisted neurological dx px
|
$284.50 |
$284.50 |
$284.50 |
$242.50
|
|
Unlisted oph svc/procedure
|
$238.00 |
$238.00 |
$238.00 |
$40.26
|
|
Unlisted orl service/px
|
$108.50 |
$108.50 |
$108.50 |
$132.60
|
|
Unlisted procedure colon
|
$3,234.67 |
$3,234.67 |
$3,234.67 |
$1,702.50
|
|
Unlisted procedure esophagus
|
$3,443.00 |
$3,443.00 |
$3,443.00 |
$1,998.88
|
|
Unlisted procedure eyelids
|
$14,024.00 |
$14,024.00 |
$14,024.00 |
$833.00
|
|
Unlisted procedure larynx
|
$1,537.83 |
$1,537.83 |
$1,537.83 |
$924.00
|
|
Unlisted procedure microbiology
|
$65.00 |
$65.00 |
$65.00 |
$523.50
|
|
Unlisted procedure pancreas
|
$951.50 |
$951.50 |
$951.50 |
$3,986.00
|
|
Unlisted procedure rectum
|
$3,597.50 |
$3,597.50 |
$3,597.50 |
$1,220.35
|
|
Unlisted procedure spine
|
$13,183.34 |
$13,183.34 |
$13,183.34 |
$4,659.85
|
|
Unlisted px abdomen muscskel
|
$10,636.66 |
$10,636.66 |
$10,636.66 |
$1,848.60
|
|
Unlisted px accessory sinus
|
$2,817.17 |
$2,817.17 |
$2,817.17 |
$3,335.28
|
|
Unlisted px ant segment eye
|
$4,718.50 |
$4,718.50 |
$4,718.50 |
$2,698.92
|
|
Unlisted px arthroscopy
|
$7,301.25 |
$7,301.25 |
$7,301.25 |
$2,765.60
|
|
Unlisted px biliary tract
|
$1,551.50 |
$1,551.50 |
$1,551.50 |
$2,718.10
|
|
Unlisted px casting/strpg
|
$230.50 |
$230.50 |
$230.50 |
$219.70
|
|
Unlisted px conjunctiva
|
$1,841.50 |
$1,841.50 |
$1,841.50 |
$479.62
|
|
Unlisted px external ear
|
$13,815.00 |
$13,815.00 |
$13,815.00 |
$325.68
|
|
Unlisted px foot/toes
|
$4,705.13 |
$4,705.13 |
$4,705.13 |
$1,225.50
|
|
Unlisted px forearm/wrist
|
$5,809.50 |
$5,809.50 |
$5,809.50 |
$593.60
|
|
Unlisted px hands/fingers
|
$9,227.50 |
$9,227.50 |
$9,227.50 |
$354.20
|
|
Unlisted px inner ear
|
$9,541.50 |
$9,541.50 |
$9,541.50 |
$571.20
|
|
Unlisted px lacrimal system
|
$1,307.38 |
$1,307.38 |
$1,307.38 |
$416.50
|
|
Unlisted px leg/ankle
|
$138,060.00 |
$138,060.00 |
$138,060.00 |
$811.00
|
|
Unlisted px male genital sys
|
$10,465.50 |
$10,465.50 |
$10,465.50 |
$343.55
|
|
Unlisted px mediastinum
|
$8,334.50 |
$8,334.50 |
$8,334.50 |
$397.60
|
|
Unlisted px middle ear
|
$3,913.25 |
$3,913.25 |
$3,913.25 |
$343.50
|
|
Unlisted px neck/thorax
|
$5,310.83 |
$5,310.83 |
$5,310.83 |
$571.20
|
|
Unlisted px pelvis/hip joint
|
$11,218.50 |
$11,218.50 |
$11,218.50 |
$3,118.44
|
|
Unlisted px posterior segmnt
|
$10,620.00 |
$10,620.00 |
$10,620.00 |
$3,173.34
|
|
Unlisted px salivry glnd/dux
|
$6,213.50 |
$6,213.50 |
$6,213.50 |
$1,265.16
|
|
Unlisted px small intestine
|
$3,112.00 |
$3,112.00 |
$3,112.00 |
$2,102.10
|
|
Unlisted px tongue flr mouth
|
$1,981.13 |
$1,981.13 |
$1,981.13 |
$282.50
|
|
Unlisted px vestibule mouth
|
$1,654.00 |
$1,654.00 |
$1,654.00 |
$456.96
|
|
Unlisted spec derm svc/px
|
$324.50 |
$324.50 |
$324.50 |
$223.08
|
|
Unlisted special svc px/rprt
|
$7.50 |
$7.50 |
$7.50 |
$90.00
|
|
Unlisted surgical path px
|
$1,011.50 |
$1,011.50 |
$1,011.50 |
$217.75
|
|
Unlisted ultrasound procedure
|
$304.00 |
$304.00 |
$304.00 |
$321.20
|
|
Unlisted urinalysis px
|
$89.50 |
$89.50 |
$89.50 |
$25.72
|
|
Unlstd laps px sprmatic cord
|
$7,445.17 |
$7,445.17 |
$7,445.17 |
$4,713.11
|
|
Unsched dialysis esrd pt hos
|
$1,556.00 |
$1,556.00 |
$1,556.00 |
$1,268.17
|
|
Upgrade pm system
|
$48,380.00 |
$48,380.00 |
$48,380.00 |
$12,077.00
|
