|
Tympanostomy/ven tube/loc/top anes 69433
|
$203.50 |
$655.00 |
$7,093.00 |
|
|
Tympp antrt/mastoid without ossic chain recnst 69635
|
$2,416.80 |
$2,416.80 |
$2,416.80 |
|
|
Ua w/micro/comp poc
|
$4.50 |
$17.50 |
$34.20 |
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$20,945.01 |
$42,093.60 |
$58,327.52 |
|
|
Ugt1a1 gene analy common variants
|
$180.00 |
$270.00 |
$1,034.50 |
|
|
Ultrasound abdomen aorta screening study aaa
|
$157.50 |
$380.00 |
$600.00 |
|
|
Ultrasound bone density measure
|
$161.00 |
$161.00 |
$161.00 |
|
|
Ultrasound breast complete
|
$38.00 |
$483.34 |
$883.00 |
|
|
Ultrasound breast unilateral limited (both sides)
|
$113.00 |
$498.00 |
$1,129.00 |
|
|
Ultrasound chest
|
$212.00 |
$306.00 |
$933.00 |
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$24.00 |
$81.50 |
$1,237.00 |
|
|
Ultrasound dx ophth b-scan
|
$32.00 |
$204.50 |
$585.00 |
|
|
Ultrasound elastography parenchyma
|
$62.00 |
$233.50 |
$281.00 |
|
|
Ultrasound encephalogram
|
$31.00 |
$280.00 |
$724.50 |
|
|
Ultrasound exam k transpl w/doppler
|
$260.00 |
$470.50 |
$718.00 |
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$37.00 |
$278.00 |
$1,116.00 |
|
|
Ultrasound guidance for vascular access
|
$14.00 |
$240.00 |
$780.00 |
|
|
Ultrasound guided needle placement supervision & interpretation
|
$35.00 |
$528.50 |
$5,482.33 |
|
|
Ultrasound guide intraoperative
|
$386.00 |
$470.50 |
$9,219.63 |
|
|
Ultrasound guide tissue ablation
|
$409.50 |
$409.50 |
$1,204.50 |
|
|
Ultrasound hips infant dynamic
|
$116.00 |
$319.50 |
$442.50 |
|
|
Ultrasound infant hips ltd without stress
|
$184.80 |
$215.50 |
$304.00 |
|
|
Ultrasound joint complete left
|
$48.00 |
$279.00 |
$726.00 |
|
|
Ultrasound joint/nonvascular extremity limited left
|
$205.00 |
$592.00 |
$1,054.00 |
|
|
Ultrasound ob >=14wks ea addl gest
|
$188.50 |
$405.00 |
$1,044.50 |
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$58.00 |
$299.50 |
$710.50 |
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$91.50 |
$408.50 |
$749.00 |
|
|
Ultrasound pregnant uterus follow up per fetus
|
$251.00 |
$313.50 |
$671.00 |
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$226.00 |
$368.50 |
$702.00 |
|
|
Ultrasound pregnant uterus transvaginal
|
$63.20 |
$340.50 |
$883.80 |
|
|
Ultrasound prostate/transrectal
|
$33.00 |
$247.20 |
$702.00 |
|
|
Ultrasound retroperitoneal limited
|
$227.50 |
$436.50 |
$869.00 |
|
|
Ultrasound scrotum and contents
|
$260.00 |
$438.00 |
$883.80 |
|
|
Ultrasound spinal canal and contents
|
$124.50 |
$437.50 |
$524.50 |
|
|
Ultrasound transabd ea addl gest
|
$214.00 |
$315.00 |
$919.50 |
|
|
Ultrasound transvaginal non obstetric
|
$103.00 |
$440.50 |
$1,040.00 |
|
|
Ultrasound trgt dyn mbubb 1st les
|
$574.00 |
$574.00 |
$574.00 |
|
|
Ultrasound trgt dyn mbubb ea addl
|
$402.50 |
$402.50 |
$402.50 |
|
|
Umbilicoplasty 15847
|
$997.67 |
$4,530.83 |
$16,815.00 |
|
|
Unlisted all/immlg svc/px
|
$46.50 |
$46.50 |
$46.50 |
|
|
Unlisted chemotherapy px
|
$51.00 |
$62.50 |
$618.50 |
|
|
Unlisted cranfcl&maxlfcl px
|
$10,927.50 |
$10,927.50 |
$10,927.50 |
|
|
Unlisted CT procedure
|
$414.00 |
$414.00 |
$1,067.00 |
|
|
Unlisted dialysis procedure
|
$482.50 |
$1,127.50 |
$2,066.00 |
|
|
Unlisted dx gi procedure
|
$659.00 |
$659.00 |
$659.00 |
|
|
Unlisted fluoroscopic px
|
$123.50 |
$331.20 |
$649.50 |
|
|
Unlisted hematology&coagj px
|
$8.00 |
$45.00 |
$127.50 |
|
|
Unlisted hystsc px uterus
|
$1,368.75 |
$1,913.60 |
$3,162.50 |
|
|
Unlisted laparoscopic liver biopy 47379
|
$1,395.00 |
$2,758.66 |
$18,641.34 |
|
|
Unlisted laparoscopic procedure 49659
|
$1,171.00 |
$1,188.00 |
$37,484.00 |
|
|
Unlisted laparoscopic reduction intestine 44238
|
$1,668.00 |
$2,075.00 |
$23,168.00 |
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$1,228.00 |
$1,228.00 |
$1,971.00 |
|
|
Unlisted laps px appendix
|
$825.00 |
$825.00 |
$17,639.00 |
|
|
Unlisted laps px bladder
|
$4,184.75 |
$11,998.25 |
$19,383.00 |
|
|
Unlisted laps px esoph
|
$15,346.00 |
$15,346.00 |
$15,346.00 |
|
|
Unlisted laps px lymphtc sys
|
$21.50 |
$21.50 |
$18,368.17 |
|
|
Unlisted laps px ovidct ovry
|
$5,709.42 |
$6,380.50 |
$11,102.25 |
|
|
Unlisted laps px ureter
|
$6,975.60 |
$20,612.63 |
$33,555.00 |
|
|
Unlisted laps px uterus
|
$1,081.00 |
$1,081.00 |
$22,533.50 |
|
|
Unlisted maaa
|
$587.00 |
$587.00 |
$3,206.50 |
|
|
Unlisted mr procedure
|
$212.00 |
$1,352.00 |
$2,009.00 |
|
|
Unlisted muscskel px head
|
$109.50 |
$109.50 |
$8,155.50 |
|
|
Unlisted neurological dx px
|
$203.50 |
$252.50 |
$286.00 |
|
|
Unlisted oph svc/procedure
|
$238.00 |
$238.00 |
$238.00 |
|
|
Unlisted orl service/px
|
$42.50 |
$42.50 |
$108.50 |
|
|
Unlisted procedure colon
|
$1,091.00 |
$1,356.00 |
$3,234.67 |
|
|
Unlisted procedure esophagus
|
$210.17 |
$1,358.50 |
$3,443.00 |
|
|
Unlisted procedure eyelids
|
$365.00 |
$365.00 |
$14,024.00 |
|
|
Unlisted procedure larynx
|
$137.00 |
$137.00 |
$1,537.83 |
|
|
Unlisted procedure microbiology
|
$6.00 |
$6.00 |
$1,208.00 |
|
|
Unlisted procedure pancreas
|
$951.50 |
$951.50 |
$1,569.50 |
|
|
Unlisted procedure rectum
|
$152.50 |
$348.50 |
$3,597.50 |
|
|
Unlisted procedure spine
|
$106.50 |
$272.00 |
$19,858.00 |
|
|
Unlisted px abdomen muscskel
|
$133.50 |
$458.00 |
$10,636.66 |
|
|
Unlisted px accessory sinus
|
$1,417.00 |
$1,429.50 |
$2,817.17 |
|
|
Unlisted px ant segment eye
|
$1,979.17 |
$3,111.00 |
$4,718.50 |
|
|
Unlisted px arthroscopy
|
$596.50 |
$2,249.17 |
$7,301.25 |
|
|
Unlisted px biliary tract
|
$886.50 |
$886.50 |
$1,551.50 |
|
|
Unlisted px casting/strpg
|
$201.00 |
$222.00 |
$241.00 |
|
|
Unlisted px conjunctiva
|
$387.00 |
$387.00 |
$1,841.50 |
|
|
Unlisted px diaphragm
|
$118.50 |
$118.50 |
$118.50 |
|
|
Unlisted px external ear
|
$20.00 |
$20.50 |
$13,815.00 |
|
|
Unlisted px foot/toes
|
$216.50 |
$792.00 |
$5,767.00 |
|
|
Unlisted px forearm/wrist
|
$872.00 |
$902.50 |
$6,072.00 |
|
|
Unlisted px hands/fingers
|
$216.50 |
$308.50 |
$9,227.50 |
|
|
Unlisted px inner ear
|
$9,541.50 |
$9,541.50 |
$9,541.50 |
|
|
Unlisted px lacrimal system
|
$273.50 |
$348.00 |
$1,364.00 |
|
|
Unlisted px leg/ankle
|
$284.50 |
$313.50 |
$138,060.00 |
|
|
Unlisted px male genital sys
|
$306.50 |
$307.50 |
$10,465.50 |
|
|
Unlisted px mediastinum
|
$118.50 |
$118.50 |
$8,334.50 |
|
|
Unlisted px middle ear
|
$272.50 |
$273.00 |
$3,913.25 |
|
|
Unlisted px neck/thorax
|
$272.50 |
$453.50 |
$5,310.83 |
|
|
Unlisted px pelvis/hip joint
|
$576.50 |
$592.50 |
$14,793.00 |
|
|
Unlisted px posterior segmnt
|
$2,653.00 |
$2,834.50 |
$10,620.00 |
|
|
Unlisted px salivry glnd/dux
|
$6,213.50 |
$6,213.50 |
$6,213.50 |
|
|
Unlisted px small intestine
|
$333.50 |
$1,042.50 |
$3,112.00 |
|
|
Unlisted px tongue flr mouth
|
$272.50 |
$273.00 |
$1,981.13 |
|
|
Unlisted px vestibule mouth
|
$1,654.00 |
$1,654.00 |
$1,654.00 |
|
|
Unlisted spec derm svc/px
|
$113.00 |
$113.00 |
$341.00 |
|
|
Unlisted special svc px/rprt
|
$5.00 |
$5.00 |
$7.50 |
|