Unit Price Base Price Service Type Procedure
University Physicians Group: Prices of Provider Services CPT Unit Base Service Procedure Modifier Code ype Current Procedural Terminology (CPT) Price Price T 00100 PR ANESTH,SALIVARY GLAND W/BX 1.00 5.00 Anesthesia 00102 PR ANESTH,CLEFT LIP REPAIR 1.00 6.00 Anesthesia 00103 PR ANESTH,BLEPHAROPLASTY 1.00 5.00 Anesthesia 00104 ANESTH,ELECTROSHOCK/ ECT 1.00 4.00 Anesthesia 00120 ANESTH,EAR SURGERY 1.00 5.00 Anesthesia 00124 ANESTH,EAR EXAM 1.00 4.00 Anesthesia 00126 PR ANESTH,TYMPANOTOMY 1.00 4.00 Anesthesia 00140 PR ANESTH,PROCEDURES ON EYE 1.00 5.00 Anesthesia 00142 ANESTH, LENS SURGERY 1.00 4.00 Anesthesia 00144 PR ANESTH,CORNEAL TRANSPLANT 1.00 6.00 Anesthesia 00145 ANESTH, VITREORETINAL SURG 1.00 6.00 Anesthesia 00147 PR ANESTH,IRIDECTOMY 1.00 4.00 Anesthesia 00148 ANESTH,EYE EXAM 1.00 4.00 Anesthesia 00160 PR ANESTH,NOSE,SINUS SURGERY 1.00 5.00 Anesthesia 00162 PR ANESTH,NOSE,RADICAL SINUS 1.00 7.00 Anesthesia SURGERY 00164 PR ANESTH,BIOPSY OF NOSE 1.00 4.00 Anesthesia 00170 PR ANESTH,PROCEDURE ON MOUTH 1.00 5.00 Anesthesia 00172 PR ANESTH,CLEFT PALATE REPAIR 1.00 6.00 Anesthesia 00174 PR ANESTH,EXCIS RETROPHARYNG 1.00 6.00 Anesthesia 00176 PR ANESTH,PHARYNX SURG 1.00 7.00 Anesthesia 00190 PR ANESTH,FACIAL BONE SURGERY 1.00 5.00 Anesthesia 00192 PR ANESTH,RADICAL FACIAL BONE 1.00 7.00 Anesthesia SURGERY 00210 PR ANESTH,OPEN HEAD SURGERY 1.00 11.00 Anesthesia 00211 PR ANESTH, INTRACRANIAL 1.00 10.00 Anesthesia HEMATOMA EVACUATION 00212 PR ANESTH,SKULL SURG SUBDUR 1.00 5.00 Anesthesia 00214 PR ANESTH,SKULL SURG BURR 1.00 9.00 Anesthesia
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