|
Tympanostomy/ven tube/loc/top anes 69433
|
$89.49 |
$89.49 |
$89.49 |
$911.43
|
|
Ultrasound abdomen aorta screening study aaa
|
$171.00 |
$171.00 |
$171.00 |
$394.20
|
|
Ultrasound breast complete
|
$237.69 |
$237.69 |
$237.69 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$201.21 |
$201.21 |
$201.21 |
$449.35
|
|
Ultrasound chest
|
$262.77 |
$262.77 |
$262.77 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$121.22 |
$121.22 |
$121.22 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$76.95 |
$76.95 |
$76.95 |
$296.80
|
|
Ultrasound elastography parenchyma
|
$166.44 |
$166.44 |
$166.44 |
$307.00
|
|
Ultrasound encephalogram
|
$206.91 |
$206.91 |
$206.91 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$422.94 |
$422.94 |
$422.94 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$258.78 |
$258.78 |
$258.78 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$153.90 |
$153.90 |
$153.90 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$336.87 |
$336.87 |
$336.87 |
$720.15
|
|
Ultrasound guide intraoperative
|
$298.87 |
$298.87 |
$298.87 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$73.15 |
$73.15 |
$73.15 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$211.28 |
$211.28 |
$211.28 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$206.91 |
$206.91 |
$206.91 |
$311.25
|
|
Ultrasound joint complete left
|
$258.78 |
$258.78 |
$258.78 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$251.18 |
$251.18 |
$251.18 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$258.78 |
$258.78 |
$258.78 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$166.63 |
$166.63 |
$166.63 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$443.27 |
$443.27 |
$443.27 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$153.33 |
$153.33 |
$153.33 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$187.91 |
$187.91 |
$187.91 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$258.78 |
$258.78 |
$258.78 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$263.15 |
$263.15 |
$263.15 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$258.78 |
$258.78 |
$258.78 |
$486.50
|
|
Ultrasound scrotum and contents
|
$258.78 |
$258.78 |
$258.78 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$220.21 |
$220.21 |
$220.21 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$206.91 |
$206.91 |
$206.91 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$258.78 |
$258.78 |
$258.78 |
$558.35
|
|
Umbilical artery cath newborn 36660
|
$43.70 |
$43.70 |
$43.70 |
$206.64
|
|
Umbilicoplasty 15847
|
$410.02 |
$410.02 |
$410.02 |
$4,172.97
|
|
Unlistd noninvas vasc dx std
|
$8.93 |
$8.93 |
$8.93 |
$528.80
|
|
Unlisted fluoroscopic px
|
$60.04 |
$60.04 |
$60.04 |
$305.76
|
|
Unlisted laparoscopic liver biopy 47379
|
$698.63 |
$698.63 |
$698.63 |
$5,419.00
|
|
Unlisted laparoscopic procedure 49659
|
$203.68 |
$203.68 |
$203.68 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$809.97 |
$809.97 |
$809.97 |
$5,419.00
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$66.12 |
$66.12 |
$66.12 |
$6,463.42
|
|
Unlisted laps px bladder
|
$1,070.27 |
$1,070.27 |
$1,070.27 |
$5,082.74
|
|
Unlisted laps px ovidct ovry
|
$173.28 |
$173.28 |
$173.28 |
$6,904.15
|
|
Unlisted laps px renal
|
$492.10 |
$492.10 |
$492.10 |
$5,110.00
|
|
Unlisted laps px spleen
|
$858.99 |
$858.99 |
$858.99 |
$4,627.00
|
|
Unlisted laps px uterus
|
$380.38 |
$380.38 |
$380.38 |
$4,627.00
|
|
Unlisted maaa
|
$46.94 |
$46.94 |
$46.94 |
$235.20
|
|
Unlisted misc path test
|
$1.78 |
$1.78 |
$1.78 |
$89.40
|
|
Unlisted oph svc/procedure
|
$11.59 |
$11.59 |
$11.59 |
$40.26
|
|
Unlisted procedure microbiology
|
$84.17 |
$84.17 |
$84.17 |
$523.50
|
|
Unlisted procedure rectum
|
$228.38 |
$228.38 |
$228.38 |
$1,220.35
|
|
Unlisted procedure urinary 58750
|
$586.72 |
$586.72 |
$586.72 |
$1,181.29
|
|
Unlisted px abdomen muscskel
|
$402.99 |
$402.99 |
$402.99 |
$1,848.60
|
|
Unlisted px accessory sinus
|
$83.41 |
$83.41 |
$83.41 |
$3,335.28
|
|
Unlisted px ant segment eye
|
$119.70 |
$119.70 |
$119.70 |
$2,698.92
|
|
Unlisted px arthroscopy
|
$467.02 |
$467.02 |
$467.02 |
$2,765.60
|
|
Unlisted px conjunctiva
|
$49.21 |
$49.21 |
$49.21 |
$479.62
|
|
Unlisted px external ear
|
$49.21 |
$49.21 |
$49.21 |
$325.68
|
|
Unlisted px foot/toes
|
$1,038.54 |
$1,038.54 |
$1,038.54 |
$1,225.50
|
|
Unlisted px leg/ankle
|
$199.69 |
$199.69 |
$199.69 |
$811.00
|
|
Unlisted px male genital sys
|
$183.35 |
$183.35 |
$183.35 |
$343.55
|
|
Unlisted px middle ear
|
$60.04 |
$60.04 |
$60.04 |
$343.50
|
|
Unlisted px neck/thorax
|
$49.40 |
$49.40 |
$49.40 |
$571.20
|
|
Unlisted px pelvis/hip joint
|
$49.21 |
$49.21 |
$49.21 |
$3,118.44
|
|
Unlisted px small intestine
|
$1,042.72 |
$1,042.72 |
$1,042.72 |
$2,102.10
|
|
Unlisted px tongue flr mouth
|
$52.06 |
$52.06 |
$52.06 |
$282.50
|
|
Unlisted special svc px/rprt
|
$42.37 |
$42.37 |
$42.37 |
$90.00
|
|
Unlisted ultrasound procedure
|
$226.67 |
$226.67 |
$226.67 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$1,022.39 |
$1,022.39 |
$1,022.39 |
$1,268.17
|
|
Upgrade pm system
|
$9,271.62 |
$9,271.62 |
$9,271.62 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,983.79 |
$1,983.79 |
$1,983.79 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,341.97 |
$1,341.97 |
$1,341.97 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,184.84 |
$1,184.84 |
$1,184.84 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$79.23 |
$79.23 |
$79.23 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$88.92 |
$88.92 |
$88.92 |
$1,768.00
|
|
Uppr gi scope w/submuc inj
|
$88.92 |
$88.92 |
$88.92 |
$1,872.00
|
|
Urachal cyst/sinus excision 51500
|
$418.00 |
$418.00 |
$418.00 |
$6,082.67
|
|
Urea nitrogen
|
$26.79 |
$26.79 |
$26.79 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$35.15 |
$35.15 |
$35.15 |
$51.75
|
|
Urea nitrogen clearance
|
$1.12 |
$1.12 |
$1.12 |
$42.25
|
|
Ureteral reflux study
|
$20.14 |
$20.14 |
$20.14 |
$952.50
|
|
Ureter endoscopy & treatment
|
$201.40 |
$201.40 |
$201.40 |
$5,631.74
|
|
Ureteroneocystostomy 50780
|
$717.63 |
$717.63 |
$717.63 |
$4,457.05
|
|
Ureteroureterostomy 50760
|
$725.99 |
$725.99 |
$725.99 |
$2,999.40
|
|
Urethrcystgrphy rtrgrde s&i
|
$372.02 |
$372.02 |
$372.02 |
$579.73
|
|
Urethrlys transvag with scope
|
$485.26 |
$485.26 |
$485.26 |
$4,081.37
|
|
Urethrocystography void s&i
|
$275.50 |
$275.50 |
$275.50 |
$622.35
|
|
Uric acid blood
|
$29.45 |
$29.45 |
$29.45 |
$48.75
|
|
Uric acid urine
|
$33.82 |
$33.82 |
$33.82 |
$44.33
|
|
Urinalysis microscopic only
|
$17.10 |
$17.10 |
$17.10 |
$26.35
|
|
Urinalysis (with microscopy)
|
$25.46 |
$25.46 |
$25.46 |
$55.00
|
|
Urinalysis (without microscopy)
|
$13.11 |
$13.11 |
$13.11 |
$35.75
|
|
Urine Culture Test
|
$33.25 |
$33.25 |
$33.25 |
$81.50
|
|
Urine flow measurement 51736
|
$5.32 |
$5.32 |
$5.32 |
$210.00
|
|
Urine pregnancy test
|
$41.42 |
$41.42 |
$41.42 |
$67.20
|
|
Urography, antegrade
|
$422.18 |
$422.18 |
$422.18 |
$622.35
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$1,546.32 |
$1,546.32 |
$1,546.32 |
$5,184.34
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$73.29 |
$73.29 |
$73.29 |
$155.16
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$28.46 |
$28.46 |
$28.46 |
$75.39
|
|
Vaccine influenza inactivated adjuvant im
|
$80.20 |
$80.20 |
$80.20 |
$109.50
|
|
Vaccine influenza nos 0.5ml dose im
|
$4.94 |
$4.94 |
$4.94 |
$24.20
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$20.03 |
$20.03 |
$20.03 |
$47.88
|
