|
Ultrasound guide tissue ablation
|
$103.95 |
$103.95 |
$103.95 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$37.26 |
$37.26 |
$37.26 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$31.32 |
$31.32 |
$31.32 |
$311.25
|
|
Ultrasound joint complete left
|
$254.61 |
$254.61 |
$254.61 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$305.10 |
$305.10 |
$305.10 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$458.19 |
$458.19 |
$458.19 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$168.48 |
$168.48 |
$168.48 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$196.56 |
$196.56 |
$196.56 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$203.58 |
$203.58 |
$203.58 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$216.81 |
$216.81 |
$216.81 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$228.96 |
$228.96 |
$228.96 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$222.21 |
$222.21 |
$222.21 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$232.74 |
$232.74 |
$232.74 |
$486.50
|
|
Ultrasound scrotum and contents
|
$393.66 |
$393.66 |
$393.66 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$139.05 |
$139.05 |
$139.05 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$90.18 |
$90.18 |
$90.18 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$317.25 |
$317.25 |
$317.25 |
$558.35
|
|
Umbilical artery cath newborn 36660
|
$62.10 |
$62.10 |
$62.10 |
$206.64
|
|
Umbilicoplasty 15847
|
$582.66 |
$582.66 |
$582.66 |
$4,172.97
|
|
Unlistd noninvas vasc dx std
|
$12.69 |
$12.69 |
$12.69 |
$528.80
|
|
Unlisted laparoscopic liver biopy 47379
|
$992.79 |
$992.79 |
$992.79 |
$5,419.00
|
|
Unlisted laparoscopic procedure 49659
|
$289.44 |
$289.44 |
$289.44 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$1,151.01 |
$1,151.01 |
$1,151.01 |
$5,419.00
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$93.96 |
$93.96 |
$93.96 |
$6,463.42
|
|
Unlisted laps px bladder
|
$1,520.91 |
$1,520.91 |
$1,520.91 |
$5,082.74
|
|
Unlisted laps px ovidct ovry
|
$246.24 |
$246.24 |
$246.24 |
$6,904.15
|
|
Unlisted laps px renal
|
$699.30 |
$699.30 |
$699.30 |
$5,110.00
|
|
Unlisted laps px spleen
|
$1,220.67 |
$1,220.67 |
$1,220.67 |
$4,627.00
|
|
Unlisted laps px uterus
|
$540.54 |
$540.54 |
$540.54 |
$4,627.00
|
|
Unlisted misc path test
|
$2.52 |
$2.52 |
$2.52 |
$89.40
|
|
Unlisted oph svc/procedure
|
$16.47 |
$16.47 |
$16.47 |
$40.26
|
|
Unlisted procedure microbiology
|
$119.61 |
$119.61 |
$119.61 |
$523.50
|
|
Unlisted procedure rectum
|
$324.54 |
$324.54 |
$324.54 |
$1,220.35
|
|
Unlisted procedure urinary 58750
|
$833.76 |
$833.76 |
$833.76 |
$1,181.29
|
|
Unlisted px abdomen muscskel
|
$572.67 |
$572.67 |
$572.67 |
$1,848.60
|
|
Unlisted px accessory sinus
|
$118.53 |
$118.53 |
$118.53 |
$3,335.28
|
|
Unlisted px ant segment eye
|
$170.10 |
$170.10 |
$170.10 |
$2,698.92
|
|
Unlisted px arthroscopy
|
$663.66 |
$663.66 |
$663.66 |
$2,765.60
|
|
Unlisted px casting/strpg
|
$111.24 |
$111.24 |
$111.24 |
$219.70
|
|
Unlisted px conjunctiva
|
$69.93 |
$69.93 |
$69.93 |
$479.62
|
|
Unlisted px external ear
|
$69.93 |
$69.93 |
$69.93 |
$325.68
|
|
Unlisted px foot/toes
|
$1,475.82 |
$1,475.82 |
$1,475.82 |
$1,225.50
|
|
Unlisted px leg/ankle
|
$794.07 |
$794.07 |
$794.07 |
$811.00
|
|
Unlisted px male genital sys
|
$260.55 |
$260.55 |
$260.55 |
$343.55
|
|
Unlisted px middle ear
|
$85.32 |
$85.32 |
$85.32 |
$343.50
|
|
Unlisted px neck/thorax
|
$119.07 |
$119.07 |
$119.07 |
$571.20
|
|
Unlisted px pelvis/hip joint
|
$69.93 |
$69.93 |
$69.93 |
$3,118.44
|
|
Unlisted px small intestine
|
$1,481.76 |
$1,481.76 |
$1,481.76 |
$2,102.10
|
|
Unlisted px tongue flr mouth
|
$73.98 |
$73.98 |
$73.98 |
$282.50
|
|
Unlisted special svc px/rprt
|
$60.21 |
$60.21 |
$60.21 |
$90.00
|
|
Unlisted ultrasound procedure
|
$262.71 |
$262.71 |
$262.71 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$713.07 |
$713.07 |
$713.07 |
$1,268.17
|
|
Upgrade pm system
|
$427.68 |
$427.68 |
$427.68 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$810.00 |
$810.00 |
$810.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$675.00 |
$675.00 |
$675.00 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$607.50 |
$607.50 |
$607.50 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$112.59 |
$112.59 |
$112.59 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$126.36 |
$126.36 |
$126.36 |
$1,768.00
|
|
Uppr gi scope w/submuc inj
|
$126.36 |
$126.36 |
$126.36 |
$1,872.00
|
|
Urachal cyst/sinus excision 51500
|
$594.00 |
$594.00 |
$594.00 |
$6,082.67
|
|
Urea nitrogen
|
$47.79 |
$47.79 |
$47.79 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$63.45 |
$63.45 |
$63.45 |
$51.75
|
|
Urea nitrogen clearance
|
$1.59 |
$1.59 |
$1.59 |
$42.25
|
|
Ureteral reflux study
|
$28.62 |
$28.62 |
$28.62 |
$952.50
|
|
Ureter endoscopy & treatment
|
$286.20 |
$286.20 |
$286.20 |
$5,631.74
|
|
Ureteroneocystostomy 50780
|
$1,019.79 |
$1,019.79 |
$1,019.79 |
$4,457.05
|
|
Ureteroureterostomy 50760
|
$1,031.67 |
$1,031.67 |
$1,031.67 |
$2,999.40
|
|
Urethrcystgrphy rtrgrde s&i
|
$380.16 |
$380.16 |
$380.16 |
$579.73
|
|
Urethrlys transvag with scope
|
$689.58 |
$689.58 |
$689.58 |
$4,081.37
|
|
Urethrocystography void s&i
|
$332.64 |
$332.64 |
$332.64 |
$622.35
|
|
Uric acid blood
|
$65.34 |
$65.34 |
$65.34 |
$48.75
|
|
Uric acid urine
|
$12.15 |
$12.15 |
$12.15 |
$44.33
|
|
Urinalysis microscopic only
|
$15.93 |
$15.93 |
$15.93 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$2.43 |
$2.43 |
$2.43 |
$25.72
|
|
Urinalysis (with microscopy)
|
$71.01 |
$71.01 |
$71.01 |
$55.00
|
|
Urinalysis (without microscopy)
|
$15.66 |
$15.66 |
$15.66 |
$35.75
|
|
Urine Culture Test
|
$95.58 |
$95.58 |
$95.58 |
$81.50
|
|
Urine flow measurement 51736
|
$12.96 |
$12.96 |
$12.96 |
$210.00
|
|
Urine pregnancy test
|
$45.09 |
$45.09 |
$45.09 |
$67.20
|
|
Urography, antegrade
|
$25.65 |
$25.65 |
$25.65 |
$622.35
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$109.08 |
$109.08 |
$109.08 |
$224.25
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$99.36 |
$99.36 |
$99.36 |
$209.40
|
|
Vaccine dtap < 7 years im
|
$70.99 |
$70.99 |
$70.99 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$75.06 |
$75.06 |
$75.06 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$57.78 |
$57.78 |
$57.78 |
$105.95
|
|
Vaccine dtap-ipv/hib im
|
$76.14 |
$76.14 |
$76.14 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$18.36 |
$18.36 |
$18.36 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$27.27 |
$27.27 |
$27.27 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$48.33 |
$48.33 |
$48.33 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$202.23 |
$202.23 |
$202.23 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$26.46 |
$26.46 |
$26.46 |
$79.15
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$50.76 |
$50.76 |
$50.76 |
$84.75
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$62.37 |
$62.37 |
$62.37 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$669.93 |
$669.93 |
$669.93 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$28.08 |
$28.08 |
$28.08 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$137.70 |
$137.70 |
$137.70 |
$576.48
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$109.89 |
$109.89 |
$109.89 |
$282.50
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$56.43 |
$56.43 |
$56.43 |
$143.20
|
|
Vaccine influenza inactivated adjuvant im
|
$56.43 |
$56.43 |
$56.43 |
$109.50
|
|
Vaccine influenza nos 0.5ml dose im
|
$14.85 |
$14.85 |
$14.85 |
$24.20
|
