|
Ultrasound encephalogram
|
$255.36 |
$255.36 |
$502.50 |
|
|
Ultrasound exam k transpl w/doppler
|
$189.12 |
$189.12 |
$412.50 |
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$276.80 |
$276.80 |
$479.25 |
|
|
Ultrasound guidance for vascular access
|
$155.84 |
$155.84 |
$312.00 |
|
|
Ultrasound guided needle placement supervision & interpretation
|
$218.24 |
$218.24 |
$318.75 |
|
|
Ultrasound guide intraoperative
|
$194.25 |
$194.25 |
$256.96 |
|
|
Ultrasound guide tissue ablation
|
$188.48 |
$188.48 |
$490.50 |
|
|
Ultrasound hips infant dynamic
|
$571.50 |
$571.50 |
$571.50 |
|
|
Ultrasound infant hips ltd without stress
|
$357.75 |
$357.75 |
$357.75 |
|
|
Ultrasound joint complete left
|
$203.52 |
$203.52 |
$342.75 |
|
|
Ultrasound joint/nonvascular extremity limited left
|
$210.24 |
$210.24 |
$300.00 |
|
|
Ultrasound ob >=14wks ea addl gest
|
$283.50 |
$283.50 |
$325.76 |
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$258.75 |
$258.75 |
$325.76 |
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$241.92 |
$241.92 |
$748.50 |
|
|
Ultrasound pregnant uterus follow up per fetus
|
$212.48 |
$212.48 |
$507.00 |
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$199.68 |
$199.68 |
$305.25 |
|
|
Ultrasound pregnant uterus transvaginal
|
$214.08 |
$214.08 |
$532.50 |
|
|
Ultrasound prostate/transrectal
|
$36.16 |
$36.16 |
$501.75 |
|
|
Ultrasound retroperitoneal limited
|
$213.12 |
$213.12 |
$480.00 |
|
|
Ultrasound scrotum and contents
|
$200.00 |
$200.00 |
$457.50 |
|
|
Ultrasound spinal canal and contents
|
$720.00 |
$720.00 |
$720.00 |
|
|
Ultrasound transabd ea addl gest
|
$135.68 |
$135.68 |
$811.50 |
|
|
Ultrasound transvaginal non obstetric
|
$212.80 |
$212.80 |
$559.50 |
|
|
Ultrasound trgt dyn mbubb 1st les
|
$1,012.50 |
$1,012.50 |
$1,012.50 |
|
|
Ultraviolet therapy
|
$21.75 |
$21.75 |
$21.75 |
|
|
Umbilical artery cath newborn 36660
|
$239.25 |
$239.25 |
$239.25 |
|
|
Unit mobile power mpu
|
$9.00 |
$9.00 |
$9.00 |
|
|
Unlistd noninvas vasc dx std
|
$27.20 |
$27.20 |
$27.20 |
|
|
Unlisted CT procedure
|
$367.50 |
$367.50 |
$367.50 |
|
|
Unlisted dx gi procedure
|
$166.08 |
$166.08 |
$166.08 |
|
|
Unlisted fluoroscopic px
|
$272.25 |
$272.25 |
$272.25 |
|
|
Unlisted laparoscopic liver biopy 47379
|
$453.12 |
$453.12 |
$453.12 |
|
|
Unlisted laparoscopic procedure 49659
|
$401.92 |
$401.92 |
$401.92 |
|
|
Unlisted laparoscopic reduction intestine 44238
|
$745.60 |
$745.60 |
$745.60 |
|
|
Unlisted laps px bladder
|
$1,689.60 |
$1,689.60 |
$1,689.60 |
|
|
Unlisted mr procedure
|
$435.00 |
$435.00 |
$435.00 |
|
|
Unlisted procedure liver
|
$2,059.50 |
$2,059.50 |
$2,059.50 |
|
|
Unlisted px abdomen muscskel
|
$289.28 |
$289.28 |
$289.28 |
|
|
Unlisted px casting/strpg
|
$153.75 |
$153.75 |
$153.75 |
|
|
Unlisted px diaphragm
|
$1,424.00 |
$1,424.00 |
$1,424.00 |
|
|
Unlisted px foot/toes
|
$227.52 |
$227.52 |
$227.52 |
|
|
Unlisted px middle ear
|
$214.72 |
$214.72 |
$214.72 |
|
|
Unlisted px palate uvula
|
$166.40 |
$166.40 |
$166.40 |
|
|
Unlisted px small intestine
|
$726.72 |
$726.72 |
$2,568.75 |
|
|
Unlisted reprod med lab proc
|
$138.75 |
$138.75 |
$138.75 |
|
|
Unlisted transfusion med px
|
$128.00 |
$128.00 |
$128.00 |
|
|
Unsched dialysis esrd pt hos
|
$825.00 |
$825.00 |
$982.08 |
|
|
Upgrade pm system
|
$5,291.52 |
$5,291.52 |
$11,747.25 |
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,122.56 |
$1,122.56 |
$2,325.00 |
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$928.00 |
$928.00 |
$2,257.50 |
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$843.52 |
$843.52 |
$1,965.00 |
|
|
Upper Endoscopy (EGD, diagnostic)
|
$96.96 |
$96.96 |
$1,983.75 |
|
|
Upper Endoscopy (EGD, with biopsy)
|
$109.44 |
$109.44 |
$1,476.00 |
|
|
Uppr gi scope w/submuc inj
|
$109.44 |
$109.44 |
$1,462.50 |
|
|
Urachal cyst/sinus excision 51500
|
$10,242.75 |
$10,242.75 |
$10,242.75 |
|
|
Urea nitrogen
|
$32.25 |
$32.25 |
$43.20 |
|
|
Urea nitrogen 24 hour urine
|
$21.44 |
$21.44 |
$30.00 |
|
|
Urea nitrogen clearance
|
$41.25 |
$41.25 |
$41.25 |
|
|
Urea nitrogen semi-quant
|
$24.75 |
$24.75 |
$24.75 |
|
|
Ureteral reflux study
|
$997.50 |
$997.50 |
$997.50 |
|
|
Urethrcystgrphy rtrgrde s&i
|
$301.12 |
$301.12 |
$654.75 |
|
|
Urethrocystography void s&i
|
$327.04 |
$327.04 |
$654.75 |
|
|
Uric acid blood
|
$37.50 |
$37.50 |
$50.24 |
|
|
Uric acid urine
|
$31.50 |
$31.50 |
$43.20 |
|
|
Urinalysis glass test
|
$17.25 |
$17.25 |
$17.25 |
|
|
Urinalysis microscopic only
|
$10.24 |
$10.24 |
$25.50 |
|
|
Urinalysis qual/semiquant excpt ia
|
$10.50 |
$10.50 |
$10.50 |
|
|
Urinalysis (with microscopy)
|
$33.75 |
$33.75 |
$34.88 |
|
|
Urinalysis (without microscopy)
|
$15.75 |
$15.75 |
$24.00 |
|
|
Urinary bldr retent nuc study
|
$195.75 |
$195.75 |
$195.75 |
|
|
Urinary reflex study
|
$685.50 |
$685.50 |
$685.50 |
|
|
Urine Culture Test
|
$36.80 |
$36.80 |
$60.75 |
|
|
Urine flow measurement 51736
|
$206.25 |
$206.25 |
$206.25 |
|
|
Urine pregnancy test
|
$22.72 |
$22.72 |
$49.50 |
|
|
Urine screen for bacteria
|
$111.00 |
$111.00 |
$111.00 |
|
|
Urography, antegrade
|
$1,026.00 |
$1,026.00 |
$1,026.00 |
|
|
Urography inf drip &/or bolus
|
$504.00 |
$504.00 |
$504.00 |
|
|
Use 1st target lesion
|
$338.25 |
$338.25 |
$338.25 |
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$4,963.74 |
$4,963.74 |
$4,963.74 |
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$62,970.90 |
$62,970.90 |
$62,970.90 |
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$335.57 |
$335.57 |
$335.57 |
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$305.61 |
$305.61 |
$305.61 |
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$401.19 |
$401.19 |
$401.19 |
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$228.29 |
$228.29 |
$228.29 |
|
|
Vaccine dtap < 7 years im
|
$14.40 |
$14.40 |
$14.40 |
|
|
Vaccine dtap-hep b-ipv im
|
$237.45 |
$237.45 |
$237.45 |
|
|
Vaccine dtap-ipv 4-6 years im
|
$92.80 |
$92.80 |
$92.80 |
|
|
Vaccine dtap-ipv/hib im
|
$250.88 |
$250.88 |
$300.42 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$97.77 |
$97.77 |
$97.77 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$44.03 |
$44.03 |
$45.76 |
|
|
Vaccine hepatitis a (hepa) adult im
|
$227.81 |
$227.81 |
$227.81 |
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$310.13 |
$310.13 |
$310.13 |
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$22.12 |
$22.12 |
$22.12 |
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$196.71 |
$196.71 |
$196.71 |
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$44.16 |
$44.16 |
$113.13 |
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$368.21 |
$368.21 |
$368.21 |
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$41.57 |
$41.57 |
$41.57 |
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$125.44 |
$125.44 |
$772.07 |
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$21.76 |
$21.76 |
$203.78 |
|
|
Vaccine influenza inactivated adjuvant im
|
$112.31 |
$112.31 |
$203.78 |
|
