|
Ultrasound encephalogram
|
$288.38 |
$556.00 |
$942.66 |
|
|
Ultrasound exam k transpl w/doppler
|
$405.00 |
$497.50 |
$1,414.02 |
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$225.00 |
$405.00 |
$861.92 |
|
|
Ultrasound Guidance for a Needle Procedure
|
$324.60 |
$399.50 |
$942.66 |
|
|
Ultrasound guidance for vascular access
|
$239.40 |
$333.60 |
$942.66 |
|
|
Ultrasound guide intraoperative
|
$313.88 |
$536.00 |
$861.92 |
|
|
Ultrasound guide tissue ablation
|
$324.60 |
$324.60 |
$942.66 |
|
|
Ultrasound hips infant dynamic
|
$143.40 |
$588.50 |
$942.66 |
|
|
Ultrasound infant hips ltd without stress
|
$91.80 |
$112.80 |
$942.66 |
|
|
Ultrasound joint complete left
|
$334.80 |
$334.80 |
$1,962.27 |
|
|
Ultrasound ob >=14wks ea addl gest
|
$204.75 |
$350.40 |
$523.80 |
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$241.80 |
$298.20 |
$861.92 |
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$390.98 |
$800.00 |
$861.92 |
|
|
Ultrasound pregnant uterus follow up per fetus
|
$259.50 |
$476.40 |
$561.00 |
|
|
Ultrasound prostate/transrectal
|
$462.60 |
$529.20 |
$942.66 |
|
|
Ultrasound spinal canal and contents
|
$217.88 |
$402.00 |
$942.66 |
|
|
Ultrasound transabd ea addl gest
|
$164.12 |
$413.50 |
$544.20 |
|
|
Ultrasound trgt dyn mbubb 1st les
|
$942.66 |
$942.66 |
$942.66 |
|
|
Ultraviolet therapy
|
$42.60 |
$42.60 |
$70.99 |
|
|
Umbilical artery cath newborn 36660
|
$2,196.60 |
$2,196.60 |
$2,196.60 |
|
|
Unit mobile power mpu
|
$20,230.80 |
$20,230.80 |
$20,230.80 |
|
|
Unlistd noninvas vasc dx std
|
$1,329.50 |
$1,354.50 |
$1,968.26 |
|
|
Unlisted chemotherapy px
|
$101.40 |
$101.40 |
$835.29 |
|
|
Unlisted CT procedure
|
$542.40 |
$542.40 |
$685.20 |
|
|
Unlisted cytogenetic study
|
$123.56 |
$123.56 |
$123.56 |
|
|
Unlisted dx gi procedure
|
$1,422.00 |
$1,686.00 |
$3,231.00 |
|
|
Unlisted fetal invas px w/us
|
$507.00 |
$507.00 |
$507.00 |
|
|
Unlisted fluoroscopic px
|
$330.60 |
$330.60 |
$580.34 |
|
|
Unlisted hematology&coagj px
|
$53.64 |
$76.80 |
$132.00 |
|
|
Unlisted maaa
|
$463.00 |
$472.00 |
$2,374.62 |
|
|
Unlisted mr procedure
|
$582.60 |
$582.60 |
$3,258.04 |
|
|
Unlisted neurological dx px
|
$1,607.54 |
$1,607.54 |
$1,607.54 |
|
|
Unlisted orl service/px
|
$34.80 |
$223.20 |
$408.50 |
|
|
Unlisted procedure liver
|
$997.20 |
$997.20 |
$3,350.90 |
|
|
Unlisted procedure microbiology
|
$5,036.59 |
$5,036.59 |
$5,036.59 |
|
|
Unlisted psychiatric service/proc 90899
|
$1,722.59 |
$1,722.59 |
$1,722.59 |
|
|
Unlisted px casting/strpg
|
$81.60 |
$124.20 |
$549.20 |
|
|
Unlisted px med radj physics
|
$723.14 |
$723.14 |
$723.14 |
|
|
Unlisted px ther rad tx plng
|
$1,339.00 |
$1,339.00 |
$1,339.00 |
|
|
Unlisted px tongue flr mouth
|
$241.00 |
$241.00 |
$241.00 |
|
|
Unlisted resp px dx nuc med
|
$1,457.13 |
$1,457.13 |
$1,457.13 |
|
|
Unlisted surgical path px
|
$68.76 |
$68.76 |
$68.76 |
|
|
Unlisted transfusion med px
|
$250.20 |
$250.20 |
$1,138.52 |
|
|
Unlisted ultrasound procedure
|
$164.40 |
$407.50 |
$1,336.12 |
|
|
Unlisted urinalysis px
|
$33.60 |
$46.80 |
$79.20 |
|
|
Unsched dialysis esrd pt hos
|
$1,110.00 |
$1,110.00 |
$1,683.96 |
|
|
Upgrade pm system
|
$9,148.80 |
$11,733.60 |
$72,805.03 |
|
|
Upper Arm (Humerus) X-ray (left side)
|
$262.00 |
$362.40 |
$2,046.12 |
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$542.40 |
$839.50 |
$3,823.33 |
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$485.62 |
$718.00 |
$3,358.16 |
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$582.60 |
$1,040.00 |
$4,507.36 |
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$582.60 |
$919.00 |
$3,565.20 |
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$582.60 |
$824.50 |
$3,225.02 |
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$210.12 |
$238.20 |
$1,164.19 |
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$221.12 |
$283.80 |
$1,231.28 |
|
|
Upper ext fx orthosis rad/ul
|
$23.40 |
$166.20 |
$465.92 |
|
|
Upper GI Barium X-ray (barium and gas)
|
$465.62 |
$704.40 |
$1,134.36 |
|
|
Upper GI Barium X-ray (barium only)
|
$400.12 |
$659.40 |
$2,474.78 |
|
|
Urea nitrogen
|
$23.00 |
$59.40 |
$100.80 |
|
|
Urea nitrogen 24 hour urine
|
$9.00 |
$61.50 |
$119.40 |
|
|
Urea nitrogen clearance
|
$110.50 |
$112.00 |
$116.00 |
|
|
Ureteral embolization/occl
|
$1,817.40 |
$1,873.20 |
$1,873.20 |
|
|
Ureteral reflux study
|
$603.60 |
$961.20 |
$1,879.76 |
|
|
Urethrcystgrphy rtrgrde s&i
|
$258.00 |
$615.00 |
$954.82 |
|
|
Urethrocystography void s&i
|
$258.00 |
$569.40 |
$2,184.91 |
|
|
Uric acid blood
|
$24.60 |
$55.98 |
$116.40 |
|
|
Uric acid urine
|
$32.00 |
$79.20 |
$137.40 |
|
|
Urinalysis microscopic only
|
$14.00 |
$41.40 |
$72.00 |
|
|
Urinalysis qual/semiquant excpt ia
|
$20.40 |
$52.47 |
$73.20 |
|
|
Urinalysis (with microscopy)
|
$18.38 |
$49.80 |
$135.00 |
|
|
Urinalysis (without microscopy)
|
$12.12 |
$69.00 |
$114.00 |
|
|
Urinary bldr retent nuc study
|
$403.80 |
$403.80 |
$479.41 |
|
|
Urine Culture Test
|
$16.38 |
$118.20 |
$233.40 |
|
|
Urine pregnancy test
|
$15.11 |
$93.00 |
$161.40 |
|
|
Urography, antegrade
|
$351.00 |
$351.00 |
$2,083.16 |
|
|
Urography inf drip &/or bolus
|
$551.40 |
$551.40 |
$551.40 |
|
|
Urokinase 250,000 iu inj
|
$905.51 |
$905.51 |
$905.51 |
|
|
Urokinase 5000 iu injection
|
$199.82 |
$199.82 |
$199.82 |
|
|
Use 1st target lesion
|
$942.66 |
$942.66 |
$942.66 |
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$3,183.44 |
$4,413.80 |
$5,748.88 |
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$37,645.70 |
$37,645.70 |
$154,889.53 |
|
|
Vaccine Administration (one shot)
|
$78.60 |
$87.00 |
$161.29 |
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$276.53 |
$276.53 |
$276.53 |
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$313.80 |
$313.80 |
$334.80 |
|
|
Vaccine dtap < 7 years im
|
$49.35 |
$49.35 |
$99.83 |
|
|
Vaccine dtap-hep b-ipv im
|
$165.26 |
$165.26 |
$180.74 |
|
|
Vaccine dtap-ipv 4-6 years im
|
$131.65 |
$150.98 |
$150.98 |
|
|
Vaccine dtap-ipv/hib im
|
$1,065.23 |
$1,065.23 |
$1,065.23 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$52.77 |
$52.77 |
$291.05 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$48.82 |
$61.05 |
$115.37 |
|
|
Vaccine hepatitis a (hepa) adult im
|
$135.49 |
$170.44 |
$693.19 |
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$201.80 |
$238.59 |
$238.59 |
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$55.28 |
$127.36 |
$301.11 |
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$175.91 |
$175.91 |
$481.00 |
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$296.22 |
$296.22 |
$1,417.81 |
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$45.91 |
$45.91 |
$218.30 |
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$433.16 |
$1,062.82 |
$3,162.56 |
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$418.42 |
$418.42 |
$418.42 |
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$66.09 |
$179.55 |
$669.65 |
|
|
Vaccine influenza inactivated adjuvant im
|
$34.61 |
$34.61 |
$34.61 |
|
