|
Tx tarsal bone fx without manip 28450
|
$390.60 |
$390.60 |
$410.40 |
$423.15
|
|
Tympanic membrane repair
|
$723.00 |
$723.00 |
$759.00 |
$2,133.48
|
|
Tympanolysis transcanal 69450
|
$1,018.80 |
$1,018.80 |
$1,069.80 |
$3,837.72
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$742.20 |
$742.20 |
$779.40 |
$911.43
|
|
Tympp antrt/mastoidotomy prosthesis torp 69637
|
$2,576.40 |
$2,576.40 |
$2,705.40 |
$6,740.80
|
|
Tympp antrt/mastoid without ossic chain recnst 69635
|
$2,289.00 |
$2,289.00 |
$2,403.60 |
$7,000.36
|
|
Ua w/micro/comp poc
|
$141.00 |
$141.00 |
$148.20 |
$23.00
|
|
Ultrasound breast complete
|
$507.00 |
$507.00 |
$553.80 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$472.80 |
$472.80 |
$516.60 |
$452.00
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$259.20 |
$259.20 |
$272.40 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$118.80 |
$118.80 |
$130.20 |
$296.80
|
|
Ultrasound encephalogram
|
$342.60 |
$342.60 |
$374.40 |
$488.80
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$296.40 |
$296.40 |
$324.00 |
$477.10
|
|
Ultrasound Guidance for a Needle Procedure
|
$804.00 |
$804.00 |
$844.20 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$236.40 |
$236.40 |
$273.00 |
$388.08
|
|
Ultrasound guide intraoperative
|
$472.80 |
$472.80 |
$516.60 |
$632.85
|
|
Ultrasound hips infant dynamic
|
$224.40 |
$224.40 |
$245.40 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$163.80 |
$163.80 |
$179.40 |
$304.00
|
|
Ultrasound joint complete left
|
$218.40 |
$218.40 |
$238.80 |
$560.25
|
|
Ultrasound ob >=14wks ea addl gest
|
$279.00 |
$279.00 |
$305.40 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$192.00 |
$192.00 |
$210.00 |
$333.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$331.20 |
$331.20 |
$361.80 |
$698.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$252.00 |
$252.00 |
$275.40 |
$428.25
|
|
Ultrasound prostate/transrectal
|
$318.60 |
$318.60 |
$388.80 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$364.80 |
$364.80 |
$398.40 |
$459.00
|
|
Ultrasound transabd ea addl gest
|
$213.60 |
$213.60 |
$233.40 |
$417.15
|
|
Umbilical artery cath newborn 36660
|
$137.40 |
$137.40 |
$144.00 |
$223.80
|
|
Umbilicoplasty 15847
|
$624.60 |
$624.60 |
$655.80 |
$4,172.97
|
|
Unlisted laparoscopic liver biopy 47379
|
$623.40 |
$623.40 |
$654.60 |
$6,307.38
|
|
Unlisted laparoscopic procedure 49659
|
$3,136.80 |
$3,136.80 |
$3,293.40 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$2,424.00 |
$2,424.00 |
$2,545.20 |
$5,419.00
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$1,161.00 |
$1,161.00 |
$1,219.20 |
$6,463.42
|
|
Unlisted procedure urinary 58750
|
$1,674.60 |
$1,674.60 |
$1,758.60 |
$926.40
|
|
Unlisted psychiatric service/proc 90899
|
$115.20 |
$115.20 |
$121.20 |
$277.76
|
|
Unlisted special svc px/rprt
|
$7.80 |
$7.80 |
$9.00 |
$90.00
|
|
Unlisted ultrasound procedure
|
$133.20 |
$133.20 |
$157.80 |
$335.00
|
|
Unlisted urinalysis px
|
$37.80 |
$37.80 |
$42.60 |
$25.72
|
|
Upgrade pm system
|
$13,495.20 |
$13,495.20 |
$15,587.40 |
$12,087.24
|
|
Upper Arm (Humerus) X-ray (left side)
|
$257.40 |
$257.40 |
$281.40 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$1,284.00 |
$1,284.00 |
$1,443.00 |
$1,648.20
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,229.40 |
$1,229.40 |
$1,381.20 |
$1,425.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,162.40 |
$2,162.40 |
$2,361.60 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,167.60 |
$1,167.60 |
$1,275.60 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,594.80 |
$1,594.80 |
$1,741.80 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$204.00 |
$204.00 |
$223.20 |
$320.45
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$225.00 |
$225.00 |
$246.00 |
$380.82
|
|
Upper Endoscopy (EGD, diagnostic)
|
$172.80 |
$172.80 |
$181.20 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$195.00 |
$195.00 |
$204.60 |
$1,768.00
|
|
Upper ext harvest for cabg1 seg 35600
|
$480.00 |
$480.00 |
$504.00 |
$627.20
|
|
Upper GI Barium X-ray (barium and gas)
|
$333.00 |
$333.00 |
$363.60 |
$657.77
|
|
Upper GI Barium X-ray (barium only)
|
$317.40 |
$317.40 |
$346.80 |
$603.20
|
|
Uppr gi scope w/submuc inj
|
$630.00 |
$630.00 |
$661.80 |
$1,872.00
|
|
Urachal cyst/sinus excision 51500
|
$1,254.60 |
$1,254.60 |
$1,317.60 |
$6,082.67
|
|
Urea nitrogen
|
$34.20 |
$34.20 |
$37.80 |
$42.00
|
|
Urea nitrogen 24 hour urine
|
$50.40 |
$50.40 |
$56.40 |
$51.77
|
|
Ureteral reflux study
|
$735.00 |
$735.00 |
$802.80 |
$952.50
|
|
Ureteroneocystostomy 50780
|
$2,203.20 |
$2,203.20 |
$2,313.60 |
$4,457.05
|
|
Ureteroureterostomy 50760
|
$2,095.20 |
$2,095.20 |
$2,200.20 |
$2,773.01
|
|
Urethrcystgrphy rtrgrde s&i
|
$313.80 |
$313.80 |
$343.20 |
$584.23
|
|
Urethrocystography void s&i
|
$439.80 |
$439.80 |
$480.60 |
$637.80
|
|
Uric acid blood
|
$35.40 |
$35.40 |
$40.20 |
$48.96
|
|
Uric acid urine
|
$38.40 |
$38.40 |
$43.20 |
$44.14
|
|
Urinalysis microscopic only
|
$16.20 |
$16.20 |
$17.40 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$102.00 |
$102.00 |
$113.40 |
$25.72
|
|
Urinalysis (with microscopy)
|
$26.40 |
$26.40 |
$28.20 |
$54.60
|
|
Urinalysis (without microscopy)
|
$21.00 |
$21.00 |
$200.40 |
$35.35
|
|
Urinary bldr retent nuc study
|
$267.00 |
$267.00 |
$292.20 |
$350.66
|
|
Urine Culture Test
|
$45.00 |
$45.00 |
$47.40 |
$81.27
|
|
Urine flow measurement 51736
|
$85.80 |
$85.80 |
$90.00 |
$210.00
|
|
Urine pregnancy test
|
$60.60 |
$60.60 |
$67.80 |
$67.80
|
|
Urography, antegrade
|
$550.80 |
$550.80 |
$601.80 |
$622.35
|
|
Urography inf drip &/or bolus
|
$393.00 |
$393.00 |
$429.60 |
$642.50
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$23,483.45 |
$23,483.45 |
$25,816.55 |
$5,205.00
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$46,966.91 |
$46,966.91 |
$51,633.07 |
$51,633.07
|
|
Vaccine Administration (one shot)
|
$43.20 |
$43.20 |
$52.80 |
$67.74
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$263.57 |
$263.57 |
$263.57 |
$227.04
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$240.91 |
$240.91 |
$240.91 |
$211.89
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$240.91 |
$240.91 |
$274.01 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$148.80 |
$148.80 |
$159.71 |
$123.20
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$114.26 |
$114.26 |
$114.26 |
$80.15
|
|
Vaccine dtap < 7 years im
|
$61.39 |
$61.39 |
$66.25 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$169.85 |
$169.85 |
$195.95 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$119.81 |
$119.81 |
$126.79 |
$105.95
|
|
Vaccine dtap-ipv-hib-hepb im
|
$270.73 |
$270.73 |
$288.65 |
$174.72
|
|
Vaccine dtap-ipv/hib im
|
$199.37 |
$199.37 |
$199.37 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$65.04 |
$65.04 |
$65.04 |
$72.00
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$63.25 |
$63.25 |
$63.25 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$152.29 |
$152.29 |
$165.01 |
$168.95
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$112.22 |
$112.22 |
$116.72 |
$231.56
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$140.56 |
$140.56 |
$144.41 |
$80.28
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$130.79 |
$130.79 |
$140.37 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$261.45 |
$261.45 |
$273.90 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$60.45 |
$60.45 |
$64.23 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$521.70 |
$521.70 |
$557.26 |
$562.20
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$126.46 |
$126.46 |
$152.43 |
$143.20
|
|
Vaccine influenza inactivated adjuvant im
|
$142.36 |
$142.36 |
$142.36 |
$96.84
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$47.38 |
$47.38 |
$47.38 |
$48.59
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$16.34 |
$16.34 |
$16.34 |
$35.88
|
|
Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im
|
$132.61 |
$132.61 |
$132.61 |
$72.80
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$50.08 |
$50.08 |
$50.08 |
$33.21
|