|
Ultrasound guidance for vascular access
|
$286.65 |
$286.65 |
$351.00 |
|
|
Ultrasound guided needle placement supervision & interpretation
|
$527.80 |
$670.15 |
$871.00 |
|
|
Ultrasound guide intraoperative
|
$546.65 |
$727.35 |
$1,076.40 |
|
|
Ultrasound guide tissue ablation
|
$1,037.40 |
$1,037.40 |
$1,037.40 |
|
|
Ultrasound hips infant dynamic
|
$538.20 |
$538.20 |
$665.60 |
|
|
Ultrasound infant hips ltd without stress
|
$258.70 |
$258.70 |
$377.65 |
|
|
Ultrasound joint complete left
|
$35.25 |
$626.60 |
$776.75 |
|
|
Ultrasound joint/nonvascular extremity limited left
|
$24.00 |
$616.85 |
$1,318.85 |
|
|
Ultrasound ob >=14wks ea addl gest
|
$202.80 |
$342.55 |
$538.20 |
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$220.35 |
$282.75 |
$366.60 |
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$388.05 |
$760.50 |
$1,190.15 |
|
|
Ultrasound pregnant uterus follow up per fetus
|
$220.35 |
$311.35 |
$373.10 |
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$265.85 |
$388.05 |
$627.25 |
|
|
Ultrasound pregnant uterus transvaginal
|
$342.55 |
$411.45 |
$590.85 |
|
|
Ultrasound prostate/transrectal
|
$366.60 |
$395.20 |
$525.85 |
|
|
Ultrasound retroperitoneal limited
|
$230.10 |
$424.45 |
$873.60 |
|
|
Ultrasound scrotum and contents
|
$39.00 |
$580.45 |
$949.00 |
|
|
Ultrasound spinal canal and contents
|
$382.85 |
$412.10 |
$415.35 |
|
|
Ultrasound transabd ea addl gest
|
$232.70 |
$443.95 |
$513.50 |
|
|
Ultrasound transvaginal non obstetric
|
$41.25 |
$583.70 |
$905.45 |
|
|
Ultraviolet therapy
|
$43.55 |
$43.55 |
$43.55 |
|
|
Umbilical artery cath newborn 36660
|
$722.80 |
$722.80 |
$722.80 |
|
|
Unit mobile power mpu
|
$13,936.00 |
$13,936.00 |
$13,936.00 |
|
|
Unlisted fluoroscopic px
|
$672.10 |
$672.10 |
$672.10 |
|
|
Unlisted laparoscopic liver biopy 47379
|
$2,636.40 |
$11,472.80 |
$24,890.05 |
|
|
Unlisted laparoscopic procedure 49659
|
$17,828.15 |
$17,828.15 |
$26,568.24 |
|
|
Unlisted laparoscopic reduction intestine 44238
|
$2,303.60 |
$2,303.60 |
$19,318.29 |
|
|
Unlisted laps px appendix
|
$1,652.30 |
$1,701.70 |
$24,780.58 |
|
|
Unlisted laps px bladder
|
$12,516.97 |
$12,516.97 |
$12,516.97 |
|
|
Unlisted laps px ovidct ovry
|
$7,485.18 |
$7,485.18 |
$11,574.02 |
|
|
Unlisted laps px spleen
|
$15,988.84 |
$15,988.84 |
$15,988.84 |
|
|
Unlisted mr procedure
|
$1,298.70 |
$1,298.70 |
$2,579.85 |
|
|
Unlisted muscskel px head
|
$2,893.15 |
$2,893.15 |
$2,893.15 |
|
|
Unlisted neurological dx px
|
$128.05 |
$128.05 |
$413.40 |
|
|
Unlisted procedure colon
|
$604.50 |
$604.50 |
$604.50 |
|
|
Unlisted procedure esophagus
|
$2,558.07 |
$2,558.07 |
$2,558.07 |
|
|
Unlisted procedure eyelids
|
$7,699.37 |
$7,699.37 |
$7,699.37 |
|
|
Unlisted procedure larynx
|
$12,554.16 |
$12,554.16 |
$12,554.16 |
|
|
Unlisted procedure liver
|
$37,043.77 |
$37,043.77 |
$37,043.77 |
|
|
Unlisted procedure microbiology
|
$33.80 |
$33.80 |
$164.45 |
|
|
Unlisted procedure rectum
|
$19,937.54 |
$19,937.54 |
$19,937.54 |
|
|
Unlisted procedure spine
|
$5,073.90 |
$5,073.90 |
$5,073.90 |
|
|
Unlisted px ant segment eye
|
$110.50 |
$110.50 |
$2,641.60 |
|
|
Unlisted px arthroscopy
|
$8,651.39 |
$26,600.12 |
$54,739.68 |
|
|
Unlisted px biliary tract
|
$4,666.35 |
$4,666.35 |
$4,666.35 |
|
|
Unlisted px casting/strpg
|
$97.50 |
$97.50 |
$111.80 |
|
|
Unlisted px foot/toes
|
$2,849.60 |
$2,849.60 |
$2,849.60 |
|
|
Unlisted px hands/fingers
|
$349.70 |
$349.70 |
$349.70 |
|
|
Unlisted px lacrimal system
|
$6,222.57 |
$6,222.57 |
$6,222.57 |
|
|
Unlisted px leg/ankle
|
$759.20 |
$759.20 |
$759.20 |
|
|
Unlisted px middle ear
|
$25,468.01 |
$25,468.01 |
$25,468.01 |
|
|
Unlisted px neck/thorax
|
$12,435.80 |
$12,435.80 |
$12,435.80 |
|
|
Unlisted px pelvis/hip joint
|
$8,160.10 |
$8,160.10 |
$8,160.10 |
|
|
Unlisted px posterior segmnt
|
$16,151.39 |
$16,151.39 |
$16,151.39 |
|
|
Unlisted px salivry glnd/dux
|
$24,442.12 |
$24,442.12 |
$24,442.12 |
|
|
Unlisted px small intestine
|
$618.15 |
$618.15 |
$5,335.40 |
|
|
Unlisted px tongue flr mouth
|
$386.75 |
$386.75 |
$386.75 |
|
|
Unlisted transfusion med px
|
$100.75 |
$158.60 |
$177.45 |
|
|
Unlisted ultrasound procedure
|
$212.55 |
$212.55 |
$260.65 |
|
|
Unlstd laps px sprmatic cord
|
$29,217.19 |
$29,217.19 |
$29,217.19 |
|
|
Unsched dialysis esrd pt hos
|
$1,027.00 |
$1,027.00 |
$1,398.80 |
|
|
Upgrade pm system
|
$29,010.89 |
$29,010.89 |
$29,010.89 |
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,561.95 |
$2,583.10 |
$3,146.00 |
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,450.15 |
$1,948.70 |
$2,941.25 |
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$94.50 |
$1,794.00 |
$2,189.20 |
|
|
Upper Endoscopy (EGD, diagnostic)
|
$2,895.10 |
$3,311.93 |
$7,432.50 |
|
|
Upper Endoscopy (EGD, with biopsy)
|
$3,435.05 |
$4,107.16 |
$7,903.79 |
|
|
Uppr gi scope w/submuc inj
|
$4,312.59 |
$5,055.67 |
$6,924.24 |
|
|
Urachal cyst/sinus excision 51500
|
$10,702.50 |
$10,702.50 |
$10,702.50 |
|
|
Urea nitrogen
|
$21.75 |
$48.10 |
$90.35 |
|
|
Urea nitrogen 24 hour urine
|
$3.25 |
$55.90 |
$93.60 |
|
|
Ureteral reflux study
|
$832.65 |
$832.65 |
$832.65 |
|
|
Urethrcystgrphy rtrgrde s&i
|
$496.60 |
$496.60 |
$663.00 |
|
|
Urethrocystography void s&i
|
$601.25 |
$702.00 |
$949.65 |
|
|
Uric acid blood
|
$21.75 |
$48.75 |
$111.15 |
|
|
Uric acid urine
|
$45.50 |
$63.70 |
$120.25 |
|
|
Urinalysis microscopic only
|
$18.85 |
$35.10 |
$64.35 |
|
|
Urinalysis (with microscopy)
|
$19.50 |
$53.95 |
$113.75 |
|
|
Urinalysis (without microscopy)
|
$11.25 |
$37.70 |
$81.25 |
|
|
Urinary bldr retent nuc study
|
$751.40 |
$751.40 |
$751.40 |
|
|
Urine Culture Test
|
$24.75 |
$95.55 |
$159.90 |
|
|
Urine pregnancy test
|
$24.00 |
$73.45 |
$137.80 |
|
|
Urography, antegrade
|
$392.60 |
$588.25 |
$707.85 |
|
|
Urography inf drip &/or bolus
|
$692.25 |
$692.25 |
$692.25 |
|
|
Use 1st target lesion
|
$748.80 |
$748.80 |
$748.80 |
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$7,241.17 |
$9,179.72 |
$9,700.52 |
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$63,077.71 |
$63,077.71 |
$66,658.97 |
|
|
Vaccine dtap < 7 years im
|
$29.25 |
$88.47 |
$123.67 |
|
|
Vaccine dtap-hep b-ipv im
|
$193.50 |
$324.80 |
$349.24 |
|
|
Vaccine dtap-ipv 4-6 years im
|
$126.00 |
$126.00 |
$188.04 |
|
|
Vaccine dtap-ipv-hib-hepb im
|
$792.00 |
$792.00 |
$792.00 |
|
|
Vaccine dtap-ipv/hib im
|
$156.00 |
$156.00 |
$412.03 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$29.25 |
$92.87 |
$99.85 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$39.78 |
$39.78 |
$52.50 |
|
|
Vaccine hepatitis a (hepa) adult im
|
$70.50 |
$70.50 |
$118.60 |
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$52.50 |
$268.45 |
$288.66 |
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$84.75 |
$84.75 |
$84.75 |
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$63.00 |
$241.64 |
$314.13 |
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$29.25 |
$86.19 |
$124.04 |
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$307.50 |
$307.50 |
$1,067.10 |
|
