|
Ultrasound guide tissue ablation
|
$238.98 |
$238.98 |
$350.75 |
|
|
Ultrasound hips infant dynamic
|
$299.50 |
$314.58 |
$421.51 |
|
|
Ultrasound infant hips ltd without stress
|
$292.74 |
$292.74 |
$415.36 |
|
|
Ultrasound joint complete left
|
$380.10 |
$451.26 |
$769.92 |
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$402.36 |
$402.36 |
$402.36 |
|
|
Ultrasound ob >=14wks ea addl gest
|
$149.50 |
$279.72 |
$731.00 |
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$238.85 |
$279.72 |
$816.72 |
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$288.42 |
$490.98 |
$1,339.62 |
|
|
Ultrasound pregnant uterus follow up per fetus
|
$182.62 |
$297.50 |
$512.11 |
|
|
Ultrasound prostate/transrectal
|
$77.19 |
$302.40 |
$1,140.70 |
|
|
Ultrasound spinal canal and contents
|
$290.64 |
$343.50 |
$1,382.95 |
|
|
Ultrasound transabd ea addl gest
|
$327.52 |
$408.24 |
$1,339.62 |
|
|
Ultraviolet therapy
|
$31.54 |
$31.54 |
$31.54 |
|
|
Umbilical artery cath newborn 36660
|
$104.42 |
$168.42 |
$253.76 |
|
|
Unlisted dx gi procedure
|
$1,598.52 |
$1,598.52 |
$1,598.52 |
|
|
Unlisted fluoroscopic px
|
$285.60 |
$285.60 |
$958.92 |
|
|
Unlisted hematology&coagj px
|
$34.31 |
$34.31 |
$34.31 |
|
|
Unlisted mr procedure
|
$67.20 |
$67.20 |
$655.75 |
|
|
Unlisted orl service/px
|
$40.32 |
$40.32 |
$118.69 |
|
|
Unlisted procedure liver
|
$371.70 |
$371.70 |
$371.70 |
|
|
Unlisted procedure microbiology
|
$13.50 |
$13.50 |
$13.50 |
|
|
Unlisted procedure rectum
|
$746.00 |
$746.00 |
$746.00 |
|
|
Unlisted procedure spine
|
$3,536.17 |
$3,536.17 |
$3,536.17 |
|
|
Unlisted px biliary tract
|
$599.76 |
$599.76 |
$2,411.33 |
|
|
Unlisted px casting/strpg
|
$132.80 |
$147.00 |
$279.65 |
|
|
Unlisted px external ear
|
$158.34 |
$158.34 |
$187.88 |
|
|
Unlisted px foot/toes
|
$1,547.00 |
$1,797.60 |
$1,797.60 |
|
|
Unlisted px hands/fingers
|
$178.77 |
$213.36 |
$1,430.50 |
|
|
Unlisted px leg/ankle
|
$473.36 |
$1,528.38 |
$2,379.00 |
|
|
Unlisted px male genital sys
|
$157.92 |
$157.92 |
$237.18 |
|
|
Unlisted px pelvis/hip joint
|
$430.66 |
$430.66 |
$430.66 |
|
|
Unlisted px small intestine
|
$2,102.10 |
$2,102.10 |
$2,774.69 |
|
|
Unlisted px tongue flr mouth
|
$161.65 |
$173.88 |
$191.73 |
|
|
Unlisted transfusion med px
|
$55.66 |
$63.84 |
$236.30 |
|
|
Unlisted ultrasound procedure
|
$189.42 |
$189.42 |
$387.35 |
|
|
Unlisted urinalysis px
|
$26.50 |
$30.71 |
$353.60 |
|
|
Unsched dialysis esrd pt hos
|
$468.72 |
$468.72 |
$888.16 |
|
|
Upgrade pm system
|
$5,329.10 |
$10,574.76 |
$10,574.76 |
|
|
Upper Arm (Humerus) X-ray (left side)
|
$191.36 |
$217.00 |
$394.12 |
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$1,102.50 |
$1,593.50 |
$2,750.60 |
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$912.18 |
$1,386.00 |
$2,595.05 |
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,716.04 |
$1,748.88 |
$4,323.10 |
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,430.03 |
$1,577.10 |
$4,089.35 |
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,144.02 |
$1,561.56 |
$3,894.70 |
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$183.96 |
$219.00 |
$400.35 |
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$230.16 |
$306.50 |
$531.20 |
|
|
Upper Endoscopy (EGD, diagnostic)
|
$643.02 |
$643.02 |
$2,244.32 |
|
|
Upper Endoscopy (EGD, with biopsy)
|
$483.80 |
$1,924.86 |
$2,244.32 |
|
|
Upper ext fx orthosis rad/ul
|
$33.39 |
$33.39 |
$33.79 |
|
|
Upper GI Barium X-ray (barium and gas)
|
$465.36 |
$530.04 |
$1,098.92 |
|
|
Upper GI Barium X-ray (barium only)
|
$325.08 |
$478.19 |
$1,034.18 |
|
|
Uppr gi scope w/submuc inj
|
$974.42 |
$986.16 |
$997.90 |
|
|
Urea nitrogen
|
$17.94 |
$39.90 |
$78.20 |
|
|
Urea nitrogen 24 hour urine
|
$13.80 |
$36.96 |
$98.60 |
|
|
Ureteral embolization/occl
|
$203.74 |
$203.74 |
$388.22 |
|
|
Ureteral reflux study
|
$537.83 |
$537.83 |
$1,403.50 |
|
|
Urethrcystgrphy rtrgrde s&i
|
$476.70 |
$504.00 |
$770.54 |
|
|
Urethrocystography void s&i
|
$420.84 |
$471.66 |
$785.88 |
|
|
Uric acid blood
|
$8.58 |
$52.92 |
$113.90 |
|
|
Uric acid urine
|
$13.57 |
$39.90 |
$128.35 |
|
|
Urinalysis microscopic only
|
$6.52 |
$44.10 |
$64.60 |
|
|
Urinalysis qual/semiquant excpt ia
|
$4.56 |
$29.40 |
$29.40 |
|
|
Urinalysis (with microscopy)
|
$19.32 |
$61.32 |
$100.43 |
|
|
Urinalysis (without microscopy)
|
$4.56 |
$34.02 |
$54.40 |
|
|
Urine Culture Test
|
$17.18 |
$71.82 |
$181.05 |
|
|
Urine pregnancy test
|
$37.82 |
$63.42 |
$113.05 |
|
|
Urography, antegrade
|
$476.50 |
$485.94 |
$1,161.95 |
|
|
Use 1st target lesion
|
$113.82 |
$113.82 |
$113.82 |
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$35.80 |
$4,249.30 |
$8,599.78 |
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$12,940.35 |
$29,537.74 |
$59,778.76 |
|
|
Vaccine Administration (one shot)
|
$38.34 |
$55.66 |
$332.83 |
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$171.12 |
$234.36 |
$474.30 |
|
|
Vaccine dtap < 7 years im
|
$26.04 |
$109.47 |
$221.53 |
|
|
Vaccine dtap-hep b-ipv im
|
$60.44 |
$137.96 |
$279.20 |
|
|
Vaccine dtap-ipv 4-6 years im
|
$44.31 |
$101.14 |
$204.68 |
|
|
Vaccine dtap-ipv/hib im
|
$118.52 |
$118.52 |
$239.86 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$25.85 |
$59.01 |
$119.41 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$5.86 |
$118.52 |
$239.86 |
|
|
Vaccine hepatitis a (hepa) adult im
|
$31.32 |
$142.98 |
$289.35 |
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$25.72 |
$58.71 |
$118.81 |
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$20.98 |
$95.75 |
$193.77 |
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$19.50 |
$77.44 |
$156.72 |
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$31.50 |
$31.50 |
$63.75 |
|
|
Vaccine influenza inactivated adjuvant im
|
$37.80 |
$59.08 |
$106.60 |
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$13.85 |
$18.90 |
$38.25 |
|
|
Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im
|
$32.34 |
$47.34 |
$85.41 |
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$14.76 |
$17.64 |
$35.70 |
|
|
Vaccine influenza quadrivalent live (laiv4) intranasal
|
$11.27 |
$17.64 |
$35.70 |
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$18.90 |
$23.66 |
$42.69 |
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$153.63 |
$350.68 |
$709.70 |
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$51.06 |
$263.34 |
$532.95 |
|
|
Vaccine mmr live subcutaneous
|
$119.85 |
$547.12 |
$1,107.26 |
|
|
Vaccine mmrv live subcutaneous
|
$336.42 |
$336.42 |
$680.84 |
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$103.94 |
$237.26 |
$480.16 |
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$178.00 |
$406.29 |
$822.25 |
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$215.10 |
$490.98 |
$993.65 |
|
|
Vaccine polio (ipv) subcutaneous/im
|
$37.74 |
$861.32 |
$1,743.14 |
|
|
Vaccine rabies im
|
$151.02 |
$689.41 |
$1,395.24 |
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$483.86 |
$1,104.47 |
$2,235.22 |
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$241.93 |
$1,104.47 |
$2,235.22 |
|