|
Ultrasound doppler velocimetry fetal umbilical artery
|
$397.70 |
$397.70 |
$397.70 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$265.85 |
$265.85 |
$265.85 |
$296.80
|
|
Ultrasound elastography ea l target les
|
$302.60 |
$302.60 |
$302.60 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$302.60 |
$302.60 |
$302.60 |
$313.95
|
|
Ultrasound encephalogram
|
$797.45 |
$797.45 |
$797.45 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$2,025.10 |
$2,025.10 |
$2,025.10 |
$575.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$985.60 |
$985.60 |
$985.60 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$1,119.90 |
$1,119.90 |
$1,119.90 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$240.55 |
$240.55 |
$240.55 |
$388.08
|
|
Ultrasound guide intraoperative
|
$1,506.65 |
$1,506.65 |
$1,506.65 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$767.80 |
$767.80 |
$767.80 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$606.10 |
$606.10 |
$606.10 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$518.50 |
$518.50 |
$518.50 |
$311.25
|
|
Ultrasound joint complete left
|
$696.05 |
$696.05 |
$696.05 |
$557.99
|
|
Ultrasound ob >=14wks ea addl gest
|
$635.80 |
$635.80 |
$635.80 |
$409.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$584.80 |
$584.80 |
$584.80 |
$335.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,183.80 |
$1,183.80 |
$1,183.80 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$785.00 |
$785.00 |
$785.00 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$687.70 |
$687.70 |
$687.70 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$797.45 |
$797.45 |
$797.45 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$1,906.25 |
$1,906.25 |
$1,906.25 |
$421.00
|
|
Unlisted chemotherapy px
|
$149.15 |
$149.15 |
$149.15 |
$143.75
|
|
Unlisted cranfcl&maxlfcl px
|
$336.70 |
$336.70 |
$336.70 |
$571.20
|
|
Unlisted CT procedure
|
$2,810.00 |
$2,810.00 |
$2,810.00 |
$732.70
|
|
Unlisted dx gi procedure
|
$1,711.55 |
$1,711.55 |
$1,711.55 |
$649.22
|
|
Unlisted fluoroscopic px
|
$685.40 |
$685.40 |
$685.40 |
$305.76
|
|
Unlisted gi px dx nuc med
|
$1,792.95 |
$1,792.95 |
$1,792.95 |
$995.00
|
|
Unlisted hystsc px uterus
|
$775.95 |
$775.95 |
$775.95 |
$3,027.89
|
|
Unlisted mr procedure
|
$2,447.25 |
$2,447.25 |
$2,447.25 |
$1,163.00
|
|
Unlisted neurological dx px
|
$207.05 |
$207.05 |
$207.05 |
$242.50
|
|
Unlisted procedure colon
|
$3,909.30 |
$3,909.30 |
$3,909.30 |
$1,839.55
|
|
Unlisted procedure esophagus
|
$1,929.50 |
$1,929.50 |
$1,929.50 |
$1,998.88
|
|
Unlisted procedure liver
|
$7,912.85 |
$7,912.85 |
$7,912.85 |
$2,287.20
|
|
Unlisted procedure rectum
|
$1,220.35 |
$1,220.35 |
$1,220.35 |
$1,223.20
|
|
Unlisted procedure spine
|
$5,541.30 |
$5,541.30 |
$5,541.30 |
$4,659.85
|
|
Unlisted px hands/fingers
|
$417.70 |
$417.70 |
$417.70 |
$354.20
|
|
Unlisted px male genital sys
|
$3,849.20 |
$3,849.20 |
$3,849.20 |
$387.84
|
|
Unlisted px neck/thorax
|
$8,585.60 |
$8,585.60 |
$8,585.60 |
$571.20
|
|
Unlisted px pelvis/hip joint
|
$13,363.70 |
$13,363.70 |
$13,363.70 |
$3,251.90
|
|
Unlisted px small intestine
|
$1,918.15 |
$1,918.15 |
$1,918.15 |
$2,118.35
|
|
Unlisted resp px dx nuc med
|
$744.70 |
$744.70 |
$744.70 |
$670.60
|
|
Unlisted surgical path px
|
$1,193.55 |
$1,193.55 |
$1,193.55 |
$217.75
|
|
Unlisted transfusion med px
|
$451.00 |
$451.00 |
$451.00 |
$147.50
|
|
Unlisted ultrasound procedure
|
$1,120.15 |
$1,120.15 |
$1,120.15 |
$335.00
|
|
Unsched dialysis esrd pt hos
|
$3,758.00 |
$3,758.00 |
$3,758.00 |
$1,296.00
|
|
Upgrade pm system
|
$5,203.95 |
$5,203.95 |
$5,203.95 |
$12,077.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$393.95 |
$393.95 |
$393.95 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$2,481.90 |
$2,481.90 |
$2,481.90 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$2,107.70 |
$2,107.70 |
$2,107.70 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$8,730.55 |
$8,730.55 |
$8,730.55 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$4,713.95 |
$4,713.95 |
$4,713.95 |
$2,392.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$4,362.00 |
$4,362.00 |
$4,362.00 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$534.95 |
$534.95 |
$534.95 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$534.95 |
$534.95 |
$534.95 |
$381.60
|
|
Upper GI Barium X-ray (barium and gas)
|
$1,054.10 |
$1,054.10 |
$1,054.10 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$1,122.85 |
$1,122.85 |
$1,122.85 |
$607.20
|
|
Urea nitrogen
|
$87.50 |
$87.50 |
$87.50 |
$42.01
|
|
Urea nitrogen 24 hour urine
|
$103.80 |
$103.80 |
$103.80 |
$51.84
|
|
Urea nitrogen clearance
|
$179.45 |
$179.45 |
$179.45 |
$34.02
|
|
Ureteral embolization/occl
|
$5,096.50 |
$5,096.50 |
$5,096.50 |
$2,079.31
|
|
Ureteral reflux study
|
$1,185.35 |
$1,185.35 |
$1,185.35 |
$952.50
|
|
Ureter endoscopy
|
$5,834.50 |
$5,834.50 |
$5,834.50 |
$3,326.40
|
|
Urethrcystgrphy rtrgrde s&i
|
$927.65 |
$927.65 |
$927.65 |
$584.00
|
|
Urethrocystography void s&i
|
$839.95 |
$839.95 |
$839.95 |
$634.50
|
|
Uric acid blood
|
$103.55 |
$103.55 |
$103.55 |
$49.32
|
|
Uric acid urine
|
$112.10 |
$112.10 |
$112.10 |
$44.52
|
|
Urinalysis microscopic only
|
$82.95 |
$82.95 |
$82.95 |
$26.35
|
|
Urinalysis (with microscopy)
|
$100.55 |
$100.55 |
$100.55 |
$55.20
|
|
Urinalysis (without microscopy)
|
$47.70 |
$47.70 |
$47.70 |
$35.91
|
|
Urine Culture Test
|
$163.80 |
$163.80 |
$163.80 |
$82.32
|
|
Urine pregnancy test
|
$35.25 |
$35.25 |
$35.25 |
$68.21
|
|
Urography, antegrade
|
$938.00 |
$938.00 |
$938.00 |
$622.35
|
|
Use 1st target lesion
|
$302.60 |
$302.60 |
$302.60 |
$332.00
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$7,606.40 |
$7,606.40 |
$7,606.40 |
$5,205.00
|
|
Vaccine Administration (one shot)
|
$59.40 |
$59.40 |
$59.40 |
$67.74
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$160.00 |
$160.00 |
$160.00 |
$224.25
|
|
Vaccine dtap < 7 years im
|
$37.90 |
$37.90 |
$37.90 |
$71.17
|
|
Vaccine hepatitis a (hepa) adult im
|
$876.97 |
$876.97 |
$876.97 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$753.18 |
$753.18 |
$753.18 |
$231.56
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$790.84 |
$790.84 |
$790.84 |
$78.25
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$61.65 |
$61.65 |
$61.65 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$1,585.45 |
$1,585.45 |
$1,585.45 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$1,901.42 |
$1,901.42 |
$1,901.42 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$3,131.29 |
$3,131.29 |
$3,131.29 |
$576.48
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$220.40 |
$220.40 |
$220.40 |
$282.50
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$746.80 |
$746.80 |
$746.80 |
$149.21
|
|
Vaccine influenza nos 0.5ml dose im
|
$28.25 |
$28.25 |
$28.25 |
$24.20
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$200.84 |
$200.84 |
$200.84 |
$48.59
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$40.55 |
$40.55 |
$40.55 |
$35.88
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$36.10 |
$36.10 |
$36.10 |
$33.60
|
|
Vaccine influenza trivalent (iiv3) 0.25ml dose im
|
$27.45 |
$27.45 |
$27.45 |
$23.20
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$326.55 |
$326.55 |
$326.55 |
$394.26
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$1,750.58 |
$1,750.58 |
$1,750.58 |
$310.93
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$1,697.40 |
$1,697.40 |
$1,697.40 |
$327.37
|
|
Vaccine mmr live subcutaneous
|
$969.09 |
$969.09 |
$969.09 |
$213.00
|
|
Vaccine mmrv live subcutaneous
|
$85.30 |
$85.30 |
$85.30 |
$424.32
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$46.75 |
$46.75 |
$46.75 |
$252.87
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$210.70 |
$210.70 |
$210.70 |
$393.25
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$2,882.91 |
$2,882.91 |
$2,882.91 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$455.35 |
$455.35 |
$455.35 |
$90.70
|