|
Tympanostomy/ven tube/loc/top anes 69433
|
$898.40 |
$898.40 |
$1,130.40 |
|
|
Ua w/micro/comp poc
|
$26.40 |
$26.40 |
$26.40 |
|
|
Ultrasound breast complete
|
$343.20 |
$343.20 |
$431.20 |
|
|
Ultrasound breast unilateral limited (both sides)
|
$358.40 |
$358.40 |
$376.80 |
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$240.00 |
$408.00 |
$512.00 |
|
|
Ultrasound dx ophth b-scan
|
$377.60 |
$377.60 |
$390.40 |
|
|
Ultrasound elastography parenchyma
|
$241.60 |
$241.60 |
$241.60 |
|
|
Ultrasound encephalogram
|
$483.20 |
$483.20 |
$488.80 |
|
|
Ultrasound exam k transpl w/doppler
|
$610.40 |
$610.40 |
$987.20 |
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$401.60 |
$576.00 |
$627.20 |
|
|
Ultrasound Guidance for a Needle Procedure
|
$799.20 |
$820.80 |
$954.40 |
|
|
Ultrasound guidance for vascular access
|
$180.80 |
$180.80 |
$589.60 |
|
|
Ultrasound guide intraoperative
|
$900.80 |
$900.80 |
$900.80 |
|
|
Ultrasound guide tissue ablation
|
$388.80 |
$388.80 |
$480.80 |
|
|
Ultrasound hips infant dynamic
|
$348.80 |
$348.80 |
$433.60 |
|
|
Ultrasound infant hips ltd without stress
|
$391.20 |
$391.20 |
$392.00 |
|
|
Ultrasound joint complete left
|
$390.40 |
$549.60 |
$624.80 |
|
|
Ultrasound ob >=14wks ea addl gest
|
$431.20 |
$431.20 |
$618.40 |
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$269.60 |
$373.60 |
$396.80 |
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$565.60 |
$565.60 |
$653.60 |
|
|
Ultrasound pregnant uterus follow up per fetus
|
$420.80 |
$420.80 |
$486.40 |
|
|
Ultrasound prostate/transrectal
|
$588.00 |
$628.00 |
$638.40 |
|
|
Ultrasound spinal canal and contents
|
$429.60 |
$429.60 |
$520.00 |
|
|
Ultrasound transabd ea addl gest
|
$410.40 |
$410.40 |
$581.60 |
|
|
Umbilical artery cath newborn 36660
|
$148.00 |
$148.00 |
$151.20 |
|
|
Unlisted chemotherapy px
|
$188.80 |
$188.80 |
$288.00 |
|
|
Unlisted cranfcl&maxlfcl px
|
$1,226.40 |
$1,226.40 |
$1,226.40 |
|
|
Unlisted cv px dx nuc med
|
$812.00 |
$812.00 |
$812.00 |
|
|
Unlisted dialysis procedure
|
$1,620.00 |
$1,620.00 |
$1,620.00 |
|
|
Unlisted dx gi procedure
|
$1,206.40 |
$1,206.40 |
$1,761.60 |
|
|
Unlisted fluoroscopic px
|
$226.40 |
$226.40 |
$226.40 |
|
|
Unlisted laps px bladder
|
$1,131.20 |
$1,131.20 |
$1,131.20 |
|
|
Unlisted mr procedure
|
$179.20 |
$179.20 |
$528.80 |
|
|
Unlisted muscskel px head
|
$708.00 |
$708.00 |
$708.00 |
|
|
Unlisted neurological dx px
|
$1,679.20 |
$1,679.20 |
$1,679.20 |
|
|
Unlisted procedure colon
|
$2,791.20 |
$2,791.20 |
$2,791.20 |
|
|
Unlisted procedure esophagus
|
$2,642.40 |
$2,642.40 |
$2,642.40 |
|
|
Unlisted procedure larynx
|
$472.80 |
$472.80 |
$1,518.40 |
|
|
Unlisted procedure liver
|
$1,984.80 |
$1,984.80 |
$4,038.40 |
|
|
Unlisted procedure pancreas
|
$3,272.00 |
$3,272.00 |
$3,272.00 |
|
|
Unlisted procedure rectum
|
$1,276.80 |
$1,276.80 |
$1,466.40 |
|
|
Unlisted procedure spine
|
$1,569.60 |
$1,569.60 |
$1,569.60 |
|
|
Unlisted px abdomen muscskel
|
$453.60 |
$453.60 |
$2,956.80 |
|
|
Unlisted px ant segment eye
|
$3,416.80 |
$3,416.80 |
$3,416.80 |
|
|
Unlisted px biliary tract
|
$4,723.20 |
$4,723.20 |
$4,723.20 |
|
|
Unlisted px casting/strpg
|
$224.80 |
$224.80 |
$224.80 |
|
|
Unlisted px foot/toes
|
$406.40 |
$406.40 |
$406.40 |
|
|
Unlisted px forearm/wrist
|
$412.80 |
$412.80 |
$412.80 |
|
|
Unlisted px hands/fingers
|
$406.40 |
$406.40 |
$932.00 |
|
|
Unlisted px leg/ankle
|
$406.40 |
$406.40 |
$4,000.00 |
|
|
Unlisted px male genital sys
|
$3,316.80 |
$3,316.80 |
$3,316.80 |
|
|
Unlisted px mediastinum
|
$2,838.40 |
$2,838.40 |
$2,838.40 |
|
|
Unlisted px neck/thorax
|
$280.80 |
$280.80 |
$2,188.80 |
|
|
Unlisted px palate uvula
|
$2,411.20 |
$2,411.20 |
$2,411.20 |
|
|
Unlisted px pelvis/hip joint
|
$783.20 |
$783.20 |
$5,344.00 |
|
|
Unlisted px small intestine
|
$3,737.60 |
$3,737.60 |
$4,720.00 |
|
|
Unlisted px tongue flr mouth
|
$408.00 |
$408.00 |
$408.00 |
|
|
Unlisted reprod med lab proc
|
$56.80 |
$56.80 |
$60.00 |
|
|
Unlisted resp px dx nuc med
|
$1,273.60 |
$1,273.60 |
$1,273.60 |
|
|
Unlisted special svc px/rprt
|
$253.60 |
$253.60 |
$253.60 |
|
|
Unlisted ultrasound procedure
|
$415.20 |
$415.20 |
$624.80 |
|
|
Unsched dialysis esrd pt hos
|
$1,620.00 |
$1,620.00 |
$1,620.00 |
|
|
Upgrade pm system
|
$16,259.20 |
$16,259.20 |
$20,794.40 |
|
|
Upper Arm (Humerus) X-ray (left side)
|
$160.80 |
$196.00 |
$393.60 |
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$1,683.20 |
$2,258.40 |
$2,820.80 |
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,360.00 |
$1,468.80 |
$2,528.80 |
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,253.60 |
$3,856.00 |
$4,052.80 |
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,558.40 |
$3,183.20 |
$3,355.20 |
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,102.40 |
$2,102.40 |
$3,093.60 |
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$237.60 |
$253.60 |
$388.00 |
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$284.00 |
$428.00 |
$443.20 |
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,760.00 |
$1,760.00 |
$2,561.60 |
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,760.00 |
$1,760.00 |
$2,573.60 |
|
|
Upper ext fx orthosis rad/ul
|
$227.00 |
$227.00 |
$308.00 |
|
|
Upper GI Barium X-ray (barium and gas)
|
$492.00 |
$868.00 |
$984.00 |
|
|
Upper GI Barium X-ray (barium only)
|
$421.60 |
$808.80 |
$893.60 |
|
|
Uppr gi scope w/submuc inj
|
$2,408.00 |
$2,408.00 |
$2,408.00 |
|
|
Urea nitrogen
|
$27.20 |
$27.20 |
$27.20 |
|
|
Urea nitrogen 24 hour urine
|
$51.20 |
$51.20 |
$51.20 |
|
|
Ureteral embolization/occl
|
$3,464.00 |
$3,464.00 |
$4,580.80 |
|
|
Ureteral reflux study
|
$692.00 |
$692.00 |
$884.00 |
|
|
Urethrcystgrphy rtrgrde s&i
|
$679.20 |
$679.20 |
$797.60 |
|
|
Urethrocystography void s&i
|
$464.00 |
$464.00 |
$915.20 |
|
|
Uric acid blood
|
$32.00 |
$32.00 |
$32.00 |
|
|
Uric acid urine
|
$43.20 |
$43.20 |
$43.20 |
|
|
Urinalysis microscopic only
|
$20.80 |
$20.80 |
$20.80 |
|
|
Urinalysis qual/semiquant excpt ia
|
$16.00 |
$16.00 |
$16.00 |
|
|
Urinalysis (with microscopy)
|
$36.00 |
$36.00 |
$36.00 |
|
|
Urinalysis (without microscopy)
|
$9.60 |
$24.00 |
$24.00 |
|
|
Urinary bldr retent nuc study
|
$303.20 |
$303.20 |
$303.20 |
|
|
Urine Culture Test
|
$42.40 |
$42.40 |
$42.40 |
|
|
Urine pregnancy test
|
$33.60 |
$33.60 |
$33.60 |
|
|
Urography, antegrade
|
$830.40 |
$830.40 |
$1,440.80 |
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$2,600.02 |
$2,600.02 |
$2,698.88 |
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$18,856.28 |
$18,856.28 |
$18,856.28 |
|
|
Vaccine Administration (one shot)
|
$62.40 |
$62.40 |
$95.20 |
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$266.68 |
$266.68 |
$369.31 |
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$105.60 |
$105.60 |
$105.60 |
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$78.40 |
$78.40 |
$537.52 |
|
|
Vaccine dtap < 7 years im
|
$39.76 |
$39.76 |
$86.28 |
|
