|
Ultrasound prostate/transrectal
|
$954.75 |
$954.75 |
$954.75 |
$532.11
|
|
Ultrasound retroperitoneal limited
|
$718.50 |
$718.50 |
$718.50 |
$518.80
|
|
Ultrasound scrotum and contents
|
$735.75 |
$735.75 |
$735.75 |
$612.55
|
|
Ultrasound spinal canal and contents
|
$352.50 |
$352.50 |
$352.50 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$701.25 |
$701.25 |
$701.25 |
$424.80
|
|
Ultrasound transvaginal non obstetric
|
$877.50 |
$877.50 |
$877.50 |
$601.60
|
|
Ultrasound trgt dyn mbubb 1st les
|
$303.00 |
$303.00 |
$303.00 |
$516.00
|
|
Unit mobile power mpu
|
$18,857.25 |
$18,857.25 |
$18,857.25 |
$18,857.25
|
|
Unlisted CT procedure
|
$1,578.75 |
$1,578.75 |
$1,578.75 |
$1,268.98
|
|
Unlisted dx gi procedure
|
$2,470.50 |
$2,470.50 |
$2,470.50 |
$613.20
|
|
Unlisted hystsc px uterus
|
$3,720.00 |
$3,720.00 |
$3,720.00 |
$2,803.60
|
|
Unlisted misc path test
|
$1,014.00 |
$1,014.00 |
$1,014.00 |
$89.40
|
|
Unlisted mr procedure
|
$1,616.25 |
$1,616.25 |
$1,616.25 |
$1,316.25
|
|
Unlisted orl service/px
|
$121.50 |
$121.50 |
$121.50 |
$292.80
|
|
Unlisted procedure colon
|
$6,297.75 |
$6,297.75 |
$6,297.75 |
$1,839.55
|
|
Unlisted procedure esophagus
|
$6,297.75 |
$6,297.75 |
$6,297.75 |
$2,642.40
|
|
Unlisted procedure larynx
|
$4,960.50 |
$4,960.50 |
$4,960.50 |
$4,960.50
|
|
Unlisted procedure liver
|
$2,802.00 |
$2,802.00 |
$2,802.00 |
$2,802.00
|
|
Unlisted procedure microbiology
|
$277.50 |
$277.50 |
$277.50 |
$523.50
|
|
Unlisted procedure pancreas
|
$2,967.75 |
$2,967.75 |
$2,967.75 |
$4,810.00
|
|
Unlisted procedure rectum
|
$1,058.25 |
$1,058.25 |
$1,058.25 |
$1,395.50
|
|
Unlisted px abdomen muscskel
|
$1,824.75 |
$1,824.75 |
$1,824.75 |
$5,500.95
|
|
Unlisted px casting/strpg
|
$316.50 |
$316.50 |
$316.50 |
$224.93
|
|
Unlisted px foot/toes
|
$3,846.75 |
$3,846.75 |
$3,846.75 |
$3,105.70
|
|
Unlisted px neck/thorax
|
$2,340.75 |
$2,340.75 |
$2,340.75 |
$2,680.22
|
|
Unlisted px small intestine
|
$2,493.00 |
$2,493.00 |
$2,493.00 |
$2,493.00
|
|
Unlisted px tongue flr mouth
|
$1,627.50 |
$1,627.50 |
$1,627.50 |
$405.60
|
|
Unlisted ultrasound procedure
|
$532.50 |
$532.50 |
$532.50 |
$426.63
|
|
Upgrade pm system
|
$13,140.75 |
$13,140.75 |
$13,140.75 |
$12,348.58
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,590.50 |
$2,590.50 |
$2,590.50 |
$2,713.80
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,441.25 |
$2,441.25 |
$2,441.25 |
$2,039.85
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,265.75 |
$2,265.75 |
$2,265.75 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$2,514.75 |
$2,514.75 |
$2,514.75 |
$1,760.00
|
|
Upper Endoscopy (EGD, with biopsy)
|
$2,464.50 |
$2,464.50 |
$2,464.50 |
$1,760.00
|
|
Uppr gi scope w/submuc inj
|
$2,262.00 |
$2,262.00 |
$2,262.00 |
$1,764.00
|
|
Urea nitrogen
|
$54.00 |
$54.00 |
$54.00 |
$38.25
|
|
Urea nitrogen 24 hour urine
|
$49.50 |
$49.50 |
$49.50 |
$48.80
|
|
Urea nitrogen clearance
|
$57.00 |
$57.00 |
$57.00 |
$34.22
|
|
Ureteral reflux study
|
$1,353.75 |
$1,353.75 |
$1,353.75 |
$986.29
|
|
Urethrcystgrphy rtrgrde s&i
|
$810.75 |
$810.75 |
$810.75 |
$574.40
|
|
Urethrocystography void s&i
|
$880.50 |
$880.50 |
$880.50 |
$695.00
|
|
Uric acid blood
|
$58.50 |
$58.50 |
$58.50 |
$45.00
|
|
Uric acid urine
|
$55.50 |
$55.50 |
$55.50 |
$44.28
|
|
Urinalysis (with microscopy)
|
$123.00 |
$123.00 |
$123.00 |
$37.39
|
|
Urinalysis (without microscopy)
|
$62.25 |
$62.25 |
$62.25 |
$32.50
|
|
Urine Culture Test
|
$126.00 |
$126.00 |
$126.00 |
$67.55
|
|
Urine flow measurement 51736
|
$148.50 |
$148.50 |
$148.50 |
$223.48
|
|
Urine pregnancy test
|
$69.75 |
$69.75 |
$69.75 |
$57.00
|
|
Urography, antegrade
|
$808.50 |
$808.50 |
$808.50 |
$607.00
|
|
Use 1st target lesion
|
$252.00 |
$252.00 |
$252.00 |
$252.00
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$8,225.22 |
$8,225.22 |
$8,225.22 |
$8,225.22
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$109,781.59 |
$109,781.59 |
$109,781.59 |
$109,781.59
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$368.25 |
$368.25 |
$368.25 |
$233.60
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$368.25 |
$368.25 |
$368.25 |
$240.91
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$331.50 |
$331.50 |
$331.50 |
$255.20
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$222.00 |
$222.00 |
$222.00 |
$171.20
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$165.00 |
$165.00 |
$165.00 |
$91.00
|
|
Vaccine dtap < 7 years im
|
$60.00 |
$60.00 |
$60.00 |
$76.58
|
|
Vaccine dtap-hep b-ipv im
|
$233.91 |
$233.91 |
$233.91 |
$157.75
|
|
Vaccine dtap-ipv 4-6 years im
|
$129.00 |
$129.00 |
$129.00 |
$129.00
|
|
Vaccine dtap-ipv/hib im
|
$25.50 |
$25.50 |
$25.50 |
$199.37
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$111.00 |
$111.00 |
$111.00 |
$85.00
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$45.33 |
$45.33 |
$45.33 |
$36.70
|
|
Vaccine hepatitis a (hepa) adult im
|
$241.96 |
$241.96 |
$241.96 |
$163.15
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$354.74 |
$354.74 |
$354.74 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$135.00 |
$135.00 |
$135.00 |
$84.38
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$54.75 |
$54.75 |
$54.75 |
$57.20
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$162.07 |
$162.07 |
$162.07 |
$140.37
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$118.50 |
$118.50 |
$118.50 |
$310.70
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$75.39 |
$75.39 |
$75.39 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$1,044.16 |
$1,044.16 |
$1,044.16 |
$557.26
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$599.25 |
$599.25 |
$599.25 |
$230.40
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$67.50 |
$67.50 |
$67.50 |
$81.00
|
|
Vaccine influenza inactivated adjuvant im
|
$50.25 |
$50.25 |
$50.25 |
$81.00
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$45.75 |
$45.75 |
$45.75 |
$45.75
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$25.50 |
$25.50 |
$25.50 |
$25.50
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$25.50 |
$25.50 |
$25.50 |
$25.50
|
|
Vaccine influenza quadrivalent live (laiv4) intranasal
|
$102.00 |
$102.00 |
$102.00 |
$37.05
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$50.25 |
$50.25 |
$50.25 |
$76.20
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$89.25 |
$89.25 |
$89.25 |
$30.40
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$569.67 |
$569.67 |
$569.67 |
$428.00
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$747.00 |
$747.00 |
$747.00 |
$335.00
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$545.45 |
$545.45 |
$545.45 |
$382.20
|
|
Vaccine mmr live subcutaneous
|
$311.03 |
$311.03 |
$311.03 |
$222.36
|
|
Vaccine mmrv live subcutaneous
|
$957.30 |
$957.30 |
$957.30 |
$621.00
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$401.34 |
$401.34 |
$401.34 |
$219.79
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$793.01 |
$793.01 |
$793.01 |
$397.18
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$239.25 |
$239.25 |
$239.25 |
$262.88
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$913.50 |
$913.50 |
$913.50 |
$547.00
|
|
Vaccine polio (ipv) subcutaneous/im
|
$1,529.59 |
$1,529.59 |
$1,529.59 |
$220.25
|
|
Vaccine rabies im
|
$1,514.28 |
$1,514.28 |
$1,514.28 |
$963.04
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$907.50 |
$907.50 |
$907.50 |
$504.00
|
|
Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im
|
$998.25 |
$998.25 |
$998.25 |
$358.40
|
|
Vaccine rotavirus attenuated (rv1) live 2 dose oral
|
$504.00 |
$504.00 |
$504.00 |
$200.70
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$344.25 |
$344.25 |
$344.25 |
$108.00
|
|
Vaccine tdap >=7 years im
|
$140.25 |
$140.25 |
$140.25 |
$136.80
|
|
Vaccine td preservative free >= 7 years im
|
$145.19 |
$145.19 |
$145.19 |
$112.10
|
|
Vaccine typhoid vicps im
|
$333.00 |
$333.00 |
$333.00 |
$253.50
|
|
Vaccine varicella live subcutaneous
|
$642.96 |
$642.96 |
$642.96 |
$434.73
|
|
Vaccine yellow fever live subcutaneous
|
$714.00 |
$714.00 |
$714.00 |
$421.20
|