|
Ultrasound pregnant uterus follow up per fetus
|
$450.75 |
$450.75 |
$450.75 |
$428.25
|
|
Ultrasound prostate/transrectal
|
$954.75 |
$954.75 |
$954.75 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$352.50 |
$352.50 |
$352.50 |
$459.00
|
|
Ultrasound transabd ea addl gest
|
$701.25 |
$701.25 |
$701.25 |
$417.15
|
|
Ultrasound trgt dyn mbubb 1st les
|
$303.00 |
$303.00 |
$303.00 |
$568.32
|
|
Unit mobile power mpu
|
$18,857.25 |
$18,857.25 |
$18,857.25 |
$14,359.52
|
|
Unlisted CT procedure
|
$1,578.75 |
$1,578.75 |
$1,578.75 |
$740.43
|
|
Unlisted dx gi procedure
|
$2,470.50 |
$2,470.50 |
$2,470.50 |
$649.22
|
|
Unlisted hystsc px uterus
|
$3,720.00 |
$3,720.00 |
$3,720.00 |
$3,027.89
|
|
Unlisted maaa
|
$1,618.50 |
$1,618.50 |
$1,618.50 |
$235.20
|
|
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 |
$1,165.00
|
|
Unlisted orl service/px
|
$121.50 |
$121.50 |
$121.50 |
$132.60
|
|
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 |
$1,998.88
|
|
Unlisted procedure larynx
|
$4,960.50 |
$4,960.50 |
$4,960.50 |
$924.00
|
|
Unlisted procedure liver
|
$2,802.00 |
$2,802.00 |
$2,802.00 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$277.50 |
$277.50 |
$277.50 |
$530.00
|
|
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 |
$1,278.72
|
|
Unlisted px abdomen muscskel
|
$1,824.75 |
$1,824.75 |
$1,824.75 |
$2,053.50
|
|
Unlisted px casting/strpg
|
$316.50 |
$316.50 |
$316.50 |
$222.00
|
|
Unlisted px foot/toes
|
$3,846.75 |
$3,846.75 |
$3,846.75 |
$1,225.50
|
|
Unlisted px neck/thorax
|
$2,340.75 |
$2,340.75 |
$2,340.75 |
$571.20
|
|
Unlisted px small intestine
|
$2,493.00 |
$2,493.00 |
$2,493.00 |
$2,118.35
|
|
Unlisted px tongue flr mouth
|
$1,627.50 |
$1,627.50 |
$1,627.50 |
$282.50
|
|
Unlisted special svc px/rprt
|
$354.00 |
$354.00 |
$354.00 |
$90.00
|
|
Unlisted ultrasound procedure
|
$532.50 |
$532.50 |
$532.50 |
$335.00
|
|
Upgrade pm system
|
$13,140.75 |
$13,140.75 |
$13,140.75 |
$12,087.24
|
|
Upper Arm (Humerus) X-ray (left side)
|
$363.75 |
$363.75 |
$363.75 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$1,732.50 |
$1,732.50 |
$1,732.50 |
$1,652.95
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,464.00 |
$1,464.00 |
$1,464.00 |
$1,422.05
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,590.50 |
$2,590.50 |
$2,590.50 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,441.25 |
$2,441.25 |
$2,441.25 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,265.75 |
$2,265.75 |
$2,265.75 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$388.50 |
$388.50 |
$388.50 |
$320.45
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$606.00 |
$606.00 |
$606.00 |
$380.82
|
|
Upper Endoscopy (EGD, diagnostic)
|
$2,514.75 |
$2,514.75 |
$2,514.75 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$2,464.50 |
$2,464.50 |
$2,464.50 |
$1,768.00
|
|
Upper GI Barium X-ray (barium and gas)
|
$813.00 |
$813.00 |
$813.00 |
$657.77
|
|
Upper GI Barium X-ray (barium only)
|
$709.50 |
$709.50 |
$709.50 |
$603.20
|
|
Uppr gi scope w/submuc inj
|
$2,262.00 |
$2,262.00 |
$2,262.00 |
$1,872.00
|
|
Urea nitrogen
|
$54.00 |
$54.00 |
$54.00 |
$42.00
|
|
Urea nitrogen 24 hour urine
|
$49.50 |
$49.50 |
$49.50 |
$51.77
|
|
Urea nitrogen clearance
|
$57.00 |
$57.00 |
$57.00 |
$34.02
|
|
Ureteral reflux study
|
$1,353.75 |
$1,353.75 |
$1,353.75 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$810.75 |
$810.75 |
$810.75 |
$592.80
|
|
Urethrocystography void s&i
|
$880.50 |
$880.50 |
$880.50 |
$631.75
|
|
Uric acid blood
|
$58.50 |
$58.50 |
$58.50 |
$48.96
|
|
Uric acid urine
|
$55.50 |
$55.50 |
$55.50 |
$44.14
|
|
Urinalysis (with microscopy)
|
$123.00 |
$123.00 |
$123.00 |
$54.60
|
|
Urinalysis (without microscopy)
|
$62.25 |
$62.25 |
$62.25 |
$35.15
|
|
Urine Culture Test
|
$126.00 |
$126.00 |
$126.00 |
$81.00
|
|
Urine flow measurement 51736
|
$148.50 |
$148.50 |
$148.50 |
$210.00
|
|
Urine pregnancy test
|
$69.75 |
$69.75 |
$69.75 |
$66.87
|
|
Urography, antegrade
|
$808.50 |
$808.50 |
$808.50 |
$622.35
|
|
Use 1st target lesion
|
$252.00 |
$252.00 |
$252.00 |
$332.00
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$8,225.22 |
$8,225.22 |
$8,225.22 |
$5,205.00
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$109,781.59 |
$109,781.59 |
$109,781.59 |
$51,633.07
|
|
Vaccine Administration (one shot)
|
$33.75 |
$33.75 |
$33.75 |
$67.74
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$368.25 |
$368.25 |
$368.25 |
$227.04
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$368.25 |
$368.25 |
$368.25 |
$211.89
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$331.50 |
$331.50 |
$331.50 |
$234.36
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$222.00 |
$222.00 |
$222.00 |
$123.20
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$165.00 |
$165.00 |
$165.00 |
$80.15
|
|
Vaccine dtap < 7 years im
|
$60.00 |
$60.00 |
$60.00 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$233.91 |
$233.91 |
$233.91 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$129.00 |
$129.00 |
$129.00 |
$105.95
|
|
Vaccine dtap-ipv/hib im
|
$25.50 |
$25.50 |
$25.50 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$111.00 |
$111.00 |
$111.00 |
$72.00
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$45.33 |
$45.33 |
$45.33 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$241.96 |
$241.96 |
$241.96 |
$169.35
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$354.74 |
$354.74 |
$354.74 |
$231.56
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$135.00 |
$135.00 |
$135.00 |
$80.28
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$54.75 |
$54.75 |
$54.75 |
$90.35
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$162.07 |
$162.07 |
$162.07 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$118.50 |
$118.50 |
$118.50 |
$274.93
|
|
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 |
$562.20
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$599.25 |
$599.25 |
$599.25 |
$282.50
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$67.50 |
$67.50 |
$67.50 |
$143.20
|
|
Vaccine influenza inactivated adjuvant im
|
$50.25 |
$50.25 |
$50.25 |
$96.84
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$45.75 |
$45.75 |
$45.75 |
$48.59
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$25.50 |
$25.50 |
$25.50 |
$28.77
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$25.50 |
$25.50 |
$25.50 |
$33.21
|
|
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 |
$72.00
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$89.25 |
$89.25 |
$89.25 |
$77.22
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$569.67 |
$569.67 |
$569.67 |
$387.95
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$747.00 |
$747.00 |
$747.00 |
$406.05
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$545.45 |
$545.45 |
$545.45 |
$323.39
|
|
Vaccine mmr live subcutaneous
|
$311.03 |
$311.03 |
$311.03 |
$211.68
|
|
Vaccine mmrv live subcutaneous
|
$957.30 |
$957.30 |
$957.30 |
$466.88
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$401.34 |
$401.34 |
$401.34 |
$251.64
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$793.01 |
$793.01 |
$793.01 |
$393.25
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$239.25 |
$239.25 |
$239.25 |
$414.46
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$913.50 |
$913.50 |
$913.50 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$1,529.59 |
$1,529.59 |
$1,529.59 |
$90.70
|
|
Vaccine rabies im
|
$1,514.28 |
$1,514.28 |
$1,514.28 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$907.50 |
$907.50 |
$907.50 |
$521.74
|
