|
Ultrasound abdomen aorta screening study aaa
|
$509.15 |
$509.15 |
$509.15 |
$394.20
|
|
Ultrasound breast unilateral limited (both sides)
|
$429.25 |
$429.25 |
$429.25 |
$449.35
|
|
Ultrasound chest
|
$518.50 |
$518.50 |
$518.50 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$518.50 |
$518.50 |
$518.50 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$501.50 |
$501.50 |
$501.50 |
$296.80
|
|
Ultrasound elastography ea l target les
|
$428.40 |
$428.40 |
$428.40 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$602.65 |
$602.65 |
$602.65 |
$307.00
|
|
Ultrasound encephalogram
|
$518.50 |
$518.50 |
$518.50 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$602.65 |
$602.65 |
$602.65 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$518.50 |
$518.50 |
$518.50 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$618.80 |
$618.80 |
$618.80 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$665.55 |
$665.55 |
$665.55 |
$720.15
|
|
Ultrasound guide intraoperative
|
$1,341.30 |
$1,341.30 |
$1,341.30 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$872.10 |
$872.10 |
$872.10 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$429.25 |
$429.25 |
$429.25 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$429.25 |
$429.25 |
$429.25 |
$311.25
|
|
Ultrasound joint/nonvascular extremity limited left
|
$506.60 |
$506.60 |
$506.60 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$477.70 |
$477.70 |
$477.70 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$243.10 |
$243.10 |
$243.10 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,156.85 |
$1,156.85 |
$1,156.85 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$518.50 |
$518.50 |
$518.50 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$518.50 |
$518.50 |
$518.50 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$518.50 |
$518.50 |
$518.50 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$549.95 |
$549.95 |
$549.95 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$518.50 |
$518.50 |
$518.50 |
$486.50
|
|
Ultrasound scrotum and contents
|
$572.05 |
$572.05 |
$572.05 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$518.50 |
$518.50 |
$518.50 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$1,248.65 |
$1,248.65 |
$1,248.65 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$518.50 |
$518.50 |
$518.50 |
$558.35
|
|
Ultraviolet therapy
|
$20.40 |
$20.40 |
$20.40 |
$39.76
|
|
Umbilical artery cath newborn 36660
|
$1,727.20 |
$1,727.20 |
$1,727.20 |
$206.64
|
|
Unit mobile power mpu
|
$10,880.00 |
$10,880.00 |
$10,880.00 |
$14,612.80
|
|
Unlistd noninvas vasc dx std
|
$985.15 |
$985.15 |
$985.15 |
$528.80
|
|
Unlisted hematology&coagj px
|
$25.50 |
$25.50 |
$25.50 |
$39.52
|
|
Unlisted mr procedure
|
$10,554.45 |
$10,554.45 |
$10,554.45 |
$1,163.00
|
|
Unlisted muscskel px head
|
$1,707.65 |
$1,707.65 |
$1,707.65 |
$478.46
|
|
Unlisted procedure esophagus
|
$2,513.45 |
$2,513.45 |
$2,513.45 |
$1,998.88
|
|
Unlisted procedure larynx
|
$663.85 |
$663.85 |
$663.85 |
$924.00
|
|
Unlisted procedure rectum
|
$6,605.35 |
$6,605.35 |
$6,605.35 |
$1,220.35
|
|
Unlisted procedure spine
|
$6,766.60 |
$6,766.60 |
$6,766.60 |
$4,659.85
|
|
Unlisted px abdomen muscskel
|
$3,860.62 |
$3,860.62 |
$3,860.62 |
$1,848.60
|
|
Unlisted px biliary tract
|
$8,238.29 |
$8,238.29 |
$8,238.29 |
$2,718.10
|
|
Unlisted px leg/ankle
|
$804.95 |
$804.95 |
$804.95 |
$811.00
|
|
Unlisted px pelvis/hip joint
|
$3,860.62 |
$3,860.62 |
$3,860.62 |
$3,118.44
|
|
Unlisted px salivry glnd/dux
|
$7,667.00 |
$7,667.00 |
$7,667.00 |
$1,265.16
|
|
Unlisted px tongue flr mouth
|
$663.85 |
$663.85 |
$663.85 |
$282.50
|
|
Unlisted urinalysis px
|
$17.00 |
$17.00 |
$17.00 |
$25.72
|
|
Unsched dialysis esrd pt hos
|
$2,493.05 |
$2,493.05 |
$2,493.05 |
$1,268.17
|
|
Upgrade pm system
|
$26,189.35 |
$26,189.35 |
$26,189.35 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$6,035.00 |
$6,035.00 |
$6,035.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,697.50 |
$3,697.50 |
$3,697.50 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,065.50 |
$2,065.50 |
$2,065.50 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$2,591.65 |
$2,591.65 |
$2,591.65 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$2,465.00 |
$2,465.00 |
$2,465.00 |
$1,768.00
|
|
Uppr gi scope w/submuc inj
|
$2,465.00 |
$2,465.00 |
$2,465.00 |
$1,872.00
|
|
Urea nitrogen
|
$16.15 |
$16.15 |
$16.15 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$22.95 |
$22.95 |
$22.95 |
$51.75
|
|
Urea nitrogen clearance
|
$29.75 |
$29.75 |
$29.75 |
$42.25
|
|
Ureteral reflux study
|
$1,852.15 |
$1,852.15 |
$1,852.15 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$1,156.00 |
$1,156.00 |
$1,156.00 |
$579.73
|
|
Urethrocystography void s&i
|
$1,156.00 |
$1,156.00 |
$1,156.00 |
$622.35
|
|
Uric acid blood
|
$17.85 |
$17.85 |
$17.85 |
$48.75
|
|
Uric acid urine
|
$21.25 |
$21.25 |
$21.25 |
$44.33
|
|
Urinalysis microscopic only
|
$13.60 |
$13.60 |
$13.60 |
$26.35
|
|
Urinalysis (with microscopy)
|
$13.60 |
$13.60 |
$13.60 |
$55.00
|
|
Urinalysis (without microscopy)
|
$10.20 |
$10.20 |
$10.20 |
$35.75
|
|
Urine Culture Test
|
$32.30 |
$32.30 |
$32.30 |
$81.50
|
|
Urine pregnancy test
|
$35.70 |
$35.70 |
$35.70 |
$67.20
|
|
Urography, antegrade
|
$1,727.20 |
$1,727.20 |
$1,727.20 |
$622.35
|
|
Use 1st target lesion
|
$518.50 |
$518.50 |
$518.50 |
$332.00
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$5,625.57 |
$5,625.57 |
$5,625.57 |
$5,184.34
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$77,313.93 |
$77,313.93 |
$77,313.93 |
$51,633.07
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$153.14 |
$153.14 |
$153.14 |
$224.25
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$346.36 |
$346.36 |
$346.36 |
$209.40
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$454.68 |
$454.68 |
$454.68 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$258.73 |
$258.73 |
$258.73 |
$123.20
|
|
Vaccine dtap-hep b-ipv im
|
$269.11 |
$269.11 |
$269.11 |
$164.63
|
|
Vaccine dtap-ipv/hib im
|
$137.82 |
$137.82 |
$137.82 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$39.84 |
$39.84 |
$39.84 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$49.90 |
$49.90 |
$49.90 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$258.18 |
$258.18 |
$258.18 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$142.06 |
$142.06 |
$142.06 |
$218.40
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$81.40 |
$81.40 |
$81.40 |
$84.75
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$128.22 |
$128.22 |
$128.22 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$417.30 |
$417.30 |
$417.30 |
$274.93
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$875.01 |
$875.01 |
$875.01 |
$576.48
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$230.95 |
$230.95 |
$230.95 |
$143.20
|
|
Vaccine influenza inactivated adjuvant im
|
$95.70 |
$95.70 |
$95.70 |
$109.50
|
|
Vaccine influenza nos 0.5ml dose im
|
$16.36 |
$16.36 |
$16.36 |
$24.20
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$74.07 |
$74.07 |
$74.07 |
$47.88
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$52.15 |
$52.15 |
$52.15 |
$76.50
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$188.39 |
$188.39 |
$188.39 |
$310.93
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$444.48 |
$444.48 |
$444.48 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$258.16 |
$258.16 |
$258.16 |
$211.68
|
|
Vaccine mmrv live subcutaneous
|
$763.18 |
$763.18 |
$763.18 |
$424.32
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$314.75 |
$314.75 |
$314.75 |
$251.64
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$602.76 |
$602.76 |
$602.76 |
$397.11
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$248.83 |
$248.83 |
$248.83 |
$414.46
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$820.76 |
$820.76 |
$820.76 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$148.26 |
$148.26 |
$148.26 |
$90.70
|
