|
Ua w/micro/comp poc
|
$6.50 |
$6.50 |
$6.50 |
$23.00
|
|
Ugt1a1 gene analy common variants
|
$877.50 |
$877.50 |
$877.50 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$312.50 |
$312.50 |
$312.50 |
$394.20
|
|
Ultrasound breast complete
|
$291.00 |
$291.00 |
$291.00 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$582.00 |
$582.00 |
$582.00 |
$449.35
|
|
Ultrasound chest
|
$306.00 |
$306.00 |
$306.00 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$81.50 |
$81.50 |
$81.50 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$168.00 |
$168.00 |
$168.00 |
$296.80
|
|
Ultrasound elastography parenchyma
|
$281.00 |
$281.00 |
$281.00 |
$307.00
|
|
Ultrasound encephalogram
|
$199.50 |
$199.50 |
$199.50 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$476.50 |
$476.50 |
$476.50 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$469.50 |
$469.50 |
$469.50 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$535.00 |
$535.00 |
$535.00 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$528.00 |
$528.00 |
$528.00 |
$720.15
|
|
Ultrasound guide intraoperative
|
$400.50 |
$400.50 |
$400.50 |
$632.85
|
|
Ultrasound infant hips ltd without stress
|
$215.50 |
$215.50 |
$215.50 |
$311.25
|
|
Ultrasound joint complete left
|
$726.00 |
$726.00 |
$726.00 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$1,054.00 |
$1,054.00 |
$1,054.00 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$469.50 |
$469.50 |
$469.50 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$58.00 |
$58.00 |
$58.00 |
$331.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$306.00 |
$306.00 |
$306.00 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$298.00 |
$298.00 |
$298.00 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$340.50 |
$340.50 |
$340.50 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$702.00 |
$702.00 |
$702.00 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$469.50 |
$469.50 |
$469.50 |
$486.50
|
|
Ultrasound scrotum and contents
|
$469.50 |
$469.50 |
$469.50 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$124.50 |
$124.50 |
$124.50 |
$463.00
|
|
Ultrasound transvaginal non obstetric
|
$469.50 |
$469.50 |
$469.50 |
$558.35
|
|
Unlisted chemotherapy px
|
$347.50 |
$347.50 |
$347.50 |
$150.00
|
|
Unlisted CT procedure
|
$1,067.00 |
$1,067.00 |
$1,067.00 |
$732.70
|
|
Unlisted fluoroscopic px
|
$445.00 |
$445.00 |
$445.00 |
$305.76
|
|
Unlisted hematology&coagj px
|
$8.00 |
$8.00 |
$8.00 |
$39.52
|
|
Unlisted laparoscopic liver biopy 47379
|
$7,226.34 |
$7,226.34 |
$7,226.34 |
$5,419.00
|
|
Unlisted laparoscopic reduction intestine 44238
|
$10,045.50 |
$10,045.50 |
$10,045.50 |
$5,419.00
|
|
Unlisted laps px ureter
|
$6,975.60 |
$6,975.60 |
$6,975.60 |
$6,212.70
|
|
Unlisted maaa
|
$587.00 |
$587.00 |
$587.00 |
$235.20
|
|
Unlisted mr procedure
|
$1,352.00 |
$1,352.00 |
$1,352.00 |
$1,163.00
|
|
Unlisted neurological dx px
|
$286.00 |
$286.00 |
$286.00 |
$242.50
|
|
Unlisted procedure colon
|
$1,601.50 |
$1,601.50 |
$1,601.50 |
$1,702.50
|
|
Unlisted procedure larynx
|
$393.50 |
$393.50 |
$393.50 |
$924.00
|
|
Unlisted procedure microbiology
|
$6.00 |
$6.00 |
$6.00 |
$523.50
|
|
Unlisted procedure rectum
|
$1,601.50 |
$1,601.50 |
$1,601.50 |
$1,220.35
|
|
Unlisted procedure spine
|
$392.00 |
$392.00 |
$392.00 |
$4,659.85
|
|
Unlisted px accessory sinus
|
$1,429.50 |
$1,429.50 |
$1,429.50 |
$3,335.28
|
|
Unlisted px ant segment eye
|
$4,082.00 |
$4,082.00 |
$4,082.00 |
$2,698.92
|
|
Unlisted px arthroscopy
|
$4,804.67 |
$4,804.67 |
$4,804.67 |
$2,765.60
|
|
Unlisted px casting/strpg
|
$241.00 |
$241.00 |
$241.00 |
$219.70
|
|
Unlisted px foot/toes
|
$4,395.67 |
$4,395.67 |
$4,395.67 |
$1,225.50
|
|
Unlisted px hands/fingers
|
$373.00 |
$373.00 |
$373.00 |
$354.20
|
|
Unlisted px lacrimal system
|
$500.50 |
$500.50 |
$500.50 |
$416.50
|
|
Unlisted px leg/ankle
|
$1,731.50 |
$1,731.50 |
$1,731.50 |
$811.00
|
|
Unlisted px middle ear
|
$393.50 |
$393.50 |
$393.50 |
$343.50
|
|
Unlisted px posterior segmnt
|
$4,082.00 |
$4,082.00 |
$4,082.00 |
$3,173.34
|
|
Unlisted px small intestine
|
$1,769.50 |
$1,769.50 |
$1,769.50 |
$2,102.10
|
|
Unlisted px tongue flr mouth
|
$393.50 |
$393.50 |
$393.50 |
$282.50
|
|
Unlisted spec derm svc/px
|
$341.00 |
$341.00 |
$341.00 |
$223.08
|
|
Unlisted special svc px/rprt
|
$5.00 |
$5.00 |
$5.00 |
$90.00
|
|
Unlisted ultrasound procedure
|
$536.00 |
$536.00 |
$536.00 |
$321.20
|
|
Unlisted urinalysis px
|
$25.00 |
$25.00 |
$25.00 |
$25.72
|
|
Unlstd laps px sprmatic cord
|
$4,399.25 |
$4,399.25 |
$4,399.25 |
$4,713.11
|
|
Upgrade pm system
|
$4,988.50 |
$4,988.50 |
$4,988.50 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,348.50 |
$2,348.50 |
$2,348.50 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,943.00 |
$1,943.00 |
$1,943.00 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,669.50 |
$1,669.50 |
$1,669.50 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$829.00 |
$829.00 |
$829.00 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,560.50 |
$1,560.50 |
$1,560.50 |
$1,768.00
|
|
Urea nitrogen
|
$36.50 |
$36.50 |
$36.50 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$34.50 |
$34.50 |
$34.50 |
$51.75
|
|
Urethrcystgrphy rtrgrde s&i
|
$410.50 |
$410.50 |
$410.50 |
$579.73
|
|
Urethrlys transvag with scope
|
$2,205.00 |
$2,205.00 |
$2,205.00 |
$4,081.37
|
|
Urethrocystography void s&i
|
$396.50 |
$396.50 |
$396.50 |
$622.35
|
|
Uric acid blood
|
$42.00 |
$42.00 |
$42.00 |
$48.75
|
|
Uric acid urine
|
$35.50 |
$35.50 |
$35.50 |
$44.33
|
|
Urinalysis microscopic only
|
$8.50 |
$8.50 |
$8.50 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$17.50 |
$17.50 |
$17.50 |
$25.72
|
|
Urinalysis (with microscopy)
|
$52.00 |
$52.00 |
$52.00 |
$55.00
|
|
Urinalysis (without microscopy)
|
$30.50 |
$30.50 |
$30.50 |
$35.75
|
|
Urinary reflex study
|
$73.00 |
$73.00 |
$73.00 |
$216.05
|
|
Urine Culture Test
|
$64.00 |
$64.00 |
$64.00 |
$81.50
|
|
Urine flow measurement 51736
|
$223.00 |
$223.00 |
$223.00 |
$210.00
|
|
Urine pregnancy test
|
$66.50 |
$66.50 |
$66.50 |
$67.20
|
|
Urography, antegrade
|
$335.00 |
$335.00 |
$335.00 |
$622.35
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$131.50 |
$131.50 |
$131.50 |
$224.25
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$113.00 |
$113.00 |
$113.00 |
$209.40
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$228.00 |
$228.00 |
$228.00 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$45.00 |
$45.00 |
$45.00 |
$123.20
|
|
Vaccine dtap < 7 years im
|
$28.00 |
$28.00 |
$28.00 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$122.00 |
$122.00 |
$122.00 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$57.50 |
$57.50 |
$57.50 |
$105.95
|
|
Vaccine dtap-ipv/hib im
|
$106.00 |
$106.00 |
$106.00 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$28.00 |
$28.00 |
$28.00 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$13.00 |
$13.00 |
$13.00 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$68.00 |
$68.00 |
$68.00 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$95.50 |
$95.50 |
$95.50 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$32.50 |
$32.50 |
$32.50 |
$79.15
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$46.50 |
$46.50 |
$46.50 |
$84.75
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$75.00 |
$75.00 |
$75.00 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$127.00 |
$127.00 |
$127.00 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$22.00 |
$22.00 |
$22.00 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$290.50 |
$290.50 |
$290.50 |
$576.48
|
