|
Tympanostomy/ven tube/loc/top anes 69433
|
$1,259.00 |
$1,259.00 |
$1,259.00 |
$911.43
|
|
Ua w/micro/comp poc
|
$18.00 |
$18.00 |
$18.00 |
$23.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$22,220.01 |
$22,220.01 |
$22,220.01 |
$20,945.01
|
|
Ugt1a1 gene analy common variants
|
$180.00 |
$180.00 |
$180.00 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$388.50 |
$388.50 |
$388.50 |
$394.20
|
|
Ultrasound breast complete
|
$498.00 |
$498.00 |
$498.00 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$498.00 |
$498.00 |
$498.00 |
$449.35
|
|
Ultrasound chest
|
$436.50 |
$436.50 |
$436.50 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$1,237.00 |
$1,237.00 |
$1,237.00 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$205.50 |
$205.50 |
$205.50 |
$296.80
|
|
Ultrasound encephalogram
|
$403.50 |
$403.50 |
$403.50 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$403.50 |
$403.50 |
$403.50 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$403.50 |
$403.50 |
$403.50 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$169.00 |
$169.00 |
$169.00 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$541.50 |
$541.50 |
$541.50 |
$720.15
|
|
Ultrasound guide intraoperative
|
$820.83 |
$820.83 |
$820.83 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$1,204.50 |
$1,204.50 |
$1,204.50 |
$560.00
|
|
Ultrasound joint/nonvascular extremity limited left
|
$847.00 |
$847.00 |
$847.00 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$271.00 |
$271.00 |
$271.00 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$300.50 |
$300.50 |
$300.50 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$490.50 |
$490.50 |
$490.50 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$277.50 |
$277.50 |
$277.50 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$251.00 |
$251.00 |
$251.00 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$452.00 |
$452.00 |
$452.00 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$272.50 |
$272.50 |
$272.50 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$438.00 |
$438.00 |
$438.00 |
$486.50
|
|
Ultrasound scrotum and contents
|
$438.00 |
$438.00 |
$438.00 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$438.50 |
$438.50 |
$438.50 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$300.50 |
$300.50 |
$300.50 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$438.00 |
$438.00 |
$438.00 |
$558.35
|
|
Umbilicoplasty 15847
|
$997.67 |
$997.67 |
$997.67 |
$4,172.97
|
|
Unlisted chemotherapy px
|
$507.00 |
$507.00 |
$507.00 |
$150.00
|
|
Unlisted dialysis procedure
|
$482.50 |
$482.50 |
$482.50 |
$1,144.00
|
|
Unlisted fluoroscopic px
|
$192.50 |
$192.50 |
$192.50 |
$305.76
|
|
Unlisted hematology&coagj px
|
$19.00 |
$19.00 |
$19.00 |
$39.52
|
|
Unlisted hystsc px uterus
|
$1,368.75 |
$1,368.75 |
$1,368.75 |
$2,803.60
|
|
Unlisted laparoscopic liver biopy 47379
|
$9,018.75 |
$9,018.75 |
$9,018.75 |
$5,419.00
|
|
Unlisted laparoscopic reduction intestine 44238
|
$23,168.00 |
$23,168.00 |
$23,168.00 |
$5,419.00
|
|
Unlisted laps px appendix
|
$5,188.00 |
$5,188.00 |
$5,188.00 |
$3,617.40
|
|
Unlisted laps px ovidct ovry
|
$5,709.42 |
$5,709.42 |
$5,709.42 |
$6,904.15
|
|
Unlisted maaa
|
$587.00 |
$587.00 |
$587.00 |
$235.20
|
|
Unlisted mr procedure
|
$2,009.00 |
$2,009.00 |
$2,009.00 |
$1,163.00
|
|
Unlisted procedure colon
|
$1,401.50 |
$1,401.50 |
$1,401.50 |
$1,702.50
|
|
Unlisted procedure microbiology
|
$6.00 |
$6.00 |
$6.00 |
$523.50
|
|
Unlisted procedure pancreas
|
$1,569.50 |
$1,569.50 |
$1,569.50 |
$3,986.00
|
|
Unlisted procedure rectum
|
$152.50 |
$152.50 |
$152.50 |
$1,220.35
|
|
Unlisted procedure spine
|
$19,858.00 |
$19,858.00 |
$19,858.00 |
$4,659.85
|
|
Unlisted px accessory sinus
|
$1,545.17 |
$1,545.17 |
$1,545.17 |
$3,335.28
|
|
Unlisted px arthroscopy
|
$3,164.00 |
$3,164.00 |
$3,164.00 |
$2,765.60
|
|
Unlisted px casting/strpg
|
$231.50 |
$231.50 |
$231.50 |
$219.70
|
|
Unlisted px foot/toes
|
$5,767.00 |
$5,767.00 |
$5,767.00 |
$1,225.50
|
|
Unlisted px hands/fingers
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$354.20
|
|
Unlisted px leg/ankle
|
$3,528.00 |
$3,528.00 |
$3,528.00 |
$811.00
|
|
Unlisted px male genital sys
|
$362.00 |
$362.00 |
$362.00 |
$343.55
|
|
Unlisted px pelvis/hip joint
|
$14,793.00 |
$14,793.00 |
$14,793.00 |
$3,118.44
|
|
Unlisted px small intestine
|
$1,042.50 |
$1,042.50 |
$1,042.50 |
$2,102.10
|
|
Unlisted px tongue flr mouth
|
$351.50 |
$351.50 |
$351.50 |
$282.50
|
|
Unlisted urinalysis px
|
$25.50 |
$25.50 |
$25.50 |
$25.72
|
|
Unlstd laps px sprmatic cord
|
$6,743.63 |
$6,743.63 |
$6,743.63 |
$4,713.11
|
|
Unsched dialysis esrd pt hos
|
$958.50 |
$958.50 |
$958.50 |
$1,268.17
|
|
Upgrade pm system
|
$4,988.50 |
$4,988.50 |
$4,988.50 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,859.50 |
$1,859.50 |
$1,859.50 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,353.50 |
$1,353.50 |
$1,353.50 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,208.50 |
$1,208.50 |
$1,208.50 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$9,515.25 |
$9,515.25 |
$9,515.25 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,032.00 |
$1,032.00 |
$1,032.00 |
$1,768.00
|
|
Uppr gi scope w/submuc inj
|
$595.83 |
$595.83 |
$595.83 |
$1,872.00
|
|
Urea nitrogen
|
$44.00 |
$44.00 |
$44.00 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$33.00 |
$33.00 |
$33.00 |
$51.75
|
|
Urethrcystgrphy rtrgrde s&i
|
$660.50 |
$660.50 |
$660.50 |
$579.73
|
|
Urethrocystography void s&i
|
$660.50 |
$660.50 |
$660.50 |
$622.35
|
|
Uric acid blood
|
$47.50 |
$47.50 |
$47.50 |
$48.75
|
|
Uric acid urine
|
$33.00 |
$33.00 |
$33.00 |
$44.33
|
|
Urinalysis microscopic only
|
$23.00 |
$23.00 |
$23.00 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$16.50 |
$16.50 |
$16.50 |
$25.72
|
|
Urinalysis (with microscopy)
|
$65.00 |
$65.00 |
$65.00 |
$55.00
|
|
Urinalysis (without microscopy)
|
$26.00 |
$26.00 |
$26.00 |
$35.75
|
|
Urine Culture Test
|
$69.50 |
$69.50 |
$69.50 |
$81.50
|
|
Urine flow measurement 51736
|
$153.00 |
$153.00 |
$153.00 |
$210.00
|
|
Urine pregnancy test
|
$71.00 |
$71.00 |
$71.00 |
$67.20
|
|
Urography, antegrade
|
$342.50 |
$342.50 |
$342.50 |
$622.35
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$16,188.02 |
$16,188.02 |
$16,188.02 |
$5,184.34
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$124.00 |
$124.00 |
$124.00 |
$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
|
$215.00 |
$215.00 |
$215.00 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$69.50 |
$69.50 |
$69.50 |
$123.20
|
|
Vaccine dtap < 7 years im
|
$27.50 |
$27.50 |
$27.50 |
$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
|
$12.50 |
$12.50 |
$12.50 |
$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
|
$46.50 |
$46.50 |
$46.50 |
$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
|
