|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$2,265.50 |
$2,265.50 |
$2,265.50 |
$2,371.50
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$2,265.50 |
$2,265.50 |
$2,265.50 |
$2,406.77
|
|
Troponin quantitative
|
$276.00 |
$276.00 |
$276.00 |
$127.20
|
|
Tte w or without fol w/con,stres
|
$1,391.00 |
$1,391.00 |
$1,391.00 |
$1,632.80
|
|
Tube trach disp innr can 5 xlt
|
$130.50 |
$130.50 |
$130.50 |
$445.99
|
|
Tx closed hip disl traumatic without anes
|
$189.00 |
$189.00 |
$189.00 |
$581.07
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$3,643.00 |
$3,643.00 |
$3,643.00 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$189.00 |
$189.00 |
$189.00 |
$535.60
|
|
Tx contour defects >10.0 cc
|
$762.50 |
$762.50 |
$762.50 |
$944.00
|
|
Tx contour defects 1.1-5.0cc 11951
|
$762.50 |
$762.50 |
$762.50 |
$804.23
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$3,981.50 |
$3,981.50 |
$3,981.50 |
$4,421.00
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$3,643.00 |
$3,643.00 |
$3,643.00 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$283.50 |
$283.50 |
$283.50 |
$416.16
|
|
Tympanic membrane repair
|
$1,822.00 |
$1,822.00 |
$1,822.00 |
$2,638.87
|
|
Ua w/micro/comp poc
|
$19.00 |
$19.00 |
$19.00 |
$23.00
|
|
Ugt1a1 gene analy common variants
|
$180.00 |
$180.00 |
$180.00 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$446.00 |
$446.00 |
$446.00 |
$394.20
|
|
Ultrasound breast complete
|
$483.34 |
$483.34 |
$483.34 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$629.00 |
$629.00 |
$629.00 |
$449.35
|
|
Ultrasound chest
|
$225.50 |
$225.50 |
$225.50 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$212.00 |
$212.00 |
$212.00 |
$338.00
|
|
Ultrasound encephalogram
|
$172.50 |
$172.50 |
$172.50 |
$488.80
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$192.50 |
$192.50 |
$192.50 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$240.00 |
$240.00 |
$240.00 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$549.00 |
$549.00 |
$549.00 |
$720.15
|
|
Ultrasound guide intraoperative
|
$527.50 |
$527.50 |
$527.50 |
$632.85
|
|
Ultrasound joint/nonvascular extremity limited left
|
$710.00 |
$710.00 |
$710.00 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$710.50 |
$710.50 |
$710.50 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$710.50 |
$710.50 |
$710.50 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$408.50 |
$408.50 |
$408.50 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$388.50 |
$388.50 |
$388.50 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$476.50 |
$476.50 |
$476.50 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$510.50 |
$510.50 |
$510.50 |
$497.12
|
|
Ultrasound retroperitoneal limited
|
$611.00 |
$611.00 |
$611.00 |
$486.50
|
|
Ultrasound scrotum and contents
|
$492.00 |
$492.00 |
$492.00 |
$608.90
|
|
Ultrasound transabd ea addl gest
|
$919.50 |
$919.50 |
$919.50 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$510.50 |
$510.50 |
$510.50 |
$558.35
|
|
Unlisted chemotherapy px
|
$51.00 |
$51.00 |
$51.00 |
$150.00
|
|
Unlisted hematology&coagj px
|
$54.00 |
$54.00 |
$54.00 |
$39.52
|
|
Unlisted maaa
|
$3,206.50 |
$3,206.50 |
$3,206.50 |
$235.20
|
|
Unlisted neurological dx px
|
$252.50 |
$252.50 |
$252.50 |
$242.50
|
|
Unlisted procedure colon
|
$1,112.00 |
$1,112.00 |
$1,112.00 |
$1,702.50
|
|
Unlisted procedure larynx
|
$273.00 |
$273.00 |
$273.00 |
$924.00
|
|
Unlisted procedure microbiology
|
$6.00 |
$6.00 |
$6.00 |
$523.50
|
|
Unlisted procedure rectum
|
$1,112.00 |
$1,112.00 |
$1,112.00 |
$1,220.35
|
|
Unlisted procedure spine
|
$272.00 |
$272.00 |
$272.00 |
$4,659.85
|
|
Unlisted px ant segment eye
|
$2,834.50 |
$2,834.50 |
$2,834.50 |
$2,698.92
|
|
Unlisted px casting/strpg
|
$201.00 |
$201.00 |
$201.00 |
$219.70
|
|
Unlisted px hands/fingers
|
$466.00 |
$466.00 |
$466.00 |
$354.20
|
|
Unlisted px lacrimal system
|
$348.00 |
$348.00 |
$348.00 |
$416.50
|
|
Unlisted px leg/ankle
|
$301.00 |
$301.00 |
$301.00 |
$811.00
|
|
Unlisted px middle ear
|
$273.00 |
$273.00 |
$273.00 |
$343.50
|
|
Unlisted px posterior segmnt
|
$2,834.50 |
$2,834.50 |
$2,834.50 |
$3,173.34
|
|
Unlisted px small intestine
|
$1,574.50 |
$1,574.50 |
$1,574.50 |
$2,102.10
|
|
Unlisted px tongue flr mouth
|
$273.00 |
$273.00 |
$273.00 |
$282.50
|
|
Unlisted spec derm svc/px
|
$237.00 |
$237.00 |
$237.00 |
$223.08
|
|
Unlisted transfusion med px
|
$255.50 |
$255.50 |
$255.50 |
$147.50
|
|
Unlisted urinalysis px
|
$79.50 |
$79.50 |
$79.50 |
$25.72
|
|
Upgrade pm system
|
$4,988.50 |
$4,988.50 |
$4,988.50 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,688.00 |
$2,688.00 |
$2,688.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,450.00 |
$1,450.00 |
$1,450.00 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,343.50 |
$1,343.50 |
$1,343.50 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$3,833.67 |
$3,833.67 |
$3,833.67 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$2,757.00 |
$2,757.00 |
$2,757.00 |
$1,768.00
|
|
Urea nitrogen
|
$36.00 |
$36.00 |
$36.00 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$35.00 |
$35.00 |
$35.00 |
$51.75
|
|
Urea nitrogen clearance
|
$62.00 |
$62.00 |
$62.00 |
$42.25
|
|
Urethrcystgrphy rtrgrde s&i
|
$480.50 |
$480.50 |
$480.50 |
$579.73
|
|
Urethrocystography void s&i
|
$970.50 |
$970.50 |
$970.50 |
$622.35
|
|
Uric acid blood
|
$41.00 |
$41.00 |
$41.00 |
$48.75
|
|
Uric acid urine
|
$38.50 |
$38.50 |
$38.50 |
$44.33
|
|
Urinalysis microscopic only
|
$17.50 |
$17.50 |
$17.50 |
$26.35
|
|
Urinalysis (with microscopy)
|
$35.00 |
$35.00 |
$35.00 |
$55.00
|
|
Urinalysis (without microscopy)
|
$29.50 |
$29.50 |
$29.50 |
$35.75
|
|
Urine Culture Test
|
$65.50 |
$65.50 |
$65.50 |
$81.50
|
|
Urine flow measurement 51736
|
$152.50 |
$152.50 |
$152.50 |
$210.00
|
|
Urine pregnancy test
|
$65.50 |
$65.50 |
$65.50 |
$67.20
|
|
Urography, antegrade
|
$445.50 |
$445.50 |
$445.50 |
$622.35
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$136.50 |
$136.50 |
$136.50 |
$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
|
$236.50 |
$236.50 |
$236.50 |
$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
|
$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
|
$71.00 |
$71.00 |
$71.00 |
$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
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$282.50 |
$282.50 |
$282.50 |
$282.50
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$79.50 |
$79.50 |
$79.50 |
$143.20
|
|
Vaccine influenza inactivated adjuvant im
|
$73.00 |
$73.00 |
$73.00 |
$109.50
|
|
Vaccine influenza nos 0.5ml dose im
|
$16.50 |
$16.50 |
$16.50 |
$24.20
|
