|
Tympanic membrane repair
|
$3,799.00 |
$3,799.00 |
$3,799.00 |
$2,638.87
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$7,093.00 |
$7,093.00 |
$7,093.00 |
$911.43
|
|
Ua w/micro/comp poc
|
$24.50 |
$24.50 |
$24.50 |
$23.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$58,327.52 |
$58,327.52 |
$58,327.52 |
$20,945.01
|
|
Ugt1a1 gene analy common variants
|
$441.50 |
$441.50 |
$441.50 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$380.00 |
$380.00 |
$380.00 |
$394.20
|
|
Ultrasound bone density measure
|
$161.00 |
$161.00 |
$161.00 |
$143.75
|
|
Ultrasound breast complete
|
$883.00 |
$883.00 |
$883.00 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$1,129.00 |
$1,129.00 |
$1,129.00 |
$449.35
|
|
Ultrasound chest
|
$475.50 |
$475.50 |
$475.50 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$268.00 |
$268.00 |
$268.00 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$314.50 |
$314.50 |
$314.50 |
$296.80
|
|
Ultrasound elastography parenchyma
|
$134.50 |
$134.50 |
$134.50 |
$307.00
|
|
Ultrasound encephalogram
|
$724.50 |
$724.50 |
$724.50 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$470.50 |
$470.50 |
$470.50 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$442.50 |
$442.50 |
$442.50 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$188.00 |
$188.00 |
$188.00 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$723.50 |
$723.50 |
$723.50 |
$720.15
|
|
Ultrasound guide intraoperative
|
$1,449.88 |
$1,449.88 |
$1,449.88 |
$632.85
|
|
Ultrasound hips infant dynamic
|
$380.50 |
$380.50 |
$380.50 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$303.50 |
$303.50 |
$303.50 |
$311.25
|
|
Ultrasound joint complete left
|
$662.00 |
$662.00 |
$662.00 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$818.00 |
$818.00 |
$818.00 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$462.00 |
$462.00 |
$462.00 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$271.00 |
$271.00 |
$271.00 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$749.00 |
$749.00 |
$749.00 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$565.00 |
$565.00 |
$565.00 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$475.00 |
$475.00 |
$475.00 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$475.50 |
$475.50 |
$475.50 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$263.00 |
$263.00 |
$263.00 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$430.50 |
$430.50 |
$430.50 |
$486.50
|
|
Ultrasound scrotum and contents
|
$475.00 |
$475.00 |
$475.00 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$524.50 |
$524.50 |
$524.50 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$315.00 |
$315.00 |
$315.00 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$536.50 |
$536.50 |
$536.50 |
$558.35
|
|
Umbilicoplasty 15847
|
$9,547.83 |
$9,547.83 |
$9,547.83 |
$4,172.97
|
|
Unlisted chemotherapy px
|
$86.00 |
$86.00 |
$86.00 |
$150.00
|
|
Unlisted dialysis procedure
|
$1,200.50 |
$1,200.50 |
$1,200.50 |
$1,144.00
|
|
Unlisted dx gi procedure
|
$659.00 |
$659.00 |
$659.00 |
$649.22
|
|
Unlisted fluoroscopic px
|
$649.50 |
$649.50 |
$649.50 |
$305.76
|
|
Unlisted hematology&coagj px
|
$45.00 |
$45.00 |
$45.00 |
$39.52
|
|
Unlisted laparoscopic liver biopy 47379
|
$11,131.67 |
$11,131.67 |
$11,131.67 |
$5,419.00
|
|
Unlisted laparoscopic procedure 49659
|
$37,484.00 |
$37,484.00 |
$37,484.00 |
$6,838.32
|
|
Unlisted laps px appendix
|
$17,639.00 |
$17,639.00 |
$17,639.00 |
$3,617.40
|
|
Unlisted laps px bladder
|
$11,998.25 |
$11,998.25 |
$11,998.25 |
$5,082.74
|
|
Unlisted laps px ovidct ovry
|
$6,380.50 |
$6,380.50 |
$6,380.50 |
$6,904.15
|
|
Unlisted laps px ureter
|
$20,612.63 |
$20,612.63 |
$20,612.63 |
$6,212.70
|
|
Unlisted laps px uterus
|
$9,690.50 |
$9,690.50 |
$9,690.50 |
$4,627.00
|
|
Unlisted maaa
|
$587.00 |
$587.00 |
$587.00 |
$235.20
|
|
Unlisted procedure esophagus
|
$210.17 |
$210.17 |
$210.17 |
$1,998.88
|
|
Unlisted procedure microbiology
|
$1,208.00 |
$1,208.00 |
$1,208.00 |
$523.50
|
|
Unlisted procedure spine
|
$1,277.38 |
$1,277.38 |
$1,277.38 |
$4,659.85
|
|
Unlisted px abdomen muscskel
|
$458.00 |
$458.00 |
$458.00 |
$1,848.60
|
|
Unlisted px ant segment eye
|
$1,979.17 |
$1,979.17 |
$1,979.17 |
$2,698.92
|
|
Unlisted px arthroscopy
|
$7,211.50 |
$7,211.50 |
$7,211.50 |
$2,765.60
|
|
Unlisted px conjunctiva
|
$882.75 |
$882.75 |
$882.75 |
$479.62
|
|
Unlisted px foot/toes
|
$5,028.50 |
$5,028.50 |
$5,028.50 |
$1,225.50
|
|
Unlisted px forearm/wrist
|
$6,072.00 |
$6,072.00 |
$6,072.00 |
$593.60
|
|
Unlisted px hands/fingers
|
$3,860.67 |
$3,860.67 |
$3,860.67 |
$354.20
|
|
Unlisted px leg/ankle
|
$313.50 |
$313.50 |
$313.50 |
$811.00
|
|
Unlisted px pelvis/hip joint
|
$3,646.50 |
$3,646.50 |
$3,646.50 |
$3,118.44
|
|
Unlisted urinalysis px
|
$72.00 |
$72.00 |
$72.00 |
$25.72
|
|
Unlstd laps px sprmatic cord
|
$6,392.67 |
$6,392.67 |
$6,392.67 |
$4,713.11
|
|
Unsched dialysis esrd pt hos
|
$1,020.50 |
$1,020.50 |
$1,020.50 |
$1,268.17
|
|
Upgrade pm system
|
$5,363.00 |
$5,363.00 |
$5,363.00 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,091.50 |
$3,091.50 |
$3,091.50 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,091.50 |
$3,091.50 |
$3,091.50 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,877.50 |
$1,877.50 |
$1,877.50 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$4,247.00 |
$4,247.00 |
$4,247.00 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$2,106.00 |
$2,106.00 |
$2,106.00 |
$1,768.00
|
|
Uppr gi scope w/submuc inj
|
$1,513.67 |
$1,513.67 |
$1,513.67 |
$1,872.00
|
|
Urea nitrogen
|
$28.00 |
$28.00 |
$28.00 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$30.50 |
$30.50 |
$30.50 |
$51.75
|
|
Urethrcystgrphy rtrgrde s&i
|
$596.00 |
$596.00 |
$596.00 |
$579.73
|
|
Urethrocystography void s&i
|
$733.50 |
$733.50 |
$733.50 |
$622.35
|
|
Uric acid blood
|
$30.50 |
$30.50 |
$30.50 |
$48.75
|
|
Uric acid urine
|
$28.00 |
$28.00 |
$28.00 |
$44.33
|
|
Urinalysis microscopic only
|
$14.00 |
$14.00 |
$14.00 |
$26.35
|
|
Urinalysis (with microscopy)
|
$28.50 |
$28.50 |
$28.50 |
$55.00
|
|
Urinalysis (without microscopy)
|
$24.50 |
$24.50 |
$24.50 |
$35.75
|
|
Urine Culture Test
|
$107.00 |
$107.00 |
$107.00 |
$81.50
|
|
Urine flow measurement 51736
|
$267.00 |
$267.00 |
$267.00 |
$210.00
|
|
Urine pregnancy test
|
$17.00 |
$17.00 |
$17.00 |
$67.20
|
|
Urography, antegrade
|
$1,332.00 |
$1,332.00 |
$1,332.00 |
$622.35
|
|
Urography inf drip &/or bolus
|
$599.00 |
$599.00 |
$599.00 |
$642.50
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$9,533.75 |
$9,533.75 |
$9,533.75 |
$5,184.34
|
|
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
|
