|
Unlisted px mediastinum
|
$397.60 |
$397.60 |
$397.60 |
$397.60
|
|
Unlisted px med radj physics
|
$526.40 |
$526.40 |
$526.40 |
$462.35
|
|
Unlisted px middle ear
|
$929.60 |
$929.60 |
$929.60 |
$343.50
|
|
Unlisted px neck/thorax
|
$571.20 |
$571.20 |
$571.20 |
$571.20
|
|
Unlisted px palate uvula
|
$571.20 |
$571.20 |
$571.20 |
$274.80
|
|
Unlisted px pelvis/hip joint
|
$5,023.20 |
$5,023.20 |
$5,023.20 |
$3,118.44
|
|
Unlisted px posterior segmnt
|
$1,405.60 |
$1,405.60 |
$1,405.60 |
$3,173.34
|
|
Unlisted px salivry glnd/dux
|
$8,008.00 |
$8,008.00 |
$8,008.00 |
$1,265.16
|
|
Unlisted px small intestine
|
$4,519.20 |
$4,519.20 |
$4,519.20 |
$2,102.10
|
|
Unlisted px temporal bone
|
$571.20 |
$571.20 |
$571.20 |
$571.20
|
|
Unlisted px ther rad tx plng
|
$182.00 |
$182.00 |
$182.00 |
$182.00
|
|
Unlisted px tongue flr mouth
|
$1,344.00 |
$1,344.00 |
$1,344.00 |
$282.50
|
|
Unlisted px vestibule mouth
|
$571.20 |
$571.20 |
$571.20 |
$456.96
|
|
Unlisted reprod med lab proc
|
$209.44 |
$209.44 |
$209.44 |
$70.00
|
|
Unlisted resp px dx nuc med
|
$2,133.60 |
$2,133.60 |
$2,133.60 |
$670.60
|
|
Unlisted spec derm svc/px
|
$448.00 |
$448.00 |
$448.00 |
$223.08
|
|
Unlisted special svc px/rprt
|
$40.88 |
$40.88 |
$40.88 |
$90.00
|
|
Unlisted surgical path px
|
$250.88 |
$250.88 |
$250.88 |
$217.75
|
|
Unlisted transfusion med px
|
$198.24 |
$198.24 |
$198.24 |
$147.50
|
|
Unlisted ultrasound procedure
|
$532.00 |
$532.00 |
$532.00 |
$321.20
|
|
Unlisted urinalysis px
|
$19.04 |
$19.04 |
$19.04 |
$25.72
|
|
Unlisted vasc endoscopy px
|
$1,523.20 |
$1,523.20 |
$1,523.20 |
$1,523.20
|
|
Unlstd hematop ret/endo lymp
|
$182.00 |
$182.00 |
$182.00 |
$473.22
|
|
Unlstd laps px mat care&dlvr
|
$3,600.80 |
$3,600.80 |
$3,600.80 |
$5,741.00
|
|
Unlstd laps px sprmatic cord
|
$3,600.80 |
$3,600.80 |
$3,600.80 |
$4,713.11
|
|
Unsched dialysis esrd pt hos
|
$1,741.60 |
$1,741.60 |
$1,741.60 |
$1,268.17
|
|
Upgrade pm system
|
$15,192.80 |
$15,192.80 |
$15,192.80 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$6,837.60 |
$6,837.60 |
$6,837.60 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$4,995.20 |
$4,995.20 |
$4,995.20 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,645.60 |
$3,645.60 |
$3,645.60 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$3,707.20 |
$3,707.20 |
$3,707.20 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$3,354.40 |
$3,354.40 |
$3,354.40 |
$1,768.00
|
|
Upper ext fx orthosis rad/ul
|
$515.20 |
$515.20 |
$515.20 |
$619.49
|
|
Uppr gi scope w/submuc inj
|
$3,068.80 |
$3,068.80 |
$3,068.80 |
$1,872.00
|
|
Urachal cyst/sinus excision 51500
|
$14,341.60 |
$14,341.60 |
$14,341.60 |
$6,082.67
|
|
Urea nitrogen
|
$19.04 |
$19.04 |
$19.04 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$67.20 |
$67.20 |
$67.20 |
$51.75
|
|
Urea nitrogen clearance
|
$80.08 |
$80.08 |
$80.08 |
$42.25
|
|
Urea nitrogen semi-quant
|
$45.92 |
$45.92 |
$45.92 |
$10.40
|
|
Ureteral embolization/occl
|
$5,958.40 |
$5,958.40 |
$5,958.40 |
$2,181.40
|
|
Ureteral reflux study
|
$2,727.20 |
$2,727.20 |
$2,727.20 |
$952.50
|
|
Ureter endoscopy
|
$3,326.40 |
$3,326.40 |
$3,326.40 |
$3,326.40
|
|
Ureter endoscopy & biopsy
|
$6,445.60 |
$6,445.60 |
$6,445.60 |
$5,696.72
|
|
Ureter endoscopy & biopsy
|
$7,683.20 |
$7,683.20 |
$7,683.20 |
$6,015.75
|
|
Ureter endoscopy & catheter
|
$3,326.40 |
$3,326.40 |
$3,326.40 |
$3,326.40
|
|
Ureter endoscopy & treatment
|
$10,718.40 |
$10,718.40 |
$10,718.40 |
$6,015.75
|
|
Ureter endoscopy & treatment
|
$8,176.00 |
$8,176.00 |
$8,176.00 |
$5,631.74
|
|
Ureter endoscopy & treatment
|
$7,683.20 |
$7,683.20 |
$7,683.20 |
$5,986.78
|
|
Ureter endoscopy & treatment
|
$10,550.40 |
$10,550.40 |
$10,550.40 |
$5,631.74
|
|
Urethrcystgrphy rtrgrde s&i
|
$856.80 |
$856.80 |
$856.80 |
$579.73
|
|
Urethrlys transvag with scope
|
$9,856.00 |
$9,856.00 |
$9,856.00 |
$4,081.37
|
|
Urethrocystography void s&i
|
$2,021.60 |
$2,021.60 |
$2,021.60 |
$622.35
|
|
Uric acid blood
|
$67.20 |
$67.20 |
$67.20 |
$48.75
|
|
Uric acid urine
|
$18.48 |
$18.48 |
$18.48 |
$44.33
|
|
Urinalysis glass test
|
$38.08 |
$38.08 |
$38.08 |
$11.20
|
|
Urinalysis microscopic only
|
$56.00 |
$56.00 |
$56.00 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$30.80 |
$30.80 |
$30.80 |
$25.72
|
|
Urinalysis (with microscopy)
|
$82.88 |
$82.88 |
$82.88 |
$55.00
|
|
Urinalysis (without microscopy)
|
$56.00 |
$56.00 |
$56.00 |
$35.75
|
|
Urinary bldr retent nuc study
|
$666.40 |
$666.40 |
$666.40 |
$350.66
|
|
Urinary reflex study
|
$515.20 |
$515.20 |
$515.20 |
$216.05
|
|
Urine Culture Test
|
$157.92 |
$157.92 |
$157.92 |
$81.50
|
|
Urine flow measurement 51736
|
$319.20 |
$319.20 |
$319.20 |
$210.00
|
|
Urine pregnancy test
|
$87.92 |
$87.92 |
$87.92 |
$67.20
|
|
Urine screen for bacteria
|
$80.08 |
$80.08 |
$80.08 |
$55.64
|
|
Urine specimen collect mult
|
$16.80 |
$16.80 |
$16.80 |
$16.80
|
|
Urography, antegrade
|
$1,372.00 |
$1,372.00 |
$1,372.00 |
$622.35
|
|
Urography inf drip &/or bolus
|
$1,920.80 |
$1,920.80 |
$1,920.80 |
$642.50
|
|
Use 1st target lesion
|
$341.60 |
$341.60 |
$341.60 |
$332.00
|
|
User adjustable heel height
|
$2,004.80 |
$2,004.80 |
$2,004.80 |
$2,004.80
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$3,706.25 |
$3,706.25 |
$3,706.25 |
$5,184.34
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$47,018.27 |
$47,018.27 |
$47,018.27 |
$51,633.07
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$250.56 |
$250.56 |
$250.56 |
$224.25
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$228.19 |
$228.19 |
$228.19 |
$209.40
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$299.55 |
$299.55 |
$299.55 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$170.45 |
$170.45 |
$170.45 |
$123.20
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$64.96 |
$64.96 |
$64.96 |
$80.15
|
|
Vaccine dtap < 7 years im
|
$52.08 |
$52.08 |
$52.08 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$177.29 |
$177.29 |
$177.29 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$166.32 |
$166.32 |
$166.32 |
$105.95
|
|
Vaccine dtap-ipv-hib-hepb im
|
$174.72 |
$174.72 |
$174.72 |
$174.72
|
|
Vaccine dtap-ipv/hib im
|
$224.31 |
$224.31 |
$224.31 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$73.00 |
$73.00 |
$73.00 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$43.12 |
$43.12 |
$43.12 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$170.09 |
$170.09 |
$170.09 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$231.56 |
$231.56 |
$231.56 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$73.92 |
$73.92 |
$73.92 |
$79.15
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 3 dose im
|
$145.60 |
$145.60 |
$145.60 |
$57.20
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$146.87 |
$146.87 |
$146.87 |
$84.75
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$127.68 |
$127.68 |
$127.68 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$274.93 |
$274.93 |
$274.93 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$57.68 |
$57.68 |
$57.68 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$576.48 |
$576.48 |
$576.48 |
$576.48
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$291.20 |
$291.20 |
$291.20 |
$282.50
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$152.15 |
$152.15 |
$152.15 |
$143.20
|
|
Vaccine influenza inactivated adjuvant im
|
$152.15 |
$152.15 |
$152.15 |
$109.50
|
|
Vaccine influenza nos 0.5ml dose im
|
$24.20 |
$24.20 |
$24.20 |
$24.20
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$52.33 |
$52.33 |
$52.33 |
$47.88
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$31.36 |
$31.36 |
$31.36 |
$35.88
|
|
Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im
|
$16.80 |
$16.80 |
$16.80 |
$72.80
|
