|
Unlisted laparoscopic procedure 49659
|
$1,977.60 |
$1,977.60 |
$1,977.60 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$1,755.20 |
$1,755.20 |
$1,755.20 |
$5,419.00
|
|
Unlisted laps px bladder
|
$1,531.20 |
$1,531.20 |
$1,531.20 |
$5,082.74
|
|
Unlisted laps px ovidct ovry
|
$1,158.40 |
$1,158.40 |
$1,158.40 |
$6,904.15
|
|
Unlisted laps px uterus
|
$768.00 |
$768.00 |
$768.00 |
$4,627.00
|
|
Unlisted maaa
|
$127.86 |
$127.86 |
$127.86 |
$235.20
|
|
Unlisted mr procedure
|
$1,158.67 |
$1,158.67 |
$1,158.67 |
$1,165.00
|
|
Unlisted muscskel px dx nuc
|
$1,384.34 |
$1,384.34 |
$1,384.34 |
$1,279.98
|
|
Unlisted nrvs sys px dx nuc
|
$1,410.40 |
$1,410.40 |
$1,410.40 |
$891.41
|
|
Unlisted procedure colon
|
$2,701.17 |
$2,701.17 |
$2,701.17 |
$1,839.55
|
|
Unlisted procedure microbiology
|
$38.58 |
$38.58 |
$38.58 |
$530.00
|
|
Unlisted procedure pancreas
|
$1,849.60 |
$1,849.60 |
$1,849.60 |
$4,810.00
|
|
Unlisted procedure rectum
|
$2,921.28 |
$2,921.28 |
$2,921.28 |
$1,278.72
|
|
Unlisted psychiatric service/proc 90899
|
$1,263.01 |
$1,263.01 |
$1,263.01 |
$277.76
|
|
Unlisted px arthroscopy
|
$2,765.60 |
$2,765.60 |
$2,765.60 |
$2,765.60
|
|
Unlisted px casting/strpg
|
$78.40 |
$78.40 |
$78.40 |
$222.00
|
|
Unlisted px foot/toes
|
$2,209.17 |
$2,209.17 |
$2,209.17 |
$1,225.50
|
|
Unlisted px pelvis/hip joint
|
$1,415.20 |
$1,415.20 |
$1,415.20 |
$3,251.90
|
|
Unlisted px salivry glnd/dux
|
$368.32 |
$368.32 |
$368.32 |
$1,173.42
|
|
Unlisted px small intestine
|
$2,636.80 |
$2,636.80 |
$2,636.80 |
$2,118.35
|
|
Unlisted px tongue flr mouth
|
$208.00 |
$208.00 |
$208.00 |
$282.50
|
|
Unlisted reprod med lab proc
|
$70.00 |
$70.00 |
$70.00 |
$70.00
|
|
Unlisted special svc px/rprt
|
$25.60 |
$25.60 |
$25.60 |
$90.00
|
|
Unlisted transfusion med px
|
$57.14 |
$57.14 |
$57.14 |
$147.50
|
|
Unlisted ultrasound procedure
|
$369.60 |
$369.60 |
$369.60 |
$335.00
|
|
Unlisted urinalysis px
|
$25.72 |
$25.72 |
$25.72 |
$25.72
|
|
Unlstd hematop ret/endo lymp
|
$1,384.34 |
$1,384.34 |
$1,384.34 |
$473.22
|
|
Unsched dialysis esrd pt hos
|
$1,939.26 |
$1,939.26 |
$1,939.26 |
$1,316.90
|
|
Upgrade pm system
|
$23,561.25 |
$23,561.25 |
$23,561.25 |
$12,087.24
|
|
Upper Arm (Humerus) X-ray (left side)
|
$294.96 |
$294.96 |
$294.96 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$1,947.16 |
$1,947.16 |
$1,947.16 |
$1,652.95
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,627.93 |
$1,627.93 |
$1,627.93 |
$1,422.05
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,467.01 |
$4,467.01 |
$4,467.01 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$4,026.96 |
$4,026.96 |
$4,026.96 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,165.86 |
$3,165.86 |
$3,165.86 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$418.96 |
$418.96 |
$418.96 |
$320.45
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$418.96 |
$418.96 |
$418.96 |
$380.82
|
|
Upper Endoscopy (EGD, diagnostic)
|
$687.20 |
$687.20 |
$687.20 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$914.40 |
$914.40 |
$914.40 |
$1,768.00
|
|
Upper ext fx orthosis rad/ul
|
$857.60 |
$857.60 |
$857.60 |
$619.49
|
|
Upper ext harvest for cabg1 seg 35600
|
$627.20 |
$627.20 |
$627.20 |
$627.20
|
|
Upper GI Barium X-ray (barium and gas)
|
$472.88 |
$472.88 |
$472.88 |
$657.77
|
|
Upper GI Barium X-ray (barium only)
|
$500.14 |
$500.14 |
$500.14 |
$603.20
|
|
Uppr gi scope w/submuc inj
|
$916.80 |
$916.80 |
$916.80 |
$1,872.00
|
|
Urachal cyst/sinus excision 51500
|
$1,605.60 |
$1,605.60 |
$1,605.60 |
$6,082.67
|
|
Urea nitrogen
|
$33.57 |
$33.57 |
$33.57 |
$42.00
|
|
Urea nitrogen 24 hour urine
|
$33.57 |
$33.57 |
$33.57 |
$51.77
|
|
Urea nitrogen clearance
|
$33.57 |
$33.57 |
$33.57 |
$34.02
|
|
Urea nitrogen semi-quant
|
$10.40 |
$10.40 |
$10.40 |
$10.40
|
|
Ureteral embolization/occl
|
$9,249.60 |
$9,249.60 |
$9,249.60 |
$2,079.31
|
|
Ureteral reflux study
|
$503.20 |
$503.20 |
$503.20 |
$952.50
|
|
Ureter endoscopy
|
$1,875.20 |
$1,875.20 |
$1,875.20 |
$3,326.40
|
|
Ureter endoscopy & biopsy
|
$2,140.80 |
$2,140.80 |
$2,140.80 |
$5,696.72
|
|
Ureter endoscopy & biopsy
|
$2,392.00 |
$2,392.00 |
$2,392.00 |
$5,986.78
|
|
Ureter endoscopy & catheter
|
$1,812.80 |
$1,812.80 |
$1,812.80 |
$3,326.40
|
|
Ureter endoscopy & treatment
|
$2,161.60 |
$2,161.60 |
$2,161.60 |
$6,015.75
|
|
Ureter endoscopy & treatment
|
$1,947.20 |
$1,947.20 |
$1,947.20 |
$5,631.74
|
|
Ureter endoscopy & treatment
|
$2,358.40 |
$2,358.40 |
$2,358.40 |
$5,986.78
|
|
Ureter endoscopy & treatment
|
$1,803.20 |
$1,803.20 |
$1,803.20 |
$5,631.74
|
|
Ureteroneocystostomy 50780
|
$5,564.80 |
$5,564.80 |
$5,564.80 |
$4,457.05
|
|
Ureteroureterostomy 50760
|
$5,649.60 |
$5,649.60 |
$5,649.60 |
$2,773.01
|
|
Urethrcystgrphy rtrgrde s&i
|
$574.40 |
$574.40 |
$574.40 |
$592.80
|
|
Urethrlys transvag with scope
|
$1,883.20 |
$1,883.20 |
$1,883.20 |
$4,081.37
|
|
Urethrocystography void s&i
|
$586.03 |
$586.03 |
$586.03 |
$631.75
|
|
Uric acid blood
|
$33.57 |
$33.57 |
$33.57 |
$48.96
|
|
Uric acid urine
|
$33.57 |
$33.57 |
$33.57 |
$44.14
|
|
Urinalysis glass test
|
$11.20 |
$11.20 |
$11.20 |
$11.20
|
|
Urinalysis microscopic only
|
$25.72 |
$25.72 |
$25.72 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$25.72 |
$25.72 |
$25.72 |
$25.72
|
|
Urinalysis (with microscopy)
|
$25.72 |
$25.72 |
$25.72 |
$54.60
|
|
Urinalysis (without microscopy)
|
$25.72 |
$25.72 |
$25.72 |
$35.15
|
|
Urinary bldr retent nuc study
|
$474.64 |
$474.64 |
$474.64 |
$350.66
|
|
Urinary reflex study
|
$605.60 |
$605.60 |
$605.60 |
$216.05
|
|
Urine Culture Test
|
$38.58 |
$38.58 |
$38.58 |
$81.00
|
|
Urine flow measurement 51736
|
$34.40 |
$34.40 |
$34.40 |
$210.00
|
|
Urine pregnancy test
|
$25.72 |
$25.72 |
$25.72 |
$66.87
|
|
Urine screen for bacteria
|
$60.00 |
$60.00 |
$60.00 |
$55.64
|
|
Urine specimen collect mult
|
$18.40 |
$18.40 |
$18.40 |
$16.80
|
|
Urography, antegrade
|
$579.20 |
$579.20 |
$579.20 |
$622.35
|
|
Urography inf drip &/or bolus
|
$264.80 |
$264.80 |
$264.80 |
$642.50
|
|
Urokinase 250,000 iu inj
|
$522.40 |
$522.40 |
$522.40 |
$522.40
|
|
Use 1st target lesion
|
$167.20 |
$167.20 |
$167.20 |
$332.00
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$24.32 |
$24.32 |
$24.32 |
$5,205.00
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$253.60 |
$253.60 |
$253.60 |
$51,633.07
|
|
Vaccine Administration (one shot)
|
$116.49 |
$116.49 |
$116.49 |
$67.74
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$233.60 |
$233.60 |
$233.60 |
$227.04
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$233.60 |
$233.60 |
$233.60 |
$211.89
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$255.20 |
$255.20 |
$255.20 |
$234.36
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$171.20 |
$171.20 |
$171.20 |
$123.20
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$128.00 |
$128.00 |
$128.00 |
$80.15
|
|
Vaccine dtap < 7 years im
|
$31.20 |
$31.20 |
$31.20 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$92.00 |
$92.00 |
$92.00 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$89.60 |
$89.60 |
$89.60 |
$105.95
|
|
Vaccine dtap-ipv-hib-hepb im
|
$320.60 |
$320.60 |
$320.60 |
$174.72
|
|
Vaccine dtap-ipv/hib im
|
$107.20 |
$107.20 |
$107.20 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$36.00 |
$36.00 |
$36.00 |
$72.00
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$32.80 |
$32.80 |
$32.80 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$77.60 |
$77.60 |
$77.60 |
$169.35
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$119.20 |
$119.20 |
$119.20 |
$231.56
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$40.00 |
$40.00 |
$40.00 |
$80.28
|
