|
Unlisted px foot/toes
|
$1,740.80 |
$1,740.80 |
$1,740.80 |
$1,225.50
|
|
Unlisted px leg/ankle
|
$324.76 |
$324.76 |
$324.76 |
$813.24
|
|
Unlisted px male genital sys
|
$791.72 |
$791.72 |
$791.72 |
$362.00
|
|
Unlisted px pelvis/hip joint
|
$1,415.20 |
$1,415.20 |
$1,415.20 |
$3,251.90
|
|
Unlisted px salivry glnd/dux
|
$318.96 |
$318.96 |
$318.96 |
$1,173.42
|
|
Unlisted px small intestine
|
$4,445.29 |
$4,445.29 |
$4,445.29 |
$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
|
|
Unsched dialysis esrd pt hos
|
$1,292.33 |
$1,292.33 |
$1,737.45 |
$1,316.90
|
|
Upgrade pm system
|
$15,468.80 |
$15,468.80 |
$19,098.30 |
$12,087.24
|
|
Upper Arm (Humerus) X-ray (left side)
|
$371.71 |
$371.71 |
$42,785.25 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$1,451.45 |
$1,451.45 |
$2,630.41 |
$1,652.95
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,320.15 |
$1,320.15 |
$2,245.72 |
$1,422.05
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,310.80 |
$4,310.80 |
$5,086.24 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,946.10 |
$1,946.10 |
$4,053.38 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,477.80 |
$2,477.80 |
$3,090.60 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$403.65 |
$403.65 |
$423.31 |
$320.45
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$442.65 |
$442.65 |
$490.52 |
$380.82
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,610.37 |
$1,610.37 |
$14,673.40 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$3,996.55 |
$3,996.55 |
$20,014.95 |
$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)
|
$706.70 |
$706.70 |
$744.25 |
$657.77
|
|
Upper GI Barium X-ray (barium only)
|
$640.09 |
$640.09 |
$672.75 |
$603.20
|
|
Uppr gi scope w/submuc inj
|
$916.80 |
$916.80 |
$19,993.05 |
$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 |
$62.40 |
$42.00
|
|
Urea nitrogen 24 hour urine
|
$33.57 |
$33.57 |
$85.80 |
$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
|
$986.29 |
$986.29 |
$986.29 |
$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
|
$658.01 |
$658.01 |
$721.50 |
$592.80
|
|
Urethrlys transvag with scope
|
$1,883.20 |
$1,883.20 |
$1,883.20 |
$4,081.37
|
|
Urethrocystography void s&i
|
$657.24 |
$657.24 |
$790.40 |
$631.75
|
|
Uric acid blood
|
$33.57 |
$33.57 |
$83.85 |
$48.96
|
|
Uric acid urine
|
$33.57 |
$33.57 |
$84.50 |
$44.14
|
|
Urinalysis glass test
|
$11.20 |
$11.20 |
$11.20 |
$11.20
|
|
Urinalysis microscopic only
|
$25.72 |
$25.72 |
$70.00 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$25.72 |
$25.72 |
$25.72 |
$25.72
|
|
Urinalysis (with microscopy)
|
$25.72 |
$25.72 |
$7,291.00 |
$54.60
|
|
Urinalysis (without microscopy)
|
$25.72 |
$25.72 |
$5,318.65 |
$35.15
|
|
Urinary bldr retent nuc study
|
$688.36 |
$688.36 |
$688.36 |
$350.66
|
|
Urinary reflex study
|
$605.60 |
$605.60 |
$605.60 |
$216.05
|
|
Urine Culture Test
|
$38.58 |
$38.58 |
$5,101.30 |
$81.00
|
|
Urine flow measurement 51736
|
$34.40 |
$34.40 |
$34.40 |
$210.00
|
|
Urine pregnancy test
|
$25.72 |
$25.72 |
$51.35 |
$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
|
$756.19 |
$756.19 |
$882.05 |
$622.35
|
|
Urography inf drip &/or bolus
|
$822.32 |
$822.32 |
$822.32 |
$642.50
|
|
Urokinase 250,000 iu inj
|
$522.40 |
$522.40 |
$522.40 |
$522.40
|
|
Use 1st target lesion
|
$408.76 |
$408.76 |
$408.76 |
$332.00
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$24.40 |
$24.40 |
$6,677.00 |
$5,205.00
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$253.60 |
$253.60 |
$45,913.60 |
$51,633.07
|
|
Vaccine Administration (one shot)
|
$39.65 |
$39.65 |
$116.23 |
$67.74
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$233.60 |
$233.60 |
$286.65 |
$227.04
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$233.60 |
$233.60 |
$559.65 |
$211.89
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$103.35 |
$103.35 |
$255.20 |
$234.36
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$68.90 |
$68.90 |
$171.20 |
$123.20
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$52.00 |
$52.00 |
$128.00 |
$80.15
|
|
Vaccine dtap < 7 years im
|
$116.08 |
$116.08 |
$142.05 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$92.00 |
$92.00 |
$513.00 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$57.20 |
$57.20 |
$89.60 |
$105.95
|
|
Vaccine dtap-ipv-hib-hepb im
|
$135.20 |
$135.20 |
$320.60 |
$174.72
|
|
Vaccine dtap-ipv/hib im
|
$103.35 |
$103.35 |
$107.20 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$39.00 |
$39.00 |
$118.96 |
$72.00
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$32.80 |
$32.80 |
$37.05 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$77.60 |
$77.60 |
$157.00 |
$169.35
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$119.20 |
$119.20 |
$124.80 |
$231.56
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$40.00 |
$40.00 |
$45.50 |
$80.28
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 3 dose im
|
$42.40 |
$42.40 |
$48.10 |
$57.20
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$57.20 |
$57.20 |
$105.60 |
$90.35
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$105.60 |
$105.60 |
$345.70 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$306.24 |
$306.24 |
$326.30 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$48.00 |
$48.00 |
$138.80 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$257.40 |
$257.40 |
$278.40 |
$562.20
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$226.20 |
$226.20 |
$230.40 |
$282.50
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$78.40 |
$78.40 |
$149.50 |
$143.20
|
|
Vaccine influenza inactivated adjuvant im
|
$76.00 |
$76.00 |
$303.40 |
$96.84
|
|
Vaccine influenza nos 0.5ml dose im
|
$21.45 |
$21.45 |
$22.71 |
$24.20
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$23.20 |
$23.20 |
$102.45 |
$48.59
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$20.00 |
$20.00 |
$42.90 |
$35.88
|
|
Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im
|
$72.80 |
$72.80 |
$157.95 |
$72.80
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$20.80 |
$20.80 |
$26.40 |
$28.77
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$21.60 |
$21.60 |
$73.00 |
$33.21
|
