|
Unlisted px lacrimal system
|
$39,927.35 |
$39,927.35 |
$39,927.35 |
|
|
Unlisted px leg/ankle
|
$324.76 |
$413.40 |
$30,325.57 |
|
|
Unlisted px male genital sys
|
$157.92 |
$550.24 |
$791.72 |
|
|
Unlisted px pelvis/hip joint
|
$1,415.20 |
$1,415.20 |
$1,415.20 |
|
|
Unlisted px salivry glnd/dux
|
$318.96 |
$318.96 |
$368.32 |
|
|
Unlisted px small intestine
|
$1,443.84 |
$2,636.80 |
$6,943.45 |
|
|
Unlisted px tongue flr mouth
|
$99.36 |
$208.00 |
$2,426.09 |
|
|
Unlisted reprod med lab proc
|
$70.00 |
$70.00 |
$70.00 |
|
|
Unlisted special svc px/rprt
|
$7.80 |
$25.60 |
$25.60 |
|
|
Unlisted transfusion med px
|
$57.14 |
$57.14 |
$136.22 |
|
|
Unlisted ultrasound procedure
|
$133.20 |
$369.60 |
$503.64 |
|
|
Unlisted urinalysis px
|
$25.72 |
$25.72 |
$203.84 |
|
|
Unlstd hematop ret/endo lymp
|
$1,020.36 |
$1,020.36 |
$1,384.34 |
|
|
Unlstd laps px sprmatic cord
|
$27,705.82 |
$27,705.82 |
$62,536.66 |
|
|
Unsched dialysis esrd pt hos
|
$468.72 |
$934.16 |
$2,673.00 |
|
|
Upgrade pm system
|
$932.40 |
$15,587.40 |
$25,144.88 |
|
|
Upper Arm (Humerus) X-ray (left side)
|
$98.12 |
$257.40 |
$42,785.25 |
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$758.16 |
$1,733.55 |
$4,165.00 |
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$685.79 |
$1,465.44 |
$4,083.00 |
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,643.20 |
$4,425.60 |
$8,094.00 |
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,119.44 |
$2,503.39 |
$4,520.28 |
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,033.50 |
$2,551.90 |
$4,562.00 |
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$97.19 |
$261.30 |
$52,641.78 |
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$89.70 |
$333.45 |
$1,382.00 |
|
|
Upper Endoscopy (EGD, diagnostic)
|
$172.80 |
$687.20 |
$14,673.40 |
|
|
Upper Endoscopy (EGD, with biopsy)
|
$195.00 |
$1,190.40 |
$20,014.95 |
|
|
Upper ext fx orthosis rad/ul
|
$19.08 |
$857.60 |
$857.60 |
|
|
Upper ext harvest for cabg1 seg 35600
|
$480.00 |
$627.20 |
$627.20 |
|
|
Upper GI Barium X-ray (barium and gas)
|
$302.88 |
$498.31 |
$1,145.00 |
|
|
Upper GI Barium X-ray (barium only)
|
$238.40 |
$433.55 |
$1,093.95 |
|
|
Uppr gi scope w/submuc inj
|
$502.00 |
$916.80 |
$19,993.05 |
|
|
Urachal cyst/sinus excision 51500
|
$1,254.60 |
$1,605.60 |
$1,605.60 |
|
|
Urea nitrogen
|
$29.25 |
$34.80 |
$1,348.75 |
|
|
Urea nitrogen 24 hour urine
|
$27.20 |
$50.40 |
$132.00 |
|
|
Urea nitrogen clearance
|
$31.20 |
$33.57 |
$33.57 |
|
|
Urea nitrogen semi-quant
|
$10.40 |
$10.40 |
$10.40 |
|
|
Ureteral embolization/occl
|
$9,249.60 |
$9,249.60 |
$9,249.60 |
|
|
Ureteral reflux study
|
$503.20 |
$735.00 |
$1,422.67 |
|
|
Ureter endoscopy
|
$1,875.20 |
$1,875.20 |
$1,875.20 |
|
|
Ureter endoscopy & biopsy
|
$2,140.80 |
$2,140.80 |
$2,140.80 |
|
|
Ureter endoscopy & biopsy
|
$2,392.00 |
$2,392.00 |
$2,392.00 |
|
|
Ureter endoscopy & catheter
|
$1,812.80 |
$1,812.80 |
$1,812.80 |
|
|
Ureter endoscopy & treatment
|
$2,161.60 |
$2,161.60 |
$2,161.60 |
|
|
Ureter endoscopy & treatment
|
$1,947.20 |
$1,947.20 |
$1,947.20 |
|
|
Ureter endoscopy & treatment
|
$2,358.40 |
$2,358.40 |
$2,358.40 |
|
|
Ureter endoscopy & treatment
|
$1,803.20 |
$1,803.20 |
$1,803.20 |
|
|
Ureteroneocystostomy 50780
|
$2,203.20 |
$5,564.80 |
$5,564.80 |
|
|
Ureteroureterostomy 50760
|
$2,095.20 |
$5,649.60 |
$5,649.60 |
|
|
Urethrcystgrphy rtrgrde s&i
|
$288.00 |
$574.40 |
$1,110.00 |
|
|
Urethrlys transvag with scope
|
$1,883.20 |
$1,883.20 |
$1,883.20 |
|
|
Urethrocystography void s&i
|
$186.40 |
$583.80 |
$835.25 |
|
|
Uric acid blood
|
$29.25 |
$35.40 |
$165.00 |
|
|
Uric acid urine
|
$20.80 |
$39.90 |
$163.15 |
|
|
Urinalysis glass test
|
$11.20 |
$11.20 |
$11.20 |
|
|
Urinalysis microscopic only
|
$16.20 |
$25.72 |
$81.00 |
|
|
Urinalysis qual/semiquant excpt ia
|
$15.20 |
$25.72 |
$113.40 |
|
|
Urinalysis (with microscopy)
|
$25.72 |
$44.20 |
$7,291.00 |
|
|
Urinalysis (without microscopy)
|
$21.00 |
$34.02 |
$5,318.65 |
|
|
Urinary bldr retent nuc study
|
$173.60 |
$173.60 |
$688.36 |
|
|
Urinary reflex study
|
$605.60 |
$605.60 |
$605.60 |
|
|
Urine Culture Test
|
$38.58 |
$58.50 |
$5,101.30 |
|
|
Urine flow measurement 51736
|
$34.40 |
$34.40 |
$90.00 |
|
|
Urine pregnancy test
|
$25.72 |
$42.25 |
$153.00 |
|
|
Urine screen for bacteria
|
$60.00 |
$60.00 |
$60.00 |
|
|
Urine specimen collect mult
|
$18.40 |
$18.40 |
$18.40 |
|
|
Urography, antegrade
|
$292.50 |
$579.20 |
$1,357.00 |
|
|
Urography inf drip &/or bolus
|
$264.80 |
$264.80 |
$822.32 |
|
|
Urokinase 250,000 iu inj
|
$522.40 |
$522.40 |
$522.40 |
|
|
Use 1st target lesion
|
$113.82 |
$167.20 |
$758.04 |
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$24.21 |
$6,677.00 |
$25,816.55 |
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$253.60 |
$45,913.60 |
$51,633.07 |
|
|
Vaccine Administration (one shot)
|
$39.65 |
$75.71 |
$356.68 |
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$233.60 |
$263.57 |
$441.00 |
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$233.60 |
$240.91 |
$861.00 |
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$98.15 |
$255.20 |
$341.00 |
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$65.65 |
$159.71 |
$192.00 |
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$49.40 |
$114.26 |
$128.00 |
|
|
Vaccine dtap < 7 years im
|
$31.20 |
$109.47 |
$157.56 |
|
|
Vaccine dtap-hep b-ipv im
|
$92.00 |
$100.10 |
$513.00 |
|
|
Vaccine dtap-ipv 4-6 years im
|
$54.60 |
$89.60 |
$301.15 |
|
|
Vaccine dtap-ipv-hib-hepb im
|
$128.70 |
$152.00 |
$347.00 |
|
|
Vaccine dtap-ipv/hib im
|
$98.15 |
$107.20 |
$262.12 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$36.00 |
$39.00 |
$118.96 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$32.80 |
$37.05 |
$138.27 |
|
|
Vaccine hepatitis a (hepa) adult im
|
$77.60 |
$135.85 |
$697.00 |
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$112.22 |
$119.20 |
$281.00 |
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$40.00 |
$45.50 |
$185.55 |
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 3 dose im
|
$42.40 |
$45.50 |
$74.00 |
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$54.60 |
$84.00 |
$105.60 |
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$95.75 |
$130.79 |
$33,066.51 |
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$162.40 |
$306.24 |
$502.00 |
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$48.00 |
$115.57 |
$138.80 |
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$245.05 |
$278.40 |
$1,547.80 |
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$215.15 |
$230.40 |
$348.00 |
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$31.50 |
$126.46 |
$230.00 |
|
|
Vaccine influenza inactivated adjuvant im
|
$37.80 |
$76.00 |
$303.40 |
|
|
Vaccine influenza nos 0.5ml dose im
|
$18.40 |
$20.15 |
$33.00 |
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$18.90 |
$47.38 |
$1,149.20 |
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$16.34 |
$40.95 |
$66.00 |
|
|
Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im
|
$32.34 |
$72.80 |
$243.00 |
|
