|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$479.72 |
$479.72 |
$479.72 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$328.08 |
$328.08 |
$328.08 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$143.75 |
$143.75 |
$143.75 |
$320.45
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$143.75 |
$143.75 |
$143.75 |
$380.82
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,247.13 |
$1,247.13 |
$1,247.13 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,247.13 |
$1,247.13 |
$1,247.13 |
$1,768.00
|
|
Upper ext fx orthosis rad/ul
|
$606.30 |
$606.30 |
$606.30 |
$619.49
|
|
Upper ext harvest for cabg1 seg 35600
|
$259.30 |
$259.30 |
$259.30 |
$627.20
|
|
Upper GI Barium X-ray (barium and gas)
|
$241.18 |
$241.18 |
$241.18 |
$657.77
|
|
Upper GI Barium X-ray (barium only)
|
$241.18 |
$241.18 |
$241.18 |
$603.20
|
|
Uppr gi scope w/submuc inj
|
$1,247.13 |
$1,247.13 |
$1,247.13 |
$1,872.00
|
|
Urachal cyst/sinus excision 51500
|
$8,312.83 |
$8,312.83 |
$8,312.83 |
$6,082.67
|
|
Urea nitrogen
|
$5.45 |
$5.45 |
$5.45 |
$42.00
|
|
Urea nitrogen 24 hour urine
|
$7.67 |
$7.67 |
$7.67 |
$51.77
|
|
Urea nitrogen clearance
|
$9.94 |
$9.94 |
$9.94 |
$34.02
|
|
Urea nitrogen semi-quant
|
$7.08 |
$7.08 |
$7.08 |
$10.40
|
|
Ureteral embolization/occl
|
$235.23 |
$235.23 |
$235.23 |
$2,079.31
|
|
Ureteral reflux study
|
$549.70 |
$549.70 |
$549.70 |
$952.50
|
|
Ureter endoscopy
|
$4,846.99 |
$4,846.99 |
$4,846.99 |
$3,326.40
|
|
Ureter endoscopy & biopsy
|
$7,372.68 |
$7,372.68 |
$7,372.68 |
$5,696.72
|
|
Ureter endoscopy & biopsy
|
$7,372.68 |
$7,372.68 |
$7,372.68 |
$5,986.78
|
|
Ureter endoscopy & catheter
|
$4,846.99 |
$4,846.99 |
$4,846.99 |
$3,326.40
|
|
Ureter endoscopy & treatment
|
$7,372.68 |
$7,372.68 |
$7,372.68 |
$6,015.75
|
|
Ureter endoscopy & treatment
|
$7,372.68 |
$7,372.68 |
$7,372.68 |
$5,631.74
|
|
Ureter endoscopy & treatment
|
$7,372.68 |
$7,372.68 |
$7,372.68 |
$5,986.78
|
|
Ureter endoscopy & treatment
|
$7,372.68 |
$7,372.68 |
$7,372.68 |
$5,631.74
|
|
Ureteroneocystostomy 50780
|
$1,473.37 |
$1,473.37 |
$1,473.37 |
$4,457.05
|
|
Ureteroureterostomy 50760
|
$1,509.66 |
$1,509.66 |
$1,509.66 |
$2,773.01
|
|
Urethrcystgrphy rtrgrde s&i
|
$328.08 |
$328.08 |
$328.08 |
$592.80
|
|
Urethrlys transvag with scope
|
$4,846.99 |
$4,846.99 |
$4,846.99 |
$4,081.37
|
|
Urethrocystography void s&i
|
$328.08 |
$328.08 |
$328.08 |
$631.75
|
|
Uric acid blood
|
$6.24 |
$6.24 |
$6.24 |
$48.96
|
|
Uric acid urine
|
$7.01 |
$7.01 |
$7.01 |
$44.14
|
|
Urinalysis glass test
|
$6.49 |
$6.49 |
$6.49 |
$11.20
|
|
Urinalysis microscopic only
|
$4.21 |
$4.21 |
$4.21 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$2.99 |
$2.99 |
$2.99 |
$25.72
|
|
Urinalysis (with microscopy)
|
$4.37 |
$4.37 |
$4.37 |
$54.60
|
|
Urinalysis (without microscopy)
|
$3.11 |
$3.11 |
$3.11 |
$35.15
|
|
Urinary bldr retent nuc study
|
$87.52 |
$87.52 |
$87.52 |
$350.66
|
|
Urinary pouch on barr w/flng
|
$6.25 |
$6.25 |
$6.25 |
$9.89
|
|
Urinary pouch w/barrier
|
$11.83 |
$11.83 |
$11.83 |
$5.70
|
|
Urinary reflex study
|
$81.77 |
$81.77 |
$81.77 |
$216.05
|
|
Urinary suspensory
|
$80.19 |
$80.19 |
$80.19 |
$52.20
|
|
Urine Culture Test
|
$11.14 |
$11.14 |
$11.14 |
$81.00
|
|
Urine flow measurement 51736
|
$182.95 |
$182.95 |
$182.95 |
$210.00
|
|
Urine ost pouch w faucet/tap
|
$12.82 |
$12.82 |
$12.82 |
$2.00
|
|
Urine pregnancy test
|
$11.88 |
$11.88 |
$11.88 |
$66.87
|
|
Urine screen for bacteria
|
$41.37 |
$41.37 |
$41.37 |
$55.64
|
|
Urine shunt to intestine
|
$1,588.56 |
$1,588.56 |
$1,588.56 |
$1,588.56
|
|
Urine specimen collect mult
|
$12.89 |
$12.89 |
$12.89 |
$16.80
|
|
Urography, antegrade
|
$479.72 |
$479.72 |
$479.72 |
$622.35
|
|
Urography inf drip &/or bolus
|
$241.18 |
$241.18 |
$241.18 |
$642.50
|
|
Use 1st target lesion
|
$143.75 |
$143.75 |
$143.75 |
$332.00
|
|
User adjustable heel height
|
$3,082.74 |
$3,082.74 |
$3,082.74 |
$2,004.80
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$17.24 |
$17.24 |
$17.24 |
$5,205.00
|
|
U/s trtmt, not leiomyomata
|
$17,653.66 |
$17,653.66 |
$17,653.66 |
$17,653.66
|
|
Vaccine Administration (one shot)
|
$29.00 |
$29.00 |
$29.00 |
$67.74
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$223.08 |
$223.08 |
$223.08 |
$227.04
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$131.00 |
$131.00 |
$131.00 |
$211.89
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$151.00 |
$151.00 |
$151.00 |
$234.36
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$85.00 |
$85.00 |
$85.00 |
$123.20
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$63.00 |
$63.00 |
$63.00 |
$80.15
|
|
Vaccine dtap < 7 years im
|
$22.00 |
$22.00 |
$22.00 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$67.00 |
$67.00 |
$67.00 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$49.00 |
$49.00 |
$49.00 |
$105.95
|
|
Vaccine dtap-ipv/hib im
|
$43.00 |
$43.00 |
$43.00 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$40.00 |
$40.00 |
$40.00 |
$72.00
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$17.00 |
$17.00 |
$17.00 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$109.00 |
$109.00 |
$109.00 |
$169.35
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$166.00 |
$166.00 |
$166.00 |
$231.56
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$29.00 |
$29.00 |
$29.00 |
$80.28
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$103.70 |
$103.70 |
$103.70 |
$90.35
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$287.00 |
$287.00 |
$287.00 |
$562.20
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$310.00 |
$310.00 |
$310.00 |
$282.50
|
|
Vaccine influenza inactivated adjuvant im
|
$135.46 |
$135.46 |
$135.46 |
$96.84
|
|
Vaccine influenza nos 0.5ml dose im
|
$30.46 |
$30.46 |
$30.46 |
$24.20
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$27.00 |
$27.00 |
$27.00 |
$35.88
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$32.00 |
$32.00 |
$32.00 |
$28.77
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$24.00 |
$24.00 |
$24.00 |
$33.21
|
|
Vaccine influenza quadrivalent (iiv4) split virus 0.25 ml im
|
$17.00 |
$17.00 |
$17.00 |
$20.80
|
|
Vaccine influenza quadrivalent live (laiv4) intranasal
|
$25.00 |
$25.00 |
$25.00 |
$37.05
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$62.00 |
$62.00 |
$62.00 |
$72.00
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$68.30 |
$68.30 |
$68.30 |
$77.22
|
|
Vaccine influenza trivalent (iiv3) 0.25ml dose im
|
$15.23 |
$15.23 |
$15.23 |
$23.20
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$295.00 |
$295.00 |
$295.00 |
$387.95
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$112.00 |
$112.00 |
$112.00 |
$323.39
|
|
Vaccine mmr live subcutaneous
|
$125.00 |
$125.00 |
$125.00 |
$211.68
|
|
Vaccine mmrv live subcutaneous
|
$366.00 |
$366.00 |
$366.00 |
$466.88
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$154.00 |
$154.00 |
$154.00 |
$251.64
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$115.00 |
$115.00 |
$115.00 |
$393.25
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$371.64 |
$371.64 |
$371.64 |
$414.46
|
|
Vaccine polio (ipv) subcutaneous/im
|
$56.00 |
$56.00 |
$56.00 |
$90.70
|
|
Vaccine rabies im
|
$324.00 |
$324.00 |
$324.00 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$300.00 |
$300.00 |
$300.00 |
$521.74
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$325.00 |
$325.00 |
$325.00 |
$1,104.47
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$525.00 |
$525.00 |
$525.00 |
$980.10
|
|
Vaccine rotavirus attenuated (rv1) live 2 dose oral
|
$90.00 |
$90.00 |
$90.00 |
$200.70
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$87.00 |
$87.00 |
$87.00 |
$126.14
|
|
Vaccine tdap >=7 years im
|
$62.00 |
$62.00 |
$62.00 |
$131.22
|
|
Vaccine td preservative free >= 7 years im
|
$36.00 |
$36.00 |
$36.00 |
$110.19
|
