|
Unlisted mr procedure
|
$97.54 |
$97.54 |
$97.54 |
$1,032.20
|
|
Unlisted muscskel px dx nuc
|
$445.16 |
$445.16 |
$445.16 |
$475.51
|
|
Unlisted muscskel px head
|
$257.26 |
$257.26 |
$257.26 |
$274.80
|
|
Unlisted neurological dx px
|
$173.33 |
$173.33 |
$173.33 |
$185.15
|
|
Unlisted nrvs sys px dx nuc
|
$445.16 |
$445.16 |
$445.16 |
$475.51
|
|
Unlisted oph svc/procedure
|
$27.13 |
$27.13 |
$27.13 |
$28.98
|
|
Unlisted orl service/px
|
$27.13 |
$27.13 |
$27.13 |
$121.50
|
|
Unlisted procedure colon
|
$1,010.01 |
$1,010.01 |
$1,010.01 |
$1,580.44
|
|
Unlisted procedure esophagus
|
$1,038.65 |
$1,038.65 |
$1,038.65 |
$1,215.50
|
|
Unlisted procedure eyelids
|
$331.16 |
$331.16 |
$331.16 |
$479.62
|
|
Unlisted procedure larynx
|
$257.26 |
$257.26 |
$257.26 |
$4,350.00
|
|
Unlisted procedure liver
|
$779.45 |
$779.45 |
$779.45 |
$2,694.00
|
|
Unlisted procedure orbit
|
$331.16 |
$331.16 |
$331.16 |
$353.74
|
|
Unlisted procedure pancreas
|
$779.45 |
$779.45 |
$779.45 |
$2,967.75
|
|
Unlisted procedure rectum
|
$1,010.01 |
$1,010.01 |
$1,010.01 |
$1,278.72
|
|
Unlisted procedure spine
|
$265.74 |
$265.74 |
$265.74 |
$4,706.35
|
|
Unlisted psychiatric service/proc 90899
|
$33.00 |
$33.00 |
$33.00 |
$96.48
|
|
Unlisted px abdomen muscskel
|
$265.74 |
$265.74 |
$265.74 |
$2,633.80
|
|
Unlisted px accessory sinus
|
$257.26 |
$257.26 |
$257.26 |
$257.26
|
|
Unlisted px ant segment eye
|
$2,526.64 |
$2,526.64 |
$2,526.64 |
$2,698.92
|
|
Unlisted px arthroscopy
|
$265.74 |
$265.74 |
$265.74 |
$4,087.20
|
|
Unlisted px biliary tract
|
$1,038.65 |
$1,038.65 |
$1,038.65 |
$2,718.10
|
|
Unlisted px casting/strpg
|
$174.80 |
$174.80 |
$174.80 |
$224.93
|
|
Unlisted px conjunctiva
|
$331.16 |
$331.16 |
$331.16 |
$353.74
|
|
Unlisted px exc pressure ulc
|
$779.45 |
$779.45 |
$779.45 |
$832.60
|
|
Unlisted px external ear
|
$257.26 |
$257.26 |
$257.26 |
$354.00
|
|
Unlisted px extraocular musc
|
$331.16 |
$331.16 |
$331.16 |
$352.04
|
|
Unlisted px foot/toes
|
$265.74 |
$265.74 |
$265.74 |
$3,105.70
|
|
Unlisted px forearm/wrist
|
$265.74 |
$265.74 |
$265.74 |
$3,521.60
|
|
Unlisted px hands/fingers
|
$265.74 |
$265.74 |
$265.74 |
$379.44
|
|
Unlisted px inner ear
|
$257.26 |
$257.26 |
$257.26 |
$4,881.00
|
|
Unlisted px lacrimal system
|
$331.16 |
$331.16 |
$331.16 |
$359.15
|
|
Unlisted px leg/ankle
|
$265.74 |
$265.74 |
$265.74 |
$811.00
|
|
Unlisted px male genital sys
|
$269.43 |
$269.43 |
$269.43 |
$897.95
|
|
Unlisted px med radj physics
|
$147.09 |
$147.09 |
$147.09 |
$376.03
|
|
Unlisted px middle ear
|
$257.26 |
$257.26 |
$257.26 |
$1,975.05
|
|
Unlisted px neck/thorax
|
$257.26 |
$257.26 |
$257.26 |
$2,680.22
|
|
Unlisted px palate uvula
|
$257.26 |
$257.26 |
$257.26 |
$257.04
|
|
Unlisted px pelvis/hip joint
|
$265.74 |
$265.74 |
$265.74 |
$2,108.82
|
|
Unlisted px posterior segmnt
|
$2,526.64 |
$2,526.64 |
$2,526.64 |
$3,997.80
|
|
Unlisted px salivry glnd/dux
|
$257.26 |
$257.26 |
$257.26 |
$486.72
|
|
Unlisted px small intestine
|
$1,038.65 |
$1,038.65 |
$1,038.65 |
$2,118.35
|
|
Unlisted px temporal bone
|
$257.26 |
$257.26 |
$257.26 |
$274.80
|
|
Unlisted px ther rad tx plng
|
$147.09 |
$147.09 |
$147.09 |
$157.11
|
|
Unlisted px tongue flr mouth
|
$257.26 |
$257.26 |
$257.26 |
$274.80
|
|
Unlisted px vestibule mouth
|
$257.26 |
$257.26 |
$257.26 |
$274.80
|
|
Unlisted reprod med lab proc
|
$59.19 |
$59.19 |
$59.19 |
$70.00
|
|
Unlisted resp px dx nuc med
|
$445.16 |
$445.16 |
$445.16 |
$545.61
|
|
Unlisted spec derm svc/px
|
$220.12 |
$220.12 |
$220.12 |
$219.93
|
|
Unlisted surgical path px
|
$59.19 |
$59.19 |
$59.19 |
$71.65
|
|
Unlisted transfusion med px
|
$27.13 |
$27.13 |
$27.13 |
$141.35
|
|
Unlisted ultrasound procedure
|
$97.54 |
$97.54 |
$97.54 |
$321.20
|
|
Unlisted vasc endoscopy px
|
$684.92 |
$684.92 |
$684.92 |
$862.57
|
|
Unlstd hematop ret/endo lymp
|
$445.16 |
$445.16 |
$445.16 |
$475.51
|
|
Unlstd laps px mat care&dlvr
|
$6,463.42 |
$6,463.42 |
$6,463.42 |
$6,463.42
|
|
Unlstd laps px sprmatic cord
|
$6,463.42 |
$6,463.42 |
$6,463.42 |
$4,881.00
|
|
Unsched dialysis esrd pt hos
|
$775.16 |
$775.16 |
$775.16 |
$1,505.29
|
|
Upgrade pm system
|
$11,593.70 |
$11,593.70 |
$11,593.70 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$395.64 |
$395.64 |
$395.64 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$395.64 |
$395.64 |
$395.64 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$267.78 |
$267.78 |
$267.78 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,038.65 |
$1,038.65 |
$1,038.65 |
$1,588.59
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,038.65 |
$1,038.65 |
$1,038.65 |
$1,656.60
|
|
Uppr gi scope w/submuc inj
|
$1,038.65 |
$1,038.65 |
$1,038.65 |
$1,773.85
|
|
Urachal cyst/sinus excision 51500
|
$6,463.42 |
$6,463.42 |
$6,463.42 |
$6,082.67
|
|
Urea nitrogen
|
$3.95 |
$3.95 |
$3.95 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$5.56 |
$5.56 |
$5.56 |
$50.00
|
|
Urea nitrogen clearance
|
$7.20 |
$7.20 |
$7.20 |
$33.57
|
|
Ureteral reflux study
|
$445.16 |
$445.16 |
$445.16 |
$961.20
|
|
Ureter endoscopy
|
$3,820.84 |
$3,820.84 |
$3,820.84 |
$3,820.84
|
|
Ureter endoscopy & biopsy
|
$5,631.74 |
$5,631.74 |
$5,631.74 |
$5,626.86
|
|
Ureter endoscopy & biopsy
|
$5,631.74 |
$5,631.74 |
$5,631.74 |
$5,626.86
|
|
Ureter endoscopy & catheter
|
$3,820.84 |
$3,820.84 |
$3,820.84 |
$3,820.84
|
|
Ureter endoscopy & treatment
|
$5,631.74 |
$5,631.74 |
$5,631.74 |
$5,626.86
|
|
Ureter endoscopy & treatment
|
$5,631.74 |
$5,631.74 |
$5,631.74 |
$5,339.00
|
|
Ureter endoscopy & treatment
|
$5,631.74 |
$5,631.74 |
$5,631.74 |
$5,626.86
|
|
Ureter endoscopy & treatment
|
$5,631.74 |
$5,631.74 |
$5,631.74 |
$5,339.00
|
|
Urethrcystgrphy rtrgrde s&i
|
$267.78 |
$267.78 |
$267.78 |
$574.40
|
|
Urethrlys transvag with scope
|
$3,820.84 |
$3,820.84 |
$3,820.84 |
$4,081.37
|
|
Urethrocystography void s&i
|
$267.78 |
$267.78 |
$267.78 |
$634.50
|
|
Uric acid blood
|
$4.52 |
$4.52 |
$4.52 |
$46.64
|
|
Uric acid urine
|
$5.08 |
$5.08 |
$5.08 |
$46.75
|
|
Urinalysis microscopic only
|
$3.05 |
$3.05 |
$3.05 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$2.17 |
$2.17 |
$2.17 |
$25.72
|
|
Urinalysis (with microscopy)
|
$3.17 |
$3.17 |
$3.17 |
$48.14
|
|
Urinalysis (without microscopy)
|
$2.25 |
$2.25 |
$2.25 |
$38.99
|
|
Urinary reflex study
|
$65.80 |
$65.80 |
$65.80 |
$152.00
|
|
Urine Culture Test
|
$8.07 |
$8.07 |
$8.07 |
$84.81
|
|
Urine flow measurement 51736
|
$142.80 |
$142.80 |
$142.80 |
$152.54
|
|
Urine pregnancy test
|
$8.61 |
$8.61 |
$8.61 |
$66.40
|
|
Urography, antegrade
|
$395.64 |
$395.64 |
$395.64 |
$593.37
|
|
Urography inf drip &/or bolus
|
$197.21 |
$197.21 |
$197.21 |
$641.69
|
|
Use 1st target lesion
|
$117.81 |
$117.81 |
$117.81 |
$245.30
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$13.29 |
$13.29 |
$13.29 |
$6,892.54
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$157.68 |
$157.68 |
$157.68 |
$66,658.97
|
|
U/s trtmt, not leiomyomata
|
$14,254.12 |
$14,254.12 |
$14,254.12 |
$14,241.77
|
|
Vaccine rabies im
|
$312.03 |
$312.03 |
$312.03 |
$945.46
|
|
Vaccinia vrs vac 0.3 ml perq
|
$0.01 |
$0.01 |
$0.01 |
$0.01
|
|
Vag hys/<250g/rmv tube/rpr entero 58263
|
$5,468.70 |
$5,468.70 |
$5,468.70 |
$5,345.59
|
|
Vag hyst incl t/o complex
|
$5,468.70 |
$5,468.70 |
$5,468.70 |
$5,735.60
|
