|
Upper ext fx orthosis rad/ul
|
$45.15 |
$52.97 |
$74.65 |
|
|
Upper GI Barium X-ray (barium and gas)
|
$178.66 |
$215.10 |
$275.47 |
|
|
Upper GI Barium X-ray (barium only)
|
$156.60 |
$205.16 |
$340.50 |
|
|
Uppr gi scope w/submuc inj
|
$1,024.64 |
$3,986.00 |
$6,839.00 |
|
|
Urachal cyst/sinus excision 51500
|
$3,786.00 |
$6,311.00 |
$6,870.89 |
|
|
Urea nitrogen
|
$3.95 |
$4.35 |
$20.50 |
|
|
Urea nitrogen 24 hour urine
|
$5.56 |
$6.12 |
$6.12 |
|
|
Urea nitrogen clearance
|
$7.20 |
$7.92 |
$7.92 |
|
|
Urea nitrogen semi-quant
|
$5.13 |
$5.64 |
$5.64 |
|
|
Ureteral embolization/occl
|
$5,339.00 |
$5,741.00 |
$6,311.00 |
|
|
Ureteral reflux study
|
$213.23 |
$439.15 |
$473.22 |
|
|
Ureter endoscopy
|
$3,769.31 |
$4,061.71 |
$6,839.00 |
|
|
Ureter endoscopy & biopsy
|
$3,786.00 |
$5,626.86 |
$6,839.00 |
|
|
Ureter endoscopy & biopsy
|
$3,786.00 |
$5,626.86 |
$6,839.00 |
|
|
Ureter endoscopy & catheter
|
$3,769.31 |
$4,061.71 |
$6,839.00 |
|
|
Ureter endoscopy & treatment
|
$3,786.00 |
$5,626.86 |
$6,839.00 |
|
|
Ureter endoscopy & treatment
|
$3,786.00 |
$5,626.86 |
$6,839.00 |
|
|
Ureter endoscopy & treatment
|
$3,786.00 |
$5,626.86 |
$6,839.00 |
|
|
Ureter endoscopy & treatment
|
$3,786.00 |
$5,626.86 |
$6,839.00 |
|
|
Urethrcystgrphy rtrgrde s&i
|
$108.36 |
$267.78 |
$372.71 |
|
|
Urethrlys transvag with scope
|
$3,769.31 |
$4,061.71 |
$6,839.00 |
|
|
Urethrocystography void s&i
|
$166.28 |
$245.54 |
$284.66 |
|
|
Uric acid blood
|
$4.52 |
$4.97 |
$7.50 |
|
|
Uric acid urine
|
$5.08 |
$5.59 |
$27.00 |
|
|
Urinalysis glass test
|
$4.70 |
$5.17 |
$5.17 |
|
|
Urinalysis microscopic only
|
$3.05 |
$3.36 |
$19.00 |
|
|
Urinalysis qual/semiquant excpt ia
|
$2.17 |
$2.39 |
$2.39 |
|
|
Urinalysis (with microscopy)
|
$3.17 |
$3.49 |
$42.80 |
|
|
Urinalysis (without microscopy)
|
$2.25 |
$2.48 |
$32.00 |
|
|
Urinary bldr retent nuc study
|
$154.14 |
$154.14 |
$181.09 |
|
|
Urinary reflex study
|
$64.92 |
$3,986.00 |
$6,839.00 |
|
|
Urine Culture Test
|
$8.07 |
$8.88 |
$61.00 |
|
|
Urine flow measurement 51736
|
$140.87 |
$3,986.00 |
$6,839.00 |
|
|
Urine pregnancy test
|
$8.61 |
$9.47 |
$14.00 |
|
|
Urine screen for bacteria
|
$29.98 |
$32.98 |
$32.98 |
|
|
Urine specimen collect mult
|
$9.71 |
$9.71 |
$9.71 |
|
|
Urography, antegrade
|
$219.17 |
$318.75 |
$420.58 |
|
|
Urography inf drip &/or bolus
|
$194.55 |
$197.04 |
$209.65 |
|
|
Use 1st target lesion
|
$116.22 |
$117.70 |
$132.03 |
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$12.97 |
$13.29 |
$13.29 |
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$157.68 |
$157.68 |
$159.91 |
|
|
U/s trtmt, not leiomyomata
|
$14,061.89 |
$14,241.77 |
$15,152.74 |
|
|
Vaccine Administration (one shot)
|
$22.44 |
$59.33 |
$83.81 |
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$52.05 |
$61.08 |
$140.67 |
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$51.46 |
$60.38 |
$139.06 |
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$58.24 |
$68.33 |
$157.38 |
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$34.76 |
$40.79 |
$93.94 |
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$25.96 |
$30.46 |
$70.15 |
|
|
Vaccine dtap < 7 years im
|
$19.09 |
$20.33 |
$46.83 |
|
|
Vaccine dtap-hep b-ipv im
|
$29.16 |
$31.07 |
$71.55 |
|
|
Vaccine dtap-ipv 4-6 years im
|
$20.62 |
$21.60 |
$50.61 |
|
|
Vaccine dtap-ipv-hib-hepb im
|
$56.97 |
$69.03 |
$153.97 |
|
|
Vaccine dtap-ipv/hib im
|
$31.84 |
$33.92 |
$78.13 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$12.07 |
$12.86 |
$29.62 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$4.57 |
$5.37 |
$12.36 |
|
|
Vaccine hepatitis a (hepa) adult im
|
$27.04 |
$31.72 |
$73.07 |
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$45.23 |
$47.37 |
$111.00 |
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$11.34 |
$13.30 |
$30.64 |
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$18.02 |
$21.14 |
$48.70 |
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$55.10 |
$57.71 |
$135.21 |
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$6.63 |
$7.78 |
$17.93 |
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$107.90 |
$114.95 |
$264.75 |
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$114.79 |
$122.29 |
$281.66 |
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$29.85 |
$35.03 |
$80.68 |
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$6.45 |
$7.57 |
$17.44 |
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$7.58 |
$8.89 |
$20.48 |
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$7.76 |
$9.11 |
$20.98 |
|
|
Vaccine influenza quadrivalent (iiv4) split virus 0.25 ml im
|
$4.71 |
$4.73 |
$11.08 |
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$24.66 |
$28.94 |
$66.66 |
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$66.42 |
$77.94 |
$179.50 |
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$48.65 |
$57.08 |
$131.47 |
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$21.69 |
$25.45 |
$58.70 |
|
|
Vaccine mmr live subcutaneous
|
$16.59 |
$19.42 |
$44.83 |
|
|
Vaccine mmrv live subcutaneous
|
$124.31 |
$130.19 |
$305.02 |
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$45.21 |
$53.04 |
$122.16 |
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$85.85 |
$100.73 |
$232.00 |
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$91.33 |
$107.16 |
$246.81 |
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$97.67 |
$114.60 |
$263.93 |
|
|
Vaccine polio (ipv) subcutaneous/im
|
$11.31 |
$12.05 |
$27.77 |
|
|
Vaccine rabies im
|
$143.55 |
$243.28 |
$387.91 |
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$246.88 |
$247.47 |
$579.80 |
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$246.88 |
$247.47 |
$579.80 |
|
|
Vaccine rotavirus attenuated (rv1) live 2 dose oral
|
$42.37 |
$49.72 |
$114.51 |
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$42.21 |
$44.21 |
$103.58 |
|
|
Vaccine tdap >=7 years im
|
$15.31 |
$17.96 |
$41.38 |
|
|
Vaccine td preservative free >= 7 years im
|
$13.65 |
$16.01 |
$36.88 |
|
|
Vaccine typhoid vicps im
|
$44.88 |
$47.01 |
$110.14 |
|
|
Vaccine varicella live subcutaneous
|
$67.32 |
$71.72 |
$165.18 |
|
|
Vaccine yellow fever live subcutaneous
|
$61.43 |
$61.57 |
$144.27 |
|
|
Vaccinia vrs vac 0.3 ml perq
|
$0.01 |
$0.01 |
$0.01 |
|
|
Vag hys/<250g/rmv tube/rpr entero 58263
|
$3,786.00 |
$5,463.96 |
$6,839.00 |
|
|
Vag hyst incl t/o complex
|
$3,786.00 |
$5,463.96 |
$6,839.00 |
|
|
Vag hyst including t/o
|
$3,786.00 |
$5,463.96 |
$6,839.00 |
|
|
Vag hyst t/o & repair compl
|
$3,786.00 |
$6,311.00 |
$8,708.57 |
|
|
Vag hyst w/enterocele compl 58294
|
$3,786.00 |
$5,463.96 |
$6,839.00 |
|
|
Vag hyst w/enterocele repair
|
$3,786.00 |
$5,463.96 |
$6,839.00 |
|
|
Vaginal bx
|
$219.85 |
$3,986.00 |
$6,839.00 |
|
|
Vaginal delivery after cesarean delivery 59612
|
$3,474.84 |
$3,986.00 |
$6,839.00 |
|
|
Vaginal hysterectomy
|
$3,786.00 |
$5,463.96 |
$6,839.00 |
|
|
Vaginectomy partial w/nodes
|
$3,474.84 |
$3,986.00 |
$6,839.00 |
|
