|
Unlisted px diaphragm
|
$18,105.47 |
$18,105.47 |
$22,283.66 |
$6,325.20
|
|
Unlisted px foot/toes
|
$654.26 |
$654.26 |
$805.25 |
$1,225.50
|
|
Unlisted px hands/fingers
|
$3,251.90 |
$3,251.90 |
$4,002.34 |
$349.70
|
|
Unlisted px lacrimal system
|
$918.99 |
$918.99 |
$918.99 |
$416.50
|
|
Unlisted px pelvis/hip joint
|
$3,251.90 |
$3,251.90 |
$4,002.34 |
$3,251.90
|
|
Unlisted px small intestine
|
$2,195.76 |
$2,195.76 |
$2,664.20 |
$2,118.35
|
|
Unlisted px tongue flr mouth
|
$618.08 |
$618.08 |
$618.08 |
$282.50
|
|
Unlisted resp px dx nuc med
|
$1,146.14 |
$1,146.14 |
$1,146.14 |
$670.60
|
|
Unlisted spec derm svc/px
|
$584.21 |
$584.21 |
$627.20 |
$223.08
|
|
Unlisted transfusion med px
|
$61.13 |
$61.13 |
$61.13 |
$147.50
|
|
Unlisted ultrasound procedure
|
$222.56 |
$222.56 |
$238.91 |
$335.00
|
|
Unsched dialysis esrd pt hos
|
$1,806.38 |
$1,806.38 |
$1,939.30 |
$1,316.90
|
|
Upgrade pm system
|
$11,881.43 |
$11,881.43 |
$11,938.26 |
$12,087.24
|
|
Upper Arm (Humerus) X-ray (left side)
|
$201.75 |
$201.75 |
$248.30 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$795.04 |
$795.04 |
$845.92 |
$1,680.60
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$489.02 |
$489.02 |
$520.31 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,648.98 |
$1,648.98 |
$1,652.32 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,648.98 |
$1,648.98 |
$1,652.32 |
$2,410.98
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,006.36 |
$1,006.36 |
$1,307.22 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$275.16 |
$275.16 |
$338.66 |
$322.50
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$275.16 |
$275.16 |
$338.66 |
$381.75
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,706.99 |
$1,706.99 |
$2,100.91 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$2,195.76 |
$2,195.76 |
$2,357.31 |
$1,768.00
|
|
Upper GI Barium X-ray (barium and gas)
|
$336.54 |
$336.54 |
$414.21 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$336.54 |
$336.54 |
$414.21 |
$612.00
|
|
Urea nitrogen
|
$14.31 |
$14.31 |
$17.61 |
$42.00
|
|
Urea nitrogen 24 hour urine
|
$17.18 |
$17.18 |
$21.14 |
$51.77
|
|
Urea nitrogen clearance
|
$23.92 |
$23.92 |
$29.44 |
$34.02
|
|
Ureteral embolization/occl
|
$829.86 |
$829.86 |
$829.86 |
$2,079.31
|
|
Urethrcystgrphy rtrgrde s&i
|
$579.34 |
$579.34 |
$713.03 |
$584.23
|
|
Urethrocystography void s&i
|
$579.34 |
$579.34 |
$713.03 |
$637.80
|
|
Uric acid blood
|
$16.35 |
$16.35 |
$20.13 |
$48.96
|
|
Uric acid urine
|
$17.18 |
$17.18 |
$21.14 |
$44.35
|
|
Urinalysis microscopic only
|
$11.02 |
$11.02 |
$13.56 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$7.83 |
$7.83 |
$9.63 |
$25.72
|
|
Urinalysis (with microscopy)
|
$11.50 |
$11.50 |
$14.15 |
$54.60
|
|
Urinalysis (without microscopy)
|
$8.13 |
$8.13 |
$10.01 |
$35.75
|
|
Urinary reflex study
|
$192.19 |
$192.19 |
$192.19 |
$216.05
|
|
Urine Culture Test
|
$29.19 |
$29.19 |
$35.93 |
$81.27
|
|
Urine flow measurement 51736
|
$335.52 |
$335.52 |
$335.52 |
$210.00
|
|
Urine pregnancy test
|
$25.23 |
$25.23 |
$31.06 |
$67.80
|
|
Urography, antegrade
|
$732.28 |
$732.28 |
$901.26 |
$622.35
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$34.43 |
$34.43 |
$42.38 |
$5,205.00
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$663.04 |
$663.04 |
$816.05 |
$51,633.07
|
|
Vaccine Administration (one shot)
|
$67.74 |
$67.74 |
$83.37 |
$67.74
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$239.41 |
$239.41 |
$294.66 |
$227.04
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$236.64 |
$236.64 |
$291.25 |
$211.89
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$196.27 |
$196.27 |
$241.57 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$243.53 |
$243.53 |
$299.73 |
$123.20
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$243.53 |
$243.53 |
$270.22 |
$80.15
|
|
Vaccine dtap < 7 years im
|
$57.91 |
$57.91 |
$71.27 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$135.58 |
$135.58 |
$166.86 |
$165.26
|
|
Vaccine dtap-ipv 4-6 years im
|
$122.60 |
$122.60 |
$150.90 |
$105.95
|
|
Vaccine dtap-ipv-hib-hepb im
|
$211.02 |
$211.02 |
$259.71 |
$174.72
|
|
Vaccine dtap-ipv/hib im
|
$226.53 |
$226.53 |
$278.81 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$59.05 |
$59.05 |
$72.67 |
$72.00
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$26.03 |
$26.03 |
$32.03 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$142.10 |
$142.10 |
$174.89 |
$168.95
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$208.36 |
$208.36 |
$256.45 |
$231.56
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$59.94 |
$59.94 |
$73.78 |
$80.28
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 3 dose im
|
$43.78 |
$43.78 |
$47.20 |
$57.20
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$43.41 |
$43.41 |
$53.42 |
$90.35
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$78.97 |
$78.97 |
$97.19 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$271.43 |
$271.43 |
$334.07 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$45.38 |
$45.38 |
$55.85 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$641.57 |
$641.57 |
$789.62 |
$570.87
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$434.17 |
$434.17 |
$460.38 |
$282.50
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$169.88 |
$169.88 |
$209.09 |
$143.20
|
|
Vaccine influenza nos 0.5ml dose im
|
$38.47 |
$38.47 |
$47.34 |
$24.20
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$40.94 |
$40.94 |
$50.38 |
$48.59
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$36.51 |
$36.51 |
$44.94 |
$35.88
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$37.99 |
$37.99 |
$46.75 |
$28.77
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$39.11 |
$39.11 |
$48.14 |
$33.21
|
|
Vaccine influenza quadrivalent live (laiv4) intranasal
|
$45.34 |
$45.34 |
$55.80 |
$37.05
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$127.48 |
$127.48 |
$156.90 |
$72.00
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$68.98 |
$68.98 |
$84.90 |
$82.71
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$330.07 |
$330.07 |
$406.24 |
$400.03
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$343.22 |
$343.22 |
$422.42 |
$406.05
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$315.15 |
$315.15 |
$387.88 |
$310.93
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$330.07 |
$330.07 |
$406.24 |
$323.39
|
|
Vaccine mmr live subcutaneous
|
$183.83 |
$183.83 |
$226.25 |
$211.68
|
|
Vaccine mmrv live subcutaneous
|
$568.55 |
$568.55 |
$699.75 |
$466.88
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$208.94 |
$208.94 |
$257.16 |
$251.64
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$462.57 |
$462.57 |
$569.32 |
$393.25
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$439.52 |
$439.52 |
$540.95 |
$414.46
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$462.57 |
$462.57 |
$569.32 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$87.84 |
$87.84 |
$108.11 |
$90.70
|
|
Vaccine rabies im
|
$791.49 |
$791.49 |
$974.14 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$531.55 |
$531.55 |
$654.22 |
$521.74
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$1,031.86 |
$1,031.86 |
$1,269.98 |
$1,104.47
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$1,031.86 |
$1,031.86 |
$1,269.98 |
$980.10
|
|
Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im
|
$508.64 |
$508.64 |
$626.02 |
$407.74
|
|
Vaccine rotavirus attenuated (rv1) live 2 dose oral
|
$174.28 |
$174.28 |
$214.50 |
$200.70
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$174.28 |
$174.28 |
$214.50 |
$126.50
|
|
Vaccine tdap >=7 years im
|
$97.06 |
$97.06 |
$119.46 |
$131.22
|
|
Vaccine td preservative free >= 7 years im
|
$83.37 |
$83.37 |
$102.61 |
$110.19
|
|
Vaccine varicella live subcutaneous
|
$385.63 |
$385.63 |
$474.62 |
$364.16
|
|
Vad battery clip set hmii 14-v li-ion
|
$1,072.50 |
$1,072.50 |
$1,072.50 |
$1,932.00
|
|
Vad cable power module dc input
|
$438.75 |
$438.75 |
$438.75 |
$731.74
|
|
Vad univ batt charger hm 1440
|
$10,530.00 |
$10,530.00 |
$10,530.00 |
$14,814.14
|
