|
Unlisted surgical path px
|
$63.23 |
$63.23 |
$63.23 |
|
|
Unlisted transfusion med px
|
$28.69 |
$28.98 |
$61.13 |
|
|
Unlisted ultrasound procedure
|
$104.19 |
$104.19 |
$238.91 |
|
|
Unlisted vasc endoscopy px
|
$731.62 |
$731.62 |
$731.62 |
|
|
Unlstd hematop ret/endo lymp
|
$475.51 |
$475.51 |
$475.51 |
|
|
Unlstd laps px mat care&dlvr
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
|
|
Unlstd laps px sprmatic cord
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
|
|
Unsched dialysis esrd pt hos
|
$406.20 |
$828.02 |
$3,903.00 |
|
|
Upgrade pm system
|
$290.62 |
$12,384.25 |
$12,384.25 |
|
|
Upper Arm (Humerus) X-ray (left side)
|
$104.19 |
$119.40 |
$1,147.00 |
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$210.66 |
$210.66 |
$3,969.00 |
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$125.84 |
$489.02 |
$2,842.00 |
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$422.61 |
$975.00 |
$10,547.00 |
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$422.61 |
$736.20 |
$7,597.00 |
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$286.04 |
$682.20 |
$6,747.00 |
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$125.84 |
$159.60 |
$1,393.00 |
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$125.84 |
$176.40 |
$1,778.00 |
|
|
Upper Endoscopy (EGD, diagnostic)
|
$75.02 |
$1,109.47 |
$2,100.91 |
|
|
Upper Endoscopy (EGD, with biopsy)
|
$84.26 |
$1,109.47 |
$4,245.76 |
|
|
Upper ext harvest for cabg1 seg 35600
|
$112.42 |
$112.42 |
$112.42 |
|
|
Upper GI Barium X-ray (barium and gas)
|
$210.66 |
$336.54 |
$2,340.00 |
|
|
Upper GI Barium X-ray (barium only)
|
$210.66 |
$336.54 |
$1,960.00 |
|
|
Uppr gi scope w/submuc inj
|
$84.26 |
$1,109.47 |
$1,109.47 |
|
|
Urachal cyst/sinus excision 51500
|
$395.12 |
$6,904.15 |
$6,904.15 |
|
|
Urea nitrogen
|
$3.95 |
$9.60 |
$110.00 |
|
|
Urea nitrogen 24 hour urine
|
$5.56 |
$11.40 |
$384.00 |
|
|
Urea nitrogen clearance
|
$4.84 |
$7.20 |
$384.00 |
|
|
Urea nitrogen semi-quant
|
$3.52 |
$5.13 |
$5.13 |
|
|
Ureteral embolization/occl
|
$109.12 |
$829.86 |
$829.86 |
|
|
Ureteral reflux study
|
$16.50 |
$475.51 |
$2,618.00 |
|
|
Ureter endoscopy
|
$226.60 |
$4,081.37 |
$4,081.37 |
|
|
Ureter endoscopy & biopsy
|
$215.60 |
$6,015.75 |
$6,015.75 |
|
|
Ureter endoscopy & biopsy
|
$288.86 |
$6,015.75 |
$6,015.75 |
|
|
Ureter endoscopy & catheter
|
$218.90 |
$4,081.37 |
$4,081.37 |
|
|
Ureter endoscopy & treatment
|
$216.70 |
$6,015.75 |
$6,015.75 |
|
|
Ureter endoscopy & treatment
|
$192.94 |
$6,015.75 |
$6,015.75 |
|
|
Ureter endoscopy & treatment
|
$285.12 |
$6,015.75 |
$6,015.75 |
|
|
Ureter endoscopy & treatment
|
$217.36 |
$6,015.75 |
$6,015.75 |
|
|
Ureteroneocystostomy 50780
|
$686.62 |
$686.62 |
$686.62 |
|
|
Ureteroureterostomy 50760
|
$695.64 |
$695.64 |
$695.64 |
|
|
Urethrcystgrphy rtrgrde s&i
|
$9.46 |
$286.04 |
$1,723.00 |
|
|
Urethrlys transvag with scope
|
$462.22 |
$4,081.37 |
$4,081.37 |
|
|
Urethrocystography void s&i
|
$286.04 |
$286.04 |
$2,532.00 |
|
|
Uric acid blood
|
$4.52 |
$10.80 |
$125.00 |
|
|
Uric acid urine
|
$5.08 |
$11.40 |
$125.00 |
|
|
Urinalysis glass test
|
$3.08 |
$4.70 |
$4.70 |
|
|
Urinalysis microscopic only
|
$2.20 |
$3.05 |
$150.00 |
|
|
Urinalysis qual/semiquant excpt ia
|
$1.32 |
$2.17 |
$107.00 |
|
|
Urinalysis (with microscopy)
|
$3.17 |
$7.80 |
$110.00 |
|
|
Urinalysis (without microscopy)
|
$2.25 |
$6.00 |
$90.00 |
|
|
Urinary bldr retent nuc study
|
$4.62 |
$4.62 |
$4.62 |
|
|
Urinary reflex study
|
$34.54 |
$70.29 |
$192.19 |
|
|
Urine Culture Test
|
$8.07 |
$19.80 |
$181.00 |
|
|
Urine flow measurement 51736
|
$5.06 |
$152.54 |
$1,323.00 |
|
|
Urine pregnancy test
|
$8.61 |
$15.60 |
$86.00 |
|
|
Urine screen for bacteria
|
$19.80 |
$29.98 |
$29.98 |
|
|
Urine shunt to intestine
|
$754.60 |
$754.60 |
$754.60 |
|
|
Urine specimen collect mult
|
$6.16 |
$6.16 |
$6.16 |
|
|
Urography, antegrade
|
$228.60 |
$422.61 |
$1,702.00 |
|
|
Urography inf drip &/or bolus
|
$210.66 |
$210.66 |
$1,430.00 |
|
|
Use 1st target lesion
|
$17.38 |
$125.84 |
$1,456.00 |
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$12.97 |
$12.97 |
$272.39 |
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$159.91 |
$159.91 |
$97,450.01 |
|
|
U/s trtmt, not leiomyomata
|
$5,229.00 |
$5,229.00 |
$5,229.00 |
|
|
Vaccine Administration (one shot)
|
$12.00 |
$84.22 |
$342.00 |
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$184.16 |
$239.41 |
$658.00 |
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$169.03 |
$236.64 |
$1,204.98 |
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$191.10 |
$196.27 |
$1,212.52 |
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$122.85 |
$243.53 |
$808.50 |
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$91.57 |
$243.53 |
$1,811.25 |
|
|
Vaccine dtap < 7 years im
|
$46.85 |
$57.91 |
$199.71 |
|
|
Vaccine dtap-hep b-ipv im
|
$100.70 |
$135.58 |
$624.40 |
|
|
Vaccine dtap-ipv 4-6 years im
|
$73.05 |
$122.60 |
$327.57 |
|
|
Vaccine dtap-ipv-hib-hepb im
|
$205.71 |
$211.02 |
$908.05 |
|
|
Vaccine dtap-ipv/hib im
|
$144.44 |
$226.53 |
$278.81 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$41.94 |
$59.05 |
$185.31 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$17.71 |
$26.03 |
$39.64 |
|
|
Vaccine hepatitis a (hepa) adult im
|
$58.44 |
$142.10 |
$268.66 |
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$208.36 |
$368.60 |
$409.24 |
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$43.39 |
$59.94 |
$246.67 |
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 3 dose im
|
$43.78 |
$47.20 |
$47.20 |
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$43.41 |
$53.42 |
$152.48 |
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$31.46 |
$97.19 |
$240.81 |
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$68.53 |
$271.43 |
$855.54 |
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$45.38 |
$51.88 |
$198.76 |
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$396.44 |
$641.57 |
$1,448.62 |
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$386.70 |
$434.17 |
$460.38 |
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$111.51 |
$169.88 |
$307.38 |
|
|
Vaccine influenza inactivated adjuvant im
|
$498.28 |
$498.28 |
$498.28 |
|
|
Vaccine influenza nos 0.5ml dose im
|
$29.39 |
$38.47 |
$47.34 |
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$31.49 |
$40.94 |
$126.47 |
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$26.44 |
$36.51 |
$44.94 |
|
|
Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im
|
$461.76 |
$461.76 |
$461.76 |
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$37.99 |
$46.75 |
$267.50 |
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$12.00 |
$91.73 |
$136.12 |
|
|
Vaccine influenza quadrivalent live (laiv4) intranasal
|
$37.25 |
$45.34 |
$82.95 |
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$91.25 |
$127.48 |
$429.94 |
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$24.00 |
$68.98 |
$220.48 |
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$266.21 |
$330.07 |
$406.24 |
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$343.22 |
$422.42 |
$1,391.78 |
|
