|
Unlisted CT procedure
|
$897.62 |
$897.62 |
$897.62 |
$740.43
|
|
Unlisted fluoroscopic px
|
$28.60 |
$28.60 |
$28.60 |
$305.76
|
|
Unlisted hematology&coagj px
|
$96.94 |
$96.94 |
$96.94 |
$39.52
|
|
Unlisted laparoscopic procedure 49659
|
$310.44 |
$310.44 |
$310.44 |
$6,838.32
|
|
Unlisted misc path test
|
$338.18 |
$338.18 |
$338.18 |
$89.40
|
|
Unlisted mr procedure
|
$742.96 |
$742.96 |
$742.96 |
$1,165.00
|
|
Unlisted procedure eyelids
|
$460.20 |
$460.20 |
$460.20 |
$2,174.90
|
|
Unlisted procedure liver
|
$1,978.02 |
$1,978.02 |
$1,978.02 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$3,250.82 |
$3,250.82 |
$3,250.82 |
$530.00
|
|
Unlisted procedure urinary 58750
|
$664.04 |
$664.04 |
$664.04 |
$926.40
|
|
Unlisted px ant segment eye
|
$368.42 |
$368.42 |
$368.42 |
$2,698.92
|
|
Unlisted px small intestine
|
$2,636.62 |
$2,636.62 |
$2,636.62 |
$2,118.35
|
|
Unlisted px tongue flr mouth
|
$653.42 |
$653.42 |
$653.42 |
$282.50
|
|
Unlisted resp px dx nuc med
|
$988.64 |
$988.64 |
$988.64 |
$670.60
|
|
Unlisted surgical path px
|
$150.22 |
$150.22 |
$150.22 |
$216.00
|
|
Unlisted transfusion med px
|
$154.66 |
$154.66 |
$154.66 |
$147.50
|
|
Unlisted ultrasound procedure
|
$463.98 |
$463.98 |
$463.98 |
$335.00
|
|
Unsched dialysis esrd pt hos
|
$1,967.66 |
$1,967.66 |
$1,967.66 |
$1,316.90
|
|
Upgrade pm system
|
$343.46 |
$343.46 |
$343.46 |
$12,087.24
|
|
Upper Arm (Humerus) X-ray (left side)
|
$340.40 |
$340.40 |
$340.40 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$1,814.48 |
$1,814.48 |
$1,814.48 |
$1,652.95
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,084.10 |
$1,084.10 |
$1,084.10 |
$1,422.05
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,765.86 |
$3,765.86 |
$3,765.86 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,013.28 |
$3,013.28 |
$3,013.28 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,039.44 |
$2,039.44 |
$2,039.44 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$411.44 |
$411.44 |
$411.44 |
$320.45
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$513.56 |
$513.56 |
$513.56 |
$380.82
|
|
Upper Endoscopy (EGD, diagnostic)
|
$88.66 |
$88.66 |
$88.66 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$99.58 |
$99.58 |
$99.58 |
$1,768.00
|
|
Upper ext harvest for cabg1 seg 35600
|
$132.86 |
$132.86 |
$132.86 |
$627.20
|
|
Upper GI Barium X-ray (barium and gas)
|
$688.20 |
$688.20 |
$688.20 |
$657.77
|
|
Upper GI Barium X-ray (barium only)
|
$688.20 |
$688.20 |
$688.20 |
$603.20
|
|
Uppr gi scope w/submuc inj
|
$99.58 |
$99.58 |
$99.58 |
$1,872.00
|
|
Urachal cyst/sinus excision 51500
|
$466.96 |
$466.96 |
$466.96 |
$6,082.67
|
|
Urea nitrogen
|
$25.16 |
$25.16 |
$25.16 |
$42.00
|
|
Urea nitrogen 24 hour urine
|
$35.52 |
$35.52 |
$35.52 |
$51.77
|
|
Urea nitrogen clearance
|
$5.72 |
$5.72 |
$5.72 |
$34.02
|
|
Urea nitrogen semi-quant
|
$4.16 |
$4.16 |
$4.16 |
$10.40
|
|
Ureteral embolization/occl
|
$128.96 |
$128.96 |
$128.96 |
$2,079.31
|
|
Ureteral reflux study
|
$1,554.00 |
$1,554.00 |
$1,554.00 |
$952.50
|
|
Ureter endoscopy
|
$267.80 |
$267.80 |
$267.80 |
$3,326.40
|
|
Ureter endoscopy & biopsy
|
$254.80 |
$254.80 |
$254.80 |
$5,696.72
|
|
Ureter endoscopy & biopsy
|
$341.38 |
$341.38 |
$341.38 |
$5,986.78
|
|
Ureter endoscopy & catheter
|
$258.70 |
$258.70 |
$258.70 |
$3,326.40
|
|
Ureter endoscopy & treatment
|
$256.10 |
$256.10 |
$256.10 |
$6,015.75
|
|
Ureter endoscopy & treatment
|
$228.02 |
$228.02 |
$228.02 |
$5,631.74
|
|
Ureter endoscopy & treatment
|
$336.96 |
$336.96 |
$336.96 |
$5,986.78
|
|
Ureter endoscopy & treatment
|
$256.88 |
$256.88 |
$256.88 |
$5,631.74
|
|
Ureteroneocystostomy 50780
|
$811.46 |
$811.46 |
$811.46 |
$4,457.05
|
|
Ureteroureterostomy 50760
|
$822.12 |
$822.12 |
$822.12 |
$2,773.01
|
|
Urethrcystgrphy rtrgrde s&i
|
$934.62 |
$934.62 |
$934.62 |
$592.80
|
|
Urethrlys transvag with scope
|
$546.26 |
$546.26 |
$546.26 |
$4,081.37
|
|
Urethrocystography void s&i
|
$934.62 |
$934.62 |
$934.62 |
$631.75
|
|
Uric acid blood
|
$28.86 |
$28.86 |
$28.86 |
$48.96
|
|
Uric acid urine
|
$32.56 |
$32.56 |
$32.56 |
$44.14
|
|
Urinalysis glass test
|
$3.64 |
$3.64 |
$3.64 |
$11.20
|
|
Urinalysis microscopic only
|
$19.24 |
$19.24 |
$19.24 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$14.06 |
$14.06 |
$14.06 |
$25.72
|
|
Urinalysis (with microscopy)
|
$20.72 |
$20.72 |
$20.72 |
$54.60
|
|
Urinalysis (without microscopy)
|
$14.06 |
$14.06 |
$14.06 |
$35.15
|
|
Urinary bldr retent nuc study
|
$5.46 |
$5.46 |
$5.46 |
$350.66
|
|
Urinary reflex study
|
$40.82 |
$40.82 |
$40.82 |
$216.05
|
|
Urine Culture Test
|
$51.06 |
$51.06 |
$51.06 |
$81.00
|
|
Urine flow measurement 51736
|
$5.98 |
$5.98 |
$5.98 |
$210.00
|
|
Urine pregnancy test
|
$54.02 |
$54.02 |
$54.02 |
$66.87
|
|
Urine screen for bacteria
|
$23.40 |
$23.40 |
$23.40 |
$55.64
|
|
Urine shunt to intestine
|
$891.80 |
$891.80 |
$891.80 |
$1,588.56
|
|
Urine specimen collect mult
|
$7.28 |
$7.28 |
$7.28 |
$16.80
|
|
Urography, antegrade
|
$1,380.84 |
$1,380.84 |
$1,380.84 |
$622.35
|
|
Urography inf drip &/or bolus
|
$688.20 |
$688.20 |
$688.20 |
$642.50
|
|
Use 1st target lesion
|
$20.54 |
$20.54 |
$20.54 |
$332.00
|
|
Vaccine Administration (one shot)
|
$175.38 |
$175.38 |
$175.38 |
$67.74
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$59.80 |
$59.80 |
$59.80 |
$234.36
|
|
Vaccine dtap < 7 years im
|
$14.22 |
$14.22 |
$14.22 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$51.93 |
$51.93 |
$51.93 |
$164.63
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$6.58 |
$6.58 |
$6.58 |
$43.12
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$37.17 |
$37.17 |
$37.17 |
$155.16
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$14.82 |
$14.82 |
$14.82 |
$75.39
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$145.04 |
$145.04 |
$145.04 |
$143.20
|
|
Vaccine influenza inactivated adjuvant im
|
$145.04 |
$145.04 |
$145.04 |
$96.84
|
|
Vaccine influenza nos 0.5ml dose im
|
$32.56 |
$32.56 |
$32.56 |
$24.20
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$34.04 |
$34.04 |
$34.04 |
$48.59
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$73.26 |
$73.26 |
$73.26 |
$77.22
|
|
Vaccine influenza trivalent (iiv3) 0.25ml dose im
|
$16.28 |
$16.28 |
$16.28 |
$23.20
|
|
Vaccine mmr live subcutaneous
|
$48.34 |
$48.34 |
$48.34 |
$211.68
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$60.88 |
$60.88 |
$60.88 |
$251.64
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$146.88 |
$146.88 |
$146.88 |
$563.36
|
|
Vaccine rabies im
|
$226.00 |
$226.00 |
$226.00 |
$858.95
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$289.19 |
$289.19 |
$289.19 |
$980.10
|
|
Vaccine tdap >=7 years im
|
$42.31 |
$42.31 |
$42.31 |
$131.22
|
|
Vaccine td preservative free >= 7 years im
|
$21.19 |
$21.19 |
$21.19 |
$110.19
|
|
Vaccine varicella live subcutaneous
|
$94.77 |
$94.77 |
$94.77 |
$364.16
|
|
Vag hys/<250g/rmv tube/rpr entero 58263
|
$726.96 |
$726.96 |
$726.96 |
$5,345.59
|
|
Vag hyst incl t/o complex
|
$907.14 |
$907.14 |
$907.14 |
$5,813.46
|
|
Vag hyst including t/o
|
$677.30 |
$677.30 |
$677.30 |
$5,110.00
|
|
Vag hyst t/o & repair compl
|
$955.50 |
$955.50 |
$955.50 |
$8,081.64
|
|
Vag hyst w/enterocele compl 58294
|
$887.90 |
$887.90 |
$887.90 |
$5,468.70
|
|
Vag hyst w/enterocele repair
|
$653.12 |
$653.12 |
$653.12 |
$5,463.96
|
|
Vaginal bx
|
$566.10 |
$566.10 |
$566.10 |
$471.12
|
|
Vaginal delivery after cesarean delivery 59612
|
$7,823.28 |
$7,823.28 |
$7,823.28 |
$3,866.47
|
