|
Unlisted procedure colon
|
$1,983.83 |
$1,983.83 |
$1,983.83 |
$1,839.55
|
|
Unlisted procedure esophagus
|
$7,348.20 |
$7,348.20 |
$7,348.20 |
$1,998.88
|
|
Unlisted procedure eyelids
|
$479.62 |
$479.62 |
$479.62 |
$2,174.90
|
|
Unlisted procedure larynx
|
$5,023.51 |
$5,023.51 |
$5,023.51 |
$924.00
|
|
Unlisted procedure liver
|
$3,071.62 |
$3,071.62 |
$3,071.62 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$2,118.52 |
$2,118.52 |
$2,118.52 |
$530.00
|
|
Unlisted procedure orbit
|
$479.62 |
$479.62 |
$479.62 |
$437.00
|
|
Unlisted procedure pancreas
|
$6,597.79 |
$6,597.79 |
$6,597.79 |
$4,810.00
|
|
Unlisted procedure rectum
|
$875.12 |
$875.12 |
$875.12 |
$1,278.72
|
|
Unlisted procedure spine
|
$9,924.31 |
$9,924.31 |
$9,924.31 |
$4,706.35
|
|
Unlisted px abdomen muscskel
|
$7,349.98 |
$7,349.98 |
$7,349.98 |
$2,053.50
|
|
Unlisted px accessory sinus
|
$167.79 |
$167.79 |
$167.79 |
$3,335.28
|
|
Unlisted px ant segment eye
|
$3,110.31 |
$3,110.31 |
$3,110.31 |
$2,698.92
|
|
Unlisted px arthroscopy
|
$11,433.76 |
$11,433.76 |
$11,433.76 |
$2,765.60
|
|
Unlisted px biliary tract
|
$15,476.87 |
$15,476.87 |
$15,476.87 |
$3,055.00
|
|
Unlisted px casting/strpg
|
$224.93 |
$224.93 |
$224.93 |
$222.00
|
|
Unlisted px conjunctiva
|
$479.62 |
$479.62 |
$479.62 |
$479.62
|
|
Unlisted px diaphragm
|
$4,846.78 |
$4,846.78 |
$4,846.78 |
$6,325.20
|
|
Unlisted px exc pressure ulc
|
$626.83 |
$626.83 |
$626.83 |
$973.71
|
|
Unlisted px external ear
|
$7,359.08 |
$7,359.08 |
$7,359.08 |
$325.68
|
|
Unlisted px extraocular musc
|
$3,718.79 |
$3,718.79 |
$3,718.79 |
$739.20
|
|
Unlisted px foot/toes
|
$6,994.18 |
$6,994.18 |
$6,994.18 |
$1,225.50
|
|
Unlisted px forearm/wrist
|
$4,964.24 |
$4,964.24 |
$4,964.24 |
$859.50
|
|
Unlisted px hands/fingers
|
$6,841.45 |
$6,841.45 |
$6,841.45 |
$349.70
|
|
Unlisted px inner ear
|
$10,216.64 |
$10,216.64 |
$10,216.64 |
$571.20
|
|
Unlisted px lacrimal system
|
$479.62 |
$479.62 |
$479.62 |
$416.50
|
|
Unlisted px leg/ankle
|
$6,818.24 |
$6,818.24 |
$6,818.24 |
$813.24
|
|
Unlisted px male genital sys
|
$4,942.08 |
$4,942.08 |
$4,942.08 |
$362.00
|
|
Unlisted px med radj physics
|
$376.03 |
$376.03 |
$376.03 |
$462.35
|
|
Unlisted px middle ear
|
$2,162.16 |
$2,162.16 |
$2,162.16 |
$343.50
|
|
Unlisted px neck/thorax
|
$2,680.22 |
$2,680.22 |
$2,680.22 |
$571.20
|
|
Unlisted px palate uvula
|
$167.79 |
$167.79 |
$167.79 |
$274.80
|
|
Unlisted px pelvis/hip joint
|
$9,872.02 |
$9,872.02 |
$9,872.02 |
$3,251.90
|
|
Unlisted px salivry glnd/dux
|
$4,032.00 |
$4,032.00 |
$4,032.00 |
$1,173.42
|
|
Unlisted px small intestine
|
$3,029.95 |
$3,029.95 |
$3,029.95 |
$2,118.35
|
|
Unlisted px ther rad tx plng
|
$398.11 |
$398.11 |
$398.11 |
$182.00
|
|
Unlisted px tongue flr mouth
|
$203.98 |
$203.98 |
$203.98 |
$282.50
|
|
Unlisted px vestibule mouth
|
$167.79 |
$167.79 |
$167.79 |
$456.96
|
|
Unlisted spec derm svc/px
|
$139.21 |
$139.21 |
$139.21 |
$223.08
|
|
Unlisted special svc px/rprt
|
$210.00 |
$210.00 |
$210.00 |
$90.00
|
|
Unlisted ultrasound procedure
|
$2,861.95 |
$2,861.95 |
$2,861.95 |
$335.00
|
|
Unlisted vasc endoscopy px
|
$3,160.00 |
$3,160.00 |
$3,160.00 |
$1,523.20
|
|
Unlstd laps px sprmatic cord
|
$4,608.50 |
$4,608.50 |
$4,608.50 |
$4,713.11
|
|
Unsched dialysis esrd pt hos
|
$1,748.01 |
$1,748.01 |
$1,748.01 |
$1,316.90
|
|
Upgrade pm system
|
$16,584.26 |
$16,584.26 |
$16,584.26 |
$12,087.24
|
|
Upper Arm (Humerus) X-ray (left side)
|
$353.69 |
$353.69 |
$353.69 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$2,041.20 |
$2,041.20 |
$2,041.20 |
$1,652.95
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,768.19 |
$1,768.19 |
$1,768.19 |
$1,422.05
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,855.61 |
$3,855.61 |
$3,855.61 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,039.85 |
$2,039.85 |
$2,039.85 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,143.16 |
$2,143.16 |
$2,143.16 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$403.23 |
$403.23 |
$403.23 |
$320.45
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$450.25 |
$450.25 |
$450.25 |
$380.82
|
|
Upper GI Barium X-ray (barium and gas)
|
$704.42 |
$704.42 |
$704.42 |
$657.77
|
|
Upper GI Barium X-ray (barium only)
|
$771.95 |
$771.95 |
$771.95 |
$603.20
|
|
Urachal cyst/sinus excision 51500
|
$6,620.59 |
$6,620.59 |
$6,620.59 |
$6,082.67
|
|
Urea nitrogen
|
$63.50 |
$63.50 |
$63.50 |
$42.00
|
|
Urea nitrogen 24 hour urine
|
$86.29 |
$86.29 |
$86.29 |
$51.77
|
|
Urea nitrogen clearance
|
$20.07 |
$20.07 |
$20.07 |
$34.02
|
|
Ureteral embolization/occl
|
$1,591.37 |
$1,591.37 |
$1,591.37 |
$2,079.31
|
|
Ureteral reflux study
|
$1,298.73 |
$1,298.73 |
$1,298.73 |
$952.50
|
|
Ureter endoscopy
|
$949.04 |
$949.04 |
$949.04 |
$3,326.40
|
|
Ureter endoscopy & biopsy
|
$5,080.40 |
$5,080.40 |
$5,080.40 |
$5,696.72
|
|
Ureter endoscopy & catheter
|
$1,579.40 |
$1,579.40 |
$1,579.40 |
$3,326.40
|
|
Ureter endoscopy & treatment
|
$4,407.52 |
$4,407.52 |
$4,407.52 |
$5,631.74
|
|
Ureter endoscopy & treatment
|
$3,935.24 |
$3,935.24 |
$3,935.24 |
$5,631.74
|
|
Ureteroureterostomy 50760
|
$2,773.01 |
$2,773.01 |
$2,773.01 |
$2,773.01
|
|
Urethrcystgrphy rtrgrde s&i
|
$690.54 |
$690.54 |
$690.54 |
$592.80
|
|
Urethrlys transvag with scope
|
$5,235.32 |
$5,235.32 |
$5,235.32 |
$4,081.37
|
|
Urethrocystography void s&i
|
$706.96 |
$706.96 |
$706.96 |
$631.75
|
|
Uric acid blood
|
$48.44 |
$48.44 |
$48.44 |
$48.96
|
|
Uric acid urine
|
$63.21 |
$63.21 |
$63.21 |
$44.14
|
|
Urinalysis microscopic only
|
$36.01 |
$36.01 |
$36.01 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$46.86 |
$46.86 |
$46.86 |
$25.72
|
|
Urinalysis (with microscopy)
|
$77.87 |
$77.87 |
$77.87 |
$54.60
|
|
Urinalysis (without microscopy)
|
$96.30 |
$96.30 |
$96.30 |
$35.15
|
|
Urinary bldr retent nuc study
|
$350.66 |
$350.66 |
$350.66 |
$350.66
|
|
Urinary reflex study
|
$316.14 |
$316.14 |
$316.14 |
$216.05
|
|
Urine Culture Test
|
$86.92 |
$86.92 |
$86.92 |
$81.00
|
|
Urine flow measurement 51736
|
$230.92 |
$230.92 |
$230.92 |
$210.00
|
|
Urine pregnancy test
|
$7.69 |
$7.69 |
$7.69 |
$66.87
|
|
Urography, antegrade
|
$701.49 |
$701.49 |
$701.49 |
$622.35
|
|
Urography inf drip &/or bolus
|
$709.58 |
$709.58 |
$709.58 |
$642.50
|
|
Use 1st target lesion
|
$352.21 |
$352.21 |
$352.21 |
$332.00
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$3,644.13 |
$3,644.13 |
$3,644.13 |
$5,205.00
|
|
Vaccine Administration (one shot)
|
$67.70 |
$67.70 |
$67.70 |
$67.74
|
|
Vaccine dtap < 7 years im
|
$101.02 |
$101.02 |
$101.02 |
$68.19
|
|
Vaccine dtap-ipv/hib im
|
$280.15 |
$280.15 |
$280.15 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$46.99 |
$46.99 |
$46.99 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$225.31 |
$225.31 |
$225.31 |
$169.35
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$179.89 |
$179.89 |
$179.89 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$402.20 |
$402.20 |
$402.20 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$103.22 |
$103.22 |
$103.22 |
$75.39
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$81.00 |
$81.00 |
$81.00 |
$143.20
|
|
Vaccine influenza inactivated adjuvant im
|
$81.00 |
$81.00 |
$81.00 |
$96.84
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$27.00 |
$27.00 |
$27.00 |
$48.59
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$605.69 |
$605.69 |
$605.69 |
$387.95
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$426.43 |
$426.43 |
$426.43 |
$323.39
|
|
Vaccine mmr live subcutaneous
|
$254.57 |
$254.57 |
$254.57 |
$211.68
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$729.93 |
$729.93 |
$729.93 |
$563.36
|
