|
Unlisted laparoscopic procedure 49659
|
$1,188.00 |
$1,188.00 |
$1,188.00 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$3,527.67 |
$3,527.67 |
$3,527.67 |
$5,419.00
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$1,228.00 |
$1,228.00 |
$1,228.00 |
$6,463.42
|
|
Unlisted laps px appendix
|
$825.00 |
$825.00 |
$825.00 |
$3,617.40
|
|
Unlisted laps px lymphtc sys
|
$21.50 |
$21.50 |
$21.50 |
$6,870.89
|
|
Unlisted laps px uterus
|
$4,548.50 |
$4,548.50 |
$4,548.50 |
$4,627.00
|
|
Unlisted maaa
|
$587.00 |
$587.00 |
$587.00 |
$235.20
|
|
Unlisted muscskel px head
|
$109.50 |
$109.50 |
$109.50 |
$478.46
|
|
Unlisted procedure colon
|
$1,148.00 |
$1,148.00 |
$1,148.00 |
$1,702.50
|
|
Unlisted procedure esophagus
|
$1,411.50 |
$1,411.50 |
$1,411.50 |
$1,998.88
|
|
Unlisted procedure larynx
|
$137.00 |
$137.00 |
$137.00 |
$924.00
|
|
Unlisted procedure microbiology
|
$6.00 |
$6.00 |
$6.00 |
$523.50
|
|
Unlisted procedure rectum
|
$348.50 |
$348.50 |
$348.50 |
$1,220.35
|
|
Unlisted procedure spine
|
$106.50 |
$106.50 |
$106.50 |
$4,659.85
|
|
Unlisted px abdomen muscskel
|
$303.00 |
$303.00 |
$303.00 |
$1,848.60
|
|
Unlisted px arthroscopy
|
$1,084.13 |
$1,084.13 |
$1,084.13 |
$2,765.60
|
|
Unlisted px biliary tract
|
$886.50 |
$886.50 |
$886.50 |
$2,718.10
|
|
Unlisted px conjunctiva
|
$387.00 |
$387.00 |
$387.00 |
$479.62
|
|
Unlisted px diaphragm
|
$118.50 |
$118.50 |
$118.50 |
$6,547.57
|
|
Unlisted px external ear
|
$20.00 |
$20.00 |
$20.00 |
$325.68
|
|
Unlisted px foot/toes
|
$216.50 |
$216.50 |
$216.50 |
$1,225.50
|
|
Unlisted px forearm/wrist
|
$902.50 |
$902.50 |
$902.50 |
$593.60
|
|
Unlisted px hands/fingers
|
$216.50 |
$216.50 |
$216.50 |
$354.20
|
|
Unlisted px lacrimal system
|
$273.50 |
$273.50 |
$273.50 |
$416.50
|
|
Unlisted px leg/ankle
|
$286.00 |
$286.00 |
$286.00 |
$811.00
|
|
Unlisted px male genital sys
|
$306.50 |
$306.50 |
$306.50 |
$343.55
|
|
Unlisted px mediastinum
|
$118.50 |
$118.50 |
$118.50 |
$397.60
|
|
Unlisted px neck/thorax
|
$460.00 |
$460.00 |
$460.00 |
$571.20
|
|
Unlisted px pelvis/hip joint
|
$592.50 |
$592.50 |
$592.50 |
$3,118.44
|
|
Unlisted px small intestine
|
$541.00 |
$541.00 |
$541.00 |
$2,102.10
|
|
Unlisted spec derm svc/px
|
$113.00 |
$113.00 |
$113.00 |
$223.08
|
|
Unlisted urinalysis px
|
$76.00 |
$76.00 |
$76.00 |
$25.72
|
|
Upgrade pm system
|
$4,157.00 |
$4,157.00 |
$4,157.00 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,830.00 |
$1,830.00 |
$1,830.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,284.00 |
$1,284.00 |
$1,284.00 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,540.50 |
$1,540.50 |
$1,540.50 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,274.00 |
$1,274.00 |
$1,274.00 |
$1,768.00
|
|
Uppr gi scope w/submuc inj
|
$150.00 |
$150.00 |
$150.00 |
$1,872.00
|
|
Urachal cyst/sinus excision 51500
|
$666.50 |
$666.50 |
$666.50 |
$6,082.67
|
|
Urea nitrogen
|
$30.50 |
$30.50 |
$30.50 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$28.50 |
$28.50 |
$28.50 |
$51.75
|
|
Urethrcystgrphy rtrgrde s&i
|
$837.00 |
$837.00 |
$837.00 |
$579.73
|
|
Urethrlys transvag with scope
|
$785.00 |
$785.00 |
$785.00 |
$4,081.37
|
|
Uric acid blood
|
$31.50 |
$31.50 |
$31.50 |
$48.75
|
|
Uric acid urine
|
$28.50 |
$28.50 |
$28.50 |
$44.33
|
|
Urinalysis microscopic only
|
$28.50 |
$28.50 |
$28.50 |
$26.35
|
|
Urinalysis (with microscopy)
|
$33.50 |
$33.50 |
$33.50 |
$55.00
|
|
Urinalysis (without microscopy)
|
$21.00 |
$21.00 |
$21.00 |
$35.75
|
|
Urine Culture Test
|
$88.50 |
$88.50 |
$88.50 |
$81.50
|
|
Urine flow measurement 51736
|
$9.00 |
$9.00 |
$9.00 |
$210.00
|
|
Urine pregnancy test
|
$44.50 |
$44.50 |
$44.50 |
$67.20
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$186.00 |
$186.00 |
$186.00 |
$224.25
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$169.50 |
$169.50 |
$169.50 |
$209.40
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$150.50 |
$150.50 |
$150.50 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$67.50 |
$67.50 |
$67.50 |
$123.20
|
|
Vaccine dtap < 7 years im
|
$41.00 |
$41.00 |
$41.00 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$183.00 |
$183.00 |
$183.00 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$86.00 |
$86.00 |
$86.00 |
$105.95
|
|
Vaccine dtap-ipv/hib im
|
$159.00 |
$159.00 |
$159.00 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$41.50 |
$41.50 |
$41.50 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$18.50 |
$18.50 |
$18.50 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$102.00 |
$102.00 |
$102.00 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$143.00 |
$143.00 |
$143.00 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$49.00 |
$49.00 |
$49.00 |
$79.15
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$69.50 |
$69.50 |
$69.50 |
$84.75
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$69.50 |
$69.50 |
$69.50 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$190.00 |
$190.00 |
$190.00 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$33.00 |
$33.00 |
$33.00 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$435.50 |
$435.50 |
$435.50 |
$576.48
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$119.00 |
$119.00 |
$119.00 |
$143.20
|
|
Vaccine influenza inactivated adjuvant im
|
$109.50 |
$109.50 |
$109.50 |
$109.50
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$29.00 |
$29.00 |
$29.00 |
$47.88
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$48.50 |
$48.50 |
$48.50 |
$76.50
|
|
Vaccine influenza trivalent (iiv3) 0.25ml dose im
|
$14.50 |
$14.50 |
$14.50 |
$31.20
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$229.00 |
$229.00 |
$229.00 |
$400.03
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$254.50 |
$254.50 |
$254.50 |
$409.35
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$220.50 |
$220.50 |
$220.50 |
$310.93
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$156.50 |
$156.50 |
$156.50 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$129.00 |
$129.00 |
$129.00 |
$211.68
|
|
Vaccine mmrv live subcutaneous
|
$404.00 |
$404.00 |
$404.00 |
$424.32
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$158.00 |
$158.00 |
$158.00 |
$251.64
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$294.00 |
$294.00 |
$294.00 |
$414.46
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$363.50 |
$363.50 |
$363.50 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$61.50 |
$61.50 |
$61.50 |
$90.70
|
|
Vaccine rabies im
|
$609.00 |
$609.00 |
$609.00 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$406.00 |
$406.00 |
$406.00 |
$538.84
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$789.00 |
$789.00 |
$789.00 |
$1,104.47
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$789.00 |
$789.00 |
$789.00 |
$997.44
|
|
Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im
|
$342.00 |
$342.00 |
$342.00 |
$499.62
|
|
Vaccine rotavirus attenuated (rv1) live 2 dose oral
|
$154.50 |
$154.50 |
$154.50 |
$200.70
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$126.50 |
$126.50 |
$126.50 |
$126.14
|
|
Vaccine tdap >=7 years im
|
$68.00 |
$68.00 |
$68.00 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$69.50 |
$69.50 |
$69.50 |
$112.10
|
|
Vaccine typhoid vicps im
|
$212.50 |
$212.50 |
$212.50 |
$264.78
|
|
Vaccine varicella live subcutaneous
|
$274.00 |
$274.00 |
$274.00 |
$365.17
|
|
Vaccine yellow fever live subcutaneous
|
$308.50 |
$308.50 |
$308.50 |
$418.46
|
|
Vag hys/<250g/rmv tube/rpr entero 58263
|
$1,050.50 |
$1,050.50 |
$1,050.50 |
$5,345.59
|
|
Vag hyst incl t/o complex
|
$1,387.50 |
$1,387.50 |
$1,387.50 |
$5,735.60
|
|
Vag hyst including t/o
|
$7,925.50 |
$7,925.50 |
$7,925.50 |
$4,827.18
|
|
Vag hyst w/enterocele repair
|
$942.50 |
$942.50 |
$942.50 |
$5,468.70
|
