|
Unlisted surgical path px
|
$1,011.50 |
$1,011.50 |
$1,011.50 |
|
|
Unlisted transfusion med px
|
$255.50 |
$255.50 |
$255.50 |
|
|
Unlisted ultrasound procedure
|
$304.00 |
$304.00 |
$536.00 |
|
|
Unlisted urinalysis px
|
$23.50 |
$74.50 |
$101.50 |
|
|
Unlstd laps px sprmatic cord
|
$3,954.33 |
$6,392.67 |
$7,910.00 |
|
|
Unsched dialysis esrd pt hos
|
$683.50 |
$1,500.00 |
$1,624.50 |
|
|
Upgrade pm system
|
$4,157.00 |
$4,988.50 |
$48,380.00 |
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,588.80 |
$1,928.00 |
$4,926.60 |
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$836.00 |
$1,943.00 |
$3,242.40 |
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$868.50 |
$1,381.00 |
$3,243.60 |
|
|
Upper Endoscopy (EGD, diagnostic)
|
$132.50 |
$1,135.00 |
$15,955.50 |
|
|
Upper Endoscopy (EGD, with biopsy)
|
$140.50 |
$1,346.50 |
$4,250.00 |
|
|
Upper ext fx orthosis rad/ul
|
$352.50 |
$352.50 |
$352.50 |
|
|
Uppr gi scope w/submuc inj
|
$140.50 |
$224.80 |
$8,230.00 |
|
|
Urachal cyst/sinus excision 51500
|
$660.50 |
$666.50 |
$18,504.00 |
|
|
Urea nitrogen
|
$9.60 |
$28.00 |
$73.80 |
|
|
Urea nitrogen 24 hour urine
|
$17.60 |
$33.00 |
$86.40 |
|
|
Urea nitrogen clearance
|
$30.00 |
$30.00 |
$62.00 |
|
|
Ureteral embolization/occl
|
$1,169.00 |
$1,169.00 |
$1,169.00 |
|
|
Ureteral reflux study
|
$609.00 |
$609.00 |
$921.50 |
|
|
Ureter endoscopy & treatment
|
$5,400.50 |
$5,400.50 |
$6,030.00 |
|
|
Ureteroureterostomy 50760
|
$24,672.75 |
$24,672.75 |
$24,672.75 |
|
|
Urethrcystgrphy rtrgrde s&i
|
$410.50 |
$595.50 |
$900.00 |
|
|
Urethrlys transvag with scope
|
$774.50 |
$785.00 |
$4,536.50 |
|
|
Urethrocystography void s&i
|
$396.50 |
$684.50 |
$1,224.50 |
|
|
Uric acid blood
|
$10.40 |
$31.50 |
$67.80 |
|
|
Uric acid urine
|
$11.00 |
$28.50 |
$38.50 |
|
|
Urinalysis microscopic only
|
$4.80 |
$25.00 |
$58.20 |
|
|
Urinalysis qual/semiquant excpt ia
|
$14.00 |
$16.50 |
$17.50 |
|
|
Urinalysis (with microscopy)
|
$20.80 |
$34.50 |
$65.00 |
|
|
Urinalysis (without microscopy)
|
$10.40 |
$21.00 |
$58.20 |
|
|
Urinary reflex study
|
$70.50 |
$70.50 |
$73.00 |
|
|
Urine Culture Test
|
$31.50 |
$65.50 |
$127.80 |
|
|
Urine flow measurement 51736
|
$8.50 |
$16.00 |
$771.50 |
|
|
Urine pregnancy test
|
$13.00 |
$33.50 |
$142.20 |
|
|
Urography, antegrade
|
$335.00 |
$903.50 |
$1,332.00 |
|
|
Urography inf drip &/or bolus
|
$599.00 |
$670.00 |
$900.00 |
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$7,440.00 |
$10,794.60 |
$16,188.02 |
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$26,937.96 |
$26,937.96 |
$26,937.96 |
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$124.00 |
$136.50 |
$297.60 |
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$113.00 |
$113.00 |
$271.20 |
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$100.50 |
$225.00 |
$589.50 |
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$45.00 |
$67.50 |
$108.00 |
|
|
Vaccine dtap < 7 years im
|
$27.50 |
$27.50 |
$65.60 |
|
|
Vaccine dtap-hep b-ipv im
|
$63.00 |
$94.50 |
$183.00 |
|
|
Vaccine dtap-ipv 4-6 years im
|
$57.50 |
$57.50 |
$137.60 |
|
|
Vaccine dtap-ipv/hib im
|
$106.00 |
$106.00 |
$254.40 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$28.00 |
$28.00 |
$66.40 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$12.50 |
$12.50 |
$29.60 |
|
|
Vaccine hepatitis a (hepa) adult im
|
$68.00 |
$68.00 |
$163.20 |
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$95.50 |
$95.50 |
$228.80 |
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$32.50 |
$32.50 |
$78.40 |
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$46.50 |
$46.50 |
$111.20 |
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$46.50 |
$69.50 |
$263.40 |
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$127.00 |
$127.00 |
$304.00 |
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$22.00 |
$22.00 |
$52.80 |
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$290.50 |
$290.50 |
$696.80 |
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$138.50 |
$282.50 |
$290.50 |
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$79.50 |
$79.50 |
$190.40 |
|
|
Vaccine influenza inactivated adjuvant im
|
$73.00 |
$73.00 |
$250.80 |
|
|
Vaccine influenza nos 0.5ml dose im
|
$16.00 |
$16.50 |
$18.00 |
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$19.50 |
$19.50 |
$54.90 |
|
|
Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im
|
$46.50 |
$69.00 |
$69.00 |
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$26.00 |
$26.00 |
$69.00 |
|
|
Vaccine influenza quadrivalent (iiv4) split virus 0.25 ml im
|
$9.50 |
$10.00 |
$10.00 |
|
|
Vaccine influenza quadrivalent live (laiv4) intranasal
|
$26.50 |
$29.50 |
$59.00 |
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$62.50 |
$66.00 |
$66.00 |
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$32.50 |
$32.50 |
$77.60 |
|
|
Vaccine influenza trivalent (iiv3) 0.25ml dose im
|
$10.00 |
$10.00 |
$23.20 |
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$153.00 |
$154.50 |
$366.40 |
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$170.00 |
$170.00 |
$407.20 |
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$147.00 |
$147.00 |
$352.80 |
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$104.50 |
$156.50 |
$250.40 |
|
|
Vaccine mmr live subcutaneous
|
$86.00 |
$86.00 |
$206.40 |
|
|
Vaccine mmrv live subcutaneous
|
$269.50 |
$269.50 |
$646.40 |
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$105.50 |
$105.50 |
$451.80 |
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$130.50 |
$207.00 |
$598.80 |
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$181.50 |
$206.00 |
$570.75 |
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$242.50 |
$242.50 |
$991.20 |
|
|
Vaccine polio (ipv) subcutaneous/im
|
$41.00 |
$41.00 |
$98.40 |
|
|
Vaccine rabies im
|
$406.00 |
$406.00 |
$1,326.00 |
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$271.00 |
$271.00 |
$649.60 |
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$789.00 |
$1,183.50 |
$1,262.40 |
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$789.00 |
$1,183.50 |
$1,262.40 |
|
|
Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im
|
$228.00 |
$228.00 |
$547.20 |
|
|
Vaccine rotavirus attenuated (rv1) live 2 dose oral
|
$103.00 |
$103.00 |
$247.20 |
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$84.50 |
$84.50 |
$218.00 |
|
|
Vaccine tdap >=7 years im
|
$45.50 |
$59.00 |
$205.20 |
|
|
Vaccine td preservative free >= 7 years im
|
$46.50 |
$46.50 |
$147.00 |
|
|
Vaccine typhoid vicps im
|
$141.50 |
$141.50 |
$340.00 |
|
|
Vaccine varicella live subcutaneous
|
$183.00 |
$183.00 |
$438.40 |
|
|
Vaccine yellow fever live subcutaneous
|
$205.50 |
$205.50 |
$493.60 |
|
|
Vacuum drain bottle/tube kit
|
$183.50 |
$1,088.00 |
$1,326.50 |
|
|
Vag hys/<250g/rmv tube/rpr entero 58263
|
$1,020.00 |
$1,050.50 |
$7,275.00 |
|
|
Vag hyst incl t/o complex
|
$1,276.00 |
$1,314.00 |
$57,718.50 |
|
|
Vag hyst including t/o
|
$950.00 |
$7,319.00 |
$18,460.00 |
|
|
Vag hyst w/enterocele repair
|
$921.50 |
$942.50 |
$6,418.40 |
|
|
Vaginal bx
|
$58.50 |
$715.00 |
$7,010.50 |
|
|
Vaginal delivery after cesarean delivery 59612
|
$2,981.00 |
$3,204.50 |
$5,247.20 |
|
|
Vaginal Delivery (full care)
|
$1,840.00 |
$2,615.00 |
$5,700.00 |
|
