|
Unlisted ultrasound procedure
|
$227.15 |
$227.15 |
$227.15 |
$335.00
|
|
Unlisted urinalysis px
|
$9.07 |
$9.07 |
$9.07 |
$25.72
|
|
Unlstd hematop ret/endo lymp
|
$1,482.88 |
$1,482.88 |
$1,482.88 |
$473.22
|
|
Unsched dialysis esrd pt hos
|
$710.60 |
$710.60 |
$1,722.12 |
$1,316.90
|
|
Upgrade pm system
|
$13,613.05 |
$13,613.05 |
$31,360.02 |
$12,087.24
|
|
Upper Arm (Humerus) X-ray (left side)
|
$342.10 |
$342.10 |
$601.04 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$2,609.20 |
$2,609.20 |
$5,086.29 |
$1,652.95
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$2,371.60 |
$2,371.60 |
$3,104.12 |
$1,422.05
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,009.05 |
$3,009.05 |
$3,179.18 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,757.70 |
$2,757.70 |
$3,179.18 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,025.63 |
$2,025.63 |
$2,506.90 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$403.70 |
$403.70 |
$601.04 |
$320.45
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$414.15 |
$414.15 |
$675.44 |
$380.82
|
|
Upper Endoscopy (EGD, diagnostic)
|
$3,541.46 |
$3,541.46 |
$3,541.46 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$2,857.25 |
$2,857.25 |
$3,541.46 |
$1,768.00
|
|
Upper ext fx orthosis rad/ul
|
$70.40 |
$70.40 |
$70.40 |
$619.49
|
|
Upper ext harvest for cabg1 seg 35600
|
$2,340.00 |
$2,340.00 |
$2,340.00 |
$627.20
|
|
Upper GI Barium X-ray (barium and gas)
|
$652.85 |
$652.85 |
$1,079.10 |
$657.77
|
|
Upper GI Barium X-ray (barium only)
|
$528.55 |
$528.55 |
$1,079.10 |
$603.20
|
|
Uppr gi scope w/submuc inj
|
$1,510.40 |
$1,510.40 |
$1,510.40 |
$1,872.00
|
|
Urachal cyst/sinus excision 51500
|
$4,629.60 |
$4,629.60 |
$4,629.60 |
$6,082.67
|
|
Urea nitrogen
|
$39.60 |
$39.60 |
$64.80 |
$42.00
|
|
Urea nitrogen 24 hour urine
|
$58.30 |
$58.30 |
$64.28 |
$51.77
|
|
Ureteral embolization/occl
|
$5,776.08 |
$5,776.08 |
$5,776.08 |
$2,079.31
|
|
Ureteral reflux study
|
$1,021.90 |
$1,021.90 |
$1,630.56 |
$952.50
|
|
Ureteroureterostomy 50760
|
$11,840.80 |
$11,840.80 |
$11,840.80 |
$2,773.01
|
|
Urethrcystgrphy rtrgrde s&i
|
$468.05 |
$468.05 |
$1,799.30 |
$592.80
|
|
Urethrocystography void s&i
|
$855.80 |
$855.80 |
$2,192.59 |
$631.75
|
|
Uric acid blood
|
$31.35 |
$31.35 |
$63.40 |
$48.96
|
|
Uric acid urine
|
$39.05 |
$39.05 |
$64.28 |
$44.14
|
|
Urinalysis microscopic only
|
$43.39 |
$43.39 |
$55.00 |
$26.35
|
|
Urinalysis (with microscopy)
|
$63.20 |
$63.20 |
$63.80 |
$54.60
|
|
Urinalysis (without microscopy)
|
$37.40 |
$37.40 |
$38.40 |
$35.15
|
|
Urinary reflex study
|
$399.85 |
$399.85 |
$399.85 |
$216.05
|
|
Urine Culture Test
|
$103.95 |
$103.95 |
$108.35 |
$81.00
|
|
Urine flow measurement 51736
|
$292.00 |
$292.00 |
$292.00 |
$210.00
|
|
Urine pregnancy test
|
$90.75 |
$90.75 |
$109.04 |
$66.87
|
|
Urine screen for bacteria
|
$448.80 |
$448.80 |
$448.80 |
$55.64
|
|
Urine shunt to intestine
|
$11,840.80 |
$11,840.80 |
$11,840.80 |
$1,588.56
|
|
Urography, antegrade
|
$542.30 |
$542.30 |
$2,192.59 |
$622.35
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$24.67 |
$24.67 |
$24.67 |
$5,205.00
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$294.40 |
$294.40 |
$294.40 |
$51,633.07
|
|
Vaccine Administration (one shot)
|
$100.96 |
$100.96 |
$133.10 |
$67.74
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$296.88 |
$296.88 |
$296.88 |
$227.04
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$243.20 |
$243.20 |
$243.20 |
$211.89
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$217.60 |
$217.60 |
$217.60 |
$234.36
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$147.20 |
$147.20 |
$147.20 |
$123.20
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$109.60 |
$109.60 |
$109.60 |
$80.15
|
|
Vaccine dtap < 7 years im
|
$180.80 |
$180.80 |
$180.80 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$226.76 |
$226.76 |
$226.76 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$180.80 |
$180.80 |
$180.80 |
$105.95
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$118.96 |
$118.96 |
$118.96 |
$72.00
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$74.40 |
$74.40 |
$74.40 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$202.60 |
$202.60 |
$202.60 |
$169.35
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$114.40 |
$114.40 |
$114.40 |
$231.56
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$88.80 |
$88.80 |
$88.80 |
$80.28
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$124.00 |
$124.00 |
$124.00 |
$90.35
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$181.20 |
$181.20 |
$181.20 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$306.24 |
$306.24 |
$306.24 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$115.62 |
$115.62 |
$115.62 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$345.60 |
$345.60 |
$345.60 |
$562.20
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$345.60 |
$345.60 |
$345.60 |
$282.50
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$71.20 |
$71.20 |
$71.20 |
$143.20
|
|
Vaccine influenza inactivated adjuvant im
|
$257.60 |
$257.60 |
$257.60 |
$96.84
|
|
Vaccine influenza nos 0.5ml dose im
|
$36.80 |
$36.80 |
$36.80 |
$24.20
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$36.80 |
$36.80 |
$36.80 |
$48.59
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$36.80 |
$36.80 |
$36.80 |
$35.88
|
|
Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im
|
$71.20 |
$71.20 |
$71.20 |
$72.80
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$36.80 |
$36.80 |
$36.80 |
$28.77
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$97.93 |
$97.93 |
$97.93 |
$33.21
|
|
Vaccine influenza quadrivalent (iiv4) split virus 0.25 ml im
|
$36.80 |
$36.80 |
$36.80 |
$20.80
|
|
Vaccine influenza quadrivalent live (laiv4) intranasal
|
$44.00 |
$44.00 |
$44.00 |
$37.05
|
|
Vaccine influenza trivalent (iiv3) 0.25ml dose im
|
$36.80 |
$36.80 |
$36.80 |
$23.20
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$428.00 |
$428.00 |
$428.00 |
$387.95
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$252.80 |
$252.80 |
$252.80 |
$406.05
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$321.80 |
$321.80 |
$321.80 |
$323.39
|
|
Vaccine mmr live subcutaneous
|
$222.36 |
$222.36 |
$222.36 |
$211.68
|
|
Vaccine mmrv live subcutaneous
|
$320.00 |
$320.00 |
$320.00 |
$466.88
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$93.60 |
$93.60 |
$93.60 |
$251.64
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$192.00 |
$192.00 |
$192.00 |
$393.25
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$488.52 |
$488.52 |
$488.52 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$52.80 |
$52.80 |
$52.80 |
$90.70
|
|
Vaccine rabies im
|
$748.84 |
$748.84 |
$748.84 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$542.00 |
$542.00 |
$542.00 |
$521.74
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$901.60 |
$901.60 |
$901.60 |
$1,104.47
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$824.00 |
$824.00 |
$824.00 |
$980.10
|
|
Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im
|
$456.80 |
$456.80 |
$456.80 |
$407.74
|
|
Vaccine rotavirus attenuated (rv1) live 2 dose oral
|
$180.80 |
$180.80 |
$180.80 |
$200.70
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$180.80 |
$180.80 |
$180.80 |
$126.14
|
|
Vaccine tdap >=7 years im
|
$146.20 |
$146.20 |
$146.20 |
$131.22
|
|
Vaccine td preservative free >= 7 years im
|
$134.52 |
$134.52 |
$134.52 |
$110.19
|
|
Vaccine typhoid vicps im
|
$209.60 |
$209.60 |
$209.60 |
$253.50
|
|
Vaccine varicella live subcutaneous
|
$362.84 |
$362.84 |
$362.84 |
$364.16
|
|
Vaccine yellow fever live subcutaneous
|
$184.80 |
$184.80 |
$184.80 |
$418.46
|
|
Vacuum drain bottle/tube kit
|
$925.36 |
$925.36 |
$925.36 |
$325.20
|
|
Vaginal bx
|
$777.24 |
$777.24 |
$777.24 |
$471.12
|
|
Vaginal delivery after cesarean delivery 59612
|
$3,253.60 |
$3,253.60 |
$3,253.60 |
$3,866.47
|
|
Vaginal Delivery (full care)
|
$5,561.60 |
$5,561.60 |
$5,561.60 |
$4,184.00
|
|
Vaginal hysterectomy
|
$2,939.20 |
$2,939.20 |
$2,939.20 |
$5,766.00
|
|
Vagotomy & pylorus repair
|
$5,631.20 |
$5,631.20 |
$5,631.20 |
$2,948.00
|
