|
Unlisted procedure larynx
|
$570.90 |
$570.90 |
$570.90 |
|
|
Unlisted procedure liver
|
$2,425.00 |
$2,580.00 |
$10,945.00 |
|
|
Unlisted procedure microbiology
|
$107.20 |
$530.00 |
$530.00 |
|
|
Unlisted procedure pancreas
|
$147.50 |
$147.50 |
$8,257.26 |
|
|
Unlisted procedure rectum
|
$2,823.51 |
$2,823.51 |
$2,823.51 |
|
|
Unlisted procedure spine
|
$3,010.00 |
$3,010.00 |
$8,297.61 |
|
|
Unlisted psychiatric service/proc 90899
|
$480.70 |
$480.70 |
$480.70 |
|
|
Unlisted px abdomen muscskel
|
$969.10 |
$969.10 |
$969.10 |
|
|
Unlisted px biliary tract
|
$2,246.64 |
$3,055.00 |
$3,055.00 |
|
|
Unlisted px casting/strpg
|
$110.00 |
$285.78 |
$409.75 |
|
|
Unlisted px diaphragm
|
$5,417.60 |
$5,417.60 |
$5,417.60 |
|
|
Unlisted px foot/toes
|
$545.82 |
$545.82 |
$545.82 |
|
|
Unlisted px hands/fingers
|
$3,856.60 |
$3,856.60 |
$3,856.60 |
|
|
Unlisted px med radj physics
|
$196.02 |
$495.00 |
$512.05 |
|
|
Unlisted px neck/thorax
|
$429.66 |
$429.66 |
$429.66 |
|
|
Unlisted px pelvis/hip joint
|
$5,088.60 |
$10,395.00 |
$16,630.40 |
|
|
Unlisted px salivry glnd/dux
|
$1,048.30 |
$1,048.30 |
$1,048.30 |
|
|
Unlisted px small intestine
|
$281.60 |
$1,083.06 |
$2,649.22 |
|
|
Unlisted px ther rad tx plng
|
$2,720.00 |
$2,720.00 |
$2,720.00 |
|
|
Unlisted px tongue flr mouth
|
$372.35 |
$372.35 |
$372.35 |
|
|
Unlisted reprod med lab proc
|
$65.00 |
$65.00 |
$67.63 |
|
|
Unlisted special svc px/rprt
|
$205.15 |
$205.15 |
$205.15 |
|
|
Unlisted surgical path px
|
$97.90 |
$1,824.24 |
$1,824.24 |
|
|
Unlisted transfusion med px
|
$26.95 |
$145.00 |
$319.88 |
|
|
Unlisted ultrasound procedure
|
$75.00 |
$75.00 |
$400.95 |
|
|
Unlisted urinalysis px
|
$9.07 |
$584.76 |
$584.76 |
|
|
Unlstd hematop ret/endo lymp
|
$1,482.88 |
$1,482.88 |
$1,482.88 |
|
|
Unsched dialysis esrd pt hos
|
$680.90 |
$1,240.00 |
$1,722.12 |
|
|
Upgrade pm system
|
$3,135.55 |
$12,087.24 |
$31,360.02 |
|
|
Upper Arm (Humerus) X-ray (left side)
|
$70.68 |
$315.48 |
$601.04 |
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$357.39 |
$1,570.00 |
$5,086.29 |
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$286.14 |
$1,470.00 |
$3,104.12 |
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,111.50 |
$3,179.18 |
$7,450.60 |
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$877.23 |
$2,210.00 |
$3,234.00 |
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$808.26 |
$2,110.00 |
$5,147.81 |
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$94.62 |
$304.15 |
$601.04 |
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$111.15 |
$312.50 |
$727.20 |
|
|
Upper Endoscopy (EGD, diagnostic)
|
$234.27 |
$1,083.06 |
$3,541.46 |
|
|
Upper Endoscopy (EGD, with biopsy)
|
$241.68 |
$2,318.75 |
$3,541.46 |
|
|
Upper ext fx orthosis rad/ul
|
$70.40 |
$70.40 |
$70.40 |
|
|
Upper ext harvest for cabg1 seg 35600
|
$2,340.00 |
$2,340.00 |
$2,340.00 |
|
|
Upper GI Barium X-ray (barium and gas)
|
$200.07 |
$705.00 |
$1,079.10 |
|
|
Upper GI Barium X-ray (barium only)
|
$191.52 |
$528.55 |
$1,079.10 |
|
|
Uppr gi scope w/submuc inj
|
$242.25 |
$770.62 |
$1,510.40 |
|
|
Urachal cyst/sinus excision 51500
|
$4,629.60 |
$4,629.60 |
$4,629.60 |
|
|
Urea nitrogen
|
$10.83 |
$27.50 |
$144.66 |
|
|
Urea nitrogen 24 hour urine
|
$12.54 |
$54.12 |
$84.70 |
|
|
Urea nitrogen clearance
|
$72.50 |
$72.50 |
$217.14 |
|
|
Urea nitrogen semi-quant
|
$38.69 |
$38.69 |
$38.69 |
|
|
Ureteral embolization/occl
|
$369.60 |
$3,785.00 |
$5,776.08 |
|
|
Ureteral reflux study
|
$851.40 |
$1,032.35 |
$1,936.00 |
|
|
Ureteroureterostomy 50760
|
$11,840.80 |
$11,840.80 |
$11,840.80 |
|
|
Urethrcystgrphy rtrgrde s&i
|
$224.19 |
$515.00 |
$1,799.30 |
|
|
Urethrocystography void s&i
|
$207.76 |
$690.00 |
$2,192.59 |
|
|
Uric acid blood
|
$17.10 |
$46.64 |
$199.17 |
|
|
Uric acid urine
|
$15.39 |
$46.75 |
$64.28 |
|
|
Urinalysis microscopic only
|
$3.99 |
$20.00 |
$80.64 |
|
|
Urinalysis qual/semiquant excpt ia
|
$16.96 |
$24.38 |
$64.68 |
|
|
Urinalysis (with microscopy)
|
$18.24 |
$57.50 |
$119.15 |
|
|
Urinalysis (without microscopy)
|
$9.01 |
$25.00 |
$169.98 |
|
|
Urinary bldr retent nuc study
|
$130.38 |
$130.38 |
$130.38 |
|
|
Urinary reflex study
|
$399.85 |
$399.85 |
$464.81 |
|
|
Urine Culture Test
|
$39.22 |
$80.00 |
$210.78 |
|
|
Urine flow measurement 51736
|
$50.88 |
$272.50 |
$292.00 |
|
|
Urine pregnancy test
|
$16.53 |
$59.89 |
$109.04 |
|
|
Urine screen for bacteria
|
$9.01 |
$9.01 |
$448.80 |
|
|
Urine shunt to intestine
|
$11,840.80 |
$11,840.80 |
$11,840.80 |
|
|
Urography, antegrade
|
$201.40 |
$560.00 |
$2,192.59 |
|
|
Urography inf drip &/or bolus
|
$650.00 |
$747.78 |
$747.78 |
|
|
Urokinase 5000 iu injection
|
$8.48 |
$8.48 |
$8.48 |
|
|
Use 1st target lesion
|
$207.35 |
$360.00 |
$360.00 |
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$10.17 |
$35.39 |
$16,791.75 |
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$210.94 |
$210.94 |
$294.40 |
|
|
Vaccine Administration (one shot)
|
$32.50 |
$44.00 |
$133.10 |
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$296.88 |
$296.88 |
$296.88 |
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$125.00 |
$125.00 |
$243.20 |
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$217.60 |
$217.60 |
$217.60 |
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$147.20 |
$147.20 |
$147.20 |
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$109.60 |
$109.60 |
$109.60 |
|
|
Vaccine dtap < 7 years im
|
$28.50 |
$42.39 |
$180.80 |
|
|
Vaccine dtap-hep b-ipv im
|
$106.53 |
$170.19 |
$338.55 |
|
|
Vaccine dtap-ipv 4-6 years im
|
$57.57 |
$64.13 |
$180.80 |
|
|
Vaccine dtap-ipv-hib-hepb im
|
$140.45 |
$140.45 |
$140.45 |
|
|
Vaccine dtap-ipv/hib im
|
$125.97 |
$125.97 |
$125.97 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$41.34 |
$55.99 |
$118.96 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$39.75 |
$41.04 |
$130.09 |
|
|
Vaccine hepatitis a (hepa) adult im
|
$87.98 |
$149.77 |
$256.79 |
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$114.40 |
$133.56 |
$446.01 |
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$34.20 |
$64.84 |
$107.80 |
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 3 dose im
|
$63.60 |
$63.60 |
$63.60 |
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$124.00 |
$124.00 |
$124.00 |
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$59.28 |
$125.34 |
$234.02 |
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$163.53 |
$285.62 |
$472.54 |
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$20.74 |
$85.64 |
$141.90 |
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$202.42 |
$312.93 |
$1,025.16 |
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$204.58 |
$220.02 |
$345.60 |
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$62.50 |
$133.15 |
$313.43 |
|
|
Vaccine influenza inactivated adjuvant im
|
$51.94 |
$88.35 |
$257.60 |
|
|
Vaccine influenza nos 0.5ml dose im
|
$19.61 |
$20.67 |
$36.80 |
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$15.00 |
$48.61 |
$101.11 |
|
