|
Tx phalangeal shaft fx open prox/middle ea
|
$8,675.77 |
$8,675.77 |
$8,675.77 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$4,652.29 |
$4,652.29 |
$4,652.29 |
$469.20
|
|
Ua w/micro/comp poc
|
$130.34 |
$130.34 |
$130.34 |
$24.45
|
|
Ugt1a1 gene analy common variants
|
$345.46 |
$345.46 |
$345.46 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$1,602.55 |
$1,602.55 |
$1,602.55 |
$403.26
|
|
Ultrasound breast complete
|
$2,063.28 |
$2,063.28 |
$2,063.28 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$1,923.06 |
$1,923.06 |
$1,923.06 |
$449.35
|
|
Ultrasound chest
|
$1,842.92 |
$1,842.92 |
$1,842.92 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$1,557.54 |
$1,557.54 |
$1,784.75 |
$340.14
|
|
Ultrasound dx ophth b-scan
|
$3,525.59 |
$3,525.59 |
$3,525.59 |
$330.40
|
|
Ultrasound elastography ea l target les
|
$387.41 |
$387.41 |
$387.41 |
$136.11
|
|
Ultrasound elastography parenchyma
|
$387.41 |
$387.41 |
$5,902.60 |
$284.25
|
|
Ultrasound encephalogram
|
$1,602.55 |
$1,602.55 |
$1,602.55 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$1,842.92 |
$1,842.92 |
$2,658.00 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$1,892.81 |
$1,892.81 |
$2,025.00 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$2,027.10 |
$2,027.10 |
$2,739.00 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$2,189.40 |
$2,189.40 |
$2,189.40 |
$701.35
|
|
Ultrasound guide intraoperative
|
$1,602.55 |
$1,602.55 |
$1,602.55 |
$632.90
|
|
Ultrasound guide tissue ablation
|
$1,462.27 |
$1,462.27 |
$1,462.27 |
$498.40
|
|
Ultrasound hips infant dynamic
|
$961.51 |
$961.51 |
$3,562.90 |
$403.00
|
|
Ultrasound infant hips ltd without stress
|
$961.51 |
$961.51 |
$961.51 |
$321.35
|
|
Ultrasound joint complete left
|
$2,437.49 |
$2,437.49 |
$2,437.49 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$1,847.16 |
$1,847.16 |
$1,847.16 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$1,538.43 |
$1,538.43 |
$1,538.43 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$1,095.52 |
$1,095.52 |
$1,095.52 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,602.55 |
$1,602.55 |
$4,618.00 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$1,602.55 |
$1,602.55 |
$1,602.55 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$1,602.55 |
$1,602.55 |
$2,223.00 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$1,602.55 |
$1,602.55 |
$1,602.55 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$1,602.55 |
$1,602.55 |
$1,602.55 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$1,896.48 |
$1,896.48 |
$1,896.48 |
$498.00
|
|
Ultrasound scrotum and contents
|
$1,842.92 |
$1,842.92 |
$1,842.92 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$961.51 |
$961.51 |
$2,977.00 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$1,560.03 |
$1,560.03 |
$3,290.00 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$1,842.92 |
$1,842.92 |
$1,842.92 |
$567.44
|
|
Unlistd noninvas vasc dx std
|
$1,285.41 |
$1,285.41 |
$1,285.41 |
$819.65
|
|
Unlisted cytogenetic study
|
$604.27 |
$604.27 |
$604.27 |
$132.48
|
|
Unlisted fluoroscopic px
|
$1,846.05 |
$1,846.05 |
$1,846.05 |
$324.85
|
|
Unlisted mr procedure
|
$4,973.03 |
$4,973.03 |
$8,556.90 |
$1,032.20
|
|
Unlisted procedure microbiology
|
$75.63 |
$75.63 |
$75.63 |
$487.50
|
|
Unlisted px casting/strpg
|
$760.39 |
$760.39 |
$760.39 |
$224.93
|
|
Unlisted px pelvis/hip joint
|
$1,520.36 |
$1,520.36 |
$1,520.36 |
$2,108.82
|
|
Unlisted transfusion med px
|
$691.17 |
$691.17 |
$691.17 |
$141.35
|
|
Unsched dialysis esrd pt hos
|
$4,957.94 |
$4,957.94 |
$6,799.21 |
$1,469.76
|
|
Upgrade pm system
|
$23,405.67 |
$23,405.67 |
$23,405.67 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$7,305.32 |
$7,305.32 |
$24,552.00 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$6,115.59 |
$6,115.59 |
$23,489.95 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$5,468.12 |
$5,468.12 |
$19,355.60 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,937.06 |
$1,937.06 |
$1,937.06 |
$1,588.59
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,937.06 |
$1,937.06 |
$1,937.06 |
$1,656.60
|
|
Uppr gi scope w/submuc inj
|
$1,937.06 |
$1,937.06 |
$1,937.06 |
$1,773.85
|
|
Urea nitrogen
|
$143.50 |
$143.50 |
$143.50 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$134.53 |
$134.53 |
$1,137.62 |
$50.00
|
|
Urea nitrogen clearance
|
$814.84 |
$814.84 |
$814.84 |
$33.57
|
|
Ureteral embolization/occl
|
$19,429.87 |
$19,429.87 |
$19,429.87 |
$3,041.22
|
|
Ureteral reflux study
|
$2,219.56 |
$2,219.56 |
$2,219.56 |
$961.20
|
|
Urethrcystgrphy rtrgrde s&i
|
$2,406.42 |
$2,406.42 |
$5,525.85 |
$574.40
|
|
Urethrocystography void s&i
|
$1,581.00 |
$1,581.00 |
$2,502.25 |
$634.50
|
|
Uric acid blood
|
$105.95 |
$105.95 |
$1,176.68 |
$46.64
|
|
Uric acid urine
|
$16.00 |
$16.00 |
$130.24 |
$46.75
|
|
Urinalysis microscopic only
|
$101.72 |
$101.72 |
$333.10 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$153.47 |
$153.47 |
$153.47 |
$25.72
|
|
Urinalysis (with microscopy)
|
$222.81 |
$222.81 |
$915.74 |
$48.14
|
|
Urinalysis (without microscopy)
|
$130.13 |
$130.13 |
$130.13 |
$38.99
|
|
Urine Culture Test
|
$183.25 |
$183.25 |
$977.59 |
$84.81
|
|
Urine pregnancy test
|
$101.35 |
$101.35 |
$101.35 |
$66.40
|
|
Urography, antegrade
|
$2,818.38 |
$2,818.38 |
$2,818.38 |
$593.37
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$16,950.50 |
$16,950.50 |
$35,061.00 |
$5,521.54
|
|
Vaccine dtap < 7 years im
|
$809.20 |
$809.20 |
$809.20 |
$87.80
|
|
Vaccine dtap-ipv/hib im
|
$1,189.00 |
$1,189.00 |
$1,189.00 |
$248.80
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$222.00 |
$222.00 |
$222.00 |
$45.33
|
|
Vaccine hepatitis a (hepa) adult im
|
$705.00 |
$705.00 |
$910.22 |
$178.07
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$2,628.56 |
$2,628.56 |
$2,628.56 |
$218.40
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$1,344.51 |
$1,344.51 |
$2,156.00 |
$173.98
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$218.00 |
$218.00 |
$218.00 |
$79.04
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$1,206.70 |
$1,206.70 |
$1,206.70 |
$686.67
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$1,825.49 |
$1,825.49 |
$1,825.49 |
$157.41
|
|
Vaccine influenza inactivated adjuvant im
|
$806.14 |
$806.14 |
$806.14 |
$110.25
|
|
Vaccine influenza nos 0.5ml dose im
|
$193.76 |
$193.76 |
$193.76 |
$36.80
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$135.00 |
$135.00 |
$529.15 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$445.92 |
$445.92 |
$445.92 |
$42.90
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$889.06 |
$889.06 |
$889.06 |
$103.88
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$691.84 |
$691.84 |
$691.84 |
$499.00
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$7,925.00 |
$7,925.00 |
$7,925.00 |
$426.80
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$1,402.00 |
$1,402.00 |
$1,402.00 |
$349.15
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$668.26 |
$668.26 |
$4,777.36 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$2,558.64 |
$2,558.64 |
$2,558.64 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$474.76 |
$474.76 |
$906.00 |
$274.95
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$2,161.00 |
$2,161.00 |
$2,161.00 |
$397.18
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$2,160.64 |
$2,160.64 |
$2,160.64 |
$385.45
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$971.18 |
$971.18 |
$971.18 |
$715.41
|
|
Vaccine polio (ipv) subcutaneous/im
|
$2,253.00 |
$2,253.00 |
$2,253.00 |
$119.17
|
|
Vaccine rabies im
|
$10,641.68 |
$10,641.68 |
$10,641.68 |
$945.46
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$986.78 |
$986.78 |
$986.78 |
$624.00
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$4,669.00 |
$4,669.00 |
$4,669.00 |
$1,196.00
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$1,772.40 |
$1,772.40 |
$1,772.40 |
$1,159.00
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$2,755.20 |
$2,755.20 |
$2,755.20 |
$108.00
|
|
Vaccine tdap >=7 years im
|
$1,264.23 |
$1,264.23 |
$1,354.64 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$1,029.84 |
$1,029.84 |
$1,039.70 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$1,472.24 |
$1,472.24 |
$1,472.24 |
$447.80
|
