|
Tte w or without fol w/cont, f/u
|
$687.70 |
$687.70 |
$687.70 |
$1,178.00
|
|
Tube trach disp innr can 6 xlt
|
$22.75 |
$22.75 |
$22.75 |
$16.80
|
|
Tubular dressing
|
$38.35 |
$38.35 |
$38.35 |
$28.46
|
|
Tx atrial fib pulm vein isol
|
$29,766.10 |
$29,766.10 |
$29,766.10 |
$29,030.54
|
|
Tx l/r atrial fib addl
|
$13,529.10 |
$13,529.10 |
$13,529.10 |
$6,986.85
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$281.45 |
$281.45 |
$281.45 |
$21,992.26
|
|
Ugt1a1 gene analy common variants
|
$254.80 |
$254.80 |
$254.80 |
$438.75
|
|
Ultrasound breast complete
|
$716.30 |
$716.30 |
$716.30 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$573.30 |
$573.30 |
$573.30 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$588.25 |
$588.25 |
$588.25 |
$338.00
|
|
Ultrasound elastography ea l target les
|
$250.90 |
$250.90 |
$250.90 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$404.30 |
$404.30 |
$404.30 |
$313.95
|
|
Ultrasound encephalogram
|
$936.65 |
$936.65 |
$936.65 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$494.00 |
$494.00 |
$494.00 |
$575.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$732.55 |
$732.55 |
$732.55 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$1,708.20 |
$1,708.20 |
$1,708.20 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$92.30 |
$92.30 |
$92.30 |
$388.08
|
|
Ultrasound guide intraoperative
|
$976.95 |
$976.95 |
$976.95 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$267.80 |
$267.80 |
$267.80 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$1,032.85 |
$1,032.85 |
$1,032.85 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$616.20 |
$616.20 |
$616.20 |
$311.25
|
|
Ultrasound joint complete left
|
$391.30 |
$391.30 |
$391.30 |
$557.99
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$328.90 |
$328.90 |
$328.90 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$818.35 |
$818.35 |
$818.35 |
$409.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$732.55 |
$732.55 |
$732.55 |
$335.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$922.35 |
$922.35 |
$922.35 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$732.55 |
$732.55 |
$732.55 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$1,300.00 |
$1,300.00 |
$1,300.00 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$865.15 |
$865.15 |
$865.15 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$818.35 |
$818.35 |
$818.35 |
$421.00
|
|
Ultrasound trgt dyn mbubb 1st les
|
$724.75 |
$724.75 |
$724.75 |
$568.32
|
|
Ultrasound trgt dyn mbubb ea addl
|
$507.65 |
$507.65 |
$507.65 |
$348.00
|
|
Unlisted CT procedure
|
$3,387.80 |
$3,387.80 |
$3,387.80 |
$732.70
|
|
Unlisted fluoroscopic px
|
$6,561.75 |
$6,561.75 |
$6,561.75 |
$305.76
|
|
Unlisted maaa
|
$6,232.20 |
$6,232.20 |
$6,232.20 |
$235.20
|
|
Unlisted mr procedure
|
$202.80 |
$202.80 |
$202.80 |
$1,163.00
|
|
Unlisted procedure liver
|
$1,493.70 |
$1,493.70 |
$1,493.70 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$384.15 |
$384.15 |
$384.15 |
$530.00
|
|
Unlisted procedure spine
|
$5,007.60 |
$5,007.60 |
$5,007.60 |
$4,659.85
|
|
Unlisted px biliary tract
|
$17,588.35 |
$17,588.35 |
$17,588.35 |
$3,055.00
|
|
Unlisted px casting/strpg
|
$434.85 |
$434.85 |
$434.85 |
$222.00
|
|
Unlisted px leg/ankle
|
$687.70 |
$687.70 |
$687.70 |
$882.30
|
|
Unlisted px neck/thorax
|
$5,007.60 |
$5,007.60 |
$5,007.60 |
$571.20
|
|
Unlisted px pelvis/hip joint
|
$12,868.05 |
$12,868.05 |
$12,868.05 |
$3,251.90
|
|
Unlisted special svc px/rprt
|
$4,892.55 |
$4,892.55 |
$4,892.55 |
$90.00
|
|
Upgrade pm system
|
$9,377.55 |
$9,377.55 |
$9,377.55 |
$12,077.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$581.10 |
$581.10 |
$581.10 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$3,174.60 |
$3,174.60 |
$3,174.60 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$3,212.95 |
$3,212.95 |
$3,212.95 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,832.10 |
$4,832.10 |
$4,832.10 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$4,122.95 |
$4,122.95 |
$4,122.95 |
$2,392.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,775.20 |
$3,775.20 |
$3,775.20 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$724.75 |
$724.75 |
$724.75 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$739.05 |
$739.05 |
$739.05 |
$381.60
|
|
Upper ext harvest for cabg1 seg 35600
|
$24,357.45 |
$24,357.45 |
$24,357.45 |
$627.20
|
|
Upper GI Barium X-ray (barium and gas)
|
$1,274.00 |
$1,274.00 |
$1,274.00 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$1,180.40 |
$1,180.40 |
$1,180.40 |
$607.20
|
|
Urea nitrogen
|
$98.15 |
$98.15 |
$98.15 |
$42.01
|
|
Urea nitrogen 24 hour urine
|
$163.15 |
$163.15 |
$163.15 |
$51.84
|
|
Ureteral embolization/occl
|
$5,243.55 |
$5,243.55 |
$5,243.55 |
$2,079.31
|
|
Ureteral reflux study
|
$1,423.50 |
$1,423.50 |
$1,423.50 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$1,104.35 |
$1,104.35 |
$1,104.35 |
$584.00
|
|
Urethrocystography void s&i
|
$1,046.50 |
$1,046.50 |
$1,046.50 |
$634.50
|
|
Uric acid blood
|
$54.60 |
$54.60 |
$54.60 |
$49.32
|
|
Uric acid urine
|
$122.85 |
$122.85 |
$122.85 |
$44.52
|
|
Urinalysis microscopic only
|
$149.50 |
$149.50 |
$149.50 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$36.40 |
$36.40 |
$36.40 |
$25.72
|
|
Urinalysis (with microscopy)
|
$163.15 |
$163.15 |
$163.15 |
$55.20
|
|
Urinalysis (without microscopy)
|
$88.40 |
$88.40 |
$88.40 |
$35.91
|
|
Urinary bldr retent nuc study
|
$569.40 |
$569.40 |
$569.40 |
$350.66
|
|
Urine ost pouch w faucet/tap
|
$1.30 |
$1.30 |
$1.30 |
$2.00
|
|
Urine pregnancy test
|
$125.45 |
$125.45 |
$125.45 |
$68.21
|
|
Urography, antegrade
|
$2,689.70 |
$2,689.70 |
$2,689.70 |
$622.35
|
|
Urography inf drip &/or bolus
|
$1,700.40 |
$1,700.40 |
$1,700.40 |
$642.50
|
|
Use 1st target lesion
|
$404.30 |
$404.30 |
$404.30 |
$332.00
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$155.35 |
$155.35 |
$155.35 |
$5,205.00
|
|
Vaccine Administration (one shot)
|
$118.30 |
$118.30 |
$118.30 |
$67.74
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$224.25 |
$224.25 |
$224.25 |
$224.25
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$239.85 |
$239.85 |
$239.85 |
$236.50
|
|
Vaccine dtap < 7 years im
|
$50.05 |
$50.05 |
$50.05 |
$71.17
|
|
Vaccine dtap-hep b-ipv im
|
$156.00 |
$156.00 |
$156.00 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$105.95 |
$105.95 |
$105.95 |
$105.95
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$23.40 |
$23.40 |
$23.40 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$135.20 |
$135.20 |
$135.20 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$218.40 |
$218.40 |
$218.40 |
$231.56
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$61.75 |
$61.75 |
$61.75 |
$78.25
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$120.25 |
$120.25 |
$120.25 |
$155.16
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$49.40 |
$49.40 |
$49.40 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$439.40 |
$439.40 |
$439.40 |
$576.48
|
|
Vaccine influenza inactivated adjuvant im
|
$120.25 |
$120.25 |
$120.25 |
$110.25
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$34.45 |
$34.45 |
$34.45 |
$48.59
|
|
Vaccine influenza quadrivalent (iiv4) split virus 0.25 ml im
|
$26.65 |
$26.65 |
$26.65 |
$20.80
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$53.30 |
$53.30 |
$53.30 |
$82.71
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$387.40 |
$387.40 |
$387.40 |
$394.26
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$291.20 |
$291.20 |
$291.20 |
$409.35
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$272.35 |
$272.35 |
$272.35 |
$327.37
|
|
Vaccine mmr live subcutaneous
|
$159.90 |
$159.90 |
$159.90 |
$213.00
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$202.80 |
$202.80 |
$202.80 |
$252.87
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$393.25 |
$393.25 |
$393.25 |
$393.25
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$385.45 |
$385.45 |
$385.45 |
$414.46
|
