|
Tx open iphlngl jt disl internal fixation sngl
|
$7,008.48 |
$7,008.48 |
$7,008.48 |
$4,421.00
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$7,008.48 |
$7,008.48 |
$7,008.48 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$610.56 |
$610.56 |
$610.56 |
$416.16
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$191.98 |
$191.98 |
$191.98 |
$20,945.01
|
|
Ugt1a1 gene analy common variants
|
$915.12 |
$915.12 |
$915.12 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$626.40 |
$626.40 |
$626.40 |
$394.20
|
|
Ultrasound breast complete
|
$1,212.48 |
$1,212.48 |
$1,212.48 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$919.44 |
$919.44 |
$919.44 |
$449.35
|
|
Ultrasound chest
|
$671.04 |
$671.04 |
$671.04 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$316.80 |
$316.80 |
$316.80 |
$338.00
|
|
Ultrasound elastography ea l target les
|
$142.56 |
$142.56 |
$142.56 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$285.12 |
$285.12 |
$285.12 |
$307.00
|
|
Ultrasound encephalogram
|
$1,169.28 |
$1,169.28 |
$1,169.28 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$1,267.92 |
$1,267.92 |
$1,267.92 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$403.20 |
$403.20 |
$403.20 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$783.36 |
$783.36 |
$783.36 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$846.00 |
$846.00 |
$846.00 |
$720.15
|
|
Ultrasound guide intraoperative
|
$1,293.12 |
$1,293.12 |
$1,293.12 |
$632.85
|
|
Ultrasound hips infant dynamic
|
$1,434.24 |
$1,434.24 |
$1,434.24 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$1,154.88 |
$1,154.88 |
$1,154.88 |
$311.25
|
|
Ultrasound joint complete left
|
$1,070.64 |
$1,070.64 |
$1,070.64 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$768.24 |
$768.24 |
$768.24 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$518.40 |
$518.40 |
$518.40 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$390.96 |
$390.96 |
$390.96 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$964.80 |
$964.80 |
$964.80 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$761.76 |
$761.76 |
$761.76 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$852.48 |
$852.48 |
$852.48 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$1,316.16 |
$1,316.16 |
$1,316.16 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$1,058.40 |
$1,058.40 |
$1,058.40 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$1,026.72 |
$1,026.72 |
$1,026.72 |
$486.50
|
|
Ultrasound scrotum and contents
|
$1,023.84 |
$1,023.84 |
$1,023.84 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$1,187.28 |
$1,187.28 |
$1,187.28 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$711.36 |
$711.36 |
$711.36 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$915.12 |
$915.12 |
$915.12 |
$558.35
|
|
Umbilical artery cath newborn 36660
|
$295.20 |
$295.20 |
$295.20 |
$206.64
|
|
Unlisted chemotherapy px
|
$99.36 |
$99.36 |
$99.36 |
$150.00
|
|
Unlisted cranfcl&maxlfcl px
|
$501.84 |
$501.84 |
$501.84 |
$571.20
|
|
Unlisted cytogenetic study
|
$457.92 |
$457.92 |
$457.92 |
$160.18
|
|
Unlisted hematology&coagj px
|
$87.12 |
$87.12 |
$87.12 |
$39.52
|
|
Unlisted mr procedure
|
$211.68 |
$211.68 |
$211.68 |
$1,163.00
|
|
Unlisted procedure microbiology
|
$654.48 |
$654.48 |
$654.48 |
$523.50
|
|
Unlisted procedure rectum
|
$1,969.20 |
$1,969.20 |
$1,969.20 |
$1,220.35
|
|
Unlisted px ant segment eye
|
$4,926.24 |
$4,926.24 |
$4,926.24 |
$2,698.92
|
|
Unlisted px casting/strpg
|
$414.72 |
$414.72 |
$414.72 |
$219.70
|
|
Unlisted px hands/fingers
|
$1,187.28 |
$1,187.28 |
$1,187.28 |
$354.20
|
|
Unlisted px male genital sys
|
$525.60 |
$525.60 |
$525.60 |
$343.55
|
|
Unlisted px med radj physics
|
$313.20 |
$313.20 |
$313.20 |
$462.35
|
|
Unlisted px neck/thorax
|
$501.84 |
$501.84 |
$501.84 |
$571.20
|
|
Unlisted px palate uvula
|
$501.84 |
$501.84 |
$501.84 |
$274.80
|
|
Unlisted px small intestine
|
$2,025.36 |
$2,025.36 |
$2,025.36 |
$2,102.10
|
|
Unlisted px vestibule mouth
|
$501.84 |
$501.84 |
$501.84 |
$456.96
|
|
Unlisted transfusion med px
|
$75.60 |
$75.60 |
$75.60 |
$147.50
|
|
Unsched dialysis esrd pt hos
|
$4,767.12 |
$4,767.12 |
$4,767.12 |
$1,268.17
|
|
Upgrade pm system
|
$26,503.92 |
$26,503.92 |
$26,503.92 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$5,382.00 |
$5,382.00 |
$5,382.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$4,641.12 |
$4,641.12 |
$4,641.12 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,399.84 |
$3,399.84 |
$3,399.84 |
$2,034.41
|
|
Urea nitrogen
|
$40.32 |
$40.32 |
$40.32 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$69.84 |
$69.84 |
$69.84 |
$51.75
|
|
Ureteral embolization/occl
|
$1,509.84 |
$1,509.84 |
$1,509.84 |
$2,181.40
|
|
Ureteral reflux study
|
$1,916.64 |
$1,916.64 |
$1,916.64 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$1,009.44 |
$1,009.44 |
$1,009.44 |
$579.73
|
|
Urethrocystography void s&i
|
$856.80 |
$856.80 |
$856.80 |
$622.35
|
|
Uric acid blood
|
$59.04 |
$59.04 |
$59.04 |
$48.75
|
|
Uric acid urine
|
$103.68 |
$103.68 |
$103.68 |
$44.33
|
|
Urinalysis microscopic only
|
$41.04 |
$41.04 |
$41.04 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$44.64 |
$44.64 |
$44.64 |
$25.72
|
|
Urinalysis (with microscopy)
|
$60.48 |
$60.48 |
$60.48 |
$55.00
|
|
Urinalysis (without microscopy)
|
$46.08 |
$46.08 |
$46.08 |
$35.75
|
|
Urine Culture Test
|
$167.04 |
$167.04 |
$167.04 |
$81.50
|
|
Urine pregnancy test
|
$111.60 |
$111.60 |
$111.60 |
$67.20
|
|
Urography, antegrade
|
$1,021.68 |
$1,021.68 |
$1,021.68 |
$622.35
|
|
Use 1st target lesion
|
$285.12 |
$285.12 |
$285.12 |
$332.00
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$42.26 |
$42.26 |
$42.26 |
$5,184.34
|
|
Vaccine dtap < 7 years im
|
$126.22 |
$126.22 |
$126.22 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$444.96 |
$444.96 |
$444.96 |
$164.63
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$78.26 |
$78.26 |
$78.26 |
$43.12
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$168.52 |
$168.52 |
$168.52 |
$79.15
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$311.54 |
$311.54 |
$311.54 |
$155.16
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$125.86 |
$125.86 |
$125.86 |
$75.39
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$89.68 |
$89.68 |
$89.68 |
$47.88
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$912.38 |
$912.38 |
$912.38 |
$400.03
|
|
Vaccine mmr live subcutaneous
|
$421.70 |
$421.70 |
$421.70 |
$211.68
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$505.80 |
$505.80 |
$505.80 |
$251.64
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$977.65 |
$977.65 |
$977.65 |
$397.11
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$1,222.92 |
$1,222.92 |
$1,222.92 |
$563.36
|
|
Vaccine rabies im
|
$1,502.03 |
$1,502.03 |
$1,502.03 |
$858.95
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$1,922.00 |
$1,922.00 |
$1,922.00 |
$1,104.47
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$1,922.00 |
$1,922.00 |
$1,922.00 |
$997.44
|
|
Vaccine tdap >=7 years im
|
$208.98 |
$208.98 |
$208.98 |
$131.34
|
|
Vaginal bx
|
$8,220.96 |
$8,220.96 |
$8,220.96 |
$455.94
|
|
Valproic acid total therapeutic drug level
|
$4,256.64 |
$4,256.64 |
$4,256.64 |
$114.72
|
|
Valvuloplasty aortic
|
$21,720.96 |
$21,720.96 |
$21,720.96 |
$7,830.80
|
|
Valvuloplasty mitral
|
$43,038.00 |
$43,038.00 |
$43,038.00 |
$10,877.90
|
|
Valvuloplasty pulmonary
|
$43,038.00 |
$43,038.00 |
$43,038.00 |
$11,945.20
|
|
Vancomycin 1,000 mg intravenous injection
|
$8.64 |
$8.64 |
$8.64 |
$251.86
|
|
Vancomycin peak therapeutic drug level
|
$170.64 |
$170.64 |
$170.64 |
$136.13
|
|
Varicella zoster antibody igg
|
$123.12 |
$123.12 |
$123.12 |
$86.80
|
|
Vasopressin 20 unit/ml intravenous solution
|
$22.70 |
$22.70 |
$22.70 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$80.87 |
$80.87 |
$80.87 |
$18,732.33
|
