|
Trnscath tx thromblytc art/ven sbsq day
|
$1,358.47 |
$1,358.47 |
$1,593.21 |
$4,505.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$1,283.76 |
$1,283.76 |
$1,614.88 |
$4,793.13
|
|
Trnscath tx thromblytc vein ini day
|
$2,400.41 |
$2,400.41 |
$2,989.97 |
$4,329.36
|
|
Troponin quantitative
|
$128.54 |
$128.54 |
$150.75 |
$123.75
|
|
Tte w or without contr, cont ecg
|
$994.95 |
$994.95 |
$994.95 |
$1,876.20
|
|
Tte w or without fol w/con,stres
|
$1,401.05 |
$1,401.05 |
$1,643.14 |
$1,582.75
|
|
Tx atrial fib pulm vein isol
|
$8,647.20 |
$8,647.20 |
$8,647.20 |
$32,426.20
|
|
Tx closed hip disl traumatic without anes
|
$212.09 |
$212.09 |
$248.74 |
$657.28
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$1,355.26 |
$1,355.26 |
$1,699.21 |
$3,874.79
|
|
Tx closed tib shaft fx without manip
|
$253.46 |
$253.46 |
$297.26 |
$635.46
|
|
Tx l/r atrial fib addl
|
$1,296.90 |
$1,296.90 |
$1,296.90 |
$7,717.80
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$1,923.22 |
$1,923.22 |
$2,411.33 |
$4,449.44
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$1,826.02 |
$1,826.02 |
$2,141.55 |
$4,499.12
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$1,196.19 |
$1,196.19 |
$1,402.89 |
$4,281.00
|
|
Tx open nsl sptl fx
|
$1,981.06 |
$1,981.06 |
$2,323.39 |
$4,289.04
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$1,940.90 |
$1,940.90 |
$2,276.28 |
$4,499.12
|
|
Ugt1a1 gene analy common variants
|
$375.97 |
$375.97 |
$440.94 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$165.49 |
$165.49 |
$190.32 |
$403.26
|
|
Ultrasound breast complete
|
$353.88 |
$353.88 |
$488.51 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$283.19 |
$283.19 |
$332.12 |
$449.35
|
|
Ultrasound chest
|
$363.92 |
$363.92 |
$456.28 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$110.47 |
$110.47 |
$110.47 |
$340.14
|
|
Ultrasound elastography parenchyma
|
$97.61 |
$97.61 |
$122.38 |
$284.25
|
|
Ultrasound encephalogram
|
$399.67 |
$399.67 |
$501.11 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$483.22 |
$483.22 |
$515.71 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$162.68 |
$162.68 |
$190.79 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$221.33 |
$221.33 |
$242.61 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$335.40 |
$335.40 |
$393.36 |
$701.35
|
|
Ultrasound guide intraoperative
|
$171.12 |
$171.12 |
$200.69 |
$632.90
|
|
Ultrasound guide tissue ablation
|
$186.55 |
$186.55 |
$186.55 |
$498.40
|
|
Ultrasound hips infant dynamic
|
$153.85 |
$153.85 |
$192.89 |
$403.00
|
|
Ultrasound infant hips ltd without stress
|
$124.52 |
$124.52 |
$156.13 |
$321.35
|
|
Ultrasound joint complete left
|
$565.16 |
$565.16 |
$662.82 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$307.29 |
$307.29 |
$360.38 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$399.67 |
$399.67 |
$501.11 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$126.53 |
$126.53 |
$148.40 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$229.36 |
$229.36 |
$229.36 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$187.99 |
$187.99 |
$220.47 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$288.41 |
$288.41 |
$338.24 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$313.31 |
$313.31 |
$392.83 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$1,621.97 |
$1,621.97 |
$1,902.24 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$438.63 |
$438.63 |
$549.96 |
$498.00
|
|
Ultrasound scrotum and contents
|
$561.55 |
$561.55 |
$658.58 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$230.16 |
$230.16 |
$269.94 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$153.85 |
$153.85 |
$153.85 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$700.93 |
$700.93 |
$878.82 |
$567.44
|
|
Ultrasound trgt dyn mbubb 1st les
|
$170.07 |
$170.07 |
$170.07 |
$479.72
|
|
Umbilical artery cath newborn 36660
|
$28.12 |
$28.12 |
$32.98 |
$265.85
|
|
Unlisted chemotherapy px
|
$57.95 |
$57.95 |
$57.95 |
$153.85
|
|
Unlisted CT procedure
|
$388.65 |
$388.65 |
$388.65 |
$1,043.00
|
|
Unlisted dx gi procedure
|
$148.62 |
$148.62 |
$186.34 |
$482.90
|
|
Unlisted procedure esophagus
|
$863.20 |
$863.20 |
$1,012.36 |
$1,215.50
|
|
Unlisted procedure liver
|
$94.00 |
$94.00 |
$110.24 |
$2,694.00
|
|
Unlisted procedure microbiology
|
$190.80 |
$190.80 |
$239.22 |
$487.50
|
|
Unlisted procedure rectum
|
$293.02 |
$293.02 |
$293.02 |
$1,278.72
|
|
Unlisted px hands/fingers
|
$150.23 |
$150.23 |
$188.36 |
$379.44
|
|
Unlisted px palate uvula
|
$228.96 |
$228.96 |
$287.07 |
$257.04
|
|
Unlisted ultrasound procedure
|
$166.70 |
$166.70 |
$195.50 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$412.12 |
$412.12 |
$1,178.65 |
$1,480.70
|
|
Upgrade pm system
|
$1,577.38 |
$1,577.38 |
$1,849.95 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,456.48 |
$1,456.48 |
$1,553.64 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,127.51 |
$1,127.51 |
$1,190.43 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,033.51 |
$1,033.51 |
$1,101.87 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,004.19 |
$1,004.19 |
$1,177.71 |
$1,588.59
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,205.03 |
$1,205.03 |
$1,510.86 |
$1,656.60
|
|
Urea nitrogen
|
$16.88 |
$16.88 |
$19.79 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$33.34 |
$33.34 |
$39.10 |
$50.00
|
|
Urea nitrogen clearance
|
$22.50 |
$22.50 |
$26.39 |
$33.57
|
|
Ureteral reflux study
|
$377.58 |
$377.58 |
$442.82 |
$961.20
|
|
Urethrcystgrphy rtrgrde s&i
|
$394.45 |
$394.45 |
$462.61 |
$574.40
|
|
Urethrocystography void s&i
|
$394.45 |
$394.45 |
$462.61 |
$634.50
|
|
Uric acid blood
|
$65.08 |
$65.08 |
$76.32 |
$46.64
|
|
Uric acid urine
|
$28.93 |
$28.93 |
$36.27 |
$46.75
|
|
Urinalysis microscopic only
|
$21.29 |
$21.29 |
$26.70 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$34.55 |
$34.55 |
$40.52 |
$25.72
|
|
Urinalysis (with microscopy)
|
$47.80 |
$47.80 |
$56.06 |
$48.14
|
|
Urinalysis (without microscopy)
|
$35.35 |
$35.35 |
$41.46 |
$38.99
|
|
Urine Culture Test
|
$49.81 |
$49.81 |
$58.42 |
$84.81
|
|
Urine pregnancy test
|
$30.53 |
$30.53 |
$38.28 |
$66.40
|
|
Urography, antegrade
|
$318.13 |
$318.13 |
$373.10 |
$593.37
|
|
Urography inf drip &/or bolus
|
$265.11 |
$265.11 |
$310.92 |
$641.69
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$4,927.67 |
$4,927.67 |
$6,178.29 |
$5,521.54
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$64,232.71 |
$64,232.71 |
$80,534.71 |
$56,553.85
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$36.87 |
$36.87 |
$46.22 |
$45.33
|
|
Vaccine hepatitis a (hepa) adult im
|
$115.66 |
$115.66 |
$145.01 |
$178.07
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$83.69 |
$83.69 |
$104.92 |
$173.98
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$45.25 |
$45.25 |
$56.74 |
$79.04
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$45.04 |
$45.04 |
$56.47 |
$40.01
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$257.53 |
$257.53 |
$322.88 |
$499.00
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$222.72 |
$222.72 |
$279.24 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$142.87 |
$142.87 |
$179.13 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$171.48 |
$171.48 |
$214.99 |
$274.95
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$322.87 |
$322.87 |
$404.81 |
$397.18
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$360.20 |
$360.20 |
$451.61 |
$715.41
|
|
Vaccine rabies im
|
$485.92 |
$485.92 |
$609.24 |
$945.46
|
|
Vaccine tdap >=7 years im
|
$83.68 |
$83.68 |
$104.92 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$68.51 |
$68.51 |
$85.90 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$52.55 |
$52.55 |
$65.89 |
$447.80
|
|
Valproic acid total therapeutic drug level
|
$89.58 |
$89.58 |
$105.06 |
$115.00
|
|
Valrubicin injection
|
$3,768.94 |
$3,768.94 |
$4,725.48 |
$2,813.49
|
