|
Ugt1a1 gene analy common variants
|
$619.20 |
$619.20 |
$2,041.63 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$498.60 |
$498.60 |
$942.66 |
$394.20
|
|
Ultrasound breast complete
|
$844.20 |
$844.20 |
$1,885.32 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$844.20 |
$844.20 |
$1,885.32 |
$449.35
|
|
Ultrasound chest
|
$400.20 |
$400.20 |
$942.66 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$438.00 |
$438.00 |
$438.00 |
$338.00
|
|
Ultrasound elastography ea l target les
|
$238.20 |
$238.20 |
$942.66 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$238.20 |
$238.20 |
$942.66 |
$307.00
|
|
Ultrasound encephalogram
|
$277.80 |
$277.80 |
$942.66 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$716.40 |
$716.40 |
$1,414.02 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$796.20 |
$796.20 |
$861.92 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$893.40 |
$893.40 |
$942.66 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$893.40 |
$893.40 |
$942.66 |
$720.15
|
|
Ultrasound guide intraoperative
|
$511.20 |
$511.20 |
$861.92 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$942.66 |
$942.66 |
$942.66 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$502.20 |
$502.20 |
$942.66 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$942.66 |
$942.66 |
$942.66 |
$311.25
|
|
Ultrasound joint complete left
|
$388.20 |
$388.20 |
$1,962.27 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$252.00 |
$252.00 |
$3,228.37 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$204.75 |
$204.75 |
$369.60 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$369.60 |
$369.60 |
$861.92 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$209.40 |
$209.40 |
$861.92 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$501.00 |
$501.00 |
$550.80 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$624.60 |
$624.60 |
$861.92 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$672.00 |
$672.00 |
$861.92 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$942.66 |
$942.66 |
$942.66 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$991.20 |
$991.20 |
$1,962.27 |
$486.50
|
|
Ultrasound scrotum and contents
|
$513.00 |
$513.00 |
$942.66 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$420.60 |
$420.60 |
$942.66 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$130.80 |
$130.80 |
$501.00 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$676.20 |
$676.20 |
$861.92 |
$558.35
|
|
Ultrasound trgt dyn mbubb 1st les
|
$942.66 |
$942.66 |
$942.66 |
$568.32
|
|
Ultraviolet therapy
|
$70.99 |
$70.99 |
$70.99 |
$39.76
|
|
Umbilical artery cath newborn 36660
|
$130.80 |
$130.80 |
$130.80 |
$206.64
|
|
Unlistd noninvas vasc dx std
|
$1,968.26 |
$1,968.26 |
$1,968.26 |
$528.80
|
|
Unlisted chemotherapy px
|
$387.00 |
$387.00 |
$835.29 |
$150.00
|
|
Unlisted CT procedure
|
$2,167.20 |
$2,167.20 |
$2,167.20 |
$732.70
|
|
Unlisted cytogenetic study
|
$123.56 |
$123.56 |
$123.56 |
$160.18
|
|
Unlisted fluoroscopic px
|
$580.34 |
$580.34 |
$580.34 |
$305.76
|
|
Unlisted hematology&coagj px
|
$53.64 |
$53.64 |
$53.64 |
$39.52
|
|
Unlisted maaa
|
$2,374.62 |
$2,374.62 |
$2,374.62 |
$235.20
|
|
Unlisted misc path test
|
$40.20 |
$40.20 |
$40.20 |
$89.40
|
|
Unlisted mr procedure
|
$3,258.04 |
$3,258.04 |
$3,258.04 |
$1,163.00
|
|
Unlisted neurological dx px
|
$1,607.54 |
$1,607.54 |
$1,607.54 |
$242.50
|
|
Unlisted procedure liver
|
$3,350.90 |
$3,350.90 |
$3,350.90 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$159.00 |
$159.00 |
$5,036.59 |
$523.50
|
|
Unlisted procedure urinary 58750
|
$15,847.50 |
$15,847.50 |
$15,847.50 |
$1,181.29
|
|
Unlisted psychiatric service/proc 90899
|
$1,722.59 |
$1,722.59 |
$1,722.59 |
$277.76
|
|
Unlisted px arthroscopy
|
$30,820.21 |
$30,820.21 |
$30,820.21 |
$2,765.60
|
|
Unlisted px casting/strpg
|
$549.20 |
$549.20 |
$549.20 |
$219.70
|
|
Unlisted px hands/fingers
|
$378.00 |
$378.00 |
$378.00 |
$354.20
|
|
Unlisted px med radj physics
|
$723.14 |
$723.14 |
$723.14 |
$462.35
|
|
Unlisted px pelvis/hip joint
|
$27,349.32 |
$27,349.32 |
$27,349.32 |
$3,118.44
|
|
Unlisted px small intestine
|
$1,433.40 |
$1,433.40 |
$1,433.40 |
$2,102.10
|
|
Unlisted px tongue flr mouth
|
$408.60 |
$408.60 |
$408.60 |
$282.50
|
|
Unlisted px vestibule mouth
|
$384.60 |
$384.60 |
$384.60 |
$456.96
|
|
Unlisted resp px dx nuc med
|
$1,457.13 |
$1,457.13 |
$1,457.13 |
$670.60
|
|
Unlisted surgical path px
|
$68.76 |
$68.76 |
$68.76 |
$217.75
|
|
Unlisted transfusion med px
|
$1,138.52 |
$1,138.52 |
$1,138.52 |
$147.50
|
|
Unlisted ultrasound procedure
|
$1,336.12 |
$1,336.12 |
$1,336.12 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$1,683.96 |
$1,683.96 |
$2,458.20 |
$1,268.17
|
|
Upgrade pm system
|
$11,694.00 |
$11,694.00 |
$72,805.03 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,301.80 |
$3,301.80 |
$4,507.36 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,841.60 |
$2,841.60 |
$3,258.04 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,273.40 |
$2,273.40 |
$3,225.02 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$7,438.09 |
$7,438.09 |
$7,438.09 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$10,549.20 |
$10,549.20 |
$10,549.20 |
$1,768.00
|
|
Upper ext fx orthosis rad/ul
|
$465.92 |
$465.92 |
$465.92 |
$619.49
|
|
Uppr gi scope w/submuc inj
|
$9,496.21 |
$9,496.21 |
$9,496.21 |
$1,872.00
|
|
Urea nitrogen
|
$46.61 |
$46.61 |
$91.80 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$57.15 |
$57.15 |
$96.00 |
$51.75
|
|
Urea nitrogen clearance
|
$22.20 |
$22.20 |
$22.20 |
$42.25
|
|
Ureteral reflux study
|
$1,879.76 |
$1,879.76 |
$1,879.76 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$465.60 |
$465.60 |
$954.82 |
$579.73
|
|
Urethrocystography void s&i
|
$967.80 |
$967.80 |
$2,184.91 |
$622.35
|
|
Uric acid blood
|
$55.98 |
$55.98 |
$112.80 |
$48.75
|
|
Uric acid urine
|
$27.00 |
$27.00 |
$58.32 |
$44.33
|
|
Urinalysis microscopic only
|
$27.00 |
$27.00 |
$35.00 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$52.47 |
$52.47 |
$52.47 |
$25.72
|
|
Urinalysis (with microscopy)
|
$39.60 |
$39.60 |
$71.40 |
$55.00
|
|
Urinalysis (without microscopy)
|
$28.00 |
$28.00 |
$54.00 |
$35.75
|
|
Urinary bldr retent nuc study
|
$479.41 |
$479.41 |
$479.41 |
$350.66
|
|
Urine Culture Test
|
$100.26 |
$100.26 |
$134.40 |
$81.50
|
|
Urine pregnancy test
|
$15.11 |
$15.11 |
$29.40 |
$67.20
|
|
Urography, antegrade
|
$423.00 |
$423.00 |
$2,083.16 |
$622.35
|
|
Use 1st target lesion
|
$238.20 |
$238.20 |
$942.66 |
$332.00
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$5,748.88 |
$5,748.88 |
$12,463.56 |
$5,184.34
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$42,852.66 |
$42,852.66 |
$154,889.53 |
$51,633.07
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$276.53 |
$276.53 |
$276.53 |
$224.25
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$334.80 |
$334.80 |
$334.80 |
$236.50
|
|
Vaccine dtap < 7 years im
|
$39.96 |
$39.96 |
$39.96 |
$68.19
|
|
Vaccine dtap-ipv/hib im
|
$1,065.23 |
$1,065.23 |
$1,065.23 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$291.05 |
$291.05 |
$291.05 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$115.37 |
$115.37 |
$115.37 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$693.19 |
$693.19 |
$693.19 |
$166.62
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$301.11 |
$301.11 |
$301.11 |
$79.15
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$481.00 |
$481.00 |
$481.00 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$210.30 |
$210.30 |
$1,417.81 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$0.06 |
$0.06 |
$218.30 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$3,162.56 |
$3,162.56 |
$3,162.56 |
$576.48
|
