|
Tte w or without contr, cont ecg
|
$994.95 |
$994.95 |
$1,878.58 |
|
|
Tte w or without fol w/con,stres
|
$1,120.47 |
$1,643.14 |
$1,797.59 |
|
|
Tx atrial fib pulm vein isol
|
$8,647.20 |
$8,647.20 |
$8,647.20 |
|
|
Tx closed hip disl traumatic without anes
|
$212.09 |
$248.74 |
$694.41 |
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$288.06 |
$1,199.69 |
$1,699.21 |
|
|
Tx closed tib shaft fx without manip
|
$253.46 |
$288.06 |
$874.61 |
|
|
Tx l/r atrial fib addl
|
$449.97 |
$875.89 |
$1,296.90 |
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$1,923.22 |
$1,923.22 |
$2,411.33 |
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$948.27 |
$1,826.02 |
$16,876.11 |
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$1,039.49 |
$1,196.19 |
$1,433.63 |
|
|
Tx open nsl fx uncomp
|
$1,196.20 |
$1,196.20 |
$1,196.20 |
|
|
Tx open nsl sptl fx
|
$1,284.30 |
$1,721.90 |
$2,323.39 |
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$1,787.70 |
$2,069.65 |
$2,351.47 |
|
|
Tx tarsal bone fx without manip 28450
|
$232.30 |
$232.30 |
$288.06 |
|
|
Ua w/micro/comp poc
|
$11.07 |
$11.07 |
$11.46 |
|
|
Ugt1a1 gene analy common variants
|
$334.00 |
$375.97 |
$440.94 |
|
|
Ultrasound abdomen aorta screening study aaa
|
$130.11 |
$248.74 |
$781.57 |
|
|
Ultrasound breast complete
|
$353.88 |
$488.51 |
$1,197.54 |
|
|
Ultrasound breast unilateral limited (both sides)
|
$245.37 |
$367.58 |
$658.72 |
|
|
Ultrasound chest
|
$178.07 |
$346.33 |
$610.46 |
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$110.47 |
$110.47 |
$1,013.99 |
|
|
Ultrasound elastography parenchyma
|
$97.61 |
$122.38 |
$370.88 |
|
|
Ultrasound encephalogram
|
$245.55 |
$399.67 |
$501.11 |
|
|
Ultrasound exam k transpl w/doppler
|
$355.41 |
$483.22 |
$515.71 |
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$107.02 |
$140.76 |
$950.79 |
|
|
Ultrasound guidance for vascular access
|
$163.46 |
$215.00 |
$1,986.98 |
|
|
Ultrasound guided needle placement supervision & interpretation
|
$236.38 |
$393.36 |
$673.70 |
|
|
Ultrasound guide intraoperative
|
$171.12 |
$207.77 |
$1,428.51 |
|
|
Ultrasound guide tissue ablation
|
$186.55 |
$186.55 |
$186.55 |
|
|
Ultrasound hips infant dynamic
|
$153.85 |
$196.98 |
$1,738.59 |
|
|
Ultrasound infant hips ltd without stress
|
$124.52 |
$124.52 |
$156.13 |
|
|
Ultrasound joint complete left
|
$340.10 |
$469.04 |
$776.01 |
|
|
Ultrasound joint/nonvascular extremity limited left
|
$226.95 |
$340.10 |
$1,047.47 |
|
|
Ultrasound ob >=14wks ea addl gest
|
$305.28 |
$399.67 |
$1,036.95 |
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$97.78 |
$126.53 |
$507.02 |
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$229.36 |
$229.36 |
$405.33 |
|
|
Ultrasound pregnant uterus follow up per fetus
|
$131.57 |
$184.99 |
$220.47 |
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$195.60 |
$338.24 |
$1,092.05 |
|
|
Ultrasound pregnant uterus transvaginal
|
$245.37 |
$424.76 |
$1,320.23 |
|
|
Ultrasound prostate/transrectal
|
$1,553.88 |
$1,632.53 |
$2,043.91 |
|
|
Ultrasound retroperitoneal limited
|
$343.71 |
$438.63 |
$1,112.24 |
|
|
Ultrasound scrotum and contents
|
$399.47 |
$592.35 |
$1,529.40 |
|
|
Ultrasound spinal canal and contents
|
$141.83 |
$269.94 |
$1,070.36 |
|
|
Ultrasound transabd ea addl gest
|
$153.85 |
$153.85 |
$425.86 |
|
|
Ultrasound transvaginal non obstetric
|
$524.48 |
$700.93 |
$1,437.05 |
|
|
Ultrasound trgt dyn mbubb 1st les
|
$170.07 |
$170.07 |
$170.07 |
|
|
Umbilical artery cath newborn 36660
|
$23.56 |
$28.12 |
$32.98 |
|
|
Unlisted chemotherapy px
|
$57.95 |
$57.95 |
$57.95 |
|
|
Unlisted CT procedure
|
$388.65 |
$388.65 |
$388.65 |
|
|
Unlisted dx gi procedure
|
$130.96 |
$148.62 |
$186.34 |
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$2,177.41 |
$2,177.41 |
$2,177.41 |
|
|
Unlisted mr procedure
|
$76.01 |
$76.01 |
$76.01 |
|
|
Unlisted procedure esophagus
|
$759.35 |
$863.20 |
$1,045.58 |
|
|
Unlisted procedure liver
|
$94.00 |
$94.00 |
$110.24 |
|
|
Unlisted procedure microbiology
|
$169.50 |
$190.80 |
$239.22 |
|
|
Unlisted procedure rectum
|
$293.02 |
$293.02 |
$293.02 |
|
|
Unlisted px hands/fingers
|
$150.23 |
$150.23 |
$188.36 |
|
|
Unlisted px palate uvula
|
$203.40 |
$228.96 |
$287.07 |
|
|
Unlisted transfusion med px
|
$319.88 |
$319.88 |
$319.88 |
|
|
Unlisted ultrasound procedure
|
$166.70 |
$166.70 |
$195.50 |
|
|
Unsched dialysis esrd pt hos
|
$412.12 |
$437.13 |
$1,178.65 |
|
|
Upgrade pm system
|
$1,577.38 |
$1,849.95 |
$5,656.56 |
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,108.69 |
$1,554.25 |
$5,894.89 |
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,100.55 |
$1,169.95 |
$5,293.49 |
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$839.98 |
$1,101.87 |
$4,811.27 |
|
|
Upper Endoscopy (EGD, diagnostic)
|
$892.09 |
$1,004.19 |
$1,272.85 |
|
|
Upper Endoscopy (EGD, with biopsy)
|
$892.09 |
$1,095.71 |
$1,510.86 |
|
|
Urea nitrogen
|
$16.88 |
$41.46 |
$100.88 |
|
|
Urea nitrogen 24 hour urine
|
$10.35 |
$39.10 |
$114.51 |
|
|
Urea nitrogen clearance
|
$3.22 |
$22.50 |
$27.49 |
|
|
Ureteral reflux study
|
$377.58 |
$414.95 |
$449.76 |
|
|
Urethrcystgrphy rtrgrde s&i
|
$211.83 |
$255.01 |
$462.61 |
|
|
Urethrocystography void s&i
|
$171.88 |
$462.61 |
$877.15 |
|
|
Uric acid blood
|
$36.16 |
$65.08 |
$127.59 |
|
|
Uric acid urine
|
$28.93 |
$36.27 |
$245.58 |
|
|
Urinalysis microscopic only
|
$10.00 |
$15.03 |
$26.70 |
|
|
Urinalysis qual/semiquant excpt ia
|
$34.55 |
$40.52 |
$91.23 |
|
|
Urinalysis (with microscopy)
|
$30.79 |
$47.80 |
$94.16 |
|
|
Urinalysis (without microscopy)
|
$11.57 |
$34.37 |
$169.98 |
|
|
Urine Culture Test
|
$49.48 |
$55.16 |
$115.67 |
|
|
Urine pregnancy test
|
$30.53 |
$38.28 |
$95.64 |
|
|
Urography, antegrade
|
$193.05 |
$373.10 |
$448.21 |
|
|
Urography inf drip &/or bolus
|
$244.45 |
$310.92 |
$627.64 |
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$4,377.59 |
$5,205.00 |
$53,897.79 |
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$57,062.34 |
$64,232.71 |
$80,534.71 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$32.75 |
$36.87 |
$46.22 |
|
|
Vaccine hepatitis a (hepa) adult im
|
$102.75 |
$122.17 |
$280.74 |
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$793.25 |
$793.25 |
$793.25 |
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$74.34 |
$88.40 |
$410.27 |
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$40.20 |
$45.25 |
$56.74 |
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$1,838.81 |
$1,838.81 |
$1,838.81 |
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$553.72 |
$553.72 |
$553.72 |
|
|
Vaccine influenza inactivated adjuvant im
|
$249.70 |
$249.70 |
$249.70 |
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$167.08 |
$167.08 |
$167.08 |
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$142.26 |
$142.26 |
$142.26 |
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$40.01 |
$45.04 |
$56.47 |
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$274.43 |
$274.43 |
$274.43 |
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$228.78 |
$272.02 |
$1,047.09 |
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$197.86 |
$235.25 |
$1,010.84 |
|
|
Vaccine mmr live subcutaneous
|
$126.92 |
$142.87 |
$179.13 |
|
