|
Tte w or without contr, cont ecg
|
$1,396.50 |
$1,396.50 |
$1,968.40 |
|
|
Tte w or without fol w/con,stres
|
$1,303.15 |
$1,303.15 |
$2,124.00 |
|
|
Tte w or without fol w/cont, f/u
|
$1,594.00 |
$1,594.00 |
$1,594.00 |
|
|
Tx closed distal humerus fx
|
$808.55 |
$1,104.05 |
$3,038.35 |
|
|
Tx closed hip disl traumatic without anes
|
$392.80 |
$972.55 |
$1,585.20 |
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$1,252.50 |
$1,672.30 |
$9,684.15 |
|
|
Tx closed tib shaft fx without manip
|
$276.80 |
$643.75 |
$1,083.85 |
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$5,679.50 |
$5,679.50 |
$5,679.50 |
|
|
Tx tarsal bone fx without manip 28450
|
$402.25 |
$435.55 |
$943.45 |
|
|
Tympanometry & reflex thresh
|
$194.40 |
$194.40 |
$207.90 |
|
|
Ua w/micro/comp poc
|
$12.50 |
$24.45 |
$77.65 |
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$26,528.46 |
$26,528.46 |
$26,528.46 |
|
|
Ugt1a1 gene analy common variants
|
$585.00 |
$971.00 |
$1,460.15 |
|
|
Ultrasound breast complete
|
$385.55 |
$567.30 |
$897.50 |
|
|
Ultrasound breast unilateral limited (both sides)
|
$308.70 |
$540.45 |
$665.45 |
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$223.80 |
$483.75 |
$867.60 |
|
|
Ultrasound dx ophth b-scan
|
$109.25 |
$330.40 |
$594.85 |
|
|
Ultrasound elastography ea l target les
|
$455.60 |
$455.60 |
$455.60 |
|
|
Ultrasound elastography parenchyma
|
$323.75 |
$323.75 |
$728.35 |
|
|
Ultrasound encephalogram
|
$356.15 |
$596.55 |
$1,102.70 |
|
|
Ultrasound exam k transpl w/doppler
|
$359.00 |
$642.50 |
$1,297.50 |
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$409.80 |
$744.60 |
$1,687.40 |
|
|
Ultrasound Guidance for a Needle Procedure
|
$674.85 |
$842.20 |
$1,121.65 |
|
|
Ultrasound guidance for vascular access
|
$157.70 |
$377.95 |
$637.05 |
|
|
Ultrasound guide intraoperative
|
$904.30 |
$924.60 |
$1,909.80 |
|
|
Ultrasound guide tissue ablation
|
$265.00 |
$1,121.65 |
$1,121.65 |
|
|
Ultrasound hips infant dynamic
|
$427.85 |
$461.00 |
$1,051.40 |
|
|
Ultrasound infant hips ltd without stress
|
$427.85 |
$427.85 |
$427.85 |
|
|
Ultrasound joint complete left
|
$429.00 |
$738.30 |
$1,051.40 |
|
|
Ultrasound ob >=14wks ea addl gest
|
$393.65 |
$604.95 |
$2,334.20 |
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$244.00 |
$653.40 |
$727.50 |
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$877.25 |
$1,166.15 |
$1,328.15 |
|
|
Ultrasound pregnant uterus follow up per fetus
|
$461.00 |
$604.95 |
$867.60 |
|
|
Ultrasound prostate/transrectal
|
$363.40 |
$858.35 |
$1,453.60 |
|
|
Ultrasound spinal canal and contents
|
$505.50 |
$529.50 |
$607.35 |
|
|
Ultrasound transabd ea addl gest
|
$877.25 |
$877.25 |
$877.25 |
|
|
Ultraviolet therapy
|
$63.45 |
$63.45 |
$63.45 |
|
|
Umbilical artery cath newborn 36660
|
$148.45 |
$148.45 |
$148.45 |
|
|
Unlisted chemotherapy px
|
$64.15 |
$179.50 |
$404.30 |
|
|
Unlisted dialysis procedure
|
$1,429.30 |
$1,429.30 |
$1,429.30 |
|
|
Unlisted laparoscopic liver biopy 47379
|
$1,942.00 |
$1,942.00 |
$1,942.00 |
|
|
Unlisted mr procedure
|
$3,839.85 |
$3,839.85 |
$3,839.85 |
|
|
Unlisted procedure rectum
|
$476.40 |
$476.40 |
$476.40 |
|
|
Unlisted px biliary tract
|
$674.85 |
$674.85 |
$674.85 |
|
|
Unlisted px casting/strpg
|
$103.90 |
$103.90 |
$103.90 |
|
|
Unlisted px pelvis/hip joint
|
$353.00 |
$353.00 |
$353.00 |
|
|
Unlisted px small intestine
|
$1,046.15 |
$1,424.45 |
$2,738.40 |
|
|
Unlisted surgical path px
|
$31.10 |
$31.10 |
$1,112.50 |
|
|
Unlisted transfusion med px
|
$37.70 |
$37.70 |
$419.20 |
|
|
Unlisted ultrasound procedure
|
$491.35 |
$507.10 |
$540.90 |
|
|
Upgrade pm system
|
$41,076.90 |
$41,076.90 |
$41,076.90 |
|
|
Upper Arm (Humerus) X-ray (left side)
|
$236.55 |
$383.30 |
$473.75 |
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$2,050.30 |
$2,233.90 |
$3,251.40 |
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,038.10 |
$1,382.10 |
$1,920.60 |
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,191.75 |
$3,186.60 |
$3,956.45 |
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,864.50 |
$2,702.50 |
$3,136.80 |
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,296.25 |
$2,181.10 |
$2,554.55 |
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$240.05 |
$400.85 |
$627.55 |
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$330.25 |
$469.65 |
$738.30 |
|
|
Upper GI Barium X-ray (barium and gas)
|
$1,004.15 |
$1,120.50 |
$1,761.90 |
|
|
Upper GI Barium X-ray (barium only)
|
$644.60 |
$1,033.85 |
$1,503.55 |
|
|
Urea nitrogen
|
$22.95 |
$89.10 |
$95.40 |
|
|
Urea nitrogen 24 hour urine
|
$50.00 |
$94.50 |
$144.30 |
|
|
Urea nitrogen clearance
|
$18.00 |
$55.55 |
$107.95 |
|
|
Ureteral reflux study
|
$1,206.60 |
$1,257.80 |
$2,411.90 |
|
|
Urethrcystgrphy rtrgrde s&i
|
$554.70 |
$1,194.50 |
$1,507.90 |
|
|
Urethrocystography void s&i
|
$584.45 |
$1,137.75 |
$2,395.65 |
|
|
Uric acid blood
|
$25.65 |
$93.15 |
$99.25 |
|
|
Uric acid urine
|
$24.35 |
$53.10 |
$153.00 |
|
|
Urinalysis microscopic only
|
$30.00 |
$37.25 |
$90.80 |
|
|
Urinalysis qual/semiquant excpt ia
|
$39.00 |
$39.00 |
$39.00 |
|
|
Urinalysis (with microscopy)
|
$35.05 |
$82.35 |
$150.20 |
|
|
Urinalysis (without microscopy)
|
$21.55 |
$59.35 |
$97.60 |
|
|
Urine Culture Test
|
$74.50 |
$120.00 |
$206.55 |
|
|
Urine pregnancy test
|
$29.10 |
$47.60 |
$90.10 |
|
|
Urography, antegrade
|
$533.10 |
$920.90 |
$1,356.45 |
|
|
Use 1st target lesion
|
$455.60 |
$455.60 |
$455.60 |
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$5,061.30 |
$5,579.35 |
$6,446.71 |
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$34,803.95 |
$35,748.44 |
$88,661.26 |
|
|
Vaccine Administration (one shot)
|
$6.75 |
$56.15 |
$134.25 |
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$160.00 |
$160.00 |
$160.00 |
|
|
Vaccine dtap < 7 years im
|
$239.28 |
$239.28 |
$288.80 |
|
|
Vaccine hepatitis a (hepa) adult im
|
$278.23 |
$436.70 |
$840.82 |
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$604.17 |
$604.17 |
$1,292.50 |
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$758.24 |
$758.24 |
$758.24 |
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$247.17 |
$366.19 |
$705.05 |
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$1,052.49 |
$1,052.49 |
$1,301.47 |
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$114.69 |
$371.88 |
$716.01 |
|
|
Vaccine influenza nos 0.5ml dose im
|
$28.35 |
$28.35 |
$28.35 |
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$30.85 |
$110.02 |
$228.93 |
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$28.55 |
$28.55 |
$28.55 |
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$1,652.28 |
$1,652.28 |
$1,731.61 |
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$588.40 |
$588.40 |
$1,678.41 |
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$570.53 |
$891.65 |
$1,627.43 |
|
|
Vaccine mmr live subcutaneous
|
$192.77 |
$482.58 |
$929.14 |
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$815.81 |
$815.81 |
$1,142.68 |
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$1,310.35 |
$1,310.35 |
$1,310.35 |
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$969.00 |
$1,292.04 |
$2,068.14 |
|
|
Vaccine polio (ipv) subcutaneous/im
|
$189.26 |
$204.08 |
$259.75 |
|
|
Vaccine rabies im
|
$1,543.64 |
$1,751.21 |
$2,403.41 |
|
