|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$6,108.96 |
$6,108.96 |
$6,108.96 |
$17,191.88
|
|
Ugt1a1 gene analy common variants
|
$298.00 |
$298.00 |
$298.00 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$1,505.00 |
$1,505.00 |
$1,505.00 |
$403.26
|
|
Ultrasound breast complete
|
$1,120.00 |
$1,120.00 |
$1,120.00 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$731.00 |
$731.00 |
$731.00 |
$449.35
|
|
Ultrasound chest
|
$1,000.00 |
$1,000.00 |
$1,000.00 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$735.00 |
$735.00 |
$735.00 |
$340.14
|
|
Ultrasound elastography parenchyma
|
$1,456.00 |
$1,456.00 |
$1,456.00 |
$284.25
|
|
Ultrasound encephalogram
|
$897.00 |
$897.00 |
$897.00 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$1,513.00 |
$1,513.00 |
$1,513.00 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$2,329.00 |
$2,329.00 |
$2,329.00 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$2,111.00 |
$2,111.00 |
$2,111.00 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$2,111.00 |
$2,111.00 |
$2,111.00 |
$701.35
|
|
Ultrasound guide intraoperative
|
$1,204.00 |
$1,204.00 |
$1,204.00 |
$632.90
|
|
Ultrasound joint complete left
|
$1,000.00 |
$1,000.00 |
$1,000.00 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$539.00 |
$539.00 |
$539.00 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$1,162.00 |
$1,162.00 |
$1,162.00 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$873.00 |
$873.00 |
$873.00 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,244.00 |
$1,244.00 |
$1,244.00 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$1,058.00 |
$1,058.00 |
$1,058.00 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$1,244.00 |
$1,244.00 |
$1,244.00 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$1,386.00 |
$1,386.00 |
$1,386.00 |
$485.48
|
|
Ultrasound retroperitoneal limited
|
$3,827.00 |
$3,827.00 |
$3,827.00 |
$498.00
|
|
Ultrasound scrotum and contents
|
$1,948.00 |
$1,948.00 |
$1,948.00 |
$617.28
|
|
Ultrasound transvaginal non obstetric
|
$2,186.00 |
$2,186.00 |
$2,186.00 |
$567.44
|
|
Unlisted CT procedure
|
$1,046.00 |
$1,046.00 |
$1,046.00 |
$1,043.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$10,547.00 |
$10,547.00 |
$10,547.00 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$7,597.00 |
$7,597.00 |
$7,597.00 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$6,747.00 |
$6,747.00 |
$6,747.00 |
$2,013.08
|
|
Upper Endoscopy (EGD, with biopsy)
|
$4,245.76 |
$4,245.76 |
$4,245.76 |
$1,656.60
|
|
Urea nitrogen
|
$110.00 |
$110.00 |
$110.00 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$384.00 |
$384.00 |
$384.00 |
$50.00
|
|
Urea nitrogen clearance
|
$384.00 |
$384.00 |
$384.00 |
$33.57
|
|
Ureteral reflux study
|
$2,381.00 |
$2,381.00 |
$2,381.00 |
$961.20
|
|
Urethrcystgrphy rtrgrde s&i
|
$1,723.00 |
$1,723.00 |
$1,723.00 |
$574.40
|
|
Urethrocystography void s&i
|
$1,251.00 |
$1,251.00 |
$1,251.00 |
$634.50
|
|
Uric acid blood
|
$125.00 |
$125.00 |
$125.00 |
$46.64
|
|
Uric acid urine
|
$125.00 |
$125.00 |
$125.00 |
$46.75
|
|
Urinalysis microscopic only
|
$150.00 |
$150.00 |
$150.00 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$107.00 |
$107.00 |
$107.00 |
$25.72
|
|
Urinalysis (with microscopy)
|
$110.00 |
$110.00 |
$110.00 |
$48.14
|
|
Urinalysis (without microscopy)
|
$90.00 |
$90.00 |
$90.00 |
$38.99
|
|
Urine Culture Test
|
$181.00 |
$181.00 |
$181.00 |
$84.81
|
|
Urine pregnancy test
|
$86.00 |
$86.00 |
$86.00 |
$66.40
|
|
Urography, antegrade
|
$1,702.00 |
$1,702.00 |
$1,702.00 |
$593.37
|
|
Use 1st target lesion
|
$1,456.00 |
$1,456.00 |
$1,456.00 |
$245.30
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$272.39 |
$272.39 |
$272.39 |
$5,521.54
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$97,450.01 |
$97,450.01 |
$97,450.01 |
$56,553.85
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$658.00 |
$658.00 |
$658.00 |
$223.08
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$1,204.98 |
$1,204.98 |
$1,204.98 |
$218.88
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$1,212.52 |
$1,212.52 |
$1,212.52 |
$239.85
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$808.50 |
$808.50 |
$808.50 |
$131.67
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$1,811.25 |
$1,811.25 |
$1,811.25 |
$91.00
|
|
Vaccine dtap < 7 years im
|
$199.71 |
$199.71 |
$199.71 |
$87.80
|
|
Vaccine dtap-hep b-ipv im
|
$624.40 |
$624.40 |
$624.40 |
$193.83
|
|
Vaccine dtap-ipv 4-6 years im
|
$327.57 |
$327.57 |
$327.57 |
$126.84
|
|
Vaccine dtap-ipv-hib-hepb im
|
$908.05 |
$908.05 |
$908.05 |
$158.30
|
|
Vaccine dtap-ipv/hib im
|
$239.38 |
$239.38 |
$239.38 |
$248.80
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$185.31 |
$185.31 |
$185.31 |
$85.00
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$39.64 |
$39.64 |
$39.64 |
$45.33
|
|
Vaccine hepatitis a (hepa) adult im
|
$268.66 |
$268.66 |
$268.66 |
$178.07
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$409.24 |
$409.24 |
$409.24 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$246.67 |
$246.67 |
$246.67 |
$84.38
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$152.48 |
$152.48 |
$152.48 |
$61.50
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$240.81 |
$240.81 |
$240.81 |
$173.98
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$855.54 |
$855.54 |
$855.54 |
$306.24
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$198.76 |
$198.76 |
$198.76 |
$79.04
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$1,448.62 |
$1,448.62 |
$1,448.62 |
$686.67
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$307.38 |
$307.38 |
$307.38 |
$157.41
|
|
Vaccine influenza inactivated adjuvant im
|
$498.28 |
$498.28 |
$498.28 |
$110.25
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$126.47 |
$126.47 |
$126.47 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im
|
$461.76 |
$461.76 |
$461.76 |
$104.63
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$267.50 |
$267.50 |
$267.50 |
$26.40
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$136.12 |
$136.12 |
$136.12 |
$40.01
|
|
Vaccine influenza quadrivalent live (laiv4) intranasal
|
$82.95 |
$82.95 |
$82.95 |
$37.05
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$429.94 |
$429.94 |
$429.94 |
$72.00
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$220.48 |
$220.48 |
$220.48 |
$103.88
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$1,391.78 |
$1,391.78 |
$1,391.78 |
$426.80
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$770.49 |
$770.49 |
$770.49 |
$349.15
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$1,019.96 |
$1,019.96 |
$1,019.96 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$288.43 |
$288.43 |
$288.43 |
$224.04
|
|
Vaccine mmrv live subcutaneous
|
$880.07 |
$880.07 |
$880.07 |
$474.24
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$740.85 |
$740.85 |
$740.85 |
$274.95
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$1,379.70 |
$1,379.70 |
$1,379.70 |
$397.18
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$1,456.88 |
$1,456.88 |
$1,456.88 |
$385.45
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$1,554.63 |
$1,554.63 |
$1,554.63 |
$715.41
|
|
Vaccine polio (ipv) subcutaneous/im
|
$179.54 |
$179.54 |
$179.54 |
$119.17
|
|
Vaccine rabies im
|
$1,065.96 |
$1,065.96 |
$1,065.96 |
$945.46
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$849.56 |
$849.56 |
$849.56 |
$624.00
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$2,954.78 |
$2,954.78 |
$2,954.78 |
$1,196.00
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$1,477.39 |
$1,477.39 |
$1,477.39 |
$1,159.00
|
|
Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im
|
$942.87 |
$942.87 |
$942.87 |
$440.40
|
|
Vaccine rotavirus attenuated (rv1) live 2 dose oral
|
$299.79 |
$299.79 |
$299.79 |
$200.70
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$139.97 |
$139.97 |
$139.97 |
$108.00
|
|
Vaccine tdap >=7 years im
|
$308.25 |
$308.25 |
$308.25 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$201.96 |
$201.96 |
$201.96 |
$131.77
|
|
Vaccine typhoid vicps im
|
$696.78 |
$696.78 |
$696.78 |
$205.22
|
|
Vaccine varicella live subcutaneous
|
$579.75 |
$579.75 |
$579.75 |
$447.80
|
|
Valproic acid total therapeutic drug level
|
$201.00 |
$201.00 |
$201.00 |
$115.00
|
|
Vancomycin hcl injection
|
$7.00 |
$7.00 |
$7.00 |
$186.80
|
