|
Trnscath plc vas stent w/s&i ini vein
|
$22,748.70 |
$22,748.70 |
$22,748.70 |
$15,408.00
|
|
Trnscath retrv pq vasc fb w/guide
|
$7,001.80 |
$7,001.80 |
$7,001.80 |
$4,969.90
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$63,356.80 |
$63,356.80 |
$63,356.80 |
$6,156.00
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$25,662.00 |
$25,662.00 |
$25,662.00 |
$4,505.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$24,507.60 |
$24,507.60 |
$24,507.60 |
$4,793.13
|
|
Trnscath tx thromblytc vein ini day
|
$47,902.40 |
$47,902.40 |
$47,902.40 |
$4,329.36
|
|
Troponin quantitative
|
$59.80 |
$59.80 |
$59.80 |
$123.75
|
|
Tte w or without fol w/con,stres
|
$1,607.45 |
$1,607.45 |
$1,607.45 |
$1,573.00
|
|
Tte w or without fol w/cont, com
|
$1,945.45 |
$1,945.45 |
$1,945.45 |
$1,220.31
|
|
Tumor cell deplete of harvst
|
$438.10 |
$438.10 |
$438.10 |
$547.20
|
|
Tx atrial fib pulm vein isol
|
$41,078.70 |
$41,078.70 |
$41,078.70 |
$32,426.20
|
|
Tx l/r atrial fib addl
|
$4,202.90 |
$4,202.90 |
$4,202.90 |
$7,717.80
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$161.80 |
$161.80 |
$161.80 |
$15,137.87
|
|
Ugt1a1 gene analy common variants
|
$1,714.70 |
$1,714.70 |
$1,714.70 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$150.15 |
$150.15 |
$150.15 |
$403.26
|
|
Ultrasound breast complete
|
$1,220.70 |
$1,220.70 |
$1,220.70 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$924.30 |
$924.30 |
$924.30 |
$449.35
|
|
Ultrasound chest
|
$247.65 |
$247.65 |
$247.65 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$157.95 |
$157.95 |
$157.95 |
$340.14
|
|
Ultrasound elastography parenchyma
|
$313.95 |
$313.95 |
$313.95 |
$284.25
|
|
Ultrasound encephalogram
|
$225.55 |
$225.55 |
$225.55 |
$481.60
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$244.40 |
$244.40 |
$244.40 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$280.15 |
$280.15 |
$280.15 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$441.35 |
$441.35 |
$441.35 |
$701.35
|
|
Ultrasound guide intraoperative
|
$386.10 |
$386.10 |
$386.10 |
$632.90
|
|
Ultrasound guide tissue ablation
|
$174.20 |
$174.20 |
$174.20 |
$498.40
|
|
Ultrasound joint complete left
|
$433.55 |
$433.55 |
$433.55 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$278.85 |
$278.85 |
$278.85 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$215.15 |
$215.15 |
$215.15 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$178.75 |
$178.75 |
$178.75 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$446.55 |
$446.55 |
$446.55 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$212.55 |
$212.55 |
$212.55 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$137.15 |
$137.15 |
$137.15 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$284.70 |
$284.70 |
$284.70 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$421.20 |
$421.20 |
$421.20 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$321.10 |
$321.10 |
$321.10 |
$498.00
|
|
Ultrasound scrotum and contents
|
$399.75 |
$399.75 |
$399.75 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$536.90 |
$536.90 |
$536.90 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$168.35 |
$168.35 |
$168.35 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$427.70 |
$427.70 |
$427.70 |
$567.44
|
|
Unit mobile power mpu
|
$16,547.86 |
$16,547.86 |
$16,547.86 |
$16,315.20
|
|
Unlisted chemotherapy px
|
$532.35 |
$532.35 |
$532.35 |
$153.85
|
|
Unlisted CT procedure
|
$3,196.05 |
$3,196.05 |
$3,196.05 |
$1,043.00
|
|
Unlisted fluoroscopic px
|
$267.80 |
$267.80 |
$267.80 |
$324.85
|
|
Unlisted mr procedure
|
$373.10 |
$373.10 |
$373.10 |
$1,032.20
|
|
Unlisted procedure colon
|
$1,236.95 |
$1,236.95 |
$1,236.95 |
$1,580.44
|
|
Unlisted procedure microbiology
|
$487.50 |
$487.50 |
$487.50 |
$487.50
|
|
Unlisted procedure pancreas
|
$3,772.60 |
$3,772.60 |
$3,772.60 |
$2,967.75
|
|
Unlisted procedure spine
|
$9,750.65 |
$9,750.65 |
$9,750.65 |
$4,706.35
|
|
Unlisted px biliary tract
|
$3,772.60 |
$3,772.60 |
$3,772.60 |
$2,718.10
|
|
Unlisted px male genital sys
|
$967.85 |
$967.85 |
$967.85 |
$897.95
|
|
Unlisted px pelvis/hip joint
|
$3,505.45 |
$3,505.45 |
$3,505.45 |
$2,108.82
|
|
Unlisted px small intestine
|
$1,236.95 |
$1,236.95 |
$1,236.95 |
$2,118.35
|
|
Unlisted reprod med lab proc
|
$155.35 |
$155.35 |
$155.35 |
$70.00
|
|
Unlisted ultrasound procedure
|
$354.90 |
$354.90 |
$354.90 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$3,965.00 |
$3,965.00 |
$3,965.00 |
$1,480.70
|
|
Upgrade pm system
|
$12,077.00 |
$12,077.00 |
$12,077.00 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,935.70 |
$1,935.70 |
$1,935.70 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,550.90 |
$1,550.90 |
$1,550.90 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,286.35 |
$1,286.35 |
$1,286.35 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$2,598.70 |
$2,598.70 |
$2,598.70 |
$1,588.59
|
|
Upper Endoscopy (EGD, with biopsy)
|
$2,738.45 |
$2,738.45 |
$2,738.45 |
$1,656.60
|
|
Uppr gi scope w/submuc inj
|
$1,314.95 |
$1,314.95 |
$1,314.95 |
$1,773.85
|
|
Urea nitrogen
|
$5.85 |
$5.85 |
$5.85 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$46.15 |
$46.15 |
$46.15 |
$50.00
|
|
Urea nitrogen clearance
|
$31.85 |
$31.85 |
$31.85 |
$33.57
|
|
Ureteral embolization/occl
|
$2,181.40 |
$2,181.40 |
$2,181.40 |
$3,041.22
|
|
Ureteral reflux study
|
$2,340.00 |
$2,340.00 |
$2,340.00 |
$961.20
|
|
Urethrcystgrphy rtrgrde s&i
|
$614.25 |
$614.25 |
$614.25 |
$574.40
|
|
Urethrocystography void s&i
|
$661.05 |
$661.05 |
$661.05 |
$634.50
|
|
Uric acid blood
|
$11.05 |
$11.05 |
$11.05 |
$46.64
|
|
Uric acid urine
|
$94.90 |
$94.90 |
$94.90 |
$46.75
|
|
Urinalysis microscopic only
|
$59.80 |
$59.80 |
$59.80 |
$26.35
|
|
Urinalysis (with microscopy)
|
$7.80 |
$7.80 |
$7.80 |
$48.14
|
|
Urinalysis (without microscopy)
|
$40.30 |
$40.30 |
$40.30 |
$38.99
|
|
Urine Culture Test
|
$135.85 |
$135.85 |
$135.85 |
$84.81
|
|
Urine pregnancy test
|
$83.20 |
$83.20 |
$83.20 |
$66.40
|
|
Urography, antegrade
|
$510.25 |
$510.25 |
$510.25 |
$593.37
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$52.58 |
$52.58 |
$52.58 |
$4,495.91
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$0.01 |
$0.01 |
$0.01 |
$50,368.90
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$60.68 |
$60.68 |
$60.68 |
$45.33
|
|
Vaccine hepatitis a (hepa) adult im
|
$244.26 |
$244.26 |
$244.26 |
$178.07
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$101.38 |
$101.38 |
$101.38 |
$84.38
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$105.73 |
$105.73 |
$105.73 |
$173.98
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$109.69 |
$109.69 |
$109.69 |
$79.04
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$494.83 |
$494.83 |
$494.83 |
$686.67
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$303.88 |
$303.88 |
$303.88 |
$157.41
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$89.80 |
$89.80 |
$89.80 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$79.28 |
$79.28 |
$79.28 |
$40.01
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$700.73 |
$700.73 |
$700.73 |
$499.00
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$408.94 |
$408.94 |
$408.94 |
$349.15
|
|
Vaccine mmr live subcutaneous
|
$302.16 |
$302.16 |
$302.16 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$394.41 |
$394.41 |
$394.41 |
$274.95
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$812.27 |
$812.27 |
$812.27 |
$715.41
|
|
Vaccine rabies im
|
$1,036.49 |
$1,036.49 |
$1,036.49 |
$945.46
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$844.45 |
$844.45 |
$844.45 |
$624.00
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$1,449.07 |
$1,449.07 |
$1,449.07 |
$1,196.00
|
|
Vaccine tdap >=7 years im
|
$148.06 |
$148.06 |
$148.06 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$144.53 |
$144.53 |
$144.53 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$563.48 |
$563.48 |
$563.48 |
$447.80
|
