|
Tx tarsal bone fx without manip 28450
|
$218.40 |
$218.40 |
$218.40 |
$416.16
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$178,648.86 |
$178,648.86 |
$178,648.86 |
$20,945.01
|
|
Ugt1a1 gene analy common variants
|
$701.40 |
$701.40 |
$701.40 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$486.00 |
$486.00 |
$486.00 |
$394.20
|
|
Ultrasound bone density measure
|
$600.60 |
$600.60 |
$600.60 |
$143.75
|
|
Ultrasound breast complete
|
$128.40 |
$128.40 |
$128.40 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$1,234.80 |
$1,234.80 |
$1,234.80 |
$449.35
|
|
Ultrasound chest
|
$1,320.60 |
$1,320.60 |
$1,320.60 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$1,646.40 |
$1,646.40 |
$1,646.40 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$185.40 |
$185.40 |
$185.40 |
$296.80
|
|
Ultrasound elastography ea l target les
|
$700.80 |
$700.80 |
$700.80 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$921.60 |
$921.60 |
$921.60 |
$307.00
|
|
Ultrasound encephalogram
|
$880.80 |
$880.80 |
$880.80 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$1,125.60 |
$1,125.60 |
$1,125.60 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$214.20 |
$214.20 |
$214.20 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$1,345.80 |
$1,345.80 |
$1,345.80 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$2,637.60 |
$2,637.60 |
$2,637.60 |
$720.15
|
|
Ultrasound guide intraoperative
|
$600.60 |
$600.60 |
$600.60 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$385.80 |
$385.80 |
$385.80 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$909.00 |
$909.00 |
$909.00 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$196.20 |
$196.20 |
$196.20 |
$311.25
|
|
Ultrasound joint complete left
|
$745.80 |
$745.80 |
$745.80 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$1,081.20 |
$1,081.20 |
$1,081.20 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$168.00 |
$168.00 |
$168.00 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$73.20 |
$73.20 |
$73.20 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$267.60 |
$267.60 |
$267.60 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$129.60 |
$129.60 |
$129.60 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$577.80 |
$577.80 |
$577.80 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$577.80 |
$577.80 |
$577.80 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$1,129.20 |
$1,129.20 |
$1,129.20 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$1,724.40 |
$1,724.40 |
$1,724.40 |
$486.50
|
|
Ultrasound scrotum and contents
|
$921.60 |
$921.60 |
$921.60 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$2,118.00 |
$2,118.00 |
$2,118.00 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$168.00 |
$168.00 |
$168.00 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$1,409.40 |
$1,409.40 |
$1,409.40 |
$558.35
|
|
Umbilicoplasty 15847
|
$179,123.72 |
$179,123.72 |
$179,123.72 |
$4,172.97
|
|
Unlisted chemotherapy px
|
$389.40 |
$389.40 |
$389.40 |
$150.00
|
|
Unlisted dx gi procedure
|
$1,137.60 |
$1,137.60 |
$1,137.60 |
$649.22
|
|
Unlisted laparoscopic liver biopy 47379
|
$86,953.75 |
$86,953.75 |
$86,953.75 |
$5,419.00
|
|
Unlisted laps px ureter
|
$94,711.65 |
$94,711.65 |
$94,711.65 |
$6,212.70
|
|
Unlisted misc path test
|
$44.40 |
$44.40 |
$44.40 |
$89.40
|
|
Unlisted procedure eyelids
|
$45,693.06 |
$45,693.06 |
$45,693.06 |
$833.00
|
|
Unlisted procedure microbiology
|
$206.40 |
$206.40 |
$206.40 |
$523.50
|
|
Unlisted procedure pancreas
|
$8,642.22 |
$8,642.22 |
$8,642.22 |
$3,986.00
|
|
Unlisted procedure spine
|
$1,179.60 |
$1,179.60 |
$1,179.60 |
$4,659.85
|
|
Unlisted px abdomen muscskel
|
$26,924.51 |
$26,924.51 |
$26,924.51 |
$1,848.60
|
|
Unlisted px arthroscopy
|
$54,839.54 |
$54,839.54 |
$54,839.54 |
$2,765.60
|
|
Unlisted px foot/toes
|
$35,639.63 |
$35,639.63 |
$35,639.63 |
$1,225.50
|
|
Unlisted px hands/fingers
|
$378.00 |
$378.00 |
$378.00 |
$354.20
|
|
Unlisted px middle ear
|
$20,433.00 |
$20,433.00 |
$20,433.00 |
$343.50
|
|
Unlisted px neck/thorax
|
$1,050.60 |
$1,050.60 |
$1,050.60 |
$571.20
|
|
Unlisted px pelvis/hip joint
|
$49,651.84 |
$49,651.84 |
$49,651.84 |
$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 reprod med lab proc
|
$150.60 |
$150.60 |
$150.60 |
$70.00
|
|
Unlisted surgical path px
|
$278.40 |
$278.40 |
$278.40 |
$217.75
|
|
Unlisted ultrasound procedure
|
$781.20 |
$781.20 |
$781.20 |
$321.20
|
|
Unlstd laps px sprmatic cord
|
$67,198.09 |
$67,198.09 |
$67,198.09 |
$4,713.11
|
|
Unsched dialysis esrd pt hos
|
$1,596.00 |
$1,596.00 |
$1,596.00 |
$1,268.17
|
|
Upgrade pm system
|
$7,371.60 |
$7,371.60 |
$7,371.60 |
$12,077.00
|
|
Upper Endoscopy (EGD, diagnostic)
|
$11,026.03 |
$11,026.03 |
$11,026.03 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$18,944.00 |
$18,944.00 |
$18,944.00 |
$1,768.00
|
|
Uppr gi scope w/submuc inj
|
$29,974.05 |
$29,974.05 |
$29,974.05 |
$1,872.00
|
|
Urea nitrogen
|
$121.20 |
$121.20 |
$121.20 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$172.80 |
$172.80 |
$172.80 |
$51.75
|
|
Urea nitrogen clearance
|
$106.20 |
$106.20 |
$106.20 |
$42.25
|
|
Ureteral reflux study
|
$2,562.00 |
$2,562.00 |
$2,562.00 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$1,863.00 |
$1,863.00 |
$1,863.00 |
$579.73
|
|
Urethrocystography void s&i
|
$1,863.00 |
$1,863.00 |
$1,863.00 |
$622.35
|
|
Uric acid blood
|
$128.40 |
$128.40 |
$128.40 |
$48.75
|
|
Uric acid urine
|
$134.40 |
$134.40 |
$134.40 |
$44.33
|
|
Urinalysis microscopic only
|
$81.00 |
$81.00 |
$81.00 |
$26.35
|
|
Urinalysis (with microscopy)
|
$69.60 |
$69.60 |
$69.60 |
$55.00
|
|
Urinalysis (without microscopy)
|
$54.00 |
$54.00 |
$54.00 |
$35.75
|
|
Urinary bldr retent nuc study
|
$2,231.40 |
$2,231.40 |
$2,231.40 |
$350.66
|
|
Urine Culture Test
|
$151.20 |
$151.20 |
$151.20 |
$81.50
|
|
Urine flow measurement 51736
|
$8,826.60 |
$8,826.60 |
$8,826.60 |
$210.00
|
|
Urine pregnancy test
|
$114.60 |
$114.60 |
$114.60 |
$67.20
|
|
Urography, antegrade
|
$819.60 |
$819.60 |
$819.60 |
$622.35
|
|
Use 1st target lesion
|
$700.80 |
$700.80 |
$700.80 |
$332.00
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$68,167.98 |
$68,167.98 |
$68,167.98 |
$5,184.34
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$43,727.22 |
$43,727.22 |
$43,727.22 |
$51,633.07
|
|
Vaccine dtap < 7 years im
|
$75.48 |
$75.48 |
$75.48 |
$68.19
|
|
Vaccine dtap-ipv 4-6 years im
|
$150.78 |
$150.78 |
$150.78 |
$105.95
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$75.54 |
$75.54 |
$75.54 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$34.20 |
$34.20 |
$34.20 |
$43.12
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$173.34 |
$173.34 |
$173.34 |
$84.75
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$0.06 |
$0.06 |
$0.06 |
$75.39
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$182.88 |
$182.88 |
$182.88 |
$76.50
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$604.68 |
$604.68 |
$604.68 |
$400.03
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$425.22 |
$425.22 |
$425.22 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$235.20 |
$235.20 |
$235.20 |
$211.68
|
|
Vaccine mmrv live subcutaneous
|
$694.02 |
$694.02 |
$694.02 |
$424.32
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$722.22 |
$722.22 |
$722.22 |
$563.36
|
|
Vaccine rabies im
|
$1,150.50 |
$1,150.50 |
$1,150.50 |
$858.95
|
|
Vaccine tdap >=7 years im
|
$124.32 |
$124.32 |
$124.32 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$101.40 |
$101.40 |
$101.40 |
$112.10
|
|
Vaccine varicella live subcutaneous
|
$489.90 |
$489.90 |
$489.90 |
$365.17
|
|
Vad univ batt charger hm 1440
|
$18,420.41 |
$18,420.41 |
$18,420.41 |
$14,827.28
|
