|
Ua w/micro/comp poc
|
$16.90 |
$16.90 |
$16.90 |
$25.72
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$43,258.60 |
$43,258.60 |
$43,258.60 |
$71.90
|
|
Ugt1a1 gene analy common variants
|
$1,281.15 |
$1,281.15 |
$1,281.15 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$317.20 |
$317.20 |
$317.20 |
$394.20
|
|
Ultrasound breast complete
|
$533.00 |
$533.00 |
$533.00 |
$519.20
|
|
Ultrasound breast unilateral limited (both sides)
|
$452.40 |
$452.40 |
$452.40 |
$427.00
|
|
Ultrasound chest
|
$598.00 |
$598.00 |
$598.00 |
$430.10
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$1,047.15 |
$1,047.15 |
$1,047.15 |
$340.03
|
|
Ultrasound elastography parenchyma
|
$302.25 |
$302.25 |
$302.25 |
$275.98
|
|
Ultrasound encephalogram
|
$715.65 |
$715.65 |
$715.65 |
$463.50
|
|
Ultrasound exam k transpl w/doppler
|
$584.35 |
$584.35 |
$584.35 |
$494.00
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$572.00 |
$572.00 |
$572.00 |
$428.68
|
|
Ultrasound guidance for vascular access
|
$364.65 |
$364.65 |
$364.65 |
$300.00
|
|
Ultrasound guided needle placement supervision & interpretation
|
$787.80 |
$787.80 |
$787.80 |
$629.64
|
|
Ultrasound guide intraoperative
|
$602.55 |
$602.55 |
$602.55 |
$628.80
|
|
Ultrasound guide tissue ablation
|
$884.65 |
$884.65 |
$884.65 |
$463.50
|
|
Ultrasound joint complete left
|
$533.65 |
$533.65 |
$533.65 |
$534.00
|
|
Ultrasound joint/nonvascular extremity limited left
|
$564.20 |
$564.20 |
$564.20 |
$426.60
|
|
Ultrasound ob >=14wks ea addl gest
|
$674.70 |
$674.70 |
$674.70 |
$431.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$435.50 |
$435.50 |
$435.50 |
$304.80
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$714.35 |
$714.35 |
$714.35 |
$680.71
|
|
Ultrasound pregnant uterus follow up per fetus
|
$587.60 |
$587.60 |
$587.60 |
$393.32
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$668.20 |
$668.20 |
$668.20 |
$434.20
|
|
Ultrasound pregnant uterus transvaginal
|
$697.45 |
$697.45 |
$697.45 |
$477.10
|
|
Ultrasound prostate/transrectal
|
$527.15 |
$527.15 |
$527.15 |
$515.63
|
|
Ultrasound retroperitoneal limited
|
$482.30 |
$482.30 |
$482.30 |
$469.58
|
|
Ultrasound scrotum and contents
|
$954.85 |
$954.85 |
$954.85 |
$558.03
|
|
Ultrasound spinal canal and contents
|
$305.50 |
$305.50 |
$305.50 |
$415.00
|
|
Ultrasound transabd ea addl gest
|
$588.90 |
$588.90 |
$588.90 |
$424.80
|
|
Ultrasound transvaginal non obstetric
|
$879.45 |
$879.45 |
$879.45 |
$523.20
|
|
Unlisted CT procedure
|
$584.35 |
$584.35 |
$584.35 |
$1,268.98
|
|
Unlisted fluoroscopic px
|
$646.75 |
$646.75 |
$646.75 |
$256.00
|
|
Unlisted laparoscopic liver biopy 47379
|
$9,730.74 |
$9,730.74 |
$9,730.74 |
$6,307.38
|
|
Unlisted laparoscopic procedure 49659
|
$9,127.89 |
$9,127.89 |
$9,127.89 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$18,011.75 |
$18,011.75 |
$18,011.75 |
$4,981.62
|
|
Unlisted laps px appendix
|
$19,765.43 |
$19,765.43 |
$19,765.43 |
$3,617.40
|
|
Unlisted laps px bladder
|
$18,322.82 |
$18,322.82 |
$18,322.82 |
$5,082.74
|
|
Unlisted laps px esoph
|
$13,649.50 |
$13,649.50 |
$13,649.50 |
$6,429.80
|
|
Unlisted laps px lymphtc sys
|
$14,970.51 |
$14,970.51 |
$14,970.51 |
$10,488.59
|
|
Unlisted laps px ovidct ovry
|
$16,649.41 |
$16,649.41 |
$16,649.41 |
$4,713.11
|
|
Unlisted laps px testis
|
$13,219.57 |
$13,219.57 |
$13,219.57 |
$6,457.82
|
|
Unlisted laps px ureter
|
$22,458.34 |
$22,458.34 |
$22,458.34 |
$6,376.26
|
|
Unlisted laps px uterus
|
$18,428.66 |
$18,428.66 |
$18,428.66 |
$6,457.82
|
|
Unlisted neurological dx px
|
$174.85 |
$174.85 |
$174.85 |
$176.93
|
|
Unlisted procedure liver
|
$4,293.90 |
$4,293.90 |
$4,293.90 |
$2,802.00
|
|
Unlisted procedure microbiology
|
$1,210.95 |
$1,210.95 |
$1,210.95 |
$384.15
|
|
Unlisted procedure pancreas
|
$4,932.47 |
$4,932.47 |
$4,932.47 |
$4,810.00
|
|
Unlisted procedure rectum
|
$13,066.03 |
$13,066.03 |
$13,066.03 |
$1,395.50
|
|
Unlisted px accessory sinus
|
$17,937.38 |
$17,937.38 |
$17,937.38 |
$257.04
|
|
Unlisted px arthroscopy
|
$17,922.90 |
$17,922.90 |
$17,922.90 |
$11,433.76
|
|
Unlisted px biliary tract
|
$9,105.15 |
$9,105.15 |
$9,105.15 |
$3,598.64
|
|
Unlisted px male genital sys
|
$11,957.11 |
$11,957.11 |
$11,957.11 |
$1,925.04
|
|
Unlisted px small intestine
|
$3,857.33 |
$3,857.33 |
$3,857.33 |
$2,493.00
|
|
Unlisted transfusion med px
|
$156.00 |
$156.00 |
$156.00 |
$113.36
|
|
Unlisted ultrasound procedure
|
$253.50 |
$253.50 |
$253.50 |
$335.00
|
|
Unsched dialysis esrd pt hos
|
$1,329.90 |
$1,329.90 |
$1,329.90 |
$980.20
|
|
Upgrade pm system
|
$26,338.65 |
$26,338.65 |
$26,338.65 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,027.05 |
$3,027.05 |
$3,027.05 |
$2,590.50
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,176.85 |
$2,176.85 |
$2,176.85 |
$2,001.87
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,037.75 |
$2,037.75 |
$2,037.75 |
$1,794.00
|
|
Upper Endoscopy (EGD, diagnostic)
|
$2,637.15 |
$2,637.15 |
$2,637.15 |
$1,760.00
|
|
Upper Endoscopy (EGD, with biopsy)
|
$3,662.96 |
$3,662.96 |
$3,662.96 |
$1,760.00
|
|
Uppr gi scope w/submuc inj
|
$4,112.87 |
$4,112.87 |
$4,112.87 |
$1,247.13
|
|
Urea nitrogen
|
$48.75 |
$48.75 |
$48.75 |
$38.25
|
|
Urea nitrogen 24 hour urine
|
$69.55 |
$69.55 |
$69.55 |
$42.90
|
|
Ureteral reflux study
|
$1,175.85 |
$1,175.85 |
$1,175.85 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$656.50 |
$656.50 |
$656.50 |
$554.28
|
|
Urethrocystography void s&i
|
$622.05 |
$622.05 |
$622.05 |
$586.50
|
|
Uric acid blood
|
$16.25 |
$16.25 |
$16.25 |
$44.00
|
|
Uric acid urine
|
$59.15 |
$59.15 |
$59.15 |
$43.20
|
|
Urinalysis microscopic only
|
$8.45 |
$8.45 |
$8.45 |
$25.72
|
|
Urinalysis (with microscopy)
|
$11.05 |
$11.05 |
$11.05 |
$37.39
|
|
Urinalysis (without microscopy)
|
$92.30 |
$92.30 |
$92.30 |
$33.00
|
|
Urine Culture Test
|
$28.60 |
$28.60 |
$28.60 |
$63.84
|
|
Urine pregnancy test
|
$205.40 |
$205.40 |
$205.40 |
$57.00
|
|
Urography, antegrade
|
$702.65 |
$702.65 |
$702.65 |
$593.37
|
|
Use 1st target lesion
|
$252.85 |
$252.85 |
$252.85 |
$252.00
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$16,296.36 |
$16,296.36 |
$16,296.36 |
$8,225.22
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$111,850.54 |
$111,850.54 |
$111,850.54 |
$89,537.92
|
|
Vaccine dtap < 7 years im
|
$124.39 |
$124.39 |
$124.39 |
$66.69
|
|
Vaccine dtap-hep b-ipv im
|
$470.09 |
$470.09 |
$470.09 |
$169.85
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$57.57 |
$57.57 |
$57.57 |
$39.78
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$388.53 |
$388.53 |
$388.53 |
$84.38
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$312.62 |
$312.62 |
$312.62 |
$162.07
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$722.21 |
$722.21 |
$722.21 |
$310.70
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$124.74 |
$124.74 |
$124.74 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$1,436.32 |
$1,436.32 |
$1,436.32 |
$521.70
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$373.94 |
$373.94 |
$373.94 |
$130.67
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$86.35 |
$86.35 |
$86.35 |
$47.38
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$1,096.08 |
$1,096.08 |
$1,096.08 |
$400.03
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$771.49 |
$771.49 |
$771.49 |
$156.00
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$769.73 |
$769.73 |
$769.73 |
$321.80
|
|
Vaccine mmr live subcutaneous
|
$418.82 |
$418.82 |
$418.82 |
$222.36
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$512.17 |
$512.17 |
$512.17 |
$195.69
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$1,346.83 |
$1,346.83 |
$1,346.83 |
$579.50
|
|
Vaccine polio (ipv) subcutaneous/im
|
$205.87 |
$205.87 |
$205.87 |
$100.00
|
|
Vaccine rabies im
|
$1,527.99 |
$1,527.99 |
$1,527.99 |
$800.00
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$2,603.09 |
$2,603.09 |
$2,603.09 |
$1,159.00
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$2,603.09 |
$2,603.09 |
$2,603.09 |
$997.44
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$446.17 |
$446.17 |
$446.17 |
$108.00
|