|
Trnscath plc vas stent w/s&i ea addl vein
|
$2,719.80 |
$2,719.80 |
$2,719.80 |
$8,790.54
|
|
Trnscath plc vas stent w/s&i ini vein
|
$4,478.40 |
$4,478.40 |
$4,478.40 |
$14,558.70
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$6,156.00 |
$6,156.00 |
$6,156.00 |
$5,139.20
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$2,325.60 |
$2,325.60 |
$2,325.60 |
$4,350.00
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$4,843.20 |
$4,843.20 |
$4,843.20 |
$4,379.34
|
|
Trnscath tx thromblytc vein ini day
|
$5,236.20 |
$5,236.20 |
$5,236.20 |
$3,866.70
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$11,606.40 |
$11,606.40 |
$11,606.40 |
$4,727.52
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$5,275.20 |
$5,275.20 |
$5,275.20 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$4,493.40 |
$4,493.40 |
$4,493.40 |
$2,406.77
|
|
Troponin quantitative
|
$91.20 |
$91.20 |
$91.20 |
$127.20
|
|
Tte w or without fol w/con,stres
|
$968.40 |
$968.40 |
$968.40 |
$1,632.80
|
|
Tte w or without fol w/cont, com
|
$904.80 |
$904.80 |
$904.80 |
$1,254.50
|
|
Tte w or without fol w/cont, f/u
|
$534.60 |
$534.60 |
$534.60 |
$1,178.00
|
|
Tube trach disp innr can 5 xlt
|
$220.80 |
$220.80 |
$220.80 |
$445.99
|
|
Tube trach disp innr can 6 xlt
|
$77.40 |
$77.40 |
$77.40 |
$16.80
|
|
Tubular dressing
|
$4.80 |
$4.80 |
$4.80 |
$28.46
|
|
Tx atrial fib pulm vein isol
|
$19,314.00 |
$19,314.00 |
$19,314.00 |
$29,030.54
|
|
Tx closed hip disl traumatic without anes
|
$825.60 |
$825.60 |
$825.60 |
$586.80
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$3,355.20 |
$3,355.20 |
$3,355.20 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$3,355.20 |
$3,355.20 |
$3,355.20 |
$535.60
|
|
Tx l/r atrial fib addl
|
$5,650.20 |
$5,650.20 |
$5,650.20 |
$6,986.85
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$6,510.60 |
$6,510.60 |
$6,510.60 |
$4,499.12
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$6,348.00 |
$6,348.00 |
$6,348.00 |
$4,529.60
|
|
Tx tarsal bone fx without manip 28450
|
$825.60 |
$825.60 |
$825.60 |
$419.73
|
|
Ua w/micro/comp poc
|
$4.80 |
$4.80 |
$4.80 |
$23.00
|
|
Ugt1a1 gene analy common variants
|
$1,194.60 |
$1,194.60 |
$1,194.60 |
$438.75
|
|
Ultrasound breast complete
|
$546.60 |
$546.60 |
$546.60 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$479.40 |
$479.40 |
$479.40 |
$452.40
|
|
Ultrasound dx ophth b-scan
|
$634.20 |
$634.20 |
$634.20 |
$296.80
|
|
Ultrasound encephalogram
|
$610.20 |
$610.20 |
$610.20 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$718.80 |
$718.80 |
$718.80 |
$575.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$540.00 |
$540.00 |
$540.00 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$1,009.80 |
$1,009.80 |
$1,009.80 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$400.20 |
$400.20 |
$400.20 |
$388.08
|
|
Ultrasound guide intraoperative
|
$628.80 |
$628.80 |
$628.80 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$1,161.00 |
$1,161.00 |
$1,161.00 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$1,000.20 |
$1,000.20 |
$1,000.20 |
$403.88
|
|
Ultrasound joint complete left
|
$847.80 |
$847.80 |
$847.80 |
$557.99
|
|
Ultrasound ob >=14wks ea addl gest
|
$309.00 |
$309.00 |
$309.00 |
$409.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$309.00 |
$309.00 |
$309.00 |
$335.00
|
|
Ultrasound pregnant uterus follow up per fetus
|
$690.60 |
$690.60 |
$690.60 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$695.40 |
$695.40 |
$695.40 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$571.80 |
$571.80 |
$571.80 |
$463.00
|
|
Unlisted CT procedure
|
$624.00 |
$624.00 |
$624.00 |
$732.70
|
|
Unlisted cv px dx nuc med
|
$1,864.20 |
$1,864.20 |
$1,864.20 |
$1,747.20
|
|
Unlisted misc path test
|
$93.00 |
$93.00 |
$93.00 |
$89.40
|
|
Unlisted procedure colon
|
$1,566.60 |
$1,566.60 |
$1,566.60 |
$1,839.55
|
|
Unlisted procedure microbiology
|
$124.80 |
$124.80 |
$124.80 |
$530.00
|
|
Unlisted procedure rectum
|
$3,156.60 |
$3,156.60 |
$3,156.60 |
$1,223.20
|
|
Unlisted px casting/strpg
|
$126.00 |
$126.00 |
$126.00 |
$222.00
|
|
Unlisted px external ear
|
$126.00 |
$126.00 |
$126.00 |
$325.68
|
|
Unlisted px leg/ankle
|
$114.60 |
$114.60 |
$114.60 |
$882.30
|
|
Unlisted px posterior segmnt
|
$3,997.80 |
$3,997.80 |
$3,997.80 |
$3,173.34
|
|
Unsched dialysis esrd pt hos
|
$1,665.00 |
$1,665.00 |
$1,665.00 |
$1,296.00
|
|
Upgrade pm system
|
$5,231.40 |
$5,231.40 |
$5,231.40 |
$12,077.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$567.00 |
$567.00 |
$567.00 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$2,555.40 |
$2,555.40 |
$2,555.40 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$2,074.20 |
$2,074.20 |
$2,074.20 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,010.40 |
$4,010.40 |
$4,010.40 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,051.00 |
$3,051.00 |
$3,051.00 |
$2,392.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,514.00 |
$2,514.00 |
$2,514.00 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$642.00 |
$642.00 |
$642.00 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$551.40 |
$551.40 |
$551.40 |
$381.60
|
|
Upper Endoscopy (EGD, diagnostic)
|
$3,526.20 |
$3,526.20 |
$3,526.20 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$3,526.20 |
$3,526.20 |
$3,526.20 |
$1,768.00
|
|
Upper GI Barium X-ray (barium and gas)
|
$580.20 |
$580.20 |
$580.20 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$580.20 |
$580.20 |
$580.20 |
$607.20
|
|
Uppr gi scope w/submuc inj
|
$3,526.20 |
$3,526.20 |
$3,526.20 |
$1,872.00
|
|
Urea nitrogen
|
$39.60 |
$39.60 |
$39.60 |
$42.01
|
|
Urea nitrogen 24 hour urine
|
$63.00 |
$63.00 |
$63.00 |
$51.84
|
|
Urethrcystgrphy rtrgrde s&i
|
$642.60 |
$642.60 |
$642.60 |
$584.00
|
|
Uric acid blood
|
$48.60 |
$48.60 |
$48.60 |
$49.32
|
|
Uric acid urine
|
$52.20 |
$52.20 |
$52.20 |
$44.52
|
|
Urinalysis (with microscopy)
|
$102.60 |
$102.60 |
$102.60 |
$55.20
|
|
Urinalysis (without microscopy)
|
$37.80 |
$37.80 |
$37.80 |
$35.91
|
|
Urinary suspensory
|
$21.00 |
$21.00 |
$21.00 |
$52.20
|
|
Urine Culture Test
|
$218.40 |
$218.40 |
$218.40 |
$82.32
|
|
Urine pregnancy test
|
$93.00 |
$93.00 |
$93.00 |
$68.21
|
|
Urography, antegrade
|
$1,132.80 |
$1,132.80 |
$1,132.80 |
$622.35
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$76.00 |
$76.00 |
$76.00 |
$5,205.00
|
|
Vaccine Administration (one shot)
|
$12.00 |
$12.00 |
$12.00 |
$67.74
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$340.00 |
$340.00 |
$340.00 |
$224.25
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$199.20 |
$199.20 |
$199.20 |
$209.40
|
|
Vaccine dtap < 7 years im
|
$32.40 |
$32.40 |
$32.40 |
$71.17
|
|
Vaccine dtap-hep b-ipv im
|
$37.80 |
$37.80 |
$37.80 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$36.60 |
$36.60 |
$36.60 |
$105.95
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$31.20 |
$31.20 |
$31.20 |
$70.53
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$31.20 |
$31.20 |
$31.20 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$108.00 |
$108.00 |
$108.00 |
$166.62
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$39.60 |
$39.60 |
$39.60 |
$78.25
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$86.40 |
$86.40 |
$86.40 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$168.80 |
$168.80 |
$168.80 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$63.20 |
$63.20 |
$63.20 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$186.00 |
$186.00 |
$186.00 |
$576.48
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$186.00 |
$186.00 |
$186.00 |
$282.50
|
|
Vaccine influenza nos 0.5ml dose im
|
$12.00 |
$12.00 |
$12.00 |
$24.20
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$13.20 |
$13.20 |
$13.20 |
$35.88
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$12.00 |
$12.00 |
$12.00 |
$33.60
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$24.00 |
$24.00 |
$24.00 |
$82.71
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$109.60 |
$109.60 |
$109.60 |
$394.26
|
