|
Tte w or without fol w/cont, com
|
$876.61 |
$876.61 |
$876.61 |
$1,220.31
|
|
Tte w or without fol w/cont, f/u
|
$651.08 |
$651.08 |
$651.08 |
$1,077.92
|
|
Tube trach disp innr can 5 xlt
|
$369.16 |
$369.16 |
$369.16 |
$445.99
|
|
Tube trach fen sz 6 uncuffed
|
$86.51 |
$86.51 |
$86.51 |
$155.98
|
|
Tx atrial fib pulm vein isol
|
$17,966.64 |
$17,966.64 |
$17,966.64 |
$29,030.54
|
|
Tx l/r atrial fib addl
|
$4,851.00 |
$4,851.00 |
$4,851.00 |
$6,769.00
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$1,410.55 |
$1,410.55 |
$1,410.55 |
$4,468.55
|
|
Ua w/micro/comp poc
|
$15.97 |
$15.97 |
$15.97 |
$23.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$59,860.38 |
$59,860.38 |
$59,860.38 |
$20,945.01
|
|
Ultrasound abdomen aorta screening study aaa
|
$333.56 |
$333.56 |
$333.56 |
$394.20
|
|
Ultrasound chest
|
$374.72 |
$374.72 |
$374.72 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$236.29 |
$236.29 |
$236.29 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$388.53 |
$388.53 |
$388.53 |
$296.80
|
|
Ultrasound elastography ea l target les
|
$164.26 |
$164.26 |
$164.26 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$164.26 |
$164.26 |
$164.26 |
$307.00
|
|
Ultrasound encephalogram
|
$319.66 |
$319.66 |
$319.66 |
$488.80
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$354.79 |
$354.79 |
$354.79 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$319.66 |
$319.66 |
$319.66 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$534.21 |
$534.21 |
$534.21 |
$720.15
|
|
Ultrasound guide intraoperative
|
$415.48 |
$415.48 |
$415.48 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$314.36 |
$314.36 |
$314.36 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$312.66 |
$312.66 |
$312.66 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$278.79 |
$278.79 |
$278.79 |
$311.25
|
|
Ultrasound ob >=14wks ea addl gest
|
$430.58 |
$430.58 |
$430.58 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$272.96 |
$272.96 |
$272.96 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$657.92 |
$657.92 |
$657.92 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$286.43 |
$286.43 |
$286.43 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$296.20 |
$296.20 |
$296.20 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$390.59 |
$390.59 |
$390.59 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$395.03 |
$395.03 |
$395.03 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$367.34 |
$367.34 |
$367.34 |
$486.50
|
|
Ultrasound scrotum and contents
|
$435.59 |
$435.59 |
$435.59 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$367.75 |
$367.75 |
$367.75 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$315.80 |
$315.80 |
$315.80 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$444.90 |
$444.90 |
$444.90 |
$558.35
|
|
Umbilical artery cath newborn 36660
|
$165.51 |
$165.51 |
$165.51 |
$206.64
|
|
Umbilical cord occlud w/us
|
$233.17 |
$233.17 |
$233.17 |
$754.00
|
|
Unlisted cytogenetic study
|
$117.82 |
$117.82 |
$117.82 |
$160.18
|
|
Unlisted fluoroscopic px
|
$476.11 |
$476.11 |
$476.11 |
$305.76
|
|
Unlisted hematology&coagj px
|
$42.80 |
$42.80 |
$42.80 |
$39.52
|
|
Unlisted mr procedure
|
$1,495.90 |
$1,495.90 |
$1,495.90 |
$1,163.00
|
|
Unlisted procedure esophagus
|
$738.47 |
$738.47 |
$738.47 |
$1,998.88
|
|
Unlisted procedure liver
|
$1,034.58 |
$1,034.58 |
$1,034.58 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$1,366.39 |
$1,366.39 |
$1,366.39 |
$523.50
|
|
Unlisted procedure rectum
|
$421.48 |
$421.48 |
$421.48 |
$1,220.35
|
|
Unlisted px hands/fingers
|
$183.13 |
$183.13 |
$183.13 |
$354.20
|
|
Unlisted px male genital sys
|
$229.81 |
$229.81 |
$229.81 |
$343.55
|
|
Unlisted px med radj physics
|
$627.74 |
$627.74 |
$627.74 |
$462.35
|
|
Unlisted px tongue flr mouth
|
$191.59 |
$191.59 |
$191.59 |
$282.50
|
|
Unlisted special svc px/rprt
|
$34.09 |
$34.09 |
$34.09 |
$90.00
|
|
Unlisted transfusion med px
|
$152.22 |
$152.22 |
$152.22 |
$147.50
|
|
Unsched dialysis esrd pt hos
|
$973.37 |
$973.37 |
$973.37 |
$1,268.17
|
|
Upgrade pm system
|
$4,806.26 |
$4,806.26 |
$4,806.26 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,216.49 |
$3,216.49 |
$3,216.49 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,122.89 |
$2,122.89 |
$2,122.89 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,090.72 |
$2,090.72 |
$2,090.72 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$619.13 |
$619.13 |
$619.13 |
$1,751.66
|
|
Urea nitrogen
|
$17.13 |
$17.13 |
$17.13 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$29.52 |
$29.52 |
$29.52 |
$51.75
|
|
Urea nitrogen clearance
|
$26.67 |
$26.67 |
$26.67 |
$42.25
|
|
Ureteral embolization/occl
|
$1,413.33 |
$1,413.33 |
$1,413.33 |
$2,181.40
|
|
Ureteral reflux study
|
$640.25 |
$640.25 |
$640.25 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$444.19 |
$444.19 |
$444.19 |
$579.73
|
|
Urethrocystography void s&i
|
$577.45 |
$577.45 |
$577.45 |
$622.35
|
|
Uric acid blood
|
$17.56 |
$17.56 |
$17.56 |
$48.75
|
|
Uric acid urine
|
$31.00 |
$31.00 |
$31.00 |
$44.33
|
|
Urinalysis microscopic only
|
$18.85 |
$18.85 |
$18.85 |
$26.35
|
|
Urinalysis (with microscopy)
|
$30.58 |
$30.58 |
$30.58 |
$55.00
|
|
Urinalysis (without microscopy)
|
$27.06 |
$27.06 |
$27.06 |
$35.75
|
|
Urinary bldr retent nuc study
|
$349.37 |
$349.37 |
$349.37 |
$350.66
|
|
Urine Culture Test
|
$60.22 |
$60.22 |
$60.22 |
$81.50
|
|
Urine pregnancy test
|
$51.48 |
$51.48 |
$51.48 |
$67.20
|
|
Urography, antegrade
|
$425.31 |
$425.31 |
$425.31 |
$622.35
|
|
Use 1st target lesion
|
$164.26 |
$164.26 |
$164.26 |
$332.00
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$11,502.14 |
$11,502.14 |
$11,502.14 |
$5,184.34
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$177.17 |
$177.17 |
$177.17 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$113.69 |
$113.69 |
$113.69 |
$123.20
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$84.91 |
$84.91 |
$84.91 |
$80.15
|
|
Vaccine dtap < 7 years im
|
$39.75 |
$39.75 |
$39.75 |
$68.19
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$90.48 |
$90.48 |
$90.48 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$63.20 |
$63.20 |
$63.20 |
$166.62
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$163.52 |
$163.52 |
$163.52 |
$155.16
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$81.76 |
$81.76 |
$81.76 |
$75.39
|
|
Vaccine influenza inactivated adjuvant im
|
$82.89 |
$82.89 |
$82.89 |
$109.50
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$15.27 |
$15.27 |
$15.27 |
$47.88
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$247.63 |
$247.63 |
$247.63 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$156.65 |
$156.65 |
$156.65 |
$211.68
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$200.41 |
$200.41 |
$200.41 |
$251.64
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$474.22 |
$474.22 |
$474.22 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$72.34 |
$72.34 |
$72.34 |
$90.70
|
|
Vaccine rabies im
|
$642.03 |
$642.03 |
$642.03 |
$858.95
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$747.00 |
$747.00 |
$747.00 |
$1,104.47
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$747.00 |
$747.00 |
$747.00 |
$997.44
|
|
Vaccine tdap >=7 years im
|
$80.01 |
$80.01 |
$80.01 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$50.69 |
$50.69 |
$50.69 |
$112.10
|
|
Vaccine varicella live subcutaneous
|
$180.81 |
$180.81 |
$180.81 |
$365.17
|
|
Vacuum drain bottle/tube kit
|
$541.90 |
$541.90 |
$541.90 |
$325.20
|
|
Valproic acid total therapeutic drug level
|
$66.26 |
$66.26 |
$66.26 |
$114.72
|
|
Valrubicin injection
|
$1,974.13 |
$1,974.13 |
$1,974.13 |
$2,813.49
|
|
Valvuloplasty aortic
|
$3,946.62 |
$3,946.62 |
$3,946.62 |
$7,830.80
|
