|
Tte w or without fol w/cont, com
|
$873.15 |
$873.15 |
$873.15 |
$1,220.31
|
|
Tte w or without fol w/cont, f/u
|
$648.50 |
$648.50 |
$648.50 |
$1,077.92
|
|
Tube trach disp innr can 5 xlt
|
$367.71 |
$367.71 |
$367.71 |
$445.99
|
|
Tube trach fen sz 6 uncuffed
|
$86.17 |
$86.17 |
$86.17 |
$155.98
|
|
Tx atrial fib pulm vein isol
|
$17,895.63 |
$17,895.63 |
$17,895.63 |
$29,030.54
|
|
Tx l/r atrial fib addl
|
$4,831.82 |
$4,831.82 |
$4,831.82 |
$6,769.00
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$1,404.97 |
$1,404.97 |
$1,404.97 |
$4,468.55
|
|
Ua w/micro/comp poc
|
$15.91 |
$15.91 |
$15.91 |
$23.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$59,623.79 |
$59,623.79 |
$59,623.79 |
$20,945.01
|
|
Ultrasound abdomen aorta screening study aaa
|
$332.24 |
$332.24 |
$332.24 |
$394.20
|
|
Ultrasound chest
|
$373.24 |
$373.24 |
$373.24 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$235.36 |
$235.36 |
$235.36 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$386.99 |
$386.99 |
$386.99 |
$296.80
|
|
Ultrasound elastography ea l target les
|
$163.61 |
$163.61 |
$163.61 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$163.61 |
$163.61 |
$163.61 |
$307.00
|
|
Ultrasound encephalogram
|
$318.40 |
$318.40 |
$318.40 |
$488.80
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$353.39 |
$353.39 |
$353.39 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$318.40 |
$318.40 |
$318.40 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$532.10 |
$532.10 |
$532.10 |
$720.15
|
|
Ultrasound guide intraoperative
|
$413.84 |
$413.84 |
$413.84 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$313.12 |
$313.12 |
$313.12 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$311.42 |
$311.42 |
$311.42 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$277.69 |
$277.69 |
$277.69 |
$311.25
|
|
Ultrasound ob >=14wks ea addl gest
|
$428.88 |
$428.88 |
$428.88 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$271.88 |
$271.88 |
$271.88 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$655.32 |
$655.32 |
$655.32 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$285.30 |
$285.30 |
$285.30 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$295.03 |
$295.03 |
$295.03 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$389.04 |
$389.04 |
$389.04 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$393.47 |
$393.47 |
$393.47 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$365.89 |
$365.89 |
$365.89 |
$486.50
|
|
Ultrasound scrotum and contents
|
$433.87 |
$433.87 |
$433.87 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$366.29 |
$366.29 |
$366.29 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$314.56 |
$314.56 |
$314.56 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$443.15 |
$443.15 |
$443.15 |
$558.35
|
|
Umbilical artery cath newborn 36660
|
$164.86 |
$164.86 |
$164.86 |
$206.64
|
|
Umbilical cord occlud w/us
|
$232.24 |
$232.24 |
$232.24 |
$754.00
|
|
Unlisted cytogenetic study
|
$117.35 |
$117.35 |
$117.35 |
$160.18
|
|
Unlisted fluoroscopic px
|
$474.23 |
$474.23 |
$474.23 |
$305.76
|
|
Unlisted hematology&coagj px
|
$42.63 |
$42.63 |
$42.63 |
$39.52
|
|
Unlisted mr procedure
|
$1,489.99 |
$1,489.99 |
$1,489.99 |
$1,163.00
|
|
Unlisted procedure esophagus
|
$735.55 |
$735.55 |
$735.55 |
$1,998.88
|
|
Unlisted procedure liver
|
$1,030.49 |
$1,030.49 |
$1,030.49 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$1,360.99 |
$1,360.99 |
$1,360.99 |
$523.50
|
|
Unlisted procedure rectum
|
$419.81 |
$419.81 |
$419.81 |
$1,220.35
|
|
Unlisted px hands/fingers
|
$182.40 |
$182.40 |
$182.40 |
$354.20
|
|
Unlisted px male genital sys
|
$228.90 |
$228.90 |
$228.90 |
$343.55
|
|
Unlisted px med radj physics
|
$625.26 |
$625.26 |
$625.26 |
$462.35
|
|
Unlisted px tongue flr mouth
|
$190.83 |
$190.83 |
$190.83 |
$282.50
|
|
Unlisted special svc px/rprt
|
$33.95 |
$33.95 |
$33.95 |
$90.00
|
|
Unlisted transfusion med px
|
$151.61 |
$151.61 |
$151.61 |
$147.50
|
|
Unsched dialysis esrd pt hos
|
$969.52 |
$969.52 |
$969.52 |
$1,268.17
|
|
Upgrade pm system
|
$4,787.26 |
$4,787.26 |
$4,787.26 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,203.78 |
$3,203.78 |
$3,203.78 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,114.50 |
$2,114.50 |
$2,114.50 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,082.46 |
$2,082.46 |
$2,082.46 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$616.68 |
$616.68 |
$616.68 |
$1,751.66
|
|
Urea nitrogen
|
$17.06 |
$17.06 |
$17.06 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$29.40 |
$29.40 |
$29.40 |
$51.75
|
|
Urea nitrogen clearance
|
$26.56 |
$26.56 |
$26.56 |
$42.25
|
|
Ureteral embolization/occl
|
$1,407.75 |
$1,407.75 |
$1,407.75 |
$2,181.40
|
|
Ureteral reflux study
|
$637.72 |
$637.72 |
$637.72 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$442.43 |
$442.43 |
$442.43 |
$579.73
|
|
Urethrocystography void s&i
|
$575.17 |
$575.17 |
$575.17 |
$622.35
|
|
Uric acid blood
|
$17.49 |
$17.49 |
$17.49 |
$48.75
|
|
Uric acid urine
|
$30.87 |
$30.87 |
$30.87 |
$44.33
|
|
Urinalysis microscopic only
|
$18.77 |
$18.77 |
$18.77 |
$26.35
|
|
Urinalysis (with microscopy)
|
$30.46 |
$30.46 |
$30.46 |
$55.00
|
|
Urinalysis (without microscopy)
|
$26.95 |
$26.95 |
$26.95 |
$35.75
|
|
Urinary bldr retent nuc study
|
$347.98 |
$347.98 |
$347.98 |
$350.66
|
|
Urine Culture Test
|
$59.98 |
$59.98 |
$59.98 |
$81.50
|
|
Urine pregnancy test
|
$51.27 |
$51.27 |
$51.27 |
$67.20
|
|
Urography, antegrade
|
$423.63 |
$423.63 |
$423.63 |
$622.35
|
|
Use 1st target lesion
|
$163.61 |
$163.61 |
$163.61 |
$332.00
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$11,456.68 |
$11,456.68 |
$11,456.68 |
$5,184.34
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$176.47 |
$176.47 |
$176.47 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$113.24 |
$113.24 |
$113.24 |
$123.20
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$84.57 |
$84.57 |
$84.57 |
$80.15
|
|
Vaccine dtap < 7 years im
|
$39.59 |
$39.59 |
$39.59 |
$68.19
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$90.12 |
$90.12 |
$90.12 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$62.95 |
$62.95 |
$62.95 |
$166.62
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$162.88 |
$162.88 |
$162.88 |
$155.16
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$81.44 |
$81.44 |
$81.44 |
$75.39
|
|
Vaccine influenza inactivated adjuvant im
|
$82.57 |
$82.57 |
$82.57 |
$109.50
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$15.21 |
$15.21 |
$15.21 |
$47.88
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$246.65 |
$246.65 |
$246.65 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$156.03 |
$156.03 |
$156.03 |
$211.68
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$199.62 |
$199.62 |
$199.62 |
$251.64
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$472.35 |
$472.35 |
$472.35 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$72.06 |
$72.06 |
$72.06 |
$90.70
|
|
Vaccine rabies im
|
$639.49 |
$639.49 |
$639.49 |
$858.95
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$744.04 |
$744.04 |
$744.04 |
$1,104.47
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$744.04 |
$744.04 |
$744.04 |
$997.44
|
|
Vaccine tdap >=7 years im
|
$79.69 |
$79.69 |
$79.69 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$50.49 |
$50.49 |
$50.49 |
$112.10
|
|
Vaccine varicella live subcutaneous
|
$180.09 |
$180.09 |
$180.09 |
$365.17
|
|
Vacuum drain bottle/tube kit
|
$539.76 |
$539.76 |
$539.76 |
$325.20
|
|
Valproic acid total therapeutic drug level
|
$66.00 |
$66.00 |
$66.00 |
$114.72
|
|
Valrubicin injection
|
$1,966.33 |
$1,966.33 |
$1,966.33 |
$2,813.49
|
|
Valvuloplasty aortic
|
$3,931.02 |
$3,931.02 |
$3,931.02 |
$7,830.80
|
