|
Treatment missed abortion completed surgically 1st trimester
|
$905.24 |
$905.24 |
$928.56 |
$3,820.53
|
|
Treatment of miscarriage
|
$905.24 |
$905.24 |
$928.56 |
$4,146.69
|
|
Treatment radiation delivery level 2
|
$1,595.30 |
$1,595.30 |
$1,595.30 |
$735.00
|
|
Treponema pallidum antibody
|
$44.52 |
$44.52 |
$54.06 |
$72.80
|
|
Trg gene rearrangement anal
|
$279.31 |
$279.31 |
$899.41 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$5.23 |
$5.27 |
$5.42 |
$55.80
|
|
Trichinella antibody
|
$43.46 |
$62.54 |
$62.54 |
$70.65
|
|
Trichomonas assay w/optic
|
$25.44 |
$45.58 |
$45.58 |
$66.00
|
|
Triglycerides
|
$21.73 |
$21.73 |
$46.64 |
$54.60
|
|
Trimethobenzamide hcl inj
|
$91.49 |
$91.49 |
$104.50 |
$128.00
|
|
Trim nail(s)
|
$130.38 |
$134.09 |
$134.09 |
$70.29
|
|
Trim nondyst nails
|
$134.09 |
$134.09 |
$167.48 |
$124.22
|
|
Triptorelin pamoate
|
$1,461.67 |
$1,461.67 |
$1,520.67 |
$4,619.39
|
|
Trnscath plc stent crv crtd without prtct
|
$7,103.06 |
$7,103.06 |
$7,103.06 |
$7,944.75
|
|
Trnscath plc stent crv crtd w/prtct
|
$10,333.41 |
$10,333.41 |
$14,984.69 |
$11,099.98
|
|
Trnscath plc stnt ante carotid art
|
$3,507.54 |
$3,507.54 |
$6,047.83 |
$9,114.56
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$4,915.75 |
$4,915.75 |
$6,231.21 |
$8,244.55
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$4,448.82 |
$4,448.82 |
$6,231.21 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$8,897.64 |
$8,897.64 |
$12,462.42 |
$15,408.00
|
|
Trnscath retrv pq vasc fb w/guide
|
$8,040.10 |
$8,040.10 |
$8,040.10 |
$4,969.90
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$3,460.90 |
$3,460.90 |
$12,930.94 |
$6,156.00
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$1,739.46 |
$1,739.46 |
$5,359.36 |
$4,505.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$1,739.46 |
$1,739.46 |
$2,357.44 |
$4,793.13
|
|
Trnscath tx thromblytc vein ini day
|
$2,086.08 |
$2,086.08 |
$12,999.84 |
$4,329.36
|
|
Troponin quantitative
|
$73.14 |
$73.14 |
$80.56 |
$123.75
|
|
Twelve volt battery utah/equ
|
$948.59 |
$948.59 |
$948.59 |
$868.97
|
|
Tx atrial fib pulm vein isol
|
$18,348.60 |
$18,348.60 |
$56,211.80 |
$32,426.20
|
|
Tx l/r atrial fib addl
|
$9,174.30 |
$9,174.30 |
$28,105.90 |
$7,717.80
|
|
Ua w/micro/comp poc
|
$22.79 |
$22.79 |
$22.79 |
$24.45
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$111.14 |
$111.14 |
$111.14 |
$17,191.88
|
|
Ugt1a1 gene analy common variants
|
$827.33 |
$827.33 |
$863.90 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$271.36 |
$351.92 |
$351.92 |
$403.26
|
|
Ultrasound breast complete
|
$528.41 |
$534.24 |
$534.24 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$498.73 |
$510.39 |
$510.39 |
$449.35
|
|
Ultrasound chest
|
$347.15 |
$347.15 |
$504.03 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$284.08 |
$284.08 |
$331.25 |
$340.14
|
|
Ultrasound encephalogram
|
$282.49 |
$282.49 |
$485.48 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$610.03 |
$610.03 |
$610.03 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$346.09 |
$367.29 |
$367.29 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$275.07 |
$275.07 |
$351.92 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$374.18 |
$374.18 |
$520.99 |
$701.35
|
|
Ultrasound guide intraoperative
|
$385.31 |
$385.84 |
$385.84 |
$632.90
|
|
Ultrasound guide tissue ablation
|
$289.91 |
$303.16 |
$303.16 |
$498.40
|
|
Ultrasound hips infant dynamic
|
$249.10 |
$249.10 |
$586.71 |
$403.00
|
|
Ultrasound infant hips ltd without stress
|
$175.96 |
$175.96 |
$367.29 |
$321.35
|
|
Ultrasound joint complete left
|
$367.29 |
$367.29 |
$513.57 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$239.03 |
$286.73 |
$286.73 |
$448.50
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$198.22 |
$198.22 |
$198.22 |
$280.02
|
|
Ultrasound ob >=14wks ea addl gest
|
$183.91 |
$183.91 |
$311.11 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$183.91 |
$183.91 |
$310.05 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$404.92 |
$404.92 |
$652.96 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$390.61 |
$469.58 |
$469.58 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$367.29 |
$367.29 |
$410.22 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$371.00 |
$371.00 |
$515.16 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$350.86 |
$350.86 |
$741.47 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$453.15 |
$469.58 |
$469.58 |
$498.00
|
|
Ultrasound scrotum and contents
|
$385.84 |
$385.84 |
$579.82 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$367.29 |
$367.29 |
$701.19 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$202.46 |
$202.46 |
$326.48 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$469.58 |
$469.58 |
$520.99 |
$567.44
|
|
Umbilical artery cath newborn 36660
|
$350.33 |
$350.33 |
$449.97 |
$265.85
|
|
Unlisted mr procedure
|
$1,028.20 |
$1,028.20 |
$1,028.20 |
$1,032.20
|
|
Unlisted transfusion med px
|
$225.78 |
$225.78 |
$283.02 |
$141.35
|
|
Upgrade pm system
|
$9,284.54 |
$9,284.54 |
$14,269.19 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,441.07 |
$1,441.07 |
$3,271.69 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,391.25 |
$1,391.25 |
$2,073.89 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,337.19 |
$1,337.19 |
$2,027.25 |
$2,013.08
|
|
Urea nitrogen
|
$19.08 |
$19.08 |
$39.75 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$21.20 |
$21.20 |
$39.22 |
$50.00
|
|
Urea nitrogen semi-quant
|
$38.69 |
$38.69 |
$38.69 |
$5.64
|
|
Urethrcystgrphy rtrgrde s&i
|
$224.19 |
$224.19 |
$253.87 |
$574.40
|
|
Urethrocystography void s&i
|
$207.76 |
$207.76 |
$437.25 |
$634.50
|
|
Uric acid blood
|
$21.20 |
$21.20 |
$46.64 |
$46.64
|
|
Uric acid urine
|
$23.32 |
$23.32 |
$49.29 |
$46.75
|
|
Urinalysis microscopic only
|
$11.66 |
$11.66 |
$25.44 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$16.96 |
$16.96 |
$16.96 |
$25.72
|
|
Urinalysis (with microscopy)
|
$22.26 |
$22.26 |
$25.44 |
$48.14
|
|
Urinalysis (without microscopy)
|
$9.01 |
$9.01 |
$16.96 |
$38.99
|
|
Urine Culture Test
|
$39.22 |
$39.22 |
$64.66 |
$84.81
|
|
Urine pregnancy test
|
$39.75 |
$39.75 |
$59.89 |
$66.40
|
|
Urography, antegrade
|
$201.40 |
$201.40 |
$488.66 |
$593.37
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$10.17 |
$22.52 |
$23.78 |
$5,521.54
|
|
Vaccine dtap < 7 years im
|
$37.63 |
$37.63 |
$37.63 |
$87.80
|
|
Vaccine dtap-hep b-ipv im
|
$123.49 |
$123.49 |
$123.49 |
$193.83
|
|
Vaccine dtap-ipv 4-6 years im
|
$66.01 |
$66.01 |
$66.01 |
$126.84
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$42.02 |
$42.02 |
$55.99 |
$85.00
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$40.79 |
$40.79 |
$42.25 |
$45.33
|
|
Vaccine hepatitis a (hepa) adult im
|
$92.75 |
$92.75 |
$115.48 |
$178.07
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$140.82 |
$140.82 |
$140.82 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$64.84 |
$64.84 |
$64.84 |
$84.38
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$115.66 |
$115.66 |
$127.14 |
$173.98
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$275.37 |
$285.62 |
$285.62 |
$306.24
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$20.74 |
$47.36 |
$66.78 |
$79.04
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$202.42 |
$202.42 |
$202.42 |
$686.67
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$269.66 |
$269.66 |
$269.66 |
$226.20
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$133.15 |
$133.15 |
$133.15 |
$157.41
|
|
Vaccine influenza inactivated adjuvant im
|
$77.91 |
$77.91 |
$77.91 |
$110.25
|
|
Vaccine influenza nos 0.5ml dose im
|
$20.67 |
$20.67 |
$20.67 |
$36.80
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$45.97 |
$46.48 |
$48.61 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$16.70 |
$16.70 |
$24.51 |
$42.90
|
