|
Tte w or without fol w/con,stres
|
$1,657.92 |
$1,657.92 |
$1,657.92 |
$1,632.80
|
|
Tube trach disp innr can 6 xlt
|
$10.00 |
$10.00 |
$10.00 |
$16.80
|
|
Tx atrial fib pulm vein isol
|
$17,666.22 |
$17,666.22 |
$17,666.22 |
$29,030.54
|
|
Tx closed hip disl traumatic without anes
|
$662.64 |
$662.64 |
$662.64 |
$581.07
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$6,407.94 |
$6,407.94 |
$6,407.94 |
$3,977.49
|
|
Tx l/r atrial fib addl
|
$3,003.00 |
$3,003.00 |
$3,003.00 |
$6,769.00
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$7,569.54 |
$7,569.54 |
$7,569.54 |
$4,468.55
|
|
Tyms gene com variants
|
$140.00 |
$140.00 |
$140.00 |
$192.29
|
|
Ugt1a1 gene analy common variants
|
$235.00 |
$235.00 |
$619.08 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$380.00 |
$380.00 |
$386.76 |
$394.20
|
|
Ultrasound breast complete
|
$546.48 |
$546.48 |
$880.00 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$392.70 |
$392.70 |
$660.00 |
$449.35
|
|
Ultrasound chest
|
$352.50 |
$352.50 |
$405.24 |
$460.85
|
|
Ultrasound dx ophth b-scan
|
$222.42 |
$222.42 |
$222.42 |
$296.80
|
|
Ultrasound elastography ea l target les
|
$180.00 |
$180.00 |
$180.00 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$362.50 |
$362.50 |
$362.50 |
$307.00
|
|
Ultrasound encephalogram
|
$570.00 |
$570.00 |
$629.64 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$573.54 |
$573.54 |
$670.00 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$398.64 |
$398.64 |
$585.00 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$370.26 |
$370.26 |
$690.00 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$699.60 |
$699.60 |
$720.00 |
$720.15
|
|
Ultrasound guide intraoperative
|
$292.50 |
$292.50 |
$839.52 |
$632.85
|
|
Ultrasound hips infant dynamic
|
$370.00 |
$370.00 |
$377.52 |
$403.88
|
|
Ultrasound joint complete left
|
$566.28 |
$566.28 |
$750.00 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$384.78 |
$384.78 |
$565.00 |
$425.45
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$355.00 |
$355.00 |
$355.00 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$307.56 |
$307.56 |
$330.00 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$251.46 |
$251.46 |
$267.50 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$535.00 |
$535.00 |
$650.10 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$321.42 |
$321.42 |
$387.50 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$335.28 |
$335.28 |
$387.50 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$440.22 |
$440.22 |
$452.50 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$228.36 |
$228.36 |
$228.36 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$392.50 |
$392.50 |
$517.44 |
$486.50
|
|
Ultrasound scrotum and contents
|
$578.16 |
$578.16 |
$595.00 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$349.80 |
$349.80 |
$405.00 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$297.00 |
$297.00 |
$297.00 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$292.50 |
$292.50 |
$531.30 |
$558.35
|
|
Ultrasound trgt dyn mbubb 1st les
|
$685.00 |
$685.00 |
$685.00 |
$568.32
|
|
Ultrasound trgt dyn mbubb ea addl
|
$342.50 |
$342.50 |
$342.50 |
$348.00
|
|
Umbilical artery cath newborn 36660
|
$347.50 |
$347.50 |
$347.50 |
$206.64
|
|
Unlisted chemotherapy px
|
$127.50 |
$127.50 |
$127.50 |
$150.00
|
|
Unlisted CT procedure
|
$331.98 |
$331.98 |
$331.98 |
$732.70
|
|
Unlisted cv px dx nuc med
|
$951.06 |
$951.06 |
$951.06 |
$1,200.00
|
|
Unlisted cytogenetic study
|
$372.90 |
$372.90 |
$372.90 |
$160.18
|
|
Unlisted dialysis procedure
|
$510.18 |
$510.18 |
$510.18 |
$1,144.00
|
|
Unlisted dx gi procedure
|
$940.00 |
$940.00 |
$940.00 |
$649.22
|
|
Unlisted fluoroscopic px
|
$460.00 |
$460.00 |
$460.00 |
$305.76
|
|
Unlisted mr procedure
|
$1,385.00 |
$1,385.00 |
$2,233.44 |
$1,163.00
|
|
Unlisted neurological dx px
|
$394.02 |
$394.02 |
$394.02 |
$242.50
|
|
Unlisted procedure larynx
|
$570.90 |
$570.90 |
$570.90 |
$924.00
|
|
Unlisted procedure microbiology
|
$530.00 |
$530.00 |
$530.00 |
$523.50
|
|
Unlisted px casting/strpg
|
$285.78 |
$285.78 |
$285.78 |
$219.70
|
|
Unlisted px foot/toes
|
$545.82 |
$545.82 |
$545.82 |
$1,225.50
|
|
Unlisted px med radj physics
|
$196.02 |
$196.02 |
$495.00 |
$462.35
|
|
Unlisted px small intestine
|
$1,083.06 |
$1,083.06 |
$1,083.06 |
$2,102.10
|
|
Unlisted reprod med lab proc
|
$65.00 |
$65.00 |
$65.00 |
$70.00
|
|
Unlisted surgical path px
|
$1,824.24 |
$1,824.24 |
$1,824.24 |
$217.75
|
|
Unlisted transfusion med px
|
$145.00 |
$145.00 |
$145.00 |
$147.50
|
|
Unlisted ultrasound procedure
|
$75.00 |
$75.00 |
$293.70 |
$321.20
|
|
Unlisted urinalysis px
|
$584.76 |
$584.76 |
$584.76 |
$25.72
|
|
Unsched dialysis esrd pt hos
|
$1,240.00 |
$1,240.00 |
$1,240.00 |
$1,268.17
|
|
Upgrade pm system
|
$12,087.24 |
$12,087.24 |
$12,087.24 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,651.88 |
$2,651.88 |
$3,265.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,210.00 |
$2,210.00 |
$2,410.98 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,110.00 |
$2,110.00 |
$2,295.48 |
$2,034.41
|
|
Urea nitrogen
|
$25.74 |
$25.74 |
$27.50 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$54.12 |
$54.12 |
$57.50 |
$51.75
|
|
Urea nitrogen clearance
|
$72.50 |
$72.50 |
$217.14 |
$42.25
|
|
Ureteral embolization/occl
|
$369.60 |
$369.60 |
$3,715.00 |
$2,181.40
|
|
Ureteral reflux study
|
$1,023.66 |
$1,023.66 |
$1,023.66 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$515.00 |
$515.00 |
$747.78 |
$579.73
|
|
Urethrocystography void s&i
|
$690.00 |
$690.00 |
$747.78 |
$622.35
|
|
Uric acid blood
|
$31.02 |
$31.02 |
$57.50 |
$48.75
|
|
Uric acid urine
|
$31.02 |
$31.02 |
$52.50 |
$44.33
|
|
Urinalysis microscopic only
|
$20.00 |
$20.00 |
$21.78 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$64.68 |
$64.68 |
$64.68 |
$25.72
|
|
Urinalysis (with microscopy)
|
$38.28 |
$38.28 |
$57.50 |
$55.00
|
|
Urinalysis (without microscopy)
|
$25.00 |
$25.00 |
$35.64 |
$35.75
|
|
Urine Culture Test
|
$59.40 |
$59.40 |
$80.00 |
$81.50
|
|
Urine pregnancy test
|
$59.40 |
$59.40 |
$77.50 |
$67.20
|
|
Urography, antegrade
|
$560.00 |
$560.00 |
$616.44 |
$622.35
|
|
Urography inf drip &/or bolus
|
$650.00 |
$650.00 |
$747.78 |
$642.50
|
|
Use 1st target lesion
|
$360.00 |
$360.00 |
$360.00 |
$332.00
|
|
Vaccine dtap < 7 years im
|
$142.33 |
$142.33 |
$142.33 |
$68.19
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$85.64 |
$85.64 |
$141.90 |
$75.39
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$101.11 |
$101.11 |
$101.11 |
$47.88
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$15.84 |
$15.84 |
$15.84 |
$33.60
|
|
Vaccine mmr live subcutaneous
|
$320.86 |
$320.86 |
$320.86 |
$211.68
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$706.27 |
$706.27 |
$706.27 |
$563.36
|
|
Vaccine rabies im
|
$769.49 |
$769.49 |
$1,084.28 |
$858.95
|
|
Vaccine tdap >=7 years im
|
$117.74 |
$117.74 |
$158.99 |
$131.34
|
|
Valproic acid total therapeutic drug level
|
$77.88 |
$77.88 |
$122.50 |
$114.72
|
|
Valvuloplasty aortic
|
$6,585.48 |
$6,585.48 |
$6,585.48 |
$7,830.80
|
|
Valvuloplasty mitral
|
$13,098.36 |
$13,098.36 |
$13,098.36 |
$10,877.90
|
|
Vancomycin hcl injection
|
$29.66 |
$29.66 |
$29.66 |
$154.40
|
|
Vancomycin peak therapeutic drug level
|
$95.70 |
$95.70 |
$142.50 |
$136.13
|
|
Varicella zoster antibody igg
|
$68.64 |
$68.64 |
$85.00 |
$86.80
|
|
Vasc emb/occ w/prs cath
|
$20,240.00 |
$20,240.00 |
$20,240.00 |
$21,009.00
|
|
Vedolizumab 300 mg intravenous solution
|
$67.98 |
$67.98 |
$67.98 |
$18,732.33
|
