|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$120.53 |
$120.53 |
$120.53 |
$210.00
|
|
Treatment radiation delivery level 2
|
$540.43 |
$540.43 |
$540.43 |
$735.00
|
|
Treponema pallidum antibody
|
$95.42 |
$95.42 |
$95.42 |
$72.80
|
|
Trg gene rearrangement anal
|
$172.15 |
$172.15 |
$172.15 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$56.08 |
$56.08 |
$56.08 |
$55.80
|
|
Triamcinolone a inj prs-free
|
$1,220.07 |
$1,220.07 |
$1,220.07 |
$1,309.80
|
|
Trichinella antibody
|
$20.88 |
$20.88 |
$20.88 |
$70.65
|
|
Triglycerides
|
$168.52 |
$168.52 |
$168.52 |
$54.60
|
|
Trimethobenzamide hcl inj
|
$32.93 |
$32.93 |
$32.93 |
$128.00
|
|
Triptorelin pamoate
|
$1,878.79 |
$1,878.79 |
$1,878.79 |
$4,619.39
|
|
Trnscath plc stent crv crtd without prtct
|
$3,815.05 |
$3,815.05 |
$3,815.05 |
$7,944.75
|
|
Trnscath plc stent crv crtd w/prtct
|
$4,098.24 |
$4,098.24 |
$4,098.24 |
$11,099.98
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$11,606.96 |
$11,606.96 |
$11,606.96 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$11,606.96 |
$11,606.96 |
$11,606.96 |
$15,408.00
|
|
Trnscath retrv pq vasc fb w/guide
|
$2,247.63 |
$2,247.63 |
$2,247.63 |
$4,969.90
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$3,903.21 |
$3,903.21 |
$3,903.21 |
$6,156.00
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$2,380.99 |
$2,380.99 |
$2,380.99 |
$4,505.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$1,405.05 |
$1,405.05 |
$1,405.05 |
$4,793.13
|
|
Trnscath tx thromblytc vein ini day
|
$4,215.42 |
$4,215.42 |
$4,215.42 |
$4,329.36
|
|
Troponin quantitative
|
$223.48 |
$223.48 |
$223.48 |
$123.75
|
|
Tte w or without fol w/con,stres
|
$913.73 |
$913.73 |
$913.73 |
$1,582.75
|
|
Tx atrial fib pulm vein isol
|
$18,064.14 |
$18,064.14 |
$18,064.14 |
$32,426.20
|
|
Tx l/r atrial fib addl
|
$6,765.75 |
$6,765.75 |
$6,765.75 |
$7,717.80
|
|
Ultrasound abdomen aorta screening study aaa
|
$513.09 |
$513.09 |
$513.09 |
$403.26
|
|
Ultrasound bone density measure
|
$182.75 |
$182.75 |
$182.75 |
$117.81
|
|
Ultrasound chest
|
$547.12 |
$547.12 |
$547.12 |
$459.55
|
|
Ultrasound encephalogram
|
$666.26 |
$666.26 |
$666.26 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$709.22 |
$709.22 |
$709.22 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$768.09 |
$768.09 |
$768.09 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$551.31 |
$551.31 |
$551.31 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$606.55 |
$606.55 |
$606.55 |
$701.35
|
|
Ultrasound guide intraoperative
|
$578.93 |
$578.93 |
$578.93 |
$632.90
|
|
Ultrasound guide tissue ablation
|
$578.93 |
$578.93 |
$578.93 |
$498.40
|
|
Ultrasound hips infant dynamic
|
$909.27 |
$909.27 |
$909.27 |
$403.00
|
|
Ultrasound ob >=14wks ea addl gest
|
$338.43 |
$338.43 |
$338.43 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$285.42 |
$285.42 |
$285.42 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$500.25 |
$500.25 |
$500.25 |
$690.48
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$351.54 |
$351.54 |
$351.54 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$450.87 |
$450.87 |
$450.87 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$516.71 |
$516.71 |
$516.71 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$329.22 |
$329.22 |
$329.22 |
$498.00
|
|
Ultrasound scrotum and contents
|
$945.54 |
$945.54 |
$945.54 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$412.37 |
$412.37 |
$412.37 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$320.02 |
$320.02 |
$320.02 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$666.81 |
$666.81 |
$666.81 |
$567.44
|
|
Unlisted procedure microbiology
|
$97.65 |
$97.65 |
$97.65 |
$487.50
|
|
Unlisted px small intestine
|
$865.46 |
$865.46 |
$865.46 |
$2,118.35
|
|
Unsched dialysis esrd pt hos
|
$1,815.18 |
$1,815.18 |
$1,815.18 |
$1,469.76
|
|
Upgrade pm system
|
$10,206.66 |
$10,206.66 |
$10,206.66 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,273.79 |
$3,273.79 |
$3,273.79 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,982.79 |
$2,982.79 |
$2,982.79 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,425.07 |
$2,425.07 |
$2,425.07 |
$2,013.08
|
|
Urea nitrogen
|
$104.63 |
$104.63 |
$104.63 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$79.24 |
$79.24 |
$79.24 |
$50.00
|
|
Ureteral reflux study
|
$1,076.67 |
$1,076.67 |
$1,076.67 |
$961.20
|
|
Urethrcystgrphy rtrgrde s&i
|
$584.23 |
$584.23 |
$584.23 |
$574.40
|
|
Urethrocystography void s&i
|
$584.23 |
$584.23 |
$584.23 |
$634.50
|
|
Uric acid blood
|
$109.09 |
$109.09 |
$109.09 |
$46.64
|
|
Uric acid urine
|
$101.56 |
$101.56 |
$101.56 |
$46.75
|
|
Urinalysis microscopic only
|
$11.44 |
$11.44 |
$11.44 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$33.48 |
$33.48 |
$33.48 |
$25.72
|
|
Urinalysis (with microscopy)
|
$114.39 |
$114.39 |
$114.39 |
$48.14
|
|
Urinalysis (without microscopy)
|
$73.66 |
$73.66 |
$73.66 |
$38.99
|
|
Urinary bldr retent nuc study
|
$1,076.67 |
$1,076.67 |
$1,076.67 |
$309.22
|
|
Urine Culture Test
|
$190.28 |
$190.28 |
$190.28 |
$84.81
|
|
Urography inf drip &/or bolus
|
$1,126.89 |
$1,126.89 |
$1,126.89 |
$641.69
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$1,255.50 |
$1,255.50 |
$1,255.50 |
$5,521.54
|
|
Vaccine dtap < 7 years im
|
$34.60 |
$34.60 |
$34.60 |
$87.80
|
|
Vaccine dtap-hep b-ipv im
|
$115.79 |
$115.79 |
$115.79 |
$193.83
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$22.88 |
$22.88 |
$22.88 |
$45.33
|
|
Vaccine hepatitis a (hepa) adult im
|
$95.42 |
$95.42 |
$95.42 |
$178.07
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$44.92 |
$44.92 |
$44.92 |
$84.38
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$66.96 |
$66.96 |
$66.96 |
$173.98
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$415.71 |
$415.71 |
$415.71 |
$686.67
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$25.39 |
$25.39 |
$25.39 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$25.11 |
$25.11 |
$25.11 |
$40.01
|
|
Vaccine mmr live subcutaneous
|
$101.28 |
$101.28 |
$101.28 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$151.50 |
$151.50 |
$151.50 |
$274.95
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$291.84 |
$291.84 |
$291.84 |
$397.18
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$321.69 |
$321.69 |
$321.69 |
$715.41
|
|
Vaccine polio (ipv) subcutaneous/im
|
$47.71 |
$47.71 |
$47.71 |
$119.17
|
|
Vaccine rabies im
|
$489.93 |
$489.93 |
$489.93 |
$945.46
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$639.75 |
$639.75 |
$639.75 |
$1,196.00
|
|
Vaccine tdap >=7 years im
|
$57.48 |
$57.48 |
$57.48 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$35.16 |
$35.16 |
$35.16 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$225.44 |
$225.44 |
$225.44 |
$447.80
|
|
Valproic acid total therapeutic drug level
|
$221.53 |
$221.53 |
$221.53 |
$115.00
|
|
Valvuloplasty aortic
|
$4,871.34 |
$4,871.34 |
$4,871.34 |
$7,324.85
|
|
Valvuloplasty mitral
|
$5,055.21 |
$5,055.21 |
$5,055.21 |
$10,435.39
|
|
Valvuloplasty pulmonary
|
$5,055.21 |
$5,055.21 |
$5,055.21 |
$11,945.20
|
|
Vancomycin hcl injection
|
$92.63 |
$92.63 |
$92.63 |
$186.80
|
|
Vancomycin peak therapeutic drug level
|
$155.41 |
$155.41 |
$155.41 |
$126.79
|
|
Varicella zoster antibody igg
|
$4.26 |
$4.26 |
$4.26 |
$82.55
|
|
Vasopressin 20 unit/ml intravenous solution
|
$274.54 |
$274.54 |
$274.54 |
$362.93
|
|
Veeg cont 2-12 hrs
|
$404.83 |
$404.83 |
$404.83 |
$1,485.05
|
|
Veeg ea 12-26hr cont mntr
|
$1,058.53 |
$1,058.53 |
$1,058.53 |
$3,332.45
|
|
Veeg intrmnt 2-12 hrs
|
$210.93 |
$210.93 |
$210.93 |
$904.90
|
|
Veeg unmon 12-26 hrs
|
$404.83 |
$404.83 |
$404.83 |
$1,411.20
|
|
Veeg unmon 2-12 hrs
|
$210.93 |
$210.93 |
$210.93 |
$704.79
|
|
Vein x-ray adrenal glands
|
$2,943.73 |
$2,943.73 |
$2,943.73 |
$3,999.60
|
