|
Trnscath tx thromblytc art/ven sbsq day
|
$785.89 |
$785.89 |
$1,038.24 |
$4,505.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$740.33 |
$740.33 |
$978.05 |
$4,793.13
|
|
Trnscath tx thromblytc vein ini day
|
$1,138.84 |
$1,138.84 |
$1,504.52 |
$4,329.36
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$1,562.41 |
$1,562.41 |
$2,064.10 |
$2,986.34
|
|
Troponin quantitative
|
$136.04 |
$136.04 |
$179.72 |
$123.75
|
|
Tx atrial fib pulm vein isol
|
$14,399.56 |
$14,399.56 |
$19,023.27 |
$32,426.20
|
|
Tx l/r atrial fib addl
|
$2,592.02 |
$2,592.02 |
$3,424.32 |
$7,717.80
|
|
Ultrasound abdomen aorta screening study aaa
|
$388.04 |
$388.04 |
$512.64 |
$403.26
|
|
Ultrasound chest
|
$408.54 |
$408.54 |
$539.72 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$429.03 |
$429.03 |
$566.79 |
$340.14
|
|
Ultrasound dx ophth b-scan
|
$134.29 |
$134.29 |
$177.41 |
$330.40
|
|
Ultrasound encephalogram
|
$469.79 |
$469.79 |
$620.64 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$419.44 |
$419.44 |
$554.12 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$469.79 |
$469.79 |
$620.64 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$304.11 |
$304.11 |
$401.76 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$407.45 |
$407.45 |
$538.28 |
$701.35
|
|
Ultrasound guide intraoperative
|
$230.65 |
$230.65 |
$304.71 |
$632.90
|
|
Ultrasound hips infant dynamic
|
$322.86 |
$322.86 |
$426.53 |
$403.00
|
|
Ultrasound ob >=14wks ea addl gest
|
$257.24 |
$257.24 |
$339.84 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$175.71 |
$175.71 |
$232.13 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$608.88 |
$608.88 |
$804.39 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$408.54 |
$408.54 |
$539.72 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$408.54 |
$408.54 |
$539.72 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$408.54 |
$408.54 |
$539.72 |
$485.48
|
|
Ultrasound retroperitoneal limited
|
$408.54 |
$408.54 |
$539.72 |
$498.00
|
|
Ultrasound scrotum and contents
|
$408.54 |
$408.54 |
$539.72 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$469.79 |
$469.79 |
$620.64 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$194.90 |
$194.90 |
$257.48 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$408.54 |
$408.54 |
$539.72 |
$567.44
|
|
Unit mobile power mpu
|
$10,989.38 |
$10,989.38 |
$14,518.08 |
$16,315.20
|
|
Unlisted CT procedure
|
$732.70 |
$732.70 |
$967.97 |
$1,043.00
|
|
Unlisted cytogenetic study
|
$100.28 |
$100.28 |
$132.48 |
$132.48
|
|
Unlisted procedure microbiology
|
$582.33 |
$582.33 |
$769.31 |
$487.50
|
|
Unlisted procedure spine
|
$6,129.73 |
$6,129.73 |
$8,097.99 |
$4,706.35
|
|
Unlisted psychiatric service/proc 90899
|
$73.03 |
$73.03 |
$96.48 |
$96.48
|
|
Unlisted transfusion med px
|
$70.85 |
$70.85 |
$93.60 |
$141.35
|
|
Unsched dialysis esrd pt hos
|
$616.29 |
$616.29 |
$814.18 |
$1,469.76
|
|
Upgrade pm system
|
$2,796.07 |
$2,796.07 |
$3,693.89 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,826.41 |
$1,826.41 |
$2,412.87 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,881.13 |
$1,881.13 |
$2,485.16 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,187.23 |
$1,187.23 |
$1,568.45 |
$2,013.08
|
|
Urea nitrogen
|
$21.80 |
$21.80 |
$28.80 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$46.44 |
$46.44 |
$61.35 |
$50.00
|
|
Ureteral embolization/occl
|
$475.46 |
$475.46 |
$628.13 |
$3,041.22
|
|
Urethrcystgrphy rtrgrde s&i
|
$531.05 |
$531.05 |
$701.57 |
$574.40
|
|
Urethrocystography void s&i
|
$531.05 |
$531.05 |
$701.57 |
$634.50
|
|
Uric acid blood
|
$39.24 |
$39.24 |
$51.84 |
$46.64
|
|
Uric acid urine
|
$39.24 |
$39.24 |
$51.84 |
$46.75
|
|
Urinalysis microscopic only
|
$11.12 |
$11.12 |
$14.69 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$3.27 |
$3.27 |
$4.32 |
$25.72
|
|
Urinalysis (with microscopy)
|
$27.69 |
$27.69 |
$36.58 |
$48.14
|
|
Urinalysis (without microscopy)
|
$23.55 |
$23.55 |
$31.11 |
$38.99
|
|
Urine Culture Test
|
$44.04 |
$44.04 |
$58.18 |
$84.81
|
|
Urine pregnancy test
|
$54.72 |
$54.72 |
$72.29 |
$66.40
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$1,674.24 |
$1,674.24 |
$1,674.24 |
$5,521.54
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$189.22 |
$189.22 |
$189.22 |
$239.85
|
|
Vaccine dtap < 7 years im
|
$32.92 |
$32.92 |
$43.49 |
$87.80
|
|
Vaccine dtap-hep b-ipv im
|
$247.40 |
$247.40 |
$247.40 |
$193.83
|
|
Vaccine dtap-ipv 4-6 years im
|
$76.32 |
$76.32 |
$76.32 |
$126.84
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$13.30 |
$13.30 |
$36.29 |
$45.33
|
|
Vaccine hepatitis a (hepa) adult im
|
$101.96 |
$101.96 |
$101.96 |
$178.07
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$36.19 |
$36.19 |
$47.81 |
$84.38
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$64.75 |
$64.75 |
$85.54 |
$173.98
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$48.40 |
$48.40 |
$63.94 |
$79.04
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$220.61 |
$220.61 |
$220.61 |
$226.20
|
|
Vaccine influenza inactivated adjuvant im
|
$76.96 |
$76.96 |
$101.67 |
$110.25
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$21.59 |
$21.59 |
$28.52 |
$48.29
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$77.48 |
$77.48 |
$77.48 |
$72.00
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$200.56 |
$200.56 |
$264.96 |
$499.00
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$154.78 |
$154.78 |
$204.48 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$86.11 |
$86.11 |
$113.76 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$122.52 |
$122.52 |
$161.86 |
$274.95
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$236.32 |
$236.32 |
$312.20 |
$397.18
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$282.31 |
$282.31 |
$372.96 |
$715.41
|
|
Vaccine polio (ipv) subcutaneous/im
|
$48.68 |
$48.68 |
$48.68 |
$119.17
|
|
Vaccine rabies im
|
$445.38 |
$445.38 |
$524.16 |
$945.46
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$0.01 |
$0.01 |
$684.29 |
$1,196.00
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$0.01 |
$0.01 |
$684.29 |
$1,159.00
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$124.13 |
$124.13 |
$124.13 |
$108.00
|
|
Vaccine tdap >=7 years im
|
$46.66 |
$46.66 |
$61.64 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$85.24 |
$85.24 |
$112.61 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$182.47 |
$182.47 |
$241.06 |
$447.80
|
|
Vaccinia vrs vac 0.3 ml perq
|
$0.01 |
$0.01 |
$0.01 |
$0.01
|
|
Vad battery clip set hmii 14-v li-ion
|
$1,345.06 |
$1,345.06 |
$1,776.96 |
$1,683.99
|
|
Vad cable power module dc input
|
$2,274.83 |
$2,274.83 |
$3,005.28 |
$915.95
|
|
Vad univ batt charger hm 1440
|
$10,989.38 |
$10,989.38 |
$14,518.08 |
$14,893.34
|
|
Valproic acid total therapeutic drug level
|
$84.81 |
$84.81 |
$112.04 |
$115.00
|
|
Valvuloplasty aortic
|
$4,594.57 |
$4,594.57 |
$6,069.89 |
$7,324.85
|
|
Valvuloplasty mitral
|
$2,848.61 |
$2,848.61 |
$3,763.30 |
$10,435.39
|
|
Vancomycin hcl injection
|
$31.18 |
$31.18 |
$41.19 |
$186.80
|
|
Vancomycin peak therapeutic drug level
|
$120.56 |
$120.56 |
$159.27 |
$126.79
|
|
Varicella zoster antibody igg
|
$3.33 |
$3.33 |
$4.40 |
$82.55
|
|
Varicella-zoster immue globin im
|
$1,887.88 |
$1,887.88 |
$1,887.88 |
$2,372.84
|
|
Vasopressin 20 unit/ml intravenous solution
|
$1,448.40 |
$1,448.40 |
$1,913.48 |
$362.93
|
|
Vedolizumab 300 mg intravenous solution
|
$6,572.05 |
$6,572.05 |
$6,572.05 |
$20,730.98
|
|
Veeg cont 2-12 hrs
|
$464.13 |
$464.13 |
$613.16 |
$1,485.05
|
|
Veeg ea 12-26hr cont mntr
|
$1,213.39 |
$1,213.39 |
$1,603.01 |
$3,332.45
|
|
Veeg intrmnt 2-12 hrs
|
$241.77 |
$241.77 |
$319.40 |
$904.90
|
|
Veeg unmon 12-26 hrs
|
$464.13 |
$464.13 |
$613.16 |
$1,411.20
|
|
Veeg unmon 2-12 hrs
|
$241.77 |
$241.77 |
$319.40 |
$704.79
|
