|
Tube trach disp innr can 5 xlt
|
$476.75 |
$476.75 |
$476.75 |
$460.58
|
|
Tube trach fen sz 6 uncuffed
|
$138.84 |
$138.84 |
$138.84 |
$132.40
|
|
Tx atrial fib pulm vein isol
|
$111,980.79 |
$111,980.79 |
$111,980.79 |
$32,426.20
|
|
Tx l/r atrial fib addl
|
$10,049.27 |
$10,049.27 |
$10,049.27 |
$7,717.80
|
|
Tympanometry & reflex thresh
|
$318.43 |
$318.43 |
$318.43 |
$173.18
|
|
Ultrasound abdomen aorta screening study aaa
|
$263.63 |
$263.63 |
$263.63 |
$403.26
|
|
Ultrasound breast complete
|
$754.80 |
$754.80 |
$754.80 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$666.00 |
$666.00 |
$666.00 |
$449.35
|
|
Ultrasound chest
|
$444.56 |
$444.56 |
$444.56 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$624.28 |
$624.28 |
$624.28 |
$340.14
|
|
Ultrasound encephalogram
|
$1,886.07 |
$1,886.07 |
$1,886.07 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$513.93 |
$513.93 |
$4,024.08 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$883.65 |
$883.65 |
$883.65 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$340.22 |
$340.22 |
$340.22 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$946.92 |
$946.92 |
$946.92 |
$701.35
|
|
Ultrasound joint complete left
|
$693.29 |
$693.29 |
$693.29 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$684.22 |
$684.22 |
$684.22 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$159.75 |
$159.75 |
$159.75 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$154.66 |
$154.66 |
$154.66 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$617.90 |
$617.90 |
$617.90 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$340.96 |
$340.96 |
$340.96 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$340.96 |
$340.96 |
$340.96 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$549.27 |
$549.27 |
$549.27 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$750.36 |
$750.36 |
$750.36 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$444.56 |
$444.56 |
$444.56 |
$498.00
|
|
Ultrasound scrotum and contents
|
$632.61 |
$632.61 |
$632.61 |
$617.28
|
|
Ultrasound transabd ea addl gest
|
$199.25 |
$199.25 |
$199.25 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$710.31 |
$710.31 |
$710.31 |
$567.44
|
|
Unlisted procedure microbiology
|
$10.92 |
$10.92 |
$10.92 |
$487.50
|
|
Unlisted transfusion med px
|
$12.86 |
$12.86 |
$12.86 |
$141.35
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$622.25 |
$622.25 |
$622.25 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$590.15 |
$590.15 |
$590.15 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$558.05 |
$558.05 |
$558.05 |
$2,013.08
|
|
Urea nitrogen
|
$10.55 |
$10.55 |
$10.55 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$42.00 |
$42.00 |
$42.00 |
$50.00
|
|
Urea nitrogen clearance
|
$13.97 |
$13.97 |
$13.97 |
$33.57
|
|
Ureteral reflux study
|
$6,437.36 |
$6,437.36 |
$6,437.36 |
$961.20
|
|
Urethrcystgrphy rtrgrde s&i
|
$370.00 |
$370.00 |
$370.00 |
$574.40
|
|
Urethrocystography void s&i
|
$432.81 |
$432.81 |
$432.81 |
$634.50
|
|
Uric acid blood
|
$50.14 |
$50.14 |
$50.14 |
$46.64
|
|
Uric acid urine
|
$27.20 |
$27.20 |
$27.20 |
$46.75
|
|
Urinalysis microscopic only
|
$6.57 |
$6.57 |
$554.80 |
$26.35
|
|
Urinalysis (with microscopy)
|
$22.20 |
$22.20 |
$22.20 |
$48.14
|
|
Urinalysis (without microscopy)
|
$10.45 |
$10.45 |
$10.45 |
$38.99
|
|
Urine Culture Test
|
$80.01 |
$80.01 |
$1,903.18 |
$84.81
|
|
Urine pregnancy test
|
$75.94 |
$75.94 |
$75.94 |
$66.40
|
|
Urography, antegrade
|
$588.49 |
$588.49 |
$588.49 |
$593.37
|
|
Vaccine dtap < 7 years im
|
$125.28 |
$125.28 |
$125.28 |
$87.80
|
|
Vaccine dtap-ipv/hib im
|
$196.56 |
$196.56 |
$196.56 |
$248.80
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$48.14 |
$48.14 |
$48.14 |
$85.00
|
|
Vaccine hepatitis a (hepa) adult im
|
$89.64 |
$89.64 |
$89.64 |
$178.07
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$89.64 |
$89.64 |
$89.64 |
$84.38
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$48.14 |
$48.14 |
$48.14 |
$61.50
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$197.64 |
$197.64 |
$197.64 |
$173.98
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$48.14 |
$48.14 |
$251.00 |
$79.04
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$163.08 |
$163.08 |
$163.08 |
$157.41
|
|
Vaccine influenza nos 0.5ml dose im
|
$48.29 |
$48.29 |
$179.28 |
$36.80
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$48.29 |
$48.29 |
$48.29 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$576.72 |
$576.72 |
$576.72 |
$42.90
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$179.28 |
$179.28 |
$179.28 |
$26.40
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$48.23 |
$48.23 |
$179.28 |
$40.01
|
|
Vaccine influenza quadrivalent (iiv4) split virus 0.25 ml im
|
$125.28 |
$125.28 |
$125.28 |
$20.80
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$170.64 |
$170.64 |
$170.64 |
$72.00
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$401.76 |
$401.76 |
$401.76 |
$349.15
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$415.80 |
$415.80 |
$415.80 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$52.17 |
$52.17 |
$348.84 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$62.90 |
$62.90 |
$347.76 |
$274.95
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$147.83 |
$147.83 |
$514.08 |
$397.18
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$763.56 |
$763.56 |
$763.56 |
$385.45
|
|
Vaccine rabies im
|
$396.47 |
$396.47 |
$2,046.60 |
$945.46
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$1,616.00 |
$1,616.00 |
$1,616.00 |
$1,196.00
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$1,616.00 |
$1,616.00 |
$1,616.00 |
$1,159.00
|
|
Vaccine tdap >=7 years im
|
$48.10 |
$48.10 |
$254.88 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$47.96 |
$47.96 |
$254.88 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$588.60 |
$588.60 |
$588.60 |
$447.80
|
|
Valproic acid total therapeutic drug level
|
$76.13 |
$76.13 |
$76.13 |
$115.00
|
|
Valvuloplasty pulmonary
|
$31,082.78 |
$31,082.78 |
$31,082.78 |
$11,945.20
|
|
Vancomycin 750 mg intravenous solution
|
$105.00 |
$105.00 |
$105.00 |
$129.78
|
|
Vancomycin hcl injection
|
$64.00 |
$64.00 |
$64.00 |
$83.79
|
|
Vancomycin peak therapeutic drug level
|
$75.76 |
$75.76 |
$75.76 |
$126.79
|
|
Varicella zoster antibody igg
|
$10.45 |
$10.45 |
$244.73 |
$82.55
|
|
Vasopressin 20 unit/ml intravenous solution
|
$889.00 |
$889.00 |
$889.00 |
$394.13
|
|
Veeg cont 2-12 hrs
|
$763.87 |
$763.87 |
$763.87 |
$1,485.05
|
|
Veeg ea 12-26hr cont mntr
|
$1,429.77 |
$1,429.77 |
$1,429.77 |
$3,332.45
|
|
Veeg intrmnt 2-12 hrs
|
$1,511.45 |
$1,511.45 |
$1,511.45 |
$904.90
|
|
Veeg unmon 12-26 hrs
|
$763.31 |
$763.31 |
$763.31 |
$1,411.20
|
|
Veeg unmon 2-12 hrs
|
$413.94 |
$413.94 |
$413.94 |
$704.79
|
|
Vein x-ray kidney
|
$4,043.45 |
$4,043.45 |
$4,043.45 |
$2,716.20
|
|
Vein x-ray liver
|
$13,133.66 |
$13,133.66 |
$13,133.66 |
$3,320.80
|
|
Vein x-ray liver w/hemodynam
|
$2,370.04 |
$2,370.04 |
$6,116.60 |
$3,413.25
|
|
Vein x-ray liver w/hemodynam
|
$4,359.25 |
$4,359.25 |
$7,698.24 |
$3,439.84
|
|
Vein x-ray liver without hemodyn
|
$7,698.24 |
$7,698.24 |
$7,698.24 |
$2,489.25
|
|
Vein x-ray skull epidural
|
$5,936.98 |
$5,936.98 |
$5,936.98 |
$1,344.60
|
|
Venogram ext bil s&i
|
$590.24 |
$590.24 |
$590.24 |
$1,838.28
|
|
Venogram extremity supervision & interpretation unilateral
|
$581.83 |
$581.83 |
$581.83 |
$1,326.00
|
|
Venous sampling s&i
|
$4,416.78 |
$4,416.78 |
$4,416.78 |
$4,416.78
|
|
Ventilator each subsequent day
|
$461.21 |
$461.21 |
$461.21 |
$1,305.92
|
|
Ventilator initial day
|
$688.85 |
$688.85 |
$688.85 |
$1,540.80
|
|
Vinblastine 1 mg/ml intravenous solution
|
$135.00 |
$135.00 |
$135.00 |
$186.71
|
|
Vincristine 1 mg/ml intravenous solution
|
$181.44 |
$181.44 |
$181.44 |
$104.79
|
