|
Treponema pallidum antibody
|
$258.60 |
$258.60 |
$258.60 |
$74.40
|
|
Trg gene rearrangement anal
|
$741.00 |
$741.00 |
$741.00 |
$474.50
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$45.84 |
$45.84 |
$45.84 |
$28.90
|
|
Triamcinolone a inj prs-free
|
$1,309.80 |
$1,309.80 |
$1,309.80 |
$696.00
|
|
Trichinella antibody
|
$166.20 |
$166.20 |
$166.20 |
$56.55
|
|
Trichomonas assay w/optic
|
$115.80 |
$115.80 |
$115.80 |
$68.90
|
|
Triglycerides
|
$123.00 |
$123.00 |
$123.00 |
$48.75
|
|
Trimethobenzamide hcl inj
|
$120.73 |
$120.73 |
$120.73 |
$105.89
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$24,247.80 |
$24,247.80 |
$24,247.80 |
$9,418.42
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$24,247.80 |
$24,247.80 |
$24,247.80 |
$9,565.92
|
|
Trnscath plc vas stent w/s&i ini vein
|
$31,075.80 |
$31,075.80 |
$31,075.80 |
$15,873.70
|
|
Trnscath retrv pq vasc fb w/guide
|
$11,213.40 |
$11,213.40 |
$11,213.40 |
$5,555.55
|
|
Troponin quantitative
|
$277.20 |
$277.20 |
$277.20 |
$112.80
|
|
Tympanometry & reflex thresh
|
$246.00 |
$246.00 |
$246.00 |
$170.00
|
|
Ultrasound abdomen aorta screening study aaa
|
$331.20 |
$331.20 |
$331.20 |
$394.20
|
|
Ultrasound breast complete
|
$1,176.00 |
$1,176.00 |
$1,176.00 |
$519.20
|
|
Ultrasound breast unilateral limited (both sides)
|
$674.40 |
$674.40 |
$674.40 |
$427.00
|
|
Ultrasound chest
|
$235.20 |
$235.20 |
$235.20 |
$430.10
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$245.40 |
$245.40 |
$245.40 |
$340.03
|
|
Ultrasound elastography parenchyma
|
$547.20 |
$547.20 |
$547.20 |
$275.98
|
|
Ultrasound encephalogram
|
$324.60 |
$324.60 |
$324.60 |
$463.50
|
|
Ultrasound exam k transpl w/doppler
|
$405.00 |
$405.00 |
$405.00 |
$494.00
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$306.00 |
$306.00 |
$306.00 |
$428.68
|
|
Ultrasound guidance for vascular access
|
$333.60 |
$333.60 |
$333.60 |
$300.00
|
|
Ultrasound guided needle placement supervision & interpretation
|
$324.60 |
$324.60 |
$324.60 |
$629.64
|
|
Ultrasound guide intraoperative
|
$568.20 |
$568.20 |
$568.20 |
$628.80
|
|
Ultrasound infant hips ltd without stress
|
$112.80 |
$112.80 |
$112.80 |
$311.25
|
|
Ultrasound joint complete left
|
$334.80 |
$334.80 |
$334.80 |
$534.00
|
|
Ultrasound joint/nonvascular extremity limited left
|
$281.40 |
$281.40 |
$281.40 |
$426.60
|
|
Ultrasound ob >=14wks ea addl gest
|
$350.40 |
$350.40 |
$350.40 |
$431.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$298.20 |
$298.20 |
$298.20 |
$304.80
|
|
Ultrasound pregnant uterus follow up per fetus
|
$301.80 |
$301.80 |
$301.80 |
$393.32
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$293.40 |
$293.40 |
$293.40 |
$434.20
|
|
Ultrasound pregnant uterus transvaginal
|
$330.60 |
$330.60 |
$330.60 |
$477.10
|
|
Ultrasound retroperitoneal limited
|
$239.40 |
$239.40 |
$239.40 |
$469.58
|
|
Ultrasound scrotum and contents
|
$382.20 |
$382.20 |
$382.20 |
$558.03
|
|
Ultrasound spinal canal and contents
|
$324.60 |
$324.60 |
$324.60 |
$415.00
|
|
Ultrasound transvaginal non obstetric
|
$330.60 |
$330.60 |
$330.60 |
$523.20
|
|
Unlisted chemotherapy px
|
$101.40 |
$101.40 |
$101.40 |
$197.60
|
|
Unlisted dx gi procedure
|
$1,780.20 |
$1,780.20 |
$1,780.20 |
$613.20
|
|
Unlisted mr procedure
|
$582.60 |
$582.60 |
$582.60 |
$1,249.50
|
|
Unlisted orl service/px
|
$34.80 |
$34.80 |
$34.80 |
$153.60
|
|
Unlisted px casting/strpg
|
$81.60 |
$81.60 |
$81.60 |
$223.45
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$582.60 |
$582.60 |
$582.60 |
$2,590.50
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$582.60 |
$582.60 |
$582.60 |
$2,001.87
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$582.60 |
$582.60 |
$582.60 |
$1,794.00
|
|
Urea nitrogen
|
$80.40 |
$80.40 |
$80.40 |
$38.25
|
|
Urea nitrogen 24 hour urine
|
$101.40 |
$101.40 |
$101.40 |
$42.90
|
|
Ureteral reflux study
|
$720.60 |
$720.60 |
$720.60 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$258.00 |
$258.00 |
$258.00 |
$554.28
|
|
Urethrocystography void s&i
|
$258.00 |
$258.00 |
$258.00 |
$586.50
|
|
Uric acid blood
|
$109.20 |
$109.20 |
$109.20 |
$44.00
|
|
Uric acid urine
|
$125.40 |
$125.40 |
$125.40 |
$43.20
|
|
Urinalysis microscopic only
|
$72.00 |
$72.00 |
$72.00 |
$25.72
|
|
Urinalysis (with microscopy)
|
$49.80 |
$49.80 |
$49.80 |
$37.39
|
|
Urinalysis (without microscopy)
|
$69.60 |
$69.60 |
$69.60 |
$33.00
|
|
Urinary bldr retent nuc study
|
$403.80 |
$403.80 |
$403.80 |
$309.22
|
|
Urine Culture Test
|
$123.00 |
$123.00 |
$123.00 |
$63.84
|
|
Urine pregnancy test
|
$120.00 |
$120.00 |
$120.00 |
$57.00
|
|
Urography, antegrade
|
$351.00 |
$351.00 |
$351.00 |
$593.37
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$4,413.80 |
$4,413.80 |
$4,413.80 |
$8,225.22
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$42,196.74 |
$42,196.74 |
$42,196.74 |
$89,537.92
|
|
Vaccine dtap < 7 years im
|
$49.35 |
$49.35 |
$49.35 |
$66.69
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$52.77 |
$52.77 |
$52.77 |
$70.53
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$48.82 |
$48.82 |
$48.82 |
$39.78
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$55.28 |
$55.28 |
$55.28 |
$84.38
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$175.91 |
$175.91 |
$175.91 |
$162.07
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$45.91 |
$45.91 |
$45.91 |
$75.39
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$179.55 |
$179.55 |
$179.55 |
$130.67
|
|
Vaccine influenza inactivated adjuvant im
|
$34.61 |
$34.61 |
$34.61 |
$81.00
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$47.88 |
$47.88 |
$47.88 |
$47.38
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$47.65 |
$47.65 |
$47.65 |
$26.40
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$49.02 |
$49.02 |
$49.02 |
$29.60
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$53.06 |
$53.06 |
$53.06 |
$72.00
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$329.24 |
$329.24 |
$329.24 |
$321.80
|
|
Vaccine mmr live subcutaneous
|
$417.25 |
$417.25 |
$417.25 |
$222.36
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$166.40 |
$166.40 |
$166.40 |
$195.69
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$429.30 |
$429.30 |
$429.30 |
$393.25
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$633.56 |
$633.56 |
$633.56 |
$579.50
|
|
Vaccine polio (ipv) subcutaneous/im
|
$119.17 |
$119.17 |
$119.17 |
$100.00
|
|
Vaccine rabies im
|
$659.39 |
$659.39 |
$659.39 |
$800.00
|
|
Vaccine tdap >=7 years im
|
$122.69 |
$122.69 |
$122.69 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$120.13 |
$120.13 |
$120.13 |
$112.10
|
|
Vaccine varicella live subcutaneous
|
$313.70 |
$313.70 |
$313.70 |
$434.73
|
|
Valproic acid total therapeutic drug level
|
$274.20 |
$274.20 |
$274.20 |
$100.80
|
|
Valrubicin injection
|
$2,929.63 |
$2,929.63 |
$2,929.63 |
$2,929.63
|
|
Vancomycin peak therapeutic drug level
|
$304.80 |
$304.80 |
$304.80 |
$116.00
|
|
Varicella zoster antibody igg
|
$136.80 |
$136.80 |
$136.80 |
$90.35
|
|
Vasopressin 20 unit/ml intravenous solution
|
$543.52 |
$543.52 |
$543.52 |
$330.41
|
|
Vedolizumab 300 mg intravenous solution
|
$46.29 |
$46.29 |
$46.29 |
$22,019.50
|
|
Veeg ea 12-26hr cont mntr
|
$2,119.80 |
$2,119.80 |
$2,119.80 |
$3,447.00
|
|
Vein x-ray kidney
|
$1,419.60 |
$1,419.60 |
$1,419.60 |
$2,600.00
|
|
Vein x-ray liver
|
$2,266.80 |
$2,266.80 |
$2,266.80 |
$2,740.00
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$288.00 |
$288.00 |
$288.00 |
$123.00
|
|
Venipuncture <3 yrs other vein
|
$129.60 |
$129.60 |
$129.60 |
$46.80
|
|
Venogram ext bil s&i
|
$1,146.60 |
$1,146.60 |
$1,146.60 |
$1,697.72
|
|
Venogram extremity supervision & interpretation unilateral
|
$607.20 |
$607.20 |
$607.20 |
$1,270.23
|
|
Ventilator each subsequent day
|
$1,497.00 |
$1,497.00 |
$1,497.00 |
$1,138.50
|
|
Ventilator initial day
|
$1,665.00 |
$1,665.00 |
$1,665.00 |
$1,331.00
|
|
Version cephalic external
|
$1,138.80 |
$1,138.80 |
$1,138.80 |
$2,361.75
|
