|
Troponin quantitative
|
$679.25 |
$679.25 |
$679.25 |
$127.60
|
|
Tube drain vert dev st 5-40f
|
$17.68 |
$17.68 |
$17.68 |
$27.60
|
|
Tube trach disp innr can 5 xlt
|
$425.24 |
$425.24 |
$425.24 |
$445.99
|
|
Tube trach disp innr can 6 xlt
|
$2.78 |
$2.78 |
$2.78 |
$16.80
|
|
Tube trach fen sz 6 uncuffed
|
$128.15 |
$128.15 |
$128.15 |
$160.88
|
|
Tx closed tib shaft fx without manip
|
$1,137.00 |
$1,137.00 |
$1,137.00 |
$535.60
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$1,752.00 |
$1,752.00 |
$1,752.00 |
$4,499.12
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$2,066.00 |
$2,066.00 |
$2,066.00 |
$4,637.36
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$944.00 |
$944.00 |
$944.00 |
$911.43
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$35,496.45 |
$35,496.45 |
$35,496.45 |
$21,992.26
|
|
Ultrasound breast unilateral limited (both sides)
|
$553.15 |
$553.15 |
$553.15 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$284.70 |
$284.70 |
$284.70 |
$338.00
|
|
Ultrasound encephalogram
|
$329.55 |
$329.55 |
$329.55 |
$494.92
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$466.70 |
$466.70 |
$466.70 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$2,284.75 |
$2,284.75 |
$2,284.75 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$2,489.62 |
$2,489.62 |
$2,489.62 |
$388.08
|
|
Ultrasound hips infant dynamic
|
$391.30 |
$391.30 |
$391.30 |
$403.88
|
|
Ultrasound joint complete left
|
$825.50 |
$825.50 |
$825.50 |
$557.99
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$234.65 |
$234.65 |
$234.65 |
$334.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$326.30 |
$326.30 |
$326.30 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$570.00 |
$570.00 |
$570.00 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$385.45 |
$385.45 |
$385.45 |
$463.00
|
|
Unit mobile power mpu
|
$11,821.68 |
$11,821.68 |
$11,821.68 |
$14,359.52
|
|
Unlisted chemotherapy px
|
$85.80 |
$85.80 |
$85.80 |
$149.15
|
|
Unlisted dialysis procedure
|
$33,066.51 |
$33,066.51 |
$33,066.51 |
$1,144.00
|
|
Unlisted procedure microbiology
|
$507.00 |
$507.00 |
$507.00 |
$530.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$269.10 |
$269.10 |
$269.10 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$1,623.05 |
$1,623.05 |
$1,623.05 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$2,057.25 |
$2,057.25 |
$2,057.25 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,595.15 |
$3,595.15 |
$3,595.15 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,717.65 |
$2,717.65 |
$2,717.65 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$874.25 |
$874.25 |
$874.25 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$418.60 |
$418.60 |
$418.60 |
$381.60
|
|
Upper Endoscopy (EGD, diagnostic)
|
$10,152.54 |
$10,152.54 |
$10,152.54 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$11,677.09 |
$11,677.09 |
$11,677.09 |
$1,768.00
|
|
Upper GI Barium X-ray (barium and gas)
|
$627.25 |
$627.25 |
$627.25 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$496.60 |
$496.60 |
$496.60 |
$607.20
|
|
Urea nitrogen
|
$29.25 |
$29.25 |
$29.25 |
$42.25
|
|
Urea nitrogen 24 hour urine
|
$66.95 |
$66.95 |
$66.95 |
$52.00
|
|
Urethrcystgrphy rtrgrde s&i
|
$787.80 |
$787.80 |
$787.80 |
$584.00
|
|
Uric acid blood
|
$45.50 |
$45.50 |
$45.50 |
$49.44
|
|
Uric acid urine
|
$163.15 |
$163.15 |
$163.15 |
$45.36
|
|
Urinalysis microscopic only
|
$48.75 |
$48.75 |
$48.75 |
$26.46
|
|
Urinalysis (with microscopy)
|
$406.90 |
$406.90 |
$406.90 |
$55.20
|
|
Urinalysis (without microscopy)
|
$46.15 |
$46.15 |
$46.15 |
$36.00
|
|
Urine Culture Test
|
$411.45 |
$411.45 |
$411.45 |
$83.00
|
|
Urine pregnancy test
|
$36.40 |
$36.40 |
$36.40 |
$68.78
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$6,677.00 |
$6,677.00 |
$6,677.00 |
$5,205.00
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$45,913.60 |
$45,913.60 |
$45,913.60 |
$51,633.07
|
|
Vaccine Administration (one shot)
|
$39.65 |
$39.65 |
$39.65 |
$67.70
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$286.65 |
$286.65 |
$286.65 |
$224.25
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$559.65 |
$559.65 |
$559.65 |
$209.40
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$103.35 |
$103.35 |
$103.35 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$68.90 |
$68.90 |
$68.90 |
$123.20
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$52.00 |
$52.00 |
$52.00 |
$80.15
|
|
Vaccine dtap < 7 years im
|
$142.05 |
$142.05 |
$142.05 |
$71.17
|
|
Vaccine dtap-hep b-ipv im
|
$513.00 |
$513.00 |
$513.00 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$301.15 |
$301.15 |
$301.15 |
$105.95
|
|
Vaccine dtap-ipv-hib-hepb im
|
$135.20 |
$135.20 |
$135.20 |
$174.72
|
|
Vaccine dtap-ipv/hib im
|
$103.35 |
$103.35 |
$103.35 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$39.00 |
$39.00 |
$39.00 |
$70.53
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$62.60 |
$62.60 |
$62.60 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$412.25 |
$412.25 |
$412.25 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$124.80 |
$124.80 |
$124.80 |
$231.56
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$185.55 |
$185.55 |
$185.55 |
$78.25
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 3 dose im
|
$48.10 |
$48.10 |
$48.10 |
$57.20
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$57.20 |
$57.20 |
$57.20 |
$90.35
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$33,066.51 |
$33,066.51 |
$33,066.51 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$326.30 |
$326.30 |
$326.30 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$138.80 |
$138.80 |
$138.80 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$1,547.80 |
$1,547.80 |
$1,547.80 |
$576.48
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$226.20 |
$226.20 |
$226.20 |
$282.50
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$149.50 |
$149.50 |
$149.50 |
$149.21
|
|
Vaccine influenza inactivated adjuvant im
|
$303.40 |
$303.40 |
$303.40 |
$110.25
|
|
Vaccine influenza nos 0.5ml dose im
|
$21.45 |
$21.45 |
$21.45 |
$24.20
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$102.45 |
$102.45 |
$102.45 |
$48.59
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$42.90 |
$42.90 |
$42.90 |
$35.88
|
|
Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im
|
$157.95 |
$157.95 |
$157.95 |
$72.80
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$20.80 |
$20.80 |
$20.80 |
$28.77
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$45.50 |
$45.50 |
$45.50 |
$33.60
|
|
Vaccine influenza quadrivalent (iiv4) split virus 0.25 ml im
|
$22.10 |
$22.10 |
$22.10 |
$20.80
|
|
Vaccine influenza quadrivalent live (laiv4) intranasal
|
$56.55 |
$56.55 |
$56.55 |
$37.05
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$149.50 |
$149.50 |
$149.50 |
$72.00
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$524.55 |
$524.55 |
$524.55 |
$82.71
|
|
Vaccine influenza trivalent (iiv3) 0.25ml dose im
|
$32.50 |
$32.50 |
$32.50 |
$27.45
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$1,156.10 |
$1,156.10 |
$1,156.10 |
$394.26
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$169.00 |
$169.00 |
$169.00 |
$409.35
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$149.50 |
$149.50 |
$149.50 |
$310.93
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$813.00 |
$813.00 |
$813.00 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$466.05 |
$466.05 |
$466.05 |
$213.00
|
|
Vaccine mmrv live subcutaneous
|
$1,445.85 |
$1,445.85 |
$1,445.85 |
$424.32
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$556.15 |
$556.15 |
$556.15 |
$252.87
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$524.55 |
$524.55 |
$524.55 |
$397.11
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$501.15 |
$501.15 |
$501.15 |
$414.46
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$1,376.55 |
$1,376.55 |
$1,376.55 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$220.20 |
$220.20 |
$220.20 |
$90.70
|
|
Vaccine rabies im
|
$1,998.80 |
$1,998.80 |
$1,998.80 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$1,467.45 |
$1,467.45 |
$1,467.45 |
$538.84
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$2,736.70 |
$2,736.70 |
$2,736.70 |
$1,105.21
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$2,736.70 |
$2,736.70 |
$2,736.70 |
$1,031.86
|