|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$3,801.95 |
$3,801.95 |
$3,801.95 |
$2,423.00
|
|
Troponin quantitative
|
$109.20 |
$109.20 |
$109.20 |
$127.60
|
|
Tx closed distal humerus fx
|
$3,038.35 |
$3,038.35 |
$3,038.35 |
$594.88
|
|
Tx closed hip disl traumatic without anes
|
$1,585.20 |
$1,585.20 |
$1,585.20 |
$586.40
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$9,684.15 |
$9,684.15 |
$9,684.15 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$1,083.85 |
$1,083.85 |
$1,083.85 |
$535.60
|
|
Ua w/micro/comp poc
|
$36.40 |
$36.40 |
$36.40 |
$23.00
|
|
Ugt1a1 gene analy common variants
|
$1,460.15 |
$1,460.15 |
$1,460.15 |
$438.75
|
|
Ultrasound breast complete
|
$385.55 |
$385.55 |
$385.55 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$498.80 |
$498.80 |
$498.80 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$223.80 |
$223.80 |
$223.80 |
$338.00
|
|
Ultrasound elastography ea l target les
|
$455.60 |
$455.60 |
$455.60 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$455.60 |
$455.60 |
$455.60 |
$313.95
|
|
Ultrasound encephalogram
|
$356.15 |
$356.15 |
$356.15 |
$494.92
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$409.80 |
$409.80 |
$409.80 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$900.50 |
$900.50 |
$900.50 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$157.70 |
$157.70 |
$157.70 |
$388.08
|
|
Ultrasound guide intraoperative
|
$972.45 |
$972.45 |
$972.45 |
$632.85
|
|
Ultrasound hips infant dynamic
|
$461.00 |
$461.00 |
$461.00 |
$403.88
|
|
Ultrasound joint complete left
|
$429.00 |
$429.00 |
$429.00 |
$557.99
|
|
Ultrasound ob >=14wks ea addl gest
|
$393.65 |
$393.65 |
$393.65 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$244.00 |
$244.00 |
$244.00 |
$334.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$461.00 |
$461.00 |
$461.00 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$363.40 |
$363.40 |
$363.40 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$505.50 |
$505.50 |
$505.50 |
$463.00
|
|
Unlisted chemotherapy px
|
$404.30 |
$404.30 |
$404.30 |
$149.15
|
|
Unlisted mr procedure
|
$3,839.85 |
$3,839.85 |
$3,839.85 |
$1,165.00
|
|
Unlisted px pelvis/hip joint
|
$353.00 |
$353.00 |
$353.00 |
$3,251.90
|
|
Unlisted px small intestine
|
$2,738.40 |
$2,738.40 |
$2,738.40 |
$2,118.35
|
|
Upper Arm (Humerus) X-ray (left side)
|
$248.05 |
$248.05 |
$248.05 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$2,050.30 |
$2,050.30 |
$2,050.30 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,430.20 |
$1,430.20 |
$1,430.20 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,956.45 |
$3,956.45 |
$3,956.45 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,136.80 |
$3,136.80 |
$3,136.80 |
$2,369.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,554.55 |
$2,554.55 |
$2,554.55 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$273.70 |
$273.70 |
$273.70 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$330.25 |
$330.25 |
$330.25 |
$381.60
|
|
Upper GI Barium X-ray (barium and gas)
|
$1,064.90 |
$1,064.90 |
$1,064.90 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$644.60 |
$644.60 |
$644.60 |
$607.20
|
|
Urea nitrogen
|
$47.30 |
$47.30 |
$47.30 |
$42.25
|
|
Urea nitrogen 24 hour urine
|
$50.00 |
$50.00 |
$50.00 |
$52.00
|
|
Urea nitrogen clearance
|
$55.55 |
$55.55 |
$55.55 |
$38.35
|
|
Ureteral reflux study
|
$1,257.80 |
$1,257.80 |
$1,257.80 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$704.95 |
$704.95 |
$704.95 |
$584.00
|
|
Urethrocystography void s&i
|
$885.60 |
$885.60 |
$885.60 |
$631.40
|
|
Uric acid blood
|
$52.55 |
$52.55 |
$52.55 |
$49.44
|
|
Uric acid urine
|
$37.90 |
$37.90 |
$37.90 |
$45.36
|
|
Urinalysis microscopic only
|
$35.05 |
$35.05 |
$35.05 |
$26.46
|
|
Urinalysis (with microscopy)
|
$36.35 |
$36.35 |
$36.35 |
$55.20
|
|
Urinalysis (without microscopy)
|
$24.35 |
$24.35 |
$24.35 |
$36.00
|
|
Urine Culture Test
|
$91.60 |
$91.60 |
$91.60 |
$83.00
|
|
Urine pregnancy test
|
$60.20 |
$60.20 |
$60.20 |
$68.78
|
|
Urography, antegrade
|
$618.75 |
$618.75 |
$618.75 |
$622.35
|
|
Use 1st target lesion
|
$455.60 |
$455.60 |
$455.60 |
$332.00
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$6,446.71 |
$6,446.71 |
$6,446.71 |
$5,205.00
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$88,661.26 |
$88,661.26 |
$88,661.26 |
$51,633.07
|
|
Vaccine Administration (one shot)
|
$41.75 |
$41.75 |
$41.75 |
$67.70
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$160.00 |
$160.00 |
$160.00 |
$224.25
|
|
Vaccine hepatitis a (hepa) adult im
|
$436.70 |
$436.70 |
$436.70 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$604.17 |
$604.17 |
$604.17 |
$231.56
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$366.19 |
$366.19 |
$366.19 |
$75.39
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$371.88 |
$371.88 |
$371.88 |
$149.21
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$110.02 |
$110.02 |
$110.02 |
$48.59
|
|
Vaccine mmr live subcutaneous
|
$482.58 |
$482.58 |
$482.58 |
$213.00
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$1,292.04 |
$1,292.04 |
$1,292.04 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$204.08 |
$204.08 |
$204.08 |
$90.70
|
|
Vaccine rabies im
|
$2,058.24 |
$2,058.24 |
$2,058.24 |
$858.95
|
|
Vaginal bx
|
$760.00 |
$760.00 |
$760.00 |
$455.94
|
|
Valproic acid total therapeutic drug level
|
$148.30 |
$148.30 |
$148.30 |
$115.00
|
|
Vancomycin hcl injection
|
$172.35 |
$172.35 |
$172.35 |
$149.49
|
|
Vancomycin peak therapeutic drug level
|
$148.30 |
$148.30 |
$148.30 |
$136.13
|
|
Varicella zoster antibody igg
|
$148.10 |
$148.10 |
$148.10 |
$86.80
|
|
Vasopressin 20 unit/ml intravenous solution
|
$111.52 |
$111.52 |
$111.52 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$28,467.24 |
$28,467.24 |
$28,467.24 |
$18,732.33
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$284.40 |
$284.40 |
$284.40 |
$188.83
|
|
Venipuncture <3 yrs other vein
|
$155.00 |
$155.00 |
$155.00 |
$67.00
|
|
Ventilator each subsequent day
|
$3,864.75 |
$3,864.75 |
$3,864.75 |
$1,184.00
|
|
Ventilator Management (first day)
|
$5,747.90 |
$5,747.90 |
$5,747.90 |
$1,434.60
|
|
Ventricular puncture prev burr hole without inj 61020
|
$2,483.55 |
$2,483.55 |
$2,483.55 |
$1,314.30
|
|
Version cephalic external
|
$8,572.80 |
$8,572.80 |
$8,572.80 |
$2,361.75
|
|
Video Swallow Study (Modified Barium Swallow)
|
$744.10 |
$744.10 |
$744.10 |
$524.50
|
|
Vinblastine 1 mg/ml intravenous solution
|
$272.51 |
$272.51 |
$272.51 |
$165.00
|
|
Vincristine 1 mg/ml intravenous solution
|
$197.95 |
$197.95 |
$197.95 |
$87.15
|
|
Vital capacity test
|
$180.65 |
$180.65 |
$180.65 |
$173.18
|
|
Vitamin b-12
|
$164.40 |
$164.40 |
$164.40 |
$100.28
|
|
Vitamin D Test
|
$319.65 |
$319.65 |
$319.65 |
$132.00
|
|
Walking (Gait) Training (each 15 minutes)
|
$141.55 |
$141.55 |
$141.55 |
$87.50
|
|
Warde 1003990 aldosterone
|
$328.80 |
$328.80 |
$328.80 |
$144.73
|
|
Warde 1005020 citrate 24 hour urine
|
$198.30 |
$198.30 |
$198.30 |
$100.10
|
|
Warde 1005055 5-hiaa 24 hour urine
|
$124.80 |
$124.80 |
$124.80 |
$64.08
|
|
Warde 1006955 catecholamines fractionated 24 hour urine
|
$241.25 |
$241.25 |
$241.25 |
$113.10
|
|
Warde 1007138 vanillymandelic acid 24 hour urine
|
$150.95 |
$150.95 |
$150.95 |
$70.85
|
|
Warde 1015200 kappa light chain free
|
$111.65 |
$111.65 |
$111.65 |
$65.20
|
|
Warde 3004000 immunoglobulin subclass 1
|
$39.20 |
$39.20 |
$39.20 |
$39.36
|
|
Warde 3008005 oligoclonal bands
|
$193.70 |
$193.70 |
$193.70 |
$108.50
|
|
Warde 3016000 west nile virus antibody
|
$120.15 |
$120.15 |
$120.15 |
$71.60
|
|
Warde 3016000 west nile virus antibody igg
|
$102.65 |
$102.65 |
$102.65 |
$70.74
|
|
Warde 3400652 ova & parasites direct smear concentration and id
|
$80.05 |
$80.05 |
$80.05 |
$62.50
|
|
Warde 3400652 smear complex special stain ova/parasites
|
$98.40 |
$98.40 |
$98.40 |
$73.60
|
|
Warde 3400852 arsenic
|
$183.05 |
$183.05 |
$183.05 |
$101.00
|