|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$133.28 |
$133.28 |
$133.28 |
$197.60
|
|
Treatment radiation delivery level 2
|
$273.84 |
$273.84 |
$273.84 |
$737.25
|
|
Treponema pallidum antibody
|
$22.96 |
$22.96 |
$22.96 |
$74.40
|
|
Trichinella antibody
|
$24.46 |
$24.46 |
$24.46 |
$56.55
|
|
Triglycerides
|
$25.20 |
$25.20 |
$25.20 |
$48.75
|
|
Trim nail(s)
|
$70.56 |
$70.56 |
$70.56 |
$91.77
|
|
Trim nondyst nails
|
$74.48 |
$74.48 |
$74.48 |
$124.22
|
|
Trnscath plc stent crv crtd without prtct
|
$4,030.88 |
$4,030.88 |
$4,030.88 |
$7,944.75
|
|
Trnscath plc stent crv crtd w/prtct
|
$5,995.36 |
$5,995.36 |
$5,995.36 |
$9,767.25
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$9,485.28 |
$9,485.28 |
$9,485.28 |
$9,418.42
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$9,485.28 |
$9,485.28 |
$9,485.28 |
$9,565.92
|
|
Trnscath plc vas stent w/s&i ini vein
|
$16,186.80 |
$16,186.80 |
$16,186.80 |
$15,873.70
|
|
Trnscath retrv pq vasc fb w/guide
|
$6,812.96 |
$6,812.96 |
$6,812.96 |
$5,555.55
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$7,897.12 |
$7,897.12 |
$7,897.12 |
$6,354.94
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$6,960.80 |
$6,960.80 |
$6,960.80 |
$4,770.98
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$2,977.52 |
$2,977.52 |
$2,977.52 |
$5,324.40
|
|
Trnscath tx thromblytc vein ini day
|
$7,897.12 |
$7,897.12 |
$7,897.12 |
$4,201.80
|
|
Troponin quantitative
|
$53.20 |
$53.20 |
$53.20 |
$112.80
|
|
Tte w or without contr, cont ecg
|
$1,237.04 |
$1,237.04 |
$1,237.04 |
$1,613.95
|
|
Tte w or without fol w/con,stres
|
$1,172.08 |
$1,172.08 |
$1,172.08 |
$1,108.76
|
|
Tube trach disp innr can 5 xlt
|
$105.84 |
$105.84 |
$105.84 |
$416.99
|
|
Tube trach fen sz 6 uncuffed
|
$99.12 |
$99.12 |
$99.12 |
$132.40
|
|
Tx atrial fib pulm vein isol
|
$20,889.68 |
$20,889.68 |
$20,889.68 |
$32,426.20
|
|
Tx l/r atrial fib addl
|
$4,085.76 |
$4,085.76 |
$4,085.76 |
$6,986.85
|
|
Ultrasound abdomen aorta screening study aaa
|
$129.36 |
$129.36 |
$129.36 |
$394.20
|
|
Ultrasound breast complete
|
$705.60 |
$705.60 |
$705.60 |
$519.20
|
|
Ultrasound breast unilateral limited (both sides)
|
$611.52 |
$611.52 |
$611.52 |
$427.00
|
|
Ultrasound chest
|
$84.56 |
$84.56 |
$84.56 |
$430.10
|
|
Ultrasound guidance for vascular access
|
$43.68 |
$43.68 |
$43.68 |
$300.00
|
|
Ultrasound guided needle placement supervision & interpretation
|
$199.36 |
$199.36 |
$199.36 |
$629.64
|
|
Ultrasound guide intraoperative
|
$180.32 |
$180.32 |
$180.32 |
$628.80
|
|
Ultrasound joint complete left
|
$1,008.56 |
$1,008.56 |
$1,008.56 |
$534.00
|
|
Ultrasound joint/nonvascular extremity limited left
|
$901.60 |
$901.60 |
$901.60 |
$426.60
|
|
Ultrasound ob >=14wks ea addl gest
|
$260.96 |
$260.96 |
$260.96 |
$431.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$61.04 |
$61.04 |
$61.04 |
$304.80
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$725.20 |
$725.20 |
$725.20 |
$680.71
|
|
Ultrasound pregnant uterus follow up per fetus
|
$197.12 |
$197.12 |
$197.12 |
$393.32
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$347.20 |
$347.20 |
$347.20 |
$434.20
|
|
Ultrasound pregnant uterus transvaginal
|
$304.64 |
$304.64 |
$304.64 |
$477.10
|
|
Ultrasound prostate/transrectal
|
$325.36 |
$325.36 |
$325.36 |
$515.63
|
|
Ultrasound retroperitoneal limited
|
$211.12 |
$211.12 |
$211.12 |
$469.58
|
|
Ultrasound scrotum and contents
|
$372.40 |
$372.40 |
$372.40 |
$558.03
|
|
Ultrasound transabd ea addl gest
|
$565.04 |
$565.04 |
$565.04 |
$424.80
|
|
Ultrasound transvaginal non obstetric
|
$125.44 |
$125.44 |
$125.44 |
$523.20
|
|
Unlisted reprod med lab proc
|
$58.86 |
$58.86 |
$58.86 |
$67.63
|
|
Unsched dialysis esrd pt hos
|
$855.68 |
$855.68 |
$855.68 |
$980.20
|
|
Upgrade pm system
|
$13,825.84 |
$13,825.84 |
$13,825.84 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,972.32 |
$1,972.32 |
$1,972.32 |
$2,590.50
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,726.48 |
$1,726.48 |
$1,726.48 |
$2,001.87
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,480.08 |
$1,480.08 |
$1,480.08 |
$1,794.00
|
|
Urea nitrogen
|
$12.45 |
$12.45 |
$12.45 |
$38.25
|
|
Urea nitrogen 24 hour urine
|
$13.44 |
$13.44 |
$13.44 |
$42.90
|
|
Urea nitrogen clearance
|
$30.24 |
$30.24 |
$30.24 |
$33.57
|
|
Urethrcystgrphy rtrgrde s&i
|
$222.32 |
$222.32 |
$222.32 |
$554.28
|
|
Urethrocystography void s&i
|
$248.08 |
$248.08 |
$248.08 |
$586.50
|
|
Uric acid blood
|
$17.92 |
$17.92 |
$17.92 |
$44.00
|
|
Uric acid urine
|
$12.88 |
$12.88 |
$12.88 |
$43.20
|
|
Urinalysis microscopic only
|
$9.52 |
$9.52 |
$9.52 |
$25.72
|
|
Urinalysis qual/semiquant excpt ia
|
$8.96 |
$8.96 |
$8.96 |
$22.75
|
|
Urinalysis (with microscopy)
|
$11.20 |
$11.20 |
$11.20 |
$37.39
|
|
Urinalysis (without microscopy)
|
$9.52 |
$9.52 |
$9.52 |
$33.00
|
|
Urine Culture Test
|
$35.84 |
$35.84 |
$35.84 |
$63.84
|
|
Urine pregnancy test
|
$38.64 |
$38.64 |
$38.64 |
$57.00
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$254.91 |
$254.91 |
$254.91 |
$321.80
|
|
Vaccine rabies im
|
$183.96 |
$183.96 |
$183.96 |
$800.00
|
|
Vaginal bx
|
$220.64 |
$220.64 |
$220.64 |
$2,603.25
|
|
Valproic acid total therapeutic drug level
|
$46.48 |
$46.48 |
$46.48 |
$100.80
|
|
Valvuloplasty aortic
|
$5,434.24 |
$5,434.24 |
$5,434.24 |
$7,826.12
|
|
Valvuloplasty mitral
|
$10,165.68 |
$10,165.68 |
$10,165.68 |
$10,435.39
|
|
Vancomycin peak therapeutic drug level
|
$78.40 |
$78.40 |
$78.40 |
$116.00
|
|
Varicella zoster antibody igg
|
$30.24 |
$30.24 |
$30.24 |
$90.35
|
|
Vedolizumab 300 mg intravenous solution
|
$14.59 |
$14.59 |
$14.59 |
$22,019.50
|
|
Vein x-ray kidney
|
$1,131.20 |
$1,131.20 |
$1,131.20 |
$2,600.00
|
|
Vein x-ray liver w/hemodynam
|
$784.00 |
$784.00 |
$784.00 |
$2,669.10
|
|
Vein x-ray liver without hemodyn
|
$1,070.72 |
$1,070.72 |
$1,070.72 |
$2,015.91
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$59.36 |
$59.36 |
$59.36 |
$123.00
|
|
Venogram ext bil s&i
|
$1,201.76 |
$1,201.76 |
$1,201.76 |
$1,697.72
|
|
Venogram extremity supervision & interpretation unilateral
|
$600.88 |
$600.88 |
$600.88 |
$1,270.23
|
|
Venous mech thrombectomy
|
$5,711.44 |
$5,711.44 |
$5,711.44 |
$9,059.31
|
|
Ventilator each subsequent day
|
$1,305.92 |
$1,305.92 |
$1,305.92 |
$1,138.50
|
|
Ventilator initial day
|
$1,305.92 |
$1,305.92 |
$1,305.92 |
$1,331.00
|
|
Very long chain fatty acids
|
$56.64 |
$56.64 |
$56.64 |
$157.30
|
|
Vinblastine 1 mg/ml intravenous solution
|
$3.16 |
$3.16 |
$3.16 |
$159.60
|
|
Vincristine 1 mg/ml intravenous solution
|
$35.62 |
$35.62 |
$35.62 |
$52.02
|
|
Visit established high 40-54 minutes/level 5
|
$189.28 |
$189.28 |
$189.28 |
$186.60
|
|
Vital capacity test
|
$64.40 |
$64.40 |
$64.40 |
$170.00
|
|
Vitamin b-12
|
$37.52 |
$37.52 |
$37.52 |
$89.70
|
|
Vitamin D Test
|
$48.16 |
$48.16 |
$48.16 |
$132.60
|
|
Voriconazole in ns IV syringe 5 mg/ml (pediatric) - cnr
|
$4.47 |
$4.47 |
$4.47 |
$59.11
|
|
Warde 1005020 citrate 24 hour urine
|
$35.84 |
$35.84 |
$35.84 |
$113.75
|
|
Warde 1005055 5-hiaa 24 hour urine
|
$16.80 |
$16.80 |
$16.80 |
$72.50
|
|
Warde 1007138 vanillymandelic acid 24 hour urine
|
$20.16 |
$20.16 |
$20.16 |
$83.06
|
|
Warde 3004000 immunoglobulin subclass 1
|
$54.88 |
$54.88 |
$54.88 |
$51.20
|
|
Warde 3008005 oligoclonal bands
|
$72.80 |
$72.80 |
$72.80 |
$117.13
|
|
Warde 3016000 west nile virus antibody
|
$21.84 |
$21.84 |
$21.84 |
$78.65
|
|
Warde 3016000 west nile virus antibody igg
|
$18.48 |
$18.48 |
$18.48 |
$78.00
|
|
Warde 3016300 saccharomyces cerevisiae iga antibody
|
$27.44 |
$27.44 |
$27.44 |
$70.85
|
|
Warde 3400652 ova & parasites direct smear concentration and id
|
$71.68 |
$71.68 |
$71.68 |
$60.00
|
|
Warde 3400652 smear complex special stain ova/parasites
|
$101.36 |
$101.36 |
$101.36 |
$79.30
|
|
Warde 3400852 arsenic
|
$117.60 |
$117.60 |
$117.60 |
$107.38
|
