|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$192.00 |
$192.00 |
$192.00 |
$147.48
|
|
Treatment of ankle fracture 27786
|
$588.80 |
$588.80 |
$588.80 |
$523.20
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$39,468.14 |
$39,468.14 |
$39,468.14 |
$73,346.25
|
|
Treponema pallidum antibody
|
$66.40 |
$66.40 |
$66.40 |
$72.05
|
|
Trg gene rearrangement anal
|
$492.00 |
$492.00 |
$492.00 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$41.57 |
$41.57 |
$41.57 |
$43.09
|
|
Triglycerides
|
$149.60 |
$149.60 |
$149.60 |
$58.50
|
|
Trim nondyst nails
|
$112.00 |
$112.00 |
$112.00 |
$113.88
|
|
Troponin quantitative
|
$116.80 |
$116.80 |
$116.80 |
$127.60
|
|
Tte w or without contr, cont ecg
|
$2,420.00 |
$2,420.00 |
$2,420.00 |
$2,067.00
|
|
Tte w or without fol w/con,stres
|
$2,511.20 |
$2,511.20 |
$2,511.20 |
$1,632.80
|
|
Tx closed hip disl traumatic without anes
|
$586.40 |
$586.40 |
$586.40 |
$586.40
|
|
Ua w/micro/comp poc
|
$50.40 |
$50.40 |
$50.40 |
$23.00
|
|
Ultrasound breast complete
|
$480.00 |
$480.00 |
$480.00 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$496.80 |
$496.80 |
$496.80 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$511.20 |
$511.20 |
$511.20 |
$338.00
|
|
Ultrasound elastography parenchyma
|
$241.60 |
$241.60 |
$241.60 |
$313.95
|
|
Ultrasound encephalogram
|
$481.60 |
$481.60 |
$481.60 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$658.40 |
$658.40 |
$658.40 |
$578.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$624.00 |
$624.00 |
$624.00 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$765.60 |
$765.60 |
$765.60 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$540.00 |
$540.00 |
$540.00 |
$388.08
|
|
Ultrasound guide intraoperative
|
$1,037.60 |
$1,037.60 |
$1,037.60 |
$632.85
|
|
Ultrasound hips infant dynamic
|
$453.60 |
$453.60 |
$453.60 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$620.80 |
$620.80 |
$620.80 |
$311.25
|
|
Ultrasound joint complete left
|
$696.00 |
$696.00 |
$696.00 |
$557.99
|
|
Ultrasound ob >=14wks ea addl gest
|
$554.40 |
$554.40 |
$554.40 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$502.40 |
$502.40 |
$502.40 |
$334.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$988.80 |
$988.80 |
$988.80 |
$698.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$524.80 |
$524.80 |
$524.80 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$656.00 |
$656.00 |
$656.00 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$521.60 |
$521.60 |
$521.60 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$580.00 |
$580.00 |
$580.00 |
$419.50
|
|
Unlisted chemotherapy px
|
$178.40 |
$178.40 |
$178.40 |
$149.15
|
|
Unlisted cranfcl&maxlfcl px
|
$4,292.00 |
$4,292.00 |
$4,292.00 |
$571.20
|
|
Unlisted procedure rectum
|
$1,292.80 |
$1,292.80 |
$1,292.80 |
$1,223.20
|
|
Unlisted px ant segment eye
|
$2,442.40 |
$2,442.40 |
$2,442.40 |
$2,698.92
|
|
Unlisted px small intestine
|
$2,814.40 |
$2,814.40 |
$2,814.40 |
$2,118.35
|
|
Unlisted reprod med lab proc
|
$66.40 |
$66.40 |
$66.40 |
$70.00
|
|
Unlisted transfusion med px
|
$484.80 |
$484.80 |
$484.80 |
$147.50
|
|
Upper Arm (Humerus) X-ray (left side)
|
$313.60 |
$313.60 |
$313.60 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$2,295.20 |
$2,295.20 |
$2,295.20 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$2,012.00 |
$2,012.00 |
$2,012.00 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,863.20 |
$3,863.20 |
$3,863.20 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,304.00 |
$3,304.00 |
$3,304.00 |
$2,369.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,707.20 |
$2,707.20 |
$2,707.20 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$334.40 |
$334.40 |
$334.40 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$366.40 |
$366.40 |
$366.40 |
$381.60
|
|
Upper Endoscopy (EGD, diagnostic)
|
$2,584.80 |
$2,584.80 |
$2,584.80 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$2,576.80 |
$2,576.80 |
$2,576.80 |
$1,768.00
|
|
Upper GI Barium X-ray (barium and gas)
|
$811.20 |
$811.20 |
$811.20 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$591.20 |
$591.20 |
$591.20 |
$607.20
|
|
Urea nitrogen
|
$45.60 |
$45.60 |
$45.60 |
$42.25
|
|
Urea nitrogen 24 hour urine
|
$69.60 |
$69.60 |
$69.60 |
$52.00
|
|
Ureteral reflux study
|
$1,333.60 |
$1,333.60 |
$1,333.60 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$785.60 |
$785.60 |
$785.60 |
$584.00
|
|
Urethrocystography void s&i
|
$722.40 |
$722.40 |
$722.40 |
$631.40
|
|
Uric acid blood
|
$40.80 |
$40.80 |
$40.80 |
$49.44
|
|
Uric acid urine
|
$53.60 |
$53.60 |
$53.60 |
$45.36
|
|
Urinalysis microscopic only
|
$38.40 |
$38.40 |
$38.40 |
$26.46
|
|
Urinalysis qual/semiquant excpt ia
|
$50.40 |
$50.40 |
$50.40 |
$25.72
|
|
Urinalysis (with microscopy)
|
$60.80 |
$60.80 |
$60.80 |
$55.20
|
|
Urinalysis (without microscopy)
|
$47.20 |
$47.20 |
$47.20 |
$36.00
|
|
Urinary bldr retent nuc study
|
$455.20 |
$455.20 |
$455.20 |
$350.66
|
|
Urine Culture Test
|
$92.00 |
$92.00 |
$92.00 |
$83.00
|
|
Urine pregnancy test
|
$30.40 |
$30.40 |
$30.40 |
$68.78
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$3,624.45 |
$3,624.45 |
$3,624.45 |
$5,205.00
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$35,620.92 |
$35,620.92 |
$35,620.92 |
$51,633.07
|
|
Vaccine Administration (one shot)
|
$92.80 |
$92.80 |
$92.80 |
$67.70
|
|
Vaccine dtap < 7 years im
|
$68.29 |
$68.29 |
$68.29 |
$71.17
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$190.85 |
$190.85 |
$190.85 |
$231.56
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$113.76 |
$113.76 |
$113.76 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$367.17 |
$367.17 |
$367.17 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$72.11 |
$72.11 |
$72.11 |
$75.39
|
|
Vaccine influenza inactivated adjuvant im
|
$58.24 |
$58.24 |
$58.24 |
$110.25
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$33.55 |
$33.55 |
$33.55 |
$82.71
|
|
Vaccine mmr live subcutaneous
|
$142.44 |
$142.44 |
$142.44 |
$213.00
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$271.97 |
$271.97 |
$271.97 |
$252.87
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$260.04 |
$260.04 |
$260.04 |
$397.11
|
|
Vaccine polio (ipv) subcutaneous/im
|
$271.12 |
$271.12 |
$271.12 |
$90.70
|
|
Vaccine rabies im
|
$963.04 |
$963.04 |
$963.04 |
$858.95
|
|
Vaccine tdap >=7 years im
|
$80.75 |
$80.75 |
$80.75 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$71.28 |
$71.28 |
$71.28 |
$112.10
|
|
Vaccine typhoid vicps im
|
$145.96 |
$145.96 |
$145.96 |
$264.78
|
|
Vaccine varicella live subcutaneous
|
$396.97 |
$396.97 |
$396.97 |
$365.17
|
|
Valproic acid total therapeutic drug level
|
$120.00 |
$120.00 |
$120.00 |
$115.00
|
|
Vancomycin 1,000 mg intravenous injection
|
$74.84 |
$74.84 |
$74.84 |
$259.05
|
|
Vancomycin 750 mg intravenous solution
|
$49.30 |
$49.30 |
$49.30 |
$90.33
|
|
Vancomycin peak therapeutic drug level
|
$154.40 |
$154.40 |
$154.40 |
$136.13
|
|
Varicella zoster antibody igg
|
$54.40 |
$54.40 |
$54.40 |
$86.80
|
|
Vasopressin 20 unit/ml intravenous solution
|
$70.24 |
$70.24 |
$70.24 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$12,688.32 |
$12,688.32 |
$12,688.32 |
$18,732.33
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$58.40 |
$58.40 |
$58.40 |
$188.83
|
|
Ventilator each subsequent day
|
$946.40 |
$946.40 |
$946.40 |
$1,184.00
|
|
Ventilator Management (first day)
|
$1,172.00 |
$1,172.00 |
$1,172.00 |
$1,434.60
|
|
Version cephalic external
|
$2,428.00 |
$2,428.00 |
$2,428.00 |
$2,361.75
|
|
Very long chain fatty acids
|
$92.00 |
$92.00 |
$92.00 |
$139.88
|
|
Video Swallow Study (Modified Barium Swallow)
|
$791.20 |
$791.20 |
$791.20 |
$524.50
|
|
Vinblastine 1 mg/ml intravenous solution
|
$303.48 |
$303.48 |
$303.48 |
$165.00
|
|
Vincristine 1 mg/ml intravenous solution
|
$287.63 |
$287.63 |
$287.63 |
$87.15
|