|
Trnscath tx thromblytc cath rmv sbsq day
|
$1,531.20 |
$1,531.20 |
$1,531.20 |
$4,379.34
|
|
Troponin quantitative
|
$24.00 |
$24.00 |
$24.00 |
$127.20
|
|
Tte w or without contr, cont ecg
|
$618.60 |
$618.60 |
$618.60 |
$2,075.90
|
|
Tte w or without fol w/con,stres
|
$618.60 |
$618.60 |
$618.60 |
$1,632.80
|
|
Tte w or without fol w/cont, com
|
$873.60 |
$873.60 |
$873.60 |
$1,254.50
|
|
Tte w or without fol w/cont, f/u
|
$1,789.20 |
$1,789.20 |
$1,789.20 |
$1,178.00
|
|
Tube trach disp innr can 5 xlt
|
$105.00 |
$105.00 |
$105.00 |
$445.99
|
|
Tx closed distal humerus fx
|
$98.40 |
$98.40 |
$98.40 |
$594.88
|
|
Tx closed hip disl traumatic without anes
|
$102.00 |
$102.00 |
$102.00 |
$586.80
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$6,833.40 |
$6,833.40 |
$6,833.40 |
$4,499.12
|
|
Tympanometry & reflex thresh
|
$76.20 |
$76.20 |
$76.20 |
$173.18
|
|
Ultrasound breast complete
|
$126.00 |
$126.00 |
$126.00 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$124.20 |
$124.20 |
$124.20 |
$452.40
|
|
Ultrasound encephalogram
|
$181.80 |
$181.80 |
$181.80 |
$494.92
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$181.80 |
$181.80 |
$181.80 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$342.00 |
$342.00 |
$342.00 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$49.80 |
$49.80 |
$49.80 |
$388.08
|
|
Ultrasound guide intraoperative
|
$243.00 |
$243.00 |
$243.00 |
$632.85
|
|
Ultrasound ob >=14wks ea addl gest
|
$1,693.20 |
$1,693.20 |
$1,693.20 |
$409.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$108.00 |
$108.00 |
$108.00 |
$335.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$257.40 |
$257.40 |
$257.40 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$94.80 |
$94.80 |
$94.80 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$181.80 |
$181.80 |
$181.80 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$122.40 |
$122.40 |
$122.40 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$156.00 |
$156.00 |
$156.00 |
$421.00
|
|
Unlisted CT procedure
|
$624.00 |
$624.00 |
$624.00 |
$732.70
|
|
Unlisted hematology&coagj px
|
$43.80 |
$43.80 |
$43.80 |
$39.52
|
|
Unlisted procedure microbiology
|
$128.40 |
$128.40 |
$128.40 |
$530.00
|
|
Unlisted procedure rectum
|
$383.40 |
$383.40 |
$383.40 |
$1,223.20
|
|
Unlisted px ant segment eye
|
$103.80 |
$103.80 |
$103.80 |
$2,698.92
|
|
Unlisted px casting/strpg
|
$103.20 |
$103.20 |
$103.20 |
$222.00
|
|
Unlisted px hands/fingers
|
$4,707.60 |
$4,707.60 |
$4,707.60 |
$354.20
|
|
Unlisted px posterior segmnt
|
$3,949.20 |
$3,949.20 |
$3,949.20 |
$3,173.34
|
|
Unlisted px small intestine
|
$1,762.20 |
$1,762.20 |
$1,762.20 |
$2,118.35
|
|
Unlisted px tongue flr mouth
|
$97.20 |
$97.20 |
$97.20 |
$282.50
|
|
Unsched dialysis esrd pt hos
|
$406.20 |
$406.20 |
$406.20 |
$1,296.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$119.40 |
$119.40 |
$119.40 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$669.60 |
$669.60 |
$669.60 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$507.00 |
$507.00 |
$507.00 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$975.00 |
$975.00 |
$975.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$736.20 |
$736.20 |
$736.20 |
$2,392.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$682.20 |
$682.20 |
$682.20 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$159.60 |
$159.60 |
$159.60 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$176.40 |
$176.40 |
$176.40 |
$381.60
|
|
Upper Endoscopy (EGD, diagnostic)
|
$979.80 |
$979.80 |
$979.80 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,152.60 |
$1,152.60 |
$1,152.60 |
$1,768.00
|
|
Upper GI Barium X-ray (barium and gas)
|
$432.00 |
$432.00 |
$432.00 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$447.60 |
$447.60 |
$447.60 |
$607.20
|
|
Uppr gi scope w/submuc inj
|
$979.80 |
$979.80 |
$979.80 |
$1,872.00
|
|
Urea nitrogen
|
$9.60 |
$9.60 |
$9.60 |
$42.01
|
|
Urea nitrogen 24 hour urine
|
$11.40 |
$11.40 |
$11.40 |
$51.84
|
|
Urea nitrogen clearance
|
$135.60 |
$135.60 |
$135.60 |
$34.02
|
|
Urethrcystgrphy rtrgrde s&i
|
$312.00 |
$312.00 |
$312.00 |
$584.00
|
|
Urethrocystography void s&i
|
$304.20 |
$304.20 |
$304.20 |
$634.50
|
|
Uric acid blood
|
$10.80 |
$10.80 |
$10.80 |
$49.32
|
|
Uric acid urine
|
$11.40 |
$11.40 |
$11.40 |
$44.52
|
|
Urinalysis microscopic only
|
$7.20 |
$7.20 |
$7.20 |
$26.35
|
|
Urinalysis (with microscopy)
|
$7.80 |
$7.80 |
$7.80 |
$55.20
|
|
Urinalysis (without microscopy)
|
$6.00 |
$6.00 |
$6.00 |
$35.91
|
|
Urine Culture Test
|
$19.80 |
$19.80 |
$19.80 |
$82.32
|
|
Urine pregnancy test
|
$15.60 |
$15.60 |
$15.60 |
$68.21
|
|
Urography, antegrade
|
$228.60 |
$228.60 |
$228.60 |
$622.35
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$66.00 |
$66.00 |
$66.00 |
$5,205.00
|
|
Vaccine Administration (one shot)
|
$12.00 |
$12.00 |
$12.00 |
$67.74
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$340.00 |
$340.00 |
$340.00 |
$224.25
|
|
Vaccine dtap < 7 years im
|
$48.60 |
$48.60 |
$48.60 |
$71.17
|
|
Vaccine hepatitis a (hepa) adult im
|
$108.00 |
$108.00 |
$108.00 |
$166.62
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$86.40 |
$86.40 |
$86.40 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$126.60 |
$126.60 |
$126.60 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$63.20 |
$63.20 |
$63.20 |
$75.39
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$12.00 |
$12.00 |
$12.00 |
$33.60
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$24.00 |
$24.00 |
$24.00 |
$82.71
|
|
Vaccine mmr live subcutaneous
|
$64.80 |
$64.80 |
$64.80 |
$213.00
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$75.00 |
$75.00 |
$75.00 |
$252.87
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$144.00 |
$144.00 |
$144.00 |
$393.25
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$192.00 |
$192.00 |
$192.00 |
$563.36
|
|
Vaccine rabies im
|
$800.00 |
$800.00 |
$800.00 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$672.00 |
$672.00 |
$672.00 |
$538.84
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$1,196.00 |
$1,196.00 |
$1,196.00 |
$1,105.21
|
|
Vaccine tdap >=7 years im
|
$42.40 |
$42.40 |
$42.40 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$74.40 |
$74.40 |
$74.40 |
$112.10
|
|
Vacuum drain bottle/tube kit
|
$1,686.60 |
$1,686.60 |
$1,686.60 |
$325.20
|
|
Vaginal bx
|
$98.40 |
$98.40 |
$98.40 |
$459.42
|
|
Valproic acid total therapeutic drug level
|
$33.00 |
$33.00 |
$33.00 |
$115.00
|
|
Vancomycin hcl injection
|
$33.00 |
$33.00 |
$33.00 |
$149.49
|
|
Vancomycin peak therapeutic drug level
|
$33.00 |
$33.00 |
$33.00 |
$135.60
|
|
Varicella zoster antibody igg
|
$31.20 |
$31.20 |
$31.20 |
$86.80
|
|
Vasopressin 20 unit/ml intravenous solution
|
$25.40 |
$25.40 |
$25.40 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$15,257.40 |
$15,257.40 |
$15,257.40 |
$18,732.33
|
|
Venogram extremity supervision & interpretation unilateral
|
$1,193.40 |
$1,193.40 |
$1,193.40 |
$1,382.58
|
|
Ventilator each subsequent day
|
$610.80 |
$610.80 |
$610.80 |
$1,178.74
|
|
Ventilator Management (first day)
|
$721.80 |
$721.80 |
$721.80 |
$1,434.60
|
|
Version cephalic external
|
$294.00 |
$294.00 |
$294.00 |
$2,361.75
|
|
Very long chain fatty acids
|
$394.80 |
$394.80 |
$394.80 |
$139.88
|
|
Video Swallow Study (Modified Barium Swallow)
|
$412.20 |
$412.20 |
$412.20 |
$524.50
|
|
Vinblastine 1 mg/ml intravenous solution
|
$91.20 |
$91.20 |
$91.20 |
$163.80
|
|
Vincristine 1 mg/ml intravenous solution
|
$15.60 |
$15.60 |
$15.60 |
$87.15
|
|
Vinorelbine 10 mg/ml intravenous solution (wrapper)
|
$55.20 |
$55.20 |
$55.20 |
$223.55
|
|
Visual audiometry (vra)
|
$122.40 |
$122.40 |
$122.40 |
$220.60
|
|
Vitamin b-12
|
$36.60 |
$36.60 |
$36.60 |
$100.20
|
