|
Triglycerides
|
$40.85 |
$40.85 |
$40.85 |
$58.50
|
|
Trim nondyst nails
|
$143.81 |
$143.81 |
$143.81 |
$113.88
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$2,048.16 |
$2,048.16 |
$2,048.16 |
$2,551.20
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$4,840.15 |
$4,840.15 |
$4,840.15 |
$2,837.09
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$4,840.15 |
$4,840.15 |
$4,840.15 |
$2,620.20
|
|
Troponin quantitative
|
$155.52 |
$155.52 |
$155.52 |
$127.60
|
|
Tte w or without contr, cont ecg
|
$2,268.42 |
$2,268.42 |
$2,268.42 |
$2,067.00
|
|
Tx closed hip disl traumatic without anes
|
$685.37 |
$685.37 |
$685.37 |
$586.40
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$6,163.48 |
$6,163.48 |
$6,163.48 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$633.26 |
$633.26 |
$633.26 |
$535.60
|
|
Tx tarsal bone fx without manip 28450
|
$524.10 |
$524.10 |
$524.10 |
$419.04
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$1,140.33 |
$1,140.33 |
$1,140.33 |
$911.43
|
|
Ugt1a1 gene analy common variants
|
$538.36 |
$538.36 |
$538.36 |
$438.75
|
|
Ultrasound breast complete
|
$543.76 |
$543.76 |
$543.76 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$535.08 |
$535.08 |
$535.08 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$267.40 |
$267.40 |
$267.40 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$291.80 |
$291.80 |
$291.80 |
$296.80
|
|
Ultrasound elastography parenchyma
|
$208.93 |
$208.93 |
$208.93 |
$313.95
|
|
Ultrasound encephalogram
|
$469.05 |
$469.05 |
$469.05 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$522.92 |
$522.92 |
$522.92 |
$578.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$608.90 |
$608.90 |
$608.90 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$314.87 |
$314.87 |
$314.87 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$292.32 |
$292.32 |
$292.32 |
$388.08
|
|
Ultrasound guide intraoperative
|
$314.87 |
$314.87 |
$314.87 |
$632.85
|
|
Ultrasound hips infant dynamic
|
$462.54 |
$462.54 |
$462.54 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$362.23 |
$362.23 |
$362.23 |
$311.25
|
|
Ultrasound joint complete left
|
$302.30 |
$302.30 |
$302.30 |
$557.99
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$256.80 |
$256.80 |
$256.80 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$365.98 |
$365.98 |
$365.98 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$493.40 |
$493.40 |
$493.40 |
$334.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$681.62 |
$681.62 |
$681.62 |
$698.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$532.49 |
$532.49 |
$532.49 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$541.59 |
$541.59 |
$541.59 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$463.88 |
$463.88 |
$463.88 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$740.96 |
$740.96 |
$740.96 |
$419.50
|
|
Unlisted misc path test
|
$125.45 |
$125.45 |
$125.45 |
$89.40
|
|
Unlisted procedure microbiology
|
$1,082.58 |
$1,082.58 |
$1,082.58 |
$530.00
|
|
Unlisted px small intestine
|
$2,172.75 |
$2,172.75 |
$2,172.75 |
$2,118.35
|
|
Unlisted ultrasound procedure
|
$203.85 |
$203.85 |
$203.85 |
$332.16
|
|
Upper Arm (Humerus) X-ray (left side)
|
$388.71 |
$388.71 |
$388.71 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$1,435.69 |
$1,435.69 |
$1,435.69 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,410.27 |
$1,410.27 |
$1,410.27 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,825.71 |
$2,825.71 |
$2,825.71 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,294.38 |
$2,294.38 |
$2,294.38 |
$2,369.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,147.84 |
$2,147.84 |
$2,147.84 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$234.98 |
$234.98 |
$234.98 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$311.40 |
$311.40 |
$311.40 |
$381.60
|
|
Upper GI Barium X-ray (barium and gas)
|
$641.06 |
$641.06 |
$641.06 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$462.54 |
$462.54 |
$462.54 |
$607.20
|
|
Urea nitrogen
|
$66.90 |
$66.90 |
$66.90 |
$42.25
|
|
Urea nitrogen 24 hour urine
|
$77.34 |
$77.34 |
$77.34 |
$52.00
|
|
Urethrcystgrphy rtrgrde s&i
|
$559.38 |
$559.38 |
$559.38 |
$584.00
|
|
Urethrocystography void s&i
|
$426.96 |
$426.96 |
$426.96 |
$631.40
|
|
Uric acid blood
|
$59.96 |
$59.96 |
$59.96 |
$49.44
|
|
Uric acid urine
|
$82.10 |
$82.10 |
$82.10 |
$45.36
|
|
Urinalysis microscopic only
|
$43.43 |
$43.43 |
$43.43 |
$26.46
|
|
Urinalysis (with microscopy)
|
$77.34 |
$77.34 |
$77.34 |
$55.20
|
|
Urinalysis (without microscopy)
|
$40.85 |
$40.85 |
$40.85 |
$36.00
|
|
Urine Culture Test
|
$83.39 |
$83.39 |
$83.39 |
$83.00
|
|
Urine pregnancy test
|
$28.68 |
$28.68 |
$28.68 |
$68.78
|
|
Urography, antegrade
|
$740.12 |
$740.12 |
$740.12 |
$622.35
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$24.10 |
$24.10 |
$24.10 |
$5,205.00
|
|
Vaccine Administration (one shot)
|
$63.47 |
$63.47 |
$63.47 |
$67.70
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$184.16 |
$184.16 |
$184.16 |
$224.25
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$169.03 |
$169.03 |
$169.03 |
$209.40
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$191.10 |
$191.10 |
$191.10 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$122.85 |
$122.85 |
$122.85 |
$123.20
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$91.57 |
$91.57 |
$91.57 |
$80.15
|
|
Vaccine dtap < 7 years im
|
$46.85 |
$46.85 |
$46.85 |
$71.17
|
|
Vaccine dtap-hep b-ipv im
|
$146.37 |
$146.37 |
$146.37 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$93.05 |
$93.05 |
$93.05 |
$105.95
|
|
Vaccine dtap-ipv-hib-hepb im
|
$205.71 |
$205.71 |
$205.71 |
$174.72
|
|
Vaccine dtap-ipv/hib im
|
$144.44 |
$144.44 |
$144.44 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$41.94 |
$41.94 |
$41.94 |
$70.53
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$19.17 |
$19.17 |
$19.17 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$58.44 |
$58.44 |
$58.44 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$368.60 |
$368.60 |
$368.60 |
$231.56
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$43.48 |
$43.48 |
$43.48 |
$78.25
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$104.40 |
$104.40 |
$104.40 |
$155.16
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$51.88 |
$51.88 |
$51.88 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$481.83 |
$481.83 |
$481.83 |
$576.48
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$388.79 |
$388.79 |
$388.79 |
$282.50
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$111.51 |
$111.51 |
$111.51 |
$149.21
|
|
Vaccine influenza nos 0.5ml dose im
|
$29.39 |
$29.39 |
$29.39 |
$24.20
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$31.49 |
$31.49 |
$31.49 |
$48.59
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$26.44 |
$26.44 |
$26.44 |
$35.88
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$91.73 |
$91.73 |
$91.73 |
$33.60
|
|
Vaccine influenza quadrivalent live (laiv4) intranasal
|
$37.25 |
$37.25 |
$37.25 |
$37.05
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$91.25 |
$91.25 |
$91.25 |
$72.00
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$49.35 |
$49.35 |
$49.35 |
$82.71
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$326.70 |
$326.70 |
$326.70 |
$394.26
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$218.91 |
$218.91 |
$218.91 |
$310.93
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$218.91 |
$218.91 |
$218.91 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$176.90 |
$176.90 |
$176.90 |
$213.00
|
|
Vaccine mmrv live subcutaneous
|
$422.53 |
$422.53 |
$422.53 |
$424.32
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$38.94 |
$38.94 |
$38.94 |
$252.87
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$368.60 |
$368.60 |
$368.60 |
$397.11
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$338.10 |
$338.10 |
$338.10 |
$414.46
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$404.11 |
$404.11 |
$404.11 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$87.34 |
$87.34 |
$87.34 |
$90.70
|