|
Tte w or without fol w/con,stres
|
$2,845.20 |
$2,845.20 |
$2,845.20 |
$1,632.80
|
|
Tube trach disp innr can 5 xlt
|
$793.43 |
$793.43 |
$793.43 |
$445.99
|
|
Tx closed distal humerus fx
|
$360.00 |
$360.00 |
$360.00 |
$594.88
|
|
Tx closed hip disl traumatic without anes
|
$764.40 |
$764.40 |
$764.40 |
$581.07
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$2,231.40 |
$2,231.40 |
$2,231.40 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$394.20 |
$394.20 |
$394.20 |
$535.60
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$33,330.06 |
$33,330.06 |
$33,330.06 |
$20,945.01
|
|
Ugt1a1 gene analy common variants
|
$656.40 |
$656.40 |
$656.40 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$422.40 |
$422.40 |
$422.40 |
$394.20
|
|
Ultrasound breast complete
|
$640.20 |
$640.20 |
$640.20 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$640.20 |
$640.20 |
$640.20 |
$449.35
|
|
Ultrasound chest
|
$525.00 |
$525.00 |
$525.00 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$208.80 |
$208.80 |
$208.80 |
$338.00
|
|
Ultrasound encephalogram
|
$703.20 |
$703.20 |
$703.20 |
$488.80
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$468.60 |
$468.60 |
$468.60 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$168.00 |
$168.00 |
$168.00 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$1,638.00 |
$1,638.00 |
$1,638.00 |
$720.15
|
|
Ultrasound guide tissue ablation
|
$1,099.80 |
$1,099.80 |
$1,099.80 |
$560.00
|
|
Ultrasound joint complete left
|
$550.20 |
$550.20 |
$550.20 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$664.80 |
$664.80 |
$664.80 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$934.20 |
$934.20 |
$934.20 |
$407.20
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$885.60 |
$885.60 |
$885.60 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$448.80 |
$448.80 |
$448.80 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$313.80 |
$313.80 |
$313.80 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$762.60 |
$762.60 |
$762.60 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$651.00 |
$651.00 |
$651.00 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$570.60 |
$570.60 |
$570.60 |
$486.50
|
|
Ultrasound scrotum and contents
|
$882.00 |
$882.00 |
$882.00 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$844.20 |
$844.20 |
$844.20 |
$463.00
|
|
Ultrasound transvaginal non obstetric
|
$706.80 |
$706.80 |
$706.80 |
$558.35
|
|
Unlisted chemotherapy px
|
$541.20 |
$541.20 |
$541.20 |
$150.00
|
|
Unlisted misc path test
|
$44.40 |
$44.40 |
$44.40 |
$89.40
|
|
Unlisted procedure microbiology
|
$237.00 |
$237.00 |
$237.00 |
$523.50
|
|
Unlisted px hands/fingers
|
$378.00 |
$378.00 |
$378.00 |
$354.20
|
|
Unlisted px male genital sys
|
$20,868.31 |
$20,868.31 |
$20,868.31 |
$343.55
|
|
Unlisted px neck/thorax
|
$874.20 |
$874.20 |
$874.20 |
$571.20
|
|
Unlisted px small intestine
|
$1,433.40 |
$1,433.40 |
$1,433.40 |
$2,102.10
|
|
Unlisted px tongue flr mouth
|
$408.60 |
$408.60 |
$408.60 |
$282.50
|
|
Unlisted px vestibule mouth
|
$384.60 |
$384.60 |
$384.60 |
$456.96
|
|
Unlisted reprod med lab proc
|
$126.60 |
$126.60 |
$126.60 |
$70.00
|
|
Unlisted surgical path px
|
$261.60 |
$261.60 |
$261.60 |
$217.75
|
|
Unlisted ultrasound procedure
|
$679.20 |
$679.20 |
$679.20 |
$321.20
|
|
Upgrade pm system
|
$7,276.80 |
$7,276.80 |
$7,276.80 |
$12,077.00
|
|
Upper Endoscopy (EGD, diagnostic)
|
$4,360.53 |
$4,360.53 |
$4,360.53 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$13,941.42 |
$13,941.42 |
$13,941.42 |
$1,768.00
|
|
Urea nitrogen
|
$88.20 |
$88.20 |
$88.20 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$42.00 |
$42.00 |
$42.00 |
$51.75
|
|
Urea nitrogen clearance
|
$122.40 |
$122.40 |
$122.40 |
$42.25
|
|
Urethrcystgrphy rtrgrde s&i
|
$411.60 |
$411.60 |
$411.60 |
$579.73
|
|
Urethrocystography void s&i
|
$411.60 |
$411.60 |
$411.60 |
$622.35
|
|
Uric acid blood
|
$33.60 |
$33.60 |
$33.60 |
$48.75
|
|
Uric acid urine
|
$23.40 |
$23.40 |
$23.40 |
$44.33
|
|
Urinalysis microscopic only
|
$12.60 |
$12.60 |
$12.60 |
$26.35
|
|
Urinalysis (with microscopy)
|
$25.20 |
$25.20 |
$25.20 |
$55.00
|
|
Urinalysis (without microscopy)
|
$23.40 |
$23.40 |
$23.40 |
$35.75
|
|
Urine Culture Test
|
$46.80 |
$46.80 |
$46.80 |
$81.50
|
|
Urine pregnancy test
|
$36.60 |
$36.60 |
$36.60 |
$67.20
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$12,717.90 |
$12,717.90 |
$12,717.90 |
$5,184.34
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$43,727.22 |
$43,727.22 |
$43,727.22 |
$51,633.07
|
|
Vaccine dtap < 7 years im
|
$62.16 |
$62.16 |
$62.16 |
$68.19
|
|
Vaccine dtap-ipv-hib-hepb im
|
$63.84 |
$63.84 |
$63.84 |
$174.72
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$278.16 |
$278.16 |
$278.16 |
$218.40
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$0.06 |
$0.06 |
$0.06 |
$75.39
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$130.68 |
$130.68 |
$130.68 |
$76.50
|
|
Vaccine mmr live subcutaneous
|
$205.80 |
$205.80 |
$205.80 |
$211.68
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$594.78 |
$594.78 |
$594.78 |
$563.36
|
|
Vaccine tdap >=7 years im
|
$103.32 |
$103.32 |
$103.32 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$88.74 |
$88.74 |
$88.74 |
$112.10
|
|
Vad univ batt charger hm 1440
|
$18,600.49 |
$18,600.49 |
$18,600.49 |
$14,827.28
|
|
Valproate in ns IV syringe 10 mg/ml (pediatric) - cnr
|
$26.28 |
$26.28 |
$26.28 |
$24.12
|
|
Valproic acid total therapeutic drug level
|
$78.60 |
$78.60 |
$78.60 |
$114.72
|
|
Vancomycin 1,000 mg intravenous injection
|
$36.90 |
$36.90 |
$36.90 |
$251.86
|
|
Vancomycin peak therapeutic drug level
|
$98.40 |
$98.40 |
$98.40 |
$136.13
|
|
Varicella zoster antibody igg
|
$169.20 |
$169.20 |
$169.20 |
$86.80
|
|
Varus/valgus strap padded/li
|
$255.56 |
$255.56 |
$255.56 |
$115.53
|
|
Vasopressin 20 unit/ml intravenous solution
|
$18.78 |
$18.78 |
$18.78 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$28,079.76 |
$28,079.76 |
$28,079.76 |
$18,732.33
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$830.40 |
$830.40 |
$830.40 |
$202.80
|
|
Venogram ext bil s&i
|
$8,104.20 |
$8,104.20 |
$8,104.20 |
$1,797.50
|
|
Venogram extremity supervision & interpretation unilateral
|
$4,051.80 |
$4,051.80 |
$4,051.80 |
$1,366.20
|
|
Venous mech thrombectomy
|
$15,279.60 |
$15,279.60 |
$15,279.60 |
$7,965.00
|
|
Ventilator each subsequent day
|
$1,102.80 |
$1,102.80 |
$1,102.80 |
$1,204.00
|
|
Ventilator initial day
|
$1,527.60 |
$1,527.60 |
$1,527.60 |
$1,431.43
|
|
Very long chain fatty acids
|
$221.40 |
$221.40 |
$221.40 |
$139.88
|
|
Vest large holster
|
$1,372.17 |
$1,372.17 |
$1,372.17 |
$1,078.25
|
|
Vinblastine 1 mg/ml intravenous solution
|
$166.80 |
$166.80 |
$166.80 |
$165.00
|
|
Vincristine 1 mg/ml intravenous solution
|
$110.16 |
$110.16 |
$110.16 |
$87.15
|
|
Vinorelbine 10 mg/ml intravenous solution (wrapper)
|
$279.18 |
$279.18 |
$279.18 |
$223.55
|
|
Virus isolation addl studies ea
|
$122.40 |
$122.40 |
$122.40 |
$77.50
|
|
Visit established high 40-54 minutes/level 5
|
$900.00 |
$900.00 |
$900.00 |
$227.50
|
|
Vital capacity test
|
$288.60 |
$288.60 |
$288.60 |
$170.00
|
|
Vitamin b-12
|
$77.40 |
$77.40 |
$77.40 |
$100.00
|
|
Vitamin D Test
|
$223.20 |
$223.20 |
$223.20 |
$132.00
|
|
Vkorc1 gene
|
$111.60 |
$111.60 |
$111.60 |
$176.80
|
|
Volume measurement urine timed
|
$5.40 |
$5.40 |
$5.40 |
$21.45
|
|
Warde 1003990 aldosterone
|
$390.60 |
$390.60 |
$390.60 |
$144.73
|
|
Warde 1005020 citrate 24 hour urine
|
$133.80 |
$133.80 |
$133.80 |
$97.50
|
|
Warde 1005055 5-hiaa 24 hour urine
|
$157.80 |
$157.80 |
$157.80 |
$63.50
|
|
Warde 1006955 catecholamines fractionated 24 hour urine
|
$283.80 |
$283.80 |
$283.80 |
$113.10
|
|
Warde 1007138 vanillymandelic acid 24 hour urine
|
$178.80 |
$178.80 |
$178.80 |
$70.85
|
