|
Treat hip dislocation
|
$4,799.40 |
$4,799.40 |
$4,799.40 |
$2,211.05
|
|
Treat hip socket fracture
|
$10,752.60 |
$10,752.60 |
$10,752.60 |
$1,392.00
|
|
Treat humerus fracture
|
$3,013.20 |
$3,013.20 |
$3,013.20 |
$1,790.00
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$133.20 |
$133.20 |
$133.20 |
$227.70
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$60.00 |
$60.00 |
$60.00 |
$147.48
|
|
Treatment of ankle fracture 27786
|
$1,942.20 |
$1,942.20 |
$1,942.20 |
$523.20
|
|
Treatment of fibula fracture 27780
|
$1,537.20 |
$1,537.20 |
$1,537.20 |
$501.20
|
|
Treat ulnar fracture
|
$2,421.60 |
$2,421.60 |
$2,421.60 |
$1,677.20
|
|
Treponema pallidum antibody
|
$75.00 |
$75.00 |
$75.00 |
$72.05
|
|
Trg gene rearrangement anal
|
$1,114.20 |
$1,114.20 |
$1,114.20 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$11.80 |
$11.80 |
$11.80 |
$43.09
|
|
Triamcinolone a inj prs-free
|
$21.00 |
$21.00 |
$21.00 |
$223.56
|
|
Triglycerides
|
$41.40 |
$41.40 |
$41.40 |
$58.50
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$4,576.20 |
$4,576.20 |
$4,576.20 |
$2,620.20
|
|
Troponin quantitative
|
$66.60 |
$66.60 |
$66.60 |
$127.60
|
|
Tte w or without contr, cont ecg
|
$1,876.20 |
$1,876.20 |
$1,876.20 |
$2,067.00
|
|
Tx closed distal humerus fx
|
$122.40 |
$122.40 |
$122.40 |
$594.88
|
|
Tx closed hip disl traumatic without anes
|
$3,584.40 |
$3,584.40 |
$3,584.40 |
$586.40
|
|
Tx closed tib shaft fx without manip
|
$1,689.60 |
$1,689.60 |
$1,689.60 |
$535.60
|
|
Ultrasound breast complete
|
$520.80 |
$520.80 |
$520.80 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$291.00 |
$291.00 |
$291.00 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$459.60 |
$459.60 |
$459.60 |
$338.00
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$324.60 |
$324.60 |
$324.60 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$318.00 |
$318.00 |
$318.00 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$133.20 |
$133.20 |
$133.20 |
$388.08
|
|
Ultrasound joint complete left
|
$626.40 |
$626.40 |
$626.40 |
$557.99
|
|
Ultrasound ob >=14wks ea addl gest
|
$705.60 |
$705.60 |
$705.60 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$285.60 |
$285.60 |
$285.60 |
$334.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$2,256.60 |
$2,256.60 |
$2,256.60 |
$698.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$564.00 |
$564.00 |
$564.00 |
$425.60
|
|
Unlisted CT procedure
|
$624.00 |
$624.00 |
$624.00 |
$732.70
|
|
Unlisted hematology&coagj px
|
$75.60 |
$75.60 |
$75.60 |
$39.52
|
|
Unlisted procedure microbiology
|
$578.40 |
$578.40 |
$578.40 |
$530.00
|
|
Unlisted procedure rectum
|
$791.40 |
$791.40 |
$791.40 |
$1,223.20
|
|
Unlisted px posterior segmnt
|
$4,036.20 |
$4,036.20 |
$4,036.20 |
$3,173.34
|
|
Unlisted px small intestine
|
$130.80 |
$130.80 |
$130.80 |
$2,118.35
|
|
Unlisted urinalysis px
|
$21.00 |
$21.00 |
$21.00 |
$25.72
|
|
Upper Arm (Humerus) X-ray (left side)
|
$108.00 |
$108.00 |
$108.00 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$2,213.40 |
$2,213.40 |
$2,213.40 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$847.80 |
$847.80 |
$847.80 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,916.00 |
$2,916.00 |
$2,916.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$4,953.00 |
$4,953.00 |
$4,953.00 |
$2,369.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,705.20 |
$1,705.20 |
$1,705.20 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$125.40 |
$125.40 |
$125.40 |
$381.60
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,214.40 |
$1,214.40 |
$1,214.40 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,656.60 |
$1,656.60 |
$1,656.60 |
$1,768.00
|
|
Upper GI Barium X-ray (barium and gas)
|
$497.40 |
$497.40 |
$497.40 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$497.40 |
$497.40 |
$497.40 |
$607.20
|
|
Uppr gi scope w/submuc inj
|
$4,581.60 |
$4,581.60 |
$4,581.60 |
$1,872.00
|
|
Urea nitrogen
|
$30.00 |
$30.00 |
$30.00 |
$42.25
|
|
Urea nitrogen 24 hour urine
|
$82.80 |
$82.80 |
$82.80 |
$52.00
|
|
Urea nitrogen clearance
|
$103.80 |
$103.80 |
$103.80 |
$38.35
|
|
Urethrocystography void s&i
|
$288.60 |
$288.60 |
$288.60 |
$631.40
|
|
Uric acid blood
|
$33.00 |
$33.00 |
$33.00 |
$49.44
|
|
Uric acid urine
|
$28.20 |
$28.20 |
$28.20 |
$45.36
|
|
Urinalysis (with microscopy)
|
$33.00 |
$33.00 |
$33.00 |
$55.20
|
|
Urinalysis (without microscopy)
|
$19.20 |
$19.20 |
$19.20 |
$36.00
|
|
Urine Culture Test
|
$58.80 |
$58.80 |
$58.80 |
$83.00
|
|
Urine pregnancy test
|
$37.80 |
$37.80 |
$37.80 |
$68.78
|
|
Vaccine Administration (one shot)
|
$12.00 |
$12.00 |
$12.00 |
$67.70
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$340.00 |
$340.00 |
$340.00 |
$224.25
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$156.80 |
$156.80 |
$156.80 |
$231.56
|
|
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
|
$168.80 |
$168.80 |
$168.80 |
$274.93
|
|
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 meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$122.40 |
$122.40 |
$122.40 |
$329.24
|
|
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 |
$397.11
|
|
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 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
|
|
Valproic acid total therapeutic drug level
|
$91.20 |
$91.20 |
$91.20 |
$115.00
|
|
Vancomycin 1,000 mg intravenous injection
|
$0.60 |
$0.60 |
$0.60 |
$259.05
|
|
Vancomycin hcl injection
|
$31.20 |
$31.20 |
$31.20 |
$149.49
|
|
Vancomycin peak therapeutic drug level
|
$66.60 |
$66.60 |
$66.60 |
$136.13
|
|
Varicella zoster antibody igg
|
$91.20 |
$91.20 |
$91.20 |
$86.80
|
|
Vasopressin 20 unit/ml intravenous solution
|
$19.00 |
$19.00 |
$19.00 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$16,630.20 |
$16,630.20 |
$16,630.20 |
$18,732.33
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$128.40 |
$128.40 |
$128.40 |
$188.83
|
|
Ventilator each subsequent day
|
$845.40 |
$845.40 |
$845.40 |
$1,184.00
|
|
Ventilator Management (first day)
|
$832.80 |
$832.80 |
$832.80 |
$1,434.60
|
|
Very long chain fatty acids
|
$345.00 |
$345.00 |
$345.00 |
$139.88
|
|
Video Swallow Study (Modified Barium Swallow)
|
$640.80 |
$640.80 |
$640.80 |
$524.50
|
|
Vitamin b-12
|
$75.00 |
$75.00 |
$75.00 |
$100.28
|
|
Vitamin D Test
|
$141.00 |
$141.00 |
$141.00 |
$132.00
|
|
Volume measurement urine timed
|
$24.60 |
$24.60 |
$24.60 |
$21.64
|
|
Vutrisiran 25 mg/0.5 ml subcutaneous syringe
|
$9,373.80 |
$9,373.80 |
$9,373.80 |
$177,291.55
|
|
Walking (Gait) Training (each 15 minutes)
|
$75.00 |
$75.00 |
$75.00 |
$87.50
|
|
Warde 1003990 aldosterone
|
$190.20 |
$190.20 |
$190.20 |
$144.73
|
|
Warde 1005020 citrate 24 hour urine
|
$119.40 |
$119.40 |
$119.40 |
$100.10
|
|
Warde 1005055 5-hiaa 24 hour urine
|
$66.60 |
$66.60 |
$66.60 |
$64.08
|
|
Warde 1006955 catecholamines fractionated 24 hour urine
|
$115.80 |
$115.80 |
$115.80 |
$113.10
|
|
Warde 1007138 vanillymandelic acid 24 hour urine
|
$83.40 |
$83.40 |
$83.40 |
$70.85
|
|
Warde 1015200 kappa light chain free
|
$58.80 |
$58.80 |
$58.80 |
$65.20
|
|
Warde 3004000 immunoglobulin subclass 1
|
$409.20 |
$409.20 |
$409.20 |
$39.36
|
|
Warde 3008005 oligoclonal bands
|
$303.00 |
$303.00 |
$303.00 |
$108.50
|
|
Warde 3016000 west nile virus antibody
|
$274.20 |
$274.20 |
$274.20 |
$71.60
|
|
Warde 3016000 west nile virus antibody igg
|
$216.00 |
$216.00 |
$216.00 |
$70.74
|
