|
Treponema pallidum antibody
|
$110.40 |
$110.40 |
$110.40 |
$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
|
$10.80 |
$10.80 |
$10.80 |
$43.00
|
|
Trichinella antibody
|
$141.00 |
$141.00 |
$141.00 |
$70.65
|
|
Trichomonas assay w/optic
|
$104.40 |
$104.40 |
$104.40 |
$57.40
|
|
Triglycerides
|
$32.40 |
$32.40 |
$32.40 |
$58.05
|
|
Trilaciclib 300 mg intravenous solution
|
$10.80 |
$10.80 |
$10.80 |
$4,043.12
|
|
Trim nail(s)
|
$109.20 |
$109.20 |
$109.20 |
$78.40
|
|
Trim nondyst nails
|
$145.80 |
$145.80 |
$145.80 |
$114.48
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$3,178.80 |
$3,178.80 |
$3,178.80 |
$2,406.77
|
|
Troponin quantitative
|
$112.80 |
$112.80 |
$112.80 |
$127.20
|
|
Tte w or without contr, cont ecg
|
$2,405.40 |
$2,405.40 |
$2,405.40 |
$2,075.90
|
|
Tte w or without fol w/con,stres
|
$2,405.40 |
$2,405.40 |
$2,405.40 |
$1,632.80
|
|
Tube drain vert dev st 5-40f
|
$19.20 |
$19.20 |
$19.20 |
$27.60
|
|
Tx closed distal humerus fx
|
$255.60 |
$255.60 |
$255.60 |
$594.88
|
|
Tx closed hip disl traumatic without anes
|
$2,429.40 |
$2,429.40 |
$2,429.40 |
$586.80
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$2,396.40 |
$2,396.40 |
$2,396.40 |
$3,977.49
|
|
Ua w/micro/comp poc
|
$26.40 |
$26.40 |
$26.40 |
$23.00
|
|
Ugt1a1 gene analy common variants
|
$1,240.20 |
$1,240.20 |
$1,240.20 |
$438.75
|
|
Ultrasound breast complete
|
$765.00 |
$765.00 |
$765.00 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$538.20 |
$538.20 |
$538.20 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$179.40 |
$179.40 |
$179.40 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$514.80 |
$514.80 |
$514.80 |
$296.80
|
|
Ultrasound encephalogram
|
$790.80 |
$790.80 |
$790.80 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$1,491.00 |
$1,491.00 |
$1,491.00 |
$575.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$748.20 |
$748.20 |
$748.20 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$487.20 |
$487.20 |
$487.20 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$91.80 |
$91.80 |
$91.80 |
$388.08
|
|
Ultrasound joint complete left
|
$625.80 |
$625.80 |
$625.80 |
$557.99
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$676.80 |
$676.80 |
$676.80 |
$335.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,582.80 |
$1,582.80 |
$1,582.80 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$1,002.60 |
$1,002.60 |
$1,002.60 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$1,126.20 |
$1,126.20 |
$1,126.20 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$602.40 |
$602.40 |
$602.40 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$677.40 |
$677.40 |
$677.40 |
$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 mr procedure
|
$4,380.00 |
$4,380.00 |
$4,380.00 |
$1,163.00
|
|
Unlisted procedure microbiology
|
$288.60 |
$288.60 |
$288.60 |
$530.00
|
|
Unlisted px ant segment eye
|
$777.00 |
$777.00 |
$777.00 |
$2,698.92
|
|
Unlisted px casting/strpg
|
$189.00 |
$189.00 |
$189.00 |
$222.00
|
|
Unlisted px hands/fingers
|
$3,680.40 |
$3,680.40 |
$3,680.40 |
$354.20
|
|
Unlisted px male genital sys
|
$144.60 |
$144.60 |
$144.60 |
$387.84
|
|
Unlisted px posterior segmnt
|
$4,036.20 |
$4,036.20 |
$4,036.20 |
$3,173.34
|
|
Unlisted px small intestine
|
$2,335.80 |
$2,335.80 |
$2,335.80 |
$2,118.35
|
|
Unlisted transfusion med px
|
$525.60 |
$525.60 |
$525.60 |
$147.50
|
|
Unsched dialysis esrd pt hos
|
$721.80 |
$721.80 |
$721.80 |
$1,296.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$243.00 |
$243.00 |
$243.00 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$2,110.20 |
$2,110.20 |
$2,110.20 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,815.00 |
$1,815.00 |
$1,815.00 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,601.80 |
$3,601.80 |
$3,601.80 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,219.60 |
$3,219.60 |
$3,219.60 |
$2,392.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$4,861.20 |
$4,861.20 |
$4,861.20 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$507.60 |
$507.60 |
$507.60 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$487.20 |
$487.20 |
$487.20 |
$381.60
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,872.60 |
$1,872.60 |
$1,872.60 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$2,476.20 |
$2,476.20 |
$2,476.20 |
$1,768.00
|
|
Upper GI Barium X-ray (barium and gas)
|
$547.20 |
$547.20 |
$547.20 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$547.20 |
$547.20 |
$547.20 |
$607.20
|
|
Uppr gi scope w/submuc inj
|
$3,258.00 |
$3,258.00 |
$3,258.00 |
$1,872.00
|
|
Urea nitrogen
|
$27.00 |
$27.00 |
$27.00 |
$42.01
|
|
Urea nitrogen 24 hour urine
|
$58.80 |
$58.80 |
$58.80 |
$51.84
|
|
Urethrcystgrphy rtrgrde s&i
|
$340.20 |
$340.20 |
$340.20 |
$584.00
|
|
Urethrocystography void s&i
|
$315.00 |
$315.00 |
$315.00 |
$634.50
|
|
Uric acid blood
|
$96.60 |
$96.60 |
$96.60 |
$49.32
|
|
Uric acid urine
|
$32.40 |
$32.40 |
$32.40 |
$44.52
|
|
Urinalysis microscopic only
|
$60.60 |
$60.60 |
$60.60 |
$26.35
|
|
Urinalysis (with microscopy)
|
$102.60 |
$102.60 |
$102.60 |
$55.20
|
|
Urinalysis (without microscopy)
|
$60.00 |
$60.00 |
$60.00 |
$35.91
|
|
Urine Culture Test
|
$48.00 |
$48.00 |
$48.00 |
$82.32
|
|
Urine pregnancy test
|
$67.20 |
$67.20 |
$67.20 |
$68.21
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$49.20 |
$49.20 |
$49.20 |
$5,205.00
|
|
Vaccine Administration (one shot)
|
$12.00 |
$12.00 |
$12.00 |
$67.74
|
|
Vaccine dtap < 7 years im
|
$43.20 |
$43.20 |
$43.20 |
$71.17
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$86.40 |
$86.40 |
$86.40 |
$155.16
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$63.20 |
$63.20 |
$63.20 |
$75.39
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$248.00 |
$248.00 |
$248.00 |
$282.50
|
|
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 menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$82.20 |
$82.20 |
$82.20 |
$310.93
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$129.60 |
$129.60 |
$129.60 |
$327.37
|
|
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 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
|
$55.80 |
$55.80 |
$55.80 |
$112.10
|
|
Vaccine varicella live subcutaneous
|
$116.00 |
$116.00 |
$116.00 |
$365.17
|
|
Vacuum drain bottle/tube kit
|
$325.20 |
$325.20 |
$325.20 |
$325.20
|
|
Vaginal bx
|
$83.40 |
$83.40 |
$83.40 |
$459.42
|
|
Valproic acid total therapeutic drug level
|
$75.60 |
$75.60 |
$75.60 |
$115.00
|
|
Vancomycin 1,000 mg intravenous injection
|
$5.40 |
$5.40 |
$5.40 |
$251.86
|
|
Vancomycin hcl injection
|
$54.60 |
$54.60 |
$54.60 |
$149.49
|
|
Vancomycin peak therapeutic drug level
|
$105.00 |
$105.00 |
$105.00 |
$135.60
|
|
Varicella zoster antibody igg
|
$201.00 |
$201.00 |
$201.00 |
$86.80
|
|
Vasopressin 20 unit/ml intravenous solution
|
$8.00 |
$8.00 |
$8.00 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$74.20 |
$74.20 |
$74.20 |
$18,732.33
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$78.60 |
$78.60 |
$78.60 |
$197.04
|
