|
Treponema pallidum antibody
|
$145.20 |
$145.20 |
$145.20 |
$72.05
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$20.40 |
$20.40 |
$20.40 |
$43.09
|
|
Triglycerides
|
$31.20 |
$31.20 |
$31.20 |
$58.50
|
|
Troponin quantitative
|
$47.40 |
$47.40 |
$47.40 |
$127.60
|
|
Truss add to std pad scrotal
|
$16.80 |
$16.80 |
$16.80 |
$75.60
|
|
Tube drain vert dev st 5-40f
|
$4.20 |
$4.20 |
$4.20 |
$27.60
|
|
Tube trach disp innr can 5 xlt
|
$93.60 |
$93.60 |
$93.60 |
$445.99
|
|
Tx closed tib shaft fx without manip
|
$345.60 |
$345.60 |
$345.60 |
$535.60
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$3,417.60 |
$3,417.60 |
$3,417.60 |
$4,499.12
|
|
Ugt1a1 gene analy common variants
|
$296.40 |
$296.40 |
$296.40 |
$438.75
|
|
Ultrasound breast complete
|
$483.00 |
$483.00 |
$483.00 |
$532.00
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$301.80 |
$301.80 |
$301.80 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$1,375.20 |
$1,375.20 |
$1,375.20 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$53.40 |
$53.40 |
$53.40 |
$388.08
|
|
Ultrasound joint complete left
|
$278.40 |
$278.40 |
$278.40 |
$557.99
|
|
Ultrasound ob >=14wks ea addl gest
|
$719.40 |
$719.40 |
$719.40 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$200.40 |
$200.40 |
$200.40 |
$334.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$681.60 |
$681.60 |
$681.60 |
$698.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$262.20 |
$262.20 |
$262.20 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$387.00 |
$387.00 |
$387.00 |
$557.40
|
|
Ultrasound transabd ea addl gest
|
$384.00 |
$384.00 |
$384.00 |
$419.50
|
|
Unlisted CT procedure
|
$84.00 |
$84.00 |
$84.00 |
$732.70
|
|
Unlisted gi px dx nuc med
|
$736.80 |
$736.80 |
$736.80 |
$995.00
|
|
Unlisted gu px dx nuc med
|
$694.80 |
$694.80 |
$694.80 |
$805.62
|
|
Unlisted hematology&coagj px
|
$14.40 |
$14.40 |
$14.40 |
$39.52
|
|
Unlisted muscskel px dx nuc
|
$779.40 |
$779.40 |
$779.40 |
$1,279.98
|
|
Unlisted nrvs sys px dx nuc
|
$1,006.20 |
$1,006.20 |
$1,006.20 |
$891.41
|
|
Unlisted procedure microbiology
|
$23.40 |
$23.40 |
$23.40 |
$530.00
|
|
Unlisted ultrasound procedure
|
$262.20 |
$262.20 |
$262.20 |
$332.16
|
|
Unlstd hematop ret/endo lymp
|
$814.80 |
$814.80 |
$814.80 |
$473.22
|
|
Upper Arm (Humerus) X-ray (left side)
|
$217.80 |
$217.80 |
$217.80 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$1,153.20 |
$1,153.20 |
$1,153.20 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,167.00 |
$1,167.00 |
$1,167.00 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,313.40 |
$4,313.40 |
$4,313.40 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,526.00 |
$2,526.00 |
$2,526.00 |
$2,369.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,338.80 |
$2,338.80 |
$2,338.80 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$134.40 |
$134.40 |
$134.40 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$143.40 |
$143.40 |
$143.40 |
$381.60
|
|
Upper Endoscopy (EGD, diagnostic)
|
$903.00 |
$903.00 |
$903.00 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,346.40 |
$1,346.40 |
$1,346.40 |
$1,768.00
|
|
Upper GI Barium X-ray (barium and gas)
|
$349.20 |
$349.20 |
$349.20 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$349.20 |
$349.20 |
$349.20 |
$607.20
|
|
Urea nitrogen
|
$62.40 |
$62.40 |
$62.40 |
$42.25
|
|
Urea nitrogen 24 hour urine
|
$88.80 |
$88.80 |
$88.80 |
$52.00
|
|
Ureteral reflux study
|
$397.20 |
$397.20 |
$397.20 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$624.00 |
$624.00 |
$624.00 |
$584.00
|
|
Urethrocystography void s&i
|
$321.00 |
$321.00 |
$321.00 |
$631.40
|
|
Uric acid blood
|
$46.20 |
$46.20 |
$46.20 |
$49.44
|
|
Uric acid urine
|
$78.00 |
$78.00 |
$78.00 |
$45.36
|
|
Urinalysis microscopic only
|
$51.00 |
$51.00 |
$51.00 |
$26.46
|
|
Urinalysis (with microscopy)
|
$100.80 |
$100.80 |
$100.80 |
$55.20
|
|
Urinalysis (without microscopy)
|
$80.40 |
$80.40 |
$80.40 |
$36.00
|
|
Urinary bldr retent nuc study
|
$221.40 |
$221.40 |
$221.40 |
$350.66
|
|
Urine Culture Test
|
$140.40 |
$140.40 |
$140.40 |
$83.00
|
|
Urine pregnancy test
|
$146.40 |
$146.40 |
$146.40 |
$68.78
|
|
Urography inf drip &/or bolus
|
$64.80 |
$64.80 |
$64.80 |
$642.50
|
|
Vaccine Administration (one shot)
|
$42.00 |
$42.00 |
$42.00 |
$67.70
|
|
Vaccine dtap < 7 years im
|
$75.60 |
$75.60 |
$75.60 |
$71.17
|
|
Vaccine dtap-hep b-ipv im
|
$412.80 |
$412.80 |
$412.80 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$158.40 |
$158.40 |
$158.40 |
$105.95
|
|
Vaccine dtap-ipv/hib im
|
$282.00 |
$282.00 |
$282.00 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$51.00 |
$51.00 |
$51.00 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$211.80 |
$211.80 |
$211.80 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$265.20 |
$265.20 |
$265.20 |
$231.56
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$170.40 |
$170.40 |
$170.40 |
$78.25
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$175.20 |
$175.20 |
$175.20 |
$155.16
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$141.00 |
$141.00 |
$141.00 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$492.00 |
$492.00 |
$492.00 |
$576.48
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$25.80 |
$25.80 |
$25.80 |
$72.00
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$385.20 |
$385.20 |
$385.20 |
$394.26
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$818.40 |
$818.40 |
$818.40 |
$409.35
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$384.60 |
$384.60 |
$384.60 |
$310.93
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$384.60 |
$384.60 |
$384.60 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$231.60 |
$231.60 |
$231.60 |
$213.00
|
|
Vaccine mmrv live subcutaneous
|
$593.40 |
$593.40 |
$593.40 |
$424.32
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$183.00 |
$183.00 |
$183.00 |
$252.87
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$358.20 |
$358.20 |
$358.20 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$105.60 |
$105.60 |
$105.60 |
$90.70
|
|
Vaccine rabies im
|
$746.40 |
$746.40 |
$746.40 |
$858.95
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$126.60 |
$126.60 |
$126.60 |
$126.14
|
|
Vaccine tdap >=7 years im
|
$197.40 |
$197.40 |
$197.40 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$103.80 |
$103.80 |
$103.80 |
$112.10
|
|
Vaccine varicella live subcutaneous
|
$243.60 |
$243.60 |
$243.60 |
$365.17
|
|
Valproic acid total therapeutic drug level
|
$73.20 |
$73.20 |
$73.20 |
$115.00
|
|
Vancomycin hcl injection
|
$12.00 |
$12.00 |
$12.00 |
$149.49
|
|
Vancomycin peak therapeutic drug level
|
$246.60 |
$246.60 |
$246.60 |
$136.13
|
|
Varicella zoster antibody igg
|
$174.60 |
$174.60 |
$174.60 |
$86.80
|
|
Vasectomy
|
$2,741.40 |
$2,741.40 |
$2,741.40 |
$2,424.12
|
|
Vedolizumab 300 mg intravenous solution
|
$10,108.20 |
$10,108.20 |
$10,108.20 |
$18,732.33
|
|
Venogram ext bil s&i
|
$1,086.00 |
$1,086.00 |
$1,086.00 |
$1,829.42
|
|
Venogram extremity supervision & interpretation unilateral
|
$1,072.80 |
$1,072.80 |
$1,072.80 |
$1,382.58
|
|
Venous thrombosis imaging
|
$430.80 |
$430.80 |
$430.80 |
$697.20
|
|
Ven thrombosis images bilat
|
$567.60 |
$567.60 |
$567.60 |
$796.50
|
|
Ventilator each subsequent day
|
$471.00 |
$471.00 |
$471.00 |
$1,184.00
|
|
Ventilator Management (first day)
|
$576.00 |
$576.00 |
$576.00 |
$1,434.60
|
|
Very long chain fatty acids
|
$392.40 |
$392.40 |
$392.40 |
$139.88
|
|
Video Swallow Study (Modified Barium Swallow)
|
$222.60 |
$222.60 |
$222.60 |
$524.50
|
|
Visit established high 40-54 minutes/level 5
|
$103.80 |
$103.80 |
$103.80 |
$240.50
|
|
Vital capacity test
|
$134.40 |
$134.40 |
$134.40 |
$173.18
|
|
Vitamin b-12
|
$82.20 |
$82.20 |
$82.20 |
$100.28
|