|
Trg gene rearrangement anal
|
$1,051.20 |
$1,051.20 |
$1,051.20 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$12.80 |
$12.80 |
$12.80 |
$43.09
|
|
Trichinella antibody
|
$176.40 |
$176.40 |
$176.40 |
$70.65
|
|
Triglycerides
|
$39.00 |
$39.00 |
$39.00 |
$58.50
|
|
Trimethobenzamide hcl inj
|
$77.60 |
$77.60 |
$77.60 |
$117.49
|
|
Trim nail(s)
|
$112.80 |
$112.80 |
$112.80 |
$79.00
|
|
Triptorelin pamoate
|
$2,681.40 |
$2,681.40 |
$2,681.40 |
$4,619.39
|
|
Trnscath plc vas stent w/s&i ini vein
|
$12,780.00 |
$12,780.00 |
$12,780.00 |
$14,461.50
|
|
Trnscath retrv pq vasc fb w/guide
|
$6,120.00 |
$6,120.00 |
$6,120.00 |
$4,766.40
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$8,554.80 |
$8,554.80 |
$8,554.80 |
$5,139.20
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$4,368.00 |
$4,368.00 |
$4,368.00 |
$2,620.20
|
|
Troponin quantitative
|
$114.60 |
$114.60 |
$114.60 |
$127.60
|
|
Tte w or without contr, cont ecg
|
$2,588.40 |
$2,588.40 |
$2,588.40 |
$2,067.00
|
|
Tte w or without fol w/con,stres
|
$626.40 |
$626.40 |
$626.40 |
$1,632.80
|
|
Tube trach disp innr can 5 xlt
|
$141.00 |
$141.00 |
$141.00 |
$445.99
|
|
Tube trach disp innr can 6 xlt
|
$72.60 |
$72.60 |
$72.60 |
$16.80
|
|
Tx closed distal humerus fx
|
$134.40 |
$134.40 |
$134.40 |
$594.88
|
|
Tx closed hip disl traumatic without anes
|
$3,032.40 |
$3,032.40 |
$3,032.40 |
$586.40
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$5,734.80 |
$5,734.80 |
$5,734.80 |
$4,499.12
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$4,281.00 |
$4,281.00 |
$4,281.00 |
$4,499.12
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$6,170.40 |
$6,170.40 |
$6,170.40 |
$4,637.36
|
|
Ugt1a1 gene analy common variants
|
$1,240.20 |
$1,240.20 |
$1,240.20 |
$438.75
|
|
Ultrasound breast complete
|
$627.00 |
$627.00 |
$627.00 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$400.20 |
$400.20 |
$400.20 |
$452.40
|
|
Ultrasound encephalogram
|
$552.00 |
$552.00 |
$552.00 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$426.00 |
$426.00 |
$426.00 |
$578.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$385.80 |
$385.80 |
$385.80 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$354.00 |
$354.00 |
$354.00 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$254.40 |
$254.40 |
$254.40 |
$388.08
|
|
Ultrasound hips infant dynamic
|
$516.60 |
$516.60 |
$516.60 |
$403.88
|
|
Ultrasound joint complete left
|
$625.80 |
$625.80 |
$625.80 |
$557.99
|
|
Ultrasound ob >=14wks ea addl gest
|
$1,906.20 |
$1,906.20 |
$1,906.20 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$610.80 |
$610.80 |
$610.80 |
$334.50
|
|
Ultrasound prostate/transrectal
|
$354.00 |
$354.00 |
$354.00 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$354.00 |
$354.00 |
$354.00 |
$463.00
|
|
Unlisted CT procedure
|
$624.00 |
$624.00 |
$624.00 |
$732.70
|
|
Unlisted hematology&coagj px
|
$72.00 |
$72.00 |
$72.00 |
$39.52
|
|
Unlisted mr procedure
|
$173.40 |
$173.40 |
$173.40 |
$1,165.00
|
|
Unlisted procedure microbiology
|
$312.00 |
$312.00 |
$312.00 |
$530.00
|
|
Unlisted px forearm/wrist
|
$109.20 |
$109.20 |
$109.20 |
$859.50
|
|
Unlisted px leg/ankle
|
$118.20 |
$118.20 |
$118.20 |
$882.30
|
|
Unlisted px posterior segmnt
|
$4,036.20 |
$4,036.20 |
$4,036.20 |
$3,173.34
|
|
Unlisted px tongue flr mouth
|
$118.20 |
$118.20 |
$118.20 |
$282.50
|
|
Unlisted ultrasound procedure
|
$306.00 |
$306.00 |
$306.00 |
$332.16
|
|
Unsched dialysis esrd pt hos
|
$1,776.60 |
$1,776.60 |
$1,776.60 |
$1,292.33
|
|
Upper Arm (Humerus) X-ray (left side)
|
$119.40 |
$119.40 |
$119.40 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$1,636.80 |
$1,636.80 |
$1,636.80 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,368.00 |
$1,368.00 |
$1,368.00 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,864.00 |
$3,864.00 |
$3,864.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,224.80 |
$2,224.80 |
$2,224.80 |
$2,369.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,205.00 |
$2,205.00 |
$2,205.00 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$154.80 |
$154.80 |
$154.80 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$186.00 |
$186.00 |
$186.00 |
$381.60
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,558.20 |
$1,558.20 |
$1,558.20 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$2,132.40 |
$2,132.40 |
$2,132.40 |
$1,768.00
|
|
Upper GI Barium X-ray (barium and gas)
|
$520.80 |
$520.80 |
$520.80 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$520.80 |
$520.80 |
$520.80 |
$607.20
|
|
Urea nitrogen
|
$34.80 |
$34.80 |
$34.80 |
$42.25
|
|
Urea nitrogen 24 hour urine
|
$43.80 |
$43.80 |
$43.80 |
$52.00
|
|
Urea nitrogen clearance
|
$103.20 |
$103.20 |
$103.20 |
$38.35
|
|
Urethrcystgrphy rtrgrde s&i
|
$306.60 |
$306.60 |
$306.60 |
$584.00
|
|
Urethrocystography void s&i
|
$306.60 |
$306.60 |
$306.60 |
$631.40
|
|
Uric acid blood
|
$36.00 |
$36.00 |
$36.00 |
$49.44
|
|
Uric acid urine
|
$36.00 |
$36.00 |
$36.00 |
$45.36
|
|
Urinalysis (with microscopy)
|
$36.00 |
$36.00 |
$36.00 |
$55.20
|
|
Urinalysis (without microscopy)
|
$17.40 |
$17.40 |
$17.40 |
$36.00
|
|
Urinary pouch on barr w/flng
|
$12.60 |
$12.60 |
$12.60 |
$9.89
|
|
Urine Culture Test
|
$84.60 |
$84.60 |
$84.60 |
$83.00
|
|
Urine pregnancy test
|
$39.00 |
$39.00 |
$39.00 |
$68.78
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$70.20 |
$70.20 |
$70.20 |
$5,205.00
|
|
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 haemophilus influenzae type b (hib) prp-t 4 dose im
|
$31.20 |
$31.20 |
$31.20 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$81.00 |
$81.00 |
$81.00 |
$166.62
|
|
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 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
|
$109.20 |
$109.20 |
$109.20 |
$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 mengingoccocal serogroup b 2 dose im
|
$109.60 |
$109.60 |
$109.60 |
$394.26
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$108.80 |
$108.80 |
$108.80 |
$329.24
|
|
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 |
$397.11
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$192.00 |
$192.00 |
$192.00 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$38.40 |
$38.40 |
$38.40 |
$90.70
|
|
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
|
$74.40 |
$74.40 |
$74.40 |
$112.10
|
|
Vacuum drain bottle/tube kit
|
$341.40 |
$341.40 |
$341.40 |
$325.20
|
|
Valproic acid total therapeutic drug level
|
$96.00 |
$96.00 |
$96.00 |
$115.00
|
|
Vancomycin 1,000 mg intravenous injection
|
$0.60 |
$0.60 |
$0.60 |
$259.05
|
|
Vancomycin hcl injection
|
$42.00 |
$42.00 |
$42.00 |
$149.49
|
|
Vancomycin peak therapeutic drug level
|
$102.00 |
$102.00 |
$102.00 |
$136.13
|
|
Varicella zoster antibody igg
|
$64.80 |
$64.80 |
$64.80 |
$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)
|
$122.40 |
$122.40 |
$122.40 |
$188.83
|
