|
Trnscath tx thromblytc artery non-intracrn ini day
|
$2,946.00 |
$2,946.00 |
$3,240.60 |
$5,069.50
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$745.20 |
$745.20 |
$819.72 |
$4,250.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$819.72 |
$819.72 |
$1,490.40 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$886.20 |
$886.20 |
$974.82 |
$3,866.70
|
|
Troponin quantitative
|
$32.67 |
$32.67 |
$62.37 |
$127.20
|
|
Tte w or without contr, cont ecg
|
$403.50 |
$403.50 |
$443.85 |
$2,012.40
|
|
Tx atrial fib pulm vein isol
|
$4,734.30 |
$4,734.30 |
$5,207.73 |
$29,030.54
|
|
Tx l/r atrial fib addl
|
$1,794.00 |
$1,794.00 |
$1,973.40 |
$6,769.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$11,358.86 |
$11,358.86 |
$12,494.75 |
$20,945.01
|
|
Ultrasound abdomen aorta screening study aaa
|
$50.10 |
$50.10 |
$55.11 |
$394.20
|
|
Ultrasound breast complete
|
$284.40 |
$284.40 |
$312.84 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$189.60 |
$189.60 |
$208.56 |
$449.35
|
|
Ultrasound chest
|
$120.00 |
$120.00 |
$132.00 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$50.10 |
$50.10 |
$55.11 |
$338.00
|
|
Ultrasound elastography parenchyma
|
$111.30 |
$111.30 |
$122.43 |
$307.00
|
|
Ultrasound encephalogram
|
$131.40 |
$131.40 |
$144.54 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$162.60 |
$162.60 |
$178.86 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$50.10 |
$50.10 |
$55.11 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$90.30 |
$90.30 |
$99.33 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$126.00 |
$126.00 |
$138.60 |
$720.15
|
|
Ultrasound guide intraoperative
|
$179.40 |
$179.40 |
$197.34 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$34.20 |
$34.20 |
$37.62 |
$560.00
|
|
Ultrasound joint/nonvascular extremity limited left
|
$154.20 |
$154.20 |
$169.62 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$243.90 |
$243.90 |
$268.29 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$198.60 |
$198.60 |
$218.46 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$99.33 |
$99.33 |
$99.33 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$50.16 |
$50.16 |
$50.16 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$79.50 |
$79.50 |
$99.00 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$191.10 |
$191.10 |
$210.21 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$191.10 |
$191.10 |
$210.21 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$66.60 |
$66.60 |
$73.26 |
$486.50
|
|
Ultrasound scrotum and contents
|
$103.50 |
$103.50 |
$113.85 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$54.90 |
$54.90 |
$60.39 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$31.68 |
$31.68 |
$31.68 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$83.70 |
$83.70 |
$92.07 |
$558.35
|
|
Unlisted maaa
|
$227.70 |
$227.70 |
$434.70 |
$235.20
|
|
Unlisted mr procedure
|
$867.00 |
$867.00 |
$953.70 |
$1,163.00
|
|
Unlisted neurological dx px
|
$288.75 |
$288.75 |
$288.75 |
$242.50
|
|
Unlisted procedure liver
|
$1,122.60 |
$1,122.60 |
$1,234.86 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$118.80 |
$118.80 |
$118.80 |
$523.50
|
|
Unlisted px med radj physics
|
$258.60 |
$258.60 |
$284.46 |
$462.35
|
|
Unlisted ultrasound procedure
|
$144.30 |
$144.30 |
$158.73 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$595.20 |
$595.20 |
$654.72 |
$1,268.17
|
|
Upgrade pm system
|
$3,533.70 |
$3,533.70 |
$3,887.07 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$867.00 |
$867.00 |
$953.70 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$705.00 |
$705.00 |
$775.50 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$705.00 |
$705.00 |
$775.50 |
$2,034.41
|
|
Urea nitrogen
|
$13.20 |
$13.20 |
$25.20 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$14.19 |
$14.19 |
$27.09 |
$51.75
|
|
Urethrcystgrphy rtrgrde s&i
|
$129.60 |
$129.60 |
$142.56 |
$579.73
|
|
Urethrocystography void s&i
|
$142.80 |
$142.80 |
$157.08 |
$622.35
|
|
Uric acid blood
|
$14.85 |
$14.85 |
$28.35 |
$48.75
|
|
Uric acid urine
|
$44.22 |
$44.22 |
$84.42 |
$44.33
|
|
Urinalysis (with microscopy)
|
$10.56 |
$10.56 |
$20.16 |
$55.00
|
|
Urinalysis (without microscopy)
|
$7.59 |
$7.59 |
$14.49 |
$35.75
|
|
Urine Culture Test
|
$26.73 |
$26.73 |
$51.03 |
$81.50
|
|
Urine pregnancy test
|
$21.12 |
$21.12 |
$40.32 |
$67.20
|
|
Urography, antegrade
|
$169.20 |
$169.20 |
$186.12 |
$622.35
|
|
User adjustable heel height
|
$37.40 |
$37.40 |
$37.40 |
$2,004.80
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$3,693.30 |
$3,693.30 |
$4,062.63 |
$5,184.34
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$151.00 |
$151.00 |
$166.10 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$85.50 |
$85.50 |
$94.05 |
$123.20
|
|
Vaccine dtap-ipv 4-6 years im
|
$85.50 |
$85.50 |
$94.05 |
$105.95
|
|
Vaccine dtap-ipv-hib-hepb im
|
$149.11 |
$149.11 |
$164.02 |
$174.72
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$53.06 |
$53.06 |
$58.37 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$22.94 |
$22.94 |
$25.23 |
$43.12
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$125.87 |
$125.87 |
$138.46 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$159.24 |
$159.24 |
$175.16 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$50.78 |
$50.78 |
$55.85 |
$75.39
|
|
Vaccine influenza inactivated adjuvant im
|
$88.04 |
$88.04 |
$96.84 |
$109.50
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$38.86 |
$38.86 |
$42.75 |
$47.88
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$85.50 |
$85.50 |
$94.05 |
$76.50
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$242.44 |
$242.44 |
$266.68 |
$400.03
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$175.70 |
$175.70 |
$193.26 |
$310.93
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$170.48 |
$170.48 |
$187.53 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$99.80 |
$99.80 |
$109.78 |
$211.68
|
|
Vaccine mmrv live subcutaneous
|
$283.88 |
$283.88 |
$312.27 |
$424.32
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$119.70 |
$119.70 |
$131.67 |
$251.64
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$231.38 |
$231.38 |
$254.51 |
$397.11
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$234.21 |
$234.21 |
$257.63 |
$414.46
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$280.62 |
$280.62 |
$308.69 |
$563.36
|
|
Vaccine rabies im
|
$461.27 |
$461.27 |
$507.39 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$301.61 |
$301.61 |
$331.77 |
$538.84
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$568.59 |
$568.59 |
$625.45 |
$1,104.47
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$506.09 |
$506.09 |
$556.70 |
$997.44
|
|
Vaccine tdap >=7 years im
|
$85.50 |
$85.50 |
$94.05 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$85.50 |
$85.50 |
$94.05 |
$112.10
|
|
Vaccine varicella live subcutaneous
|
$196.29 |
$196.29 |
$215.92 |
$365.17
|
|
Valproic acid total therapeutic drug level
|
$44.88 |
$44.88 |
$85.68 |
$114.72
|
|
Valvuloplasty aortic
|
$2,931.60 |
$2,931.60 |
$3,224.76 |
$7,830.80
|
|
Valvuloplasty mitral
|
$2,931.60 |
$2,931.60 |
$3,224.76 |
$10,877.90
|
|
Valvuloplasty pulmonary
|
$4,840.80 |
$4,840.80 |
$4,840.80 |
$11,945.20
|
|
Vancomycin peak therapeutic drug level
|
$44.88 |
$44.88 |
$85.68 |
$136.13
|
|
Vanomycin dna amp probe
|
$18.81 |
$18.81 |
$35.91 |
$78.40
|
|
Varicella zoster antibody igg
|
$18.90 |
$18.90 |
$75.24 |
$86.80
|
|
Vasc emb/occ w/prs cath
|
$7,665.00 |
$7,665.00 |
$8,431.50 |
$21,009.00
|
|
Vedolizumab 300 mg intravenous solution
|
$9,569.57 |
$9,569.57 |
$10,526.53 |
$18,732.33
|
|
Veeg intrmnt 2-12 hrs
|
$188.76 |
$188.76 |
$188.76 |
$961.00
|
|
Veeg unmon 12-26 hrs
|
$326.70 |
$326.70 |
$359.37 |
$1,671.09
|
|
Veeg unmon 2-12 hrs
|
$326.70 |
$326.70 |
$359.37 |
$826.15
|
