|
Tube trach disp innr can 6 xlt
|
$10.00 |
$10.00 |
$10.00 |
$16.80
|
|
Tube trach fen sz 6 uncuffed
|
$125.00 |
$125.00 |
$125.00 |
$155.98
|
|
Tympanometry & reflex thresh
|
$115.00 |
$115.00 |
$115.00 |
$170.00
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$910.00 |
$910.00 |
$910.00 |
$911.43
|
|
Tyms gene com variants
|
$140.00 |
$140.00 |
$140.00 |
$192.29
|
|
Ua w/micro/comp poc
|
$15.00 |
$15.00 |
$15.00 |
$23.00
|
|
Ugt1a1 gene analy common variants
|
$235.00 |
$235.00 |
$235.00 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$380.00 |
$380.00 |
$380.00 |
$394.20
|
|
Ultrasound breast complete
|
$1,140.00 |
$1,140.00 |
$1,140.00 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$850.00 |
$850.00 |
$850.00 |
$449.35
|
|
Ultrasound chest
|
$470.00 |
$470.00 |
$470.00 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$285.00 |
$285.00 |
$285.00 |
$338.00
|
|
Ultrasound elastography ea l target les
|
$180.00 |
$180.00 |
$180.00 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$362.50 |
$362.50 |
$362.50 |
$307.00
|
|
Ultrasound encephalogram
|
$570.00 |
$570.00 |
$570.00 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$670.00 |
$670.00 |
$670.00 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$482.50 |
$482.50 |
$482.50 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$560.00 |
$560.00 |
$560.00 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$720.00 |
$720.00 |
$720.00 |
$720.15
|
|
Ultrasound guide intraoperative
|
$292.50 |
$292.50 |
$292.50 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$420.00 |
$420.00 |
$420.00 |
$560.00
|
|
Ultrasound infant hips ltd without stress
|
$247.50 |
$247.50 |
$247.50 |
$311.25
|
|
Ultrasound joint complete left
|
$750.00 |
$750.00 |
$750.00 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$565.00 |
$565.00 |
$565.00 |
$425.45
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$355.00 |
$355.00 |
$355.00 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$330.00 |
$330.00 |
$330.00 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$267.50 |
$267.50 |
$267.50 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$535.00 |
$535.00 |
$535.00 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$387.50 |
$387.50 |
$387.50 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$387.50 |
$387.50 |
$387.50 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$452.50 |
$452.50 |
$452.50 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$790.00 |
$790.00 |
$790.00 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$580.00 |
$580.00 |
$580.00 |
$486.50
|
|
Ultrasound scrotum and contents
|
$595.00 |
$595.00 |
$595.00 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$405.00 |
$405.00 |
$405.00 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$267.50 |
$267.50 |
$267.50 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$490.00 |
$490.00 |
$490.00 |
$558.35
|
|
Ultrasound trgt dyn mbubb 1st les
|
$685.00 |
$685.00 |
$685.00 |
$568.32
|
|
Ultrasound trgt dyn mbubb ea addl
|
$342.50 |
$342.50 |
$342.50 |
$348.00
|
|
Umbilical artery cath newborn 36660
|
$347.50 |
$347.50 |
$347.50 |
$206.64
|
|
Unlistd noninvas vasc dx std
|
$427.50 |
$427.50 |
$427.50 |
$528.80
|
|
Unlisted CT procedure
|
$1,540.00 |
$1,540.00 |
$1,540.00 |
$732.70
|
|
Unlisted dx gi procedure
|
$940.00 |
$940.00 |
$940.00 |
$649.22
|
|
Unlisted fluoroscopic px
|
$460.00 |
$460.00 |
$460.00 |
$305.76
|
|
Unlisted mr procedure
|
$1,385.00 |
$1,385.00 |
$1,385.00 |
$1,163.00
|
|
Unlisted neurological dx px
|
$242.50 |
$242.50 |
$242.50 |
$242.50
|
|
Unlisted orl service/px
|
$80.00 |
$80.00 |
$80.00 |
$132.60
|
|
Unlisted procedure liver
|
$2,580.00 |
$2,580.00 |
$2,580.00 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$530.00 |
$530.00 |
$530.00 |
$523.50
|
|
Unlisted px casting/strpg
|
$110.00 |
$110.00 |
$110.00 |
$219.70
|
|
Unlisted px med radj physics
|
$495.00 |
$495.00 |
$495.00 |
$462.35
|
|
Unlisted reprod med lab proc
|
$65.00 |
$65.00 |
$65.00 |
$70.00
|
|
Unlisted transfusion med px
|
$145.00 |
$145.00 |
$145.00 |
$147.50
|
|
Unlisted ultrasound procedure
|
$75.00 |
$75.00 |
$75.00 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$1,240.00 |
$1,240.00 |
$1,240.00 |
$1,268.17
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,265.00 |
$3,265.00 |
$3,265.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,210.00 |
$2,210.00 |
$2,210.00 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,110.00 |
$2,110.00 |
$2,110.00 |
$2,034.41
|
|
Urea nitrogen
|
$27.50 |
$27.50 |
$27.50 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$57.50 |
$57.50 |
$57.50 |
$51.75
|
|
Urea nitrogen clearance
|
$72.50 |
$72.50 |
$72.50 |
$42.25
|
|
Ureteral embolization/occl
|
$4,230.00 |
$4,230.00 |
$4,230.00 |
$2,181.40
|
|
Urethrcystgrphy rtrgrde s&i
|
$515.00 |
$515.00 |
$515.00 |
$579.73
|
|
Urethrocystography void s&i
|
$690.00 |
$690.00 |
$690.00 |
$622.35
|
|
Uric acid blood
|
$57.50 |
$57.50 |
$57.50 |
$48.75
|
|
Uric acid urine
|
$52.50 |
$52.50 |
$52.50 |
$44.33
|
|
Urinalysis microscopic only
|
$20.00 |
$20.00 |
$20.00 |
$26.35
|
|
Urinalysis (with microscopy)
|
$57.50 |
$57.50 |
$57.50 |
$55.00
|
|
Urinalysis (without microscopy)
|
$25.00 |
$25.00 |
$25.00 |
$35.75
|
|
Urine Culture Test
|
$80.00 |
$80.00 |
$80.00 |
$81.50
|
|
Urine pregnancy test
|
$77.50 |
$77.50 |
$77.50 |
$67.20
|
|
Urography, antegrade
|
$560.00 |
$560.00 |
$560.00 |
$622.35
|
|
Use 1st target lesion
|
$360.00 |
$360.00 |
$360.00 |
$332.00
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$53.46 |
$53.46 |
$53.46 |
$5,184.34
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$89.80 |
$89.80 |
$89.80 |
$75.39
|
|
Vaccine mmr live subcutaneous
|
$292.01 |
$292.01 |
$292.01 |
$211.68
|
|
Vaccine tdap >=7 years im
|
$137.39 |
$137.39 |
$137.39 |
$131.34
|
|
Vacuum drain bottle/tube kit
|
$487.50 |
$487.50 |
$487.50 |
$325.20
|
|
Valproic acid total therapeutic drug level
|
$122.50 |
$122.50 |
$122.50 |
$114.72
|
|
Vancomycin hcl injection
|
$29.23 |
$29.23 |
$29.23 |
$154.40
|
|
Vancomycin peak therapeutic drug level
|
$142.50 |
$142.50 |
$142.50 |
$136.13
|
|
Varicella zoster antibody igg
|
$85.00 |
$85.00 |
$85.00 |
$86.80
|
|
Vasc emb/occ w/prs cath
|
$20,240.00 |
$20,240.00 |
$20,240.00 |
$21,009.00
|
|
Vedolizumab 300 mg intravenous solution
|
$100.52 |
$100.52 |
$100.52 |
$18,732.33
|
|
Veeg intrmnt 2-12 hrs
|
$1,330.00 |
$1,330.00 |
$1,330.00 |
$961.00
|
|
Vein x-ray adrenal glands
|
$3,935.00 |
$3,935.00 |
$3,935.00 |
$3,935.00
|
|
Vein x-ray kidney
|
$2,095.00 |
$2,095.00 |
$2,095.00 |
$2,766.73
|
|
Vein x-ray liver
|
$2,095.00 |
$2,095.00 |
$2,095.00 |
$3,305.50
|
|
Vein x-ray liver w/hemodynam
|
$2,365.00 |
$2,365.00 |
$2,365.00 |
$3,486.86
|
|
Vein x-ray liver w/hemodynam
|
$2,515.00 |
$2,515.00 |
$2,515.00 |
$3,483.84
|
|
Vein x-ray liver without hemodyn
|
$1,575.00 |
$1,575.00 |
$1,575.00 |
$2,452.80
|
|
Ven-artl shunt det mbubb njx
|
$630.00 |
$630.00 |
$630.00 |
$484.25
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$70.00 |
$70.00 |
$70.00 |
$202.80
|
|
Venipuncture <3 yrs other vein
|
$70.00 |
$70.00 |
$70.00 |
$67.00
|
|
Venogram ext bil s&i
|
$1,575.00 |
$1,575.00 |
$1,575.00 |
$1,797.50
|
|
Venogram extremity supervision & interpretation unilateral
|
$1,050.00 |
$1,050.00 |
$1,050.00 |
$1,366.20
|
|
Venous mech thrombectomy
|
$4,870.00 |
$4,870.00 |
$4,870.00 |
$7,965.00
|
|
Venous m-thrombectomy add-on
|
$4,870.00 |
$4,870.00 |
$4,870.00 |
$5,094.75
|
|
Venous sampling s&i
|
$3,085.00 |
$3,085.00 |
$3,085.00 |
$4,193.20
|
|
Ventilator each subsequent day
|
$875.00 |
$875.00 |
$875.00 |
$1,204.00
|
