|
Triglycerides
|
$65.00 |
$65.00 |
$65.00 |
$57.85
|
|
Trimethobenzamide hcl inj
|
$166.35 |
$166.35 |
$166.35 |
$117.49
|
|
Trim nail(s)
|
$50.00 |
$50.00 |
$50.00 |
$77.60
|
|
Trim nondyst nails
|
$50.00 |
$50.00 |
$50.00 |
$115.70
|
|
Trnscath plc stent crv crtd w/prtct
|
$6,570.00 |
$6,570.00 |
$6,570.00 |
$9,767.25
|
|
Trnscath plc stnt ante carotid art
|
$4,095.00 |
$4,095.00 |
$4,095.00 |
$6,391.00
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$10,405.00 |
$10,405.00 |
$10,405.00 |
$8,321.86
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$10,405.00 |
$10,405.00 |
$10,405.00 |
$8,392.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$16,005.00 |
$16,005.00 |
$16,005.00 |
$14,558.70
|
|
Trnscath retrv pq vasc fb w/guide
|
$3,675.00 |
$3,675.00 |
$3,675.00 |
$4,627.00
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$2,005.00 |
$2,005.00 |
$2,005.00 |
$5,006.50
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$3,510.00 |
$3,510.00 |
$3,510.00 |
$4,250.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$3,510.00 |
$3,510.00 |
$3,510.00 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$2,005.00 |
$2,005.00 |
$2,005.00 |
$3,866.70
|
|
Troponin quantitative
|
$87.50 |
$87.50 |
$87.50 |
$128.80
|
|
Tube trach disp innr can 5 xlt
|
$150.00 |
$150.00 |
$150.00 |
$445.99
|
|
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 |
$160.88
|
|
Tyms gene com variants
|
$140.00 |
$140.00 |
$140.00 |
$192.29
|
|
Ugt1a1 gene analy common variants
|
$235.00 |
$235.00 |
$235.00 |
$406.38
|
|
Ultrasound abdomen aorta screening study aaa
|
$380.00 |
$380.00 |
$380.00 |
$394.20
|
|
Ultrasound breast complete
|
$900.00 |
$900.00 |
$900.00 |
$533.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$675.00 |
$675.00 |
$675.00 |
$455.26
|
|
Ultrasound chest
|
$390.00 |
$390.00 |
$390.00 |
$451.52
|
|
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 |
$177.00
|
|
Ultrasound elastography parenchyma
|
$362.50 |
$362.50 |
$362.50 |
$284.25
|
|
Ultrasound encephalogram
|
$570.00 |
$570.00 |
$570.00 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$670.00 |
$670.00 |
$670.00 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$450.00 |
$450.00 |
$450.00 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$285.00 |
$285.00 |
$285.00 |
$379.36
|
|
Ultrasound guided needle placement supervision & interpretation
|
$720.00 |
$720.00 |
$720.00 |
$720.00
|
|
Ultrasound guide intraoperative
|
$292.50 |
$292.50 |
$292.50 |
$625.15
|
|
Ultrasound guide tissue ablation
|
$420.00 |
$420.00 |
$420.00 |
$552.42
|
|
Ultrasound hips infant dynamic
|
$370.00 |
$370.00 |
$370.00 |
$403.00
|
|
Ultrasound joint complete left
|
$750.00 |
$750.00 |
$750.00 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$565.00 |
$565.00 |
$565.00 |
$418.80
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$355.00 |
$355.00 |
$355.00 |
$280.02
|
|
Ultrasound ob >=14wks ea addl gest
|
$330.00 |
$330.00 |
$330.00 |
$397.15
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$267.50 |
$267.50 |
$267.50 |
$323.40
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$535.00 |
$535.00 |
$535.00 |
$693.00
|
|
Ultrasound pregnant uterus follow up per fetus
|
$387.50 |
$387.50 |
$387.50 |
$420.80
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$387.50 |
$387.50 |
$387.50 |
$442.80
|
|
Ultrasound pregnant uterus transvaginal
|
$452.50 |
$452.50 |
$452.50 |
$484.52
|
|
Ultrasound retroperitoneal limited
|
$390.00 |
$390.00 |
$390.00 |
$477.10
|
|
Ultrasound scrotum and contents
|
$595.00 |
$595.00 |
$595.00 |
$606.60
|
|
Ultrasound spinal canal and contents
|
$405.00 |
$405.00 |
$405.00 |
$459.00
|
|
Ultrasound transabd ea addl gest
|
$267.50 |
$267.50 |
$267.50 |
$424.80
|
|
Ultrasound transvaginal non obstetric
|
$405.00 |
$405.00 |
$405.00 |
$549.75
|
|
Ultrasound trgt dyn mbubb 1st les
|
$685.00 |
$685.00 |
$685.00 |
$525.00
|
|
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 |
$196.03
|
|
Unlistd noninvas vasc dx std
|
$427.50 |
$427.50 |
$427.50 |
$564.60
|
|
Unlisted CT procedure
|
$1,540.00 |
$1,540.00 |
$1,540.00 |
$676.12
|
|
Unlisted fluoroscopic px
|
$460.00 |
$460.00 |
$460.00 |
$305.76
|
|
Unlisted gi px dx nuc med
|
$995.00 |
$995.00 |
$995.00 |
$1,150.80
|
|
Unlisted mr procedure
|
$1,385.00 |
$1,385.00 |
$1,385.00 |
$1,037.40
|
|
Unlisted neurological dx px
|
$242.50 |
$242.50 |
$242.50 |
$238.16
|
|
Unlisted orl service/px
|
$80.00 |
$80.00 |
$80.00 |
$121.50
|
|
Unlisted procedure liver
|
$9,690.00 |
$9,690.00 |
$9,690.00 |
$2,475.00
|
|
Unlisted procedure microbiology
|
$530.00 |
$530.00 |
$530.00 |
$487.50
|
|
Unlisted px casting/strpg
|
$110.00 |
$110.00 |
$110.00 |
$207.68
|
|
Unlisted px med radj physics
|
$495.00 |
$495.00 |
$495.00 |
$376.03
|
|
Unlisted reprod med lab proc
|
$65.00 |
$65.00 |
$65.00 |
$70.00
|
|
Unlisted transfusion med px
|
$272.50 |
$272.50 |
$272.50 |
$145.00
|
|
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 |
$1,248.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,265.00 |
$3,265.00 |
$3,265.00 |
$3,039.60
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,210.00 |
$2,210.00 |
$2,210.00 |
$2,412.60
|
|
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 |
$39.90
|
|
Urea nitrogen 24 hour urine
|
$57.50 |
$57.50 |
$57.50 |
$52.00
|
|
Urea nitrogen clearance
|
$72.50 |
$72.50 |
$72.50 |
$47.73
|
|
Ureteral embolization/occl
|
$3,755.00 |
$3,755.00 |
$3,755.00 |
$2,655.00
|
|
Urethrcystgrphy rtrgrde s&i
|
$515.00 |
$515.00 |
$515.00 |
$584.00
|
|
Urethrocystography void s&i
|
$690.00 |
$690.00 |
$690.00 |
$622.35
|
|
Uric acid blood
|
$57.50 |
$57.50 |
$57.50 |
$49.32
|
|
Uric acid urine
|
$52.50 |
$52.50 |
$52.50 |
$44.14
|
|
Urinalysis microscopic only
|
$20.00 |
$20.00 |
$20.00 |
$25.80
|
|
Urinalysis (with microscopy)
|
$57.50 |
$57.50 |
$57.50 |
$55.00
|
|
Urinalysis (without microscopy)
|
$25.00 |
$25.00 |
$25.00 |
$35.91
|
|
Urine Culture Test
|
$80.00 |
$80.00 |
$80.00 |
$84.00
|
|
Urine pregnancy test
|
$77.50 |
$77.50 |
$77.50 |
$69.48
|
|
Urography, antegrade
|
$560.00 |
$560.00 |
$560.00 |
$607.00
|
|
Use 1st target lesion
|
$360.00 |
$360.00 |
$360.00 |
$285.12
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$85.99 |
$85.99 |
$85.99 |
$74.42
|
|
Vaccine mmr live subcutaneous
|
$286.07 |
$286.07 |
$286.07 |
$213.00
|
|
Vaccine rabies im
|
$1,088.56 |
$1,088.56 |
$1,088.56 |
$858.95
|
|
Vaccine tdap >=7 years im
|
$133.93 |
$133.93 |
$133.93 |
$136.80
|
|
Vaccine varicella live subcutaneous
|
$583.61 |
$583.61 |
$583.61 |
$396.97
|
|
Valproic acid total therapeutic drug level
|
$122.50 |
$122.50 |
$122.50 |
$115.00
|
|
Vancomycin hcl injection
|
$29.92 |
$29.92 |
$29.92 |
$154.40
|
|
Vancomycin peak therapeutic drug level
|
$142.50 |
$142.50 |
$142.50 |
$135.00
|
|
Varicella zoster antibody igg
|
$85.00 |
$85.00 |
$85.00 |
$85.05
|
|
Vasc emb/occ w/prs cath
|
$20,240.00 |
$20,240.00 |
$20,240.00 |
$20,240.00
|
|
Veeg cont 2-12 hrs
|
$1,330.00 |
$1,330.00 |
$1,330.00 |
$1,500.00
|
|
Veeg ea 12-26hr cont mntr
|
$2,665.00 |
$2,665.00 |
$2,665.00 |
$2,810.56
|
|
Veeg intrmnt 2-12 hrs
|
$1,330.00 |
$1,330.00 |
$1,330.00 |
$945.35
|
|
Veeg unmon 12-26 hrs
|
$2,665.00 |
$2,665.00 |
$2,665.00 |
$1,647.00
|
|
Veeg unmon 2-12 hrs
|
$1,330.00 |
$1,330.00 |
$1,330.00 |
$813.95
|
