|
Unlisted laps px appendix
|
$6,322.02 |
$6,322.02 |
$6,322.02 |
|
|
Unlisted laps px ovidct ovry
|
$14,120.77 |
$14,120.77 |
$14,120.77 |
|
|
Unlisted mr procedure
|
$1,032.20 |
$1,032.20 |
$1,032.20 |
|
|
Unlisted neurological dx px
|
$138.45 |
$138.45 |
$138.45 |
|
|
Unlisted procedure microbiology
|
$99.45 |
$99.45 |
$99.45 |
|
|
Unlisted procedure rectum
|
$18,088.92 |
$18,088.92 |
$18,088.92 |
|
|
Unlisted px arthroscopy
|
$13,085.92 |
$13,085.92 |
$13,085.92 |
|
|
Unlisted px small intestine
|
$4,691.21 |
$4,691.21 |
$4,691.21 |
|
|
Unlisted ultrasound procedure
|
$209.30 |
$209.30 |
$209.30 |
|
|
Unsched dialysis esrd pt hos
|
$1,316.90 |
$1,316.90 |
$1,316.90 |
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,301.65 |
$2,301.65 |
$2,886.00 |
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,139.80 |
$2,139.80 |
$2,338.70 |
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,841.45 |
$1,841.45 |
$1,976.00 |
|
|
Upper Endoscopy (EGD, diagnostic)
|
$583.70 |
$1,794.22 |
$5,379.23 |
|
|
Upper Endoscopy (EGD, with biopsy)
|
$622.70 |
$3,066.91 |
$4,770.18 |
|
|
Uppr gi scope w/submuc inj
|
$693.55 |
$693.55 |
$4,831.79 |
|
|
Urea nitrogen
|
$48.75 |
$48.75 |
$57.85 |
|
|
Urea nitrogen 24 hour urine
|
$39.00 |
$39.00 |
$50.70 |
|
|
Ureteral reflux study
|
$514.15 |
$514.15 |
$692.90 |
|
|
Urethrcystgrphy rtrgrde s&i
|
$303.55 |
$303.55 |
$564.20 |
|
|
Urethrocystography void s&i
|
$460.85 |
$460.85 |
$615.55 |
|
|
Uric acid blood
|
$16.25 |
$44.20 |
$55.90 |
|
|
Uric acid urine
|
$42.25 |
$42.25 |
$50.70 |
|
|
Urinalysis microscopic only
|
$20.15 |
$23.40 |
$24.70 |
|
|
Urinalysis (with microscopy)
|
$11.05 |
$33.15 |
$46.80 |
|
|
Urinalysis (without microscopy)
|
$33.80 |
$42.90 |
$44.20 |
|
|
Urine Culture Test
|
$28.60 |
$47.45 |
$66.30 |
|
|
Urine pregnancy test
|
$59.80 |
$63.70 |
$72.80 |
|
|
Urography, antegrade
|
$879.45 |
$879.45 |
$879.45 |
|
|
Urography inf drip &/or bolus
|
$549.90 |
$549.90 |
$549.90 |
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$10,133.22 |
$10,133.22 |
$10,133.22 |
|
|
Vaccine dtap < 7 years im
|
$85.95 |
$87.80 |
$87.80 |
|
|
Vaccine dtap-hep b-ipv im
|
$281.64 |
$281.64 |
$331.79 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$94.86 |
$94.86 |
$94.86 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$40.64 |
$40.64 |
$40.64 |
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$268.45 |
$268.45 |
$268.45 |
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$216.00 |
$216.00 |
$220.64 |
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$88.04 |
$88.04 |
$90.64 |
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$263.92 |
$263.92 |
$263.92 |
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$59.66 |
$60.95 |
$60.95 |
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$773.60 |
$773.60 |
$773.60 |
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$544.51 |
$544.51 |
$544.51 |
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$531.84 |
$531.84 |
$531.84 |
|
|
Vaccine mmr live subcutaneous
|
$295.60 |
$295.60 |
$295.60 |
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$921.62 |
$950.58 |
$950.58 |
|
|
Vaccine rabies im
|
$918.01 |
$945.46 |
$945.46 |
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$1,837.26 |
$1,837.26 |
$1,837.26 |
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$1,837.26 |
$1,837.26 |
$1,837.26 |
|
|
Vaccine tdap >=7 years im
|
$147.59 |
$150.76 |
$150.77 |
|
|
Vaccine td preservative free >= 7 years im
|
$134.23 |
$137.13 |
$137.13 |
|
|
Vaccine varicella live subcutaneous
|
$590.84 |
$590.84 |
$590.84 |
|
|
Vag hyst including t/o
|
$10,319.63 |
$10,319.63 |
$10,319.63 |
|
|
Vaginal bx
|
$3,875.42 |
$3,875.42 |
$3,875.42 |
|
|
Vaginal delivery after cesarean delivery 59612
|
$1,725.75 |
$1,725.75 |
$1,725.75 |
|
|
Valproate in ns IV syringe 10 mg/ml (pediatric) - cnr
|
$20.69 |
$20.69 |
$20.69 |
|
|
Valproic acid total therapeutic drug level
|
$90.35 |
$97.50 |
$143.65 |
|
|
Valvuloplasty aortic
|
$9,421.75 |
$9,421.75 |
$9,421.75 |
|
|
Vancomycin 1,000 mg intravenous injection
|
$660.76 |
$660.76 |
$660.76 |
|
|
Vancomycin 750 mg intravenous solution
|
$29.92 |
$29.92 |
$29.92 |
|
|
Vancomycin peak therapeutic drug level
|
$92.30 |
$92.30 |
$143.65 |
|
|
Varicella zoster antibody igg
|
$64.35 |
$65.65 |
$83.20 |
|
|
Vasopressin 20 unit/ml intravenous solution
|
$29.98 |
$30.63 |
$324.51 |
|
|
Vedolizumab 300 mg intravenous solution
|
$22,019.50 |
$22,019.50 |
$23,003.79 |
|
|
Veeg unmon 12-26 hrs
|
$1,495.00 |
$1,495.00 |
$1,495.00 |
|
|
Veeg unmon 2-12 hrs
|
$889.85 |
$889.85 |
$889.85 |
|
|
Vein x-ray adrenal gland
|
$2,160.60 |
$2,160.60 |
$2,160.60 |
|
|
Vein x-ray eye socket
|
$1,182.35 |
$1,182.35 |
$1,182.35 |
|
|
Vein x-ray kidney
|
$2,209.35 |
$2,209.35 |
$2,209.35 |
|
|
Vein x-ray liver
|
$2,246.40 |
$2,246.40 |
$2,246.40 |
|
|
Vein x-ray liver w/hemodynam
|
$2,376.40 |
$2,376.40 |
$2,376.40 |
|
|
Vein x-ray skull
|
$1,904.50 |
$1,904.50 |
$1,904.50 |
|
|
Vein x-ray spleen/liver
|
$1,444.30 |
$1,444.30 |
$1,444.30 |
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$45.50 |
$57.85 |
$221.00 |
|
|
Venipuncture <3 yrs other vein
|
$45.50 |
$45.50 |
$46.80 |
|
|
Venogram ext bil s&i
|
$1,544.40 |
$1,544.40 |
$1,702.35 |
|
|
Venogram extremity supervision & interpretation unilateral
|
$1,029.60 |
$1,029.60 |
$1,138.15 |
|
|
Venous mech thrombectomy
|
$22,431.32 |
$22,431.32 |
$22,431.32 |
|
|
Venous sampling s&i
|
$2,241.85 |
$2,241.85 |
$2,241.85 |
|
|
Ven thrombosis images bilat
|
$744.90 |
$744.90 |
$744.90 |
|
|
Ventilator each subsequent day
|
$830.05 |
$833.30 |
$919.75 |
|
|
Ventilator initial day
|
$910.00 |
$910.00 |
$1,093.95 |
|
|
Version cephalic external
|
$1,129.05 |
$1,129.05 |
$1,129.05 |
|
|
Very long chain fatty acids
|
$98.15 |
$157.30 |
$157.30 |
|
|
Vinblastine 1 mg/ml intravenous solution
|
$141.24 |
$141.24 |
$145.91 |
|
|
Vincristine 1 mg/ml intravenous solution
|
$88.98 |
$88.98 |
$91.31 |
|
|
Vinorelbine 10 mg/ml intravenous solution (wrapper)
|
$171.55 |
$171.55 |
$211.25 |
|
|
Virus isolation addl studies ea
|
$72.15 |
$117.65 |
$124.15 |
|
|
Vital capacity test
|
$74.10 |
$74.10 |
$107.90 |
|
|
Vitamin b-12
|
$49.40 |
$49.40 |
$135.85 |
|
|
Vitamin D Test
|
$81.25 |
$81.25 |
$169.65 |
|
|
Voiding pressure study/intra-abd 51797
|
$280.80 |
$280.80 |
$280.80 |
|
|
Volume measurement urine timed
|
$10.40 |
$13.65 |
$19.50 |
|
|
Voriconazole in ns IV syringe 5 mg/ml (pediatric) - cnr
|
$186.18 |
$186.18 |
$226.13 |
|
|
Vulvectomy simple partial
|
$6,160.86 |
$6,160.86 |
$6,160.86 |
|
|
Warde 1003990 aldosterone
|
$122.85 |
$122.85 |
$247.00 |
|
|
Warde 1005020 citrate 24 hour urine
|
$97.50 |
$100.10 |
$116.35 |
|
|
Warde 1005055 5-hiaa 24 hour urine
|
$67.60 |
$67.60 |
$117.65 |
|
|
Warde 1006955 catecholamines fractionated 24 hour urine
|
$157.95 |
$195.00 |
$209.95 |
|
|
Warde 1007138 vanillymandelic acid 24 hour urine
|
$70.85 |
$70.85 |
$113.10 |
|
|
Warde 1015200 kappa light chain free
|
$104.65 |
$112.45 |
$126.10 |
|