|
Tympanometry & reflex thresh
|
$210.63 |
$210.63 |
$210.63 |
$173.18
|
|
Ultrasound abdomen aorta screening study aaa
|
$399.33 |
$399.33 |
$399.33 |
$403.26
|
|
Ultrasound breast complete
|
$1,028.67 |
$1,028.67 |
$1,028.67 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$1,028.67 |
$1,028.67 |
$1,028.67 |
$449.35
|
|
Ultrasound chest
|
$889.44 |
$889.44 |
$889.44 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$353.94 |
$353.94 |
$353.94 |
$340.14
|
|
Ultrasound elastography parenchyma
|
$107.10 |
$107.10 |
$107.10 |
$284.25
|
|
Ultrasound encephalogram
|
$1,164.33 |
$1,164.33 |
$1,164.33 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$1,399.95 |
$1,399.95 |
$1,399.95 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$1,102.62 |
$1,102.62 |
$1,102.62 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$205.02 |
$205.02 |
$205.02 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$751.74 |
$751.74 |
$751.74 |
$701.35
|
|
Ultrasound joint complete left
|
$1,394.85 |
$1,394.85 |
$1,394.85 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$1,332.63 |
$1,332.63 |
$1,332.63 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$1,684.53 |
$1,684.53 |
$1,684.53 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$986.34 |
$986.34 |
$986.34 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$812.94 |
$812.94 |
$812.94 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$1,073.55 |
$1,073.55 |
$1,073.55 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$1,118.43 |
$1,118.43 |
$1,118.43 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$1,286.22 |
$1,286.22 |
$1,286.22 |
$485.48
|
|
Ultrasound retroperitoneal limited
|
$1,293.87 |
$1,293.87 |
$1,293.87 |
$498.00
|
|
Ultrasound scrotum and contents
|
$1,511.13 |
$1,511.13 |
$1,511.13 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$1,078.14 |
$1,078.14 |
$1,078.14 |
$450.60
|
|
Ultrasound transvaginal non obstetric
|
$1,260.21 |
$1,260.21 |
$1,260.21 |
$567.44
|
|
Unlisted chemotherapy px
|
$308.04 |
$308.04 |
$308.04 |
$153.85
|
|
Unlisted misc path test
|
$96.90 |
$96.90 |
$96.90 |
$89.40
|
|
Unlisted procedure microbiology
|
$544.68 |
$544.68 |
$544.68 |
$487.50
|
|
Unlisted procedure rectum
|
$12,654.63 |
$12,654.63 |
$12,654.63 |
$1,278.72
|
|
Unlisted px hands/fingers
|
$13,257.96 |
$13,257.96 |
$13,257.96 |
$379.44
|
|
Unlisted px salivry glnd/dux
|
$9,462.54 |
$9,462.54 |
$9,462.54 |
$486.72
|
|
Unlisted px small intestine
|
$6,681.00 |
$6,681.00 |
$6,681.00 |
$2,118.35
|
|
Unlisted ultrasound procedure
|
$868.02 |
$868.02 |
$868.02 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$1,348.44 |
$1,348.44 |
$1,348.44 |
$1,480.70
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,194.53 |
$2,194.53 |
$2,194.53 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,136.90 |
$2,136.90 |
$2,136.90 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,263.27 |
$1,263.27 |
$1,263.27 |
$1,588.59
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,263.27 |
$1,263.27 |
$1,263.27 |
$1,656.60
|
|
Urea nitrogen
|
$66.30 |
$66.30 |
$66.30 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$62.73 |
$62.73 |
$62.73 |
$50.00
|
|
Urea nitrogen clearance
|
$86.70 |
$86.70 |
$86.70 |
$33.57
|
|
Urethrcystgrphy rtrgrde s&i
|
$1,035.30 |
$1,035.30 |
$1,035.30 |
$574.40
|
|
Urethrocystography void s&i
|
$1,668.72 |
$1,668.72 |
$1,668.72 |
$634.50
|
|
Uric acid blood
|
$72.93 |
$72.93 |
$72.93 |
$46.64
|
|
Uric acid urine
|
$17.85 |
$17.85 |
$17.85 |
$46.75
|
|
Urinalysis microscopic only
|
$70.38 |
$70.38 |
$70.38 |
$26.35
|
|
Urinalysis (with microscopy)
|
$109.14 |
$109.14 |
$109.14 |
$48.14
|
|
Urinalysis (without microscopy)
|
$132.09 |
$132.09 |
$132.09 |
$38.99
|
|
Urine Culture Test
|
$187.68 |
$187.68 |
$187.68 |
$84.81
|
|
Urine pregnancy test
|
$117.81 |
$117.81 |
$117.81 |
$66.40
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$148.84 |
$148.84 |
$148.84 |
$223.08
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$148.84 |
$148.84 |
$148.84 |
$218.88
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$133.72 |
$133.72 |
$133.72 |
$239.85
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$89.54 |
$89.54 |
$89.54 |
$131.67
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$66.67 |
$66.67 |
$66.67 |
$91.00
|
|
Vaccine dtap < 7 years im
|
$136.21 |
$136.21 |
$136.21 |
$87.80
|
|
Vaccine dtap-hep b-ipv im
|
$30.60 |
$30.60 |
$30.60 |
$193.83
|
|
Vaccine hepatitis a (hepa) adult im
|
$45.90 |
$45.90 |
$45.90 |
$178.07
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$154.79 |
$154.79 |
$154.79 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$45.90 |
$45.90 |
$45.90 |
$84.38
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$261.94 |
$261.94 |
$261.94 |
$173.98
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$174.80 |
$174.80 |
$174.80 |
$306.24
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$116.86 |
$116.86 |
$116.86 |
$79.04
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$383.52 |
$383.52 |
$383.52 |
$686.67
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$94.35 |
$94.35 |
$94.35 |
$226.20
|
|
Vaccine influenza nos 0.5ml dose im
|
$12.75 |
$12.75 |
$12.75 |
$36.80
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$96.76 |
$96.76 |
$96.76 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$17.85 |
$17.85 |
$17.85 |
$40.01
|
|
Vaccine influenza quadrivalent live (laiv4) intranasal
|
$76.50 |
$76.50 |
$76.50 |
$37.05
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$142.45 |
$142.45 |
$142.45 |
$103.88
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$45.90 |
$45.90 |
$45.90 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$314.81 |
$314.81 |
$314.81 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$51.00 |
$51.00 |
$51.00 |
$274.95
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$76.50 |
$76.50 |
$76.50 |
$397.18
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$720.50 |
$720.50 |
$720.50 |
$715.41
|
|
Vaccine polio (ipv) subcutaneous/im
|
$15.30 |
$15.30 |
$15.30 |
$119.17
|
|
Vaccine rabies im
|
$950.54 |
$950.54 |
$950.54 |
$945.46
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$800.29 |
$800.29 |
$800.29 |
$624.00
|
|
Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im
|
$995.43 |
$995.43 |
$995.43 |
$440.40
|
|
Vaccine tdap >=7 years im
|
$200.54 |
$200.54 |
$200.54 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$195.37 |
$195.37 |
$195.37 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$569.81 |
$569.81 |
$569.81 |
$447.80
|
|
Vad battery clip set hmii 14-v li-ion
|
$1,741.91 |
$1,741.91 |
$1,741.91 |
$1,683.99
|
|
Vad univ batt charger hm 1440
|
$9,438.51 |
$9,438.51 |
$9,438.51 |
$14,893.34
|
|
Vaginal bx
|
$10,701.33 |
$10,701.33 |
$10,701.33 |
$441.75
|
|
Vaginal delivery after cesarean delivery 59612
|
$3,605.19 |
$3,605.19 |
$3,605.19 |
$4,109.28
|
|
Valproic acid total therapeutic drug level
|
$120.36 |
$120.36 |
$120.36 |
$115.00
|
|
Vancomycin 1,000 mg intravenous injection
|
$300.99 |
$300.99 |
$300.99 |
$246.70
|
|
Vancomycin 750 mg intravenous solution
|
$130.18 |
$130.18 |
$130.18 |
$100.15
|
|
Vancomycin peak therapeutic drug level
|
$184.62 |
$184.62 |
$184.62 |
$126.79
|
|
Varicella zoster antibody igg
|
$191.76 |
$191.76 |
$191.76 |
$82.55
|
|
Vasopressin 20 unit/ml intravenous solution
|
$114.85 |
$114.85 |
$114.85 |
$362.93
|
|
Veeg cont 2-12 hrs
|
$1,296.93 |
$1,296.93 |
$1,296.93 |
$1,485.05
|
|
Veeg ea 12-26hr cont mntr
|
$2,593.86 |
$2,593.86 |
$2,593.86 |
$3,332.45
|
|
Veeg intrmnt 2-12 hrs
|
$622.71 |
$622.71 |
$622.71 |
$904.90
|
|
Veeg unmon 12-26 hrs
|
$1,296.93 |
$1,296.93 |
$1,296.93 |
$1,411.20
|
|
Veeg unmon 2-12 hrs
|
$622.71 |
$622.71 |
$622.71 |
$704.79
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$5,396.31 |
$5,396.31 |
$5,396.31 |
$188.65
|
|
Venipuncture <3 yrs other vein
|
$195.33 |
$195.33 |
$195.33 |
$82.11
|
|
Ventilator each subsequent day
|
$4,618.05 |
$4,618.05 |
$4,618.05 |
$1,305.92
|
|
Ventilator initial day
|
$5,585.01 |
$5,585.01 |
$5,585.01 |
$1,540.80
|
