|
Ultrasound joint/nonvascular extremity limited left
|
$509.04 |
$509.04 |
$509.04 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$185.22 |
$185.22 |
$185.22 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$122.22 |
$122.22 |
$122.22 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$475.20 |
$475.20 |
$475.20 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$104.04 |
$104.04 |
$104.04 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$370.26 |
$370.26 |
$370.26 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$364.32 |
$364.32 |
$364.32 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$316.80 |
$316.80 |
$316.80 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$465.48 |
$465.48 |
$465.48 |
$486.50
|
|
Ultrasound scrotum and contents
|
$490.68 |
$490.68 |
$490.68 |
$608.90
|
|
Ultrasound transabd ea addl gest
|
$312.30 |
$312.30 |
$312.30 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$392.94 |
$392.94 |
$392.94 |
$558.35
|
|
Unlistd noninvas vasc dx std
|
$954.72 |
$954.72 |
$954.72 |
$528.80
|
|
Unlisted laparoscopic liver biopy 47379
|
$3,335.22 |
$3,335.22 |
$3,335.22 |
$5,419.00
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$62.64 |
$62.64 |
$62.64 |
$6,463.42
|
|
Unlisted maaa
|
$44.47 |
$44.47 |
$44.47 |
$235.20
|
|
Unlisted misc path test
|
$15.48 |
$15.48 |
$15.48 |
$89.40
|
|
Unlisted mr procedure
|
$1,405.08 |
$1,405.08 |
$1,405.08 |
$1,163.00
|
|
Unlisted procedure microbiology
|
$79.74 |
$79.74 |
$79.74 |
$523.50
|
|
Unlisted px casting/strpg
|
$15.84 |
$15.84 |
$15.84 |
$219.70
|
|
Unlisted px med radj physics
|
$4.86 |
$4.86 |
$4.86 |
$462.35
|
|
Unlisted px pelvis/hip joint
|
$116.46 |
$116.46 |
$116.46 |
$3,118.44
|
|
Unlisted px ther rad tx plng
|
$50.22 |
$50.22 |
$50.22 |
$182.00
|
|
Unlisted surgical path px
|
$409.50 |
$409.50 |
$409.50 |
$217.75
|
|
Unlisted transfusion med px
|
$11.70 |
$11.70 |
$11.70 |
$147.50
|
|
Unlisted ultrasound procedure
|
$357.12 |
$357.12 |
$357.12 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$849.24 |
$849.24 |
$849.24 |
$1,268.17
|
|
Upgrade pm system
|
$12,330.00 |
$12,330.00 |
$12,330.00 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,894.14 |
$1,894.14 |
$1,894.14 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,875.96 |
$1,875.96 |
$1,875.96 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,363.68 |
$1,363.68 |
$1,363.68 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$68.22 |
$68.22 |
$68.22 |
$1,751.66
|
|
Urea nitrogen
|
$34.20 |
$34.20 |
$34.20 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$80.82 |
$80.82 |
$80.82 |
$51.75
|
|
Urea nitrogen clearance
|
$1.06 |
$1.06 |
$1.06 |
$42.25
|
|
Ureteral reflux study
|
$577.98 |
$577.98 |
$577.98 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$558.54 |
$558.54 |
$558.54 |
$579.73
|
|
Urethrocystography void s&i
|
$401.94 |
$401.94 |
$401.94 |
$622.35
|
|
Uric acid blood
|
$62.10 |
$62.10 |
$62.10 |
$48.75
|
|
Uric acid urine
|
$59.76 |
$59.76 |
$59.76 |
$44.33
|
|
Urinalysis microscopic only
|
$23.40 |
$23.40 |
$23.40 |
$26.35
|
|
Urinalysis (with microscopy)
|
$78.66 |
$78.66 |
$78.66 |
$55.00
|
|
Urinalysis (without microscopy)
|
$36.18 |
$36.18 |
$36.18 |
$35.75
|
|
Urine Culture Test
|
$120.24 |
$120.24 |
$120.24 |
$81.50
|
|
Urine pregnancy test
|
$69.48 |
$69.48 |
$69.48 |
$67.20
|
|
Urine screen for bacteria
|
$9.54 |
$9.54 |
$9.54 |
$55.64
|
|
Urography, antegrade
|
$369.72 |
$369.72 |
$369.72 |
$622.35
|
|
Vaccine dtap < 7 years im
|
$31.68 |
$31.68 |
$31.68 |
$68.19
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$27.91 |
$27.91 |
$27.91 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$20.66 |
$20.66 |
$20.66 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$67.14 |
$67.14 |
$67.14 |
$166.62
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$3.57 |
$3.57 |
$3.57 |
$79.15
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$53.10 |
$53.10 |
$53.10 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$44.46 |
$44.46 |
$44.46 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$21.60 |
$21.60 |
$21.60 |
$75.39
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$23.13 |
$23.13 |
$23.13 |
$143.20
|
|
Vaccine influenza inactivated adjuvant im
|
$86.22 |
$86.22 |
$86.22 |
$109.50
|
|
Vaccine influenza nos 0.5ml dose im
|
$14.22 |
$14.22 |
$14.22 |
$24.20
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$22.50 |
$22.50 |
$22.50 |
$47.88
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$24.48 |
$24.48 |
$24.48 |
$35.88
|
|
Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im
|
$23.13 |
$23.13 |
$23.13 |
$72.80
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$28.51 |
$28.51 |
$28.51 |
$31.03
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$25.02 |
$25.02 |
$25.02 |
$33.60
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$20.92 |
$20.92 |
$20.92 |
$76.50
|
|
Vaccine influenza trivalent (iiv3) 0.25ml dose im
|
$5.94 |
$5.94 |
$5.94 |
$31.20
|
|
Vaccine mmr live subcutaneous
|
$56.34 |
$56.34 |
$56.34 |
$211.68
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$79.74 |
$79.74 |
$79.74 |
$251.64
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$104.58 |
$104.58 |
$104.58 |
$397.11
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$103.90 |
$103.90 |
$103.90 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$44.82 |
$44.82 |
$44.82 |
$90.70
|
|
Vaccine rabies im
|
$311.84 |
$311.84 |
$311.84 |
$858.95
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$918.95 |
$918.95 |
$918.95 |
$1,104.47
|
|
Vaccine tdap >=7 years im
|
$36.57 |
$36.57 |
$36.57 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$24.92 |
$24.92 |
$24.92 |
$112.10
|
|
Vaccine typhoid vicps im
|
$89.10 |
$89.10 |
$89.10 |
$264.78
|
|
Vaccine varicella live subcutaneous
|
$87.30 |
$87.30 |
$87.30 |
$365.17
|
|
Vaccine yellow fever live subcutaneous
|
$97.46 |
$97.46 |
$97.46 |
$418.46
|
|
Valproate in ns IV syringe 10 mg/ml (pediatric) - cnr
|
$16.47 |
$16.47 |
$16.47 |
$24.12
|
|
Valproic acid total therapeutic drug level
|
$113.58 |
$113.58 |
$113.58 |
$114.72
|
|
Valvuloplasty aortic
|
$5,360.04 |
$5,360.04 |
$5,360.04 |
$7,830.80
|
|
Valvuloplasty mitral
|
$9,385.74 |
$9,385.74 |
$9,385.74 |
$10,877.90
|
|
Vancomycin 1,000 mg intravenous injection
|
$60.40 |
$60.40 |
$60.40 |
$251.86
|
|
Vancomycin 750 mg intravenous solution
|
$105.06 |
$105.06 |
$105.06 |
$90.33
|
|
Vancomycin peak therapeutic drug level
|
$154.80 |
$154.80 |
$154.80 |
$136.13
|
|
Varicella zoster antibody igg
|
$53.28 |
$53.28 |
$53.28 |
$86.80
|
|
Vasopressin 20 unit/ml intravenous solution
|
$121.73 |
$121.73 |
$121.73 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$2,337.50 |
$2,337.50 |
$2,337.50 |
$18,732.33
|
|
Vein gft fem a/p tib/pero/dis art 35566
|
$1,000.98 |
$1,000.98 |
$1,000.98 |
$8,152.00
|
|
Vein x-ray kidney
|
$2,303.46 |
$2,303.46 |
$2,303.46 |
$2,766.73
|
|
Vein x-ray liver
|
$1,898.28 |
$1,898.28 |
$1,898.28 |
$3,305.50
|
|
Vein x-ray liver w/hemodynam
|
$1,938.06 |
$1,938.06 |
$1,938.06 |
$3,486.86
|
|
Vein x-ray liver w/hemodynam
|
$1,923.66 |
$1,923.66 |
$1,923.66 |
$3,483.84
|
|
Vein x-ray liver without hemodyn
|
$934.56 |
$934.56 |
$934.56 |
$2,452.80
|
|
Vein x-ray skull
|
$1,742.04 |
$1,742.04 |
$1,742.04 |
$2,141.00
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$160.74 |
$160.74 |
$160.74 |
$202.80
|
|
Venogram ext bil s&i
|
$976.50 |
$976.50 |
$976.50 |
$1,797.50
|
|
Venogram extremity supervision & interpretation unilateral
|
$887.58 |
$887.58 |
$887.58 |
$1,366.20
|
|
Venous mech thrombectomy
|
$4,902.12 |
$4,902.12 |
$4,902.12 |
$7,965.00
|
|
Venous m-thrombectomy add-on
|
$2,577.24 |
$2,577.24 |
$2,577.24 |
$5,094.75
|
|
Ventilator each subsequent day
|
$2,009.88 |
$2,009.88 |
$2,009.88 |
$1,204.00
|