|
Unlisted px neck/thorax
|
$83.79 |
$83.79 |
$83.79 |
$571.20
|
|
Unlisted px pelvis/hip joint
|
$49.21 |
$49.21 |
$49.21 |
$3,118.44
|
|
Unlisted px small intestine
|
$1,042.72 |
$1,042.72 |
$1,042.72 |
$2,102.10
|
|
Unlisted px tongue flr mouth
|
$52.06 |
$52.06 |
$52.06 |
$282.50
|
|
Unlisted special svc px/rprt
|
$42.37 |
$42.37 |
$42.37 |
$90.00
|
|
Unlisted ultrasound procedure
|
$226.67 |
$226.67 |
$226.67 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$1,022.39 |
$1,022.39 |
$1,022.39 |
$1,268.17
|
|
Upgrade pm system
|
$300.96 |
$300.96 |
$300.96 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,983.79 |
$1,983.79 |
$1,983.79 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,341.97 |
$1,341.97 |
$1,341.97 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,184.84 |
$1,184.84 |
$1,184.84 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$79.23 |
$79.23 |
$79.23 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$88.92 |
$88.92 |
$88.92 |
$1,768.00
|
|
Uppr gi scope w/submuc inj
|
$88.92 |
$88.92 |
$88.92 |
$1,872.00
|
|
Urachal cyst/sinus excision 51500
|
$418.00 |
$418.00 |
$418.00 |
$6,082.67
|
|
Urea nitrogen
|
$26.79 |
$26.79 |
$26.79 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$35.15 |
$35.15 |
$35.15 |
$51.75
|
|
Urea nitrogen clearance
|
$1.12 |
$1.12 |
$1.12 |
$42.25
|
|
Ureteral reflux study
|
$20.14 |
$20.14 |
$20.14 |
$952.50
|
|
Ureter endoscopy & treatment
|
$201.40 |
$201.40 |
$201.40 |
$5,631.74
|
|
Ureteroneocystostomy 50780
|
$717.63 |
$717.63 |
$717.63 |
$4,457.05
|
|
Ureteroureterostomy 50760
|
$725.99 |
$725.99 |
$725.99 |
$2,999.40
|
|
Urethrcystgrphy rtrgrde s&i
|
$372.02 |
$372.02 |
$372.02 |
$579.73
|
|
Urethrlys transvag with scope
|
$485.26 |
$485.26 |
$485.26 |
$4,081.37
|
|
Urethrocystography void s&i
|
$275.50 |
$275.50 |
$275.50 |
$622.35
|
|
Uric acid blood
|
$29.45 |
$29.45 |
$29.45 |
$48.75
|
|
Uric acid urine
|
$33.82 |
$33.82 |
$33.82 |
$44.33
|
|
Urinalysis microscopic only
|
$17.10 |
$17.10 |
$17.10 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$1.71 |
$1.71 |
$1.71 |
$25.72
|
|
Urinalysis (with microscopy)
|
$25.46 |
$25.46 |
$25.46 |
$55.00
|
|
Urinalysis (without microscopy)
|
$13.11 |
$13.11 |
$13.11 |
$35.75
|
|
Urine Culture Test
|
$33.25 |
$33.25 |
$33.25 |
$81.50
|
|
Urine flow measurement 51736
|
$9.12 |
$9.12 |
$9.12 |
$210.00
|
|
Urine pregnancy test
|
$41.42 |
$41.42 |
$41.42 |
$67.20
|
|
Urography, antegrade
|
$18.05 |
$18.05 |
$18.05 |
$622.35
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$76.76 |
$76.76 |
$76.76 |
$224.25
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$69.92 |
$69.92 |
$69.92 |
$209.40
|
|
Vaccine dtap < 7 years im
|
$28.50 |
$28.50 |
$28.50 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$52.82 |
$52.82 |
$52.82 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$40.66 |
$40.66 |
$40.66 |
$105.95
|
|
Vaccine dtap-ipv/hib im
|
$53.58 |
$53.58 |
$53.58 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$12.92 |
$12.92 |
$12.92 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$19.19 |
$19.19 |
$19.19 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$34.01 |
$34.01 |
$34.01 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$142.31 |
$142.31 |
$142.31 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$18.62 |
$18.62 |
$18.62 |
$79.15
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$35.72 |
$35.72 |
$35.72 |
$84.75
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$33.44 |
$33.44 |
$33.44 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$79.99 |
$79.99 |
$79.99 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$28.43 |
$28.43 |
$28.43 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$96.90 |
$96.90 |
$96.90 |
$576.48
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$77.33 |
$77.33 |
$77.33 |
$282.50
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$39.71 |
$39.71 |
$39.71 |
$143.20
|
|
Vaccine influenza inactivated adjuvant im
|
$80.20 |
$80.20 |
$80.20 |
$109.50
|
|
Vaccine influenza nos 0.5ml dose im
|
$10.45 |
$10.45 |
$10.45 |
$24.20
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$20.03 |
$20.03 |
$20.03 |
$47.88
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$9.88 |
$9.88 |
$9.88 |
$35.88
|
|
Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im
|
$36.67 |
$36.67 |
$36.67 |
$72.80
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$11.02 |
$11.02 |
$11.02 |
$31.03
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$10.64 |
$10.64 |
$10.64 |
$33.60
|
|
Vaccine influenza quadrivalent (iiv4) split virus 0.25 ml im
|
$9.88 |
$9.88 |
$9.88 |
$20.80
|
|
Vaccine influenza quadrivalent live (laiv4) intranasal
|
$11.21 |
$11.21 |
$11.21 |
$37.05
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$34.96 |
$34.96 |
$34.96 |
$72.00
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$17.48 |
$17.48 |
$17.48 |
$76.50
|
|
Vaccine influenza trivalent (iiv3) 0.25ml dose im
|
$5.13 |
$5.13 |
$5.13 |
$31.20
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$75.24 |
$75.24 |
$75.24 |
$400.03
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$58.33 |
$58.33 |
$58.33 |
$409.35
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$198.55 |
$198.55 |
$198.55 |
$310.93
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$68.40 |
$68.40 |
$68.40 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$68.08 |
$68.08 |
$68.08 |
$211.68
|
|
Vaccine mmrv live subcutaneous
|
$153.52 |
$153.52 |
$153.52 |
$424.32
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$63.46 |
$63.46 |
$63.46 |
$251.64
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$122.55 |
$122.55 |
$122.55 |
$397.11
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$120.46 |
$120.46 |
$120.46 |
$414.46
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$141.55 |
$141.55 |
$141.55 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$20.52 |
$20.52 |
$20.52 |
$90.70
|
|
Vaccine rabies im
|
$257.37 |
$257.37 |
$257.37 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$276.07 |
$276.07 |
$276.07 |
$538.84
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$434.53 |
$434.53 |
$434.53 |
$1,104.47
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$434.53 |
$434.53 |
$434.53 |
$997.44
|
|
Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im
|
$118.75 |
$118.75 |
$118.75 |
$499.62
|
|
Vaccine rotavirus attenuated (rv1) live 2 dose oral
|
$55.29 |
$55.29 |
$55.29 |
$200.70
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$53.58 |
$53.58 |
$53.58 |
$126.14
|
|
Vaccine tdap >=7 years im
|
$46.59 |
$46.59 |
$46.59 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$15.96 |
$15.96 |
$15.96 |
$112.10
|
|
Vaccine typhoid vicps im
|
$42.94 |
$42.94 |
$42.94 |
$264.78
|
|
Vaccine varicella live subcutaneous
|
$60.23 |
$60.23 |
$60.23 |
$365.17
|
|
Vag hys/<250g/rmv tube/rpr entero 58263
|
$642.01 |
$642.01 |
$642.01 |
$5,345.59
|
|
Vag hyst incl t/o complex
|
$798.19 |
$798.19 |
$798.19 |
$5,735.60
|
|
Vag hyst including t/o
|
$599.26 |
$599.26 |
$599.26 |
$4,827.18
|
|
Vaginal bx
|
$98.99 |
$98.99 |
$98.99 |
$455.94
|
|
Vaginal delivery after cesarean delivery 59612
|
$555.94 |
$555.94 |
$555.94 |
$3,843.60
|
|
Vaginal Delivery (full care)
|
$1,533.87 |
$1,533.87 |
$1,533.87 |
$4,263.60
|
|
Vaginal hysterectomy
|
$543.02 |
$543.02 |
$543.02 |
$5,766.00
|
|
Vagotomy & pylorus repair 43640
|
$756.58 |
$756.58 |
$756.58 |
$2,628.12
|
|
Valproic acid total therapeutic drug level
|
$98.99 |
$98.99 |
$98.99 |
$114.72
|
|
Vancomycin 1,000 mg intravenous injection
|
$31.27 |
$31.27 |
$31.27 |
$251.86
|
|
Vancomycin 750 mg intravenous solution
|
$63.72 |
$63.72 |
$63.72 |
$90.33
|
|
Vancomycin peak therapeutic drug level
|
$55.86 |
$55.86 |
$55.86 |
$136.13
|
|
Varicella zoster antibody igg
|
$33.82 |
$33.82 |
$33.82 |
$86.80
|
