|
Upper Endoscopy (EGD, with biopsy)
|
$140.40 |
$140.40 |
$140.40 |
$1,768.00
|
|
Uppr gi scope w/submuc inj
|
$140.40 |
$140.40 |
$140.40 |
$1,872.00
|
|
Urachal cyst/sinus excision 51500
|
$660.00 |
$660.00 |
$660.00 |
$6,082.67
|
|
Urea nitrogen
|
$49.50 |
$49.50 |
$49.50 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$56.70 |
$56.70 |
$56.70 |
$51.75
|
|
Ureteral reflux study
|
$31.80 |
$31.80 |
$31.80 |
$952.50
|
|
Ureter endoscopy & treatment
|
$318.00 |
$318.00 |
$318.00 |
$5,631.74
|
|
Ureteroneocystostomy 50780
|
$1,133.10 |
$1,133.10 |
$1,133.10 |
$4,457.05
|
|
Ureteroureterostomy 50760
|
$1,146.30 |
$1,146.30 |
$1,146.30 |
$2,999.40
|
|
Urethrcystgrphy rtrgrde s&i
|
$362.40 |
$362.40 |
$362.40 |
$579.73
|
|
Urethrlys transvag with scope
|
$766.20 |
$766.20 |
$766.20 |
$4,081.37
|
|
Urethrocystography void s&i
|
$18.30 |
$18.30 |
$18.30 |
$622.35
|
|
Uric acid blood
|
$60.60 |
$60.60 |
$60.60 |
$48.75
|
|
Uric acid urine
|
$47.10 |
$47.10 |
$47.10 |
$44.33
|
|
Urinalysis microscopic only
|
$35.10 |
$35.10 |
$35.10 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$2.70 |
$2.70 |
$2.70 |
$25.72
|
|
Urinalysis (with microscopy)
|
$38.10 |
$38.10 |
$38.10 |
$55.00
|
|
Urinalysis (without microscopy)
|
$31.80 |
$31.80 |
$31.80 |
$35.75
|
|
Urine Culture Test
|
$71.70 |
$71.70 |
$71.70 |
$81.50
|
|
Urine flow measurement 51736
|
$14.40 |
$14.40 |
$14.40 |
$210.00
|
|
Urine pregnancy test
|
$75.90 |
$75.90 |
$75.90 |
$67.20
|
|
Urography, antegrade
|
$28.50 |
$28.50 |
$28.50 |
$622.35
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$121.20 |
$121.20 |
$121.20 |
$224.25
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$110.40 |
$110.40 |
$110.40 |
$209.40
|
|
Vaccine dtap < 7 years im
|
$45.00 |
$45.00 |
$45.00 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$83.40 |
$83.40 |
$83.40 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$64.20 |
$64.20 |
$64.20 |
$105.95
|
|
Vaccine dtap-ipv/hib im
|
$84.60 |
$84.60 |
$84.60 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$25.50 |
$25.50 |
$25.50 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$30.30 |
$30.30 |
$30.30 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$53.70 |
$53.70 |
$53.70 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$224.70 |
$224.70 |
$224.70 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$29.40 |
$29.40 |
$29.40 |
$79.15
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$56.40 |
$56.40 |
$56.40 |
$84.75
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$56.10 |
$56.10 |
$56.10 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$207.46 |
$207.46 |
$207.46 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$23.10 |
$23.10 |
$23.10 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$218.70 |
$218.70 |
$218.70 |
$576.48
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$122.10 |
$122.10 |
$122.10 |
$282.50
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$62.70 |
$62.70 |
$62.70 |
$143.20
|
|
Vaccine influenza inactivated adjuvant im
|
$166.47 |
$166.47 |
$166.47 |
$109.50
|
|
Vaccine influenza nos 0.5ml dose im
|
$16.50 |
$16.50 |
$16.50 |
$24.20
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$16.80 |
$16.80 |
$16.80 |
$47.88
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$17.10 |
$17.10 |
$17.10 |
$35.88
|
|
Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im
|
$57.90 |
$57.90 |
$57.90 |
$72.80
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$17.40 |
$17.40 |
$17.40 |
$31.03
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$32.70 |
$32.70 |
$32.70 |
$33.60
|
|
Vaccine influenza quadrivalent (iiv4) split virus 0.25 ml im
|
$15.60 |
$15.60 |
$15.60 |
$20.80
|
|
Vaccine influenza quadrivalent live (laiv4) intranasal
|
$24.00 |
$24.00 |
$24.00 |
$37.05
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$55.20 |
$55.20 |
$55.20 |
$72.00
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$27.60 |
$27.60 |
$27.60 |
$76.50
|
|
Vaccine influenza trivalent (iiv3) 0.25ml dose im
|
$8.10 |
$8.10 |
$8.10 |
$31.20
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$153.30 |
$153.30 |
$153.30 |
$400.03
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$170.70 |
$170.70 |
$170.70 |
$409.35
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$313.50 |
$313.50 |
$313.50 |
$310.93
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$108.00 |
$108.00 |
$108.00 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$100.80 |
$100.80 |
$100.80 |
$211.68
|
|
Vaccine mmrv live subcutaneous
|
$242.40 |
$242.40 |
$242.40 |
$424.32
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$100.20 |
$100.20 |
$100.20 |
$251.64
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$193.50 |
$193.50 |
$193.50 |
$397.11
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$190.20 |
$190.20 |
$190.20 |
$414.46
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$237.60 |
$237.60 |
$237.60 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$32.40 |
$32.40 |
$32.40 |
$90.70
|
|
Vaccine rabies im
|
$578.90 |
$578.90 |
$578.90 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$435.90 |
$435.90 |
$435.90 |
$538.84
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$686.10 |
$686.10 |
$686.10 |
$1,104.47
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$686.10 |
$686.10 |
$686.10 |
$997.44
|
|
Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im
|
$187.50 |
$187.50 |
$187.50 |
$499.62
|
|
Vaccine rotavirus attenuated (rv1) live 2 dose oral
|
$87.30 |
$87.30 |
$87.30 |
$200.70
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$84.60 |
$84.60 |
$84.60 |
$126.14
|
|
Vaccine tdap >=7 years im
|
$102.66 |
$102.66 |
$102.66 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$25.20 |
$25.20 |
$25.20 |
$112.10
|
|
Vaccine typhoid vicps im
|
$67.80 |
$67.80 |
$67.80 |
$264.78
|
|
Vaccine varicella live subcutaneous
|
$95.10 |
$95.10 |
$95.10 |
$365.17
|
|
Vag hys/<250g/rmv tube/rpr entero 58263
|
$1,013.70 |
$1,013.70 |
$1,013.70 |
$5,345.59
|
|
Vag hyst incl t/o complex
|
$1,260.30 |
$1,260.30 |
$1,260.30 |
$5,735.60
|
|
Vag hyst including t/o
|
$946.20 |
$946.20 |
$946.20 |
$4,827.18
|
|
Vaginal bx
|
$156.30 |
$156.30 |
$156.30 |
$455.94
|
|
Vaginal delivery after cesarean delivery 59612
|
$877.80 |
$877.80 |
$877.80 |
$3,843.60
|
|
Vaginal Delivery (full care)
|
$2,421.90 |
$2,421.90 |
$2,421.90 |
$4,263.60
|
|
Vaginal hysterectomy
|
$857.40 |
$857.40 |
$857.40 |
$5,766.00
|
|
Vagotomy & pylorus repair 43640
|
$1,194.60 |
$1,194.60 |
$1,194.60 |
$2,628.12
|
|
Valproate in ns IV syringe 10 mg/ml (pediatric) - cnr
|
$17.64 |
$17.64 |
$17.64 |
$24.12
|
|
Valproic acid total therapeutic drug level
|
$102.30 |
$102.30 |
$102.30 |
$114.72
|
|
Vancomycin 1,000 mg intravenous injection
|
$60.10 |
$60.10 |
$60.10 |
$251.86
|
|
Vancomycin 750 mg intravenous solution
|
$49.35 |
$49.35 |
$49.35 |
$90.33
|
|
Vancomycin peak therapeutic drug level
|
$135.00 |
$135.00 |
$135.00 |
$136.13
|
|
Varicella zoster antibody igg
|
$3.41 |
$3.41 |
$3.41 |
$86.80
|
|
Vasc graft into carpal bone
|
$774.60 |
$774.60 |
$774.60 |
$3,839.54
|
|
Vasectomy
|
$921.90 |
$921.90 |
$921.90 |
$2,424.12
|
|
Vasopressin 20 unit/ml intravenous solution
|
$78.30 |
$78.30 |
$78.30 |
$325.80
|
|
Vbac delivery 59610
|
$2,515.20 |
$2,515.20 |
$2,515.20 |
$4,492.00
|
|
Vbac/include postpartum care 59614
|
$1,136.70 |
$1,136.70 |
$1,136.70 |
$2,285.60
|
|
Vedolizumab 300 mg intravenous solution
|
$11,400.00 |
$11,400.00 |
$11,400.00 |
$18,732.33
|
|
Vein bypass grft fem-popliteal 35583
|
$1,369.80 |
$1,369.80 |
$1,369.80 |
$3,013.56
|
|
Vein byp fem-tibial peroneal 35585
|
$1,583.70 |
$1,583.70 |
$1,583.70 |
$2,931.20
|
|
Vein gft fem a/p tib/pero/dis art 35566
|
$1,574.10 |
$1,574.10 |
$1,574.10 |
$8,152.00
|
|
Vein x-ray kidney
|
$59.40 |
$59.40 |
$59.40 |
$2,766.73
|
|
Vein x-ray liver
|
$60.60 |
$60.60 |
$60.60 |
$3,305.50
|
|
Vein x-ray liver w/hemodynam
|
$60.00 |
$60.00 |
$60.00 |
$3,483.84
|
