|
Ultrasound hips infant dynamic
|
$405.80 |
$405.80 |
$405.80 |
$403.00
|
|
Ultrasound ob >=14wks ea addl gest
|
$323.32 |
$323.32 |
$323.32 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$220.85 |
$220.85 |
$220.85 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$765.29 |
$765.29 |
$765.29 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$513.48 |
$513.48 |
$513.48 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$513.48 |
$513.48 |
$513.48 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$513.48 |
$513.48 |
$513.48 |
$485.48
|
|
Ultrasound retroperitoneal limited
|
$513.48 |
$513.48 |
$513.48 |
$498.00
|
|
Ultrasound scrotum and contents
|
$513.48 |
$513.48 |
$513.48 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$590.47 |
$590.47 |
$590.47 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$244.96 |
$244.96 |
$244.96 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$513.48 |
$513.48 |
$513.48 |
$567.44
|
|
Unit mobile power mpu
|
$13,812.34 |
$13,812.34 |
$13,812.34 |
$16,315.20
|
|
Unlisted CT procedure
|
$920.92 |
$920.92 |
$920.92 |
$1,043.00
|
|
Unlisted cytogenetic study
|
$126.04 |
$126.04 |
$126.04 |
$132.48
|
|
Unlisted procedure microbiology
|
$731.91 |
$731.91 |
$731.91 |
$487.50
|
|
Unlisted procedure spine
|
$7,704.34 |
$7,704.34 |
$7,704.34 |
$4,706.35
|
|
Unlisted psychiatric service/proc 90899
|
$91.79 |
$91.79 |
$91.79 |
$96.48
|
|
Unlisted transfusion med px
|
$89.05 |
$89.05 |
$89.05 |
$141.35
|
|
Unsched dialysis esrd pt hos
|
$774.60 |
$774.60 |
$774.60 |
$1,469.76
|
|
Upgrade pm system
|
$3,514.33 |
$3,514.33 |
$3,514.33 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,295.58 |
$2,295.58 |
$2,295.58 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,364.35 |
$2,364.35 |
$2,364.35 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,492.21 |
$1,492.21 |
$1,492.21 |
$2,013.08
|
|
Upper ext fx orthosis rad/ul
|
$57.54 |
$57.54 |
$57.54 |
$619.49
|
|
Urea nitrogen
|
$27.40 |
$27.40 |
$27.40 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$58.37 |
$58.37 |
$58.37 |
$50.00
|
|
Ureteral embolization/occl
|
$597.60 |
$597.60 |
$597.60 |
$3,041.22
|
|
Urethrcystgrphy rtrgrde s&i
|
$667.47 |
$667.47 |
$667.47 |
$574.40
|
|
Urethrocystography void s&i
|
$667.47 |
$667.47 |
$667.47 |
$634.50
|
|
Uric acid blood
|
$49.32 |
$49.32 |
$49.32 |
$46.64
|
|
Uric acid urine
|
$49.32 |
$49.32 |
$49.32 |
$46.75
|
|
Urinalysis microscopic only
|
$13.98 |
$13.98 |
$13.98 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$4.11 |
$4.11 |
$4.11 |
$25.72
|
|
Urinalysis (with microscopy)
|
$34.80 |
$34.80 |
$34.80 |
$48.14
|
|
Urinalysis (without microscopy)
|
$29.60 |
$29.60 |
$29.60 |
$38.99
|
|
Urine Culture Test
|
$55.35 |
$55.35 |
$55.35 |
$84.81
|
|
Urine pregnancy test
|
$68.78 |
$68.78 |
$68.78 |
$66.40
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$2,104.32 |
$2,104.32 |
$2,104.32 |
$5,521.54
|
|
Vaccine dtap < 7 years im
|
$35.08 |
$35.08 |
$35.08 |
$87.80
|
|
Vaccine dtap-hep b-ipv im
|
$235.37 |
$235.37 |
$235.37 |
$193.83
|
|
Vaccine dtap-ipv 4-6 years im
|
$72.61 |
$72.61 |
$72.61 |
$126.84
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$34.53 |
$34.53 |
$34.53 |
$45.33
|
|
Vaccine hepatitis a (hepa) adult im
|
$97.00 |
$97.00 |
$97.00 |
$178.07
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$45.49 |
$45.49 |
$45.49 |
$84.38
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$81.38 |
$81.38 |
$81.38 |
$173.98
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$33.43 |
$33.43 |
$33.43 |
$79.04
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$27.13 |
$27.13 |
$27.13 |
$48.29
|
|
Vaccine influenza quadrivalent live (laiv4) intranasal
|
$155.91 |
$155.91 |
$155.91 |
$37.05
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$194.54 |
$194.54 |
$194.54 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$108.23 |
$108.23 |
$108.23 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$153.99 |
$153.99 |
$153.99 |
$274.95
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$297.02 |
$297.02 |
$297.02 |
$397.18
|
|
Vaccine polio (ipv) subcutaneous/im
|
$46.31 |
$46.31 |
$46.31 |
$119.17
|
|
Vaccine rabies im
|
$559.79 |
$559.79 |
$559.79 |
$945.46
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$0.01 |
$0.01 |
$0.01 |
$1,196.00
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$0.01 |
$0.01 |
$0.01 |
$1,159.00
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$118.10 |
$118.10 |
$118.10 |
$108.00
|
|
Vaccine tdap >=7 years im
|
$58.64 |
$58.64 |
$58.64 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$49.60 |
$49.60 |
$49.60 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$229.34 |
$229.34 |
$229.34 |
$447.80
|
|
Vaccinia vrs vac 0.3 ml perq
|
$0.01 |
$0.01 |
$0.01 |
$0.01
|
|
Vad battery clip set hmii 14-v li-ion
|
$1,690.58 |
$1,690.58 |
$1,690.58 |
$1,683.99
|
|
Vad cable power module dc input
|
$2,859.19 |
$2,859.19 |
$2,859.19 |
$915.95
|
|
Vad univ batt charger hm 1440
|
$13,812.34 |
$13,812.34 |
$13,812.34 |
$14,893.34
|
|
Valproic acid total therapeutic drug level
|
$106.59 |
$106.59 |
$106.59 |
$115.00
|
|
Valvuloplasty aortic
|
$5,774.83 |
$5,774.83 |
$5,774.83 |
$7,324.85
|
|
Valvuloplasty mitral
|
$3,580.36 |
$3,580.36 |
$3,580.36 |
$10,435.39
|
|
Vancomycin hcl injection
|
$281.68 |
$281.68 |
$281.68 |
$186.80
|
|
Vancomycin peak therapeutic drug level
|
$151.53 |
$151.53 |
$151.53 |
$126.79
|
|
Varicella zoster antibody igg
|
$4.19 |
$4.19 |
$4.19 |
$82.55
|
|
Varicella-zoster immue globin im
|
$2,372.84 |
$2,372.84 |
$2,372.84 |
$2,372.84
|
|
Varus/valgus strap padded/li
|
$91.79 |
$91.79 |
$91.79 |
$130.32
|
|
Vasopressin 20 unit/ml intravenous solution
|
$279.48 |
$279.48 |
$279.48 |
$362.93
|
|
Vedolizumab 300 mg intravenous solution
|
$8,260.28 |
$8,260.28 |
$8,260.28 |
$20,730.98
|
|
Veeg cont 2-12 hrs
|
$583.35 |
$583.35 |
$583.35 |
$1,485.05
|
|
Veeg ea 12-26hr cont mntr
|
$1,525.09 |
$1,525.09 |
$1,525.09 |
$3,332.45
|
|
Veeg intrmnt 2-12 hrs
|
$303.87 |
$303.87 |
$303.87 |
$904.90
|
|
Veeg unmon 12-26 hrs
|
$583.35 |
$583.35 |
$583.35 |
$1,411.20
|
|
Veeg unmon 2-12 hrs
|
$303.87 |
$303.87 |
$303.87 |
$704.79
|
|
Vein x-ray liver
|
$1,875.81 |
$1,875.81 |
$1,875.81 |
$3,320.80
|
|
Vein x-ray liver w/hemodynam
|
$2,029.25 |
$2,029.25 |
$2,029.25 |
$3,413.25
|
|
Vein x-ray liver w/hemodynam
|
$1,875.81 |
$1,875.81 |
$1,875.81 |
$3,439.84
|
|
Vein x-ray liver without hemodyn
|
$2,029.25 |
$2,029.25 |
$2,029.25 |
$2,489.25
|
|
Vein x-ray spleen/liver
|
$1,678.25 |
$1,678.25 |
$1,678.25 |
$3,450.30
|
|
Ven blood coll snf/hha
|
$6.31 |
$6.31 |
$6.31 |
$11.91
|
|
Venogram ext bil s&i
|
$906.40 |
$906.40 |
$906.40 |
$1,838.28
|
|
Venous mech thrombectomy
|
$4,729.79 |
$4,729.79 |
$4,729.79 |
$8,869.50
|
|
Venous m-thrombectomy add-on
|
$1,844.57 |
$1,844.57 |
$1,844.57 |
$5,352.00
|
|
Venous sampling s&i
|
$1,642.09 |
$1,642.09 |
$1,642.09 |
$4,416.78
|
|
Ventilator each subsequent day
|
$2,667.94 |
$2,667.94 |
$2,667.94 |
$1,305.92
|
|
Ventilator initial day
|
$2,774.53 |
$2,774.53 |
$2,774.53 |
$1,540.80
|
|
Version cephalic external
|
$464.98 |
$464.98 |
$464.98 |
$2,598.57
|
|
Very long chain fatty acids
|
$29.23 |
$29.23 |
$29.23 |
$140.40
|
|
Vest large holster
|
$768.57 |
$768.57 |
$768.57 |
$1,012.50
|
|
Vinblastine 1 mg/ml intravenous solution
|
$4.39 |
$4.39 |
$4.39 |
$177.38
|
|
Vincristine 1 mg/ml intravenous solution
|
$20.01 |
$20.01 |
$20.01 |
$100.19
|
|
Vinorelbine 10 mg/ml intravenous solution (wrapper)
|
$317.30 |
$317.30 |
$317.30 |
$226.75
|
|
Virus isolation addl studies ea
|
$4.39 |
$4.39 |
$4.39 |
$90.35
|
|
Vital capacity test
|
$73.44 |
$73.44 |
$73.44 |
$173.33
|
