|
Unlisted dialysis procedure
|
$2,714.13 |
$2,714.13 |
$2,714.13 |
$2,050.48
|
|
Unlisted fluoroscopic px
|
$1,846.05 |
$1,846.05 |
$1,846.05 |
$324.85
|
|
Unlisted mr procedure
|
$4,973.03 |
$4,973.03 |
$17,159.75 |
$1,032.20
|
|
Unlisted procedure microbiology
|
$75.63 |
$75.63 |
$75.63 |
$487.50
|
|
Unlisted px casting/strpg
|
$760.39 |
$760.39 |
$760.39 |
$224.93
|
|
Unlisted px pelvis/hip joint
|
$1,520.36 |
$1,520.36 |
$1,520.36 |
$2,108.82
|
|
Unlisted transfusion med px
|
$691.17 |
$691.17 |
$691.17 |
$141.35
|
|
Unsched dialysis esrd pt hos
|
$4,957.94 |
$5,022.00 |
$8,124.25 |
$1,469.76
|
|
Upgrade pm system
|
$23,405.67 |
$23,405.67 |
$23,405.67 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$7,305.32 |
$7,305.32 |
$17,521.75 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$6,115.59 |
$6,115.59 |
$18,119.75 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$5,468.12 |
$5,468.12 |
$13,494.25 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,937.06 |
$1,937.06 |
$1,937.06 |
$1,588.59
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,937.06 |
$1,937.06 |
$1,937.06 |
$1,656.60
|
|
Upper ext fx orthosis rad/ul
|
$8,819.00 |
$8,819.00 |
$8,819.00 |
$619.49
|
|
Uppr gi scope w/submuc inj
|
$1,937.06 |
$1,937.06 |
$1,937.06 |
$1,773.85
|
|
Urea nitrogen
|
$104.41 |
$104.41 |
$143.50 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$134.53 |
$196.87 |
$725.25 |
$50.00
|
|
Ureteral embolization/occl
|
$19,429.87 |
$19,429.87 |
$19,429.87 |
$3,041.22
|
|
Ureteral reflux study
|
$2,219.56 |
$2,219.56 |
$2,219.56 |
$961.20
|
|
Urethrcystgrphy rtrgrde s&i
|
$1,728.41 |
$2,406.42 |
$2,443.50 |
$574.40
|
|
Urethrocystography void s&i
|
$1,005.75 |
$1,005.75 |
$2,502.25 |
$634.50
|
|
Uric acid blood
|
$105.95 |
$131.25 |
$277.00 |
$46.64
|
|
Uric acid urine
|
$130.24 |
$130.24 |
$626.40 |
$46.75
|
|
Urinalysis microscopic only
|
$101.72 |
$135.59 |
$475.00 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$153.47 |
$153.47 |
$153.47 |
$25.72
|
|
Urinalysis (with microscopy)
|
$222.81 |
$226.71 |
$1,119.00 |
$48.14
|
|
Urinalysis (without microscopy)
|
$130.13 |
$130.13 |
$130.13 |
$38.99
|
|
Urine Culture Test
|
$183.25 |
$259.50 |
$1,906.00 |
$84.81
|
|
Urine pregnancy test
|
$101.35 |
$223.73 |
$662.00 |
$66.40
|
|
Urography, antegrade
|
$2,818.38 |
$2,818.38 |
$3,128.61 |
$593.37
|
|
Use 1st target lesion
|
$513.25 |
$513.25 |
$513.25 |
$245.30
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$14,451.75 |
$14,451.75 |
$35,061.00 |
$5,521.54
|
|
Vaccine dtap < 7 years im
|
$105.00 |
$105.00 |
$170.75 |
$87.80
|
|
Vaccine dtap-ipv 4-6 years im
|
$183.00 |
$183.00 |
$279.25 |
$126.84
|
|
Vaccine dtap-ipv/hib im
|
$308.00 |
$308.00 |
$364.75 |
$248.80
|
|
Vaccine hepatitis a (hepa) adult im
|
$525.00 |
$661.00 |
$916.00 |
$178.07
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$701.75 |
$701.75 |
$2,628.56 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$241.50 |
$241.50 |
$324.00 |
$84.38
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$125.79 |
$158.00 |
$1,344.51 |
$173.98
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$90.75 |
$90.75 |
$499.00 |
$79.04
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$1,206.70 |
$1,206.70 |
$1,400.75 |
$686.67
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$146.25 |
$146.25 |
$1,522.00 |
$226.20
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$194.99 |
$244.75 |
$1,825.49 |
$157.41
|
|
Vaccine influenza inactivated adjuvant im
|
$806.14 |
$806.14 |
$806.14 |
$110.25
|
|
Vaccine influenza nos 0.5ml dose im
|
$223.95 |
$223.95 |
$223.95 |
$36.80
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$64.25 |
$64.25 |
$529.15 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$445.92 |
$445.92 |
$445.92 |
$42.90
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$889.06 |
$889.06 |
$889.06 |
$103.88
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$691.84 |
$1,013.00 |
$1,106.50 |
$499.00
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$682.00 |
$855.75 |
$1,227.00 |
$426.80
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$393.50 |
$393.50 |
$493.75 |
$349.15
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$668.26 |
$704.00 |
$1,969.75 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$338.21 |
$681.00 |
$958.75 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$474.76 |
$771.00 |
$910.75 |
$274.95
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$737.80 |
$1,419.00 |
$1,521.00 |
$397.18
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$884.00 |
$960.75 |
$1,421.49 |
$385.45
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$971.18 |
$971.18 |
$1,014.25 |
$715.41
|
|
Vaccine polio (ipv) subcutaneous/im
|
$299.73 |
$717.00 |
$803.00 |
$119.17
|
|
Vaccine rabies im
|
$1,184.14 |
$2,270.00 |
$2,701.25 |
$945.46
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$1,109.00 |
$1,109.00 |
$1,254.75 |
$624.00
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$1,796.50 |
$1,796.50 |
$1,833.00 |
$1,196.00
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$1,796.50 |
$1,796.50 |
$1,796.50 |
$1,159.00
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$630.00 |
$630.00 |
$630.00 |
$108.00
|
|
Vaccine tdap >=7 years im
|
$184.50 |
$270.00 |
$1,264.23 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$178.28 |
$289.00 |
$1,039.70 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$616.72 |
$880.00 |
$1,251.50 |
$447.80
|
|
Valproic acid total therapeutic drug level
|
$146.15 |
$229.59 |
$1,308.50 |
$115.00
|
|
Valvuloplasty aortic
|
$8,546.68 |
$8,546.68 |
$8,546.68 |
$7,324.85
|
|
Valvuloplasty mitral
|
$17,274.10 |
$17,274.10 |
$17,274.10 |
$10,435.39
|
|
Valvuloplasty pulmonary
|
$17,824.09 |
$17,824.09 |
$17,824.09 |
$11,945.20
|
|
Vancomycin hcl injection
|
$1,221.32 |
$1,221.32 |
$1,221.32 |
$186.80
|
|
Vancomycin peak therapeutic drug level
|
$315.66 |
$315.66 |
$315.66 |
$126.79
|
|
Vanomycin dna amp probe
|
$288.58 |
$288.58 |
$561.25 |
$87.20
|
|
Varicella zoster antibody igg
|
$216.22 |
$216.22 |
$216.22 |
$82.55
|
|
Varicella-zoster immue globin im
|
$10,872.75 |
$10,872.75 |
$10,995.00 |
$2,372.84
|
|
Varus/valgus strap padded/li
|
$1,366.00 |
$1,366.00 |
$1,366.00 |
$130.32
|
|
Vasc emb/occ w/prs cath
|
$28,913.36 |
$28,913.36 |
$28,913.36 |
$21,009.00
|
|
Vasectomy
|
$5,406.23 |
$5,406.23 |
$5,406.23 |
$2,424.12
|
|
Vasopressin 20 unit/ml intravenous solution
|
$1,088.00 |
$1,088.00 |
$1,566.46 |
$362.93
|
|
Vedolizumab 300 mg intravenous solution
|
$25,816.70 |
$25,816.70 |
$57,680.75 |
$20,730.98
|
|
Veeg cont 2-12 hrs
|
$1,456.65 |
$1,824.50 |
$7,427.00 |
$1,485.05
|
|
Veeg ea 12-26hr cont mntr
|
$2,726.52 |
$3,414.50 |
$4,635.34 |
$3,332.45
|
|
Veeg intrmnt 2-12 hrs
|
$653.94 |
$951.00 |
$7,427.00 |
$904.90
|
|
Veeg unmon 12-26 hrs
|
$1,456.65 |
$1,824.50 |
$2,476.45 |
$1,411.20
|
|
Veeg unmon 2-12 hrs
|
$759.21 |
$759.21 |
$951.00 |
$704.79
|
|
Vein x-ray adrenal gland
|
$10,370.63 |
$10,370.63 |
$10,370.63 |
$2,489.25
|
|
Vein x-ray adrenal glands
|
$16,875.00 |
$16,875.00 |
$18,495.50 |
$3,999.60
|
|
Vein x-ray eye socket
|
$2,849.52 |
$2,849.52 |
$2,849.52 |
$1,128.41
|
|
Vein x-ray kidney
|
$8,013.49 |
$8,013.49 |
$8,013.49 |
$2,716.20
|
|
Vein x-ray liver
|
$6,721.53 |
$8,225.48 |
$21,907.00 |
$3,320.80
|
|
Vein x-ray liver w/hemodynam
|
$7,793.14 |
$8,225.48 |
$20,698.00 |
$3,413.25
|
|
Vein x-ray liver w/hemodynam
|
$8,065.83 |
$8,065.83 |
$24,999.00 |
$3,439.84
|
|
Vein x-ray liver without hemodyn
|
$3,243.57 |
$3,255.37 |
$4,489.00 |
$2,489.25
|
|
Vein x-ray skull
|
$3,608.98 |
$4,351.50 |
$4,488.22 |
$2,301.09
|
|
Vein x-ray skull epidural
|
$2,849.52 |
$2,849.52 |
$2,849.52 |
$1,344.60
|
|
Vein x-ray spleen/liver
|
$3,243.57 |
$4,263.50 |
$21,488.00 |
$3,450.30
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$335.00 |
$335.00 |
$9,141.33 |
$188.65
|
|
Venogram ext bil s&i
|
$6,153.68 |
$6,153.68 |
$6,153.68 |
$1,838.28
|
|
Venogram extremity supervision & interpretation unilateral
|
$3,055.72 |
$3,055.72 |
$4,374.50 |
$1,326.00
|