|
Unlisted procedure liver
|
$1,493.70 |
$1,493.70 |
$1,493.70 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$384.15 |
$384.15 |
$384.15 |
$530.00
|
|
Unlisted procedure spine
|
$5,007.60 |
$5,007.60 |
$5,007.60 |
$4,659.85
|
|
Unlisted px biliary tract
|
$17,588.35 |
$17,588.35 |
$17,588.35 |
$3,055.00
|
|
Unlisted px neck/thorax
|
$5,007.60 |
$5,007.60 |
$5,007.60 |
$571.20
|
|
Unlisted px pelvis/hip joint
|
$12,868.05 |
$12,868.05 |
$12,868.05 |
$3,251.90
|
|
Unlisted special svc px/rprt
|
$4,892.55 |
$4,892.55 |
$4,892.55 |
$90.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$581.10 |
$581.10 |
$581.10 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$3,103.75 |
$3,103.75 |
$3,103.75 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$3,012.75 |
$3,012.75 |
$3,012.75 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,832.10 |
$4,832.10 |
$4,832.10 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$4,122.95 |
$4,122.95 |
$4,122.95 |
$2,392.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,775.20 |
$3,775.20 |
$3,775.20 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$724.75 |
$724.75 |
$724.75 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$739.05 |
$739.05 |
$739.05 |
$381.60
|
|
Upper GI Barium X-ray (barium and gas)
|
$1,274.00 |
$1,274.00 |
$1,274.00 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$1,180.40 |
$1,180.40 |
$1,180.40 |
$607.20
|
|
Urea nitrogen
|
$98.15 |
$98.15 |
$98.15 |
$42.01
|
|
Urea nitrogen 24 hour urine
|
$163.15 |
$163.15 |
$163.15 |
$51.84
|
|
Ureteral embolization/occl
|
$5,243.55 |
$5,243.55 |
$5,243.55 |
$2,079.31
|
|
Ureteral reflux study
|
$1,423.50 |
$1,423.50 |
$1,423.50 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$1,104.35 |
$1,104.35 |
$1,104.35 |
$584.00
|
|
Urethrocystography void s&i
|
$1,046.50 |
$1,046.50 |
$1,046.50 |
$634.50
|
|
Uric acid blood
|
$54.60 |
$54.60 |
$54.60 |
$49.32
|
|
Uric acid urine
|
$122.85 |
$122.85 |
$122.85 |
$44.52
|
|
Urinalysis microscopic only
|
$149.50 |
$149.50 |
$149.50 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$36.40 |
$36.40 |
$36.40 |
$25.72
|
|
Urinalysis (with microscopy)
|
$163.15 |
$163.15 |
$163.15 |
$55.20
|
|
Urinalysis (without microscopy)
|
$88.40 |
$88.40 |
$88.40 |
$35.91
|
|
Urinary bldr retent nuc study
|
$569.40 |
$569.40 |
$569.40 |
$350.66
|
|
Urine ost pouch w faucet/tap
|
$1.30 |
$1.30 |
$1.30 |
$2.00
|
|
Urine pregnancy test
|
$125.45 |
$125.45 |
$125.45 |
$68.21
|
|
Urography, antegrade
|
$2,689.70 |
$2,689.70 |
$2,689.70 |
$622.35
|
|
Urography inf drip &/or bolus
|
$1,700.40 |
$1,700.40 |
$1,700.40 |
$642.50
|
|
Use 1st target lesion
|
$404.30 |
$404.30 |
$404.30 |
$332.00
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$155.35 |
$155.35 |
$155.35 |
$5,205.00
|
|
Vaccine Administration (one shot)
|
$118.30 |
$118.30 |
$118.30 |
$67.74
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$224.25 |
$224.25 |
$224.25 |
$224.25
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$239.85 |
$239.85 |
$239.85 |
$236.50
|
|
Vaccine dtap < 7 years im
|
$50.05 |
$50.05 |
$50.05 |
$71.17
|
|
Vaccine dtap-hep b-ipv im
|
$156.00 |
$156.00 |
$156.00 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$105.95 |
$105.95 |
$105.95 |
$105.95
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$23.40 |
$23.40 |
$23.40 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$135.20 |
$135.20 |
$135.20 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$218.40 |
$218.40 |
$218.40 |
$231.56
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$61.75 |
$61.75 |
$61.75 |
$78.25
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$120.25 |
$120.25 |
$120.25 |
$155.16
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$49.40 |
$49.40 |
$49.40 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$439.40 |
$439.40 |
$439.40 |
$576.48
|
|
Vaccine influenza inactivated adjuvant im
|
$81.90 |
$81.90 |
$81.90 |
$110.25
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$34.45 |
$34.45 |
$34.45 |
$48.59
|
|
Vaccine influenza quadrivalent (iiv4) split virus 0.25 ml im
|
$26.65 |
$26.65 |
$26.65 |
$20.80
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$30.55 |
$30.55 |
$30.55 |
$82.71
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$387.40 |
$387.40 |
$387.40 |
$394.26
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$291.20 |
$291.20 |
$291.20 |
$409.35
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$272.35 |
$272.35 |
$272.35 |
$327.37
|
|
Vaccine mmr live subcutaneous
|
$159.90 |
$159.90 |
$159.90 |
$213.00
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$202.80 |
$202.80 |
$202.80 |
$252.87
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$393.25 |
$393.25 |
$393.25 |
$393.25
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$385.45 |
$385.45 |
$385.45 |
$414.46
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$453.70 |
$453.70 |
$453.70 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$77.35 |
$77.35 |
$77.35 |
$90.70
|
|
Vaccine rabies im
|
$761.15 |
$761.15 |
$761.15 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$498.55 |
$498.55 |
$498.55 |
$538.84
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$963.30 |
$963.30 |
$963.30 |
$1,105.21
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$963.30 |
$963.30 |
$963.30 |
$997.44
|
|
Vaccine tdap >=7 years im
|
$81.90 |
$81.90 |
$81.90 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$69.55 |
$69.55 |
$69.55 |
$112.10
|
|
Vaccine typhoid vicps im
|
$253.50 |
$253.50 |
$253.50 |
$264.78
|
|
Vaccine varicella live subcutaneous
|
$317.20 |
$317.20 |
$317.20 |
$365.17
|
|
Vaccine yellow fever live subcutaneous
|
$296.40 |
$296.40 |
$296.40 |
$418.46
|
|
Valproic acid total therapeutic drug level
|
$446.55 |
$446.55 |
$446.55 |
$115.00
|
|
Valrubicin injection
|
$8,715.20 |
$8,715.20 |
$8,715.20 |
$2,813.49
|
|
Vancomycin 1,000 mg intravenous injection
|
$2.60 |
$2.60 |
$2.60 |
$251.86
|
|
Vancomycin 750 mg intravenous solution
|
$2.60 |
$2.60 |
$2.60 |
$90.33
|
|
Vancomycin peak therapeutic drug level
|
$411.45 |
$411.45 |
$411.45 |
$135.60
|
|
Vanomycin dna amp probe
|
$759.85 |
$759.85 |
$759.85 |
$78.40
|
|
Varicella zoster antibody igg
|
$339.95 |
$339.95 |
$339.95 |
$86.80
|
|
Vasc emb/occ w/prs cath
|
$48,347.00 |
$48,347.00 |
$48,347.00 |
$21,009.00
|
|
Vasopressin 20 unit/ml intravenous solution
|
$13.65 |
$13.65 |
$13.65 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$135.85 |
$135.85 |
$135.85 |
$18,732.33
|
|
Veeg cont 2-12 hrs
|
$3,835.65 |
$3,835.65 |
$3,835.65 |
$1,540.00
|
|
Veeg ea 12-26hr cont mntr
|
$3,835.65 |
$3,835.65 |
$3,835.65 |
$3,225.60
|
|
Veeg intrmnt 2-12 hrs
|
$826.15 |
$826.15 |
$826.15 |
$994.91
|
|
Veeg unmon 12-26 hrs
|
$3,835.65 |
$3,835.65 |
$3,835.65 |
$1,737.12
|
|
Veeg unmon 2-12 hrs
|
$826.15 |
$826.15 |
$826.15 |
$826.15
|
|
Vein x-ray adrenal gland
|
$3,224.65 |
$3,224.65 |
$3,224.65 |
$2,833.34
|
|
Vein x-ray adrenal glands
|
$3,480.10 |
$3,480.10 |
$3,480.10 |
$3,480.10
|
|
Vein x-ray eye socket
|
$2,440.75 |
$2,440.75 |
$2,440.75 |
$1,438.32
|
|
Vein x-ray kidney
|
$6,561.75 |
$6,561.75 |
$6,561.75 |
$2,870.00
|
|
Vein x-ray liver
|
$6,561.75 |
$6,561.75 |
$6,561.75 |
$3,312.00
|
|
Vein x-ray liver w/hemodynam
|
$6,561.75 |
$6,561.75 |
$6,561.75 |
$3,619.84
|
|
Vein x-ray liver w/hemodynam
|
$6,561.75 |
$6,561.75 |
$6,561.75 |
$3,683.90
|
|
Vein x-ray liver without hemodyn
|
$6,561.75 |
$6,561.75 |
$6,561.75 |
$2,452.80
|
|
Vein x-ray skull
|
$1,717.95 |
$1,717.95 |
$1,717.95 |
$2,236.50
|
|
Vein x-ray skull epidural
|
$5,275.40 |
$5,275.40 |
$5,275.40 |
$1,596.00
|
|
Vein x-ray spleen/liver
|
$2,587.00 |
$2,587.00 |
$2,587.00 |
$3,434.00
|
|
Vemp test i&r cervical
|
$456.30 |
$456.30 |
$456.30 |
$343.72
|
|
Vemp test i&r ocular
|
$456.30 |
$456.30 |
$456.30 |
$257.50
|
|
Vemp tst i&r cervical&ocular
|
$863.85 |
$863.85 |
$863.85 |
$591.50
|
