|
Ultrasound joint/nonvascular extremity limited left
|
$694.00 |
$694.00 |
$2,602.65 |
$448.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$5,319.50 |
$5,319.50 |
$5,319.50 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$447.30 |
$447.30 |
$447.30 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$437.60 |
$437.60 |
$437.60 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$375.20 |
$375.20 |
$375.20 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$5,491.35 |
$5,491.35 |
$5,491.35 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$1,622.00 |
$1,622.00 |
$1,622.00 |
$498.00
|
|
Ultrasound scrotum and contents
|
$866.00 |
$866.00 |
$866.00 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$825.60 |
$825.60 |
$825.60 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$6,148.15 |
$6,148.15 |
$6,148.15 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$687.60 |
$687.60 |
$687.60 |
$567.44
|
|
Unlisted transfusion med px
|
$230.80 |
$230.80 |
$230.80 |
$141.35
|
|
Unlisted ultrasound procedure
|
$867.15 |
$867.15 |
$867.15 |
$321.20
|
|
Upgrade pm system
|
$23,755.60 |
$23,755.60 |
$23,755.60 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$791.20 |
$791.20 |
$14,476.45 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$644.00 |
$644.00 |
$13,597.35 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$755.20 |
$755.20 |
$12,937.10 |
$2,013.08
|
|
Urea nitrogen
|
$64.92 |
$64.92 |
$64.92 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$63.79 |
$63.79 |
$63.79 |
$50.00
|
|
Urea nitrogen clearance
|
$326.25 |
$326.25 |
$326.25 |
$33.57
|
|
Ureteral reflux study
|
$6,517.95 |
$6,517.95 |
$6,517.95 |
$961.20
|
|
Urethrocystography void s&i
|
$511.60 |
$511.60 |
$511.60 |
$634.50
|
|
Uric acid blood
|
$59.23 |
$59.23 |
$59.23 |
$46.64
|
|
Uric acid urine
|
$54.67 |
$54.67 |
$54.67 |
$46.75
|
|
Urinalysis microscopic only
|
$16.41 |
$16.41 |
$40.35 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$4.96 |
$4.96 |
$4.96 |
$25.72
|
|
Urinalysis (with microscopy)
|
$61.87 |
$61.87 |
$467.00 |
$48.14
|
|
Urinalysis (without microscopy)
|
$54.21 |
$54.21 |
$54.21 |
$38.99
|
|
Urine Culture Test
|
$87.14 |
$87.14 |
$87.14 |
$84.81
|
|
Urine pregnancy test
|
$28.73 |
$28.73 |
$28.73 |
$66.40
|
|
Urography, antegrade
|
$307.20 |
$307.20 |
$307.20 |
$593.37
|
|
Urography inf drip &/or bolus
|
$4,825.85 |
$4,825.85 |
$4,825.85 |
$641.69
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$179.92 |
$179.92 |
$179.92 |
$223.08
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$177.84 |
$177.84 |
$177.84 |
$218.88
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$173.64 |
$173.64 |
$173.64 |
$239.85
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$111.44 |
$111.44 |
$111.44 |
$131.67
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$249.64 |
$249.64 |
$249.64 |
$91.00
|
|
Vaccine dtap < 7 years im
|
$58.42 |
$58.42 |
$58.42 |
$87.80
|
|
Vaccine dtap-hep b-ipv im
|
$523.70 |
$523.70 |
$523.70 |
$193.83
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$185.00 |
$185.00 |
$185.00 |
$85.00
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$65.68 |
$65.68 |
$76.00 |
$45.33
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$252.00 |
$252.00 |
$252.00 |
$84.38
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$109.00 |
$109.00 |
$109.00 |
$61.50
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$174.18 |
$174.18 |
$174.18 |
$306.24
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$83.00 |
$83.00 |
$83.00 |
$79.04
|
|
Vaccine influenza nos 0.5ml dose im
|
$115.00 |
$115.00 |
$115.00 |
$36.80
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$24.56 |
$24.56 |
$24.56 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$28.88 |
$28.88 |
$173.00 |
$26.40
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$29.22 |
$29.22 |
$76.00 |
$40.01
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$28.88 |
$28.88 |
$28.88 |
$72.00
|
|
Vaccine influenza trivalent (iiv3) 0.25ml dose im
|
$123.00 |
$123.00 |
$123.00 |
$32.50
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$493.00 |
$493.00 |
$493.00 |
$426.80
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$297.00 |
$297.00 |
$297.00 |
$349.15
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$256.78 |
$256.78 |
$480.00 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$586.00 |
$586.00 |
$586.00 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$111.94 |
$111.94 |
$715.00 |
$274.95
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$426.36 |
$426.36 |
$1,390.00 |
$397.18
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$584.00 |
$584.00 |
$584.00 |
$385.45
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$359.73 |
$359.73 |
$359.73 |
$715.41
|
|
Vaccine polio (ipv) subcutaneous/im
|
$307.00 |
$307.00 |
$307.00 |
$119.17
|
|
Vaccine rabies im
|
$577.14 |
$577.14 |
$1,009.00 |
$945.46
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$715.19 |
$715.19 |
$1,227.00 |
$1,196.00
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$924.26 |
$924.26 |
$1,292.00 |
$1,159.00
|
|
Vaccine tdap >=7 years im
|
$69.04 |
$69.04 |
$69.04 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$65.64 |
$65.64 |
$291.00 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$1,891.00 |
$1,891.00 |
$1,891.00 |
$447.80
|
|
Valproic acid total therapeutic drug level
|
$178.83 |
$178.83 |
$882.00 |
$115.00
|
|
Vancomycin 750 mg intravenous solution
|
$17.00 |
$17.00 |
$17.00 |
$100.15
|
|
Vancomycin peak therapeutic drug level
|
$109.41 |
$109.41 |
$109.41 |
$126.79
|
|
Vanomycin dna amp probe
|
$172.87 |
$172.87 |
$172.87 |
$87.20
|
|
Varicella zoster antibody igg
|
$62.08 |
$62.08 |
$62.08 |
$82.55
|
|
Vasopressin 20 unit/ml intravenous solution
|
$1.23 |
$1.23 |
$1.23 |
$362.93
|
|
Vedolizumab 300 mg intravenous solution
|
$40.00 |
$40.00 |
$40.00 |
$20,730.98
|
|
Vein x-ray kidney
|
$1,598.80 |
$1,598.80 |
$1,598.80 |
$2,716.20
|
|
Vein x-ray liver
|
$3,393.60 |
$3,393.60 |
$10,392.10 |
$3,320.80
|
|
Vein x-ray liver w/hemodynam
|
$3,393.60 |
$3,393.60 |
$3,393.60 |
$3,413.25
|
|
Vein x-ray liver w/hemodynam
|
$3,393.60 |
$3,393.60 |
$3,393.60 |
$3,439.84
|
|
Vein x-ray liver without hemodyn
|
$3,393.60 |
$3,393.60 |
$3,393.60 |
$2,489.25
|
|
Vein x-ray skull
|
$3,393.60 |
$3,393.60 |
$3,393.60 |
$2,301.09
|
|
Vein x-ray skull epidural
|
$3,393.60 |
$3,393.60 |
$3,393.60 |
$1,344.60
|
|
Venogram ext bil s&i
|
$1,495.20 |
$1,495.20 |
$1,495.20 |
$1,838.28
|
|
Venogram extremity supervision & interpretation unilateral
|
$2,266.00 |
$2,266.00 |
$2,266.00 |
$1,326.00
|
|
Venous sampling s&i
|
$3,393.60 |
$3,393.60 |
$18,107.50 |
$4,416.78
|
|
Ventilator each subsequent day
|
$4,554.15 |
$4,554.15 |
$4,554.15 |
$1,305.92
|
|
Ventilator initial day
|
$5,289.55 |
$5,289.55 |
$5,289.55 |
$1,540.80
|
|
Very long chain fatty acids
|
$22.59 |
$22.59 |
$153.25 |
$140.40
|
|
Virus isolation addl studies ea
|
$21.20 |
$21.20 |
$21.20 |
$90.35
|
|
Vital capacity test
|
$792.15 |
$792.15 |
$792.15 |
$173.33
|
|
Vitamin b-12
|
$179.04 |
$179.04 |
$370.00 |
$94.90
|
|
Vitamin D Test
|
$84.86 |
$84.86 |
$84.86 |
$132.00
|
|
Vol reduction of blood/prod
|
$63.20 |
$63.20 |
$63.20 |
$131.25
|
|
Volume measurement urine timed
|
$163.00 |
$163.00 |
$163.00 |
$21.45
|
|
Voriconazole in ns IV syringe 5 mg/ml (pediatric) - cnr
|
$15.33 |
$15.33 |
$244.00 |
$215.60
|
|
Warde 1003990 aldosterone
|
$84.53 |
$84.53 |
$84.53 |
$145.60
|
|
Warde 1005020 citrate 24 hour urine
|
$17.65 |
$17.65 |
$17.65 |
$97.61
|
|
Warde 1005055 5-hiaa 24 hour urine
|
$8.80 |
$8.80 |
$24.12 |
$72.50
|
|
Warde 1007138 vanillymandelic acid 24 hour urine
|
$6.46 |
$6.46 |
$6.60 |
$69.55
|
|
Warde 1015200 kappa light chain free
|
$26.88 |
$26.88 |
$26.88 |
$64.28
|
|
Warde 3004000 immunoglobulin subclass 1
|
$4.80 |
$4.80 |
$25.35 |
$40.70
|
|
Warde 3008005 oligoclonal bands
|
$42.60 |
$42.60 |
$42.60 |
$102.60
|
