|
Unlisted ultrasound procedure
|
$568.00 |
$568.00 |
$568.00 |
$335.00
|
|
Unsched dialysis esrd pt hos
|
$4,290.00 |
$4,290.00 |
$4,290.00 |
$1,316.90
|
|
Upgrade pm system
|
$8,442.00 |
$8,442.00 |
$8,442.00 |
$12,087.24
|
|
Upper Arm (Humerus) X-ray (left side)
|
$394.00 |
$394.00 |
$394.00 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$2,282.00 |
$2,282.00 |
$2,282.00 |
$1,680.60
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,289.00 |
$1,289.00 |
$1,289.00 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,812.00 |
$3,812.00 |
$3,812.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,290.00 |
$3,290.00 |
$3,290.00 |
$2,410.98
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,296.00 |
$2,296.00 |
$2,296.00 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$455.00 |
$455.00 |
$455.00 |
$322.50
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$523.00 |
$523.00 |
$523.00 |
$381.75
|
|
Upper Endoscopy (EGD, diagnostic)
|
$5,045.00 |
$5,045.00 |
$5,045.00 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$5,045.00 |
$5,045.00 |
$5,045.00 |
$1,768.00
|
|
Upper GI Barium X-ray (barium and gas)
|
$1,632.00 |
$1,632.00 |
$1,632.00 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$1,518.00 |
$1,518.00 |
$1,518.00 |
$612.00
|
|
Uppr gi scope w/submuc inj
|
$4,548.00 |
$4,548.00 |
$4,548.00 |
$1,872.00
|
|
Urea nitrogen
|
$105.00 |
$105.00 |
$105.00 |
$42.00
|
|
Urea nitrogen 24 hour urine
|
$122.00 |
$122.00 |
$122.00 |
$51.77
|
|
Ureteral embolization/occl
|
$754.00 |
$754.00 |
$754.00 |
$2,079.31
|
|
Urethrcystgrphy rtrgrde s&i
|
$1,210.00 |
$1,210.00 |
$1,210.00 |
$584.23
|
|
Urethrlys transvag with scope
|
$11,439.00 |
$11,439.00 |
$11,439.00 |
$4,081.37
|
|
Urethrocystography void s&i
|
$1,784.00 |
$1,784.00 |
$1,784.00 |
$637.80
|
|
Uric acid blood
|
$114.00 |
$114.00 |
$114.00 |
$48.96
|
|
Uric acid urine
|
$122.00 |
$122.00 |
$122.00 |
$44.35
|
|
Urinalysis microscopic only
|
$78.00 |
$78.00 |
$78.00 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$24.00 |
$24.00 |
$24.00 |
$25.72
|
|
Urinalysis (with microscopy)
|
$80.00 |
$80.00 |
$80.00 |
$54.60
|
|
Urinalysis (without microscopy)
|
$90.00 |
$90.00 |
$90.00 |
$35.75
|
|
Urine Culture Test
|
$201.00 |
$201.00 |
$201.00 |
$81.27
|
|
Urine pregnancy test
|
$138.00 |
$138.00 |
$138.00 |
$67.80
|
|
Urography, antegrade
|
$1,784.00 |
$1,784.00 |
$1,784.00 |
$622.35
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$37.48 |
$37.48 |
$37.48 |
$5,205.00
|
|
Vaccine Administration (one shot)
|
$202.71 |
$202.71 |
$202.71 |
$67.74
|
|
Vaccine dtap < 7 years im
|
$135.96 |
$135.96 |
$135.96 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$422.00 |
$422.00 |
$422.00 |
$165.26
|
|
Vaccine dtap-ipv/hib im
|
$457.32 |
$457.32 |
$457.32 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$131.84 |
$131.84 |
$131.84 |
$72.00
|
|
Vaccine hepatitis a (hepa) adult im
|
$344.02 |
$344.02 |
$344.02 |
$168.95
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$550.23 |
$550.23 |
$550.23 |
$231.56
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$638.60 |
$638.60 |
$638.60 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$155.53 |
$155.53 |
$155.53 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$1,109.31 |
$1,109.31 |
$1,109.31 |
$570.87
|
|
Vaccine influenza inactivated adjuvant im
|
$317.24 |
$317.24 |
$317.24 |
$106.60
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$84.47 |
$84.47 |
$84.47 |
$48.59
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$77.25 |
$77.25 |
$77.25 |
$35.88
|
|
Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im
|
$280.16 |
$280.16 |
$280.16 |
$72.80
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$84.46 |
$84.46 |
$84.46 |
$33.21
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$311.06 |
$311.06 |
$311.06 |
$72.00
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$140.08 |
$140.08 |
$140.08 |
$82.71
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$679.80 |
$679.80 |
$679.80 |
$323.39
|
|
Vaccine mmr live subcutaneous
|
$409.94 |
$409.94 |
$409.94 |
$211.68
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$902.28 |
$902.28 |
$902.28 |
$251.64
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$1,172.79 |
$1,172.79 |
$1,172.79 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$184.37 |
$184.37 |
$184.37 |
$90.70
|
|
Vaccine rabies im
|
$1,756.67 |
$1,756.67 |
$1,756.67 |
$858.95
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$1,284.41 |
$1,284.41 |
$1,284.41 |
$1,104.47
|
|
Vaccine tdap >=7 years im
|
$202.91 |
$202.91 |
$202.91 |
$131.22
|
|
Vaccine td preservative free >= 7 years im
|
$170.98 |
$170.98 |
$170.98 |
$110.19
|
|
Vad battery clip set hmii 14-v li-ion
|
$823.90 |
$823.90 |
$823.90 |
$1,932.00
|
|
Vad univ batt charger hm 1440
|
$10,776.70 |
$10,776.70 |
$10,776.70 |
$14,814.14
|
|
Vag hyst incl t/o complex
|
$9,290.00 |
$9,290.00 |
$9,290.00 |
$5,813.46
|
|
Vag hyst including t/o
|
$13,654.00 |
$13,654.00 |
$13,654.00 |
$5,110.00
|
|
Vaginal bx
|
$9,791.00 |
$9,791.00 |
$9,791.00 |
$471.12
|
|
Vaginal delivery after cesarean delivery 59612
|
$12,187.00 |
$12,187.00 |
$12,187.00 |
$3,866.47
|
|
Vaginal hysterectomy
|
$13,654.00 |
$13,654.00 |
$13,654.00 |
$5,766.00
|
|
Valproic acid total therapeutic drug level
|
$337.00 |
$337.00 |
$337.00 |
$115.00
|
|
Valvuloplasty aortic
|
$6,886.00 |
$6,886.00 |
$6,886.00 |
$8,052.60
|
|
Valvuloplasty mitral
|
$8,687.00 |
$8,687.00 |
$8,687.00 |
$10,851.48
|
|
Valvuloplasty pulmonary
|
$8,687.00 |
$8,687.00 |
$8,687.00 |
$11,945.20
|
|
Valvuloplasty/tv without ring insert 33463
|
$42,480.00 |
$42,480.00 |
$42,480.00 |
$7,556.80
|
|
Vancomycin hcl injection
|
$149.49 |
$149.49 |
$149.49 |
$149.49
|
|
Vancomycin peak therapeutic drug level
|
$337.00 |
$337.00 |
$337.00 |
$135.00
|
|
Varicella zoster antibody igg
|
$203.00 |
$203.00 |
$203.00 |
$86.80
|
|
Vasc emb/occ w/prs cath
|
$46,160.00 |
$46,160.00 |
$46,160.00 |
$21,009.00
|
|
Vasc graft into carpal bone
|
$6,653.00 |
$6,653.00 |
$6,653.00 |
$4,350.00
|
|
Vasectomy
|
$10,780.00 |
$10,780.00 |
$10,780.00 |
$2,424.12
|
|
Vbac delivery 59610
|
$12,187.00 |
$12,187.00 |
$12,187.00 |
$4,492.00
|
|
Vedolizumab 300 mg intravenous solution
|
$69.20 |
$69.20 |
$69.20 |
$18,732.33
|
|
Veeg cont 2-12 hrs
|
$2,038.00 |
$2,038.00 |
$2,038.00 |
$1,540.00
|
|
Veeg ea 12-26hr cont mntr
|
$3,815.00 |
$3,815.00 |
$3,815.00 |
$3,225.60
|
|
Veeg intrmnt 2-12 hrs
|
$1,061.00 |
$1,061.00 |
$1,061.00 |
$983.38
|
|
Veeg unmon 12-26 hrs
|
$2,038.00 |
$2,038.00 |
$2,038.00 |
$1,794.68
|
|
Veeg unmon 2-12 hrs
|
$1,061.00 |
$1,061.00 |
$1,061.00 |
$833.90
|
|
Vein x-ray eye socket
|
$10,421.00 |
$10,421.00 |
$10,421.00 |
$1,438.32
|
|
Vein x-ray kidney
|
$10,421.00 |
$10,421.00 |
$10,421.00 |
$2,990.58
|
|
Vein x-ray liver
|
$10,421.00 |
$10,421.00 |
$10,421.00 |
$3,328.80
|
|
Vein x-ray liver w/hemodynam
|
$10,421.00 |
$10,421.00 |
$10,421.00 |
$3,635.28
|
|
Vein x-ray liver w/hemodynam
|
$10,421.00 |
$10,421.00 |
$10,421.00 |
$3,694.50
|
|
Vein x-ray liver without hemodyn
|
$6,786.00 |
$6,786.00 |
$6,786.00 |
$2,482.90
|
|
Vein x-ray skull
|
$6,583.00 |
$6,583.00 |
$6,583.00 |
$2,236.50
|
|
Vein x-ray skull epidural
|
$1,596.00 |
$1,596.00 |
$1,596.00 |
$1,596.00
|
|
Vein x-ray spleen/liver
|
$10,421.00 |
$10,421.00 |
$10,421.00 |
$3,434.00
|
|
Vemp test i&r cervical
|
$432.00 |
$432.00 |
$432.00 |
$343.72
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$80.00 |
$80.00 |
$80.00 |
$188.83
|
|
Venogram ext bil s&i
|
$2,663.00 |
$2,663.00 |
$2,663.00 |
$1,838.28
|
|
Venogram extremity supervision & interpretation unilateral
|
$2,663.00 |
$2,663.00 |
$2,663.00 |
$1,388.00
|
|
Venous mech thrombectomy
|
$11,000.00 |
$11,000.00 |
$11,000.00 |
$8,212.75
|
|
Venous m-thrombectomy add-on
|
$6,514.00 |
$6,514.00 |
$6,514.00 |
$5,288.32
|
|
Venous sampling s&i
|
$10,421.00 |
$10,421.00 |
$10,421.00 |
$4,270.50
|
|
Ventilator each subsequent day
|
$998.00 |
$998.00 |
$998.00 |
$1,184.00
|
