|
Unsched dialysis esrd pt hos
|
$1,844.50 |
$1,844.50 |
$1,844.50 |
$1,268.17
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,696.30 |
$4,696.30 |
$4,696.30 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$4,101.30 |
$4,101.30 |
$4,101.30 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,809.40 |
$3,809.40 |
$3,809.40 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$7,846.78 |
$7,846.78 |
$7,846.78 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$11,659.27 |
$11,659.27 |
$11,659.27 |
$1,768.00
|
|
Uppr gi scope w/submuc inj
|
$13,608.84 |
$13,608.84 |
$13,608.84 |
$1,872.00
|
|
Urea nitrogen
|
$84.00 |
$84.00 |
$84.00 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$205.10 |
$205.10 |
$205.10 |
$51.75
|
|
Urea nitrogen clearance
|
$86.80 |
$86.80 |
$86.80 |
$42.25
|
|
Urethrcystgrphy rtrgrde s&i
|
$839.30 |
$839.30 |
$839.30 |
$579.73
|
|
Urethrlys transvag with scope
|
$15,475.00 |
$15,475.00 |
$15,475.00 |
$4,081.37
|
|
Urethrocystography void s&i
|
$897.40 |
$897.40 |
$897.40 |
$622.35
|
|
Uric acid blood
|
$79.10 |
$79.10 |
$79.10 |
$48.75
|
|
Uric acid urine
|
$125.30 |
$125.30 |
$125.30 |
$44.33
|
|
Urinalysis qual/semiquant excpt ia
|
$30.10 |
$30.10 |
$30.10 |
$25.72
|
|
Urinalysis (with microscopy)
|
$102.20 |
$102.20 |
$102.20 |
$55.00
|
|
Urinalysis (without microscopy)
|
$102.20 |
$102.20 |
$102.20 |
$35.75
|
|
Urine Culture Test
|
$177.10 |
$177.10 |
$177.10 |
$81.50
|
|
Urine pregnancy test
|
$125.30 |
$125.30 |
$125.30 |
$67.20
|
|
Urography, antegrade
|
$1,262.80 |
$1,262.80 |
$1,262.80 |
$622.35
|
|
Use 1st target lesion
|
$482.30 |
$482.30 |
$482.30 |
$332.00
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$12,365.15 |
$12,365.15 |
$12,365.15 |
$5,184.34
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$83,005.30 |
$83,005.30 |
$83,005.30 |
$51,633.07
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$69.30 |
$69.30 |
$69.30 |
$209.40
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$137.90 |
$137.90 |
$137.90 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$92.40 |
$92.40 |
$92.40 |
$123.20
|
|
Vaccine dtap < 7 years im
|
$159.77 |
$159.77 |
$159.77 |
$68.19
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$62.12 |
$62.12 |
$62.12 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$394.97 |
$394.97 |
$394.97 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$709.97 |
$709.97 |
$709.97 |
$218.40
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$387.27 |
$387.27 |
$387.27 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$440.30 |
$440.30 |
$440.30 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$158.55 |
$158.55 |
$158.55 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$1,347.15 |
$1,347.15 |
$1,347.15 |
$576.48
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$347.20 |
$347.20 |
$347.20 |
$282.50
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$302.40 |
$302.40 |
$302.40 |
$143.20
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$81.20 |
$81.20 |
$81.20 |
$47.88
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$33.60 |
$33.60 |
$33.60 |
$33.60
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$329.00 |
$329.00 |
$329.00 |
$400.03
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$247.80 |
$247.80 |
$247.80 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$505.22 |
$505.22 |
$505.22 |
$211.68
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$164.50 |
$164.50 |
$164.50 |
$251.64
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$275.80 |
$275.80 |
$275.80 |
$397.11
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$1,255.97 |
$1,255.97 |
$1,255.97 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$242.37 |
$242.37 |
$242.37 |
$90.70
|
|
Vaccine rabies im
|
$2,233.00 |
$2,233.00 |
$2,233.00 |
$858.95
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$2,586.50 |
$2,586.50 |
$2,586.50 |
$1,104.47
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$2,586.50 |
$2,586.50 |
$2,586.50 |
$997.44
|
|
Vaccine tdap >=7 years im
|
$262.32 |
$262.32 |
$262.32 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$229.25 |
$229.25 |
$229.25 |
$112.10
|
|
Vag hys/<250g/rmv tube/rpr entero 58263
|
$63,151.35 |
$63,151.35 |
$63,151.35 |
$5,345.59
|
|
Vag hyst incl t/o complex
|
$90,643.58 |
$90,643.58 |
$90,643.58 |
$5,735.60
|
|
Vag hyst including t/o
|
$60,877.16 |
$60,877.16 |
$60,877.16 |
$4,827.18
|
|
Vaginal bx
|
$22,427.17 |
$22,427.17 |
$22,427.17 |
$455.94
|
|
Vaginal hysterectomy
|
$56,155.70 |
$56,155.70 |
$56,155.70 |
$5,766.00
|
|
Valproate in ns IV syringe 10 mg/ml (pediatric) - cnr
|
$10.67 |
$10.67 |
$10.67 |
$24.12
|
|
Valproic acid total therapeutic drug level
|
$241.50 |
$241.50 |
$241.50 |
$114.72
|
|
Valrubicin injection
|
$10,918.95 |
$10,918.95 |
$10,918.95 |
$2,813.49
|
|
Valvuloplasty aortic
|
$9,383.50 |
$9,383.50 |
$9,383.50 |
$7,830.80
|
|
Valvuloplasty mitral
|
$9,664.90 |
$9,664.90 |
$9,664.90 |
$10,877.90
|
|
Valvuloplasty pulmonary
|
$6,469.40 |
$6,469.40 |
$6,469.40 |
$11,945.20
|
|
Valvuloplasty/tv w/ring insertion 33464
|
$21,092.40 |
$21,092.40 |
$21,092.40 |
$5,965.60
|
|
Vancomycin 1,000 mg intravenous injection
|
$481.07 |
$481.07 |
$481.07 |
$251.86
|
|
Vancomycin peak therapeutic drug level
|
$198.80 |
$198.80 |
$198.80 |
$136.13
|
|
Varicella zoster antibody igg
|
$249.20 |
$249.20 |
$249.20 |
$86.80
|
|
Varicella-zoster immue globin im
|
$66,119.72 |
$66,119.72 |
$66,119.72 |
$3,816.19
|
|
Vasc emb/occ w/prs cath
|
$31,976.00 |
$31,976.00 |
$31,976.00 |
$21,009.00
|
|
Vasectomy
|
$9,024.90 |
$9,024.90 |
$9,024.90 |
$2,424.12
|
|
Vasopressin 20 unit/ml intravenous solution
|
$367.67 |
$367.67 |
$367.67 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$54,628.17 |
$54,628.17 |
$54,628.17 |
$18,732.33
|
|
Veeg cont 2-12 hrs
|
$4,044.60 |
$4,044.60 |
$4,044.60 |
$1,540.00
|
|
Veeg ea 12-26hr cont mntr
|
$4,044.60 |
$4,044.60 |
$4,044.60 |
$3,225.60
|
|
Veeg intrmnt 2-12 hrs
|
$3,707.20 |
$3,707.20 |
$3,707.20 |
$961.00
|
|
Vein x-ray eye socket
|
$1,353.10 |
$1,353.10 |
$1,353.10 |
$1,438.32
|
|
Vein x-ray kidney
|
$3,749.20 |
$3,749.20 |
$3,749.20 |
$2,766.73
|
|
Vein x-ray liver
|
$3,462.20 |
$3,462.20 |
$3,462.20 |
$3,305.50
|
|
Vein x-ray liver w/hemodynam
|
$3,871.00 |
$3,871.00 |
$3,871.00 |
$3,486.86
|
|
Vein x-ray liver w/hemodynam
|
$3,899.00 |
$3,899.00 |
$3,899.00 |
$3,483.84
|
|
Vein x-ray liver without hemodyn
|
$2,452.80 |
$2,452.80 |
$2,452.80 |
$2,452.80
|
|
Vein x-ray skull
|
$1,862.00 |
$1,862.00 |
$1,862.00 |
$2,141.00
|
|
Vein x-ray spleen/liver
|
$1,512.70 |
$1,512.70 |
$1,512.70 |
$3,427.50
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$2,069.20 |
$2,069.20 |
$2,069.20 |
$202.80
|
|
Venogram ext bil s&i
|
$2,265.20 |
$2,265.20 |
$2,265.20 |
$1,797.50
|
|
Venogram extremity supervision & interpretation unilateral
|
$1,736.00 |
$1,736.00 |
$1,736.00 |
$1,366.20
|
|
Venous mech thrombectomy
|
$95,468.67 |
$95,468.67 |
$95,468.67 |
$7,965.00
|
|
Venous m-thrombectomy add-on
|
$6,379.10 |
$6,379.10 |
$6,379.10 |
$5,094.75
|
|
Venous sampling s&i
|
$2,668.40 |
$2,668.40 |
$2,668.40 |
$4,193.20
|
|
Ventilator each subsequent day
|
$942.20 |
$942.20 |
$942.20 |
$1,204.00
|
|
Ventilator initial day
|
$1,099.00 |
$1,099.00 |
$1,099.00 |
$1,431.43
|
|
Ventricular puncture prev burr hole without inj 61020
|
$1,391.60 |
$1,391.60 |
$1,391.60 |
$1,314.30
|
|
Version cephalic external
|
$7,617.75 |
$7,617.75 |
$7,617.75 |
$2,361.75
|
|
Very long chain fatty acids
|
$1,241.80 |
$1,241.80 |
$1,241.80 |
$139.88
|
|
Vinblastine 1 mg/ml intravenous solution
|
$280.00 |
$280.00 |
$280.00 |
$165.00
|
|
Vincristine 1 mg/ml intravenous solution
|
$162.75 |
$162.75 |
$162.75 |
$87.15
|
|
Vinorelbine 10 mg/ml intravenous solution (wrapper)
|
$262.67 |
$262.67 |
$262.67 |
$223.55
|
|
Virus isolation addl studies ea
|
$413.70 |
$413.70 |
$413.70 |
$77.50
|
|
Visc & infraren abd 2 prosth
|
$15,680.70 |
$15,680.70 |
$15,680.70 |
$10,796.94
|
|
Visc & infraren abd 3 prosth
|
$17,873.10 |
$17,873.10 |
$17,873.10 |
$11,878.86
|
|
Visit established high 40-54 minutes/level 5
|
$201.60 |
$201.60 |
$201.60 |
$227.50
|
