|
Unlisted ultrasound procedure
|
$105.00 |
$105.00 |
$105.00 |
$321.20
|
|
Unlisted urinalysis px
|
$114.10 |
$114.10 |
$114.10 |
$25.72
|
|
Unlstd laps px sprmatic cord
|
$50,744.91 |
$50,744.91 |
$50,744.91 |
$4,713.11
|
|
Unsched dialysis esrd pt hos
|
$1,262.80 |
$1,262.80 |
$1,262.80 |
$1,268.17
|
|
Upgrade pm system
|
$29,069.99 |
$29,069.99 |
$29,069.99 |
$12,077.00
|
|
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)
|
$4,160.04 |
$4,160.04 |
$4,160.04 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$9,470.38 |
$9,470.38 |
$9,470.38 |
$1,768.00
|
|
Uppr gi scope w/submuc inj
|
$13,063.64 |
$13,063.64 |
$13,063.64 |
$1,872.00
|
|
Urea nitrogen
|
$63.70 |
$63.70 |
$63.70 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$56.00 |
$56.00 |
$56.00 |
$51.75
|
|
Urethrcystgrphy rtrgrde s&i
|
$839.30 |
$839.30 |
$839.30 |
$579.73
|
|
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
|
$79.10 |
$79.10 |
$79.10 |
$44.33
|
|
Urinalysis microscopic only
|
$32.90 |
$32.90 |
$32.90 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$30.10 |
$30.10 |
$30.10 |
$25.72
|
|
Urinalysis (with microscopy)
|
$84.70 |
$84.70 |
$84.70 |
$55.00
|
|
Urinalysis (without microscopy)
|
$53.20 |
$53.20 |
$53.20 |
$35.75
|
|
Urine Culture Test
|
$129.50 |
$129.50 |
$129.50 |
$81.50
|
|
Urine pregnancy test
|
$128.80 |
$128.80 |
$128.80 |
$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
|
$8,741.25 |
$8,741.25 |
$8,741.25 |
$5,184.34
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$58,677.85 |
$58,677.85 |
$58,677.85 |
$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
|
$117.07 |
$117.07 |
$117.07 |
$68.19
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$51.62 |
$51.62 |
$51.62 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$107.10 |
$107.10 |
$107.10 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$326.90 |
$326.90 |
$326.90 |
$218.40
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$273.87 |
$273.87 |
$273.87 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$527.27 |
$527.27 |
$527.27 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$112.00 |
$112.00 |
$112.00 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$1,245.82 |
$1,245.82 |
$1,245.82 |
$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
|
$81.20 |
$81.20 |
$81.20 |
$143.20
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$33.60 |
$33.60 |
$33.60 |
$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
|
$861.70 |
$861.70 |
$861.70 |
$400.03
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$452.37 |
$452.37 |
$452.37 |
$310.93
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$631.40 |
$631.40 |
$631.40 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$357.17 |
$357.17 |
$357.17 |
$211.68
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$402.85 |
$402.85 |
$402.85 |
$251.64
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$275.80 |
$275.80 |
$275.80 |
$397.11
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$887.95 |
$887.95 |
$887.95 |
$563.36
|
|
Vaccine rabies im
|
$1,578.50 |
$1,578.50 |
$1,578.50 |
$858.95
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$1,828.57 |
$1,828.57 |
$1,828.57 |
$1,104.47
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$1,828.57 |
$1,828.57 |
$1,828.57 |
$997.44
|
|
Vaccine tdap >=7 years im
|
$189.00 |
$189.00 |
$189.00 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$77.00 |
$77.00 |
$77.00 |
$112.10
|
|
Vag hyst including t/o
|
$42,490.55 |
$42,490.55 |
$42,490.55 |
$4,827.18
|
|
Vag hyst w/enterocele repair
|
$39,597.17 |
$39,597.17 |
$39,597.17 |
$5,468.70
|
|
Vaginal bx
|
$132.30 |
$132.30 |
$132.30 |
$455.94
|
|
Vaginal hysterectomy
|
$30,655.39 |
$30,655.39 |
$30,655.39 |
$5,766.00
|
|
Valproate in ns IV syringe 10 mg/ml (pediatric) - cnr
|
$19.25 |
$19.25 |
$19.25 |
$24.12
|
|
Valproic acid total therapeutic drug level
|
$199.50 |
$199.50 |
$199.50 |
$114.72
|
|
Valvuloplasty aortic
|
$16,396.80 |
$16,396.80 |
$16,396.80 |
$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
|
$818.30 |
$818.30 |
$818.30 |
$251.86
|
|
Vancomycin peak therapeutic drug level
|
$185.50 |
$185.50 |
$185.50 |
$136.13
|
|
Varicella zoster antibody igg
|
$118.30 |
$118.30 |
$118.30 |
$86.80
|
|
Vasc emb/occ w/prs cath
|
$31,976.00 |
$31,976.00 |
$31,976.00 |
$21,009.00
|
|
Vasopressin 20 unit/ml intravenous solution
|
$91.87 |
$91.87 |
$91.87 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$38,617.60 |
$38,617.60 |
$38,617.60 |
$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
|
|
Veeg unmon 12-26 hrs
|
$3,623.90 |
$3,623.90 |
$3,623.90 |
$1,671.09
|
|
Veeg unmon 2-12 hrs
|
$2,364.60 |
$2,364.60 |
$2,364.60 |
$826.15
|
|
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)
|
$2,072.17 |
$2,072.17 |
$2,072.17 |
$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
|
$44,156.52 |
$44,156.52 |
$44,156.52 |
$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
|
$620.20 |
$620.20 |
$620.20 |
$1,204.00
|
|
Ventilator initial day
|
$827.40 |
$827.40 |
$827.40 |
$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
|
$5,041.57 |
$5,041.57 |
$5,041.57 |
$2,361.75
|
|
Very long chain fatty acids
|
$149.10 |
$149.10 |
$149.10 |
$139.88
|
|
Vinblastine 1 mg/ml intravenous solution
|
$197.92 |
$197.92 |
$197.92 |
$165.00
|
|
Vincristine 1 mg/ml intravenous solution
|
$129.32 |
$129.32 |
$129.32 |
$87.15
|
|
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
|
|
Vital capacity test
|
$203.70 |
$203.70 |
$203.70 |
$170.00
|
|
Vitamin b-12
|
$135.10 |
$135.10 |
$135.10 |
$100.00
|
