|
Ultrasound prostate/transrectal
|
$1,085.00 |
$1,085.00 |
$1,085.00 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$1,313.20 |
$1,313.20 |
$1,313.20 |
$486.50
|
|
Ultrasound scrotum and contents
|
$1,376.90 |
$1,376.90 |
$1,376.90 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$1,559.60 |
$1,559.60 |
$1,559.60 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$1,157.10 |
$1,157.10 |
$1,157.10 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$1,079.40 |
$1,079.40 |
$1,079.40 |
$558.35
|
|
Ultrasound trgt dyn mbubb 1st les
|
$3,213.00 |
$3,213.00 |
$3,213.00 |
$568.32
|
|
Ultrasound trgt dyn mbubb ea addl
|
$4,034.80 |
$4,034.80 |
$4,034.80 |
$348.00
|
|
Umbilical artery cath newborn 36660
|
$851.20 |
$851.20 |
$851.20 |
$206.64
|
|
Unlisted CT procedure
|
$1,941.10 |
$1,941.10 |
$1,941.10 |
$732.70
|
|
Unlisted dx gi procedure
|
$1,908.20 |
$1,908.20 |
$1,908.20 |
$649.22
|
|
Unlisted fetal invas px w/us
|
$606.90 |
$606.90 |
$606.90 |
$498.40
|
|
Unlisted fluoroscopic px
|
$26,511.80 |
$26,511.80 |
$26,511.80 |
$305.76
|
|
Unlisted hematology&coagj px
|
$65.10 |
$65.10 |
$65.10 |
$39.52
|
|
Unlisted maaa
|
$284.90 |
$284.90 |
$284.90 |
$235.20
|
|
Unlisted mr procedure
|
$2,110.50 |
$2,110.50 |
$2,110.50 |
$1,163.00
|
|
Unlisted procedure colon
|
$10,896.20 |
$10,896.20 |
$10,896.20 |
$1,702.50
|
|
Unlisted procedure esophagus
|
$15,993.60 |
$15,993.60 |
$15,993.60 |
$1,998.88
|
|
Unlisted procedure liver
|
$26,043.50 |
$26,043.50 |
$26,043.50 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$490.70 |
$490.70 |
$490.70 |
$523.50
|
|
Unlisted procedure pancreas
|
$8,447.60 |
$8,447.60 |
$8,447.60 |
$3,986.00
|
|
Unlisted procedure rectum
|
$12,129.60 |
$12,129.60 |
$12,129.60 |
$1,220.35
|
|
Unlisted px abdomen muscskel
|
$3,161.20 |
$3,161.20 |
$3,161.20 |
$1,848.60
|
|
Unlisted px biliary tract
|
$23,227.40 |
$23,227.40 |
$23,227.40 |
$2,718.10
|
|
Unlisted px leg/ankle
|
$13,652.80 |
$13,652.80 |
$13,652.80 |
$811.00
|
|
Unlisted px med radj physics
|
$1,124.20 |
$1,124.20 |
$1,124.20 |
$462.35
|
|
Unlisted px posterior segmnt
|
$8,799.70 |
$8,799.70 |
$8,799.70 |
$3,173.34
|
|
Unlisted px small intestine
|
$12,495.70 |
$12,495.70 |
$12,495.70 |
$2,102.10
|
|
Unlisted surgical path px
|
$81.20 |
$81.20 |
$81.20 |
$217.75
|
|
Unlisted ultrasound procedure
|
$105.00 |
$105.00 |
$105.00 |
$321.20
|
|
Unlisted urinalysis px
|
$114.10 |
$114.10 |
$114.10 |
$25.72
|
|
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)
|
$2,743.30 |
$2,743.30 |
$2,743.30 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$3,217.90 |
$3,217.90 |
$3,217.90 |
$1,768.00
|
|
Urea nitrogen
|
$58.80 |
$58.80 |
$58.80 |
$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
|
$53.20 |
$53.20 |
$53.20 |
$44.33
|
|
Urinalysis qual/semiquant excpt ia
|
$30.10 |
$30.10 |
$30.10 |
$25.72
|
|
Urinalysis (with microscopy)
|
$58.80 |
$58.80 |
$58.80 |
$55.00
|
|
Urinalysis (without microscopy)
|
$44.80 |
$44.80 |
$44.80 |
$35.75
|
|
Urine Culture Test
|
$91.70 |
$91.70 |
$91.70 |
$81.50
|
|
Urine pregnancy test
|
$84.00 |
$84.00 |
$84.00 |
$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
|
|
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 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
|
$84.00 |
$84.00 |
$84.00 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$440.30 |
$440.30 |
$440.30 |
$274.93
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$423.50 |
$423.50 |
$423.50 |
$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
|
$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
|
$242.90 |
$242.90 |
$242.90 |
$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
|
$314.30 |
$314.30 |
$314.30 |
$563.36
|
|
Vaccine tdap >=7 years im
|
$77.70 |
$77.70 |
$77.70 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$77.00 |
$77.00 |
$77.00 |
$112.10
|
|
Vaginal bx
|
$132.30 |
$132.30 |
$132.30 |
$455.94
|
|
Valproic acid total therapeutic drug level
|
$127.40 |
$127.40 |
$127.40 |
$114.72
|
|
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
|
$278.95 |
$278.95 |
$278.95 |
$251.86
|
|
Vancomycin peak therapeutic drug level
|
$154.70 |
$154.70 |
$154.70 |
$136.13
|
|
Varicella zoster antibody igg
|
$83.30 |
$83.30 |
$83.30 |
$86.80
|
|
Vasc emb/occ w/prs cath
|
$31,976.00 |
$31,976.00 |
$31,976.00 |
$21,009.00
|
|
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)
|
$816.90 |
$816.90 |
$816.90 |
$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 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
|
|
Ventricular puncture prev burr hole without inj 61020
|
$1,391.60 |
$1,391.60 |
$1,391.60 |
$1,314.30
|
|
Version cephalic external
|
$3,833.20 |
$3,833.20 |
$3,833.20 |
$2,361.75
|
|
Very long chain fatty acids
|
$149.10 |
$149.10 |
$149.10 |
$139.88
|
|
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
|
$49.70 |
$49.70 |
$49.70 |
$170.00
|
