|
Ultrasound guide tissue ablation
|
$62.92 |
$114.40 |
$461.61 |
|
|
Ultrasound hips infant dynamic
|
$57.20 |
$104.00 |
$215.00 |
|
|
Ultrasound infant hips ltd without stress
|
$47.08 |
$118.40 |
$266.88 |
|
|
Ultrasound joint complete left
|
$105.60 |
$183.25 |
$219.15 |
|
|
Ultrasound joint/nonvascular extremity limited left
|
$105.60 |
$160.00 |
$281.25 |
|
|
Ultrasound ob >=14wks ea addl gest
|
$70.00 |
$129.58 |
$253.44 |
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$70.00 |
$91.75 |
$235.60 |
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$266.91 |
$427.56 |
$584.80 |
|
|
Ultrasound pregnant uterus follow up per fetus
|
$94.92 |
$174.24 |
$337.48 |
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$135.30 |
$228.69 |
$518.44 |
|
|
Ultrasound pregnant uterus transvaginal
|
$87.50 |
$180.78 |
$319.95 |
|
|
Ultrasound prostate/transrectal
|
$70.84 |
$193.60 |
$375.27 |
|
|
Ultrasound retroperitoneal limited
|
$134.64 |
$224.71 |
$379.60 |
|
|
Ultrasound scrotum and contents
|
$86.68 |
$170.94 |
$306.00 |
|
|
Ultrasound spinal canal and contents
|
$72.16 |
$118.91 |
$184.32 |
|
|
Ultrasound transabd ea addl gest
|
$119.00 |
$124.95 |
$148.75 |
|
|
Ultrasound transvaginal non obstetric
|
$125.40 |
$266.88 |
$375.27 |
|
|
Ultrasound trgt dyn mbubb 1st les
|
$95.00 |
$95.00 |
$95.00 |
|
|
Umbilical artery cath newborn 36660
|
$148.00 |
$196.65 |
$344.40 |
|
|
Unlisted chemotherapy px
|
$143.75 |
$150.00 |
$156.60 |
|
|
Unlisted dx gi procedure
|
$160.44 |
$160.44 |
$160.44 |
|
|
Unlisted fluoroscopic px
|
$70.80 |
$70.80 |
$70.80 |
|
|
Unlisted gi px dx nuc med
|
$538.20 |
$538.20 |
$538.20 |
|
|
Unlisted laparoscopic liver biopy 47379
|
$1,148.00 |
$1,148.00 |
$1,148.00 |
|
|
Unlisted maaa
|
$159.00 |
$182.85 |
$198.75 |
|
|
Unlisted mr procedure
|
$347.97 |
$381.11 |
$448.80 |
|
|
Unlisted muscskel px dx nuc
|
$2,047.40 |
$2,047.40 |
$2,686.25 |
|
|
Unlisted oph svc/procedure
|
$8.82 |
$8.82 |
$8.82 |
|
|
Unlisted procedure colon
|
$575.75 |
$575.75 |
$575.75 |
|
|
Unlisted procedure esophagus
|
$428.75 |
$428.75 |
$428.75 |
|
|
Unlisted procedure liver
|
$285.40 |
$285.40 |
$285.40 |
|
|
Unlisted procedure rectum
|
$235.60 |
$289.00 |
$509.85 |
|
|
Unlisted px ant segment eye
|
$641.00 |
$761.25 |
$1,386.90 |
|
|
Unlisted px casting/strpg
|
$44.88 |
$52.21 |
$93.60 |
|
|
Unlisted px leg/ankle
|
$59.52 |
$128.96 |
$153.00 |
|
|
Unlisted px male genital sys
|
$76.40 |
$90.00 |
$387.84 |
|
|
Unlisted px med radj physics
|
$110.00 |
$110.00 |
$110.00 |
|
|
Unlisted px palate uvula
|
$128.00 |
$154.80 |
$327.60 |
|
|
Unlisted px pelvis/hip joint
|
$1,752.00 |
$1,752.00 |
$1,752.00 |
|
|
Unlisted px salivry glnd/dux
|
$572.40 |
$715.50 |
$1,488.24 |
|
|
Unlisted px small intestine
|
$1,479.50 |
$1,479.50 |
$1,479.50 |
|
|
Unlisted px tongue flr mouth
|
$68.64 |
$123.00 |
$144.80 |
|
|
Unsched dialysis esrd pt hos
|
$96.76 |
$315.50 |
$704.00 |
|
|
Upgrade pm system
|
$6,288.66 |
$9,526.50 |
$11,283.80 |
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$358.82 |
$1,388.74 |
$2,834.00 |
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$817.00 |
$1,318.36 |
$1,505.25 |
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$263.12 |
$992.68 |
$1,427.28 |
|
|
Upper Endoscopy (EGD, diagnostic)
|
$190.60 |
$190.60 |
$190.60 |
|
|
Upper Endoscopy (EGD, with biopsy)
|
$501.12 |
$501.12 |
$501.12 |
|
|
Urea nitrogen
|
$23.37 |
$34.23 |
$54.40 |
|
|
Urea nitrogen 24 hour urine
|
$11.44 |
$36.34 |
$109.60 |
|
|
Urea nitrogen clearance
|
$11.04 |
$32.40 |
$37.26 |
|
|
Ureteral embolization/occl
|
$187.95 |
$375.00 |
$468.75 |
|
|
Urethrcystgrphy rtrgrde s&i
|
$137.50 |
$179.20 |
$297.28 |
|
|
Urethrocystography void s&i
|
$118.80 |
$187.53 |
$297.28 |
|
|
Uric acid blood
|
$4.18 |
$31.74 |
$48.60 |
|
|
Uric acid urine
|
$23.68 |
$41.28 |
$166.40 |
|
|
Urinalysis glass test
|
$5.28 |
$5.28 |
$8.51 |
|
|
Urinalysis microscopic only
|
$2.64 |
$4.80 |
$44.10 |
|
|
Urinalysis qual/semiquant excpt ia
|
$1.60 |
$1.92 |
$4.16 |
|
|
Urinalysis (with microscopy)
|
$2.30 |
$28.35 |
$55.44 |
|
|
Urinalysis (without microscopy)
|
$1.98 |
$31.40 |
$43.20 |
|
|
Urine Culture Test
|
$7.26 |
$48.00 |
$77.04 |
|
|
Urine flow measurement 51736
|
$284.34 |
$284.34 |
$284.34 |
|
|
Urine pregnancy test
|
$6.38 |
$29.12 |
$66.60 |
|
|
Urography, antegrade
|
$271.40 |
$379.04 |
$438.25 |
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$465.45 |
$465.45 |
$465.45 |
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$491.51 |
$491.51 |
$491.51 |
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$261.06 |
$261.06 |
$261.06 |
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$98.90 |
$98.90 |
$98.90 |
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$14.14 |
$16.26 |
$28.00 |
|
|
Vaccine influenza nos 0.5ml dose im
|
$277.89 |
$277.89 |
$277.89 |
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$77.01 |
$77.01 |
$77.01 |
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$3.66 |
$4.21 |
$4.58 |
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$574.10 |
$574.10 |
$574.10 |
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$427.14 |
$427.14 |
$427.14 |
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$939.84 |
$939.84 |
$939.84 |
|
|
Vaccine rabies im
|
$1,296.96 |
$1,296.96 |
$1,296.96 |
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$1,588.69 |
$1,588.69 |
$1,588.69 |
|
|
Vaccine varicella live subcutaneous
|
$629.64 |
$629.64 |
$629.64 |
|
|
Vaginal bx
|
$46.08 |
$62.10 |
$116.10 |
|
|
Vaginal delivery after cesarean delivery 59612
|
$1,613.40 |
$1,882.80 |
$3,526.20 |
|
|
Vaginal Delivery (full care)
|
$2,300.00 |
$2,300.00 |
$2,300.00 |
|
|
Valproic acid total therapeutic drug level
|
$32.76 |
$67.20 |
$129.25 |
|
|
Valrubicin injection
|
$817.53 |
$1,021.91 |
$3,270.12 |
|
|
Valvuloplasty aortic
|
$3,192.84 |
$4,311.80 |
$5,206.28 |
|
|
Valvuloplasty mitral
|
$2,722.65 |
$2,722.65 |
$2,722.65 |
|
|
Vancomycin hcl injection
|
$301.37 |
$361.64 |
$1,205.47 |
|
|
Vancomycin peak therapeutic drug level
|
$33.28 |
$65.60 |
$129.25 |
|
|
Varicella zoster antibody igg
|
$26.88 |
$73.44 |
$121.50 |
|
|
Vasectomy
|
$659.34 |
$659.34 |
$1,198.80 |
|
|
Vasopressin 20 unit/ml intravenous solution
|
$955.39 |
$1,194.24 |
$3,821.58 |
|
|
Vedolizumab 300 mg intravenous solution
|
$21,631.78 |
$21,631.78 |
$21,631.78 |
|
|
Veeg cont 2-12 hrs
|
$326.20 |
$326.20 |
$332.64 |
|
|
Veeg ea 12-26hr cont mntr
|
$610.40 |
$610.40 |
$622.44 |
|
|
Veeg intrmnt 2-12 hrs
|
$170.00 |
$170.00 |
$173.46 |
|
|
Veeg unmon 12-26 hrs
|
$326.20 |
$326.20 |
$332.64 |
|
|
Veeg unmon 2-12 hrs
|
$170.00 |
$170.00 |
$173.46 |
|
|
Vein x-ray adrenal gland
|
$2,047.00 |
$2,047.00 |
$2,047.00 |
|
|
Vein x-ray adrenal glands
|
$2,047.00 |
$2,047.00 |
$2,047.00 |
|
