|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,331.20 |
$1,331.20 |
$1,821.60 |
|
|
Upper Endoscopy (EGD, diagnostic)
|
$451.20 |
$451.20 |
$990.40 |
|
|
Upper Endoscopy (EGD, with biopsy)
|
$577.60 |
$577.60 |
$990.40 |
|
|
Urea nitrogen
|
$29.60 |
$29.60 |
$52.80 |
|
|
Urea nitrogen 24 hour urine
|
$69.60 |
$69.60 |
$73.60 |
|
|
Ureteral embolization/occl
|
$2,586.40 |
$2,586.40 |
$2,586.40 |
|
|
Ureter endoscopy & treatment
|
$579.20 |
$579.20 |
$579.20 |
|
|
Urethrcystgrphy rtrgrde s&i
|
$436.80 |
$436.80 |
$436.80 |
|
|
Urethrocystography void s&i
|
$602.40 |
$602.40 |
$957.60 |
|
|
Uric acid blood
|
$23.20 |
$23.20 |
$55.20 |
|
|
Uric acid urine
|
$42.40 |
$42.40 |
$42.40 |
|
|
Urinalysis microscopic only
|
$30.40 |
$30.40 |
$47.20 |
|
|
Urinalysis qual/semiquant excpt ia
|
$84.00 |
$84.00 |
$84.00 |
|
|
Urinalysis (with microscopy)
|
$32.80 |
$32.80 |
$57.60 |
|
|
Urinalysis (without microscopy)
|
$36.00 |
$36.00 |
$44.00 |
|
|
Urine Culture Test
|
$88.00 |
$88.00 |
$90.40 |
|
|
Urine flow measurement 51736
|
$20.80 |
$20.80 |
$20.80 |
|
|
Urine pregnancy test
|
$44.80 |
$44.80 |
$61.60 |
|
|
Urography, antegrade
|
$371.20 |
$371.20 |
$492.00 |
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$5,701.18 |
$5,701.18 |
$5,701.18 |
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$38,817.40 |
$38,817.40 |
$38,817.40 |
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$233.47 |
$233.47 |
$233.60 |
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$233.47 |
$233.47 |
$233.60 |
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$209.60 |
$209.60 |
$209.76 |
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$140.45 |
$140.45 |
$140.80 |
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$104.58 |
$104.58 |
$104.80 |
|
|
Vaccine dtap < 7 years im
|
$157.21 |
$157.21 |
$159.42 |
|
|
Vaccine dtap-hep b-ipv im
|
$88.00 |
$88.00 |
$88.00 |
|
|
Vaccine dtap-ipv 4-6 years im
|
$235.06 |
$235.06 |
$235.06 |
|
|
Vaccine dtap-ipv-hib-hepb im
|
$88.00 |
$88.00 |
$88.00 |
|
|
Vaccine dtap-ipv/hib im
|
$61.60 |
$61.60 |
$61.60 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$10.40 |
$10.40 |
$69.94 |
|
|
Vaccine hepatitis a (hepa) adult im
|
$390.65 |
$390.65 |
$391.94 |
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$24.80 |
$24.80 |
$24.80 |
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$40.00 |
$40.00 |
$40.00 |
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$16.00 |
$16.00 |
$16.00 |
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$152.80 |
$152.80 |
$218.40 |
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$218.40 |
$218.40 |
$218.40 |
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$55.20 |
$55.20 |
$55.20 |
|
|
Vaccine influenza inactivated adjuvant im
|
$339.74 |
$339.74 |
$339.74 |
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$13.60 |
$13.60 |
$13.60 |
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$18.40 |
$18.40 |
$18.40 |
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$59.20 |
$59.20 |
$59.20 |
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$163.34 |
$163.34 |
$163.34 |
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$147.20 |
$147.20 |
$558.18 |
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$96.00 |
$96.00 |
$96.00 |
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$96.00 |
$96.00 |
$620.07 |
|
|
Vaccine mmr live subcutaneous
|
$74.40 |
$74.40 |
$505.65 |
|
|
Vaccine mmrv live subcutaneous
|
$228.80 |
$228.80 |
$228.80 |
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$100.80 |
$100.80 |
$100.80 |
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$192.80 |
$192.80 |
$192.80 |
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$634.68 |
$634.68 |
$634.68 |
|
|
Vaccine polio (ipv) subcutaneous/im
|
$212.80 |
$212.80 |
$212.80 |
|
|
Vaccine rabies im
|
$1,683.17 |
$1,683.17 |
$1,683.17 |
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$376.00 |
$376.00 |
$376.00 |
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$376.00 |
$376.00 |
$376.00 |
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$72.00 |
$72.00 |
$72.00 |
|
|
Vaccine tdap >=7 years im
|
$220.49 |
$220.49 |
$220.49 |
|
|
Vaccine td preservative free >= 7 years im
|
$20.80 |
$20.80 |
$229.37 |
|
|
Vaccine typhoid vicps im
|
$80.80 |
$80.80 |
$80.80 |
|
|
Vaccine varicella live subcutaneous
|
$145.60 |
$145.60 |
$427.51 |
|
|
Vad battery clip set hmii 14-v li-ion
|
$1,164.24 |
$1,164.24 |
$1,164.24 |
|
|
Vad univ batt charger hm 1440
|
$9,953.28 |
$9,953.28 |
$9,953.28 |
|
|
Vag hys/<250g/rmv tube/rpr entero 58263
|
$1,468.00 |
$1,468.00 |
$1,468.00 |
|
|
Vag hyst incl t/o complex
|
$1,837.60 |
$1,837.60 |
$1,837.60 |
|
|
Vag hyst including t/o
|
$1,369.60 |
$1,369.60 |
$1,369.60 |
|
|
Vag hyst w/enterocele repair
|
$1,324.00 |
$1,324.00 |
$1,324.00 |
|
|
Vaginal bx
|
$256.80 |
$256.80 |
$256.80 |
|
|
Vaginal delivery after cesarean delivery 59612
|
$1,404.80 |
$1,404.80 |
$4,075.20 |
|
|
Vaginal Delivery (full care)
|
$2,908.80 |
$2,908.80 |
$2,908.80 |
|
|
Vaginal hysterectomy
|
$1,240.00 |
$1,240.00 |
$1,240.00 |
|
|
Valproic acid total therapeutic drug level
|
$100.80 |
$100.80 |
$160.80 |
|
|
Valvuloplasty aortic
|
$8,400.00 |
$8,400.00 |
$8,400.00 |
|
|
Valvuloplasty mitral
|
$8,593.60 |
$8,593.60 |
$8,593.60 |
|
|
Vancomycin 1,000 mg intravenous injection
|
$98.81 |
$98.81 |
$600.58 |
|
|
Vancomycin 750 mg intravenous solution
|
$151.28 |
$151.28 |
$151.28 |
|
|
Vancomycin peak therapeutic drug level
|
$57.60 |
$57.60 |
$188.80 |
|
|
Varicella zoster antibody igg
|
$68.80 |
$68.80 |
$68.80 |
|
|
Vasectomy
|
$496.80 |
$496.80 |
$496.80 |
|
|
Vasopressin 20 unit/ml intravenous solution
|
$192.10 |
$192.10 |
$421.83 |
|
|
Vbac delivery 59610
|
$3,066.40 |
$3,066.40 |
$3,066.40 |
|
|
Vbac/include postpartum care 59614
|
$1,681.60 |
$1,681.60 |
$1,681.60 |
|
|
Vedolizumab 300 mg intravenous solution
|
$24,950.38 |
$24,950.38 |
$24,950.38 |
|
|
Veeg cont 2-12 hrs
|
$1,261.60 |
$1,261.60 |
$1,261.60 |
|
|
Veeg intrmnt 2-12 hrs
|
$464.00 |
$464.00 |
$737.60 |
|
|
Veeg unmon 12-26 hrs
|
$888.80 |
$888.80 |
$1,353.60 |
|
|
Veeg unmon 2-12 hrs
|
$464.00 |
$464.00 |
$464.00 |
|
|
Vein x-ray adrenal gland
|
$6,074.40 |
$6,074.40 |
$6,074.40 |
|
|
Vein x-ray kidney
|
$1,282.40 |
$1,282.40 |
$1,282.40 |
|
|
Vein x-ray liver
|
$1,911.20 |
$1,911.20 |
$1,911.20 |
|
|
Vein x-ray liver w/hemodynam
|
$1,473.60 |
$1,473.60 |
$1,473.60 |
|
|
Vemp test i&r cervical
|
$192.00 |
$192.00 |
$192.00 |
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$32.00 |
$32.00 |
$825.60 |
|
|
Venipuncture <3 yrs other vein
|
$25.60 |
$25.60 |
$120.00 |
|
|
Venogram ext bil s&i
|
$1,180.00 |
$1,180.00 |
$1,180.00 |
|
|
Venogram extremity supervision & interpretation unilateral
|
$613.60 |
$613.60 |
$1,379.20 |
|
|
Venous mech thrombectomy
|
$7,040.00 |
$7,040.00 |
$7,040.00 |
|
|
Venous m-thrombectomy add-on
|
$3,152.80 |
$3,152.80 |
$3,152.80 |
|
|
Ventilator each subsequent day
|
$742.40 |
$742.40 |
$1,310.40 |
|
|
Ventilator initial day
|
$1,054.40 |
$1,054.40 |
$1,844.00 |
|