|
Ultrasound chest
|
$213.44 |
$213.44 |
$275.50 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$82.80 |
$82.80 |
$90.00 |
$338.00
|
|
Ultrasound encephalogram
|
$396.50 |
$396.50 |
$396.50 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$877.00 |
$877.00 |
$877.00 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$143.52 |
$143.52 |
$194.50 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$525.32 |
$525.32 |
$527.50 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$538.00 |
$538.00 |
$546.02 |
$720.15
|
|
Ultrasound guide intraoperative
|
$304.52 |
$304.52 |
$331.00 |
$632.85
|
|
Ultrasound hips infant dynamic
|
$299.50 |
$299.50 |
$299.50 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$312.00 |
$312.00 |
$312.00 |
$311.25
|
|
Ultrasound joint complete left
|
$443.50 |
$443.50 |
$451.26 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$330.28 |
$330.28 |
$366.50 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$149.50 |
$149.50 |
$202.50 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$518.50 |
$518.50 |
$518.50 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$288.42 |
$288.42 |
$322.50 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$182.62 |
$182.62 |
$297.50 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$132.94 |
$132.94 |
$158.00 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$155.02 |
$155.02 |
$451.00 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$370.00 |
$370.00 |
$370.00 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$302.22 |
$302.22 |
$378.50 |
$486.50
|
|
Ultrasound scrotum and contents
|
$439.76 |
$439.76 |
$508.50 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$343.50 |
$343.50 |
$343.50 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$327.52 |
$327.52 |
$364.00 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$414.92 |
$414.92 |
$467.50 |
$558.35
|
|
Umbilical artery cath newborn 36660
|
$104.42 |
$104.42 |
$214.00 |
$206.64
|
|
Unlisted fluoroscopic px
|
$764.00 |
$764.00 |
$764.00 |
$305.76
|
|
Unlisted procedure microbiology
|
$13.50 |
$13.50 |
$13.50 |
$523.50
|
|
Unlisted procedure rectum
|
$746.00 |
$746.00 |
$746.00 |
$1,220.35
|
|
Unlisted px biliary tract
|
$1,323.50 |
$1,323.50 |
$1,323.50 |
$2,718.10
|
|
Unlisted px foot/toes
|
$1,547.00 |
$1,547.00 |
$1,547.00 |
$1,225.50
|
|
Unlisted px hands/fingers
|
$1,430.50 |
$1,430.50 |
$1,430.50 |
$354.20
|
|
Unlisted px leg/ankle
|
$2,379.00 |
$2,379.00 |
$2,379.00 |
$811.00
|
|
Unlisted transfusion med px
|
$55.66 |
$55.66 |
$55.66 |
$147.50
|
|
Unlisted ultrasound procedure
|
$312.50 |
$312.50 |
$312.50 |
$321.20
|
|
Unlisted urinalysis px
|
$26.50 |
$26.50 |
$26.50 |
$25.72
|
|
Unsched dialysis esrd pt hos
|
$675.00 |
$675.00 |
$675.00 |
$1,268.17
|
|
Upgrade pm system
|
$5,329.10 |
$5,329.10 |
$5,329.10 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,071.00 |
$2,071.00 |
$2,071.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,864.00 |
$1,864.00 |
$1,864.00 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,843.00 |
$1,843.00 |
$1,843.00 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,058.50 |
$1,058.50 |
$1,058.50 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,575.50 |
$1,575.50 |
$1,575.50 |
$1,768.00
|
|
Urea nitrogen
|
$17.94 |
$17.94 |
$27.50 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$13.80 |
$13.80 |
$42.50 |
$51.75
|
|
Ureteral reflux study
|
$1,403.50 |
$1,403.50 |
$1,403.50 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$568.00 |
$568.00 |
$568.00 |
$579.73
|
|
Urethrocystography void s&i
|
$579.00 |
$579.00 |
$579.00 |
$622.35
|
|
Uric acid blood
|
$16.10 |
$16.10 |
$60.50 |
$48.75
|
|
Uric acid urine
|
$25.00 |
$25.00 |
$38.18 |
$44.33
|
|
Urinalysis microscopic only
|
$9.66 |
$9.66 |
$47.50 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$24.00 |
$24.00 |
$24.00 |
$25.72
|
|
Urinalysis (with microscopy)
|
$19.32 |
$19.32 |
$70.50 |
$55.00
|
|
Urinalysis (without microscopy)
|
$20.24 |
$20.24 |
$36.50 |
$35.75
|
|
Urine Culture Test
|
$35.42 |
$35.42 |
$77.50 |
$81.50
|
|
Urine pregnancy test
|
$44.62 |
$44.62 |
$73.00 |
$67.20
|
|
Urography, antegrade
|
$476.50 |
$476.50 |
$476.50 |
$622.35
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$35.80 |
$35.80 |
$38.92 |
$5,184.34
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$12,940.35 |
$12,940.35 |
$14,065.59 |
$51,633.07
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$171.12 |
$171.12 |
$186.00 |
$236.50
|
|
Vaccine dtap < 7 years im
|
$26.04 |
$26.04 |
$28.31 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$60.44 |
$60.44 |
$65.70 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$44.31 |
$44.31 |
$48.16 |
$105.95
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$25.85 |
$25.85 |
$28.10 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$5.86 |
$5.86 |
$6.37 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$31.32 |
$31.32 |
$34.05 |
$166.62
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$25.72 |
$25.72 |
$27.96 |
$79.15
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$20.98 |
$20.98 |
$22.80 |
$155.16
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$19.50 |
$19.50 |
$21.19 |
$75.39
|
|
Vaccine influenza inactivated adjuvant im
|
$59.08 |
$59.08 |
$64.22 |
$109.50
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$13.85 |
$13.85 |
$15.05 |
$47.88
|
|
Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im
|
$47.34 |
$47.34 |
$51.45 |
$72.80
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$14.76 |
$14.76 |
$16.04 |
$33.60
|
|
Vaccine influenza quadrivalent live (laiv4) intranasal
|
$11.27 |
$11.27 |
$12.25 |
$37.05
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$23.66 |
$23.66 |
$25.72 |
$76.50
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$153.63 |
$153.63 |
$166.99 |
$400.03
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$51.06 |
$51.06 |
$55.50 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$119.85 |
$119.85 |
$130.27 |
$211.68
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$103.94 |
$103.94 |
$112.98 |
$251.64
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$178.00 |
$178.00 |
$193.47 |
$397.11
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$215.10 |
$215.10 |
$233.80 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$37.74 |
$37.74 |
$41.02 |
$90.70
|
|
Vaccine rabies im
|
$151.02 |
$151.02 |
$164.15 |
$858.95
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$483.86 |
$483.86 |
$525.94 |
$1,104.47
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$241.93 |
$241.93 |
$262.97 |
$997.44
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$18.68 |
$18.68 |
$20.30 |
$126.14
|
|
Vaccine tdap >=7 years im
|
$43.70 |
$43.70 |
$47.50 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$35.83 |
$35.83 |
$38.94 |
$112.10
|
|
Vaccine varicella live subcutaneous
|
$79.99 |
$79.99 |
$86.95 |
$365.17
|
|
Vacuum drain bottle/tube kit
|
$91.80 |
$91.80 |
$91.80 |
$325.20
|
|
Valproic acid total therapeutic drug level
|
$91.08 |
$91.08 |
$144.50 |
$114.72
|
|
Valrubicin injection
|
$153.72 |
$153.72 |
$167.08 |
$2,813.49
|
|
Valvuloplasty aortic
|
$2,390.16 |
$2,390.16 |
$2,598.00 |
$7,830.80
|
|
Valvuloplasty mitral
|
$4,371.84 |
$4,371.84 |
$4,752.00 |
$10,877.90
|
|
Valvuloplasty pulmonary
|
$4,871.00 |
$4,871.00 |
$5,367.28 |
$11,945.20
|
|
Vancomycin hcl injection
|
$0.86 |
$0.86 |
$0.93 |
$154.40
|
|
Vancomycin peak therapeutic drug level
|
$57.04 |
$57.04 |
$184.50 |
$136.13
|
|
Varicella zoster antibody igg
|
$53.36 |
$53.36 |
$74.00 |
$86.80
|
|
Vasopressin 20 unit/ml intravenous solution
|
$38.39 |
$38.39 |
$41.73 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$4,305.56 |
$4,305.56 |
$4,679.96 |
$18,732.33
|
|
Veeg cont 2-12 hrs
|
$413.54 |
$413.54 |
$421.00 |
$1,540.00
|
