|
Ultrasound prostate/transrectal
|
$302.40 |
$302.40 |
$302.40 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$317.52 |
$317.52 |
$317.52 |
$486.50
|
|
Ultrasound scrotum and contents
|
$416.22 |
$416.22 |
$416.22 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$290.64 |
$290.64 |
$290.64 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$408.24 |
$408.24 |
$408.24 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$416.64 |
$416.64 |
$416.64 |
$558.35
|
|
Umbilical artery cath newborn 36660
|
$168.42 |
$168.42 |
$168.42 |
$206.64
|
|
Unlisted dx gi procedure
|
$1,598.52 |
$1,598.52 |
$1,598.52 |
$649.22
|
|
Unlisted fluoroscopic px
|
$285.60 |
$285.60 |
$285.60 |
$305.76
|
|
Unlisted mr procedure
|
$67.20 |
$67.20 |
$67.20 |
$1,163.00
|
|
Unlisted orl service/px
|
$40.32 |
$40.32 |
$40.32 |
$132.60
|
|
Unlisted procedure liver
|
$371.70 |
$371.70 |
$371.70 |
$2,287.20
|
|
Unlisted px biliary tract
|
$599.76 |
$599.76 |
$599.76 |
$2,718.10
|
|
Unlisted px casting/strpg
|
$147.00 |
$147.00 |
$147.00 |
$219.70
|
|
Unlisted px external ear
|
$158.34 |
$158.34 |
$158.34 |
$325.68
|
|
Unlisted px foot/toes
|
$1,797.60 |
$1,797.60 |
$1,797.60 |
$1,225.50
|
|
Unlisted px hands/fingers
|
$213.36 |
$213.36 |
$213.36 |
$354.20
|
|
Unlisted px leg/ankle
|
$1,528.38 |
$1,528.38 |
$1,528.38 |
$811.00
|
|
Unlisted px male genital sys
|
$157.92 |
$157.92 |
$157.92 |
$343.55
|
|
Unlisted px small intestine
|
$2,102.10 |
$2,102.10 |
$2,102.10 |
$2,102.10
|
|
Unlisted transfusion med px
|
$63.84 |
$63.84 |
$63.84 |
$147.50
|
|
Unlisted ultrasound procedure
|
$189.42 |
$189.42 |
$189.42 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$468.72 |
$468.72 |
$468.72 |
$1,268.17
|
|
Upgrade pm system
|
$10,574.76 |
$10,574.76 |
$10,574.76 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,748.88 |
$1,748.88 |
$1,748.88 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,577.10 |
$1,577.10 |
$1,577.10 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,561.56 |
$1,561.56 |
$1,561.56 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$643.02 |
$643.02 |
$643.02 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,924.86 |
$1,924.86 |
$1,924.86 |
$1,768.00
|
|
Urea nitrogen
|
$39.90 |
$39.90 |
$39.90 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$36.96 |
$36.96 |
$36.96 |
$51.75
|
|
Urethrcystgrphy rtrgrde s&i
|
$476.70 |
$476.70 |
$476.70 |
$579.73
|
|
Urethrocystography void s&i
|
$471.66 |
$471.66 |
$471.66 |
$622.35
|
|
Uric acid blood
|
$52.92 |
$52.92 |
$52.92 |
$48.75
|
|
Uric acid urine
|
$39.90 |
$39.90 |
$39.90 |
$44.33
|
|
Urinalysis microscopic only
|
$44.10 |
$44.10 |
$44.10 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$29.40 |
$29.40 |
$29.40 |
$25.72
|
|
Urinalysis (with microscopy)
|
$61.32 |
$61.32 |
$61.32 |
$55.00
|
|
Urinalysis (without microscopy)
|
$34.02 |
$34.02 |
$34.02 |
$35.75
|
|
Urine Culture Test
|
$71.82 |
$71.82 |
$71.82 |
$81.50
|
|
Urine pregnancy test
|
$63.42 |
$63.42 |
$63.42 |
$67.20
|
|
Urography, antegrade
|
$485.94 |
$485.94 |
$485.94 |
$622.35
|
|
Use 1st target lesion
|
$113.82 |
$113.82 |
$113.82 |
$332.00
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$4,249.30 |
$4,249.30 |
$4,249.30 |
$5,184.34
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$29,537.74 |
$29,537.74 |
$29,537.74 |
$51,633.07
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$234.36 |
$234.36 |
$234.36 |
$236.50
|
|
Vaccine dtap < 7 years im
|
$109.47 |
$109.47 |
$109.47 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$137.96 |
$137.96 |
$137.96 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$101.14 |
$101.14 |
$101.14 |
$105.95
|
|
Vaccine dtap-ipv/hib im
|
$118.52 |
$118.52 |
$118.52 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$59.01 |
$59.01 |
$59.01 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$118.52 |
$118.52 |
$118.52 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$142.98 |
$142.98 |
$142.98 |
$166.62
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$58.71 |
$58.71 |
$58.71 |
$79.15
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$95.75 |
$95.75 |
$95.75 |
$155.16
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$77.44 |
$77.44 |
$77.44 |
$75.39
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$31.50 |
$31.50 |
$31.50 |
$143.20
|
|
Vaccine influenza inactivated adjuvant im
|
$37.80 |
$37.80 |
$37.80 |
$109.50
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$18.90 |
$18.90 |
$18.90 |
$47.88
|
|
Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im
|
$32.34 |
$32.34 |
$32.34 |
$72.80
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$17.64 |
$17.64 |
$17.64 |
$33.60
|
|
Vaccine influenza quadrivalent live (laiv4) intranasal
|
$17.64 |
$17.64 |
$17.64 |
$37.05
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$18.90 |
$18.90 |
$18.90 |
$76.50
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$350.68 |
$350.68 |
$350.68 |
$400.03
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$263.34 |
$263.34 |
$263.34 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$547.12 |
$547.12 |
$547.12 |
$211.68
|
|
Vaccine mmrv live subcutaneous
|
$336.42 |
$336.42 |
$336.42 |
$424.32
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$237.26 |
$237.26 |
$237.26 |
$251.64
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$406.29 |
$406.29 |
$406.29 |
$397.11
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$490.98 |
$490.98 |
$490.98 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$861.32 |
$861.32 |
$861.32 |
$90.70
|
|
Vaccine rabies im
|
$689.41 |
$689.41 |
$689.41 |
$858.95
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$1,104.47 |
$1,104.47 |
$1,104.47 |
$1,104.47
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$1,104.47 |
$1,104.47 |
$1,104.47 |
$997.44
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$170.50 |
$170.50 |
$170.50 |
$126.14
|
|
Vaccine tdap >=7 years im
|
$99.75 |
$99.75 |
$99.75 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$81.77 |
$81.77 |
$81.77 |
$112.10
|
|
Vaccine varicella live subcutaneous
|
$365.17 |
$365.17 |
$365.17 |
$365.17
|
|
Vacuum drain bottle/tube kit
|
$39.54 |
$39.54 |
$39.54 |
$325.20
|
|
Vaginal bx
|
$13.02 |
$13.02 |
$13.02 |
$455.94
|
|
Valproic acid total therapeutic drug level
|
$127.26 |
$127.26 |
$127.26 |
$114.72
|
|
Valrubicin injection
|
$3,508.68 |
$3,508.68 |
$3,508.68 |
$2,813.49
|
|
Valvuloplasty aortic
|
$3,353.28 |
$3,353.28 |
$3,353.28 |
$7,830.80
|
|
Valvuloplasty aortic valve
|
$3,378.48 |
$3,378.48 |
$3,378.48 |
$5,068.00
|
|
Valvuloplasty mitral
|
$5,898.48 |
$5,898.48 |
$5,898.48 |
$10,877.90
|
|
Valvuloplasty pulmonary
|
$5,115.60 |
$5,115.60 |
$5,115.60 |
$11,945.20
|
|
Vancomycin hcl injection
|
$41.79 |
$41.79 |
$41.79 |
$154.40
|
|
Vancomycin peak therapeutic drug level
|
$160.86 |
$160.86 |
$160.86 |
$136.13
|
|
Varicella zoster antibody igg
|
$65.52 |
$65.52 |
$65.52 |
$86.80
|
|
Varicella-zoster immue globin im
|
$3,974.34 |
$3,974.34 |
$3,974.34 |
$3,816.19
|
|
Vasopressin 20 unit/ml intravenous solution
|
$260.90 |
$260.90 |
$260.90 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$19,655.82 |
$19,655.82 |
$19,655.82 |
$18,732.33
|
|
Veeg cont 2-12 hrs
|
$433.86 |
$433.86 |
$433.86 |
$1,540.00
|
|
Veeg ea 12-26hr cont mntr
|
$660.24 |
$660.24 |
$660.24 |
$3,225.60
|
|
Veeg intrmnt 2-12 hrs
|
$1,546.44 |
$1,546.44 |
$1,546.44 |
$961.00
|
|
Vein x-ray adrenal gland
|
$1,631.70 |
$1,631.70 |
$1,631.70 |
$2,845.80
|
|
Vein x-ray adrenal glands
|
$1,175.16 |
$1,175.16 |
$1,175.16 |
$3,935.00
|
|
Vein x-ray kidney
|
$1,391.88 |
$1,391.88 |
$1,391.88 |
$2,766.73
|
|
Vein x-ray liver
|
$1,843.38 |
$1,843.38 |
$1,843.38 |
$3,305.50
|
|
Vein x-ray liver w/hemodynam
|
$1,843.38 |
$1,843.38 |
$1,843.38 |
$3,486.86
|
