|
Upper Endoscopy (EGD, with biopsy)
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,656.60
|
|
Upper ext fx orthosis rad/ul
|
$45.15 |
$45.15 |
$45.15 |
$619.49
|
|
Uppr gi scope w/submuc inj
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,773.85
|
|
Urachal cyst/sinus excision 51500
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,082.67
|
|
Urea nitrogen
|
$4.35 |
$4.35 |
$4.35 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$6.12 |
$6.12 |
$6.12 |
$50.00
|
|
Urea nitrogen clearance
|
$7.92 |
$7.92 |
$7.92 |
$33.57
|
|
Urea nitrogen semi-quant
|
$5.64 |
$5.64 |
$5.64 |
$5.64
|
|
Ureteral reflux study
|
$213.23 |
$213.23 |
$213.23 |
$961.20
|
|
Ureter endoscopy
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,820.84
|
|
Ureter endoscopy & biopsy
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,626.86
|
|
Ureter endoscopy & biopsy
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,626.86
|
|
Ureter endoscopy & catheter
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,820.84
|
|
Ureter endoscopy & treatment
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,626.86
|
|
Ureter endoscopy & treatment
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,339.00
|
|
Ureter endoscopy & treatment
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,626.86
|
|
Ureter endoscopy & treatment
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,339.00
|
|
Urethrcystgrphy rtrgrde s&i
|
$108.36 |
$108.36 |
$108.36 |
$574.40
|
|
Urethrlys transvag with scope
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,081.37
|
|
Urethrocystography void s&i
|
$166.28 |
$166.28 |
$166.28 |
$634.50
|
|
Uric acid blood
|
$4.97 |
$4.97 |
$4.97 |
$46.64
|
|
Uric acid urine
|
$5.59 |
$5.59 |
$5.59 |
$46.75
|
|
Urinalysis glass test
|
$5.17 |
$5.17 |
$5.17 |
$5.17
|
|
Urinalysis microscopic only
|
$3.36 |
$3.36 |
$3.36 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$2.39 |
$2.39 |
$2.39 |
$25.72
|
|
Urinalysis (with microscopy)
|
$3.49 |
$3.49 |
$3.49 |
$48.14
|
|
Urinalysis (without microscopy)
|
$2.48 |
$2.48 |
$2.48 |
$38.99
|
|
Urinary reflex study
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$152.00
|
|
Urine Culture Test
|
$8.88 |
$8.88 |
$8.88 |
$84.81
|
|
Urine flow measurement 51736
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$152.54
|
|
Urine pregnancy test
|
$9.47 |
$9.47 |
$9.47 |
$66.40
|
|
Urine screen for bacteria
|
$32.98 |
$32.98 |
$32.98 |
$32.98
|
|
Urine specimen collect mult
|
$9.71 |
$9.71 |
$9.71 |
$12.89
|
|
Urography, antegrade
|
$219.17 |
$219.17 |
$219.17 |
$593.37
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$52.05 |
$52.05 |
$52.05 |
$223.08
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$51.46 |
$51.46 |
$51.46 |
$218.88
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$58.24 |
$58.24 |
$58.24 |
$239.85
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$34.76 |
$34.76 |
$34.76 |
$131.67
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$25.96 |
$25.96 |
$25.96 |
$91.00
|
|
Vaccine dtap-ipv-hib-hepb im
|
$56.97 |
$56.97 |
$56.97 |
$158.30
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$4.57 |
$4.57 |
$4.57 |
$45.33
|
|
Vaccine hepatitis a (hepa) adult im
|
$27.04 |
$27.04 |
$27.04 |
$178.07
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$11.34 |
$11.34 |
$11.34 |
$84.38
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$18.02 |
$18.02 |
$18.02 |
$173.98
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$6.63 |
$6.63 |
$6.63 |
$79.04
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$29.85 |
$29.85 |
$29.85 |
$157.41
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$6.45 |
$6.45 |
$6.45 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$7.58 |
$7.58 |
$7.58 |
$42.90
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$7.76 |
$7.76 |
$7.76 |
$40.01
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$24.66 |
$24.66 |
$24.66 |
$72.00
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$66.42 |
$66.42 |
$66.42 |
$499.00
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$48.65 |
$48.65 |
$48.65 |
$349.15
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$21.69 |
$21.69 |
$21.69 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$16.59 |
$16.59 |
$16.59 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$45.21 |
$45.21 |
$45.21 |
$274.95
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$85.85 |
$85.85 |
$85.85 |
$397.18
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$91.33 |
$91.33 |
$91.33 |
$385.45
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$97.67 |
$97.67 |
$97.67 |
$715.41
|
|
Vaccine rabies im
|
$143.55 |
$143.55 |
$143.55 |
$945.46
|
|
Vaccine rotavirus attenuated (rv1) live 2 dose oral
|
$42.37 |
$42.37 |
$42.37 |
$200.70
|
|
Vaccine tdap >=7 years im
|
$15.31 |
$15.31 |
$15.31 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$13.65 |
$13.65 |
$13.65 |
$131.77
|
|
Vag hys/<250g/rmv tube/rpr entero 58263
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,345.59
|
|
Vag hyst incl t/o complex
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,735.60
|
|
Vag hyst including t/o
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,110.00
|
|
Vag hyst t/o & repair compl
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$6,037.58
|
|
Vag hyst w/enterocele compl 58294
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,232.57
|
|
Vag hyst w/enterocele repair
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,355.90
|
|
Vaginal bx
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$441.75
|
|
Vaginal delivery after cesarean delivery 59612
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,109.28
|
|
Vaginal hysterectomy
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,463.96
|
|
Vaginectomy partial w/nodes
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$4,252.00
|
|
Valproic acid total therapeutic drug level
|
$14.89 |
$14.89 |
$14.89 |
$115.00
|
|
Vancomycin peak therapeutic drug level
|
$14.89 |
$14.89 |
$14.89 |
$126.79
|
|
Vanomycin dna amp probe
|
$38.60 |
$38.60 |
$38.60 |
$87.20
|
|
Varicella zoster antibody igg
|
$14.17 |
$14.17 |
$14.17 |
$82.55
|
|
Vasc graft into carpal bone
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$3,839.54
|
|
Vasectomy
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,424.12
|
|
Vein x-ray adrenal gland
|
$917.57 |
$917.57 |
$917.57 |
$2,489.25
|
|
Vein x-ray adrenal glands
|
$1,221.37 |
$1,221.37 |
$1,221.37 |
$3,999.60
|
|
Vein x-ray eye socket
|
$678.66 |
$678.66 |
$678.66 |
$1,128.41
|
|
Vein x-ray kidney
|
$737.23 |
$737.23 |
$737.23 |
$2,716.20
|
|
Vein x-ray liver
|
$610.17 |
$610.17 |
$610.17 |
$3,320.80
|
|
Vein x-ray liver w/hemodynam
|
$737.23 |
$737.23 |
$737.23 |
$3,413.25
|
|
Vein x-ray liver w/hemodynam
|
$607.33 |
$607.33 |
$607.33 |
$3,439.84
|
|
Vein x-ray liver without hemodyn
|
$607.33 |
$607.33 |
$607.33 |
$2,489.25
|
|
Vein x-ray skull
|
$607.33 |
$607.33 |
$607.33 |
$2,301.09
|
|
Vein x-ray skull epidural
|
$678.66 |
$678.66 |
$678.66 |
$1,344.60
|
|
Ven blood coll snf/hha
|
$11.91 |
$11.91 |
$11.91 |
$11.91
|
|
Venogram ext bil s&i
|
$332.56 |
$332.56 |
$332.56 |
$1,838.28
|
|
Venous mech thrombectomy
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$8,869.50
|
|
Venous m-thrombectomy add-on
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$5,352.00
|
|
Venous sampling s&i
|
$1,221.37 |
$1,221.37 |
$1,221.37 |
$4,416.78
|
|
Venous thrombosis imaging
|
$349.20 |
$349.20 |
$349.20 |
$636.97
|
|
Ven thrombosis images bilat
|
$366.61 |
$366.61 |
$366.61 |
$779.56
|
|
Ventilator each subsequent day
|
$277.60 |
$277.60 |
$277.60 |
$1,305.92
|
|
Ventilator initial day
|
$383.38 |
$383.38 |
$383.38 |
$1,540.80
|
|
Ventricular puncture prev burr hole without inj 61020
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$1,081.00
|
|
Version cephalic external
|
$4,627.00 |
$4,627.00 |
$4,627.00 |
$2,598.57
|
|
Very long chain fatty acids
|
$21.73 |
$21.73 |
$21.73 |
$140.40
|
