|
Unlisted procedure larynx
|
$4,133.25 |
$4,133.25 |
$4,133.25 |
$924.00
|
|
Unlisted procedure liver
|
$2,802.00 |
$2,802.00 |
$2,802.00 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$277.50 |
$277.50 |
$277.50 |
$530.00
|
|
Unlisted procedure rectum
|
$882.75 |
$882.75 |
$882.75 |
$1,223.20
|
|
Unlisted px abdomen muscskel
|
$1,520.25 |
$1,520.25 |
$1,520.25 |
$1,956.50
|
|
Unlisted px casting/strpg
|
$316.50 |
$316.50 |
$316.50 |
$222.00
|
|
Unlisted px tongue flr mouth
|
$1,627.50 |
$1,627.50 |
$1,627.50 |
$282.50
|
|
Unlisted ultrasound procedure
|
$460.50 |
$460.50 |
$460.50 |
$335.00
|
|
Upgrade pm system
|
$7,818.75 |
$7,818.75 |
$7,818.75 |
$12,077.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$236.25 |
$236.25 |
$236.25 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$1,293.00 |
$1,293.00 |
$1,293.00 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$944.25 |
$944.25 |
$944.25 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,919.75 |
$2,919.75 |
$2,919.75 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,994.00 |
$2,994.00 |
$2,994.00 |
$2,392.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,847.75 |
$2,847.75 |
$2,847.75 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$306.75 |
$306.75 |
$306.75 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$307.50 |
$307.50 |
$307.50 |
$381.60
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,857.75 |
$1,857.75 |
$1,857.75 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$2,078.25 |
$2,078.25 |
$2,078.25 |
$1,768.00
|
|
Upper GI Barium X-ray (barium and gas)
|
$589.50 |
$589.50 |
$589.50 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$488.25 |
$488.25 |
$488.25 |
$607.20
|
|
Uppr gi scope w/submuc inj
|
$1,764.00 |
$1,764.00 |
$1,764.00 |
$1,872.00
|
|
Urea nitrogen
|
$38.25 |
$38.25 |
$38.25 |
$42.01
|
|
Urea nitrogen 24 hour urine
|
$39.75 |
$39.75 |
$39.75 |
$51.84
|
|
Urea nitrogen clearance
|
$57.00 |
$57.00 |
$57.00 |
$34.02
|
|
Ureteral reflux study
|
$609.00 |
$609.00 |
$609.00 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$613.50 |
$613.50 |
$613.50 |
$584.00
|
|
Urethrocystography void s&i
|
$634.50 |
$634.50 |
$634.50 |
$634.50
|
|
Uric acid blood
|
$41.25 |
$41.25 |
$41.25 |
$49.32
|
|
Uric acid urine
|
$35.25 |
$35.25 |
$35.25 |
$44.52
|
|
Urinalysis (with microscopy)
|
$27.00 |
$27.00 |
$27.00 |
$55.20
|
|
Urinalysis (without microscopy)
|
$49.50 |
$49.50 |
$49.50 |
$35.91
|
|
Urine Culture Test
|
$65.25 |
$65.25 |
$65.25 |
$82.32
|
|
Urine pregnancy test
|
$41.25 |
$41.25 |
$41.25 |
$68.21
|
|
Urography, antegrade
|
$780.00 |
$780.00 |
$780.00 |
$622.35
|
|
Use 1st target lesion
|
$151.50 |
$151.50 |
$151.50 |
$332.00
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$8,225.22 |
$8,225.22 |
$8,225.22 |
$5,205.00
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$109,781.59 |
$109,781.59 |
$109,781.59 |
$51,633.07
|
|
Vaccine Administration (one shot)
|
$36.75 |
$36.75 |
$36.75 |
$67.74
|
|
Vaccine dtap < 7 years im
|
$62.25 |
$62.25 |
$62.25 |
$71.17
|
|
Vaccine dtap-hep b-ipv im
|
$233.91 |
$233.91 |
$233.91 |
$164.63
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$99.92 |
$99.92 |
$99.92 |
$70.53
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$45.33 |
$45.33 |
$45.33 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$241.96 |
$241.96 |
$241.96 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$354.74 |
$354.74 |
$354.74 |
$231.56
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$100.79 |
$100.79 |
$100.79 |
$78.25
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$54.75 |
$54.75 |
$54.75 |
$90.35
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$162.07 |
$162.07 |
$162.07 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$118.50 |
$118.50 |
$118.50 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$75.39 |
$75.39 |
$75.39 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$1,044.16 |
$1,044.16 |
$1,044.16 |
$576.48
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$67.50 |
$67.50 |
$67.50 |
$149.21
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$45.75 |
$45.75 |
$45.75 |
$48.59
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$25.50 |
$25.50 |
$25.50 |
$33.60
|
|
Vaccine influenza quadrivalent live (laiv4) intranasal
|
$72.75 |
$72.75 |
$72.75 |
$37.05
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$50.25 |
$50.25 |
$50.25 |
$72.00
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$63.00 |
$63.00 |
$63.00 |
$82.71
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$569.67 |
$569.67 |
$569.67 |
$394.26
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$545.45 |
$545.45 |
$545.45 |
$327.37
|
|
Vaccine mmr live subcutaneous
|
$311.03 |
$311.03 |
$311.03 |
$213.00
|
|
Vaccine mmrv live subcutaneous
|
$957.30 |
$957.30 |
$957.30 |
$424.32
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$401.34 |
$401.34 |
$401.34 |
$252.87
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$793.01 |
$793.01 |
$793.01 |
$393.25
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$239.25 |
$239.25 |
$239.25 |
$414.46
|
|
Vaccine polio (ipv) subcutaneous/im
|
$1,529.59 |
$1,529.59 |
$1,529.59 |
$90.70
|
|
Vaccine rabies im
|
$1,514.28 |
$1,514.28 |
$1,514.28 |
$858.95
|
|
Vaccine rotavirus attenuated (rv1) live 2 dose oral
|
$372.30 |
$372.30 |
$372.30 |
$200.70
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$291.89 |
$291.89 |
$291.89 |
$126.14
|
|
Vaccine tdap >=7 years im
|
$131.22 |
$131.22 |
$131.22 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$145.19 |
$145.19 |
$145.19 |
$112.10
|
|
Vaccine varicella live subcutaneous
|
$642.96 |
$642.96 |
$642.96 |
$365.17
|
|
Vaccine yellow fever live subcutaneous
|
$632.19 |
$632.19 |
$632.19 |
$418.46
|
|
Vacuum drain bottle/tube kit
|
$33.75 |
$33.75 |
$33.75 |
$325.20
|
|
Vad battery clip set hmii 14-v li-ion
|
$2,592.00 |
$2,592.00 |
$2,592.00 |
$1,932.00
|
|
Vad univ batt charger hm 1440
|
$16,971.75 |
$16,971.75 |
$16,971.75 |
$14,814.14
|
|
Vaginal bx
|
$192.00 |
$192.00 |
$192.00 |
$459.42
|
|
Valproate in ns IV syringe 10 mg/ml (pediatric) - cnr
|
$22.29 |
$22.29 |
$22.29 |
$24.12
|
|
Valproic acid total therapeutic drug level
|
$117.00 |
$117.00 |
$117.00 |
$115.00
|
|
Valrubicin injection
|
$6,841.31 |
$6,841.31 |
$6,841.31 |
$2,813.49
|
|
Valvuloplasty pulmonary
|
$12,754.50 |
$12,754.50 |
$12,754.50 |
$11,945.20
|
|
Vancomycin 1,000 mg intravenous injection
|
$366.03 |
$366.03 |
$366.03 |
$251.86
|
|
Vancomycin 750 mg intravenous solution
|
$303.13 |
$303.13 |
$303.13 |
$90.33
|
|
Vancomycin peak therapeutic drug level
|
$110.25 |
$110.25 |
$110.25 |
$135.60
|
|
Varicella zoster antibody igg
|
$99.00 |
$99.00 |
$99.00 |
$86.80
|
|
Varicella-zoster immue globin im
|
$8,070.06 |
$8,070.06 |
$8,070.06 |
$3,816.19
|
|
Vasc emb/occ w/prs cath
|
$17,508.00 |
$17,508.00 |
$17,508.00 |
$21,009.00
|
|
Vasopressin 20 unit/ml intravenous solution
|
$103.53 |
$103.53 |
$103.53 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$34,608.27 |
$34,608.27 |
$34,608.27 |
$18,732.33
|
|
Veeg cont 2-12 hrs
|
$2,361.75 |
$2,361.75 |
$2,361.75 |
$1,540.00
|
|
Veeg ea 12-26hr cont mntr
|
$4,640.25 |
$4,640.25 |
$4,640.25 |
$3,225.60
|
|
Veeg intrmnt 2-12 hrs
|
$1,329.00 |
$1,329.00 |
$1,329.00 |
$994.91
|
|
Veeg unmon 12-26 hrs
|
$1,527.75 |
$1,527.75 |
$1,527.75 |
$1,737.12
|
|
Veeg unmon 2-12 hrs
|
$728.25 |
$728.25 |
$728.25 |
$826.15
|
|
Vein x-ray adrenal gland
|
$3,696.00 |
$3,696.00 |
$3,696.00 |
$2,833.34
|
|
Vein x-ray eye socket
|
$1,141.50 |
$1,141.50 |
$1,141.50 |
$1,438.32
|
|
Vein x-ray kidney
|
$1,925.25 |
$1,925.25 |
$1,925.25 |
$2,870.00
|
|
Vein x-ray liver
|
$2,163.75 |
$2,163.75 |
$2,163.75 |
$3,312.00
|
|
Vein x-ray liver w/hemodynam
|
$2,943.75 |
$2,943.75 |
$2,943.75 |
$3,619.84
|
|
Vein x-ray liver w/hemodynam
|
$3,125.25 |
$3,125.25 |
$3,125.25 |
$3,683.90
|
|
Vein x-ray liver without hemodyn
|
$3,975.00 |
$3,975.00 |
$3,975.00 |
$2,452.80
|
