|
Ultrasound guide tissue ablation
|
$272.35 |
$272.35 |
$272.35 |
$498.40
|
|
Ultrasound joint complete left
|
$542.10 |
$542.10 |
$542.10 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$366.60 |
$366.60 |
$366.60 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$241.80 |
$241.80 |
$241.80 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$201.50 |
$201.50 |
$201.50 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$559.00 |
$559.00 |
$559.00 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$332.15 |
$332.15 |
$332.15 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$214.50 |
$214.50 |
$214.50 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$350.35 |
$350.35 |
$350.35 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$597.35 |
$597.35 |
$597.35 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$442.00 |
$442.00 |
$442.00 |
$498.00
|
|
Ultrasound scrotum and contents
|
$449.80 |
$449.80 |
$449.80 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$504.40 |
$504.40 |
$504.40 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$263.25 |
$263.25 |
$263.25 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$481.00 |
$481.00 |
$481.00 |
$567.44
|
|
Unlisted chemotherapy px
|
$591.50 |
$591.50 |
$591.50 |
$153.85
|
|
Unlisted CT procedure
|
$2,159.30 |
$2,159.30 |
$2,159.30 |
$1,043.00
|
|
Unlisted fluoroscopic px
|
$193.70 |
$193.70 |
$193.70 |
$324.85
|
|
Unlisted mr procedure
|
$373.75 |
$373.75 |
$373.75 |
$1,032.20
|
|
Unlisted procedure colon
|
$566.80 |
$566.80 |
$566.80 |
$1,580.44
|
|
Unlisted procedure microbiology
|
$487.50 |
$487.50 |
$487.50 |
$487.50
|
|
Unlisted procedure pancreas
|
$1,701.70 |
$1,701.70 |
$1,701.70 |
$2,967.75
|
|
Unlisted procedure spine
|
$4,397.90 |
$4,397.90 |
$4,397.90 |
$4,706.35
|
|
Unlisted px biliary tract
|
$1,701.70 |
$1,701.70 |
$1,701.70 |
$2,718.10
|
|
Unlisted px male genital sys
|
$444.60 |
$444.60 |
$444.60 |
$897.95
|
|
Unlisted px pelvis/hip joint
|
$1,580.80 |
$1,580.80 |
$1,580.80 |
$2,108.82
|
|
Unlisted px small intestine
|
$566.80 |
$566.80 |
$566.80 |
$2,118.35
|
|
Unlisted reprod med lab proc
|
$139.75 |
$139.75 |
$139.75 |
$70.00
|
|
Unlisted ultrasound procedure
|
$555.10 |
$555.10 |
$555.10 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$2,804.10 |
$2,804.10 |
$2,804.10 |
$1,480.70
|
|
Upgrade pm system
|
$12,908.35 |
$12,908.35 |
$12,908.35 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,939.60 |
$1,939.60 |
$1,939.60 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,552.85 |
$1,552.85 |
$1,552.85 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,287.65 |
$1,287.65 |
$1,287.65 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,732.90 |
$1,732.90 |
$1,732.90 |
$1,588.59
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,875.90 |
$1,875.90 |
$1,875.90 |
$1,656.60
|
|
Uppr gi scope w/submuc inj
|
$2,140.45 |
$2,140.45 |
$2,140.45 |
$1,773.85
|
|
Urea nitrogen
|
$6.50 |
$6.50 |
$6.50 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$49.40 |
$49.40 |
$49.40 |
$50.00
|
|
Urea nitrogen clearance
|
$31.20 |
$31.20 |
$31.20 |
$33.57
|
|
Ureteral embolization/occl
|
$984.10 |
$984.10 |
$984.10 |
$3,041.22
|
|
Ureteral reflux study
|
$1,777.10 |
$1,777.10 |
$1,777.10 |
$961.20
|
|
Urethrcystgrphy rtrgrde s&i
|
$601.25 |
$601.25 |
$601.25 |
$574.40
|
|
Urethrocystography void s&i
|
$648.05 |
$648.05 |
$648.05 |
$634.50
|
|
Uric acid blood
|
$11.05 |
$11.05 |
$11.05 |
$46.64
|
|
Uric acid urine
|
$100.75 |
$100.75 |
$100.75 |
$46.75
|
|
Urinalysis microscopic only
|
$48.10 |
$48.10 |
$48.10 |
$26.35
|
|
Urinalysis (with microscopy)
|
$7.80 |
$7.80 |
$7.80 |
$48.14
|
|
Urinalysis (without microscopy)
|
$40.30 |
$40.30 |
$40.30 |
$38.99
|
|
Urine Culture Test
|
$86.45 |
$86.45 |
$86.45 |
$84.81
|
|
Urine pregnancy test
|
$83.20 |
$83.20 |
$83.20 |
$66.40
|
|
Urography, antegrade
|
$499.85 |
$499.85 |
$499.85 |
$593.37
|
|
Vaccine dtap < 7 years im
|
$93.63 |
$93.63 |
$93.63 |
$87.80
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$59.28 |
$59.28 |
$59.28 |
$45.33
|
|
Vaccine hepatitis a (hepa) adult im
|
$237.58 |
$237.58 |
$237.58 |
$178.07
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$109.69 |
$109.69 |
$109.69 |
$79.04
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$303.88 |
$303.88 |
$303.88 |
$157.41
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$89.80 |
$89.80 |
$89.80 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$79.03 |
$79.03 |
$79.03 |
$40.01
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$399.75 |
$399.75 |
$399.75 |
$349.15
|
|
Vaccine mmr live subcutaneous
|
$302.74 |
$302.74 |
$302.74 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$396.63 |
$396.63 |
$396.63 |
$274.95
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$813.40 |
$813.40 |
$813.40 |
$715.41
|
|
Vaccine rabies im
|
$1,036.49 |
$1,036.49 |
$1,036.49 |
$945.46
|
|
Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im
|
$926.35 |
$926.35 |
$926.35 |
$440.40
|
|
Vaccine tdap >=7 years im
|
$148.04 |
$148.04 |
$148.04 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$144.53 |
$144.53 |
$144.53 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$563.48 |
$563.48 |
$563.48 |
$447.80
|
|
Vaginal bx
|
$566.80 |
$566.80 |
$566.80 |
$441.75
|
|
Valproic acid total therapeutic drug level
|
$63.05 |
$63.05 |
$63.05 |
$115.00
|
|
Valvuloplasty aortic
|
$13,232.05 |
$13,232.05 |
$13,232.05 |
$7,324.85
|
|
Valvuloplasty mitral
|
$6,635.20 |
$6,635.20 |
$6,635.20 |
$10,435.39
|
|
Valvuloplasty pulmonary
|
$6,635.20 |
$6,635.20 |
$6,635.20 |
$11,945.20
|
|
Vancomycin 1,000 mg intravenous injection
|
$119.76 |
$119.76 |
$119.76 |
$246.70
|
|
Vancomycin peak therapeutic drug level
|
$46.80 |
$46.80 |
$46.80 |
$126.79
|
|
Varicella zoster antibody igg
|
$100.10 |
$100.10 |
$100.10 |
$82.55
|
|
Vasopressin 20 unit/ml intravenous solution
|
$111.83 |
$111.83 |
$111.83 |
$362.93
|
|
Vedolizumab 300 mg intravenous solution
|
$30,377.88 |
$30,377.88 |
$30,377.88 |
$20,730.98
|
|
Veeg cont 2-12 hrs
|
$2,182.05 |
$2,182.05 |
$2,182.05 |
$1,485.05
|
|
Veeg ea 12-26hr cont mntr
|
$4,364.10 |
$4,364.10 |
$4,364.10 |
$3,332.45
|
|
Veeg intrmnt 2-12 hrs
|
$1,909.05 |
$1,909.05 |
$1,909.05 |
$904.90
|
|
Veeg unmon 12-26 hrs
|
$3,818.75 |
$3,818.75 |
$3,818.75 |
$1,411.20
|
|
Veeg unmon 2-12 hrs
|
$1,909.05 |
$1,909.05 |
$1,909.05 |
$704.79
|
|
Vein x-ray adrenal gland
|
$2,414.75 |
$2,414.75 |
$2,414.75 |
$2,489.25
|
|
Vein x-ray adrenal glands
|
$4,004.65 |
$4,004.65 |
$4,004.65 |
$3,999.60
|
|
Vein x-ray kidney
|
$2,414.75 |
$2,414.75 |
$2,414.75 |
$2,716.20
|
|
Vein x-ray liver
|
$2,414.75 |
$2,414.75 |
$2,414.75 |
$3,320.80
|
|
Vein x-ray liver w/hemodynam
|
$2,414.75 |
$2,414.75 |
$2,414.75 |
$3,413.25
|
|
Vein x-ray liver w/hemodynam
|
$2,414.75 |
$2,414.75 |
$2,414.75 |
$3,439.84
|
|
Vein x-ray liver without hemodyn
|
$2,414.75 |
$2,414.75 |
$2,414.75 |
$2,489.25
|
|
Vein x-ray skull
|
$1,522.95 |
$1,522.95 |
$1,522.95 |
$2,301.09
|
|
Vein x-ray skull epidural
|
$2,237.30 |
$2,237.30 |
$2,237.30 |
$1,344.60
|
|
Vein x-ray spleen/liver
|
$3,153.15 |
$3,153.15 |
$3,153.15 |
$3,450.30
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$569.40 |
$569.40 |
$569.40 |
$188.65
|
|
Venogram ext bil s&i
|
$964.60 |
$964.60 |
$964.60 |
$1,838.28
|
|
Venogram extremity supervision & interpretation unilateral
|
$549.90 |
$549.90 |
$549.90 |
$1,326.00
|
|
Venous mech thrombectomy
|
$11,623.30 |
$11,623.30 |
$11,623.30 |
$8,869.50
|
|
Venous m-thrombectomy add-on
|
$7,363.20 |
$7,363.20 |
$7,363.20 |
$5,352.00
|
|
Venous sampling s&i
|
$4,004.65 |
$4,004.65 |
$4,004.65 |
$4,416.78
|
|
Ven thrombosis images bilat
|
$1,188.20 |
$1,188.20 |
$1,188.20 |
$779.56
|
