|
Unlisted procedure esophagus
|
$152.40 |
$152.40 |
$152.40 |
$1,998.88
|
|
Unlisted procedure microbiology
|
$193.20 |
$193.20 |
$193.20 |
$530.00
|
|
Unlisted procedure rectum
|
$515.40 |
$515.40 |
$515.40 |
$1,223.20
|
|
Unlisted px ant segment eye
|
$1,090.20 |
$1,090.20 |
$1,090.20 |
$2,698.92
|
|
Unlisted px casting/strpg
|
$117.00 |
$117.00 |
$117.00 |
$222.00
|
|
Unlisted px external ear
|
$103.20 |
$103.20 |
$103.20 |
$325.68
|
|
Unlisted px forearm/wrist
|
$173.40 |
$173.40 |
$173.40 |
$859.50
|
|
Unlisted px hands/fingers
|
$4,665.00 |
$4,665.00 |
$4,665.00 |
$354.20
|
|
Unlisted px leg/ankle
|
$393.00 |
$393.00 |
$393.00 |
$882.30
|
|
Unlisted px male genital sys
|
$104.40 |
$104.40 |
$104.40 |
$387.84
|
|
Unlisted px posterior segmnt
|
$4,036.20 |
$4,036.20 |
$4,036.20 |
$3,173.34
|
|
Unlisted px salivry glnd/dux
|
$104.40 |
$104.40 |
$104.40 |
$1,265.16
|
|
Unlisted px small intestine
|
$2,640.60 |
$2,640.60 |
$2,640.60 |
$2,118.35
|
|
Unlisted px tongue flr mouth
|
$117.00 |
$117.00 |
$117.00 |
$282.50
|
|
Unlisted surgical path px
|
$68.40 |
$68.40 |
$68.40 |
$217.75
|
|
Unsched dialysis esrd pt hos
|
$6,177.60 |
$6,177.60 |
$6,177.60 |
$1,296.00
|
|
Upgrade pm system
|
$12,843.00 |
$12,843.00 |
$12,843.00 |
$12,077.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$234.60 |
$234.60 |
$234.60 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$2,052.60 |
$2,052.60 |
$2,052.60 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,906.80 |
$1,906.80 |
$1,906.80 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,562.60 |
$2,562.60 |
$2,562.60 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,565.40 |
$1,565.40 |
$1,565.40 |
$2,392.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,642.80 |
$1,642.80 |
$1,642.80 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$349.20 |
$349.20 |
$349.20 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$388.80 |
$388.80 |
$388.80 |
$381.60
|
|
Upper Endoscopy (EGD, diagnostic)
|
$2,310.60 |
$2,310.60 |
$2,310.60 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$3,124.20 |
$3,124.20 |
$3,124.20 |
$1,768.00
|
|
Upper GI Barium X-ray (barium and gas)
|
$690.00 |
$690.00 |
$690.00 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$690.00 |
$690.00 |
$690.00 |
$607.20
|
|
Uppr gi scope w/submuc inj
|
$2,088.00 |
$2,088.00 |
$2,088.00 |
$1,872.00
|
|
Urea nitrogen
|
$55.80 |
$55.80 |
$55.80 |
$42.01
|
|
Urea nitrogen 24 hour urine
|
$97.20 |
$97.20 |
$97.20 |
$51.84
|
|
Urea nitrogen clearance
|
$144.00 |
$144.00 |
$144.00 |
$34.02
|
|
Urethrcystgrphy rtrgrde s&i
|
$245.40 |
$245.40 |
$245.40 |
$584.00
|
|
Urethrocystography void s&i
|
$245.40 |
$245.40 |
$245.40 |
$634.50
|
|
Uric acid blood
|
$155.40 |
$155.40 |
$155.40 |
$49.32
|
|
Uric acid urine
|
$118.20 |
$118.20 |
$118.20 |
$44.52
|
|
Urinalysis microscopic only
|
$83.40 |
$83.40 |
$83.40 |
$26.35
|
|
Urinalysis (with microscopy)
|
$134.40 |
$134.40 |
$134.40 |
$55.20
|
|
Urinalysis (without microscopy)
|
$36.60 |
$36.60 |
$36.60 |
$35.91
|
|
Urine Culture Test
|
$62.40 |
$62.40 |
$62.40 |
$82.32
|
|
Urine pregnancy test
|
$70.80 |
$70.80 |
$70.80 |
$68.21
|
|
Urography, antegrade
|
$501.00 |
$501.00 |
$501.00 |
$622.35
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$70.00 |
$70.00 |
$70.00 |
$5,205.00
|
|
Vaccine Administration (one shot)
|
$13.20 |
$13.20 |
$13.20 |
$67.74
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$340.00 |
$340.00 |
$340.00 |
$224.25
|
|
Vaccine dtap < 7 years im
|
$43.20 |
$43.20 |
$43.20 |
$71.17
|
|
Vaccine dtap-hep b-ipv im
|
$84.00 |
$84.00 |
$84.00 |
$164.63
|
|
Vaccine dtap-ipv/hib im
|
$65.40 |
$65.40 |
$65.40 |
$221.24
|
|
Vaccine hepatitis a (hepa) adult im
|
$108.00 |
$108.00 |
$108.00 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$156.80 |
$156.80 |
$156.80 |
$231.56
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$86.40 |
$86.40 |
$86.40 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$126.60 |
$126.60 |
$126.60 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$63.20 |
$63.20 |
$63.20 |
$75.39
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$12.00 |
$12.00 |
$12.00 |
$33.60
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$24.00 |
$24.00 |
$24.00 |
$82.71
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$109.60 |
$109.60 |
$109.60 |
$394.26
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$108.80 |
$108.80 |
$108.80 |
$327.37
|
|
Vaccine mmr live subcutaneous
|
$64.80 |
$64.80 |
$64.80 |
$213.00
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$75.00 |
$75.00 |
$75.00 |
$252.87
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$144.00 |
$144.00 |
$144.00 |
$393.25
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$192.00 |
$192.00 |
$192.00 |
$563.36
|
|
Vaccine rabies im
|
$800.00 |
$800.00 |
$800.00 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$672.00 |
$672.00 |
$672.00 |
$538.84
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$1,196.00 |
$1,196.00 |
$1,196.00 |
$1,105.21
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$897.00 |
$897.00 |
$897.00 |
$997.44
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$76.80 |
$76.80 |
$76.80 |
$126.14
|
|
Vaccine tdap >=7 years im
|
$42.40 |
$42.40 |
$42.40 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$74.40 |
$74.40 |
$74.40 |
$112.10
|
|
Vacuum drain bottle/tube kit
|
$224.40 |
$224.40 |
$224.40 |
$325.20
|
|
Valproic acid total therapeutic drug level
|
$222.60 |
$222.60 |
$222.60 |
$115.00
|
|
Valvuloplasty aortic
|
$6,790.20 |
$6,790.20 |
$6,790.20 |
$7,944.16
|
|
Vancomycin 1,000 mg intravenous injection
|
$1.80 |
$1.80 |
$1.80 |
$251.86
|
|
Vancomycin hcl injection
|
$99.00 |
$99.00 |
$99.00 |
$149.49
|
|
Vancomycin peak therapeutic drug level
|
$357.00 |
$357.00 |
$357.00 |
$135.60
|
|
Varicella zoster antibody igg
|
$60.00 |
$60.00 |
$60.00 |
$86.80
|
|
Vasopressin 20 unit/ml intravenous solution
|
$9.60 |
$9.60 |
$9.60 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$19,012.80 |
$19,012.80 |
$19,012.80 |
$18,732.33
|
|
Veeg cont 2-12 hrs
|
$1,178.40 |
$1,178.40 |
$1,178.40 |
$1,540.00
|
|
Veeg ea 12-26hr cont mntr
|
$2,205.60 |
$2,205.60 |
$2,205.60 |
$3,225.60
|
|
Veeg intrmnt 2-12 hrs
|
$615.00 |
$615.00 |
$615.00 |
$994.91
|
|
Veeg unmon 12-26 hrs
|
$1,178.40 |
$1,178.40 |
$1,178.40 |
$1,737.12
|
|
Veeg unmon 2-12 hrs
|
$615.00 |
$615.00 |
$615.00 |
$826.15
|
|
Vein x-ray kidney
|
$2,766.60 |
$2,766.60 |
$2,766.60 |
$2,870.00
|
|
Vein x-ray liver
|
$3,369.00 |
$3,369.00 |
$3,369.00 |
$3,312.00
|
|
Vein x-ray liver w/hemodynam
|
$2,766.60 |
$2,766.60 |
$2,766.60 |
$3,619.84
|
|
Vein x-ray liver w/hemodynam
|
$2,766.60 |
$2,766.60 |
$2,766.60 |
$3,683.90
|
|
Vein x-ray skull
|
$3,320.40 |
$3,320.40 |
$3,320.40 |
$2,236.50
|
|
Velaglucerase alfa 400 unit intravenous solution
|
$4,656.00 |
$4,656.00 |
$4,656.00 |
$2,632.35
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$64.20 |
$64.20 |
$64.20 |
$197.04
|
|
Venogram ext bil s&i
|
$1,699.20 |
$1,699.20 |
$1,699.20 |
$1,838.28
|
|
Venogram extremity supervision & interpretation unilateral
|
$1,338.60 |
$1,338.60 |
$1,338.60 |
$1,382.58
|
|
Venous mech thrombectomy
|
$10,687.20 |
$10,687.20 |
$10,687.20 |
$8,184.00
|
|
Venous m-thrombectomy add-on
|
$9,483.00 |
$9,483.00 |
$9,483.00 |
$5,110.00
|
|
Ventilator each subsequent day
|
$1,143.60 |
$1,143.60 |
$1,143.60 |
$1,178.74
|
|
Ventilator Management (first day)
|
$1,341.60 |
$1,341.60 |
$1,341.60 |
$1,434.60
|
|
Very long chain fatty acids
|
$432.00 |
$432.00 |
$432.00 |
$139.88
|
|
Video Swallow Study (Modified Barium Swallow)
|
$442.20 |
$442.20 |
$442.20 |
$524.50
|
|
Vinblastine 1 mg/ml intravenous solution
|
$136.80 |
$136.80 |
$136.80 |
$163.80
|
|
Vincristine 1 mg/ml intravenous solution
|
$345.00 |
$345.00 |
$345.00 |
$87.15
|
