|
Ultrasound breast complete
|
$394.20 |
$394.20 |
$394.20 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$372.60 |
$372.60 |
$372.60 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$257.40 |
$257.40 |
$257.40 |
$338.00
|
|
Ultrasound elastography parenchyma
|
$202.20 |
$202.20 |
$202.20 |
$313.95
|
|
Ultrasound encephalogram
|
$394.20 |
$394.20 |
$394.20 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$394.20 |
$394.20 |
$394.20 |
$575.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$394.20 |
$394.20 |
$394.20 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$591.00 |
$591.00 |
$591.00 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$663.60 |
$663.60 |
$663.60 |
$388.08
|
|
Ultrasound guide intraoperative
|
$890.40 |
$890.40 |
$890.40 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$649.80 |
$649.80 |
$649.80 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$280.20 |
$280.20 |
$280.20 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$280.20 |
$280.20 |
$280.20 |
$311.25
|
|
Ultrasound joint complete left
|
$394.20 |
$394.20 |
$394.20 |
$557.99
|
|
Ultrasound ob >=14wks ea addl gest
|
$976.80 |
$976.80 |
$976.80 |
$409.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$304.80 |
$304.80 |
$304.80 |
$335.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$819.60 |
$819.60 |
$819.60 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$394.20 |
$394.20 |
$394.20 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$394.20 |
$394.20 |
$394.20 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$394.20 |
$394.20 |
$394.20 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$343.20 |
$343.20 |
$343.20 |
$421.00
|
|
Unlisted CT procedure
|
$2,254.20 |
$2,254.20 |
$2,254.20 |
$732.70
|
|
Unlisted dx gi procedure
|
$613.20 |
$613.20 |
$613.20 |
$649.22
|
|
Unlisted fetal invas px w/us
|
$348.60 |
$348.60 |
$348.60 |
$498.40
|
|
Unlisted fluoroscopic px
|
$226.20 |
$226.20 |
$226.20 |
$305.76
|
|
Unlisted laparoscopic liver biopy 47379
|
$3,289.80 |
$3,289.80 |
$3,289.80 |
$6,307.38
|
|
Unlisted laparoscopic reduction intestine 44238
|
$3,467.40 |
$3,467.40 |
$3,467.40 |
$5,419.00
|
|
Unlisted mr procedure
|
$568.20 |
$568.20 |
$568.20 |
$1,163.00
|
|
Unlisted procedure liver
|
$2,287.20 |
$2,287.20 |
$2,287.20 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$112.20 |
$112.20 |
$112.20 |
$530.00
|
|
Unlisted px biliary tract
|
$1,788.00 |
$1,788.00 |
$1,788.00 |
$3,055.00
|
|
Unlisted px med radj physics
|
$404.40 |
$404.40 |
$404.40 |
$462.35
|
|
Unlisted transfusion med px
|
$32.40 |
$32.40 |
$32.40 |
$147.50
|
|
Unsched dialysis esrd pt hos
|
$2,160.60 |
$2,160.60 |
$2,160.60 |
$1,296.00
|
|
Upgrade pm system
|
$15,540.60 |
$15,540.60 |
$15,540.60 |
$12,077.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$188.40 |
$188.40 |
$188.40 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$1,424.40 |
$1,424.40 |
$1,424.40 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$876.00 |
$876.00 |
$876.00 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,713.80 |
$2,713.80 |
$2,713.80 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,713.80 |
$2,713.80 |
$2,713.80 |
$2,392.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,656.00 |
$1,656.00 |
$1,656.00 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$262.80 |
$262.80 |
$262.80 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$262.80 |
$262.80 |
$262.80 |
$381.60
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,909.80 |
$1,909.80 |
$1,909.80 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$2,083.20 |
$2,083.20 |
$2,083.20 |
$1,768.00
|
|
Upper GI Barium X-ray (barium and gas)
|
$427.80 |
$427.80 |
$427.80 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$427.80 |
$427.80 |
$427.80 |
$607.20
|
|
Urea nitrogen
|
$21.60 |
$21.60 |
$21.60 |
$42.01
|
|
Urea nitrogen 24 hour urine
|
$28.80 |
$28.80 |
$28.80 |
$51.84
|
|
Ureteral reflux study
|
$1,228.80 |
$1,228.80 |
$1,228.80 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$547.80 |
$547.80 |
$547.80 |
$584.00
|
|
Urethrocystography void s&i
|
$547.80 |
$547.80 |
$547.80 |
$634.50
|
|
Uric acid blood
|
$23.40 |
$23.40 |
$23.40 |
$49.32
|
|
Uric acid urine
|
$25.80 |
$25.80 |
$25.80 |
$44.52
|
|
Urinalysis microscopic only
|
$13.80 |
$13.80 |
$13.80 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$8.40 |
$8.40 |
$8.40 |
$25.72
|
|
Urinalysis (with microscopy)
|
$23.40 |
$23.40 |
$23.40 |
$55.20
|
|
Urinalysis (without microscopy)
|
$17.40 |
$17.40 |
$17.40 |
$35.91
|
|
Urine Culture Test
|
$45.00 |
$45.00 |
$45.00 |
$82.32
|
|
Urine pregnancy test
|
$63.00 |
$63.00 |
$63.00 |
$68.21
|
|
Urography, antegrade
|
$896.40 |
$896.40 |
$896.40 |
$622.35
|
|
Urography inf drip &/or bolus
|
$427.80 |
$427.80 |
$427.80 |
$642.50
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$46.20 |
$46.20 |
$46.20 |
$5,205.00
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$16,705.20 |
$16,705.20 |
$16,705.20 |
$51,633.07
|
|
Vaccine Administration (one shot)
|
$115.20 |
$115.20 |
$115.20 |
$67.74
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$193.20 |
$193.20 |
$193.20 |
$224.25
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$193.20 |
$193.20 |
$193.20 |
$209.40
|
|
Vaccine dtap < 7 years im
|
$32.40 |
$32.40 |
$32.40 |
$71.17
|
|
Vaccine dtap-ipv/hib im
|
$66.00 |
$66.00 |
$66.00 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$9.00 |
$9.00 |
$9.00 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$46.80 |
$46.80 |
$46.80 |
$166.62
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$43.80 |
$43.80 |
$43.80 |
$78.25
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$40.80 |
$40.80 |
$40.80 |
$155.16
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$33.00 |
$33.00 |
$33.00 |
$75.39
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$76.20 |
$76.20 |
$76.20 |
$72.00
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$51.00 |
$51.00 |
$51.00 |
$82.71
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$267.00 |
$267.00 |
$267.00 |
$394.26
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$93.60 |
$93.60 |
$93.60 |
$327.37
|
|
Vaccine mmr live subcutaneous
|
$54.00 |
$54.00 |
$54.00 |
$213.00
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$322.80 |
$322.80 |
$322.80 |
$563.36
|
|
Vaccine rabies im
|
$259.80 |
$259.80 |
$259.80 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$177.00 |
$177.00 |
$177.00 |
$538.84
|
|
Vaccine tdap >=7 years im
|
$54.00 |
$54.00 |
$54.00 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$42.60 |
$42.60 |
$42.60 |
$112.10
|
|
Valproic acid total therapeutic drug level
|
$97.20 |
$97.20 |
$97.20 |
$115.00
|
|
Valrubicin injection
|
$168.60 |
$168.60 |
$168.60 |
$2,813.49
|
|
Valvuloplasty aortic
|
$12,208.80 |
$12,208.80 |
$12,208.80 |
$7,944.16
|
|
Valvuloplasty mitral
|
$23,686.20 |
$23,686.20 |
$23,686.20 |
$10,845.00
|
|
Valvuloplasty pulmonary
|
$15,019.80 |
$15,019.80 |
$15,019.80 |
$11,945.20
|
|
Vancomycin 1,000 mg intravenous injection
|
$130.20 |
$130.20 |
$130.20 |
$251.86
|
|
Vancomycin peak therapeutic drug level
|
$97.20 |
$97.20 |
$97.20 |
$135.60
|
|
Varicella zoster antibody igg
|
$75.00 |
$75.00 |
$75.00 |
$86.80
|
|
Varicella-zoster immue globin im
|
$1,309.20 |
$1,309.20 |
$1,309.20 |
$3,816.19
|
|
Vasopressin 20 unit/ml intravenous solution
|
$201.60 |
$201.60 |
$201.60 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$5,199.60 |
$5,199.60 |
$5,199.60 |
$18,732.33
|
|
Veeg intrmnt 2-12 hrs
|
$924.60 |
$924.60 |
$924.60 |
$994.91
|
|
Vein x-ray adrenal gland
|
$5,906.40 |
$5,906.40 |
$5,906.40 |
$2,833.34
|
|
Vein x-ray adrenal glands
|
$9,796.20 |
$9,796.20 |
$9,796.20 |
$3,480.10
|
|
Vein x-ray eye socket
|
$1,344.60 |
$1,344.60 |
$1,344.60 |
$1,438.32
|
|
Vein x-ray kidney
|
$5,906.40 |
$5,906.40 |
$5,906.40 |
$2,870.00
|
