|
Unlisted spec derm svc/px
|
$230.50 |
$230.50 |
$230.50 |
$223.08
|
|
Unlisted ultrasound procedure
|
$135.00 |
$135.00 |
$135.00 |
$321.20
|
|
Unlisted urinalysis px
|
$72.00 |
$72.00 |
$72.00 |
$25.72
|
|
Unlstd laps px sprmatic cord
|
$4,524.83 |
$4,524.83 |
$4,524.83 |
$4,713.11
|
|
Unsched dialysis esrd pt hos
|
$798.50 |
$798.50 |
$798.50 |
$1,268.17
|
|
Upgrade pm system
|
$4,988.50 |
$4,988.50 |
$4,988.50 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,129.00 |
$1,129.00 |
$1,129.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$765.00 |
$765.00 |
$765.00 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$707.50 |
$707.50 |
$707.50 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,048.00 |
$1,048.00 |
$1,048.00 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,226.50 |
$1,226.50 |
$1,226.50 |
$1,768.00
|
|
Uppr gi scope w/submuc inj
|
$360.00 |
$360.00 |
$360.00 |
$1,872.00
|
|
Urea nitrogen
|
$11.50 |
$11.50 |
$11.50 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$26.00 |
$26.00 |
$26.00 |
$51.75
|
|
Urethrcystgrphy rtrgrde s&i
|
$244.00 |
$244.00 |
$244.00 |
$579.73
|
|
Urethrocystography void s&i
|
$244.00 |
$244.00 |
$244.00 |
$622.35
|
|
Uric acid blood
|
$12.00 |
$12.00 |
$12.00 |
$48.75
|
|
Uric acid urine
|
$17.00 |
$17.00 |
$17.00 |
$44.33
|
|
Urinalysis microscopic only
|
$34.50 |
$34.50 |
$34.50 |
$26.35
|
|
Urinalysis (with microscopy)
|
$13.50 |
$13.50 |
$13.50 |
$55.00
|
|
Urinalysis (without microscopy)
|
$13.00 |
$13.00 |
$13.00 |
$35.75
|
|
Urine Culture Test
|
$144.00 |
$144.00 |
$144.00 |
$81.50
|
|
Urine flow measurement 51736
|
$154.00 |
$154.00 |
$154.00 |
$210.00
|
|
Urine pregnancy test
|
$19.50 |
$19.50 |
$19.50 |
$67.20
|
|
Urography, antegrade
|
$471.50 |
$471.50 |
$471.50 |
$622.35
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$131.50 |
$131.50 |
$131.50 |
$224.25
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$113.00 |
$113.00 |
$113.00 |
$209.40
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$228.00 |
$228.00 |
$228.00 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$45.00 |
$45.00 |
$45.00 |
$123.20
|
|
Vaccine dtap < 7 years im
|
$27.50 |
$27.50 |
$27.50 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$63.00 |
$63.00 |
$63.00 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$57.50 |
$57.50 |
$57.50 |
$105.95
|
|
Vaccine dtap-ipv/hib im
|
$106.00 |
$106.00 |
$106.00 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$28.00 |
$28.00 |
$28.00 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$12.50 |
$12.50 |
$12.50 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$68.00 |
$68.00 |
$68.00 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$95.50 |
$95.50 |
$95.50 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$32.50 |
$32.50 |
$32.50 |
$79.15
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$46.50 |
$46.50 |
$46.50 |
$84.75
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$71.00 |
$71.00 |
$71.00 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$127.00 |
$127.00 |
$127.00 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$22.00 |
$22.00 |
$22.00 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$290.50 |
$290.50 |
$290.50 |
$576.48
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$282.50 |
$282.50 |
$282.50 |
$282.50
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$79.50 |
$79.50 |
$79.50 |
$143.20
|
|
Vaccine influenza inactivated adjuvant im
|
$73.00 |
$73.00 |
$73.00 |
$109.50
|
|
Vaccine influenza nos 0.5ml dose im
|
$16.50 |
$16.50 |
$16.50 |
$24.20
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$19.50 |
$19.50 |
$19.50 |
$47.88
|
|
Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im
|
$69.00 |
$69.00 |
$69.00 |
$72.80
|
|
Vaccine influenza quadrivalent (iiv4) split virus 0.25 ml im
|
$10.00 |
$10.00 |
$10.00 |
$20.80
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$65.50 |
$65.50 |
$65.50 |
$72.00
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$32.50 |
$32.50 |
$32.50 |
$76.50
|
|
Vaccine influenza trivalent (iiv3) 0.25ml dose im
|
$10.00 |
$10.00 |
$10.00 |
$31.20
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$153.00 |
$153.00 |
$153.00 |
$400.03
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$170.00 |
$170.00 |
$170.00 |
$409.35
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$147.00 |
$147.00 |
$147.00 |
$310.93
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$165.00 |
$165.00 |
$165.00 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$86.00 |
$86.00 |
$86.00 |
$211.68
|
|
Vaccine mmrv live subcutaneous
|
$269.50 |
$269.50 |
$269.50 |
$424.32
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$105.50 |
$105.50 |
$105.50 |
$251.64
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$207.00 |
$207.00 |
$207.00 |
$397.11
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$190.25 |
$190.25 |
$190.25 |
$414.46
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$242.50 |
$242.50 |
$242.50 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$41.00 |
$41.00 |
$41.00 |
$90.70
|
|
Vaccine rabies im
|
$406.00 |
$406.00 |
$406.00 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$271.00 |
$271.00 |
$271.00 |
$538.84
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$1,183.50 |
$1,183.50 |
$1,183.50 |
$1,104.47
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$1,183.50 |
$1,183.50 |
$1,183.50 |
$997.44
|
|
Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im
|
$228.00 |
$228.00 |
$228.00 |
$499.62
|
|
Vaccine rotavirus attenuated (rv1) live 2 dose oral
|
$103.00 |
$103.00 |
$103.00 |
$200.70
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$84.50 |
$84.50 |
$84.50 |
$126.14
|
|
Vaccine tdap >=7 years im
|
$59.00 |
$59.00 |
$59.00 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$46.50 |
$46.50 |
$46.50 |
$112.10
|
|
Vaccine typhoid vicps im
|
$141.50 |
$141.50 |
$141.50 |
$264.78
|
|
Vaccine varicella live subcutaneous
|
$183.00 |
$183.00 |
$183.00 |
$365.17
|
|
Vaccine yellow fever live subcutaneous
|
$205.50 |
$205.50 |
$205.50 |
$418.46
|
|
Vag hyst including t/o
|
$6,479.76 |
$6,479.76 |
$6,479.76 |
$4,827.18
|
|
Vaginal bx
|
$1,315.00 |
$1,315.00 |
$1,315.00 |
$455.94
|
|
Vaginal delivery after cesarean delivery 59612
|
$1,896.00 |
$1,896.00 |
$1,896.00 |
$3,843.60
|
|
Vaginal hysterectomy
|
$2,015.67 |
$2,015.67 |
$2,015.67 |
$5,766.00
|
|
Valproate in ns IV syringe 10 mg/ml (pediatric) - cnr
|
$4.13 |
$4.13 |
$4.13 |
$24.12
|
|
Valproic acid total therapeutic drug level
|
$51.00 |
$51.00 |
$51.00 |
$114.72
|
|
Valrubicin injection
|
$3,066.00 |
$3,066.00 |
$3,066.00 |
$2,813.49
|
|
Vancomycin 1,000 mg intravenous injection
|
$32.76 |
$32.76 |
$32.76 |
$251.86
|
|
Vancomycin hcl injection
|
$60.75 |
$60.75 |
$60.75 |
$154.40
|
|
Vancomycin peak therapeutic drug level
|
$49.00 |
$49.00 |
$49.00 |
$136.13
|
|
Varicella zoster antibody igg
|
$65.63 |
$65.63 |
$65.63 |
$86.80
|
|
Vasectomy
|
$2,595.00 |
$2,595.00 |
$2,595.00 |
$2,424.12
|
|
Vedolizumab 300 mg intravenous solution
|
$17,333.16 |
$17,333.16 |
$17,333.16 |
$18,732.33
|
|
Vein x-ray kidney
|
$2,669.50 |
$2,669.50 |
$2,669.50 |
$2,766.73
|
|
Vemp test i&r cervical
|
$196.00 |
$196.00 |
$196.00 |
$313.00
|
|
Vemp test i&r ocular
|
$196.00 |
$196.00 |
$196.00 |
$266.00
|
|
Vemp tst i&r cervical&ocular
|
$372.00 |
$372.00 |
$372.00 |
$591.50
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$46.50 |
$46.50 |
$46.50 |
$202.80
|
|
Venipuncture <3 yrs other vein
|
$9.50 |
$9.50 |
$9.50 |
$67.00
|
|
Venogram ext bil s&i
|
$1,674.00 |
$1,674.00 |
$1,674.00 |
$1,797.50
|
|
Venogram extremity supervision & interpretation unilateral
|
$1,052.00 |
$1,052.00 |
$1,052.00 |
$1,366.20
|
|
Venous mech thrombectomy
|
$7,110.50 |
$7,110.50 |
$7,110.50 |
$7,965.00
|
|
Venous m-thrombectomy add-on
|
$2,669.50 |
$2,669.50 |
$2,669.50 |
$5,094.75
|
|
Venous sampling s&i
|
$4,687.50 |
$4,687.50 |
$4,687.50 |
$4,193.20
|
