|
Unlisted px foot/toes
|
$2,301.60 |
$2,611.20 |
$3,752.00 |
|
|
Unlisted px forearm/wrist
|
$333.60 |
$3,521.60 |
$3,995.20 |
|
|
Unlisted px hands/fingers
|
$259.20 |
$336.80 |
$2,385.60 |
|
|
Unlisted px leg/ankle
|
$381.60 |
$3,088.80 |
$4,147.20 |
|
|
Unlisted px med radj physics
|
$640.80 |
$640.80 |
$640.80 |
|
|
Unlisted px neck/thorax
|
$2,014.40 |
$2,014.40 |
$2,385.60 |
|
|
Unlisted px pelvis/hip joint
|
$4,119.20 |
$5,661.60 |
$8,036.80 |
|
|
Unlisted px small intestine
|
$3,053.60 |
$3,053.60 |
$3,385.60 |
|
|
Unlisted reprod med lab proc
|
$61.60 |
$61.60 |
$61.60 |
|
|
Unlisted ultrasound procedure
|
$464.00 |
$595.20 |
$628.80 |
|
|
Unsched dialysis esrd pt hos
|
$1,640.00 |
$1,640.00 |
$1,640.00 |
|
|
Upgrade pm system
|
$3,384.00 |
$3,384.00 |
$19,753.60 |
|
|
Upper Arm (Humerus) X-ray (left side)
|
$258.40 |
$312.00 |
$404.00 |
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$2,263.20 |
$2,478.40 |
$2,824.80 |
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,902.40 |
$2,279.20 |
$2,585.60 |
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,919.20 |
$4,230.40 |
$5,039.20 |
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,048.80 |
$3,240.00 |
$3,603.20 |
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,735.20 |
$3,200.00 |
$3,687.20 |
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$324.80 |
$400.80 |
$502.40 |
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$338.40 |
$488.00 |
$613.60 |
|
|
Upper Endoscopy (EGD, diagnostic)
|
$2,482.40 |
$2,482.40 |
$2,539.20 |
|
|
Upper Endoscopy (EGD, with biopsy)
|
$2,540.00 |
$2,540.00 |
$2,577.60 |
|
|
Upper ext fx orthosis rad/ul
|
$206.40 |
$206.40 |
$206.40 |
|
|
Upper GI Barium X-ray (barium and gas)
|
$910.40 |
$928.00 |
$1,072.80 |
|
|
Upper GI Barium X-ray (barium only)
|
$846.40 |
$955.20 |
$1,040.00 |
|
|
Urea nitrogen
|
$25.60 |
$40.00 |
$70.40 |
|
|
Urea nitrogen 24 hour urine
|
$32.00 |
$39.20 |
$56.80 |
|
|
Ureteral embolization/occl
|
$1,822.40 |
$1,822.40 |
$1,822.40 |
|
|
Ureteral reflux study
|
$1,182.40 |
$1,284.00 |
$1,489.60 |
|
|
Urethrcystgrphy rtrgrde s&i
|
$846.40 |
$848.80 |
$918.40 |
|
|
Urethrocystography void s&i
|
$908.00 |
$914.40 |
$1,463.20 |
|
|
Uric acid blood
|
$35.20 |
$40.00 |
$76.00 |
|
|
Uric acid urine
|
$29.60 |
$36.00 |
$73.60 |
|
|
Urinalysis microscopic only
|
$16.00 |
$25.60 |
$40.00 |
|
|
Urinalysis qual/semiquant excpt ia
|
$13.60 |
$13.60 |
$68.00 |
|
|
Urinalysis (with microscopy)
|
$31.20 |
$38.40 |
$80.80 |
|
|
Urinalysis (without microscopy)
|
$24.80 |
$24.80 |
$41.60 |
|
|
Urinary bldr retent nuc study
|
$220.00 |
$220.00 |
$229.60 |
|
|
Urine Culture Test
|
$42.40 |
$73.60 |
$116.00 |
|
|
Urine pregnancy test
|
$30.40 |
$58.40 |
$74.40 |
|
|
Urography, antegrade
|
$931.20 |
$931.20 |
$939.20 |
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$2,619.99 |
$3,128.34 |
$5,184.34 |
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$18,526.28 |
$36,009.49 |
$49,434.96 |
|
|
Vaccine Administration (one shot)
|
$40.80 |
$98.40 |
$128.00 |
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$201.26 |
$201.26 |
$201.26 |
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$188.52 |
$188.52 |
$188.52 |
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$229.80 |
$232.02 |
$396.10 |
|
|
Vaccine dtap < 7 years im
|
$68.08 |
$68.08 |
$325.92 |
|
|
Vaccine dtap-hep b-ipv im
|
$378.20 |
$378.20 |
$378.20 |
|
|
Vaccine dtap-ipv 4-6 years im
|
$92.14 |
$95.49 |
$345.46 |
|
|
Vaccine dtap-ipv-hib-hepb im
|
$244.55 |
$244.55 |
$403.48 |
|
|
Vaccine dtap-ipv/hib im
|
$106.75 |
$106.75 |
$362.63 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$328.33 |
$328.33 |
$328.33 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$324.44 |
$324.44 |
$324.44 |
|
|
Vaccine hepatitis a (hepa) adult im
|
$103.56 |
$103.56 |
$357.70 |
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$203.88 |
$203.88 |
$382.20 |
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$330.35 |
$330.35 |
$330.35 |
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$85.32 |
$85.45 |
$352.79 |
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$106.21 |
$226.64 |
$387.48 |
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$25.93 |
$69.67 |
$76.32 |
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$385.31 |
$385.31 |
$451.55 |
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$57.48 |
$57.48 |
$60.60 |
|
|
Vaccine influenza inactivated adjuvant im
|
$49.24 |
$49.96 |
$56.80 |
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$25.00 |
$26.40 |
$28.32 |
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$25.60 |
$25.60 |
$25.60 |
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$26.40 |
$26.40 |
$26.40 |
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$86.40 |
$86.40 |
$86.40 |
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$26.71 |
$27.43 |
$41.60 |
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$413.10 |
$413.10 |
$413.10 |
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$406.05 |
$406.05 |
$406.05 |
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$220.53 |
$220.53 |
$396.21 |
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$262.63 |
$262.63 |
$396.86 |
|
|
Vaccine mmr live subcutaneous
|
$102.84 |
$104.84 |
$359.08 |
|
|
Vaccine mmrv live subcutaneous
|
$456.57 |
$456.57 |
$456.57 |
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$84.20 |
$111.49 |
$234.59 |
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$287.72 |
$313.33 |
$373.11 |
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$359.92 |
$364.10 |
$456.14 |
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$411.68 |
$411.68 |
$527.52 |
|
|
Vaccine polio (ipv) subcutaneous/im
|
$329.83 |
$329.83 |
$329.83 |
|
|
Vaccine rabies im
|
$518.56 |
$551.22 |
$574.93 |
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$370.40 |
$449.76 |
$493.46 |
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$627.11 |
$794.82 |
$794.84 |
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$691.81 |
$691.81 |
$1,225.67 |
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$58.76 |
$104.63 |
$104.63 |
|
|
Vaccine tdap >=7 years im
|
$84.94 |
$85.68 |
$337.72 |
|
|
Vaccine td preservative free >= 7 years im
|
$75.88 |
$79.45 |
$334.00 |
|
|
Vaccine varicella live subcutaneous
|
$386.44 |
$386.44 |
$386.44 |
|
|
Vaginal bx
|
$306.40 |
$306.40 |
$306.40 |
|
|
Valproic acid total therapeutic drug level
|
$71.20 |
$103.20 |
$135.20 |
|
|
Valvuloplasty aortic
|
$14,605.60 |
$14,605.60 |
$14,605.60 |
|
|
Valvuloplasty mitral
|
$16,506.40 |
$16,506.40 |
$16,506.40 |
|
|
Valvuloplasty pulmonary
|
$16,489.60 |
$16,489.60 |
$16,489.60 |
|
|
Vancomycin 1,000 mg intravenous injection
|
$69.21 |
$70.25 |
$366.34 |
|
|
Vancomycin 750 mg intravenous solution
|
$78.02 |
$87.49 |
$329.24 |
|
|
Vancomycin peak therapeutic drug level
|
$76.00 |
$100.80 |
$184.00 |
|
|
Varicella zoster antibody igg
|
$46.40 |
$54.40 |
$54.40 |
|
|
Vasopressin 20 unit/ml intravenous solution
|
$49.84 |
$61.78 |
$69.02 |
|
|
Vedolizumab 300 mg intravenous solution
|
$9,441.12 |
$10,410.24 |
$24,267.48 |
|
|
Veeg cont 2-12 hrs
|
$5,027.20 |
$5,027.20 |
$5,027.20 |
|
|
Veeg ea 12-26hr cont mntr
|
$6,340.00 |
$6,340.00 |
$6,340.00 |
|
