|
Ultrasound retroperitoneal limited
|
$381.75 |
$381.75 |
$381.75 |
$486.50
|
|
Ultrasound scrotum and contents
|
$568.35 |
$568.35 |
$568.35 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$545.55 |
$545.55 |
$545.55 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$417.15 |
$417.15 |
$417.15 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$589.80 |
$589.80 |
$589.80 |
$558.35
|
|
Unlistd noninvas vasc dx std
|
$1,105.80 |
$1,105.80 |
$1,105.80 |
$528.80
|
|
Unlisted procedure spine
|
$4,478.85 |
$4,478.85 |
$4,478.85 |
$4,659.85
|
|
Unlisted px inner ear
|
$1,476.90 |
$1,476.90 |
$1,476.90 |
$571.20
|
|
Unlisted px small intestine
|
$2,163.45 |
$2,163.45 |
$2,163.45 |
$2,102.10
|
|
Unlisted transfusion med px
|
$204.60 |
$204.60 |
$204.60 |
$147.50
|
|
Unlisted ultrasound procedure
|
$184.20 |
$184.20 |
$184.20 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$2,127.45 |
$2,127.45 |
$2,127.45 |
$1,268.17
|
|
Upgrade pm system
|
$18,019.35 |
$18,019.35 |
$18,019.35 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,264.90 |
$3,264.90 |
$3,264.90 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,612.85 |
$2,612.85 |
$2,612.85 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,394.15 |
$2,394.15 |
$2,394.15 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,824.75 |
$1,824.75 |
$1,824.75 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$731.70 |
$731.70 |
$731.70 |
$1,768.00
|
|
Upper ext fx orthosis rad/ul
|
$760.76 |
$760.76 |
$760.76 |
$619.49
|
|
Uppr gi scope w/submuc inj
|
$731.70 |
$731.70 |
$731.70 |
$1,872.00
|
|
Urea nitrogen
|
$133.20 |
$133.20 |
$133.20 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$111.45 |
$111.45 |
$111.45 |
$51.75
|
|
Ureteral reflux study
|
$820.20 |
$820.20 |
$820.20 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$622.35 |
$622.35 |
$622.35 |
$579.73
|
|
Urethrocystography void s&i
|
$622.35 |
$622.35 |
$622.35 |
$622.35
|
|
Uric acid blood
|
$130.65 |
$130.65 |
$130.65 |
$48.75
|
|
Uric acid urine
|
$130.65 |
$130.65 |
$130.65 |
$44.33
|
|
Urinalysis microscopic only
|
$43.50 |
$43.50 |
$43.50 |
$26.35
|
|
Urinalysis (with microscopy)
|
$107.85 |
$107.85 |
$107.85 |
$55.00
|
|
Urinalysis (without microscopy)
|
$107.85 |
$107.85 |
$107.85 |
$35.75
|
|
Urine Culture Test
|
$210.00 |
$210.00 |
$210.00 |
$81.50
|
|
Urine ost pouch w faucet/tap
|
$2.00 |
$2.00 |
$2.00 |
$2.00
|
|
Urine pregnancy test
|
$187.20 |
$187.20 |
$187.20 |
$67.20
|
|
Urography, antegrade
|
$622.35 |
$622.35 |
$622.35 |
$622.35
|
|
Urography inf drip &/or bolus
|
$591.75 |
$591.75 |
$591.75 |
$642.50
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$4,008.54 |
$4,008.54 |
$4,008.54 |
$5,184.34
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$55,128.85 |
$55,128.85 |
$55,128.85 |
$51,633.07
|
|
Vaccine dtap < 7 years im
|
$68.19 |
$68.19 |
$68.19 |
$68.19
|
|
Vaccine dtap-ipv/hib im
|
$221.24 |
$221.24 |
$221.24 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$72.98 |
$72.98 |
$72.98 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$33.30 |
$33.30 |
$33.30 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$192.15 |
$192.15 |
$192.15 |
$166.62
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$93.90 |
$93.90 |
$93.90 |
$79.15
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$160.86 |
$160.86 |
$160.86 |
$155.16
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$69.74 |
$69.74 |
$69.74 |
$75.39
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$149.21 |
$149.21 |
$149.21 |
$143.20
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$54.84 |
$54.84 |
$54.84 |
$33.60
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$149.21 |
$149.21 |
$149.21 |
$72.00
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$409.35 |
$409.35 |
$409.35 |
$409.35
|
|
Vaccine mmr live subcutaneous
|
$194.93 |
$194.93 |
$194.93 |
$211.68
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$252.90 |
$252.90 |
$252.90 |
$251.64
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$487.47 |
$487.47 |
$487.47 |
$397.11
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$563.36 |
$563.36 |
$563.36 |
$563.36
|
|
Vaccine rabies im
|
$858.95 |
$858.95 |
$858.95 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$637.20 |
$637.20 |
$637.20 |
$538.84
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$980.10 |
$980.10 |
$980.10 |
$1,104.47
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$980.10 |
$980.10 |
$980.10 |
$997.44
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$102.83 |
$102.83 |
$102.83 |
$126.14
|
|
Vaccine tdap >=7 years im
|
$106.66 |
$106.66 |
$106.66 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$89.72 |
$89.72 |
$89.72 |
$112.10
|
|
Vaginal bx
|
$513.30 |
$513.30 |
$513.30 |
$455.94
|
|
Vaginal delivery after cesarean delivery 59612
|
$3,843.60 |
$3,843.60 |
$3,843.60 |
$3,843.60
|
|
Valproic acid total therapeutic drug level
|
$226.50 |
$226.50 |
$226.50 |
$114.72
|
|
Valvuloplasty mitral
|
$6,889.20 |
$6,889.20 |
$6,889.20 |
$10,877.90
|
|
Valvuloplasty pulmonary
|
$17,222.70 |
$17,222.70 |
$17,222.70 |
$11,945.20
|
|
Vancomycin hcl injection
|
$459.00 |
$459.00 |
$459.00 |
$154.40
|
|
Vancomycin peak therapeutic drug level
|
$362.70 |
$362.70 |
$362.70 |
$136.13
|
|
Varicella zoster antibody igg
|
$63.45 |
$63.45 |
$63.45 |
$86.80
|
|
Varicella-zoster immue globin im
|
$4,321.49 |
$4,321.49 |
$4,321.49 |
$3,816.19
|
|
Vasopressin 20 unit/ml intravenous solution
|
$458.82 |
$458.82 |
$458.82 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$17,159.83 |
$17,159.83 |
$17,159.83 |
$18,732.33
|
|
Veeg cont 2-12 hrs
|
$1,063.95 |
$1,063.95 |
$1,063.95 |
$1,540.00
|
|
Veeg ea 12-26hr cont mntr
|
$1,990.80 |
$1,990.80 |
$1,990.80 |
$3,225.60
|
|
Veeg intrmnt 2-12 hrs
|
$554.70 |
$554.70 |
$554.70 |
$961.00
|
|
Veeg unmon 12-26 hrs
|
$1,063.95 |
$1,063.95 |
$1,063.95 |
$1,671.09
|
|
Veeg unmon 2-12 hrs
|
$554.70 |
$554.70 |
$554.70 |
$826.15
|
|
Vein x-ray adrenal gland
|
$2,405.85 |
$2,405.85 |
$2,405.85 |
$2,845.80
|
|
Vein x-ray adrenal glands
|
$3,267.30 |
$3,267.30 |
$3,267.30 |
$3,935.00
|
|
Vein x-ray liver
|
$2,502.15 |
$2,502.15 |
$2,502.15 |
$3,305.50
|
|
Vein x-ray liver w/hemodynam
|
$2,502.15 |
$2,502.15 |
$2,502.15 |
$3,486.86
|
|
Vein x-ray liver w/hemodynam
|
$2,634.90 |
$2,634.90 |
$2,634.90 |
$3,483.84
|
|
Vein x-ray liver without hemodyn
|
$3,837.30 |
$3,837.30 |
$3,837.30 |
$2,452.80
|
|
Vein x-ray skull epidural
|
$1,491.60 |
$1,491.60 |
$1,491.60 |
$1,746.50
|
|
Vein x-ray spleen/liver
|
$2,405.85 |
$2,405.85 |
$2,405.85 |
$3,427.50
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$208.50 |
$208.50 |
$208.50 |
$202.80
|
|
Venogram ext bil s&i
|
$1,931.40 |
$1,931.40 |
$1,931.40 |
$1,797.50
|
|
Venogram extremity supervision & interpretation unilateral
|
$1,448.70 |
$1,448.70 |
$1,448.70 |
$1,366.20
|
|
Venous mech thrombectomy
|
$8,611.50 |
$8,611.50 |
$8,611.50 |
$7,965.00
|
|
Venous m-thrombectomy add-on
|
$5,094.75 |
$5,094.75 |
$5,094.75 |
$5,094.75
|
|
Venous sampling s&i
|
$3,267.30 |
$3,267.30 |
$3,267.30 |
$4,193.20
|
|
Ventilator each subsequent day
|
$1,915.20 |
$1,915.20 |
$1,915.20 |
$1,204.00
|
|
Ventilator initial day
|
$3,143.25 |
$3,143.25 |
$3,143.25 |
$1,431.43
|
|
Version cephalic external
|
$1,907.85 |
$1,907.85 |
$1,907.85 |
$2,361.75
|
|
Verteporfin injection
|
$3,385.23 |
$3,385.23 |
$3,385.23 |
$3,077.48
|
|
Very long chain fatty acids
|
$315.30 |
$315.30 |
$315.30 |
$139.88
|
|
Vinblastine 1 mg/ml intravenous solution
|
$125.80 |
$125.80 |
$125.80 |
$165.00
|
|
Vincristine 1 mg/ml intravenous solution
|
$75.86 |
$75.86 |
$75.86 |
$87.15
|
|
Vinorelbine 10 mg/ml intravenous solution (wrapper)
|
$248.40 |
$248.40 |
$248.40 |
$223.55
|
|
Virus isolation addl studies ea
|
$119.10 |
$119.10 |
$119.10 |
$77.50
|
|
Vitamin b-12
|
$177.60 |
$177.60 |
$177.60 |
$100.00
|
