|
Upper Arm (Humerus) X-ray (left side)
|
$71.53 |
$285.00 |
$832.50 |
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$549.24 |
$1,810.50 |
$10,527.00 |
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$422.70 |
$1,608.50 |
$10,101.00 |
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$656.19 |
$3,315.50 |
$17,753.00 |
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$624.68 |
$2,644.00 |
$9,731.00 |
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$593.63 |
$2,000.00 |
$11,850.00 |
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$64.63 |
$362.50 |
$1,596.00 |
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$67.85 |
$360.50 |
$2,216.00 |
|
|
Upper Endoscopy (EGD, diagnostic)
|
$418.83 |
$1,484.00 |
$12,776.58 |
|
|
Upper Endoscopy (EGD, with biopsy)
|
$377.43 |
$1,484.00 |
$16,699.27 |
|
|
Upper ext fx orthosis rad/ul
|
$232.88 |
$232.88 |
$232.88 |
|
|
Upper GI Barium X-ray (barium and gas)
|
$65.70 |
$852.50 |
$4,358.00 |
|
|
Upper GI Barium X-ray (barium only)
|
$69.30 |
$852.50 |
$3,840.00 |
|
|
Uppr gi scope w/submuc inj
|
$5,782.99 |
$6,437.46 |
$18,984.56 |
|
|
Urea nitrogen
|
$6.67 |
$61.50 |
$425.40 |
|
|
Urea nitrogen 24 hour urine
|
$7.95 |
$80.50 |
$651.38 |
|
|
Urea nitrogen clearance
|
$19.50 |
$105.50 |
$106.00 |
|
|
Ureteral embolization/occl
|
$1,514.00 |
$1,567.50 |
$7,771.00 |
|
|
Ureteral reflux study
|
$179.17 |
$854.00 |
$995.00 |
|
|
Ureter endoscopy & treatment
|
$30,099.50 |
$30,099.50 |
$30,099.50 |
|
|
Urethrcystgrphy rtrgrde s&i
|
$119.55 |
$513.50 |
$3,289.00 |
|
|
Urethrocystography void s&i
|
$119.55 |
$525.00 |
$3,473.00 |
|
|
Uric acid blood
|
$7.95 |
$72.00 |
$356.00 |
|
|
Uric acid urine
|
$8.28 |
$43.20 |
$261.00 |
|
|
Urinalysis microscopic only
|
$5.06 |
$22.00 |
$43.20 |
|
|
Urinalysis qual/semiquant excpt ia
|
$3.75 |
$3.91 |
$28.00 |
|
|
Urinalysis (with microscopy)
|
$5.52 |
$89.50 |
$1,158.00 |
|
|
Urinalysis (without microscopy)
|
$3.90 |
$34.20 |
$172.00 |
|
|
Urinary bldr retent nuc study
|
$207.50 |
$207.50 |
$207.50 |
|
|
Urinary pouch w/barrier
|
$5.70 |
$5.70 |
$46.00 |
|
|
Urine Culture Test
|
$13.80 |
$112.50 |
$744.58 |
|
|
Urine flow measurement 51736
|
$54.75 |
$54.75 |
$54.75 |
|
|
Urine ost pouch w faucet/tap
|
$70.00 |
$70.00 |
$70.00 |
|
|
Urine pregnancy test
|
$10.81 |
$113.70 |
$515.00 |
|
|
Urography, antegrade
|
$119.55 |
$518.00 |
$987.00 |
|
|
Urography inf drip &/or bolus
|
$119.55 |
$946.00 |
$2,240.16 |
|
|
Use 1st target lesion
|
$152.10 |
$332.00 |
$1,011.00 |
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$3,121.00 |
$15,897.38 |
$24,418.37 |
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$23,612.70 |
$69,089.01 |
$83,956.27 |
|
|
Vaccine Administration (one shot)
|
$20.50 |
$48.00 |
$952.00 |
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$60.38 |
$72.96 |
$175.20 |
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$72.96 |
$76.61 |
$175.20 |
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$65.55 |
$68.83 |
$157.20 |
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$43.89 |
$46.08 |
$105.60 |
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$32.68 |
$34.32 |
$78.60 |
|
|
Vaccine dtap < 7 years im
|
$29.33 |
$110.97 |
$596.00 |
|
|
Vaccine dtap-hep b-ipv im
|
$50.06 |
$50.06 |
$512.92 |
|
|
Vaccine dtap-ipv 4-6 years im
|
$61.80 |
$61.80 |
$226.16 |
|
|
Vaccine dtap-ipv-hib-hepb im
|
$109.42 |
$113.98 |
$145.20 |
|
|
Vaccine dtap-ipv/hib im
|
$444.00 |
$613.44 |
$1,376.40 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$29.40 |
$358.59 |
$1,944.00 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$24.22 |
$50.27 |
$1,773.00 |
|
|
Vaccine hepatitis a (hepa) adult im
|
$84.60 |
$355.00 |
$2,425.00 |
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$75.00 |
$87.60 |
$2,048.00 |
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$25.80 |
$210.00 |
$413.21 |
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$46.20 |
$97.20 |
$884.00 |
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$176.53 |
$176.53 |
$584.06 |
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$0.01 |
$57.36 |
$308.00 |
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$155.40 |
$986.90 |
$2,660.00 |
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$114.60 |
$114.60 |
$114.60 |
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$47.45 |
$217.00 |
$877.48 |
|
|
Vaccine influenza inactivated adjuvant im
|
$67.80 |
$67.80 |
$426.84 |
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$10.71 |
$60.75 |
$259.38 |
|
|
Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im
|
$40.80 |
$81.00 |
$81.00 |
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$16.20 |
$23.12 |
$99.00 |
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$63.60 |
$63.60 |
$63.60 |
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$58.78 |
$58.78 |
$58.78 |
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$251.06 |
$290.32 |
$1,173.77 |
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$600.00 |
$665.00 |
$1,762.56 |
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$295.00 |
$1,547.64 |
$5,647.00 |
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$164.74 |
$625.31 |
$825.41 |
|
|
Vaccine mmr live subcutaneous
|
$61.76 |
$367.46 |
$2,075.00 |
|
|
Vaccine mmrv live subcutaneous
|
$87.60 |
$87.60 |
$87.60 |
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$130.80 |
$579.00 |
$1,203.12 |
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$222.60 |
$326.57 |
$516.40 |
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$972.49 |
$1,714.00 |
$2,265.00 |
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$159.00 |
$359.12 |
$1,104.52 |
|
|
Vaccine polio (ipv) subcutaneous/im
|
$26.40 |
$38.55 |
$1,207.00 |
|
|
Vaccine rabies im
|
$411.38 |
$1,564.60 |
$6,593.00 |
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$211.80 |
$343.10 |
$343.10 |
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$163.80 |
$688.81 |
$3,499.00 |
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$327.60 |
$702.05 |
$3,499.00 |
|
|
Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im
|
$195.60 |
$195.60 |
$195.60 |
|
|
Vaccine tdap >=7 years im
|
$41.40 |
$182.80 |
$1,003.42 |
|
|
Vaccine td preservative free >= 7 years im
|
$32.78 |
$158.42 |
$905.00 |
|
|
Vaccine typhoid vicps im
|
$129.60 |
$129.60 |
$129.60 |
|
|
Vaccine varicella live subcutaneous
|
$128.40 |
$749.25 |
$1,862.00 |
|
|
Vacuum drain bottle/tube kit
|
$2,760.00 |
$2,760.00 |
$2,760.00 |
|
|
Vad battery clip set hmii 14-v li-ion
|
$1,270.46 |
$1,270.46 |
$21,949.00 |
|
|
Vad cable power module dc input
|
$235.98 |
$235.98 |
$289.00 |
|
|
Vad univ batt charger hm 1440
|
$8,314.68 |
$8,588.50 |
$31,906.05 |
|
|
Vag hyst including t/o
|
$25,466.60 |
$25,466.60 |
$25,466.60 |
|
|
Vaginal bx
|
$32.00 |
$246.60 |
$20,921.22 |
|
|
Vaginal hysterectomy
|
$17,096.18 |
$20,007.05 |
$20,837.58 |
|
|
Valproate in ns IV syringe 10 mg/ml (pediatric) - cnr
|
$27.34 |
$62.58 |
$999.00 |
|
|
Valproic acid total therapeutic drug level
|
$23.46 |
$171.00 |
$790.17 |
|
|
Valvuloplasty aortic
|
$3,626.40 |
$5,575.50 |
$6,018.50 |
|
|
Valvuloplasty mitral
|
$4,357.65 |
$6,931.50 |
$22,119.60 |
|
|
Valvuloplasty pulmonary
|
$5,575.50 |
$9,716.50 |
$10,645.00 |
|
|
Vancomycin 1,000 mg intravenous injection
|
$38.95 |
$385.20 |
$2,887.88 |
|
