|
Upgrade pm system
|
$6,651.20 |
$6,651.20 |
$6,651.20 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,588.80 |
$1,588.80 |
$1,588.80 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$969.60 |
$969.60 |
$969.60 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$806.40 |
$806.40 |
$806.40 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$2,284.80 |
$2,284.80 |
$2,284.80 |
$1,768.00
|
|
Uppr gi scope w/submuc inj
|
$224.80 |
$224.80 |
$224.80 |
$1,872.00
|
|
Urachal cyst/sinus excision 51500
|
$1,056.80 |
$1,056.80 |
$1,056.80 |
$6,082.67
|
|
Urea nitrogen
|
$9.60 |
$9.60 |
$9.60 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$17.60 |
$17.60 |
$17.60 |
$51.75
|
|
Urethrlys transvag with scope
|
$1,239.20 |
$1,239.20 |
$1,239.20 |
$4,081.37
|
|
Uric acid blood
|
$10.40 |
$10.40 |
$10.40 |
$48.75
|
|
Uric acid urine
|
$16.00 |
$16.00 |
$16.00 |
$44.33
|
|
Urinalysis microscopic only
|
$4.80 |
$4.80 |
$4.80 |
$26.35
|
|
Urinalysis (with microscopy)
|
$20.80 |
$20.80 |
$20.80 |
$55.00
|
|
Urinalysis (without microscopy)
|
$10.40 |
$10.40 |
$10.40 |
$35.75
|
|
Urine Culture Test
|
$40.00 |
$40.00 |
$40.00 |
$81.50
|
|
Urine flow measurement 51736
|
$16.00 |
$16.00 |
$16.00 |
$210.00
|
|
Urine pregnancy test
|
$17.60 |
$17.60 |
$17.60 |
$67.20
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$297.60 |
$297.60 |
$297.60 |
$224.25
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$271.20 |
$271.20 |
$271.20 |
$209.40
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$240.80 |
$240.80 |
$240.80 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$108.00 |
$108.00 |
$108.00 |
$123.20
|
|
Vaccine dtap < 7 years im
|
$65.60 |
$65.60 |
$65.60 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$151.20 |
$151.20 |
$151.20 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$137.60 |
$137.60 |
$137.60 |
$105.95
|
|
Vaccine dtap-ipv/hib im
|
$254.40 |
$254.40 |
$254.40 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$66.40 |
$66.40 |
$66.40 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$29.60 |
$29.60 |
$29.60 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$163.20 |
$163.20 |
$163.20 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$228.80 |
$228.80 |
$228.80 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$78.40 |
$78.40 |
$78.40 |
$79.15
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$111.20 |
$111.20 |
$111.20 |
$84.75
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$111.20 |
$111.20 |
$111.20 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$304.00 |
$304.00 |
$304.00 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$52.80 |
$52.80 |
$52.80 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$696.80 |
$696.80 |
$696.80 |
$576.48
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$190.40 |
$190.40 |
$190.40 |
$143.20
|
|
Vaccine influenza inactivated adjuvant im
|
$175.20 |
$175.20 |
$175.20 |
$109.50
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$46.40 |
$46.40 |
$46.40 |
$47.88
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$77.60 |
$77.60 |
$77.60 |
$76.50
|
|
Vaccine influenza trivalent (iiv3) 0.25ml dose im
|
$23.20 |
$23.20 |
$23.20 |
$31.20
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$366.40 |
$366.40 |
$366.40 |
$400.03
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$407.20 |
$407.20 |
$407.20 |
$409.35
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$352.80 |
$352.80 |
$352.80 |
$310.93
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$250.40 |
$250.40 |
$250.40 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$206.40 |
$206.40 |
$206.40 |
$211.68
|
|
Vaccine mmrv live subcutaneous
|
$646.40 |
$646.40 |
$646.40 |
$424.32
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$252.80 |
$252.80 |
$252.80 |
$251.64
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$436.00 |
$436.00 |
$436.00 |
$414.46
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$581.60 |
$581.60 |
$581.60 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$98.40 |
$98.40 |
$98.40 |
$90.70
|
|
Vaccine rabies im
|
$974.40 |
$974.40 |
$974.40 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$649.60 |
$649.60 |
$649.60 |
$538.84
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$1,262.40 |
$1,262.40 |
$1,262.40 |
$1,104.47
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$1,262.40 |
$1,262.40 |
$1,262.40 |
$997.44
|
|
Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im
|
$547.20 |
$547.20 |
$547.20 |
$499.62
|
|
Vaccine rotavirus attenuated (rv1) live 2 dose oral
|
$247.20 |
$247.20 |
$247.20 |
$200.70
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$202.40 |
$202.40 |
$202.40 |
$126.14
|
|
Vaccine tdap >=7 years im
|
$108.80 |
$108.80 |
$108.80 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$111.20 |
$111.20 |
$111.20 |
$112.10
|
|
Vaccine typhoid vicps im
|
$340.00 |
$340.00 |
$340.00 |
$264.78
|
|
Vaccine varicella live subcutaneous
|
$438.40 |
$438.40 |
$438.40 |
$365.17
|
|
Vaccine yellow fever live subcutaneous
|
$493.60 |
$493.60 |
$493.60 |
$418.46
|
|
Vag hys/<250g/rmv tube/rpr entero 58263
|
$1,632.00 |
$1,632.00 |
$1,632.00 |
$5,345.59
|
|
Vag hyst incl t/o complex
|
$2,041.60 |
$2,041.60 |
$2,041.60 |
$5,735.60
|
|
Vag hyst including t/o
|
$1,520.00 |
$1,520.00 |
$1,520.00 |
$4,827.18
|
|
Vag hyst w/enterocele repair
|
$6,418.40 |
$6,418.40 |
$6,418.40 |
$5,468.70
|
|
Vaginal delivery after cesarean delivery 59612
|
$5,247.20 |
$5,247.20 |
$5,247.20 |
$3,843.60
|
|
Vaginal Delivery (full care)
|
$4,184.00 |
$4,184.00 |
$4,184.00 |
$4,263.60
|
|
Vaginal hysterectomy
|
$7,488.00 |
$7,488.00 |
$7,488.00 |
$5,766.00
|
|
Valproic acid total therapeutic drug level
|
$20.80 |
$20.80 |
$20.80 |
$114.72
|
|
Valrubicin injection
|
$3,270.40 |
$3,270.40 |
$3,270.40 |
$2,813.49
|
|
Vancomycin 1,000 mg intravenous injection
|
$27.78 |
$27.78 |
$27.78 |
$251.86
|
|
Vancomycin 750 mg intravenous solution
|
$25.64 |
$25.64 |
$25.64 |
$90.33
|
|
Vancomycin hcl injection
|
$8.91 |
$8.91 |
$8.91 |
$154.40
|
|
Vancomycin peak therapeutic drug level
|
$25.60 |
$25.60 |
$25.60 |
$136.13
|
|
Varicella zoster antibody igg
|
$117.60 |
$117.60 |
$117.60 |
$86.80
|
|
Vasectomy
|
$388.00 |
$388.00 |
$388.00 |
$2,424.12
|
|
Vbac/include postpartum care 59614
|
$2,087.20 |
$2,087.20 |
$2,087.20 |
$2,285.60
|
|
Vedolizumab 300 mg intravenous solution
|
$20,799.79 |
$20,799.79 |
$20,799.79 |
$18,732.33
|
|
Vein bypass grft fem-popliteal 35583
|
$2,525.60 |
$2,525.60 |
$2,525.60 |
$3,013.56
|
|
Vein byp fem-tibial peroneal 35585
|
$2,931.20 |
$2,931.20 |
$2,931.20 |
$2,931.20
|
|
Vein byp pop-tibl peroneal
|
$2,359.20 |
$2,359.20 |
$2,359.20 |
$6,646.40
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$20.80 |
$20.80 |
$20.80 |
$202.80
|
|
Venipuncture <3 yrs other vein
|
$14.40 |
$14.40 |
$14.40 |
$67.00
|
|
Venous mech thrombectomy
|
$656.00 |
$656.00 |
$656.00 |
$7,965.00
|
|
Venous m-thrombectomy add-on
|
$477.60 |
$477.60 |
$477.60 |
$5,094.75
|
|
Ventilator each subsequent day
|
$976.80 |
$976.80 |
$976.80 |
$1,204.00
|
|
Ventilator initial day
|
$976.80 |
$976.80 |
$976.80 |
$1,431.43
|
|
Verteporfin injection
|
$20.80 |
$20.80 |
$20.80 |
$3,077.48
|
|
Very long chain fatty acids
|
$252.00 |
$252.00 |
$252.00 |
$139.88
|
|
Vinblastine 1 mg/ml intravenous solution
|
$136.89 |
$136.89 |
$136.89 |
$165.00
|
|
Vincristine 1 mg/ml intravenous solution
|
$28.37 |
$28.37 |
$28.37 |
$87.15
|
|
Visc & infraren abd 1 prosth
|
$2,064.80 |
$2,064.80 |
$2,064.80 |
$9,715.02
|
|
Visc & infraren abd 2 prosth
|
$2,248.00 |
$2,248.00 |
$2,248.00 |
$10,796.94
|
|
Visc & infraren abd 3 prosth
|
$2,431.20 |
$2,431.20 |
$2,431.20 |
$11,878.86
|
|
Visc & infraren abd 4+ prost
|
$2,614.40 |
$2,614.40 |
$2,614.40 |
$10,660.00
|
|
Visit established high 40-54 minutes/level 5
|
$168.00 |
$168.00 |
$168.00 |
$227.50
|
|
Visual audiometry (vra)
|
$52.80 |
$52.80 |
$52.80 |
$215.25
|
|
Vital capacity test
|
$6.40 |
$6.40 |
$6.40 |
$170.00
|
