|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$493.50 |
$493.50 |
$493.50 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$276.50 |
$276.50 |
$276.50 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$259.00 |
$259.00 |
$259.00 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$465.50 |
$465.50 |
$465.50 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$35.50 |
$35.50 |
$35.50 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$436.50 |
$436.50 |
$436.50 |
$486.50
|
|
Ultrasound scrotum and contents
|
$440.50 |
$440.50 |
$440.50 |
$608.90
|
|
Ultrasound transvaginal non obstetric
|
$440.50 |
$440.50 |
$440.50 |
$558.35
|
|
Unlisted hematology&coagj px
|
$18.00 |
$18.00 |
$18.00 |
$39.52
|
|
Unlisted maaa
|
$587.00 |
$587.00 |
$587.00 |
$235.20
|
|
Unlisted muscskel px head
|
$109.50 |
$109.50 |
$109.50 |
$478.46
|
|
Unlisted px abdomen muscskel
|
$133.50 |
$133.50 |
$133.50 |
$1,848.60
|
|
Unlisted px conjunctiva
|
$387.00 |
$387.00 |
$387.00 |
$479.62
|
|
Unlisted px small intestine
|
$333.50 |
$333.50 |
$333.50 |
$2,102.10
|
|
Unlisted spec derm svc/px
|
$113.00 |
$113.00 |
$113.00 |
$223.08
|
|
Unlisted urinalysis px
|
$23.50 |
$23.50 |
$23.50 |
$25.72
|
|
Upgrade pm system
|
$4,157.00 |
$4,157.00 |
$4,157.00 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,854.50 |
$1,854.50 |
$1,854.50 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,205.50 |
$1,205.50 |
$1,205.50 |
$2,034.41
|
|
Upper Endoscopy (EGD, with biopsy)
|
$140.50 |
$140.50 |
$140.50 |
$1,768.00
|
|
Urea nitrogen
|
$39.00 |
$39.00 |
$39.00 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$29.50 |
$29.50 |
$29.50 |
$51.75
|
|
Uric acid blood
|
$42.50 |
$42.50 |
$42.50 |
$48.75
|
|
Uric acid urine
|
$29.50 |
$29.50 |
$29.50 |
$44.33
|
|
Urinalysis microscopic only
|
$21.00 |
$21.00 |
$21.00 |
$26.35
|
|
Urinalysis (with microscopy)
|
$33.00 |
$33.00 |
$33.00 |
$55.00
|
|
Urinalysis (without microscopy)
|
$19.00 |
$19.00 |
$19.00 |
$35.75
|
|
Urine Culture Test
|
$66.50 |
$66.50 |
$66.50 |
$81.50
|
|
Urine flow measurement 51736
|
$10.00 |
$10.00 |
$10.00 |
$210.00
|
|
Urine pregnancy test
|
$41.00 |
$41.00 |
$41.00 |
$67.20
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$186.00 |
$186.00 |
$186.00 |
$224.25
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$169.50 |
$169.50 |
$169.50 |
$209.40
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$150.50 |
$150.50 |
$150.50 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$67.50 |
$67.50 |
$67.50 |
$123.20
|
|
Vaccine dtap < 7 years im
|
$41.00 |
$41.00 |
$41.00 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$94.50 |
$94.50 |
$94.50 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$86.00 |
$86.00 |
$86.00 |
$105.95
|
|
Vaccine dtap-ipv/hib im
|
$159.00 |
$159.00 |
$159.00 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$41.50 |
$41.50 |
$41.50 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$18.50 |
$18.50 |
$18.50 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$102.00 |
$102.00 |
$102.00 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$143.00 |
$143.00 |
$143.00 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$49.00 |
$49.00 |
$49.00 |
$79.15
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$69.50 |
$69.50 |
$69.50 |
$84.75
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$69.50 |
$69.50 |
$69.50 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$190.00 |
$190.00 |
$190.00 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$33.00 |
$33.00 |
$33.00 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$435.50 |
$435.50 |
$435.50 |
$576.48
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$119.00 |
$119.00 |
$119.00 |
$143.20
|
|
Vaccine influenza inactivated adjuvant im
|
$109.50 |
$109.50 |
$109.50 |
$109.50
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$29.00 |
$29.00 |
$29.00 |
$47.88
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$48.50 |
$48.50 |
$48.50 |
$76.50
|
|
Vaccine influenza trivalent (iiv3) 0.25ml dose im
|
$14.50 |
$14.50 |
$14.50 |
$31.20
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$229.00 |
$229.00 |
$229.00 |
$400.03
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$254.50 |
$254.50 |
$254.50 |
$409.35
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$220.50 |
$220.50 |
$220.50 |
$310.93
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$156.50 |
$156.50 |
$156.50 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$129.00 |
$129.00 |
$129.00 |
$211.68
|
|
Vaccine mmrv live subcutaneous
|
$404.00 |
$404.00 |
$404.00 |
$424.32
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$158.00 |
$158.00 |
$158.00 |
$251.64
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$272.50 |
$272.50 |
$272.50 |
$414.46
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$363.50 |
$363.50 |
$363.50 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$61.50 |
$61.50 |
$61.50 |
$90.70
|
|
Vaccine rabies im
|
$609.00 |
$609.00 |
$609.00 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$406.00 |
$406.00 |
$406.00 |
$538.84
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$789.00 |
$789.00 |
$789.00 |
$1,104.47
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$789.00 |
$789.00 |
$789.00 |
$997.44
|
|
Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im
|
$342.00 |
$342.00 |
$342.00 |
$499.62
|
|
Vaccine rotavirus attenuated (rv1) live 2 dose oral
|
$154.50 |
$154.50 |
$154.50 |
$200.70
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$126.50 |
$126.50 |
$126.50 |
$126.14
|
|
Vaccine tdap >=7 years im
|
$68.00 |
$68.00 |
$68.00 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$69.50 |
$69.50 |
$69.50 |
$112.10
|
|
Vaccine typhoid vicps im
|
$212.50 |
$212.50 |
$212.50 |
$264.78
|
|
Vaccine varicella live subcutaneous
|
$274.00 |
$274.00 |
$274.00 |
$365.17
|
|
Vaccine yellow fever live subcutaneous
|
$308.50 |
$308.50 |
$308.50 |
$418.46
|
|
Vaginal bx
|
$58.50 |
$58.50 |
$58.50 |
$455.94
|
|
Vaginal delivery after cesarean delivery 59612
|
$3,160.00 |
$3,160.00 |
$3,160.00 |
$3,843.60
|
|
Valproic acid total therapeutic drug level
|
$74.50 |
$74.50 |
$74.50 |
$114.72
|
|
Valrubicin injection
|
$2,044.00 |
$2,044.00 |
$2,044.00 |
$2,813.49
|
|
Vancomycin 1,000 mg intravenous injection
|
$0.50 |
$0.50 |
$0.50 |
$251.86
|
|
Vancomycin peak therapeutic drug level
|
$74.50 |
$74.50 |
$74.50 |
$136.13
|
|
Varicella zoster antibody igg
|
$41.00 |
$41.00 |
$41.00 |
$86.80
|
|
Vasectomy
|
$2,002.50 |
$2,002.50 |
$2,002.50 |
$2,424.12
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$449.50 |
$449.50 |
$449.50 |
$202.80
|
|
Venipuncture <3 yrs other vein
|
$9.00 |
$9.00 |
$9.00 |
$67.00
|
|
Ventilator each subsequent day
|
$866.50 |
$866.50 |
$866.50 |
$1,204.00
|
|
Ventilator initial day
|
$874.50 |
$874.50 |
$874.50 |
$1,431.43
|
|
Verteporfin injection
|
$13.00 |
$13.00 |
$13.00 |
$3,077.48
|
|
Visit established high 40-54 minutes/level 5
|
$103.50 |
$103.50 |
$103.50 |
$227.50
|
|
Visual audiometry (vra)
|
$33.00 |
$33.00 |
$33.00 |
$215.25
|
|
Vital capacity test
|
$4.00 |
$4.00 |
$4.00 |
$170.00
|
|
Vitamin b-12
|
$92.50 |
$92.50 |
$92.50 |
$100.00
|
|
Vitamin D Test
|
$71.50 |
$71.50 |
$71.50 |
$132.00
|
|
Voriconazole in ns IV syringe 5 mg/ml (pediatric) - cnr
|
$1.50 |
$1.50 |
$1.50 |
$165.81
|
|
Warde 1003990 aldosterone
|
$26.00 |
$26.00 |
$26.00 |
$144.73
|
|
Warde 1005020 citrate 24 hour urine
|
$56.50 |
$56.50 |
$56.50 |
$97.50
|
|
Warde 1005055 5-hiaa 24 hour urine
|
$49.00 |
$49.00 |
$49.00 |
$63.50
|
|
Warde 1006955 catecholamines fractionated 24 hour urine
|
$20.50 |
$20.50 |
$20.50 |
$113.10
|
|
Warde 1007138 vanillymandelic acid 24 hour urine
|
$5.00 |
$5.00 |
$5.00 |
$70.85
|
|
Warde 1015200 kappa light chain free
|
$182.00 |
$182.00 |
$182.00 |
$65.20
|
