|
Tx closed hip disl traumatic without anes
|
$547.20 |
$547.20 |
$547.20 |
$657.28
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$5,618.40 |
$5,618.40 |
$5,618.40 |
$3,874.79
|
|
Tx closed tib shaft fx without manip
|
$504.48 |
$504.48 |
$504.48 |
$635.46
|
|
Tx l/r atrial fib addl
|
$13,690.08 |
$13,690.08 |
$13,690.08 |
$7,717.80
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$4,885.44 |
$4,885.44 |
$4,885.44 |
$4,449.44
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$8,207.04 |
$8,207.04 |
$8,207.04 |
$4,499.12
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$8,207.04 |
$8,207.04 |
$8,207.04 |
$4,281.00
|
|
Tx open nsl fx uncomp
|
$7,947.84 |
$7,947.84 |
$7,947.84 |
$4,007.22
|
|
Tx open nsl sptl fx
|
$4,893.60 |
$4,893.60 |
$4,893.60 |
$4,289.04
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$8,207.04 |
$8,207.04 |
$8,207.04 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$475.68 |
$475.68 |
$475.68 |
$469.20
|
|
Ultrasound abdomen aorta screening study aaa
|
$218.40 |
$218.40 |
$218.40 |
$403.26
|
|
Ultrasound breast complete
|
$525.12 |
$525.12 |
$525.12 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$469.44 |
$469.44 |
$469.44 |
$449.35
|
|
Ultrasound chest
|
$524.16 |
$524.16 |
$524.16 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$305.76 |
$305.76 |
$305.76 |
$340.14
|
|
Ultrasound dx ophth b-scan
|
$135.84 |
$135.84 |
$135.84 |
$330.40
|
|
Ultrasound elastography parenchyma
|
$326.88 |
$326.88 |
$326.88 |
$284.25
|
|
Ultrasound encephalogram
|
$327.84 |
$327.84 |
$327.84 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$344.16 |
$344.16 |
$344.16 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$396.00 |
$396.00 |
$396.00 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$173.76 |
$173.76 |
$173.76 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$634.08 |
$634.08 |
$634.08 |
$701.35
|
|
Ultrasound guide intraoperative
|
$931.20 |
$931.20 |
$931.20 |
$632.90
|
|
Ultrasound guide tissue ablation
|
$634.08 |
$634.08 |
$634.08 |
$498.40
|
|
Ultrasound hips infant dynamic
|
$499.68 |
$499.68 |
$499.68 |
$403.00
|
|
Ultrasound infant hips ltd without stress
|
$416.16 |
$416.16 |
$416.16 |
$321.35
|
|
Ultrasound joint complete left
|
$633.60 |
$633.60 |
$633.60 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$521.28 |
$521.28 |
$521.28 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$825.60 |
$825.60 |
$825.60 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$548.16 |
$548.16 |
$548.16 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$657.60 |
$657.60 |
$657.60 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$604.80 |
$604.80 |
$604.80 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$445.44 |
$445.44 |
$445.44 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$542.88 |
$542.88 |
$542.88 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$548.64 |
$548.64 |
$548.64 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$260.64 |
$260.64 |
$260.64 |
$498.00
|
|
Ultrasound scrotum and contents
|
$831.36 |
$831.36 |
$831.36 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$327.84 |
$327.84 |
$327.84 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$1,271.04 |
$1,271.04 |
$1,271.04 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$754.56 |
$754.56 |
$754.56 |
$567.44
|
|
Umbilical artery cath newborn 36660
|
$104.16 |
$104.16 |
$104.16 |
$265.85
|
|
Unlisted chemotherapy px
|
$106.56 |
$106.56 |
$106.56 |
$153.85
|
|
Unlisted CT procedure
|
$2,418.24 |
$2,418.24 |
$2,418.24 |
$1,043.00
|
|
Unlisted fluoroscopic px
|
$1,269.60 |
$1,269.60 |
$1,269.60 |
$324.85
|
|
Unlisted misc path test
|
$106.08 |
$106.08 |
$106.08 |
$89.40
|
|
Unlisted mr procedure
|
$2,382.24 |
$2,382.24 |
$2,382.24 |
$1,032.20
|
|
Unlisted procedure rectum
|
$1,537.44 |
$1,537.44 |
$1,537.44 |
$1,278.72
|
|
Unlisted px hands/fingers
|
$547.20 |
$547.20 |
$547.20 |
$379.44
|
|
Unlisted px neck/thorax
|
$437.76 |
$437.76 |
$437.76 |
$2,680.22
|
|
Unlisted px pelvis/hip joint
|
$486.24 |
$486.24 |
$486.24 |
$2,108.82
|
|
Unlisted px salivry glnd/dux
|
$486.72 |
$486.72 |
$486.72 |
$486.72
|
|
Unlisted px small intestine
|
$3,611.04 |
$3,611.04 |
$3,611.04 |
$2,118.35
|
|
Unlisted transfusion med px
|
$108.00 |
$108.00 |
$108.00 |
$141.35
|
|
Unlisted ultrasound procedure
|
$125.76 |
$125.76 |
$125.76 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$1,951.20 |
$1,951.20 |
$1,951.20 |
$1,469.76
|
|
Upgrade pm system
|
$3,962.40 |
$3,962.40 |
$3,962.40 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,677.12 |
$4,677.12 |
$4,677.12 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,194.40 |
$3,194.40 |
$3,194.40 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,637.60 |
$2,637.60 |
$2,637.60 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,352.16 |
$1,352.16 |
$1,352.16 |
$1,588.59
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,352.16 |
$1,352.16 |
$1,352.16 |
$1,656.60
|
|
Urea nitrogen
|
$61.92 |
$61.92 |
$61.92 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$59.04 |
$59.04 |
$59.04 |
$50.00
|
|
Ureteral embolization/occl
|
$3,574.08 |
$3,574.08 |
$3,574.08 |
$3,041.22
|
|
Urethrcystgrphy rtrgrde s&i
|
$350.40 |
$350.40 |
$350.40 |
$574.40
|
|
Urethrocystography void s&i
|
$350.40 |
$350.40 |
$350.40 |
$634.50
|
|
Uric acid blood
|
$61.92 |
$61.92 |
$61.92 |
$46.64
|
|
Uric acid urine
|
$59.04 |
$59.04 |
$59.04 |
$46.75
|
|
Urinalysis microscopic only
|
$33.12 |
$33.12 |
$33.12 |
$26.35
|
|
Urinalysis (with microscopy)
|
$94.56 |
$94.56 |
$94.56 |
$48.14
|
|
Urinalysis (without microscopy)
|
$78.24 |
$78.24 |
$78.24 |
$38.99
|
|
Urine Culture Test
|
$204.48 |
$204.48 |
$204.48 |
$84.81
|
|
Urine pregnancy test
|
$48.96 |
$48.96 |
$48.96 |
$66.40
|
|
Urography, antegrade
|
$586.08 |
$586.08 |
$586.08 |
$593.37
|
|
Vaccine dtap < 7 years im
|
$97.43 |
$97.43 |
$97.43 |
$87.80
|
|
Vaccine dtap-ipv/hib im
|
$242.83 |
$242.83 |
$242.83 |
$248.80
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$49.50 |
$49.50 |
$49.50 |
$45.33
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$180.23 |
$180.23 |
$180.23 |
$173.98
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$77.46 |
$77.46 |
$77.46 |
$79.04
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$103.88 |
$103.88 |
$103.88 |
$103.88
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$619.21 |
$619.21 |
$619.21 |
$499.00
|
|
Vaccine mmr live subcutaneous
|
$287.76 |
$287.76 |
$287.76 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$360.57 |
$360.57 |
$360.57 |
$274.95
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$715.41 |
$715.41 |
$715.41 |
$715.41
|
|
Vaccine rabies im
|
$1,360.90 |
$1,360.90 |
$1,360.90 |
$945.46
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$869.57 |
$869.57 |
$869.57 |
$624.00
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$1,568.70 |
$1,568.70 |
$1,568.70 |
$1,196.00
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$257.16 |
$257.16 |
$257.16 |
$108.00
|
|
Vaccine tdap >=7 years im
|
$163.84 |
$163.84 |
$163.84 |
$150.76
|
|
Vaccine varicella live subcutaneous
|
$454.90 |
$454.90 |
$454.90 |
$447.80
|
|
Vad battery clip set hmii 14-v li-ion
|
$1,710.72 |
$1,710.72 |
$1,710.72 |
$1,683.99
|
|
Vad univ batt charger hm 1440
|
$18,289.15 |
$18,289.15 |
$18,289.15 |
$14,893.34
|
|
Vaginal bx
|
$425.28 |
$425.28 |
$425.28 |
$441.75
|
|
Vaginal delivery after cesarean delivery 59612
|
$4,107.36 |
$4,107.36 |
$4,107.36 |
$4,109.28
|
|
Valproic acid total therapeutic drug level
|
$59.04 |
$59.04 |
$59.04 |
$115.00
|
|
Valvuloplasty aortic
|
$1,962.72 |
$1,962.72 |
$1,962.72 |
$7,324.85
|
|
Vancomycin 1,000 mg intravenous injection
|
$273.20 |
$273.20 |
$273.20 |
$246.70
|
|
Vancomycin 750 mg intravenous solution
|
$91.21 |
$91.21 |
$91.21 |
$100.15
|
|
Vancomycin peak therapeutic drug level
|
$96.00 |
$96.00 |
$96.00 |
$126.79
|
