|
Tube trach disp innr can 5 xlt
|
$774.69 |
$774.69 |
$774.69 |
$460.58
|
|
Tx closed hip disl traumatic without anes
|
$1,629.96 |
$1,629.96 |
$1,629.96 |
$657.28
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$4,502.79 |
$4,502.79 |
$4,502.79 |
$3,874.79
|
|
Tx closed tib shaft fx without manip
|
$419.73 |
$419.73 |
$419.73 |
$635.46
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$6,026.16 |
$6,026.16 |
$6,026.16 |
$4,449.44
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$6,026.16 |
$6,026.16 |
$6,026.16 |
$4,499.12
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$6,026.16 |
$6,026.16 |
$6,026.16 |
$4,281.00
|
|
Tx open nsl fx uncomp
|
$5,759.94 |
$5,759.94 |
$5,759.94 |
$4,007.22
|
|
Tx open nsl sptl fx
|
$6,059.82 |
$6,059.82 |
$6,059.82 |
$4,289.04
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$6,026.16 |
$6,026.16 |
$6,026.16 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$419.73 |
$419.73 |
$419.73 |
$469.20
|
|
Ultrasound abdomen aorta screening study aaa
|
$1,466.76 |
$1,466.76 |
$1,466.76 |
$403.26
|
|
Ultrasound breast complete
|
$1,310.19 |
$1,310.19 |
$1,310.19 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$1,310.19 |
$1,310.19 |
$1,310.19 |
$449.35
|
|
Ultrasound chest
|
$1,969.62 |
$1,969.62 |
$1,969.62 |
$459.55
|
|
Ultrasound encephalogram
|
$3,201.78 |
$3,201.78 |
$3,201.78 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$946.56 |
$946.56 |
$946.56 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$2,175.15 |
$2,175.15 |
$2,175.15 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$1,909.95 |
$1,909.95 |
$1,909.95 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$2,919.24 |
$2,919.24 |
$2,919.24 |
$701.35
|
|
Ultrasound joint complete left
|
$2,047.65 |
$2,047.65 |
$2,047.65 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$2,047.65 |
$2,047.65 |
$2,047.65 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$3,655.68 |
$3,655.68 |
$3,655.68 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$799.68 |
$799.68 |
$799.68 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$2,837.64 |
$2,837.64 |
$2,837.64 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$4,427.82 |
$4,427.82 |
$4,427.82 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$2,037.45 |
$2,037.45 |
$2,037.45 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$2,894.25 |
$2,894.25 |
$2,894.25 |
$485.48
|
|
Ultrasound retroperitoneal limited
|
$1,771.74 |
$1,771.74 |
$1,771.74 |
$498.00
|
|
Ultrasound scrotum and contents
|
$2,313.87 |
$2,313.87 |
$2,313.87 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$1,429.02 |
$1,429.02 |
$1,429.02 |
$450.60
|
|
Ultrasound transvaginal non obstetric
|
$1,781.43 |
$1,781.43 |
$1,781.43 |
$567.44
|
|
Unlisted chemotherapy px
|
$54.57 |
$54.57 |
$54.57 |
$153.85
|
|
Unlisted misc path test
|
$104.04 |
$104.04 |
$104.04 |
$89.40
|
|
Unlisted mr procedure
|
$274.38 |
$274.38 |
$274.38 |
$1,032.20
|
|
Unlisted procedure larynx
|
$434.01 |
$434.01 |
$434.01 |
$4,350.00
|
|
Unlisted procedure microbiology
|
$571.71 |
$571.71 |
$571.71 |
$487.50
|
|
Unlisted procedure rectum
|
$5,599.29 |
$5,599.29 |
$5,599.29 |
$1,278.72
|
|
Unlisted px hands/fingers
|
$5,568.18 |
$5,568.18 |
$5,568.18 |
$379.44
|
|
Unlisted px salivry glnd/dux
|
$3,968.82 |
$3,968.82 |
$3,968.82 |
$486.72
|
|
Unlisted px small intestine
|
$1,680.96 |
$1,680.96 |
$1,680.96 |
$2,118.35
|
|
Unlisted ultrasound procedure
|
$1,969.62 |
$1,969.62 |
$1,969.62 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$10,251.00 |
$10,251.00 |
$10,251.00 |
$1,480.70
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$10,866.06 |
$10,866.06 |
$10,866.06 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$6,702.42 |
$6,702.42 |
$6,702.42 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$4,433.43 |
$4,433.43 |
$4,433.43 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,519.29 |
$1,519.29 |
$1,519.29 |
$1,588.59
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,519.29 |
$1,519.29 |
$1,519.29 |
$1,656.60
|
|
Urea nitrogen
|
$148.92 |
$148.92 |
$148.92 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$256.53 |
$256.53 |
$256.53 |
$50.00
|
|
Urea nitrogen clearance
|
$44.88 |
$44.88 |
$44.88 |
$33.57
|
|
Urethrocystography void s&i
|
$822.63 |
$822.63 |
$822.63 |
$634.50
|
|
Uric acid blood
|
$166.26 |
$166.26 |
$166.26 |
$46.64
|
|
Uric acid urine
|
$17.85 |
$17.85 |
$17.85 |
$46.75
|
|
Urinalysis microscopic only
|
$76.50 |
$76.50 |
$76.50 |
$26.35
|
|
Urinalysis (with microscopy)
|
$111.69 |
$111.69 |
$111.69 |
$48.14
|
|
Urinalysis (without microscopy)
|
$122.91 |
$122.91 |
$122.91 |
$38.99
|
|
Urine Culture Test
|
$288.66 |
$288.66 |
$288.66 |
$84.81
|
|
Urine pregnancy test
|
$28.05 |
$28.05 |
$28.05 |
$66.40
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$148.84 |
$148.84 |
$148.84 |
$223.08
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$148.84 |
$148.84 |
$148.84 |
$218.88
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$133.72 |
$133.72 |
$133.72 |
$239.85
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$89.54 |
$89.54 |
$89.54 |
$131.67
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$66.67 |
$66.67 |
$66.67 |
$91.00
|
|
Vaccine dtap < 7 years im
|
$148.55 |
$148.55 |
$148.55 |
$87.80
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 3 dose im
|
$152.16 |
$152.16 |
$152.16 |
$48.10
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$261.94 |
$261.94 |
$261.94 |
$173.98
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$444.65 |
$444.65 |
$444.65 |
$306.24
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$116.86 |
$116.86 |
$116.86 |
$79.04
|
|
Vaccine influenza inactivated adjuvant im
|
$244.43 |
$244.43 |
$244.43 |
$110.25
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$142.45 |
$142.45 |
$142.45 |
$103.88
|
|
Vaccine mmr live subcutaneous
|
$314.81 |
$314.81 |
$314.81 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$383.88 |
$383.88 |
$383.88 |
$274.95
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$720.50 |
$720.50 |
$720.50 |
$715.41
|
|
Vaccine rabies im
|
$950.54 |
$950.54 |
$950.54 |
$945.46
|
|
Vaccine tdap >=7 years im
|
$212.65 |
$212.65 |
$212.65 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$195.37 |
$195.37 |
$195.37 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$569.81 |
$569.81 |
$569.81 |
$447.80
|
|
Vad battery clip set hmii 14-v li-ion
|
$1,917.61 |
$1,917.61 |
$1,917.61 |
$1,683.99
|
|
Vad univ batt charger hm 1440
|
$24,032.51 |
$24,032.51 |
$24,032.51 |
$14,893.34
|
|
Vaginal bx
|
$4,734.33 |
$4,734.33 |
$4,734.33 |
$441.75
|
|
Vaginal delivery after cesarean delivery 59612
|
$10,898.19 |
$10,898.19 |
$10,898.19 |
$4,109.28
|
|
Valproic acid total therapeutic drug level
|
$225.93 |
$225.93 |
$225.93 |
$115.00
|
|
Vancomycin 1,000 mg intravenous injection
|
$676.55 |
$676.55 |
$676.55 |
$246.70
|
|
Vancomycin 750 mg intravenous solution
|
$130.18 |
$130.18 |
$130.18 |
$100.15
|
|
Vancomycin peak therapeutic drug level
|
$269.28 |
$269.28 |
$269.28 |
$126.79
|
|
Varicella zoster antibody igg
|
$140.25 |
$140.25 |
$140.25 |
$82.55
|
|
Vasopressin 20 unit/ml intravenous solution
|
$593.54 |
$593.54 |
$593.54 |
$362.93
|
|
Veeg cont 2-12 hrs
|
$1,402.50 |
$1,402.50 |
$1,402.50 |
$1,485.05
|
|
Veeg ea 12-26hr cont mntr
|
$2,805.00 |
$2,805.00 |
$2,805.00 |
$3,332.45
|
|
Veeg intrmnt 2-12 hrs
|
$673.20 |
$673.20 |
$673.20 |
$904.90
|
|
Veeg unmon 12-26 hrs
|
$1,402.50 |
$1,402.50 |
$1,402.50 |
$1,411.20
|
|
Veeg unmon 2-12 hrs
|
$673.20 |
$673.20 |
$673.20 |
$704.79
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$4,790.94 |
$4,790.94 |
$4,790.94 |
$188.65
|
|
Venipuncture <3 yrs other vein
|
$82.11 |
$82.11 |
$82.11 |
$82.11
|
|
Ventilator each subsequent day
|
$2,965.65 |
$2,965.65 |
$2,965.65 |
$1,305.92
|
|
Ventilator initial day
|
$3,967.80 |
$3,967.80 |
$3,967.80 |
$1,540.80
|
|
Ventricular puncture prev burr hole without inj 61020
|
$1,576.41 |
$1,576.41 |
$1,576.41 |
$1,081.00
|
|
Version cephalic external
|
$5,382.54 |
$5,382.54 |
$5,382.54 |
$2,598.57
|
|
Vest large holster
|
$1,392.42 |
$1,392.42 |
$1,392.42 |
$1,012.50
|
