|
Ultrasound joint complete left
|
$608.00 |
$608.00 |
$608.00 |
$557.99
|
|
Ultrasound ob >=14wks ea addl gest
|
$558.40 |
$558.40 |
$558.40 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$202.40 |
$202.40 |
$202.40 |
$334.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$611.20 |
$611.20 |
$611.20 |
$698.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$460.80 |
$460.80 |
$460.80 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$680.80 |
$680.80 |
$680.80 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$292.80 |
$292.80 |
$292.80 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$609.60 |
$609.60 |
$609.60 |
$419.50
|
|
Umbilical artery cath newborn 36660
|
$157.60 |
$157.60 |
$157.60 |
$223.80
|
|
Unlisted cranfcl&maxlfcl px
|
$5,912.00 |
$5,912.00 |
$5,912.00 |
$571.20
|
|
Unlisted dialysis procedure
|
$1,620.00 |
$1,620.00 |
$1,620.00 |
$1,144.00
|
|
Unlisted dx gi procedure
|
$1,432.00 |
$1,432.00 |
$1,432.00 |
$649.22
|
|
Unlisted fluoroscopic px
|
$400.00 |
$400.00 |
$400.00 |
$305.76
|
|
Unlisted mr procedure
|
$1,871.20 |
$1,871.20 |
$1,871.20 |
$1,165.00
|
|
Unlisted muscskel px head
|
$6,272.00 |
$6,272.00 |
$6,272.00 |
$1,224.08
|
|
Unlisted neurological dx px
|
$804.80 |
$804.80 |
$804.80 |
$242.50
|
|
Unlisted procedure eyelids
|
$717.60 |
$717.60 |
$717.60 |
$2,174.90
|
|
Unlisted procedure larynx
|
$5,832.00 |
$5,832.00 |
$5,832.00 |
$924.00
|
|
Unlisted procedure rectum
|
$1,304.00 |
$1,304.00 |
$1,304.00 |
$1,223.20
|
|
Unlisted px casting/strpg
|
$352.00 |
$352.00 |
$352.00 |
$222.00
|
|
Unlisted px palate uvula
|
$452.80 |
$452.80 |
$452.80 |
$274.80
|
|
Unlisted px pelvis/hip joint
|
$637.60 |
$637.60 |
$637.60 |
$3,251.90
|
|
Unlisted px small intestine
|
$3,644.80 |
$3,644.80 |
$3,644.80 |
$2,118.35
|
|
Unlisted px tongue flr mouth
|
$3,837.60 |
$3,837.60 |
$3,837.60 |
$282.50
|
|
Unlisted px vestibule mouth
|
$2,883.20 |
$2,883.20 |
$2,883.20 |
$456.96
|
|
Unlisted reprod med lab proc
|
$60.00 |
$60.00 |
$60.00 |
$70.00
|
|
Unlisted ultrasound procedure
|
$452.80 |
$452.80 |
$452.80 |
$332.16
|
|
Unsched dialysis esrd pt hos
|
$1,620.00 |
$1,620.00 |
$1,620.00 |
$1,292.33
|
|
Upgrade pm system
|
$6,808.80 |
$6,808.80 |
$6,808.80 |
$12,077.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$532.80 |
$532.80 |
$532.80 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$2,369.60 |
$2,369.60 |
$2,369.60 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,924.00 |
$1,924.00 |
$1,924.00 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,034.40 |
$4,034.40 |
$4,034.40 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,460.80 |
$3,460.80 |
$3,460.80 |
$2,369.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,976.00 |
$2,976.00 |
$2,976.00 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$405.60 |
$405.60 |
$405.60 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$529.60 |
$529.60 |
$529.60 |
$381.60
|
|
Upper Endoscopy (EGD, diagnostic)
|
$2,694.40 |
$2,694.40 |
$2,694.40 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$2,652.00 |
$2,652.00 |
$2,652.00 |
$1,768.00
|
|
Upper ext fx orthosis rad/ul
|
$607.38 |
$607.38 |
$607.38 |
$619.49
|
|
Upper GI Barium X-ray (barium and gas)
|
$1,020.00 |
$1,020.00 |
$1,020.00 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$908.80 |
$908.80 |
$908.80 |
$607.20
|
|
Ureteral reflux study
|
$1,508.00 |
$1,508.00 |
$1,508.00 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$884.80 |
$884.80 |
$884.80 |
$584.00
|
|
Urethrocystography void s&i
|
$960.00 |
$960.00 |
$960.00 |
$631.40
|
|
Urinalysis (without microscopy)
|
$9.60 |
$9.60 |
$9.60 |
$36.00
|
|
Urography, antegrade
|
$940.00 |
$940.00 |
$940.00 |
$622.35
|
|
Vaccine Administration (one shot)
|
$96.80 |
$96.80 |
$96.80 |
$67.70
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$150.12 |
$150.12 |
$150.12 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$113.31 |
$113.31 |
$113.31 |
$123.20
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$198.46 |
$198.46 |
$198.46 |
$80.15
|
|
Vaccine dtap < 7 years im
|
$66.69 |
$66.69 |
$66.69 |
$71.17
|
|
Vaccine dtap-ipv 4-6 years im
|
$89.09 |
$89.09 |
$89.09 |
$105.95
|
|
Vaccine dtap-ipv-hib-hepb im
|
$175.00 |
$175.00 |
$175.00 |
$174.72
|
|
Vaccine dtap-ipv/hib im
|
$108.26 |
$108.26 |
$108.26 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$70.53 |
$70.53 |
$70.53 |
$70.53
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$56.95 |
$56.95 |
$56.95 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$102.42 |
$102.42 |
$102.42 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$135.40 |
$135.40 |
$135.40 |
$231.56
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$78.76 |
$78.76 |
$78.76 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$143.15 |
$143.15 |
$143.15 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$60.49 |
$60.49 |
$60.49 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$242.92 |
$242.92 |
$242.92 |
$576.48
|
|
Vaccine influenza inactivated adjuvant im
|
$46.84 |
$46.84 |
$46.84 |
$110.25
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$24.31 |
$24.31 |
$24.31 |
$82.71
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$170.28 |
$170.28 |
$170.28 |
$394.26
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$186.47 |
$186.47 |
$186.47 |
$409.35
|
|
Vaccine mmr live subcutaneous
|
$111.30 |
$111.30 |
$111.30 |
$213.00
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$171.20 |
$171.20 |
$171.20 |
$252.87
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$235.60 |
$235.60 |
$235.60 |
$397.11
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$234.07 |
$234.07 |
$234.07 |
$414.46
|
|
Vaccine rabies im
|
$344.93 |
$344.93 |
$344.93 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$300.00 |
$300.00 |
$300.00 |
$538.84
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$539.27 |
$539.27 |
$539.27 |
$1,105.21
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$494.63 |
$494.63 |
$494.63 |
$1,031.86
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$97.85 |
$97.85 |
$97.85 |
$126.14
|
|
Vaccine tdap >=7 years im
|
$81.16 |
$81.16 |
$81.16 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$71.60 |
$71.60 |
$71.60 |
$112.10
|
|
Vaginal bx
|
$4,390.40 |
$4,390.40 |
$4,390.40 |
$455.94
|
|
Vancomycin 1,000 mg intravenous injection
|
$112.56 |
$112.56 |
$112.56 |
$259.05
|
|
Vantas implant
|
$3,178.60 |
$3,178.60 |
$3,178.60 |
$12,207.65
|
|
Vasectomy
|
$2,690.40 |
$2,690.40 |
$2,690.40 |
$2,424.12
|
|
Vasopressin 20 unit/ml intravenous solution
|
$46.16 |
$46.16 |
$46.16 |
$325.80
|
|
Veeg cont 2-12 hrs
|
$1,980.80 |
$1,980.80 |
$1,980.80 |
$1,540.00
|
|
Vein x-ray liver w/hemodynam
|
$5,248.00 |
$5,248.00 |
$5,248.00 |
$3,662.50
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$112.00 |
$112.00 |
$112.00 |
$188.83
|
|
Venogram ext bil s&i
|
$2,334.40 |
$2,334.40 |
$2,334.40 |
$1,829.42
|
|
Venogram extremity supervision & interpretation unilateral
|
$1,908.00 |
$1,908.00 |
$1,908.00 |
$1,382.58
|
|
Venous mech thrombectomy
|
$9,392.80 |
$9,392.80 |
$9,392.80 |
$8,184.00
|
|
Venous m-thrombectomy add-on
|
$5,044.00 |
$5,044.00 |
$5,044.00 |
$5,094.75
|
|
Ventilator each subsequent day
|
$1,047.20 |
$1,047.20 |
$1,047.20 |
$1,184.00
|
|
Ventilator Management (first day)
|
$1,037.60 |
$1,037.60 |
$1,037.60 |
$1,434.60
|
|
Version cephalic external
|
$2,271.20 |
$2,271.20 |
$2,271.20 |
$2,361.75
|
|
V-exc/lip/w/pri linear closure 40520
|
$5,118.40 |
$5,118.40 |
$5,118.40 |
$3,837.72
|
|
Video Swallow Study (Modified Barium Swallow)
|
$658.40 |
$658.40 |
$658.40 |
$524.50
|
|
Visit established high 40-54 minutes/level 5
|
$208.80 |
$208.80 |
$208.80 |
$240.50
|
|
Voiding pressure study/intra-abd 51797
|
$392.80 |
$392.80 |
$392.80 |
$433.20
|
|
Voriconazole in ns IV syringe 5 mg/ml (pediatric) - cnr
|
$133.84 |
$133.84 |
$133.84 |
$165.81
|
|
Walking (Gait) Training (each 15 minutes)
|
$116.00 |
$116.00 |
$116.00 |
$87.50
|
|
Wcd device interrogate
|
$144.80 |
$144.80 |
$144.80 |
$109.20
|