|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$1,736.00 |
$1,736.00 |
$1,736.00 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$62.80 |
$62.80 |
$62.80 |
$535.60
|
|
Tx l/r atrial fib addl
|
$2,965.00 |
$2,965.00 |
$2,965.00 |
$6,769.00
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$1,931.60 |
$1,931.60 |
$1,931.60 |
$4,421.00
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$1,776.80 |
$1,776.80 |
$1,776.80 |
$4,499.12
|
|
Ugt1a1 gene analy common variants
|
$285.00 |
$285.00 |
$285.00 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$76.40 |
$76.40 |
$76.40 |
$394.20
|
|
Ultrasound breast complete
|
$141.80 |
$141.80 |
$141.80 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$106.80 |
$106.80 |
$106.80 |
$449.35
|
|
Ultrasound chest
|
$98.80 |
$98.80 |
$98.80 |
$460.85
|
|
Ultrasound dx ophth b-scan
|
$62.60 |
$62.60 |
$62.60 |
$296.80
|
|
Ultrasound encephalogram
|
$146.60 |
$146.60 |
$146.60 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$177.40 |
$177.40 |
$177.40 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$247.20 |
$247.20 |
$247.20 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$97.60 |
$97.60 |
$97.60 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$195.40 |
$195.40 |
$195.40 |
$720.15
|
|
Ultrasound guide intraoperative
|
$331.40 |
$331.40 |
$331.40 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$421.80 |
$421.80 |
$421.80 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$164.40 |
$164.40 |
$164.40 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$118.40 |
$118.40 |
$118.40 |
$311.25
|
|
Ultrasound joint complete left
|
$153.80 |
$153.80 |
$153.80 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$112.40 |
$112.40 |
$112.40 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$70.00 |
$70.00 |
$70.00 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$70.00 |
$70.00 |
$70.00 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$407.20 |
$407.20 |
$407.20 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$145.20 |
$145.20 |
$145.20 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$209.20 |
$209.20 |
$209.20 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$157.20 |
$157.20 |
$157.20 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$209.20 |
$209.20 |
$209.20 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$195.40 |
$195.40 |
$195.40 |
$486.50
|
|
Ultrasound scrotum and contents
|
$175.60 |
$175.60 |
$175.60 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$98.80 |
$98.80 |
$98.80 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$119.00 |
$119.00 |
$119.00 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$206.20 |
$206.20 |
$206.20 |
$558.35
|
|
Ultrasound trgt dyn mbubb 1st les
|
$95.00 |
$95.00 |
$95.00 |
$568.32
|
|
Umbilical artery cath newborn 36660
|
$148.00 |
$148.00 |
$148.00 |
$206.64
|
|
Unlisted chemotherapy px
|
$156.60 |
$156.60 |
$156.60 |
$150.00
|
|
Unlisted fluoroscopic px
|
$70.80 |
$70.80 |
$70.80 |
$305.76
|
|
Unlisted maaa
|
$159.00 |
$159.00 |
$159.00 |
$235.20
|
|
Unlisted mr procedure
|
$448.80 |
$448.80 |
$448.80 |
$1,163.00
|
|
Unlisted muscskel px dx nuc
|
$2,047.40 |
$2,047.40 |
$2,047.40 |
$1,279.98
|
|
Unlisted procedure liver
|
$285.40 |
$285.40 |
$285.40 |
$2,287.20
|
|
Unlisted procedure rectum
|
$235.60 |
$235.60 |
$235.60 |
$1,220.35
|
|
Unlisted px ant segment eye
|
$641.00 |
$641.00 |
$641.00 |
$2,698.92
|
|
Unlisted px casting/strpg
|
$47.60 |
$47.60 |
$47.60 |
$219.70
|
|
Unlisted px leg/ankle
|
$70.80 |
$70.80 |
$70.80 |
$811.00
|
|
Unlisted px male genital sys
|
$76.40 |
$76.40 |
$76.40 |
$343.55
|
|
Unlisted px med radj physics
|
$110.00 |
$110.00 |
$110.00 |
$462.35
|
|
Unlisted px palate uvula
|
$128.00 |
$128.00 |
$128.00 |
$274.80
|
|
Unlisted px salivry glnd/dux
|
$572.40 |
$572.40 |
$572.40 |
$1,265.16
|
|
Unlisted px tongue flr mouth
|
$144.80 |
$144.80 |
$144.80 |
$282.50
|
|
Unsched dialysis esrd pt hos
|
$242.60 |
$242.60 |
$242.60 |
$1,268.17
|
|
Upgrade pm system
|
$9,812.00 |
$9,812.00 |
$9,812.00 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,207.60 |
$1,207.60 |
$1,207.60 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$817.00 |
$817.00 |
$817.00 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$748.80 |
$748.80 |
$748.80 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$190.60 |
$190.60 |
$190.60 |
$1,751.66
|
|
Urea nitrogen
|
$34.60 |
$34.60 |
$34.60 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$32.60 |
$32.60 |
$32.60 |
$51.75
|
|
Urea nitrogen clearance
|
$32.40 |
$32.40 |
$32.40 |
$42.25
|
|
Ureteral embolization/occl
|
$375.00 |
$375.00 |
$375.00 |
$2,181.40
|
|
Urethrcystgrphy rtrgrde s&i
|
$179.20 |
$179.20 |
$179.20 |
$579.73
|
|
Urethrocystography void s&i
|
$118.80 |
$118.80 |
$118.80 |
$622.35
|
|
Uric acid blood
|
$48.60 |
$48.60 |
$48.60 |
$48.75
|
|
Uric acid urine
|
$46.80 |
$46.80 |
$46.80 |
$44.33
|
|
Urinalysis qual/semiquant excpt ia
|
$1.60 |
$1.60 |
$1.60 |
$25.72
|
|
Urinalysis (with microscopy)
|
$38.20 |
$38.20 |
$38.20 |
$55.00
|
|
Urinalysis (without microscopy)
|
$31.40 |
$31.40 |
$31.40 |
$35.75
|
|
Urine Culture Test
|
$58.80 |
$58.80 |
$58.80 |
$81.50
|
|
Urine pregnancy test
|
$66.60 |
$66.60 |
$66.60 |
$67.20
|
|
Urography, antegrade
|
$271.40 |
$271.40 |
$271.40 |
$622.35
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$14.14 |
$14.14 |
$14.14 |
$143.20
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$3.66 |
$3.66 |
$3.66 |
$33.60
|
|
Vaginal bx
|
$53.60 |
$53.60 |
$53.60 |
$455.94
|
|
Vaginal delivery after cesarean delivery 59612
|
$1,613.40 |
$1,613.40 |
$1,613.40 |
$3,843.60
|
|
Valproic acid total therapeutic drug level
|
$81.00 |
$81.00 |
$81.00 |
$114.72
|
|
Valrubicin injection
|
$817.53 |
$817.53 |
$817.53 |
$2,813.49
|
|
Valvuloplasty aortic
|
$4,311.80 |
$4,311.80 |
$4,311.80 |
$7,830.80
|
|
Vancomycin hcl injection
|
$301.37 |
$301.37 |
$301.37 |
$154.40
|
|
Vancomycin peak therapeutic drug level
|
$111.00 |
$111.00 |
$111.00 |
$136.13
|
|
Varicella zoster antibody igg
|
$81.00 |
$81.00 |
$81.00 |
$86.80
|
|
Vasopressin 20 unit/ml intravenous solution
|
$955.39 |
$955.39 |
$955.39 |
$325.80
|
|
Veeg cont 2-12 hrs
|
$326.20 |
$326.20 |
$326.20 |
$1,540.00
|
|
Veeg ea 12-26hr cont mntr
|
$610.40 |
$610.40 |
$610.40 |
$3,225.60
|
|
Veeg intrmnt 2-12 hrs
|
$170.00 |
$170.00 |
$170.00 |
$961.00
|
|
Veeg unmon 12-26 hrs
|
$326.20 |
$326.20 |
$326.20 |
$1,671.09
|
|
Veeg unmon 2-12 hrs
|
$170.00 |
$170.00 |
$170.00 |
$826.15
|
|
Vein x-ray kidney
|
$1,559.60 |
$1,559.60 |
$1,559.60 |
$2,766.73
|
|
Vein x-ray liver
|
$1,637.60 |
$1,637.60 |
$1,637.60 |
$3,305.50
|
|
Vein x-ray liver w/hemodynam
|
$1,559.60 |
$1,559.60 |
$1,559.60 |
$3,486.86
|
|
Vein x-ray liver w/hemodynam
|
$1,637.60 |
$1,637.60 |
$1,637.60 |
$3,483.84
|
|
Vein x-ray liver without hemodyn
|
$1,637.60 |
$1,637.60 |
$1,637.60 |
$2,452.80
|
|
Vein x-ray skull
|
$547.80 |
$547.80 |
$547.80 |
$2,141.00
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$164.20 |
$164.20 |
$164.20 |
$202.80
|
|
Venogram ext bil s&i
|
$530.60 |
$530.60 |
$530.60 |
$1,797.50
|
|
Venogram extremity supervision & interpretation unilateral
|
$505.20 |
$505.20 |
$505.20 |
$1,366.20
|
|
Venous mech thrombectomy
|
$2,661.80 |
$2,661.80 |
$2,661.80 |
$7,965.00
|
|
Venous m-thrombectomy add-on
|
$2,661.80 |
$2,661.80 |
$2,661.80 |
$5,094.75
|
|
Ventilator each subsequent day
|
$315.00 |
$315.00 |
$315.00 |
$1,204.00
|
|
Ventilator initial day
|
$469.20 |
$469.20 |
$469.20 |
$1,431.43
|
