|
Vag hys/<250g/rmv tube/rpr entero 58263
|
$2,112.48 |
$2,112.48 |
$2,112.48 |
$5,345.59
|
|
Vag hyst including t/o
|
$1,982.07 |
$1,982.07 |
$1,982.07 |
$4,827.18
|
|
Vaginal delivery after cesarean delivery 59612
|
$1,815.21 |
$1,815.21 |
$1,815.21 |
$3,843.60
|
|
Vaginal Delivery (full care)
|
$4,931.82 |
$4,931.82 |
$4,931.82 |
$4,263.60
|
|
Vaginal hysterectomy
|
$1,774.17 |
$1,774.17 |
$1,774.17 |
$5,766.00
|
|
Vancomycin 1,000 mg intravenous injection
|
$56.03 |
$56.03 |
$56.03 |
$251.86
|
|
Vancomycin 750 mg intravenous solution
|
$46.24 |
$46.24 |
$46.24 |
$90.33
|
|
Vasectomy
|
$798.12 |
$798.12 |
$798.12 |
$2,424.12
|
|
Vasopressin 20 unit/ml intravenous solution
|
$111.78 |
$111.78 |
$111.78 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$10,800.00 |
$10,800.00 |
$10,800.00 |
$18,719.82
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$23.22 |
$23.22 |
$23.22 |
$202.80
|
|
Venipuncture <3 yrs other vein
|
$23.22 |
$23.22 |
$23.22 |
$67.00
|
|
Venogram ext bil s&i
|
$250.56 |
$250.56 |
$250.56 |
$1,797.50
|
|
Venogram extremity supervision & interpretation unilateral
|
$181.44 |
$181.44 |
$181.44 |
$1,366.20
|
|
Version cephalic external
|
$207.36 |
$207.36 |
$207.36 |
$2,361.75
|
|
Visual audiometry (vra)
|
$85.32 |
$85.32 |
$85.32 |
$215.25
|
|
Vulvectomy simple partial
|
$1,229.04 |
$1,229.04 |
$1,229.04 |
$3,986.00
|
|
Wedge biopsy of liver 47100
|
$1,749.60 |
$1,749.60 |
$1,749.60 |
$1,584.00
|
|
Wound closure by adhesive
|
$49.68 |
$49.68 |
$49.68 |
$149.25
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$61.83 |
$61.83 |
$61.83 |
$437.41
|
|
Wrist X-ray
|
$227.88 |
$227.88 |
$227.88 |
$342.80
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$1,315.98 |
$1,315.98 |
$1,315.98 |
$2,692.80
|
|
Xfer tis s/a/l 10 sq cm/<
|
$1,486.08 |
$1,486.08 |
$1,486.08 |
$2,837.09
|
|
X-ray abdomen 1 view
|
$111.24 |
$111.24 |
$111.24 |
$258.00
|
|
X-ray abdomen 2 views
|
$41.58 |
$41.58 |
$41.58 |
$316.47
|
|
X-ray abdomen >=3 views
|
$47.52 |
$47.52 |
$47.52 |
$342.50
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$180.36 |
$180.36 |
$180.36 |
$417.30
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$108.54 |
$108.54 |
$108.54 |
$270.20
|
|
X-ray ankle 2 views (both sides)
|
$181.44 |
$181.44 |
$181.44 |
$282.50
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$144.18 |
$144.18 |
$144.18 |
$773.40
|
|
X-ray bone age studies
|
$34.02 |
$34.02 |
$34.02 |
$250.20
|
|
X-ray bone length studies
|
$48.60 |
$48.60 |
$48.60 |
$285.30
|
|
X-ray bone survey complete
|
$98.28 |
$98.28 |
$98.28 |
$660.00
|
|
X-ray bone survey infant
|
$124.74 |
$124.74 |
$124.74 |
$394.69
|
|
X-ray cervical spine 2-3 views
|
$147.42 |
$147.42 |
$147.42 |
$333.11
|
|
X-ray cervical spine 4-5 views
|
$198.18 |
$198.18 |
$198.18 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$231.12 |
$231.12 |
$231.12 |
$508.50
|
|
X-ray clavicle complete (both sides)
|
$179.82 |
$179.82 |
$179.82 |
$300.05
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$183.06 |
$183.06 |
$183.06 |
$652.19
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$222.48 |
$222.48 |
$222.48 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$163.08 |
$163.08 |
$163.08 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$120.96 |
$120.96 |
$120.96 |
$364.12
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$106.92 |
$106.92 |
$106.92 |
$483.50
|
|
X-ray exam entire spi 4/5 vw
|
$64.26 |
$64.26 |
$64.26 |
$441.48
|
|
X-ray exam of arm infant
|
$112.86 |
$112.86 |
$112.86 |
$248.44
|
|
X-ray exam of femur 1
|
$29.70 |
$29.70 |
$29.70 |
$240.00
|
|
X-ray exam of jaw joint
|
$32.40 |
$32.40 |
$32.40 |
$188.40
|
|
X-ray exam of sinuses
|
$31.32 |
$31.32 |
$31.32 |
$214.50
|
|
X-ray exam si joints
|
$122.04 |
$122.04 |
$122.04 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$164.70 |
$164.70 |
$164.70 |
$387.40
|
|
X-ray facial bones complete > 3 views
|
$174.42 |
$174.42 |
$174.42 |
$381.75
|
|
X-ray femur >=2 views (both sides)
|
$132.30 |
$132.30 |
$132.30 |
$317.25
|
|
X-ray finger(s) >= 2 views (both sides)
|
$211.14 |
$211.14 |
$211.14 |
$241.05
|
|
X-ray foot 2 views (both sides)
|
$157.14 |
$157.14 |
$157.14 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$163.08 |
$163.08 |
$163.08 |
$322.20
|
|
X-ray hand 2 views (both sides)
|
$173.88 |
$173.88 |
$173.88 |
$291.20
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$159.30 |
$159.30 |
$159.30 |
$274.95
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$49.14 |
$49.14 |
$49.14 |
$376.40
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$153.36 |
$153.36 |
$153.36 |
$374.40
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$52.92 |
$52.92 |
$52.92 |
$424.05
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$64.80 |
$64.80 |
$64.80 |
$500.28
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$122.58 |
$122.58 |
$122.58 |
$231.00
|
|
X-ray humerus >= 2 views left
|
$134.46 |
$134.46 |
$134.46 |
$309.31
|
|
X-ray knee 1-2 views (both sides)
|
$127.44 |
$127.44 |
$127.44 |
$285.00
|
|
X-ray knee 3 views (both sides)
|
$226.26 |
$226.26 |
$226.26 |
$363.20
|
|
X-ray knee ap standing bilateral
|
$147.96 |
$147.96 |
$147.96 |
$252.50
|
|
X-ray lower extremities infant > 2 views (both sides)
|
$112.86 |
$112.86 |
$112.86 |
$254.12
|
|
X-ray l/s-spine bend vw only 2-3 vw
|
$151.20 |
$151.20 |
$151.20 |
$369.15
|
|
X-ray lumbosacral spine >= 4 views
|
$190.62 |
$190.62 |
$190.62 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$220.86 |
$220.86 |
$220.86 |
$535.91
|
|
X-ray mandible complete > 4 views
|
$160.92 |
$160.92 |
$160.92 |
$361.61
|
|
X-ray mandible ltd <4 views
|
$32.40 |
$32.40 |
$32.40 |
$235.00
|
|
X-ray nasal bones complete > 3 views
|
$142.02 |
$142.02 |
$142.02 |
$274.65
|
|
X-ray neck soft tissue
|
$117.18 |
$117.18 |
$117.18 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$32.40 |
$32.40 |
$32.40 |
$225.60
|
|
X-ray optic foramina
|
$39.96 |
$39.96 |
$39.96 |
$188.40
|
|
X-ray pelvis 1-2 views
|
$108.54 |
$108.54 |
$108.54 |
$280.80
|
|
X-ray pelvis complete > 3 views
|
$157.14 |
$157.14 |
$157.14 |
$348.19
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$90.18 |
$90.18 |
$90.18 |
$754.50
|
|
X-ray ribs 2 views left
|
$137.16 |
$137.16 |
$137.16 |
$292.80
|
|
X-ray ribs 3 views bilateral
|
$163.62 |
$163.62 |
$163.62 |
$394.34
|
|
X-ray ribs w/posterior anterior chest 3 views left
|
$157.14 |
$157.14 |
$157.14 |
$354.91
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$195.48 |
$195.48 |
$195.48 |
$491.70
|
|
X-ray sacroiliac joints >= 3 views
|
$145.80 |
$145.80 |
$145.80 |
$312.00
|
|
X-ray sacrum/coccyx >= 2 views
|
$120.96 |
$120.96 |
$120.96 |
$288.80
|
|
X-ray scapula complete (both sides)
|
$131.22 |
$131.22 |
$131.22 |
$285.00
|
|
X-ray shoulder 1 view (both sides)
|
$120.42 |
$120.42 |
$120.42 |
$260.00
|
|
X-ray sinuses paranasal complete > 3 views
|
$38.88 |
$38.88 |
$38.88 |
$345.24
|
|
X-ray sinus tract/fistula/abscess
|
$91.80 |
$91.80 |
$91.80 |
$606.89
|
|
X-ray skull < 4 views
|
$133.38 |
$133.38 |
$133.38 |
$292.00
|
|
X-ray skull > 4 views complete
|
$50.22 |
$50.22 |
$50.22 |
$417.50
|
|
X-ray slg plne bdy sect without urogr
|
$104.76 |
$104.76 |
$104.76 |
$399.82
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$142.56 |
$142.56 |
$142.56 |
$557.70
|
|
X-ray small intestine follow-through study
|
$123.66 |
$123.66 |
$123.66 |
$499.50
|
|
X-ray spine single view
|
$108.54 |
$108.54 |
$108.54 |
$250.56
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$153.36 |
$153.36 |
$153.36 |
$264.48
|
|
X-ray sternum > 2 views
|
$124.74 |
$124.74 |
$124.74 |
$274.65
|
|
X-ray surgical specimen
|
$54.00 |
$54.00 |
$54.00 |
$504.00
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$94.50 |
$94.50 |
$94.50 |
$522.22
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$42.66 |
$42.66 |
$42.66 |
$327.80
|