|
Treatment of foot infection
|
$2,398.34 |
$2,398.34 |
$2,398.34 |
$2,928.60
|
|
Treatment radiation delivery level 2
|
$254.47 |
$254.47 |
$406.83 |
$830.70
|
|
Treat spinal cord lesion
|
$479.00 |
$479.00 |
$517.81 |
$1,142.50
|
|
Treat spinal cord lesion
|
$482.94 |
$482.94 |
$522.06 |
$1,337.00
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$71,510.40 |
$71,510.40 |
$71,510.40 |
$73,346.25
|
|
Treponema pallidum antibody
|
$14.06 |
$18.13 |
$69.15 |
$72.05
|
|
Treprostinil injection
|
$16.70 |
$16.70 |
$197.12 |
$19,071.84
|
|
Trg gene rearrangement anal
|
$181.58 |
$270.91 |
$7,970.43 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$0.41 |
$18.32 |
$72.58 |
$43.00
|
|
Trichinella antibody
|
$13.11 |
$13.11 |
$16.91 |
$70.65
|
|
#tricyclicantidprssnt
|
$14.54 |
$14.54 |
$14.72 |
$50.54
|
|
Triglycerides
|
$18.78 |
$24.96 |
$76.40 |
$58.05
|
|
Trimethobenzamide hcl inj
|
$24.83 |
$24.83 |
$24.83 |
$117.49
|
|
Trim nondyst nails
|
$90.65 |
$90.65 |
$90.65 |
$114.48
|
|
Trml dstrj ios bvn 1st 2 l/s
|
$4,163.54 |
$4,163.54 |
$4,163.54 |
$15,258.00
|
|
Trml dstrj ios bvn ea addl
|
$2,081.77 |
$2,081.77 |
$2,081.77 |
$7,354.00
|
|
Trnscath plc stent crv crtd without prtct
|
$2,473.06 |
$2,473.06 |
$5,393.84 |
$7,795.71
|
|
Trnscath plc stent crv crtd w/prtct
|
$3,880.72 |
$4,025.14 |
$4,195.08 |
$9,767.25
|
|
Trnscath plc stnt ante carotid art
|
$2,354.21 |
$2,544.91 |
$16,356.10 |
$6,046.25
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$3,157.20 |
$3,412.95 |
$7,960.12 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$2,630.94 |
$2,844.06 |
$9,224.54 |
$8,790.54
|
|
Trnscath plc vas stent w/s&i ini vein
|
$3,946.59 |
$4,266.29 |
$16,771.71 |
$14,558.70
|
|
Trnscath retrv pq vasc fb w/guide
|
$1,975.44 |
$2,135.47 |
$4,155.78 |
$4,766.40
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$2,450.51 |
$2,649.01 |
$4,454.89 |
$5,139.20
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$963.74 |
$1,041.80 |
$2,628.16 |
$4,350.00
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$831.99 |
$899.39 |
$2,628.16 |
$4,379.34
|
|
Trnscath tx thromblytc vein ini day
|
$1,409.80 |
$1,524.01 |
$3,519.37 |
$3,866.70
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$2,515.41 |
$2,515.41 |
$2,515.41 |
$4,727.52
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$1,207.46 |
$1,207.46 |
$1,207.46 |
$2,377.62
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$1,840.97 |
$1,840.97 |
$1,840.97 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$2,319.60 |
$2,319.60 |
$2,319.60 |
$2,527.20
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$1,794.87 |
$1,794.87 |
$1,794.87 |
$2,486.75
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$1,412.07 |
$1,412.07 |
$1,412.07 |
$2,406.77
|
|
Troponin quantitative
|
$51.30 |
$52.30 |
$189.09 |
$127.20
|
|
Tte w or without contr, cont ecg
|
$747.10 |
$747.10 |
$1,399.65 |
$2,075.90
|
|
Tte w or without fol w/con,stres
|
$471.97 |
$603.68 |
$603.68 |
$1,632.80
|
|
Tte w or without fol w/cont, com
|
$623.12 |
$623.12 |
$623.12 |
$1,254.50
|
|
Tte w or without fol w/cont, f/u
|
$330.87 |
$330.87 |
$330.87 |
$1,178.00
|
|
Tx atrial fib pulm vein isol
|
$33,603.78 |
$33,603.78 |
$38,008.64 |
$29,030.54
|
|
Tx l/r atrial fib addl
|
$5,604.80 |
$5,604.80 |
$12,097.18 |
$6,986.85
|
|
Ugt1a1 gene analy common variants
|
$210.94 |
$314.71 |
$1,151.73 |
$438.75
|
|
Ultrasound breast complete
|
$219.87 |
$250.74 |
$396.14 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$143.82 |
$169.26 |
$269.31 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$136.11 |
$137.14 |
$155.22 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$147.26 |
$147.26 |
$147.26 |
$296.80
|
|
Ultrasound elastography ea l target les
|
$64.56 |
$64.56 |
$64.56 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$137.16 |
$137.16 |
$254.03 |
$313.95
|
|
Ultrasound encephalogram
|
$215.26 |
$258.96 |
$301.02 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$194.74 |
$222.08 |
$411.80 |
$575.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$221.96 |
$253.13 |
$291.47 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$257.63 |
$272.22 |
$400.34 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$213.59 |
$243.58 |
$332.73 |
$388.08
|
|
Ultrasound guide intraoperative
|
$236.97 |
$243.66 |
$1,073.42 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$169.61 |
$193.43 |
$356.79 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$196.14 |
$223.68 |
$369.78 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$82.44 |
$143.44 |
$163.58 |
$311.25
|
|
Ultrasound joint complete left
|
$163.33 |
$186.26 |
$339.22 |
$557.99
|
|
Ultrasound ob >=14wks ea addl gest
|
$161.22 |
$184.62 |
$278.86 |
$409.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$121.45 |
$133.28 |
$307.90 |
$335.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$304.68 |
$347.45 |
$401.49 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$177.29 |
$202.18 |
$399.19 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$108.32 |
$189.16 |
$313.63 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$222.33 |
$273.62 |
$312.03 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$186.42 |
$255.82 |
$291.73 |
$421.00
|
|
Ultrasound trgt dyn mbubb 1st les
|
$393.85 |
$393.85 |
$393.85 |
$568.32
|
|
Ultrasound trgt dyn mbubb ea addl
|
$271.22 |
$271.22 |
$271.22 |
$348.00
|
|
Unit mobile power mpu
|
$7,855.87 |
$7,855.87 |
$8,517.84 |
$14,359.52
|
|
Unlisted CT procedure
|
$112.31 |
$112.31 |
$676.12 |
$732.70
|
|
Unlisted cytogenetic study
|
$1,680.04 |
$1,680.04 |
$1,680.04 |
$160.00
|
|
Unlisted dx gi procedure
|
$137.28 |
$137.28 |
$137.28 |
$649.22
|
|
Unlisted fluoroscopic px
|
$407.16 |
$407.16 |
$676.91 |
$305.76
|
|
Unlisted hematology&coagj px
|
$10.43 |
$10.43 |
$12.88 |
$39.52
|
|
Unlisted mr procedure
|
$594.78 |
$594.78 |
$782.02 |
$1,163.00
|
|
Unlisted procedure liver
|
$3,230.59 |
$3,230.59 |
$3,230.59 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$229.46 |
$229.46 |
$3,132.02 |
$530.00
|
|
Unlisted procedure spine
|
$1,370.78 |
$1,370.78 |
$1,370.78 |
$4,659.85
|
|
Unlisted px pelvis/hip joint
|
$665.88 |
$665.88 |
$665.88 |
$3,251.90
|
|
Unlisted transfusion med px
|
$46.10 |
$69.41 |
$261.67 |
$147.50
|
|
Unsched dialysis esrd pt hos
|
$378.18 |
$437.58 |
$1,117.35 |
$1,296.00
|
|
Upgrade pm system
|
$4,574.88 |
$4,574.88 |
$4,945.47 |
$12,077.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$91.87 |
$99.26 |
$325.85 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$545.97 |
$654.51 |
$2,787.08 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$436.75 |
$523.57 |
$1,858.05 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$461.57 |
$519.26 |
$2,321.15 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$384.64 |
$432.72 |
$1,917.26 |
$2,392.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$307.71 |
$346.18 |
$1,564.68 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$85.09 |
$91.93 |
$361.38 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$98.14 |
$106.03 |
$388.88 |
$381.60
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,382.08 |
$1,382.08 |
$1,382.08 |
$1,824.75
|
|
Upper GI Barium X-ray (barium and gas)
|
$160.52 |
$173.43 |
$448.09 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$158.17 |
$170.89 |
$441.60 |
$607.20
|
|
Urea nitrogen
|
$21.33 |
$26.56 |
$59.60 |
$42.01
|
|
Urea nitrogen 24 hour urine
|
$8.22 |
$8.32 |
$59.60 |
$51.84
|
|
Ureteral embolization/occl
|
$1,261.59 |
$1,261.59 |
$2,546.42 |
$2,079.31
|
|
Ureteral reflux study
|
$347.94 |
$347.94 |
$654.65 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$271.14 |
$277.18 |
$367.87 |
$584.00
|
|
Urethrocystography void s&i
|
$179.57 |
$194.02 |
$367.87 |
$634.50
|
|
Uric acid blood
|
$22.12 |
$22.40 |
$78.31 |
$49.32
|
|
Uric acid urine
|
$11.38 |
$11.52 |
$29.80 |
$44.52
|
|
Urinalysis microscopic only
|
$2.75 |
$2.75 |
$3.03 |
$26.35
|
