|
Treat finger fracture each
|
$346.65 |
$346.65 |
$346.65 |
$1,815.75
|
|
Treat foot dislocation
|
$104.69 |
$104.69 |
$104.69 |
$478.40
|
|
Treat fracture of radius
|
$346.65 |
$346.65 |
$346.65 |
$2,030.33
|
|
Treat hand dislocation
|
$940.10 |
$940.10 |
$940.10 |
$1,893.86
|
|
Treat heel fracture
|
$2,639.72 |
$2,639.72 |
$2,639.72 |
$7,907.11
|
|
Treat hip dislocation
|
$825.74 |
$825.74 |
$825.74 |
$2,561.90
|
|
Treat hip dislocation
|
$891.45 |
$891.45 |
$891.45 |
$3,152.05
|
|
Treat humerus fracture
|
$346.65 |
$346.65 |
$346.65 |
$1,950.60
|
|
Treat kneecap dislocation
|
$1,097.00 |
$1,097.00 |
$1,097.00 |
$1,351.35
|
|
Treat knee dislocation
|
$1,096.74 |
$1,096.74 |
$1,096.74 |
$2,592.08
|
|
Treat knuckle dislocation
|
$994.35 |
$994.35 |
$994.35 |
$1,893.86
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$57.31 |
$57.31 |
$57.31 |
$210.00
|
|
Treat midfoot fracture each
|
$346.65 |
$346.65 |
$346.65 |
$1,893.86
|
|
Treat thigh fracture
|
$644.40 |
$644.40 |
$644.40 |
$2,090.14
|
|
Treat toe dislocation
|
$1,151.25 |
$1,151.25 |
$1,151.25 |
$855.66
|
|
Treat wrist bone fracture
|
$346.65 |
$346.65 |
$346.65 |
$1,907.64
|
|
Treat wrist dislocation
|
$148.75 |
$148.75 |
$148.75 |
$760.00
|
|
Treponema pallidum antibody
|
$25.98 |
$25.98 |
$25.98 |
$72.80
|
|
Trg gene rearrangement anal
|
$125.32 |
$125.32 |
$125.32 |
$455.70
|
|
Triglycerides
|
$16.56 |
$16.56 |
$16.56 |
$54.60
|
|
Trim nondyst nails
|
$10.70 |
$10.70 |
$10.70 |
$124.22
|
|
Triptorelin pamoate
|
$1,613.44 |
$1,613.44 |
$1,613.44 |
$4,619.39
|
|
Troponin quantitative
|
$46.87 |
$46.87 |
$46.87 |
$123.75
|
|
Tube trach disp innr can 5 xlt
|
$21.15 |
$21.15 |
$21.15 |
$460.58
|
|
Tubular dressing
|
$1.96 |
$1.96 |
$1.96 |
$20.93
|
|
Tx closed distal humerus fx
|
$106.98 |
$106.98 |
$106.98 |
$786.00
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$1,359.34 |
$1,359.34 |
$1,359.34 |
$3,874.79
|
|
Ua w/micro/comp poc
|
$13.25 |
$13.25 |
$13.25 |
$24.45
|
|
Ultrasound abdomen aorta screening study aaa
|
$141.11 |
$141.11 |
$141.11 |
$403.26
|
|
Ultrasound breast complete
|
$87.62 |
$87.62 |
$87.62 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$87.62 |
$87.62 |
$87.62 |
$449.35
|
|
Ultrasound chest
|
$153.33 |
$153.33 |
$153.33 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$113.09 |
$113.09 |
$113.09 |
$340.14
|
|
Ultrasound encephalogram
|
$162.76 |
$162.76 |
$162.76 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$222.87 |
$222.87 |
$222.87 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$125.32 |
$125.32 |
$125.32 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$356.08 |
$356.08 |
$356.08 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$236.11 |
$236.11 |
$236.11 |
$701.35
|
|
Ultrasound guide intraoperative
|
$253.94 |
$253.94 |
$253.94 |
$632.90
|
|
Ultrasound guide tissue ablation
|
$100.61 |
$100.61 |
$100.61 |
$498.40
|
|
Ultrasound hips infant dynamic
|
$131.18 |
$131.18 |
$131.18 |
$403.00
|
|
Ultrasound infant hips ltd without stress
|
$114.62 |
$114.62 |
$114.62 |
$321.35
|
|
Ultrasound joint complete left
|
$154.35 |
$154.35 |
$154.35 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$135.76 |
$135.76 |
$135.76 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$89.66 |
$89.66 |
$89.66 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$62.15 |
$62.15 |
$62.15 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$202.75 |
$202.75 |
$202.75 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$137.80 |
$137.80 |
$137.80 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$108.51 |
$108.51 |
$108.51 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$153.08 |
$153.08 |
$153.08 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$119.71 |
$119.71 |
$119.71 |
$545.16
|
|
Ultrasound scrotum and contents
|
$188.23 |
$188.23 |
$188.23 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$83.29 |
$83.29 |
$83.29 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$141.62 |
$141.62 |
$141.62 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$199.44 |
$199.44 |
$199.44 |
$567.44
|
|
Unlistd noninvas vasc dx std
|
$227.96 |
$227.96 |
$227.96 |
$819.65
|
|
Unlisted CT procedure
|
$522.14 |
$522.14 |
$522.14 |
$1,043.00
|
|
Unlisted cytogenetic study
|
$278.90 |
$278.90 |
$278.90 |
$132.48
|
|
Unlisted cytopathology px
|
$27.51 |
$27.51 |
$27.51 |
$71.65
|
|
Unlisted mr procedure
|
$576.90 |
$576.90 |
$576.90 |
$1,032.20
|
|
Unlisted px accessory sinus
|
$72.09 |
$72.09 |
$72.09 |
$257.26
|
|
Unlisted ultrasound procedure
|
$100.10 |
$100.10 |
$100.10 |
$321.20
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,389.90 |
$1,389.90 |
$1,389.90 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,166.53 |
$1,166.53 |
$1,166.53 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$963.79 |
$963.79 |
$963.79 |
$2,013.08
|
|
Upper Endoscopy (EGD, with biopsy)
|
$656.37 |
$656.37 |
$656.37 |
$1,656.60
|
|
Urea nitrogen
|
$14.01 |
$14.01 |
$14.01 |
$45.10
|
|
Urethrcystgrphy rtrgrde s&i
|
$196.63 |
$196.63 |
$196.63 |
$574.40
|
|
Urethrocystography void s&i
|
$315.07 |
$315.07 |
$315.07 |
$634.50
|
|
Uric acid blood
|
$16.82 |
$16.82 |
$16.82 |
$46.64
|
|
Uric acid urine
|
$27.77 |
$27.77 |
$27.77 |
$46.75
|
|
Urinalysis microscopic only
|
$8.16 |
$8.16 |
$8.16 |
$26.35
|
|
Urinalysis (with microscopy)
|
$9.43 |
$9.43 |
$9.43 |
$48.14
|
|
Urinalysis (without microscopy)
|
$8.41 |
$8.41 |
$8.41 |
$38.99
|
|
Urine Culture Test
|
$36.94 |
$36.94 |
$36.94 |
$84.81
|
|
Urine pregnancy test
|
$16.82 |
$16.82 |
$16.82 |
$66.40
|
|
Urography, antegrade
|
$167.09 |
$167.09 |
$167.09 |
$593.37
|
|
Vaccine influenza nos 0.5ml dose im
|
$7.90 |
$7.90 |
$7.90 |
$36.80
|
|
Vaccine influenza trivalent (iiv3) 0.25ml dose im
|
$7.14 |
$7.14 |
$7.14 |
$32.50
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$135.48 |
$135.48 |
$135.48 |
$274.95
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$480.41 |
$480.41 |
$480.41 |
$715.41
|
|
Vaccine rabies im
|
$612.60 |
$612.60 |
$612.60 |
$945.46
|
|
Vaginal bx
|
$113.35 |
$113.35 |
$113.35 |
$441.75
|
|
Valproic acid total therapeutic drug level
|
$46.62 |
$46.62 |
$46.62 |
$115.00
|
|
Vancomycin 1,000 mg intravenous injection
|
$18.23 |
$18.23 |
$18.23 |
$246.70
|
|
Vancomycin peak therapeutic drug level
|
$38.46 |
$38.46 |
$38.46 |
$126.79
|
|
Varicella zoster antibody igg
|
$11.47 |
$11.47 |
$11.47 |
$82.55
|
|
Vasopressin 20 unit/ml intravenous solution
|
$151.61 |
$151.61 |
$151.61 |
$362.93
|
|
Venogram ext bil s&i
|
$454.39 |
$454.39 |
$454.39 |
$1,838.28
|
|
Venogram extremity supervision & interpretation unilateral
|
$395.04 |
$395.04 |
$395.04 |
$1,326.00
|
|
Ventilator each subsequent day
|
$245.79 |
$245.79 |
$245.79 |
$1,305.92
|
|
Ventilator initial day
|
$422.81 |
$422.81 |
$422.81 |
$1,540.80
|
|
Visit established high 40-54 minutes/level 5
|
$93.99 |
$93.99 |
$93.99 |
$287.73
|
|
Vital capacity test
|
$41.52 |
$41.52 |
$41.52 |
$173.33
|
|
Vitamin b-12
|
$37.96 |
$37.96 |
$37.96 |
$94.90
|
|
Vitamin D Test
|
$68.26 |
$68.26 |
$68.26 |
$132.00
|
|
Volume measurement urine timed
|
$6.12 |
$6.12 |
$6.12 |
$21.45
|
|
Voriconazole in ns IV syringe 5 mg/ml (pediatric) - cnr
|
$28.27 |
$28.27 |
$28.27 |
$215.60
|
|
Warde 1003990 aldosterone
|
$144.67 |
$144.67 |
$144.67 |
$145.60
|
|
Warde 1005020 citrate 24 hour urine
|
$109.27 |
$109.27 |
$109.27 |
$97.61
|