|
Treatment mouth roof lesion
|
$6,441.81 |
$6,441.81 |
$6,441.81 |
$4,350.00
|
|
Treatment of ankle fracture
|
$14,977.68 |
$14,977.68 |
$14,977.68 |
$7,907.11
|
|
Treatment of ankle fracture
|
$13,017.24 |
$13,017.24 |
$13,017.24 |
$7,907.11
|
|
Treatment of ankle fracture
|
$13,017.24 |
$13,017.24 |
$13,017.24 |
$7,348.32
|
|
Treatment of ankle fracture 27786
|
$504.90 |
$504.90 |
$504.90 |
$580.00
|
|
Treatment of fibula fracture
|
$14,977.68 |
$14,977.68 |
$14,977.68 |
$7,069.90
|
|
Treatment of fibula fracture 27780
|
$469.20 |
$469.20 |
$469.20 |
$558.75
|
|
Treatment of heel fracture 28400
|
$469.20 |
$469.20 |
$469.20 |
$494.00
|
|
Treatment of miscarriage
|
$6,403.05 |
$6,403.05 |
$6,403.05 |
$4,146.69
|
|
Treatment of thigh fracture
|
$408.00 |
$408.00 |
$408.00 |
$467.25
|
|
Treatment of thigh fracture
|
$2,822.85 |
$2,822.85 |
$2,822.85 |
$1,893.86
|
|
Treatment of thigh fracture
|
$469.20 |
$469.20 |
$469.20 |
$659.00
|
|
Treatment of thigh fracture
|
$13,017.24 |
$13,017.24 |
$13,017.24 |
$6,651.45
|
|
Treatment of thigh fracture
|
$1,690.14 |
$1,690.14 |
$1,690.14 |
$2,055.00
|
|
Treatment of tibia fracture
|
$13,017.24 |
$13,017.24 |
$13,017.24 |
$6,183.84
|
|
Treatment of toe fracture 28510
|
$469.20 |
$469.20 |
$469.20 |
$371.40
|
|
Treat metacarpal fracture
|
$5,857.86 |
$5,857.86 |
$5,857.86 |
$3,958.50
|
|
Treat metacarpal fracture
|
$5,857.86 |
$5,857.86 |
$5,857.86 |
$4,627.00
|
|
Treat metatarsal fracture
|
$14,977.68 |
$14,977.68 |
$14,977.68 |
$7,913.97
|
|
Treat midfoot fracture each
|
$3,248.19 |
$3,248.19 |
$3,248.19 |
$1,893.86
|
|
Treat sternum fracture
|
$408.00 |
$408.00 |
$408.00 |
$423.00
|
|
Treat thigh fracture
|
$469.20 |
$469.20 |
$469.20 |
$661.00
|
|
Treat thigh fracture
|
$13,017.24 |
$13,017.24 |
$13,017.24 |
$7,372.60
|
|
Treat thigh fracture
|
$3,248.19 |
$3,248.19 |
$3,248.19 |
$2,021.04
|
|
Treat thigh fracture
|
$469.20 |
$469.20 |
$469.20 |
$716.95
|
|
Treat thigh fx growth plate
|
$469.20 |
$469.20 |
$469.20 |
$421.50
|
|
Treat toe dislocation
|
$821.10 |
$821.10 |
$821.10 |
$855.66
|
|
Treat toe fracture
|
$6,740.16 |
$6,740.16 |
$6,740.16 |
$3,981.06
|
|
Treat ulnar fracture
|
$3,248.19 |
$3,248.19 |
$3,248.19 |
$1,861.60
|
|
Treat vaginal bleeding
|
$403.92 |
$403.92 |
$403.92 |
$400.86
|
|
Treat wrist bone fracture
|
$4,419.66 |
$4,419.66 |
$4,419.66 |
$1,907.64
|
|
Treat wrist dislocation
|
$623.73 |
$623.73 |
$623.73 |
$760.00
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$10,314.94 |
$10,314.94 |
$10,314.94 |
$101,032.80
|
|
Treponema pallidum antibody
|
$380.46 |
$380.46 |
$380.46 |
$72.80
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$84.15 |
$84.15 |
$84.15 |
$55.80
|
|
Triamcinolone a inj prs-free
|
$107.41 |
$107.41 |
$107.41 |
$1,309.80
|
|
#tricyclicantidprssnt
|
$5.56 |
$5.56 |
$5.56 |
$57.08
|
|
Triglycerides
|
$83.64 |
$83.64 |
$83.64 |
$54.60
|
|
Trim nondyst nails
|
$130.05 |
$130.05 |
$130.05 |
$124.22
|
|
Trmt of fracture (femoral shaft) 27500
|
$469.20 |
$469.20 |
$469.20 |
$777.00
|
|
Trnscath plc stent crv crtd w/prtct
|
$13,671.06 |
$13,671.06 |
$13,671.06 |
$11,099.98
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$4,034.10 |
$4,034.10 |
$4,034.10 |
$8,244.55
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$4,034.10 |
$4,034.10 |
$4,034.10 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$13,544.07 |
$13,544.07 |
$13,544.07 |
$15,408.00
|
|
Trnscath retrv pq vasc fb w/guide
|
$3,670.98 |
$3,670.98 |
$3,670.98 |
$4,969.90
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$5,786.46 |
$5,786.46 |
$5,786.46 |
$6,156.00
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$3,473.61 |
$3,473.61 |
$3,473.61 |
$4,505.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$3,473.61 |
$3,473.61 |
$3,473.61 |
$4,793.13
|
|
Trnscath tx thromblytc vein ini day
|
$5,862.45 |
$5,862.45 |
$5,862.45 |
$4,329.36
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$6,402.03 |
$6,402.03 |
$6,402.03 |
$4,805.85
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$6,931.92 |
$6,931.92 |
$6,931.92 |
$2,343.60
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$3,397.11 |
$3,397.11 |
$3,397.11 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$3,397.11 |
$3,397.11 |
$3,397.11 |
$3,322.20
|
|
Troponin quantitative
|
$280.50 |
$280.50 |
$280.50 |
$123.75
|
|
Tte w or without contr, cont ecg
|
$1,130.16 |
$1,130.16 |
$1,130.16 |
$1,876.20
|
|
Tte w or without fol w/con,stres
|
$1,397.91 |
$1,397.91 |
$1,397.91 |
$1,582.75
|
|
Tube trach disp innr can 5 xlt
|
$830.03 |
$830.03 |
$830.03 |
$460.58
|
|
Tx closed hip disl traumatic without anes
|
$1,401.48 |
$1,401.48 |
$1,401.48 |
$657.28
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$4,745.04 |
$4,745.04 |
$4,745.04 |
$3,874.79
|
|
Tx closed tib shaft fx without manip
|
$469.20 |
$469.20 |
$469.20 |
$635.46
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$6,740.16 |
$6,740.16 |
$6,740.16 |
$4,449.44
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$6,740.16 |
$6,740.16 |
$6,740.16 |
$4,499.12
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$8,984.16 |
$8,984.16 |
$8,984.16 |
$4,281.00
|
|
Tx open nsl fx uncomp
|
$6,441.81 |
$6,441.81 |
$6,441.81 |
$4,007.22
|
|
Tx open nsl sptl fx
|
$5,857.86 |
$5,857.86 |
$5,857.86 |
$4,289.04
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$6,740.16 |
$6,740.16 |
$6,740.16 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$469.20 |
$469.20 |
$469.20 |
$469.20
|
|
Ultrasound abdomen aorta screening study aaa
|
$526.32 |
$526.32 |
$526.32 |
$403.26
|
|
Ultrasound bone density measure
|
$160.65 |
$160.65 |
$160.65 |
$117.81
|
|
Ultrasound breast complete
|
$1,071.51 |
$1,071.51 |
$1,071.51 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$1,071.51 |
$1,071.51 |
$1,071.51 |
$449.35
|
|
Ultrasound chest
|
$1,291.32 |
$1,291.32 |
$1,291.32 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$1,185.24 |
$1,185.24 |
$1,185.24 |
$340.14
|
|
Ultrasound elastography parenchyma
|
$399.84 |
$399.84 |
$399.84 |
$284.25
|
|
Ultrasound encephalogram
|
$1,537.14 |
$1,537.14 |
$1,537.14 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$1,605.48 |
$1,605.48 |
$1,605.48 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$1,452.48 |
$1,452.48 |
$1,452.48 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$607.41 |
$607.41 |
$607.41 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$987.87 |
$987.87 |
$987.87 |
$701.35
|
|
Ultrasound guide intraoperative
|
$2,333.25 |
$2,333.25 |
$2,333.25 |
$632.90
|
|
Ultrasound hips infant dynamic
|
$1,506.54 |
$1,506.54 |
$1,506.54 |
$403.00
|
|
Ultrasound infant hips ltd without stress
|
$633.93 |
$633.93 |
$633.93 |
$321.35
|
|
Ultrasound joint complete left
|
$1,839.57 |
$1,839.57 |
$1,839.57 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$1,598.85 |
$1,598.85 |
$1,598.85 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$2,027.25 |
$2,027.25 |
$2,027.25 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$1,183.20 |
$1,183.20 |
$1,183.20 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,558.05 |
$1,558.05 |
$1,558.05 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$1,414.23 |
$1,414.23 |
$1,414.23 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$1,342.32 |
$1,342.32 |
$1,342.32 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$1,546.32 |
$1,546.32 |
$1,546.32 |
$485.48
|
|
Ultrasound retroperitoneal limited
|
$1,551.42 |
$1,551.42 |
$1,551.42 |
$498.00
|
|
Ultrasound scrotum and contents
|
$1,816.11 |
$1,816.11 |
$1,816.11 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$1,421.37 |
$1,421.37 |
$1,421.37 |
$450.60
|
|
Ultrasound transvaginal non obstetric
|
$1,510.11 |
$1,510.11 |
$1,510.11 |
$567.44
|
|
Umbilical artery cath newborn 36660
|
$492.66 |
$492.66 |
$492.66 |
$265.85
|
|
Unlisted chemotherapy px
|
$447.78 |
$447.78 |
$447.78 |
$153.85
|
|
Unlisted misc path test
|
$93.84 |
$93.84 |
$93.84 |
$89.40
|
|
Unlisted mr procedure
|
$279.99 |
$279.99 |
$279.99 |
$1,032.20
|
|
Unlisted procedure microbiology
|
$653.82 |
$653.82 |
$653.82 |
$487.50
|
|
Unlisted procedure rectum
|
$6,529.53 |
$6,529.53 |
$6,529.53 |
$1,278.72
|
