|
Treat toe fracture
|
$3,657.72 |
$3,657.72 |
$3,657.72 |
$3,981.06
|
|
Treat ulnar fracture
|
$1,225.02 |
$1,225.02 |
$1,225.02 |
$1,861.60
|
|
Treat ulnar fracture
|
$1,033.77 |
$1,033.77 |
$1,033.77 |
$5,419.00
|
|
Treat vaginal bleeding
|
$218.79 |
$218.79 |
$218.79 |
$400.86
|
|
Treat wrist bone fracture
|
$1,763.07 |
$1,763.07 |
$1,763.07 |
$1,907.64
|
|
Treat wrist dislocation
|
$254.49 |
$254.49 |
$254.49 |
$760.00
|
|
Treponema pallidum antibody
|
$85.68 |
$85.68 |
$85.68 |
$72.80
|
|
Treprostinil, non-comp unit
|
$1,673.43 |
$1,673.43 |
$1,673.43 |
$1,475.15
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$84.15 |
$84.15 |
$84.15 |
$55.80
|
|
Triglycerides
|
$46.92 |
$46.92 |
$46.92 |
$54.60
|
|
Trim nail(s)
|
$12.24 |
$12.24 |
$12.24 |
$70.29
|
|
Trim nondyst nails
|
$170.34 |
$170.34 |
$170.34 |
$124.22
|
|
Trmt of fracture (femoral shaft) 27500
|
$254.49 |
$254.49 |
$254.49 |
$777.00
|
|
Trnscath tx thromblytc vein ini day
|
$3,038.58 |
$3,038.58 |
$3,038.58 |
$4,329.36
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$3,318.06 |
$3,318.06 |
$3,318.06 |
$4,805.85
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$1,450.44 |
$1,450.44 |
$1,450.44 |
$2,343.60
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$1,760.52 |
$1,760.52 |
$1,760.52 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$1,760.52 |
$1,760.52 |
$1,760.52 |
$3,322.20
|
|
Troponin quantitative
|
$80.07 |
$80.07 |
$80.07 |
$123.75
|
|
Tube trach disp innr can 5 xlt
|
$509.08 |
$509.08 |
$509.08 |
$460.58
|
|
Tx closed hip disl traumatic without anes
|
$254.49 |
$254.49 |
$254.49 |
$657.28
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$3,657.72 |
$3,657.72 |
$3,657.72 |
$3,874.79
|
|
Tx closed tib shaft fx without manip
|
$1,098.03 |
$1,098.03 |
$1,098.03 |
$635.46
|
|
Tx contour defects 1.1-5.0cc 11951
|
$153.00 |
$153.00 |
$153.00 |
$724.37
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$3,657.72 |
$3,657.72 |
$3,657.72 |
$4,449.44
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$3,657.72 |
$3,657.72 |
$3,657.72 |
$4,499.12
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$3,657.72 |
$3,657.72 |
$3,657.72 |
$4,281.00
|
|
Tx open nsl fx uncomp
|
$3,496.05 |
$3,496.05 |
$3,496.05 |
$4,007.22
|
|
Tx open nsl sptl fx
|
$3,036.03 |
$3,036.03 |
$3,036.03 |
$4,289.04
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$3,657.72 |
$3,657.72 |
$3,657.72 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$435.54 |
$435.54 |
$435.54 |
$469.20
|
|
Ultrasound abdomen aorta screening study aaa
|
$491.13 |
$491.13 |
$491.13 |
$403.26
|
|
Ultrasound breast complete
|
$342.72 |
$342.72 |
$342.72 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$342.72 |
$342.72 |
$342.72 |
$449.35
|
|
Ultrasound chest
|
$467.16 |
$467.16 |
$467.16 |
$459.55
|
|
Ultrasound exam k transpl w/doppler
|
$543.66 |
$543.66 |
$543.66 |
$570.44
|
|
Ultrasound guidance for vascular access
|
$185.64 |
$185.64 |
$185.64 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$643.62 |
$643.62 |
$643.62 |
$701.35
|
|
Ultrasound joint complete left
|
$475.83 |
$475.83 |
$475.83 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$475.83 |
$475.83 |
$475.83 |
$448.50
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$273.87 |
$273.87 |
$273.87 |
$326.54
|
|
Ultrasound pregnant uterus follow up per fetus
|
$380.46 |
$380.46 |
$380.46 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$467.16 |
$467.16 |
$467.16 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$467.16 |
$467.16 |
$467.16 |
$485.48
|
|
Ultrasound scrotum and contents
|
$467.16 |
$467.16 |
$467.16 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$126.48 |
$126.48 |
$126.48 |
$450.60
|
|
Ultrasound transvaginal non obstetric
|
$467.16 |
$467.16 |
$467.16 |
$567.44
|
|
Unlisted mr procedure
|
$255.00 |
$255.00 |
$255.00 |
$1,032.20
|
|
Unlisted procedure rectum
|
$1,197.99 |
$1,197.99 |
$1,197.99 |
$1,278.72
|
|
Unlisted px arthroscopy
|
$328.95 |
$328.95 |
$328.95 |
$4,087.20
|
|
Unlisted px pelvis/hip joint
|
$361.08 |
$361.08 |
$361.08 |
$2,108.82
|
|
Unlisted px salivry glnd/dux
|
$255.51 |
$255.51 |
$255.51 |
$486.72
|
|
Unlisted px small intestine
|
$842.01 |
$842.01 |
$842.01 |
$2,118.35
|
|
Unlisted ultrasound procedure
|
$115.26 |
$115.26 |
$115.26 |
$321.20
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,236.57 |
$4,236.57 |
$4,236.57 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,788.57 |
$1,788.57 |
$1,788.57 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$842.01 |
$842.01 |
$842.01 |
$1,588.59
|
|
Upper Endoscopy (EGD, with biopsy)
|
$842.01 |
$842.01 |
$842.01 |
$1,656.60
|
|
Urea nitrogen
|
$32.64 |
$32.64 |
$32.64 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$66.30 |
$66.30 |
$66.30 |
$50.00
|
|
Uric acid blood
|
$36.72 |
$36.72 |
$36.72 |
$46.64
|
|
Urinalysis microscopic only
|
$33.66 |
$33.66 |
$33.66 |
$26.35
|
|
Urinalysis (with microscopy)
|
$35.70 |
$35.70 |
$35.70 |
$48.14
|
|
Urinalysis (without microscopy)
|
$23.46 |
$23.46 |
$23.46 |
$38.99
|
|
Urine Culture Test
|
$102.51 |
$102.51 |
$102.51 |
$84.81
|
|
Urine pregnancy test
|
$30.60 |
$30.60 |
$30.60 |
$66.40
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$148.84 |
$148.84 |
$148.84 |
$223.08
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$148.84 |
$148.84 |
$148.84 |
$218.88
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$133.72 |
$133.72 |
$133.72 |
$239.85
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$89.54 |
$89.54 |
$89.54 |
$131.67
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$66.67 |
$66.67 |
$66.67 |
$91.00
|
|
Vaccine dtap < 7 years im
|
$45.90 |
$45.90 |
$45.90 |
$87.80
|
|
Vaccine hepatitis a (hepa) adult im
|
$101.57 |
$101.57 |
$101.57 |
$178.07
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$216.42 |
$216.42 |
$216.42 |
$173.98
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$36.01 |
$36.01 |
$36.01 |
$79.04
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$383.52 |
$383.52 |
$383.52 |
$686.67
|
|
Vaccine influenza inactivated adjuvant im
|
$244.43 |
$244.43 |
$244.43 |
$110.25
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$98.22 |
$98.22 |
$98.22 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$23.94 |
$23.94 |
$23.94 |
$40.01
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$142.45 |
$142.45 |
$142.45 |
$103.88
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$629.24 |
$629.24 |
$629.24 |
$499.00
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$45.90 |
$45.90 |
$45.90 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$144.84 |
$144.84 |
$144.84 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$349.78 |
$349.78 |
$349.78 |
$274.95
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$326.40 |
$326.40 |
$326.40 |
$397.18
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$720.50 |
$720.50 |
$720.50 |
$715.41
|
|
Vaccine polio (ipv) subcutaneous/im
|
$86.70 |
$86.70 |
$86.70 |
$119.17
|
|
Vaccine rabies im
|
$911.02 |
$911.02 |
$911.02 |
$945.46
|
|
Vaccine tdap >=7 years im
|
$183.33 |
$183.33 |
$183.33 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$195.37 |
$195.37 |
$195.37 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$272.34 |
$272.34 |
$272.34 |
$447.80
|
|
Vad battery clip set hmii 14-v li-ion
|
$1,302.64 |
$1,302.64 |
$1,302.64 |
$1,683.99
|
|
Vad univ batt charger hm 1440
|
$11,104.13 |
$11,104.13 |
$11,104.13 |
$14,893.34
|
|
Vaginal bx
|
$455.94 |
$455.94 |
$455.94 |
$441.75
|
|
Vaginal delivery after cesarean delivery 59612
|
$2,884.05 |
$2,884.05 |
$2,884.05 |
$4,109.28
|
|
Valproic acid total therapeutic drug level
|
$154.02 |
$154.02 |
$154.02 |
$115.00
|
|
Vancomycin 1,000 mg intravenous injection
|
$99.86 |
$99.86 |
$99.86 |
$246.70
|
|
Vancomycin 750 mg intravenous solution
|
$176.15 |
$176.15 |
$176.15 |
$100.15
|
|
Vancomycin peak therapeutic drug level
|
$145.35 |
$145.35 |
$145.35 |
$126.79
|
|
Vasectomy
|
$634.44 |
$634.44 |
$634.44 |
$2,424.12
|
