|
Treat midfoot fracture each
|
$1,346.45 |
$1,346.45 |
$1,346.45 |
$1,893.86
|
|
Treat sternum fracture
|
$402.50 |
$402.50 |
$402.50 |
$423.00
|
|
Treat thigh fracture
|
$189.00 |
$189.00 |
$189.00 |
$661.00
|
|
Treat thigh fracture
|
$3,786.65 |
$3,786.65 |
$3,786.65 |
$7,372.60
|
|
Treat thigh fracture
|
$1,346.45 |
$1,346.45 |
$1,346.45 |
$2,021.04
|
|
Treat thigh fracture
|
$164.50 |
$164.50 |
$164.50 |
$716.95
|
|
Treat thigh fracture
|
$1,285.90 |
$1,285.90 |
$1,285.90 |
$2,090.14
|
|
Treat thigh fx growth plate
|
$164.50 |
$164.50 |
$164.50 |
$421.50
|
|
Treat toe dislocation
|
$233.80 |
$233.80 |
$233.80 |
$855.66
|
|
Treat toe fracture
|
$2,738.05 |
$2,738.05 |
$2,738.05 |
$3,981.06
|
|
Treat ulnar fracture
|
$1,548.40 |
$1,548.40 |
$1,548.40 |
$1,861.60
|
|
Treat vaginal bleeding
|
$189.00 |
$189.00 |
$189.00 |
$400.86
|
|
Treat wrist bone fracture
|
$1,548.40 |
$1,548.40 |
$1,548.40 |
$1,907.64
|
|
Treat wrist dislocation
|
$233.80 |
$233.80 |
$233.80 |
$760.00
|
|
Trg gene rearrangement anal
|
$73.50 |
$73.50 |
$73.50 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$34.16 |
$34.16 |
$34.16 |
$55.80
|
|
Triglycerides
|
$134.40 |
$134.40 |
$134.40 |
$54.60
|
|
Trimethobenzamide hci 250mg
|
$0.63 |
$0.63 |
$0.63 |
$5.28
|
|
Trimethobenzamide hcl inj
|
$148.05 |
$148.05 |
$148.05 |
$128.00
|
|
Trim nondyst nails
|
$124.95 |
$124.95 |
$124.95 |
$124.22
|
|
Trmt of fracture (femoral shaft) 27500
|
$189.00 |
$189.00 |
$189.00 |
$777.00
|
|
Trnscath plc stent crv crtd without prtct
|
$24,860.50 |
$24,860.50 |
$24,860.50 |
$7,944.75
|
|
Trnscath plc stent crv crtd w/prtct
|
$24,860.50 |
$24,860.50 |
$24,860.50 |
$11,099.98
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$2,051.35 |
$2,051.35 |
$2,051.35 |
$8,244.55
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$2,051.35 |
$2,051.35 |
$2,051.35 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$5,163.55 |
$5,163.55 |
$5,163.55 |
$15,408.00
|
|
Trnscath retrv pq vasc fb w/guide
|
$4,452.35 |
$4,452.35 |
$4,452.35 |
$4,969.90
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$3,391.15 |
$3,391.15 |
$3,391.15 |
$6,156.00
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$2,196.60 |
$2,196.60 |
$2,196.60 |
$4,505.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$2,196.60 |
$2,196.60 |
$2,196.60 |
$4,793.13
|
|
Trnscath tx thromblytc vein ini day
|
$3,391.15 |
$3,391.15 |
$3,391.15 |
$4,329.36
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$3,738.35 |
$3,738.35 |
$3,738.35 |
$4,805.85
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$1,012.55 |
$1,012.55 |
$1,012.55 |
$2,343.60
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$1,818.60 |
$1,818.60 |
$1,818.60 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$1,818.60 |
$1,818.60 |
$1,818.60 |
$3,322.20
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$1,818.60 |
$1,818.60 |
$1,818.60 |
$2,355.65
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$1,904.35 |
$1,904.35 |
$1,904.35 |
$2,190.24
|
|
Troponin quantitative
|
$168.70 |
$168.70 |
$168.70 |
$123.75
|
|
Tte w or without fol w/con,stres
|
$966.00 |
$966.00 |
$966.00 |
$1,582.75
|
|
Tube trach disp innr can 5 xlt
|
$375.95 |
$375.95 |
$375.95 |
$460.58
|
|
Tx atrial fib pulm vein isol
|
$11,144.70 |
$11,144.70 |
$11,144.70 |
$32,426.20
|
|
Tx closed distal humerus fx
|
$1,489.25 |
$1,489.25 |
$1,489.25 |
$786.00
|
|
Tx closed hip disl traumatic without anes
|
$189.00 |
$189.00 |
$189.00 |
$657.28
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$3,148.95 |
$3,148.95 |
$3,148.95 |
$3,874.79
|
|
Tx closed tib shaft fx without manip
|
$348.25 |
$348.25 |
$348.25 |
$635.46
|
|
Tx l/r atrial fib addl
|
$3,162.60 |
$3,162.60 |
$3,162.60 |
$7,717.80
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$2,738.05 |
$2,738.05 |
$2,738.05 |
$4,449.44
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$3,148.95 |
$3,148.95 |
$3,148.95 |
$4,499.12
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$3,148.95 |
$3,148.95 |
$3,148.95 |
$4,281.00
|
|
Tx open nsl fx uncomp
|
$1,731.10 |
$1,731.10 |
$1,731.10 |
$4,007.22
|
|
Tx open nsl sptl fx
|
$2,614.50 |
$2,614.50 |
$2,614.50 |
$4,289.04
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$2,738.05 |
$2,738.05 |
$2,738.05 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$164.50 |
$164.50 |
$164.50 |
$469.20
|
|
Ultrasound abdomen aorta screening study aaa
|
$166.95 |
$166.95 |
$166.95 |
$403.26
|
|
Ultrasound breast complete
|
$442.05 |
$442.05 |
$442.05 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$331.10 |
$331.10 |
$331.10 |
$449.35
|
|
Ultrasound chest
|
$292.25 |
$292.25 |
$292.25 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$230.65 |
$230.65 |
$230.65 |
$340.14
|
|
Ultrasound encephalogram
|
$602.00 |
$602.00 |
$602.00 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$602.00 |
$602.00 |
$602.00 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$367.85 |
$367.85 |
$367.85 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$52.50 |
$52.50 |
$52.50 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$365.40 |
$365.40 |
$365.40 |
$701.35
|
|
Ultrasound guide intraoperative
|
$175.00 |
$175.00 |
$175.00 |
$632.90
|
|
Ultrasound guide tissue ablation
|
$2,581.95 |
$2,581.95 |
$2,581.95 |
$498.40
|
|
Ultrasound hips infant dynamic
|
$106.40 |
$106.40 |
$106.40 |
$403.00
|
|
Ultrasound infant hips ltd without stress
|
$102.20 |
$102.20 |
$102.20 |
$321.35
|
|
Ultrasound joint complete left
|
$403.20 |
$403.20 |
$403.20 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$302.40 |
$302.40 |
$302.40 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$228.90 |
$228.90 |
$228.90 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$204.75 |
$204.75 |
$204.75 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$352.80 |
$352.80 |
$352.80 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$231.35 |
$231.35 |
$231.35 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$434.70 |
$434.70 |
$434.70 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$394.80 |
$394.80 |
$394.80 |
$485.48
|
|
Ultrasound retroperitoneal limited
|
$442.05 |
$442.05 |
$442.05 |
$498.00
|
|
Ultrasound scrotum and contents
|
$531.30 |
$531.30 |
$531.30 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$403.20 |
$403.20 |
$403.20 |
$450.60
|
|
Ultrasound transvaginal non obstetric
|
$442.05 |
$442.05 |
$442.05 |
$567.44
|
|
Umbilical artery cath newborn 36660
|
$458.15 |
$458.15 |
$458.15 |
$265.85
|
|
Unlisted chemotherapy px
|
$96.25 |
$96.25 |
$96.25 |
$153.85
|
|
Unlisted fluoroscopic px
|
$171.50 |
$171.50 |
$171.50 |
$324.85
|
|
Unlisted mr procedure
|
$166.60 |
$166.60 |
$166.60 |
$1,032.20
|
|
Unlisted procedure microbiology
|
$19.95 |
$19.95 |
$19.95 |
$487.50
|
|
Unlisted procedure rectum
|
$732.90 |
$732.90 |
$732.90 |
$1,278.72
|
|
Unlisted px hands/fingers
|
$188.65 |
$188.65 |
$188.65 |
$379.44
|
|
Unlisted px salivry glnd/dux
|
$235.55 |
$235.55 |
$235.55 |
$486.72
|
|
Unlisted px small intestine
|
$747.25 |
$747.25 |
$747.25 |
$2,118.35
|
|
Unlisted ultrasound procedure
|
$113.40 |
$113.40 |
$113.40 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$996.45 |
$996.45 |
$996.45 |
$1,469.76
|
|
Upgrade pm system
|
$9,546.95 |
$9,546.95 |
$9,546.95 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,739.70 |
$4,739.70 |
$4,739.70 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,769.85 |
$3,769.85 |
$3,769.85 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,473.05 |
$3,473.05 |
$3,473.05 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$622.65 |
$622.65 |
$622.65 |
$1,588.59
|
|
Upper Endoscopy (EGD, with biopsy)
|
$622.65 |
$622.65 |
$622.65 |
$1,656.60
|
|
Upper ext fx orthosis rad/ul
|
$872.75 |
$872.75 |
$872.75 |
$619.49
|
|
Urea nitrogen
|
$64.75 |
$64.75 |
$64.75 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$237.65 |
$237.65 |
$237.65 |
$50.00
|
|
Urea nitrogen clearance
|
$166.25 |
$166.25 |
$166.25 |
$33.57
|
