|
Treatment of thigh fracture
|
$4,287.36 |
$4,287.36 |
$4,287.36 |
$6,651.45
|
|
Treatment of thigh fracture
|
$1,188.48 |
$1,188.48 |
$1,188.48 |
$2,055.00
|
|
Treatment of tibia fracture
|
$4,287.36 |
$4,287.36 |
$4,287.36 |
$6,183.84
|
|
Treatment of toe fracture 28510
|
$425.76 |
$425.76 |
$425.76 |
$371.40
|
|
Treatment radiation delivery level 2
|
$1,168.32 |
$1,168.32 |
$1,168.32 |
$735.00
|
|
Treat metacarpal fracture
|
$4,919.04 |
$4,919.04 |
$4,919.04 |
$3,958.50
|
|
Treat metacarpal fracture
|
$4,919.04 |
$4,919.04 |
$4,919.04 |
$4,627.00
|
|
Treat metatarsal fracture
|
$4,006.08 |
$4,006.08 |
$4,006.08 |
$7,913.97
|
|
Treat midfoot fracture each
|
$1,720.32 |
$1,720.32 |
$1,720.32 |
$1,893.86
|
|
Treat spinal cord lesion
|
$2,538.24 |
$2,538.24 |
$2,538.24 |
$1,304.32
|
|
Treat sternum fracture
|
$456.00 |
$456.00 |
$456.00 |
$423.00
|
|
Treat thigh fracture
|
$425.76 |
$425.76 |
$425.76 |
$661.00
|
|
Treat thigh fracture
|
$4,287.36 |
$4,287.36 |
$4,287.36 |
$7,372.60
|
|
Treat thigh fracture
|
$1,720.32 |
$1,720.32 |
$1,720.32 |
$2,021.04
|
|
Treat thigh fracture
|
$425.76 |
$425.76 |
$425.76 |
$716.95
|
|
Treat thigh fx growth plate
|
$425.76 |
$425.76 |
$425.76 |
$421.50
|
|
Treat toe dislocation
|
$634.08 |
$634.08 |
$634.08 |
$855.66
|
|
Treat toe fracture
|
$4,596.00 |
$4,596.00 |
$4,596.00 |
$3,981.06
|
|
Treat ulnar fracture
|
$1,128.00 |
$1,128.00 |
$1,128.00 |
$1,861.60
|
|
Treat vaginal bleeding
|
$429.60 |
$429.60 |
$429.60 |
$400.86
|
|
Treat wrist bone fracture
|
$1,128.00 |
$1,128.00 |
$1,128.00 |
$1,907.64
|
|
Treat wrist dislocation
|
$407.04 |
$407.04 |
$407.04 |
$760.00
|
|
Treponema pallidum antibody
|
$111.36 |
$111.36 |
$111.36 |
$72.80
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$44.76 |
$44.76 |
$44.76 |
$55.80
|
|
Triamcinolone a inj prs-free
|
$88.25 |
$88.25 |
$88.25 |
$1,309.80
|
|
#tricyclicantidprssnt
|
$5.24 |
$5.24 |
$5.24 |
$57.08
|
|
Triglycerides
|
$62.88 |
$62.88 |
$62.88 |
$54.60
|
|
Trimethobenzamide hcl inj
|
$154.09 |
$154.09 |
$154.09 |
$128.00
|
|
Trim nondyst nails
|
$175.20 |
$175.20 |
$175.20 |
$124.22
|
|
Trmt of fracture (femoral shaft) 27500
|
$425.76 |
$425.76 |
$425.76 |
$777.00
|
|
Trnscath plc stent crv crtd without prtct
|
$16,328.64 |
$16,328.64 |
$16,328.64 |
$7,944.75
|
|
Trnscath plc stent crv crtd w/prtct
|
$16,328.64 |
$16,328.64 |
$16,328.64 |
$11,099.98
|
|
Trnscath plc stnt ante carotid art
|
$9,734.40 |
$9,734.40 |
$9,734.40 |
$9,114.56
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$4,423.20 |
$4,423.20 |
$4,423.20 |
$8,244.55
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$4,423.20 |
$4,423.20 |
$4,423.20 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$9,144.48 |
$9,144.48 |
$9,144.48 |
$15,408.00
|
|
Trnscath retrv pq vasc fb w/guide
|
$6,333.60 |
$6,333.60 |
$6,333.60 |
$4,969.90
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$3,422.88 |
$3,422.88 |
$3,422.88 |
$6,156.00
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$4,986.72 |
$4,986.72 |
$4,986.72 |
$4,505.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$4,986.72 |
$4,986.72 |
$4,986.72 |
$4,793.13
|
|
Trnscath tx thromblytc vein ini day
|
$2,235.84 |
$2,235.84 |
$2,235.84 |
$4,329.36
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$5,270.40 |
$5,270.40 |
$5,270.40 |
$4,805.85
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$2,635.20 |
$2,635.20 |
$2,635.20 |
$2,343.60
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$2,707.20 |
$2,707.20 |
$2,707.20 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$2,707.20 |
$2,707.20 |
$2,707.20 |
$3,322.20
|
|
Troponin quantitative
|
$108.00 |
$108.00 |
$108.00 |
$123.75
|
|
Tte w or without contr, cont ecg
|
$1,368.48 |
$1,368.48 |
$1,368.48 |
$1,876.20
|
|
Tte w or without fol w/con,stres
|
$2,521.92 |
$2,521.92 |
$2,521.92 |
$1,582.75
|
|
Tube trach disp innr can 5 xlt
|
$799.95 |
$799.95 |
$799.95 |
$460.58
|
|
Tx atrial fib pulm vein isol
|
$11,652.48 |
$11,652.48 |
$11,652.48 |
$32,426.20
|
|
Tx closed hip disl traumatic without anes
|
$489.60 |
$489.60 |
$489.60 |
$657.28
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$4,596.00 |
$4,596.00 |
$4,596.00 |
$3,874.79
|
|
Tx closed tib shaft fx without manip
|
$442.08 |
$442.08 |
$442.08 |
$635.46
|
|
Tx l/r atrial fib addl
|
$12,674.88 |
$12,674.88 |
$12,674.88 |
$7,717.80
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$4,596.00 |
$4,596.00 |
$4,596.00 |
$4,449.44
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$5,452.80 |
$5,452.80 |
$5,452.80 |
$4,499.12
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$5,866.08 |
$5,866.08 |
$5,866.08 |
$4,281.00
|
|
Tx open nsl fx uncomp
|
$4,771.20 |
$4,771.20 |
$4,771.20 |
$4,007.22
|
|
Tx open nsl sptl fx
|
$4,919.04 |
$4,919.04 |
$4,919.04 |
$4,289.04
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$5,866.08 |
$5,866.08 |
$5,866.08 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$425.76 |
$425.76 |
$425.76 |
$469.20
|
|
Ultrasound abdomen aorta screening study aaa
|
$303.36 |
$303.36 |
$303.36 |
$403.26
|
|
Ultrasound breast complete
|
$514.08 |
$514.08 |
$514.08 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$417.12 |
$417.12 |
$417.12 |
$449.35
|
|
Ultrasound chest
|
$953.28 |
$953.28 |
$953.28 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$315.36 |
$315.36 |
$315.36 |
$340.14
|
|
Ultrasound dx ophth b-scan
|
$162.24 |
$162.24 |
$162.24 |
$330.40
|
|
Ultrasound elastography ea l target les
|
$253.92 |
$253.92 |
$253.92 |
$136.11
|
|
Ultrasound elastography parenchyma
|
$253.92 |
$253.92 |
$253.92 |
$284.25
|
|
Ultrasound encephalogram
|
$904.80 |
$904.80 |
$904.80 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$904.80 |
$904.80 |
$904.80 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$1,085.76 |
$1,085.76 |
$1,085.76 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$264.00 |
$264.00 |
$264.00 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$740.16 |
$740.16 |
$740.16 |
$701.35
|
|
Ultrasound guide intraoperative
|
$810.24 |
$810.24 |
$810.24 |
$632.90
|
|
Ultrasound guide tissue ablation
|
$637.44 |
$637.44 |
$637.44 |
$498.40
|
|
Ultrasound hips infant dynamic
|
$794.40 |
$794.40 |
$794.40 |
$403.00
|
|
Ultrasound infant hips ltd without stress
|
$373.92 |
$373.92 |
$373.92 |
$321.35
|
|
Ultrasound joint complete left
|
$953.28 |
$953.28 |
$953.28 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$717.60 |
$717.60 |
$717.60 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$684.48 |
$684.48 |
$684.48 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$684.48 |
$684.48 |
$684.48 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,174.08 |
$1,174.08 |
$1,174.08 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$558.72 |
$558.72 |
$558.72 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$794.88 |
$794.88 |
$794.88 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$761.28 |
$761.28 |
$761.28 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$1,085.76 |
$1,085.76 |
$1,085.76 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$548.16 |
$548.16 |
$548.16 |
$498.00
|
|
Ultrasound scrotum and contents
|
$1,044.48 |
$1,044.48 |
$1,044.48 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$794.40 |
$794.40 |
$794.40 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$352.32 |
$352.32 |
$352.32 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$1,085.76 |
$1,085.76 |
$1,085.76 |
$567.44
|
|
Umbilical artery cath newborn 36660
|
$121.44 |
$121.44 |
$121.44 |
$265.85
|
|
Unlisted chemotherapy px
|
$381.12 |
$381.12 |
$381.12 |
$153.85
|
|
Unlisted CT procedure
|
$417.60 |
$417.60 |
$417.60 |
$1,043.00
|
|
Unlisted fluoroscopic px
|
$2,128.32 |
$2,128.32 |
$2,128.32 |
$324.85
|
|
Unlisted misc path test
|
$92.16 |
$92.16 |
$92.16 |
$89.40
|
|
Unlisted mr procedure
|
$567.84 |
$567.84 |
$567.84 |
$1,032.20
|
|
Unlisted procedure rectum
|
$1,501.92 |
$1,501.92 |
$1,501.92 |
$1,278.72
|
|
Unlisted procedure spine
|
$3,698.40 |
$3,698.40 |
$3,698.40 |
$4,706.35
|
