|
Treat metatarsal fracture
|
$694.64 |
$694.64 |
$694.64 |
$7,913.97
|
|
Treat midfoot fracture each
|
$1,101.57 |
$1,101.57 |
$1,101.57 |
$6,192.78
|
|
Treat radius fracture
|
$1,217.45 |
$1,217.45 |
$1,217.45 |
$6,750.12
|
|
Treat thigh fracture
|
$1,575.76 |
$1,575.76 |
$1,575.76 |
$7,372.60
|
|
Treat thigh fracture
|
$2,077.92 |
$2,077.92 |
$2,077.92 |
$5,883.20
|
|
Treat thigh fracture
|
$2,135.20 |
$2,135.20 |
$2,135.20 |
$6,048.00
|
|
Treat thigh fracture
|
$1,305.36 |
$1,305.36 |
$1,305.36 |
$3,673.60
|
|
Treat thigh fx growth plate
|
$942.39 |
$942.39 |
$942.39 |
$421.50
|
|
Treat thumb fracture
|
$829.84 |
$829.84 |
$829.84 |
$3,839.54
|
|
Treat thumb fracture
|
$1,090.91 |
$1,090.91 |
$1,090.91 |
$3,839.54
|
|
Treat toe dislocation
|
$1,607.73 |
$1,607.73 |
$1,607.73 |
$3,111.65
|
|
Treat ulnar fracture
|
$695.31 |
$695.31 |
$695.31 |
$1,861.60
|
|
Treat ulnar fracture
|
$1,361.31 |
$1,361.31 |
$1,361.31 |
$5,419.00
|
|
Treponema pallidum antibody
|
$225.11 |
$225.11 |
$225.11 |
$72.80
|
|
Trg gene rearrangement anal
|
$199.80 |
$199.80 |
$199.80 |
$455.70
|
|
Triglycerides
|
$69.93 |
$69.93 |
$69.93 |
$54.60
|
|
Trim nondyst nails
|
$41.30 |
$41.30 |
$41.30 |
$124.22
|
|
Trmt of fracture (femoral shaft) 27500
|
$1,114.22 |
$1,114.22 |
$1,114.22 |
$777.00
|
|
Trnscath tx thromblytc vein ini day
|
$5,234.76 |
$5,234.76 |
$5,234.76 |
$4,329.36
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$1,862.14 |
$1,862.14 |
$1,862.14 |
$4,805.85
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$1,009.66 |
$1,009.66 |
$1,009.66 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$1,009.66 |
$1,009.66 |
$1,009.66 |
$3,322.20
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$1,009.66 |
$1,009.66 |
$1,009.66 |
$2,355.65
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$1,218.12 |
$1,218.12 |
$1,218.12 |
$2,328.30
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$1,031.64 |
$1,031.64 |
$1,031.64 |
$2,190.24
|
|
Troponin quantitative
|
$210.46 |
$210.46 |
$210.46 |
$123.75
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$897.11 |
$897.11 |
$897.11 |
$3,874.79
|
|
Tx closed tib shaft fx without manip
|
$648.02 |
$648.02 |
$648.02 |
$635.46
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$1,338.66 |
$1,338.66 |
$1,338.66 |
$4,449.44
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$872.46 |
$872.46 |
$872.46 |
$4,499.12
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$993.68 |
$993.68 |
$993.68 |
$4,281.00
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$1,035.63 |
$1,035.63 |
$1,035.63 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$380.96 |
$380.96 |
$380.96 |
$469.20
|
|
Tympanometry & reflex thresh
|
$38.63 |
$38.63 |
$38.63 |
$173.18
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$386.95 |
$386.95 |
$386.95 |
$911.43
|
|
Ultrasound chest
|
$1,150.85 |
$1,150.85 |
$1,150.85 |
$459.55
|
|
Ultrasound encephalogram
|
$1,741.59 |
$1,741.59 |
$1,741.59 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$1,863.47 |
$1,863.47 |
$1,863.47 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$815.19 |
$815.19 |
$815.19 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$561.44 |
$561.44 |
$561.44 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$3,134.20 |
$3,134.20 |
$3,134.20 |
$701.35
|
|
Ultrasound guide intraoperative
|
$2,435.57 |
$2,435.57 |
$2,435.57 |
$632.90
|
|
Ultrasound hips infant dynamic
|
$1,830.17 |
$1,830.17 |
$1,830.17 |
$403.00
|
|
Ultrasound infant hips ltd without stress
|
$1,843.49 |
$1,843.49 |
$1,843.49 |
$321.35
|
|
Ultrasound ob >=14wks ea addl gest
|
$943.73 |
$943.73 |
$943.73 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$494.18 |
$494.18 |
$494.18 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,464.54 |
$1,464.54 |
$1,464.54 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$1,287.38 |
$1,287.38 |
$1,287.38 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$1,158.18 |
$1,158.18 |
$1,158.18 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$1,287.38 |
$1,287.38 |
$1,287.38 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$1,582.42 |
$1,582.42 |
$1,582.42 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$1,730.94 |
$1,730.94 |
$1,730.94 |
$498.00
|
|
Ultrasound scrotum and contents
|
$1,762.24 |
$1,762.24 |
$1,762.24 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$1,628.37 |
$1,628.37 |
$1,628.37 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$2,006.00 |
$2,006.00 |
$2,006.00 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$1,928.07 |
$1,928.07 |
$1,928.07 |
$567.44
|
|
Unlisted laparoscopic liver biopy 47379
|
$5,224.77 |
$5,224.77 |
$5,224.77 |
$6,307.38
|
|
Unlisted laparoscopic procedure 49659
|
$1,103.57 |
$1,103.57 |
$1,103.57 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$9,153.51 |
$9,153.51 |
$9,153.51 |
$5,741.00
|
|
Unlisted laps px ovidct ovry
|
$5,224.77 |
$5,224.77 |
$5,224.77 |
$5,339.00
|
|
Unlisted orl service/px
|
$204.47 |
$204.47 |
$204.47 |
$121.50
|
|
Unlisted px abdomen muscskel
|
$358.98 |
$358.98 |
$358.98 |
$2,633.80
|
|
Unlisted px arthroscopy
|
$1,007.66 |
$1,007.66 |
$1,007.66 |
$4,087.20
|
|
Unlisted px leg/ankle
|
$388.95 |
$388.95 |
$388.95 |
$811.00
|
|
Unlisted px male genital sys
|
$371.63 |
$371.63 |
$371.63 |
$897.95
|
|
Unlisted px pelvis/hip joint
|
$388.95 |
$388.95 |
$388.95 |
$2,108.82
|
|
Unlisted transfusion med px
|
$32.64 |
$32.64 |
$32.64 |
$141.35
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$7,659.67 |
$7,659.67 |
$7,659.67 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$6,517.48 |
$6,517.48 |
$6,517.48 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$5,828.84 |
$5,828.84 |
$5,828.84 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$616.05 |
$616.05 |
$616.05 |
$1,588.59
|
|
Upper Endoscopy (EGD, with biopsy)
|
$710.63 |
$710.63 |
$710.63 |
$1,656.60
|
|
Uppr gi scope w/submuc inj
|
$262.41 |
$262.41 |
$262.41 |
$1,773.85
|
|
Urea nitrogen
|
$46.62 |
$46.62 |
$46.62 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$57.28 |
$57.28 |
$57.28 |
$50.00
|
|
Ureteral reflux study
|
$3,800.20 |
$3,800.20 |
$3,800.20 |
$961.20
|
|
Urethrcystgrphy rtrgrde s&i
|
$438.23 |
$438.23 |
$438.23 |
$574.40
|
|
Urethrocystography void s&i
|
$1,332.67 |
$1,332.67 |
$1,332.67 |
$634.50
|
|
Uric acid blood
|
$67.94 |
$67.94 |
$67.94 |
$46.64
|
|
Uric acid urine
|
$63.27 |
$63.27 |
$63.27 |
$46.75
|
|
Urinalysis microscopic only
|
$28.64 |
$28.64 |
$28.64 |
$26.35
|
|
Urinalysis (with microscopy)
|
$59.94 |
$59.94 |
$59.94 |
$48.14
|
|
Urinalysis (without microscopy)
|
$45.29 |
$45.29 |
$45.29 |
$38.99
|
|
Urine Culture Test
|
$38.63 |
$38.63 |
$38.63 |
$84.81
|
|
Urine pregnancy test
|
$74.60 |
$74.60 |
$74.60 |
$66.40
|
|
Urography inf drip &/or bolus
|
$1,408.59 |
$1,408.59 |
$1,408.59 |
$641.69
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$95,132.88 |
$95,132.88 |
$95,132.88 |
$56,553.85
|
|
Vaccine dtap-hep b-ipv im
|
$325.92 |
$325.92 |
$325.92 |
$193.83
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$40.54 |
$40.54 |
$40.54 |
$45.33
|
|
Vaccine hepatitis a (hepa) adult im
|
$238.23 |
$238.23 |
$238.23 |
$178.07
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$427.28 |
$427.28 |
$427.28 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$124.34 |
$124.34 |
$124.34 |
$84.38
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$202.66 |
$202.66 |
$202.66 |
$173.98
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$1,860.28 |
$1,860.28 |
$1,860.28 |
$79.04
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$1,001.41 |
$1,001.41 |
$1,001.41 |
$686.67
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$73.26 |
$73.26 |
$73.26 |
$157.41
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$23.31 |
$23.31 |
$23.31 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im
|
$23.31 |
$23.31 |
$23.31 |
$104.63
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$582.52 |
$582.52 |
$582.52 |
$499.00
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$482.99 |
$482.99 |
$482.99 |
$408.70
|