|
Treatment mouth roof lesion
|
$2,858.45 |
$2,858.45 |
$2,858.45 |
$4,350.00
|
|
Treatment of ankle fracture
|
$5,779.90 |
$5,779.90 |
$5,779.90 |
$7,907.11
|
|
Treatment of ankle fracture
|
$4,291.70 |
$4,291.70 |
$4,291.70 |
$7,907.11
|
|
Treatment of ankle fracture
|
$4,291.70 |
$4,291.70 |
$4,291.70 |
$7,348.32
|
|
Treatment of ankle fracture 27786
|
$675.85 |
$675.85 |
$675.85 |
$580.00
|
|
Treatment of fibula fracture
|
$5,779.90 |
$5,779.90 |
$5,779.90 |
$7,069.90
|
|
Treatment of fibula fracture 27780
|
$675.85 |
$675.85 |
$675.85 |
$558.75
|
|
Treatment of heel fracture 28400
|
$497.00 |
$497.00 |
$497.00 |
$494.00
|
|
Treatment of miscarriage
|
$3,679.90 |
$3,679.90 |
$3,679.90 |
$4,146.69
|
|
Treatment of thigh fracture
|
$368.90 |
$368.90 |
$368.90 |
$467.25
|
|
Treatment of thigh fracture
|
$1,267.00 |
$1,267.00 |
$1,267.00 |
$1,893.86
|
|
Treatment of thigh fracture
|
$675.85 |
$675.85 |
$675.85 |
$659.00
|
|
Treatment of thigh fracture
|
$4,291.70 |
$4,291.70 |
$4,291.70 |
$6,651.45
|
|
Treatment of thigh fracture
|
$1,731.10 |
$1,731.10 |
$1,731.10 |
$2,055.00
|
|
Treatment of tibia fracture
|
$4,291.70 |
$4,291.70 |
$4,291.70 |
$6,183.84
|
|
Treatment of toe fracture 28510
|
$675.85 |
$675.85 |
$675.85 |
$371.40
|
|
Treatment radiation delivery level 2
|
$558.60 |
$558.60 |
$558.60 |
$735.00
|
|
Treat metacarpal fracture
|
$1,824.55 |
$1,824.55 |
$1,824.55 |
$3,958.50
|
|
Treat metacarpal fracture
|
$1,824.55 |
$1,824.55 |
$1,824.55 |
$4,627.00
|
|
Treat metatarsal fracture
|
$5,779.90 |
$5,779.90 |
$5,779.90 |
$7,913.97
|
|
Treat midfoot fracture each
|
$2,320.50 |
$2,320.50 |
$2,320.50 |
$1,893.86
|
|
Treat sternum fracture
|
$666.05 |
$666.05 |
$666.05 |
$423.00
|
|
Treat thigh fracture
|
$675.85 |
$675.85 |
$675.85 |
$661.00
|
|
Treat thigh fracture
|
$4,291.70 |
$4,291.70 |
$4,291.70 |
$7,372.60
|
|
Treat thigh fracture
|
$1,706.60 |
$1,706.60 |
$1,706.60 |
$2,021.04
|
|
Treat thigh fracture
|
$497.00 |
$497.00 |
$497.00 |
$716.95
|
|
Treat thigh fracture
|
$1,212.05 |
$1,212.05 |
$1,212.05 |
$2,090.14
|
|
Treat thigh fx growth plate
|
$497.00 |
$497.00 |
$497.00 |
$421.50
|
|
Treat toe dislocation
|
$675.85 |
$675.85 |
$675.85 |
$855.66
|
|
Treat toe fracture
|
$2,457.00 |
$2,457.00 |
$2,457.00 |
$3,981.06
|
|
Treat ulnar fracture
|
$2,320.50 |
$2,320.50 |
$2,320.50 |
$1,861.60
|
|
Treat vaginal bleeding
|
$185.15 |
$185.15 |
$185.15 |
$400.86
|
|
Treat wrist bone fracture
|
$1,842.75 |
$1,842.75 |
$1,842.75 |
$1,907.64
|
|
Treat wrist dislocation
|
$1,029.00 |
$1,029.00 |
$1,029.00 |
$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
|
|
Triamcinolone a inj prs-free
|
$84.79 |
$84.79 |
$84.79 |
$1,309.80
|
|
Triglycerides
|
$120.75 |
$120.75 |
$120.75 |
$54.60
|
|
Trimethobenzamide hci 250mg
|
$0.63 |
$0.63 |
$0.63 |
$5.28
|
|
Trim nondyst nails
|
$97.65 |
$97.65 |
$97.65 |
$124.22
|
|
Trmt of fracture (femoral shaft) 27500
|
$497.00 |
$497.00 |
$497.00 |
$777.00
|
|
Trnscath plc stent crv crtd without prtct
|
$11,936.05 |
$11,936.05 |
$11,936.05 |
$7,944.75
|
|
Trnscath plc stent crv crtd w/prtct
|
$14,950.25 |
$14,950.25 |
$14,950.25 |
$11,099.98
|
|
Trnscath plc stnt ante carotid art
|
$2,988.65 |
$2,988.65 |
$2,988.65 |
$9,114.56
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$2,154.60 |
$2,154.60 |
$2,154.60 |
$8,244.55
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$2,154.60 |
$2,154.60 |
$2,154.60 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$5,176.15 |
$5,176.15 |
$5,176.15 |
$15,408.00
|
|
Trnscath retrv pq vasc fb w/guide
|
$3,830.40 |
$3,830.40 |
$3,830.40 |
$4,969.90
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$7,269.85 |
$7,269.85 |
$7,269.85 |
$6,156.00
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$6,024.90 |
$6,024.90 |
$6,024.90 |
$4,505.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$6,024.90 |
$6,024.90 |
$6,024.90 |
$4,793.13
|
|
Trnscath tx thromblytc vein ini day
|
$3,911.25 |
$3,911.25 |
$3,911.25 |
$4,329.36
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$5,448.80 |
$5,448.80 |
$5,448.80 |
$4,805.85
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$3,202.50 |
$3,202.50 |
$3,202.50 |
$2,343.60
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$2,131.85 |
$2,131.85 |
$2,131.85 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$2,033.50 |
$2,033.50 |
$2,033.50 |
$3,322.20
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$2,033.50 |
$2,033.50 |
$2,033.50 |
$2,355.65
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$2,486.75 |
$2,486.75 |
$2,486.75 |
$2,328.30
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$2,486.75 |
$2,486.75 |
$2,486.75 |
$2,190.24
|
|
Troponin quantitative
|
$110.25 |
$110.25 |
$110.25 |
$123.75
|
|
Tte w or without fol w/con,stres
|
$705.25 |
$705.25 |
$705.25 |
$1,582.75
|
|
Tube trach disp innr can 5 xlt
|
$375.95 |
$375.95 |
$375.95 |
$460.58
|
|
Tx atrial fib pulm vein isol
|
$9,338.00 |
$9,338.00 |
$9,338.00 |
$32,426.20
|
|
Tx closed hip disl traumatic without anes
|
$675.85 |
$675.85 |
$675.85 |
$657.28
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$4,719.40 |
$4,719.40 |
$4,719.40 |
$3,874.79
|
|
Tx closed tib shaft fx without manip
|
$2,329.60 |
$2,329.60 |
$2,329.60 |
$635.46
|
|
Tx l/r atrial fib addl
|
$225.40 |
$225.40 |
$225.40 |
$7,717.80
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$4,719.40 |
$4,719.40 |
$4,719.40 |
$4,449.44
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$2,671.20 |
$2,671.20 |
$2,671.20 |
$4,499.12
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$2,835.70 |
$2,835.70 |
$2,835.70 |
$4,281.00
|
|
Tx open nsl fx uncomp
|
$2,858.45 |
$2,858.45 |
$2,858.45 |
$4,007.22
|
|
Tx open nsl sptl fx
|
$1,824.55 |
$1,824.55 |
$1,824.55 |
$4,289.04
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$2,457.00 |
$2,457.00 |
$2,457.00 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$497.00 |
$497.00 |
$497.00 |
$469.20
|
|
Ultrasound abdomen aorta screening study aaa
|
$172.20 |
$172.20 |
$172.20 |
$403.26
|
|
Ultrasound breast complete
|
$346.15 |
$346.15 |
$346.15 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$259.00 |
$259.00 |
$259.00 |
$449.35
|
|
Ultrasound chest
|
$404.95 |
$404.95 |
$404.95 |
$459.55
|
|
Ultrasound elastography parenchyma
|
$148.05 |
$148.05 |
$148.05 |
$284.25
|
|
Ultrasound encephalogram
|
$322.00 |
$322.00 |
$322.00 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$665.00 |
$665.00 |
$665.00 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$479.50 |
$479.50 |
$479.50 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$313.95 |
$313.95 |
$313.95 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$679.35 |
$679.35 |
$679.35 |
$701.35
|
|
Ultrasound guide intraoperative
|
$475.65 |
$475.65 |
$475.65 |
$632.90
|
|
Ultrasound hips infant dynamic
|
$103.60 |
$103.60 |
$103.60 |
$403.00
|
|
Ultrasound infant hips ltd without stress
|
$98.00 |
$98.00 |
$98.00 |
$321.35
|
|
Ultrasound joint complete left
|
$539.00 |
$539.00 |
$539.00 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$354.90 |
$354.90 |
$354.90 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$441.35 |
$441.35 |
$441.35 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$247.80 |
$247.80 |
$247.80 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$464.10 |
$464.10 |
$464.10 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$192.50 |
$192.50 |
$192.50 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$331.10 |
$331.10 |
$331.10 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$382.90 |
$382.90 |
$382.90 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$641.90 |
$641.90 |
$641.90 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$451.50 |
$451.50 |
$451.50 |
$498.00
|
|
Ultrasound scrotum and contents
|
$690.90 |
$690.90 |
$690.90 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$318.50 |
$318.50 |
$318.50 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$359.80 |
$359.80 |
$359.80 |
$425.10
|
