|
Treatment mouth roof lesion
|
$8,453.90 |
$8,453.90 |
$8,453.90 |
$4,256.70
|
|
Treatment of urethra lesion
|
$5,851.95 |
$5,851.95 |
$5,851.95 |
$2,874.36
|
|
Treatment radiation delivery level 2
|
$1,098.50 |
$1,098.50 |
$2,308.00 |
$830.70
|
|
Treat pelvic ring fracture
|
$11,095.50 |
$11,095.50 |
$11,095.50 |
$2,223.20
|
|
Treat spinal cord lesion
|
$1,901.25 |
$1,901.25 |
$1,901.25 |
$1,337.00
|
|
Treat wrist bone fracture
|
$9,087.65 |
$9,087.65 |
$9,087.65 |
$1,679.04
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$558.35 |
$558.35 |
$558.35 |
$73,346.25
|
|
Treponema pallidum antibody
|
$40.95 |
$40.95 |
$40.95 |
$72.05
|
|
Treprostinil injection
|
$533.65 |
$533.65 |
$533.65 |
$19,071.84
|
|
Treprostinil, non-comp unit
|
$14,196.00 |
$14,196.00 |
$14,196.00 |
$2,970.72
|
|
Trg gene rearrangement anal
|
$436.80 |
$436.80 |
$605.00 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$87.10 |
$87.10 |
$87.10 |
$43.00
|
|
Trichinella antibody
|
$166.00 |
$166.00 |
$166.00 |
$70.65
|
|
Trichomonas assay w/optic
|
$105.30 |
$105.30 |
$107.25 |
$57.40
|
|
#tricyclicantidprssnt
|
$7.15 |
$7.15 |
$7.15 |
$50.54
|
|
Triglycerides
|
$54.60 |
$54.60 |
$54.60 |
$58.05
|
|
Trilaciclib 300 mg intravenous solution
|
$24.70 |
$24.70 |
$24.70 |
$4,043.12
|
|
Trimethobenzamide hcl inj
|
$420.55 |
$420.55 |
$420.55 |
$117.49
|
|
Triptorelin pamoate
|
$4,533.75 |
$4,533.75 |
$4,533.75 |
$4,619.39
|
|
Trnscath plc stent crv crtd without prtct
|
$13,240.50 |
$13,240.50 |
$13,240.50 |
$7,795.71
|
|
Trnscath plc stent crv crtd w/prtct
|
$13,510.90 |
$13,510.90 |
$13,510.90 |
$9,767.25
|
|
Trnscath plc stnt ante carotid art
|
$38,714.00 |
$38,714.00 |
$38,714.00 |
$6,046.25
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$31,728.45 |
$31,728.45 |
$31,728.45 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$31,728.45 |
$31,728.45 |
$31,728.45 |
$8,790.54
|
|
Trnscath plc vas stent w/s&i ini vein
|
$47,288.80 |
$47,288.80 |
$47,288.80 |
$14,558.70
|
|
Trnscath retrv pq vasc fb w/guide
|
$6,302.40 |
$6,302.40 |
$6,302.40 |
$4,766.40
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$9,096.10 |
$9,096.10 |
$9,096.10 |
$5,139.20
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$8,294.65 |
$8,294.65 |
$8,294.65 |
$4,350.00
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$8,294.65 |
$8,294.65 |
$8,294.65 |
$4,379.34
|
|
Trnscath tx thromblytc vein ini day
|
$8,175.70 |
$8,175.70 |
$8,175.70 |
$3,866.70
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$9,480.25 |
$9,480.25 |
$9,480.25 |
$4,727.52
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$4,966.00 |
$4,966.00 |
$4,966.00 |
$2,377.62
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$5,376.15 |
$5,376.15 |
$5,376.15 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$5,376.15 |
$5,376.15 |
$5,376.15 |
$3,091.20
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$5,376.15 |
$5,376.15 |
$5,376.15 |
$2,527.20
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$3,727.75 |
$3,727.75 |
$3,727.75 |
$2,486.75
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$2,662.40 |
$2,662.40 |
$2,662.40 |
$2,406.77
|
|
Troponin quantitative
|
$347.75 |
$347.75 |
$347.75 |
$127.20
|
|
Truskin, per sq centimeter
|
$1.00 |
$9,502.35 |
$9,502.35 |
$1.00
|
|
Tte w or without contr, cont ecg
|
$2,978.95 |
$2,978.95 |
$2,978.95 |
$2,075.90
|
|
Tte w or without fol w/con,stres
|
$2,438.80 |
$2,438.80 |
$2,438.80 |
$1,632.80
|
|
Tte w or without fol w/cont, com
|
$915.20 |
$915.20 |
$915.20 |
$1,254.50
|
|
Tte w or without fol w/cont, f/u
|
$687.70 |
$687.70 |
$687.70 |
$1,178.00
|
|
Tube trach disp innr can 6 xlt
|
$22.75 |
$22.75 |
$22.75 |
$16.80
|
|
Tubular dressing
|
$38.35 |
$38.35 |
$38.35 |
$28.46
|
|
Tumor cell deplete of harvst
|
$1,282.45 |
$1,282.45 |
$1,282.45 |
$1,315.60
|
|
Tx atrial fib pulm vein isol
|
$29,766.10 |
$29,766.10 |
$29,766.10 |
$29,030.54
|
|
Tx contour defects >10.0 cc
|
$371.80 |
$371.80 |
$371.80 |
$918.06
|
|
Tx contour defects 1.1-5.0cc 11951
|
$369.85 |
$369.85 |
$369.85 |
$849.50
|
|
Tx l/r atrial fib addl
|
$13,529.10 |
$13,529.10 |
$13,529.10 |
$6,986.85
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$281.45 |
$281.45 |
$281.45 |
$21,992.26
|
|
Ugt1a1 gene analy common variants
|
$254.80 |
$254.80 |
$254.80 |
$438.75
|
|
Ultrasound breast complete
|
$716.30 |
$716.30 |
$716.30 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$573.30 |
$573.30 |
$573.30 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$588.25 |
$588.25 |
$588.25 |
$338.00
|
|
Ultrasound elastography ea l target les
|
$250.90 |
$250.90 |
$250.90 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$404.30 |
$404.30 |
$404.30 |
$313.95
|
|
Ultrasound encephalogram
|
$936.65 |
$936.65 |
$936.65 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$494.00 |
$494.00 |
$494.00 |
$575.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$732.55 |
$732.55 |
$732.55 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$1,708.20 |
$1,708.20 |
$1,708.20 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$92.30 |
$92.30 |
$92.30 |
$388.08
|
|
Ultrasound guide intraoperative
|
$976.95 |
$976.95 |
$6,908.00 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$267.80 |
$267.80 |
$846.00 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$1,032.85 |
$1,032.85 |
$1,032.85 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$616.20 |
$616.20 |
$616.20 |
$311.25
|
|
Ultrasound joint complete left
|
$391.30 |
$391.30 |
$391.30 |
$557.99
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$328.90 |
$328.90 |
$328.90 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$818.35 |
$818.35 |
$818.35 |
$409.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$732.55 |
$732.55 |
$732.55 |
$335.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$922.35 |
$922.35 |
$2,512.00 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$732.55 |
$732.55 |
$2,027.00 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$1,300.00 |
$1,300.00 |
$1,300.00 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$865.15 |
$865.15 |
$865.15 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$818.35 |
$818.35 |
$1,567.00 |
$421.00
|
|
Ultrasound trgt dyn mbubb 1st les
|
$724.75 |
$724.75 |
$724.75 |
$568.32
|
|
Ultrasound trgt dyn mbubb ea addl
|
$507.65 |
$507.65 |
$507.65 |
$348.00
|
|
Unlisted CT procedure
|
$3,387.80 |
$3,387.80 |
$3,387.80 |
$732.70
|
|
Unlisted fluoroscopic px
|
$6,561.75 |
$6,561.75 |
$6,561.75 |
$305.76
|
|
Unlisted maaa
|
$6,232.20 |
$6,232.20 |
$6,232.20 |
$235.20
|
|
Unlisted mr procedure
|
$202.80 |
$202.80 |
$202.80 |
$1,163.00
|
|
Unlisted neurological dx px
|
$431.60 |
$431.60 |
$431.60 |
$242.50
|
|
Unlisted procedure liver
|
$1,493.70 |
$1,493.70 |
$1,493.70 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$384.15 |
$384.15 |
$384.15 |
$530.00
|
|
Unlisted procedure spine
|
$5,007.60 |
$5,007.60 |
$5,007.60 |
$4,659.85
|
|
Unlisted px biliary tract
|
$17,588.35 |
$17,588.35 |
$17,588.35 |
$3,055.00
|
|
Unlisted px med radj physics
|
$36,166.05 |
$36,166.05 |
$36,166.05 |
$462.35
|
|
Unlisted px neck/thorax
|
$5,007.60 |
$5,007.60 |
$5,007.60 |
$571.20
|
|
Unlisted px pelvis/hip joint
|
$12,868.05 |
$12,868.05 |
$12,868.05 |
$3,251.90
|
|
Unlisted px salivry glnd/dux
|
$641.55 |
$641.55 |
$641.55 |
$1,265.16
|
|
Unlisted px ther rad tx plng
|
$423.15 |
$423.15 |
$423.15 |
$182.00
|
|
Unlisted px tongue flr mouth
|
$641.55 |
$641.55 |
$641.55 |
$282.50
|
|
Unlisted special svc px/rprt
|
$4,892.55 |
$4,892.55 |
$6,400.55 |
$90.00
|
|
Unlisted ultrasound procedure
|
$410.80 |
$410.80 |
$410.80 |
$335.00
|
|
Upgrade pm system
|
$9,377.55 |
$9,377.55 |
$9,377.55 |
$12,077.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$581.10 |
$581.10 |
$581.10 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$3,103.75 |
$3,103.75 |
$3,174.60 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$3,012.75 |
$3,012.75 |
$3,212.95 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,832.10 |
$4,832.10 |
$20,944.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$4,122.95 |
$4,122.95 |
$14,925.00 |
$2,392.00
|
