|
Treat fracture of radius
|
$18,750.12 |
$18,750.12 |
$18,750.12 |
$2,030.33
|
|
Treat hip dislocation
|
$18,750.12 |
$18,750.12 |
$18,750.12 |
$2,561.90
|
|
Treat knee fracture 27530
|
$2,909.55 |
$2,909.55 |
$2,909.55 |
$580.20
|
|
Treat knuckle dislocation
|
$5,180.25 |
$5,180.25 |
$5,180.25 |
$1,893.86
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$1,436.07 |
$1,436.07 |
$1,436.07 |
$241.15
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$556.14 |
$556.14 |
$556.14 |
$210.00
|
|
Treatment radiation delivery level 2
|
$885.55 |
$885.55 |
$885.55 |
$735.00
|
|
Treat toe dislocation
|
$3,413.79 |
$3,413.79 |
$3,413.79 |
$855.66
|
|
Treat wrist bone fracture
|
$18,750.12 |
$18,750.12 |
$18,750.12 |
$1,907.64
|
|
Treat wrist dislocation
|
$2,909.55 |
$2,909.55 |
$2,909.55 |
$760.00
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$346,701.26 |
$346,701.26 |
$346,701.26 |
$120,541.18
|
|
Treponema pallidum antibody
|
$141.67 |
$141.67 |
$141.67 |
$72.80
|
|
Trg gene rearrangement anal
|
$2,156.05 |
$2,156.05 |
$2,156.05 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$300.54 |
$300.54 |
$300.54 |
$45.73
|
|
Triglycerides
|
$119.78 |
$119.78 |
$119.78 |
$54.60
|
|
Trimethobenzamide hcl inj
|
$804.09 |
$804.09 |
$804.09 |
$130.97
|
|
Trim nondyst nails
|
$768.81 |
$768.81 |
$768.81 |
$124.22
|
|
Trmt of fracture (femoral shaft) 27500
|
$2,909.55 |
$2,909.55 |
$2,909.55 |
$777.00
|
|
Trnscath plc stent crv crtd w/prtct
|
$16,186.24 |
$16,186.24 |
$16,186.24 |
$11,099.98
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$22,207.83 |
$22,207.83 |
$22,207.83 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$80,965.52 |
$80,965.52 |
$80,965.52 |
$15,408.00
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$14,552.47 |
$14,552.47 |
$14,552.47 |
$6,156.00
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$10,220.13 |
$10,220.13 |
$10,220.13 |
$4,793.13
|
|
Trnscath tx thromblytc vein ini day
|
$30,801.75 |
$30,801.75 |
$30,801.75 |
$4,329.36
|
|
Troponin quantitative
|
$383.49 |
$383.49 |
$383.49 |
$123.75
|
|
Tx atrial fib pulm vein isol
|
$62,741.81 |
$62,741.81 |
$62,741.81 |
$32,426.20
|
|
Tx closed hip disl traumatic without anes
|
$2,909.55 |
$2,909.55 |
$2,909.55 |
$657.28
|
|
Tx closed tib shaft fx without manip
|
$2,909.55 |
$2,909.55 |
$2,909.55 |
$635.46
|
|
Tx l/r atrial fib addl
|
$20,654.52 |
$20,654.52 |
$20,654.52 |
$7,717.80
|
|
Ultrasound abdomen aorta screening study aaa
|
$1,542.48 |
$1,542.48 |
$1,542.48 |
$403.26
|
|
Ultrasound breast complete
|
$2,482.29 |
$2,482.29 |
$2,482.29 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$1,654.86 |
$1,654.86 |
$1,654.86 |
$449.35
|
|
Ultrasound chest
|
$1,649.83 |
$1,649.83 |
$1,649.83 |
$459.55
|
|
Ultrasound exam k transpl w/doppler
|
$2,189.38 |
$2,189.38 |
$2,189.38 |
$570.44
|
|
Ultrasound guidance for vascular access
|
$1,378.52 |
$1,378.52 |
$1,378.52 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$2,387.98 |
$2,387.98 |
$2,387.98 |
$701.35
|
|
Ultrasound joint complete left
|
$1,542.48 |
$1,542.48 |
$1,542.48 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$3,583.21 |
$3,583.21 |
$3,583.21 |
$448.50
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$1,168.13 |
$1,168.13 |
$1,168.13 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$3,249.79 |
$3,249.79 |
$3,249.79 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$1,542.48 |
$1,542.48 |
$1,542.48 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$1,452.51 |
$1,452.51 |
$1,452.51 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$1,735.89 |
$1,735.89 |
$1,735.89 |
$485.48
|
|
Ultrasound retroperitoneal limited
|
$1,991.15 |
$1,991.15 |
$1,991.15 |
$498.00
|
|
Ultrasound scrotum and contents
|
$2,202.92 |
$2,202.92 |
$2,202.92 |
$617.28
|
|
Ultrasound transvaginal non obstetric
|
$2,074.30 |
$2,074.30 |
$2,074.30 |
$567.44
|
|
Unlisted transfusion med px
|
$349.42 |
$349.42 |
$349.42 |
$141.35
|
|
Unsched dialysis esrd pt hos
|
$2,609.70 |
$2,609.70 |
$2,609.70 |
$1,478.40
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$10,499.40 |
$10,499.40 |
$10,499.40 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$7,538.55 |
$7,538.55 |
$7,538.55 |
$2,013.08
|
|
Urea nitrogen
|
$42.27 |
$42.27 |
$42.27 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$113.11 |
$113.11 |
$113.11 |
$50.00
|
|
Urethrcystgrphy rtrgrde s&i
|
$3,249.79 |
$3,249.79 |
$3,249.79 |
$574.40
|
|
Uric acid blood
|
$114.92 |
$114.92 |
$114.92 |
$46.64
|
|
Uric acid urine
|
$54.36 |
$54.36 |
$54.36 |
$46.75
|
|
Urinalysis (with microscopy)
|
$173.99 |
$173.99 |
$173.99 |
$48.14
|
|
Urinalysis (without microscopy)
|
$211.44 |
$211.44 |
$211.44 |
$38.99
|
|
Urine Culture Test
|
$200.33 |
$200.33 |
$200.33 |
$84.81
|
|
Urine pregnancy test
|
$92.13 |
$92.13 |
$92.13 |
$66.40
|
|
Urography, antegrade
|
$1,700.88 |
$1,700.88 |
$1,700.88 |
$593.37
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$84,642.65 |
$84,642.65 |
$84,642.65 |
$6,677.00
|
|
Vaccine hepatitis a (hepa) adult im
|
$550.10 |
$550.10 |
$550.10 |
$178.07
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$1,578.86 |
$1,578.86 |
$1,578.86 |
$218.40
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$810.11 |
$810.11 |
$810.11 |
$173.98
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$2,881.31 |
$2,881.31 |
$2,881.31 |
$686.67
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$1,098.07 |
$1,098.07 |
$1,098.07 |
$157.41
|
|
Vaccine influenza inactivated adjuvant im
|
$487.79 |
$487.79 |
$487.79 |
$110.25
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$321.96 |
$321.96 |
$321.96 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$272.13 |
$272.13 |
$272.13 |
$42.90
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$537.43 |
$537.43 |
$537.43 |
$103.88
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$1,637.87 |
$1,637.87 |
$1,637.87 |
$499.00
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$1,580.93 |
$1,580.93 |
$1,580.93 |
$408.70
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$1,113.61 |
$1,113.61 |
$1,113.61 |
$274.95
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$2,312.51 |
$2,312.51 |
$2,312.51 |
$715.41
|
|
Vaccine tdap >=7 years im
|
$762.05 |
$762.05 |
$762.05 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$627.62 |
$627.62 |
$627.62 |
$131.77
|
|
Valproic acid total therapeutic drug level
|
$144.88 |
$144.88 |
$144.88 |
$115.00
|
|
Vancomycin hcl injection
|
$1,160.13 |
$1,160.13 |
$1,160.13 |
$93.80
|
|
Vancomycin peak therapeutic drug level
|
$294.73 |
$294.73 |
$294.73 |
$126.79
|
|
Varicella zoster antibody igg
|
$213.97 |
$213.97 |
$213.97 |
$82.55
|
|
Vasc emb/occ w/prs cath
|
$27,689.10 |
$27,689.10 |
$27,689.10 |
$21,249.26
|
|
Vasopressin 20 unit/ml intravenous solution
|
$1,491.65 |
$1,491.65 |
$1,491.65 |
$388.58
|
|
Venogram ext bil s&i
|
$14,882.87 |
$14,882.87 |
$14,882.87 |
$1,838.28
|
|
Venogram extremity supervision & interpretation unilateral
|
$3,994.42 |
$3,994.42 |
$3,994.42 |
$1,326.00
|
|
Venous mech thrombectomy
|
$23,093.66 |
$23,093.66 |
$23,093.66 |
$8,869.50
|
|
Ventilator each subsequent day
|
$5,746.92 |
$5,746.92 |
$5,746.92 |
$1,305.92
|
|
Ventilator initial day
|
$5,746.92 |
$5,746.92 |
$5,746.92 |
$1,540.80
|
|
Vinblastine 1 mg/ml intravenous solution
|
$1,303.30 |
$1,303.30 |
$1,303.30 |
$180.43
|
|
Vincristine 1 mg/ml intravenous solution
|
$393.16 |
$393.16 |
$393.16 |
$93.90
|
|
Vinorelbine 10 mg/ml intravenous solution (wrapper)
|
$641.08 |
$641.08 |
$641.08 |
$227.50
|
|
Virus isolation addl studies ea
|
$216.14 |
$216.14 |
$216.14 |
$90.35
|
|
Vital capacity test
|
$1,958.81 |
$1,958.81 |
$1,958.81 |
$173.33
|
|
Vitamin b-12
|
$238.31 |
$238.31 |
$238.31 |
$94.90
|
|
Vitamin D Test
|
$110.00 |
$110.00 |
$110.00 |
$132.00
|
|
Warde 1003990 aldosterone
|
$142.63 |
$142.63 |
$142.63 |
$145.60
|
|
Warde 1005020 citrate 24 hour urine
|
$297.46 |
$297.46 |
$297.46 |
$97.61
|
|
Warde 1006955 catecholamines fractionated 24 hour urine
|
$88.38 |
$88.38 |
$88.38 |
$113.10
|
|
Warde 1015200 kappa light chain free
|
$184.79 |
$184.79 |
$184.79 |
$64.28
|
|
Warde 3004000 immunoglobulin subclass 1
|
$85.81 |
$85.81 |
$85.81 |
$40.70
|
|
Warde 3008005 oligoclonal bands
|
$293.07 |
$293.07 |
$293.07 |
$102.60
|