|
Treat elbow dislocation
|
$10,492.56 |
$10,492.56 |
$10,492.56 |
$2,326.40
|
|
Treat elbow fracture
|
$10,050.30 |
$10,050.30 |
$10,050.30 |
$2,125.60
|
|
Treat finger fracture each
|
$9,956.38 |
$9,956.38 |
$9,956.38 |
$1,815.75
|
|
Treat fracture of radius
|
$10,050.30 |
$10,050.30 |
$10,050.30 |
$2,030.33
|
|
Treat humerus fracture
|
$10,050.30 |
$10,050.30 |
$10,050.30 |
$2,045.35
|
|
Treat knee dislocation
|
$8,724.07 |
$8,724.07 |
$8,724.07 |
$2,592.08
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$762.37 |
$762.37 |
$762.37 |
$241.15
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$287.18 |
$287.18 |
$287.18 |
$210.00
|
|
Treatment of heel fracture 28400
|
$1,538.48 |
$1,538.48 |
$1,538.48 |
$494.00
|
|
Treat toe dislocation
|
$1,804.03 |
$1,804.03 |
$1,804.03 |
$855.66
|
|
Treat wrist bone fracture
|
$10,050.30 |
$10,050.30 |
$10,050.30 |
$1,907.64
|
|
Treat wrist dislocation
|
$2,113.80 |
$2,113.80 |
$2,113.80 |
$760.00
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$376,021.99 |
$376,021.99 |
$376,021.99 |
$101,032.80
|
|
Treponema pallidum antibody
|
$304.99 |
$304.99 |
$304.99 |
$72.80
|
|
Trg gene rearrangement anal
|
$2,777.45 |
$2,777.45 |
$2,777.45 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$371.25 |
$371.25 |
$371.25 |
$55.80
|
|
Triglycerides
|
$233.11 |
$233.11 |
$233.11 |
$54.60
|
|
Trimethobenzamide hcl inj
|
$1,003.58 |
$1,003.58 |
$1,003.58 |
$128.00
|
|
Trim nondyst nails
|
$490.72 |
$490.72 |
$490.72 |
$124.22
|
|
Trnscath plc stent crv crtd w/prtct
|
$38,284.76 |
$38,284.76 |
$38,284.76 |
$11,099.98
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$16,311.32 |
$16,311.32 |
$16,311.32 |
$8,244.55
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$14,386.57 |
$14,386.57 |
$14,386.57 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$16,311.32 |
$16,311.32 |
$16,311.32 |
$15,408.00
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$1,077.52 |
$1,077.52 |
$1,077.52 |
$6,156.00
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$1,520.86 |
$1,520.86 |
$1,520.86 |
$4,505.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$4,715.18 |
$4,715.18 |
$4,715.18 |
$4,793.13
|
|
Trnscath tx thromblytc vein ini day
|
$11,861.95 |
$11,861.95 |
$11,861.95 |
$4,329.36
|
|
Troponin quantitative
|
$291.66 |
$291.66 |
$291.66 |
$123.75
|
|
Tx atrial fib pulm vein isol
|
$26,838.53 |
$26,838.53 |
$26,838.53 |
$32,426.20
|
|
Tx l/r atrial fib addl
|
$9,361.40 |
$9,361.40 |
$9,361.40 |
$7,717.80
|
|
Ultrasound abdomen aorta screening study aaa
|
$666.09 |
$666.09 |
$666.09 |
$403.26
|
|
Ultrasound breast complete
|
$1,004.19 |
$1,004.19 |
$1,004.19 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$912.87 |
$912.87 |
$912.87 |
$449.35
|
|
Ultrasound chest
|
$1,493.70 |
$1,493.70 |
$1,493.70 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$1,165.09 |
$1,165.09 |
$1,165.09 |
$340.14
|
|
Ultrasound dx ophth b-scan
|
$927.07 |
$927.07 |
$927.07 |
$330.40
|
|
Ultrasound encephalogram
|
$1,667.06 |
$1,667.06 |
$1,667.06 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$728.73 |
$728.73 |
$728.73 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$870.61 |
$870.61 |
$870.61 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$857.39 |
$857.39 |
$857.39 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$2,159.16 |
$2,159.16 |
$2,159.16 |
$701.35
|
|
Ultrasound guide intraoperative
|
$450.53 |
$450.53 |
$450.53 |
$632.90
|
|
Ultrasound hips infant dynamic
|
$1,667.06 |
$1,667.06 |
$1,667.06 |
$403.00
|
|
Ultrasound joint complete left
|
$4,533.98 |
$4,533.98 |
$4,533.98 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$2,264.00 |
$2,264.00 |
$2,264.00 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$1,896.67 |
$1,896.67 |
$1,896.67 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$1,191.90 |
$1,191.90 |
$1,191.90 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,298.18 |
$1,298.18 |
$1,298.18 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$1,051.86 |
$1,051.86 |
$1,051.86 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$870.03 |
$870.03 |
$870.03 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$1,343.62 |
$1,343.62 |
$1,343.62 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$2,262.02 |
$2,262.02 |
$2,262.02 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$1,225.10 |
$1,225.10 |
$1,225.10 |
$498.00
|
|
Ultrasound scrotum and contents
|
$2,445.85 |
$2,445.85 |
$2,445.85 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$1,762.88 |
$1,762.88 |
$1,762.88 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$325.50 |
$325.50 |
$325.50 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$1,775.23 |
$1,775.23 |
$1,775.23 |
$567.44
|
|
Umbilical artery cath newborn 36660
|
$895.04 |
$895.04 |
$895.04 |
$265.85
|
|
Unlisted chemotherapy px
|
$382.20 |
$382.20 |
$382.20 |
$153.85
|
|
Unlisted cytogenetic study
|
$7,292.03 |
$7,292.03 |
$7,292.03 |
$132.48
|
|
Unlisted transfusion med px
|
$100.01 |
$100.01 |
$100.01 |
$141.35
|
|
Unsched dialysis esrd pt hos
|
$3,034.94 |
$3,034.94 |
$3,034.94 |
$1,480.70
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$6,046.72 |
$6,046.72 |
$6,046.72 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$4,879.79 |
$4,879.79 |
$4,879.79 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$4,032.52 |
$4,032.52 |
$4,032.52 |
$2,013.08
|
|
Urea nitrogen
|
$60.39 |
$60.39 |
$60.39 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$146.57 |
$146.57 |
$146.57 |
$50.00
|
|
Urethrcystgrphy rtrgrde s&i
|
$1,355.32 |
$1,355.32 |
$1,355.32 |
$574.40
|
|
Urethrocystography void s&i
|
$1,571.26 |
$1,571.26 |
$1,571.26 |
$634.50
|
|
Uric acid blood
|
$164.45 |
$164.45 |
$164.45 |
$46.64
|
|
Uric acid urine
|
$178.67 |
$178.67 |
$178.67 |
$46.75
|
|
Urinalysis (with microscopy)
|
$290.80 |
$290.80 |
$290.80 |
$48.14
|
|
Urinalysis (without microscopy)
|
$231.16 |
$231.16 |
$231.16 |
$38.99
|
|
Urine Culture Test
|
$280.49 |
$280.49 |
$280.49 |
$84.81
|
|
Urine pregnancy test
|
$238.63 |
$238.63 |
$238.63 |
$66.40
|
|
Urography, antegrade
|
$2,995.38 |
$2,995.38 |
$2,995.38 |
$593.37
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$116,623.29 |
$116,623.29 |
$116,623.29 |
$5,521.54
|
|
Vaccine hepatitis a (hepa) adult im
|
$684.64 |
$684.64 |
$684.64 |
$178.07
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$1,976.51 |
$1,976.51 |
$1,976.51 |
$218.40
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$1,011.15 |
$1,011.15 |
$1,011.15 |
$173.98
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$3,961.92 |
$3,961.92 |
$3,961.92 |
$686.67
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$1,372.75 |
$1,372.75 |
$1,372.75 |
$157.41
|
|
Vaccine influenza inactivated adjuvant im
|
$606.39 |
$606.39 |
$606.39 |
$110.25
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$398.15 |
$398.15 |
$398.15 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$335.57 |
$335.57 |
$335.57 |
$42.90
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$668.73 |
$668.73 |
$668.73 |
$103.88
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$2,248.55 |
$2,248.55 |
$2,248.55 |
$499.00
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$2,170.09 |
$2,170.09 |
$2,170.09 |
$408.70
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$1,526.16 |
$1,526.16 |
$1,526.16 |
$274.95
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$3,178.16 |
$3,178.16 |
$3,178.16 |
$715.41
|
|
Vaccine tdap >=7 years im
|
$950.79 |
$950.79 |
$950.79 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$781.98 |
$781.98 |
$781.98 |
$131.77
|
|
Valproic acid total therapeutic drug level
|
$333.33 |
$333.33 |
$333.33 |
$115.00
|
|
Valvuloplasty aortic
|
$9,481.24 |
$9,481.24 |
$9,481.24 |
$7,324.85
|
|
Vancomycin hcl injection
|
$888.21 |
$888.21 |
$888.21 |
$186.80
|
|
Vancomycin peak therapeutic drug level
|
$304.26 |
$304.26 |
$304.26 |
$126.79
|
|
Varicella zoster antibody igg
|
$277.63 |
$277.63 |
$277.63 |
$82.55
|
|
Vasopressin 20 unit/ml intravenous solution
|
$1,141.29 |
$1,141.29 |
$1,141.29 |
$362.93
|
|
Vein x-ray kidney
|
$6,020.76 |
$6,020.76 |
$6,020.76 |
$2,716.20
|
|
Vein x-ray liver w/hemodynam
|
$8,696.79 |
$8,696.79 |
$8,696.79 |
$3,439.84
|
