|
Treat elbow dislocation
|
$1,436.20 |
$1,436.20 |
$1,436.20 |
$7,292.92
|
|
Treat elbow fracture
|
$1,108.23 |
$1,108.23 |
$1,108.23 |
$2,125.60
|
|
Treat elbow fracture
|
$1,432.80 |
$1,432.80 |
$1,432.80 |
$8,453.60
|
|
Treat finger fracture each
|
$643.64 |
$643.64 |
$643.64 |
$1,815.75
|
|
Treat foot dislocation
|
$297.85 |
$297.85 |
$297.85 |
$527.28
|
|
Treat fracture of radius
|
$964.82 |
$964.82 |
$964.82 |
$2,030.33
|
|
Treat fracture of ulna
|
$935.97 |
$935.97 |
$935.97 |
$766.72
|
|
Treat hip dislocation
|
$1,103.98 |
$1,103.98 |
$1,103.98 |
$2,561.90
|
|
Treat humerus fracture
|
$1,093.80 |
$1,093.80 |
$1,093.80 |
$1,950.60
|
|
Treat humerus fracture
|
$1,093.80 |
$1,093.80 |
$1,093.80 |
$2,045.35
|
|
Treat kneecap dislocation
|
$929.60 |
$929.60 |
$929.60 |
$1,351.35
|
|
Treat knuckle dislocation
|
$778.98 |
$778.98 |
$778.98 |
$1,893.86
|
|
Treatment incomplete abortion completed surgically any trimester
|
$739.53 |
$739.53 |
$739.53 |
$3,806.40
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$114.56 |
$114.56 |
$114.56 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$33.95 |
$33.95 |
$33.95 |
$149.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$54.31 |
$54.31 |
$54.31 |
$210.00
|
|
Treatment missed abortion completed surgically 1st trimester
|
$739.53 |
$739.53 |
$739.53 |
$3,820.53
|
|
Treatment of ankle fracture 27786
|
$20,071.46 |
$20,071.46 |
$20,071.46 |
$580.00
|
|
Treatment of thigh fracture
|
$699.64 |
$699.64 |
$699.64 |
$2,055.00
|
|
Treatment radiation delivery level 2
|
$472.65 |
$472.65 |
$472.65 |
$735.00
|
|
Treat toe dislocation
|
$279.61 |
$279.61 |
$279.61 |
$855.66
|
|
Treat ulnar fracture
|
$876.99 |
$876.99 |
$876.99 |
$1,861.60
|
|
Treat wrist bone fracture
|
$645.34 |
$645.34 |
$645.34 |
$1,907.64
|
|
Treat wrist dislocation
|
$226.15 |
$226.15 |
$226.15 |
$760.00
|
|
Treponema pallidum antibody
|
$40.74 |
$40.74 |
$40.74 |
$72.80
|
|
Treprostinil injection
|
$628.51 |
$628.51 |
$628.51 |
$528.60
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$39.40 |
$39.40 |
$39.40 |
$48.22
|
|
Triamcinolone a inj prs-free
|
$260.98 |
$260.98 |
$260.98 |
$225.43
|
|
#tricyclicantidprssnt
|
$5.10 |
$5.10 |
$5.10 |
$57.08
|
|
Triglycerides
|
$64.50 |
$64.50 |
$64.50 |
$54.60
|
|
Trmt of fracture (femoral shaft) 27500
|
$921.12 |
$921.12 |
$921.12 |
$777.00
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$4,919.12 |
$4,919.12 |
$4,919.12 |
$8,244.55
|
|
Troponin quantitative
|
$214.69 |
$214.69 |
$214.69 |
$123.75
|
|
Tx closed hip disl traumatic without anes
|
$554.54 |
$554.54 |
$554.54 |
$657.28
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$948.27 |
$948.27 |
$948.27 |
$4,499.12
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$1,039.49 |
$1,039.49 |
$1,039.49 |
$4,281.00
|
|
Tx open nsl sptl fx
|
$1,284.30 |
$1,284.30 |
$1,284.30 |
$4,289.04
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$2,069.65 |
$2,069.65 |
$2,069.65 |
$4,499.12
|
|
Ua w/micro/comp poc
|
$11.46 |
$11.46 |
$11.46 |
$24.45
|
|
Ugt1a1 gene analy common variants
|
$397.13 |
$397.13 |
$397.13 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$336.04 |
$336.04 |
$336.04 |
$403.26
|
|
Ultrasound breast complete
|
$568.97 |
$568.97 |
$568.97 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$455.26 |
$455.26 |
$455.26 |
$449.35
|
|
Ultrasound chest
|
$302.09 |
$302.09 |
$302.09 |
$459.55
|
|
Ultrasound encephalogram
|
$304.21 |
$304.21 |
$304.21 |
$481.60
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$125.59 |
$125.59 |
$125.59 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$189.23 |
$189.23 |
$189.23 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$463.32 |
$463.32 |
$463.32 |
$701.35
|
|
Ultrasound guide intraoperative
|
$358.52 |
$358.52 |
$358.52 |
$632.90
|
|
Ultrasound hips infant dynamic
|
$263.91 |
$263.91 |
$263.91 |
$403.00
|
|
Ultrasound joint complete left
|
$776.01 |
$776.01 |
$776.01 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$441.26 |
$441.26 |
$441.26 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$1,036.95 |
$1,036.95 |
$1,036.95 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$507.02 |
$507.02 |
$507.02 |
$326.54
|
|
Ultrasound pregnant uterus follow up per fetus
|
$184.99 |
$184.99 |
$184.99 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$195.60 |
$195.60 |
$195.60 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$543.08 |
$543.08 |
$543.08 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$1,798.96 |
$1,798.96 |
$1,798.96 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$345.79 |
$345.79 |
$345.79 |
$498.00
|
|
Ultrasound scrotum and contents
|
$638.12 |
$638.12 |
$638.12 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$539.27 |
$539.27 |
$539.27 |
$450.60
|
|
Ultrasound transvaginal non obstetric
|
$707.28 |
$707.28 |
$707.28 |
$567.44
|
|
Umbilical artery cath newborn 36660
|
$28.43 |
$28.43 |
$28.43 |
$265.85
|
|
Unlisted dx gi procedure
|
$158.69 |
$158.69 |
$158.69 |
$482.90
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$2,177.41 |
$2,177.41 |
$2,177.41 |
$6,904.15
|
|
Unlisted procedure esophagus
|
$920.27 |
$920.27 |
$920.27 |
$1,215.50
|
|
Unlisted procedure microbiology
|
$201.54 |
$201.54 |
$201.54 |
$487.50
|
|
Unlisted px palate uvula
|
$241.85 |
$241.85 |
$241.85 |
$257.04
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,806.17 |
$1,806.17 |
$1,806.17 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,263.09 |
$1,263.09 |
$1,263.09 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,272.85 |
$1,272.85 |
$1,272.85 |
$1,588.59
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,272.85 |
$1,272.85 |
$1,272.85 |
$1,656.60
|
|
Urea nitrogen
|
$42.01 |
$42.01 |
$42.01 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$51.77 |
$51.77 |
$51.77 |
$50.00
|
|
Ureteral reflux study
|
$414.95 |
$414.95 |
$414.95 |
$961.20
|
|
Urethrocystography void s&i
|
$574.91 |
$574.91 |
$574.91 |
$634.50
|
|
Uric acid blood
|
$67.47 |
$67.47 |
$67.47 |
$46.64
|
|
Uric acid urine
|
$67.04 |
$67.04 |
$67.04 |
$46.75
|
|
Urinalysis microscopic only
|
$22.49 |
$22.49 |
$22.49 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$91.23 |
$91.23 |
$91.23 |
$25.72
|
|
Urinalysis (with microscopy)
|
$71.28 |
$71.28 |
$71.28 |
$48.14
|
|
Urinalysis (without microscopy)
|
$34.37 |
$34.37 |
$34.37 |
$38.99
|
|
Urine Culture Test
|
$55.16 |
$55.16 |
$55.16 |
$84.81
|
|
Urine pregnancy test
|
$32.25 |
$32.25 |
$32.25 |
$66.40
|
|
Urography, antegrade
|
$423.86 |
$423.86 |
$423.86 |
$593.37
|
|
Urography inf drip &/or bolus
|
$552.42 |
$552.42 |
$552.42 |
$641.69
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$5,205.00 |
$5,205.00 |
$5,205.00 |
$6,892.54
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$67,847.73 |
$67,847.73 |
$67,847.73 |
$66,658.97
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$38.94 |
$38.94 |
$38.94 |
$45.33
|
|
Vaccine hepatitis a (hepa) adult im
|
$122.17 |
$122.17 |
$122.17 |
$178.07
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$88.40 |
$88.40 |
$88.40 |
$173.98
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$47.80 |
$47.80 |
$47.80 |
$79.04
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$47.57 |
$47.57 |
$47.57 |
$40.01
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$272.02 |
$272.02 |
$272.02 |
$499.00
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$235.25 |
$235.25 |
$235.25 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$150.91 |
$150.91 |
$150.91 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$181.13 |
$181.13 |
$181.13 |
$274.95
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$341.04 |
$341.04 |
$341.04 |
$397.18
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$380.47 |
$380.47 |
$380.47 |
$715.41
|
|
Vaccine rabies im
|
$513.27 |
$513.27 |
$513.27 |
$945.46
|
