|
Treatment of heel fracture 28400
|
$527.05 |
$527.05 |
$527.05 |
$494.00
|
|
Treatment of thigh fracture
|
$1,565.44 |
$1,565.44 |
$1,565.44 |
$467.25
|
|
Treatment of thigh fracture
|
$1,112.62 |
$1,112.62 |
$1,112.62 |
$659.00
|
|
Treatment of thigh fracture
|
$1,093.35 |
$1,093.35 |
$1,093.35 |
$2,055.00
|
|
Treatment of toe fracture 28510
|
$182.35 |
$182.35 |
$182.35 |
$371.40
|
|
Treatment radiation delivery level 2
|
$214.82 |
$214.82 |
$214.82 |
$735.00
|
|
Treat midfoot fracture each
|
$730.80 |
$730.80 |
$730.80 |
$1,893.86
|
|
Treat thigh fracture
|
$973.45 |
$973.45 |
$973.45 |
$661.00
|
|
Treat thigh fracture
|
$1,093.35 |
$1,093.35 |
$1,093.35 |
$2,021.04
|
|
Treat thigh fx growth plate
|
$1,201.47 |
$1,201.47 |
$1,201.47 |
$421.50
|
|
Treat ulnar fracture
|
$725.81 |
$725.81 |
$725.81 |
$1,861.60
|
|
Treat wrist bone fracture
|
$911.01 |
$911.01 |
$911.01 |
$1,907.64
|
|
Treat wrist dislocation
|
$651.59 |
$651.59 |
$651.59 |
$760.00
|
|
Treponema pallidum antibody
|
$55.31 |
$55.31 |
$55.31 |
$72.80
|
|
Treprostinil injection
|
$528.60 |
$528.60 |
$528.60 |
$1,489.78
|
|
Trg gene rearrangement anal
|
$157.73 |
$157.73 |
$157.73 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$33.14 |
$33.14 |
$33.14 |
$50.70
|
|
Triamcinolone a inj prs-free
|
$219.49 |
$219.49 |
$219.49 |
$627.00
|
|
Trichinella antibody
|
$99.21 |
$99.21 |
$99.21 |
$70.65
|
|
#tricyclicantidprssnt
|
$4.29 |
$4.29 |
$4.29 |
$57.08
|
|
Triglycerides
|
$61.74 |
$61.74 |
$61.74 |
$54.60
|
|
Trmt of fracture (femoral shaft) 27500
|
$1,220.38 |
$1,220.38 |
$1,220.38 |
$777.00
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$4,137.15 |
$4,137.15 |
$4,137.15 |
$8,244.55
|
|
Troponin quantitative
|
$92.07 |
$92.07 |
$92.07 |
$123.75
|
|
Tte w or without fol w/con,stres
|
$1,120.47 |
$1,120.47 |
$1,120.47 |
$1,536.08
|
|
Tx closed hip disl traumatic without anes
|
$694.41 |
$694.41 |
$694.41 |
$657.28
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$1,199.69 |
$1,199.69 |
$1,199.69 |
$3,874.79
|
|
Tx closed tib shaft fx without manip
|
$874.61 |
$874.61 |
$874.61 |
$635.46
|
|
Tx l/r atrial fib addl
|
$449.97 |
$449.97 |
$449.97 |
$7,717.80
|
|
Tx tarsal bone fx without manip 28450
|
$232.30 |
$232.30 |
$232.30 |
$469.20
|
|
Ua w/micro/comp poc
|
$11.07 |
$11.07 |
$11.07 |
$24.45
|
|
Ugt1a1 gene analy common variants
|
$334.00 |
$334.00 |
$334.00 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$364.33 |
$364.33 |
$364.33 |
$403.26
|
|
Ultrasound breast complete
|
$1,197.54 |
$1,197.54 |
$1,197.54 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$658.72 |
$658.72 |
$658.72 |
$449.35
|
|
Ultrasound chest
|
$178.07 |
$178.07 |
$178.07 |
$459.55
|
|
Ultrasound encephalogram
|
$382.89 |
$382.89 |
$382.89 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$355.41 |
$355.41 |
$355.41 |
$570.44
|
|
Ultrasound guidance for vascular access
|
$172.00 |
$172.00 |
$172.00 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$309.02 |
$309.02 |
$309.02 |
$701.35
|
|
Ultrasound hips infant dynamic
|
$196.98 |
$196.98 |
$196.98 |
$403.00
|
|
Ultrasound joint complete left
|
$394.31 |
$394.31 |
$394.31 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$226.95 |
$226.95 |
$226.95 |
$448.50
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$97.78 |
$97.78 |
$97.78 |
$326.54
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$523.48 |
$523.48 |
$523.48 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$428.92 |
$428.92 |
$428.92 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$1,632.53 |
$1,632.53 |
$1,632.53 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$555.95 |
$555.95 |
$555.95 |
$498.00
|
|
Ultrasound scrotum and contents
|
$592.35 |
$592.35 |
$592.35 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$246.58 |
$246.58 |
$246.58 |
$450.60
|
|
Ultrasound transvaginal non obstetric
|
$550.60 |
$550.60 |
$550.60 |
$567.44
|
|
Umbilical artery cath newborn 36660
|
$23.56 |
$23.56 |
$23.56 |
$265.85
|
|
Unlisted dx gi procedure
|
$130.96 |
$130.96 |
$130.96 |
$482.90
|
|
Unlisted mr procedure
|
$76.01 |
$76.01 |
$76.01 |
$1,032.20
|
|
Unlisted procedure esophagus
|
$759.35 |
$759.35 |
$759.35 |
$1,215.50
|
|
Unlisted procedure microbiology
|
$169.50 |
$169.50 |
$169.50 |
$487.50
|
|
Unlisted px palate uvula
|
$203.40 |
$203.40 |
$203.40 |
$257.04
|
|
Unsched dialysis esrd pt hos
|
$437.13 |
$437.13 |
$437.13 |
$1,546.60
|
|
Upgrade pm system
|
$5,656.56 |
$5,656.56 |
$5,656.56 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,108.69 |
$1,108.69 |
$1,108.69 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,357.76 |
$1,357.76 |
$1,357.76 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,131.53 |
$1,131.53 |
$1,131.53 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$892.09 |
$892.09 |
$892.09 |
$1,588.59
|
|
Upper Endoscopy (EGD, with biopsy)
|
$892.09 |
$892.09 |
$892.09 |
$1,656.60
|
|
Urea nitrogen
|
$35.33 |
$35.33 |
$35.33 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$10.35 |
$10.35 |
$10.35 |
$50.00
|
|
Urea nitrogen clearance
|
$3.22 |
$3.22 |
$3.22 |
$33.57
|
|
Urethrocystography void s&i
|
$730.80 |
$730.80 |
$730.80 |
$634.50
|
|
Uric acid blood
|
$46.75 |
$46.75 |
$46.75 |
$46.64
|
|
Uric acid urine
|
$39.61 |
$39.61 |
$39.61 |
$46.75
|
|
Urinalysis microscopic only
|
$10.00 |
$10.00 |
$10.00 |
$26.35
|
|
Urinalysis (with microscopy)
|
$33.19 |
$33.19 |
$33.19 |
$48.14
|
|
Urinalysis (without microscopy)
|
$21.06 |
$21.06 |
$21.06 |
$38.99
|
|
Urine Culture Test
|
$51.03 |
$51.03 |
$51.03 |
$84.81
|
|
Urine pregnancy test
|
$95.64 |
$95.64 |
$95.64 |
$66.40
|
|
Urography, antegrade
|
$193.05 |
$193.05 |
$193.05 |
$593.37
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$4,377.59 |
$4,377.59 |
$4,377.59 |
$5,151.04
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$57,062.34 |
$57,062.34 |
$57,062.34 |
$51,633.07
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$32.75 |
$32.75 |
$32.75 |
$45.33
|
|
Vaccine hepatitis a (hepa) adult im
|
$102.75 |
$102.75 |
$102.75 |
$178.07
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$74.34 |
$74.34 |
$74.34 |
$173.98
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$40.20 |
$40.20 |
$40.20 |
$79.04
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$40.01 |
$40.01 |
$40.01 |
$40.01
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$228.78 |
$228.78 |
$228.78 |
$499.00
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$197.86 |
$197.86 |
$197.86 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$126.92 |
$126.92 |
$126.92 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$152.33 |
$152.33 |
$152.33 |
$274.95
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$286.83 |
$286.83 |
$286.83 |
$397.18
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$319.99 |
$319.99 |
$319.99 |
$715.41
|
|
Vaccine rabies im
|
$431.68 |
$431.68 |
$431.68 |
$945.46
|
|
Vaccine tdap >=7 years im
|
$74.34 |
$74.34 |
$74.34 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$60.86 |
$60.86 |
$60.86 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$46.69 |
$46.69 |
$46.69 |
$447.80
|
|
Valproic acid total therapeutic drug level
|
$41.40 |
$41.40 |
$41.40 |
$115.00
|
|
Valrubicin injection
|
$3,348.21 |
$3,348.21 |
$3,348.21 |
$2,929.63
|
|
Vancomycin hcl injection
|
$81.58 |
$81.58 |
$81.58 |
$132.89
|
|
Vancomycin peak therapeutic drug level
|
$75.30 |
$75.30 |
$75.30 |
$126.79
|
|
Varicella zoster antibody igg
|
$64.59 |
$64.59 |
$64.59 |
$82.55
|
|
Vedolizumab 300 mg intravenous solution
|
$17,872.11 |
$17,872.11 |
$17,872.11 |
$18,732.33
|
|
Velaglucerase alfa 400 unit intravenous solution
|
$1,997.84 |
$1,997.84 |
$1,997.84 |
$2,978.05
|
