|
Treat elbow fracture
|
$1,343.16 |
$1,343.16 |
$1,343.16 |
|
|
Treat finger fracture each
|
$714.74 |
$714.74 |
$714.74 |
|
|
Treat foot dislocation
|
$170.30 |
$170.30 |
$170.30 |
|
|
Treat fracture of radius
|
$714.74 |
$714.74 |
$714.74 |
|
|
Treat fracture of radius
|
$1,510.86 |
$1,510.86 |
$1,510.86 |
|
|
Treat fracture of ulna
|
$900.12 |
$900.12 |
$900.12 |
|
|
Treat hip dislocation
|
$1,354.60 |
$1,354.60 |
$1,354.60 |
|
|
Treat humerus fracture
|
$458.90 |
$458.90 |
$458.90 |
|
|
Treat humerus fracture
|
$458.90 |
$458.90 |
$458.90 |
|
|
Treat kneecap dislocation
|
$1,480.44 |
$1,480.44 |
$1,480.44 |
|
|
Treat knee dislocation
|
$1,652.04 |
$1,652.04 |
$1,652.04 |
|
|
Treat knee fracture 27530
|
$194.74 |
$194.74 |
$194.74 |
|
|
Treat lower leg dislocation
|
$143.52 |
$143.52 |
$143.52 |
|
|
Treatment incomplete abortion completed surgically any trimester
|
$4,279.34 |
$4,279.34 |
$4,279.34 |
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$99.84 |
$99.84 |
$99.84 |
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$115.96 |
$115.96 |
$115.96 |
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$165.88 |
$165.88 |
$165.88 |
|
|
Treatment of ankle fracture 27786
|
$148.46 |
$148.46 |
$148.46 |
|
|
Treatment of fibula fracture 27780
|
$194.74 |
$194.74 |
$194.74 |
|
|
Treatment of heel fracture 28400
|
$194.74 |
$194.74 |
$194.74 |
|
|
Treatment of thigh fracture
|
$1,698.58 |
$1,698.58 |
$1,698.58 |
|
|
Treatment of thigh fracture
|
$395.20 |
$395.20 |
$395.20 |
|
|
Treatment of thigh fracture
|
$1,184.04 |
$1,184.04 |
$1,184.04 |
|
|
Treatment of toe fracture 28510
|
$194.74 |
$194.74 |
$194.74 |
|
|
Treatment radiation delivery level 2
|
$189.80 |
$189.80 |
$189.80 |
|
|
Treat sternum fracture
|
$182.00 |
$182.00 |
$182.00 |
|
|
Treat thigh fracture
|
$465.92 |
$465.92 |
$465.92 |
|
|
Treat ulnar fracture
|
$1,302.60 |
$1,302.60 |
$1,302.60 |
|
|
Treat vaginal bleeding
|
$653.12 |
$653.12 |
$653.12 |
|
|
Treat wrist bone fracture
|
$458.90 |
$458.90 |
$458.90 |
|
|
Treat wrist dislocation
|
$148.46 |
$148.46 |
$148.46 |
|
|
Treponema pallidum antibody
|
$174.20 |
$174.20 |
$174.20 |
|
|
Trg gene rearrangement anal
|
$490.36 |
$490.36 |
$490.36 |
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$61.79 |
$61.79 |
$61.79 |
|
|
Triglycerides
|
$58.76 |
$58.76 |
$58.76 |
|
|
Trim nondyst nails
|
$296.40 |
$296.40 |
$296.40 |
|
|
Trnscath plc stent crv crtd without prtct
|
$5,582.98 |
$5,582.98 |
$5,582.98 |
|
|
Trnscath plc stent crv crtd w/prtct
|
$9,276.54 |
$9,276.54 |
$9,276.54 |
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$3,524.82 |
$3,524.82 |
$3,524.82 |
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$3,294.98 |
$3,294.98 |
$3,294.98 |
|
|
Trnscath plc vas stent w/s&i ini vein
|
$6,472.44 |
$6,472.44 |
$6,472.44 |
|
|
Trnscath retrv pq vasc fb w/guide
|
$3,994.38 |
$3,994.38 |
$3,994.38 |
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$4,739.54 |
$4,739.54 |
$4,739.54 |
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$3,537.30 |
$3,537.30 |
$3,537.30 |
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$2,344.94 |
$2,344.94 |
$2,344.94 |
|
|
Trnscath tx thromblytc vein ini day
|
$4,739.54 |
$4,739.54 |
$4,739.54 |
|
|
Troponin quantitative
|
$65.26 |
$65.26 |
$65.26 |
|
|
Tte w or without contr, cont ecg
|
$1,014.00 |
$1,014.00 |
$1,014.00 |
|
|
Tte w or without fol w/con,stres
|
$582.92 |
$582.92 |
$582.92 |
|
|
Tte w or without fol w/cont, com
|
$193.96 |
$193.96 |
$193.96 |
|
|
Tte w or without fol w/cont, f/u
|
$588.38 |
$588.38 |
$588.38 |
|
|
Tx atrial fib pulm vein isol
|
$14,655.42 |
$14,655.42 |
$14,655.42 |
|
|
Tx closed hip disl traumatic without anes
|
$758.94 |
$758.94 |
$758.94 |
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$917.02 |
$917.02 |
$917.02 |
|
|
Tx closed tib shaft fx without manip
|
$471.38 |
$471.38 |
$471.38 |
|
|
Tx l/r atrial fib addl
|
$3,664.18 |
$3,664.18 |
$3,664.18 |
|
|
Tx tarsal bone fx without manip 28450
|
$270.14 |
$270.14 |
$270.14 |
|
|
Ultrasound abdomen aorta screening study aaa
|
$237.90 |
$237.90 |
$237.90 |
|
|
Ultrasound breast complete
|
$177.58 |
$177.58 |
$177.58 |
|
|
Ultrasound breast unilateral limited (both sides)
|
$177.58 |
$177.58 |
$177.58 |
|
|
Ultrasound chest
|
$611.52 |
$611.52 |
$611.52 |
|
|
Ultrasound encephalogram
|
$416.52 |
$416.52 |
$416.52 |
|
|
Ultrasound exam k transpl w/doppler
|
$317.98 |
$317.98 |
$317.98 |
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$303.16 |
$303.16 |
$303.16 |
|
|
Ultrasound guidance for vascular access
|
$147.16 |
$147.16 |
$147.16 |
|
|
Ultrasound guided needle placement supervision & interpretation
|
$423.54 |
$423.54 |
$423.54 |
|
|
Ultrasound guide intraoperative
|
$496.86 |
$496.86 |
$496.86 |
|
|
Ultrasound hips infant dynamic
|
$312.52 |
$312.52 |
$312.52 |
|
|
Ultrasound joint complete left
|
$449.02 |
$449.02 |
$449.02 |
|
|
Ultrasound joint/nonvascular extremity limited left
|
$352.04 |
$352.04 |
$352.04 |
|
|
Ultrasound ob >=14wks ea addl gest
|
$629.46 |
$629.46 |
$629.46 |
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$309.92 |
$309.92 |
$309.92 |
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$124.28 |
$124.28 |
$124.28 |
|
|
Ultrasound pregnant uterus follow up per fetus
|
$247.78 |
$247.78 |
$247.78 |
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$333.06 |
$333.06 |
$333.06 |
|
|
Ultrasound pregnant uterus transvaginal
|
$361.14 |
$361.14 |
$361.14 |
|
|
Ultrasound prostate/transrectal
|
$263.90 |
$263.90 |
$263.90 |
|
|
Ultrasound retroperitoneal limited
|
$404.30 |
$404.30 |
$404.30 |
|
|
Ultrasound scrotum and contents
|
$425.62 |
$425.62 |
$425.62 |
|
|
Ultrasound spinal canal and contents
|
$492.18 |
$492.18 |
$492.18 |
|
|
Ultrasound transabd ea addl gest
|
$165.10 |
$165.10 |
$165.10 |
|
|
Ultrasound transvaginal non obstetric
|
$336.18 |
$336.18 |
$336.18 |
|
|
Unlisted chemotherapy px
|
$27.82 |
$27.82 |
$27.82 |
|
|
Unlisted dx gi procedure
|
$222.82 |
$222.82 |
$222.82 |
|
|
Unlisted fluoroscopic px
|
$142.22 |
$142.22 |
$142.22 |
|
|
Unlisted mr procedure
|
$768.30 |
$768.30 |
$768.30 |
|
|
Unlisted procedure rectum
|
$645.06 |
$645.06 |
$645.06 |
|
|
Unlisted px med radj physics
|
$107.90 |
$107.90 |
$107.90 |
|
|
Unlisted px small intestine
|
$2,280.46 |
$2,280.46 |
$2,280.46 |
|
|
Unsched dialysis esrd pt hos
|
$1,184.56 |
$1,184.56 |
$1,184.56 |
|
|
Upgrade pm system
|
$2,615.86 |
$2,615.86 |
$2,615.86 |
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$991.12 |
$991.12 |
$991.12 |
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$768.56 |
$768.56 |
$768.56 |
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$598.00 |
$598.00 |
$598.00 |
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,108.90 |
$1,108.90 |
$1,108.90 |
|
|
Upper Endoscopy (EGD, with biopsy)
|
$3,038.62 |
$3,038.62 |
$3,038.62 |
|
|
Uppr gi scope w/submuc inj
|
$1,274.52 |
$1,274.52 |
$1,274.52 |
|
|
Urea nitrogen
|
$26.78 |
$26.78 |
$26.78 |
|
|
Urea nitrogen 24 hour urine
|
$35.62 |
$35.62 |
$35.62 |
|
|
Urethrocystography void s&i
|
$372.06 |
$372.06 |
$372.06 |
|
