|
Treat finger fracture each
|
$1,344.00 |
$1,344.00 |
$1,344.00 |
$1,592.00
|
|
Treat foot dislocation
|
$801.60 |
$801.60 |
$801.60 |
$405.60
|
|
Treat fracture of radius
|
$1,344.00 |
$1,344.00 |
$1,344.00 |
$1,790.00
|
|
Treat fracture of radius
|
$4,147.20 |
$4,147.20 |
$4,147.20 |
$1,849.00
|
|
Treat hip dislocation
|
$2,252.80 |
$2,252.80 |
$2,252.80 |
$2,211.05
|
|
Treat humerus fracture
|
$2,594.40 |
$2,594.40 |
$2,594.40 |
$1,790.00
|
|
Treat humerus fracture
|
$1,344.00 |
$1,344.00 |
$1,344.00 |
$1,790.00
|
|
Treat knee dislocation
|
$1,344.00 |
$1,344.00 |
$1,344.00 |
$2,220.89
|
|
Treat lower leg dislocation
|
$571.20 |
$571.20 |
$571.20 |
$532.60
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$90.40 |
$90.40 |
$90.40 |
$227.70
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$44.80 |
$44.80 |
$44.80 |
$147.48
|
|
Treatment of ankle fracture 27786
|
$315.20 |
$315.20 |
$315.20 |
$523.20
|
|
Treatment of fibula fracture 27780
|
$360.00 |
$360.00 |
$360.00 |
$501.20
|
|
Treatment of thigh fracture
|
$5,513.60 |
$5,513.60 |
$5,513.60 |
$1,749.06
|
|
Treatment of thigh fracture
|
$1,344.00 |
$1,344.00 |
$1,344.00 |
$1,790.00
|
|
Treatment of toe fracture 28510
|
$353.60 |
$353.60 |
$353.60 |
$371.40
|
|
Treat sternum fracture
|
$1,117.60 |
$1,117.60 |
$1,117.60 |
$423.00
|
|
Treat thigh fracture
|
$2,203.20 |
$2,203.20 |
$2,203.20 |
$1,893.86
|
|
Treat ulnar fracture
|
$2,941.60 |
$2,941.60 |
$2,941.60 |
$1,677.20
|
|
Treat wrist dislocation
|
$385.60 |
$385.60 |
$385.60 |
$656.25
|
|
Treponema pallidum antibody
|
$200.00 |
$200.00 |
$200.00 |
$72.05
|
|
Trg gene rearrangement anal
|
$1,231.20 |
$1,231.20 |
$1,231.20 |
$455.70
|
|
Triglycerides
|
$114.40 |
$114.40 |
$114.40 |
$58.50
|
|
Trim nondyst nails
|
$195.20 |
$195.20 |
$195.20 |
$113.88
|
|
Trnscath plc vas stent w/s&i ini vein
|
$11,008.00 |
$11,008.00 |
$11,008.00 |
$14,461.50
|
|
Trnscath retrv pq vasc fb w/guide
|
$7,160.00 |
$7,160.00 |
$7,160.00 |
$4,766.40
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$4,532.00 |
$4,532.00 |
$4,532.00 |
$5,139.20
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$2,656.80 |
$2,656.80 |
$2,656.80 |
$4,341.66
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$2,656.80 |
$2,656.80 |
$2,656.80 |
$4,354.35
|
|
Trnscath tx thromblytc vein ini day
|
$2,656.80 |
$2,656.80 |
$2,656.80 |
$3,866.70
|
|
Troponin quantitative
|
$264.00 |
$264.00 |
$264.00 |
$127.60
|
|
Tx atrial fib pulm vein isol
|
$20,000.80 |
$20,000.80 |
$20,000.80 |
$29,030.54
|
|
Tx closed hip disl traumatic without anes
|
$2,641.60 |
$2,641.60 |
$2,641.60 |
$586.40
|
|
Tx closed tib shaft fx without manip
|
$1,074.40 |
$1,074.40 |
$1,074.40 |
$535.60
|
|
Ua w/micro/comp poc
|
$139.20 |
$139.20 |
$139.20 |
$23.00
|
|
Ultrasound breast complete
|
$1,586.40 |
$1,586.40 |
$1,586.40 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$1,586.40 |
$1,586.40 |
$1,586.40 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$484.00 |
$484.00 |
$484.00 |
$338.00
|
|
Ultrasound encephalogram
|
$908.00 |
$908.00 |
$908.00 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$1,365.60 |
$1,365.60 |
$1,365.60 |
$578.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$1,240.00 |
$1,240.00 |
$1,240.00 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$1,164.80 |
$1,164.80 |
$1,164.80 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$792.00 |
$792.00 |
$792.00 |
$388.08
|
|
Ultrasound guide intraoperative
|
$1,109.60 |
$1,109.60 |
$1,109.60 |
$632.85
|
|
Ultrasound hips infant dynamic
|
$668.80 |
$668.80 |
$668.80 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$716.00 |
$716.00 |
$716.00 |
$311.25
|
|
Ultrasound joint complete left
|
$1,604.80 |
$1,604.80 |
$1,604.80 |
$557.99
|
|
Ultrasound ob >=14wks ea addl gest
|
$2,965.60 |
$2,965.60 |
$2,965.60 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$914.40 |
$914.40 |
$914.40 |
$334.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,120.00 |
$1,120.00 |
$1,120.00 |
$698.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$1,240.00 |
$1,240.00 |
$1,240.00 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$1,568.80 |
$1,568.80 |
$1,568.80 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$1,010.40 |
$1,010.40 |
$1,010.40 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$914.40 |
$914.40 |
$914.40 |
$419.50
|
|
Ultraviolet therapy
|
$36.80 |
$36.80 |
$36.80 |
$39.76
|
|
Unlisted cytogenetic study
|
$2,388.80 |
$2,388.80 |
$2,388.80 |
$160.00
|
|
Unlisted maaa
|
$589.60 |
$589.60 |
$589.60 |
$235.20
|
|
Unlisted procedure microbiology
|
$2,279.20 |
$2,279.20 |
$2,279.20 |
$530.00
|
|
Unlisted psychiatric service/proc 90899
|
$2,424.80 |
$2,424.80 |
$2,424.80 |
$277.76
|
|
Unlisted ultrasound procedure
|
$762.40 |
$762.40 |
$762.40 |
$332.16
|
|
Upper Arm (Humerus) X-ray (left side)
|
$767.20 |
$767.20 |
$767.20 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$1,812.80 |
$1,812.80 |
$1,812.80 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,777.60 |
$1,777.60 |
$1,777.60 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$5,984.00 |
$5,984.00 |
$5,984.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$4,715.20 |
$4,715.20 |
$4,715.20 |
$2,369.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$4,715.20 |
$4,715.20 |
$4,715.20 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$459.20 |
$459.20 |
$459.20 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$527.20 |
$527.20 |
$527.20 |
$381.60
|
|
Upper GI Barium X-ray (barium and gas)
|
$1,627.20 |
$1,627.20 |
$1,627.20 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$1,440.80 |
$1,440.80 |
$1,440.80 |
$607.20
|
|
Urea nitrogen
|
$67.20 |
$67.20 |
$67.20 |
$42.25
|
|
Urea nitrogen 24 hour urine
|
$108.00 |
$108.00 |
$108.00 |
$52.00
|
|
Ureteral reflux study
|
$919.20 |
$919.20 |
$919.20 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$924.00 |
$924.00 |
$924.00 |
$584.00
|
|
Urethrocystography void s&i
|
$1,326.40 |
$1,326.40 |
$1,326.40 |
$631.40
|
|
Uric acid blood
|
$72.80 |
$72.80 |
$72.80 |
$49.44
|
|
Uric acid urine
|
$108.80 |
$108.80 |
$108.80 |
$45.36
|
|
Urinalysis microscopic only
|
$106.40 |
$106.40 |
$106.40 |
$26.46
|
|
Urinalysis qual/semiquant excpt ia
|
$96.00 |
$96.00 |
$96.00 |
$25.72
|
|
Urinalysis (with microscopy)
|
$111.20 |
$111.20 |
$111.20 |
$55.20
|
|
Urinalysis (without microscopy)
|
$66.40 |
$66.40 |
$66.40 |
$36.00
|
|
Urinary bldr retent nuc study
|
$576.80 |
$576.80 |
$576.80 |
$350.66
|
|
Urine Culture Test
|
$77.60 |
$77.60 |
$77.60 |
$83.00
|
|
Urine pregnancy test
|
$157.60 |
$157.60 |
$157.60 |
$68.78
|
|
Urography, antegrade
|
$1,140.00 |
$1,140.00 |
$1,140.00 |
$622.35
|
|
Vaccine Administration (one shot)
|
$69.60 |
$69.60 |
$69.60 |
$67.70
|
|
Valproic acid total therapeutic drug level
|
$257.60 |
$257.60 |
$257.60 |
$115.00
|
|
Valvuloplasty aortic
|
$12,898.40 |
$12,898.40 |
$12,898.40 |
$7,944.16
|
|
Valvuloplasty mitral
|
$12,898.40 |
$12,898.40 |
$12,898.40 |
$10,877.90
|
|
Valvuloplasty pulmonary
|
$12,898.40 |
$12,898.40 |
$12,898.40 |
$11,945.20
|
|
Vancomycin peak therapeutic drug level
|
$318.40 |
$318.40 |
$318.40 |
$136.13
|
|
Varicella zoster antibody igg
|
$194.40 |
$194.40 |
$194.40 |
$86.80
|
|
Vein x-ray liver w/hemodynam
|
$2,537.60 |
$2,537.60 |
$2,537.60 |
$3,610.20
|
|
Vein x-ray liver without hemodyn
|
$2,537.60 |
$2,537.60 |
$2,537.60 |
$2,452.80
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$76.80 |
$76.80 |
$76.80 |
$188.83
|
|
Venogram ext bil s&i
|
$3,054.40 |
$3,054.40 |
$3,054.40 |
$1,829.42
|
|
Venogram extremity supervision & interpretation unilateral
|
$2,800.80 |
$2,800.80 |
$2,800.80 |
$1,382.58
|
|
Venous mech thrombectomy
|
$9,359.20 |
$9,359.20 |
$9,359.20 |
$8,184.00
|
|
Venous sampling s&i
|
$7,031.20 |
$7,031.20 |
$7,031.20 |
$4,200.00
|
|
Ventilator each subsequent day
|
$1,020.00 |
$1,020.00 |
$1,020.00 |
$1,184.00
|
