|
Treat ankle dislocation
|
$1,593.00 |
$1,593.00 |
$1,593.00 |
$2,360.00
|
|
Treat clavicle dislocation 23545
|
$415.00 |
$415.00 |
$415.00 |
$692.80
|
|
Treat elbow dislocation
|
$3,332.00 |
$3,332.00 |
$3,332.00 |
$2,272.50
|
|
Treat elbow fracture
|
$1,593.00 |
$1,593.00 |
$1,593.00 |
$2,026.50
|
|
Treat finger fracture each
|
$1,593.00 |
$1,593.00 |
$1,593.00 |
$1,592.00
|
|
Treat foot dislocation
|
$320.00 |
$320.00 |
$320.00 |
$445.80
|
|
Treat foot dislocation
|
$760.00 |
$760.00 |
$760.00 |
$469.20
|
|
Treat fracture of radius
|
$1,593.00 |
$1,593.00 |
$1,593.00 |
$1,790.00
|
|
Treat fracture of radius
|
$7,631.00 |
$7,631.00 |
$7,631.00 |
$1,849.00
|
|
Treat fracture of ulna
|
$490.00 |
$490.00 |
$490.00 |
$731.04
|
|
Treat hip dislocation
|
$3,349.00 |
$3,349.00 |
$3,349.00 |
$2,211.05
|
|
Treat hip dislocation
|
$6,748.00 |
$6,748.00 |
$6,748.00 |
$2,641.60
|
|
Treat hip socket fracture
|
$962.00 |
$962.00 |
$962.00 |
$1,392.00
|
|
Treat humerus fracture
|
$1,593.00 |
$1,593.00 |
$1,593.00 |
$1,790.00
|
|
Treat humerus fracture
|
$5,626.00 |
$5,626.00 |
$5,626.00 |
$1,790.00
|
|
Treat knee fracture 27530
|
$550.00 |
$550.00 |
$550.00 |
$550.73
|
|
Treat knee fracture(s)
|
$580.00 |
$580.00 |
$580.00 |
$643.26
|
|
Treat knuckle dislocation
|
$1,958.00 |
$1,958.00 |
$1,958.00 |
$1,726.01
|
|
Treatment incomplete abortion completed surgically any trimester
|
$3,635.00 |
$3,635.00 |
$3,635.00 |
$3,928.20
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$266.00 |
$266.00 |
$266.00 |
$227.70
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$143.00 |
$143.00 |
$143.00 |
$147.48
|
|
Treatment of ankle fracture 27786
|
$493.00 |
$493.00 |
$493.00 |
$523.20
|
|
Treatment of fibula fracture 27780
|
$373.00 |
$373.00 |
$373.00 |
$501.20
|
|
Treatment of heel fracture 28400
|
$426.00 |
$426.00 |
$426.00 |
$473.00
|
|
Treatment of thigh fracture
|
$1,601.00 |
$1,601.00 |
$1,601.00 |
$1,749.06
|
|
Treatment of thigh fracture
|
$952.00 |
$952.00 |
$952.00 |
$549.00
|
|
Treatment of thigh fracture
|
$1,601.00 |
$1,601.00 |
$1,601.00 |
$1,790.00
|
|
Treatment of toe fracture 28510
|
$326.00 |
$326.00 |
$326.00 |
$371.40
|
|
Treat metacarpal fracture
|
$7,441.00 |
$7,441.00 |
$7,441.00 |
$5,857.86
|
|
Treat thigh fracture
|
$426.00 |
$426.00 |
$426.00 |
$618.80
|
|
Treat ulnar fracture
|
$1,593.00 |
$1,593.00 |
$1,593.00 |
$1,677.20
|
|
Treat wrist dislocation
|
$482.00 |
$482.00 |
$482.00 |
$656.25
|
|
Treponema pallidum antibody
|
$118.00 |
$118.00 |
$118.00 |
$72.05
|
|
Trichomonas assay w/optic
|
$66.00 |
$66.00 |
$66.00 |
$57.40
|
|
Triglycerides
|
$23.00 |
$23.00 |
$23.00 |
$58.50
|
|
Trim nondyst nails
|
$202.00 |
$202.00 |
$202.00 |
$113.88
|
|
Trnscath plc stent crv crtd without prtct
|
$2,464.00 |
$2,464.00 |
$2,464.00 |
$7,795.71
|
|
Trnscath plc stent crv crtd w/prtct
|
$2,464.00 |
$2,464.00 |
$2,464.00 |
$9,767.25
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$1,311.00 |
$1,311.00 |
$1,311.00 |
$8,776.32
|
|
Trnscath plc vas stent w/s&i ini vein
|
$17,606.00 |
$17,606.00 |
$17,606.00 |
$14,461.50
|
|
Trnscath retrv pq vasc fb w/guide
|
$10,058.00 |
$10,058.00 |
$10,058.00 |
$4,766.40
|
|
Trnscath tx thromblytc vein ini day
|
$3,527.00 |
$3,527.00 |
$3,527.00 |
$3,866.70
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$4,692.00 |
$4,692.00 |
$4,692.00 |
$4,872.75
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$6,571.00 |
$6,571.00 |
$6,571.00 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$6,663.00 |
$6,663.00 |
$6,663.00 |
$3,186.00
|
|
Troponin quantitative
|
$40.00 |
$40.00 |
$40.00 |
$127.60
|
|
Tte w or without fol w/con,stres
|
$2,624.00 |
$2,624.00 |
$2,624.00 |
$1,632.80
|
|
Tte w or without fol w/cont, com
|
$1,527.00 |
$1,527.00 |
$1,527.00 |
$1,220.31
|
|
Tte w or without fol w/cont, f/u
|
$1,178.00 |
$1,178.00 |
$1,178.00 |
$1,178.00
|
|
Tx atrial fib pulm vein isol
|
$47,320.00 |
$47,320.00 |
$47,320.00 |
$29,030.54
|
|
Tx closed hip disl traumatic without anes
|
$321.00 |
$321.00 |
$321.00 |
$586.40
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$3,237.00 |
$3,237.00 |
$3,237.00 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$637.00 |
$637.00 |
$637.00 |
$535.60
|
|
Tx l/r atrial fib addl
|
$3,735.00 |
$3,735.00 |
$3,735.00 |
$6,986.85
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$7,193.00 |
$7,193.00 |
$7,193.00 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$373.00 |
$373.00 |
$373.00 |
$419.04
|
|
Tympanometry & reflex thresh
|
$170.00 |
$170.00 |
$170.00 |
$173.18
|
|
Ua w/micro/comp poc
|
$23.00 |
$23.00 |
$23.00 |
$23.00
|
|
Ultrasound breast complete
|
$1,509.98 |
$1,509.98 |
$1,509.98 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$1,132.51 |
$1,132.51 |
$1,132.51 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$670.00 |
$670.00 |
$670.00 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$613.00 |
$613.00 |
$613.00 |
$296.80
|
|
Ultrasound elastography parenchyma
|
$1,240.00 |
$1,240.00 |
$1,240.00 |
$313.95
|
|
Ultrasound encephalogram
|
$983.00 |
$983.00 |
$983.00 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$1,127.00 |
$1,127.00 |
$1,127.00 |
$578.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$808.00 |
$808.00 |
$808.00 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$1,424.00 |
$1,424.00 |
$1,424.00 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$252.00 |
$252.00 |
$252.00 |
$388.08
|
|
Ultrasound guide intraoperative
|
$1,488.00 |
$1,488.00 |
$1,488.00 |
$632.85
|
|
Ultrasound infant hips ltd without stress
|
$1,196.00 |
$1,196.00 |
$1,196.00 |
$311.25
|
|
Ultrasound joint complete left
|
$1,012.00 |
$1,012.00 |
$1,012.00 |
$557.99
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$723.00 |
$723.00 |
$723.00 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$297.00 |
$297.00 |
$297.00 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$610.00 |
$610.00 |
$610.00 |
$334.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,745.00 |
$1,745.00 |
$1,745.00 |
$698.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$674.00 |
$674.00 |
$674.00 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$591.00 |
$591.00 |
$591.00 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$814.00 |
$814.00 |
$814.00 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$646.00 |
$646.00 |
$646.00 |
$419.50
|
|
Umbilical artery cath newborn 36660
|
$172.00 |
$172.00 |
$172.00 |
$223.80
|
|
Unlisted chemotherapy px
|
$401.00 |
$401.00 |
$401.00 |
$149.15
|
|
Unlisted CT procedure
|
$164.00 |
$164.00 |
$164.00 |
$732.70
|
|
Unlisted dialysis procedure
|
$906.00 |
$906.00 |
$906.00 |
$1,144.00
|
|
Unlisted fluoroscopic px
|
$507.00 |
$507.00 |
$507.00 |
$305.76
|
|
Unlisted mr procedure
|
$3,999.00 |
$3,999.00 |
$3,999.00 |
$1,165.00
|
|
Unlisted procedure colon
|
$8,395.00 |
$8,395.00 |
$8,395.00 |
$1,839.55
|
|
Unlisted procedure liver
|
$5,401.00 |
$5,401.00 |
$5,401.00 |
$2,287.20
|
|
Unlisted px abdomen muscskel
|
$7,311.00 |
$7,311.00 |
$7,311.00 |
$1,956.50
|
|
Unlisted px external ear
|
$356.00 |
$356.00 |
$356.00 |
$325.68
|
|
Unlisted px med radj physics
|
$709.00 |
$709.00 |
$709.00 |
$462.35
|
|
Unlisted px pelvis/hip joint
|
$15,966.00 |
$15,966.00 |
$15,966.00 |
$3,251.90
|
|
Unlisted px small intestine
|
$985.00 |
$985.00 |
$985.00 |
$2,118.35
|
|
Unlisted px tongue flr mouth
|
$1,383.00 |
$1,383.00 |
$1,383.00 |
$282.50
|
|
Unsched dialysis esrd pt hos
|
$939.00 |
$939.00 |
$939.00 |
$1,292.33
|
|
Upgrade pm system
|
$10,010.00 |
$10,010.00 |
$10,010.00 |
$12,077.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$614.00 |
$614.00 |
$614.00 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$1,669.00 |
$1,669.00 |
$1,669.00 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,076.00 |
$1,076.00 |
$1,076.00 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,387.00 |
$3,387.00 |
$3,387.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,838.00 |
$2,838.00 |
$2,838.00 |
$2,369.00
|
