|
Tetanus immune globulin inj
|
$416.65 |
$416.65 |
$416.65 |
$1,285.36
|
|
Therapeutic procd strg endur
|
$123.20 |
$123.20 |
$123.20 |
$85.68
|
|
Therapy Activity Training (each 15 minutes)
|
$132.80 |
$132.80 |
$132.80 |
$101.38
|
|
Therapy Exercise Session (each 15 minutes)
|
$128.00 |
$128.00 |
$128.00 |
$98.58
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$57.60 |
$57.60 |
$57.60 |
$57.50
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$54.40 |
$54.40 |
$54.40 |
$50.40
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$54.21 |
$54.21 |
$54.21 |
$25.54
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$556.00 |
$556.00 |
$556.00 |
$313.60
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,852.00 |
$1,852.00 |
$1,852.00 |
$1,724.25
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$1,639.20 |
$1,639.20 |
$1,639.20 |
$1,703.45
|
|
Thyroid imaging
|
$975.20 |
$975.20 |
$975.20 |
$695.60
|
|
Thyroid Ultrasound
|
$426.40 |
$426.40 |
$426.40 |
$588.50
|
|
Toe X-ray (both feet)
|
$322.40 |
$322.40 |
$322.40 |
$258.65
|
|
Tomosynthesis breast diagnostic left
|
$96.80 |
$96.80 |
$96.80 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$93.60 |
$93.60 |
$93.60 |
$74.10
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$379.20 |
$379.20 |
$379.20 |
$561.60
|
|
Transvaginal Pregnancy Ultrasound
|
$371.20 |
$371.20 |
$371.20 |
$499.20
|
|
Trauma partial team response w/critical care services level 4
|
$3,883.20 |
$3,883.20 |
$3,883.20 |
$4,523.04
|
|
Treat ankle dislocation
|
$2,205.60 |
$2,205.60 |
$2,205.60 |
$2,360.00
|
|
Treat clavicle dislocation 23545
|
$692.80 |
$692.80 |
$692.80 |
$692.80
|
|
Treat elbow fracture
|
$2,395.20 |
$2,395.20 |
$2,395.20 |
$2,026.50
|
|
Treat finger fracture each
|
$768.80 |
$768.80 |
$768.80 |
$1,592.00
|
|
Treat foot dislocation
|
$510.40 |
$510.40 |
$510.40 |
$405.60
|
|
Treat foot dislocation
|
$705.60 |
$705.60 |
$705.60 |
$534.05
|
|
Treat foot dislocation
|
$245.60 |
$245.60 |
$245.60 |
$445.80
|
|
Treat fracture of radius
|
$1,001.60 |
$1,001.60 |
$1,001.60 |
$1,790.00
|
|
Treat fracture of radius
|
$705.60 |
$705.60 |
$705.60 |
$1,849.00
|
|
Treat fracture of ulna
|
$1,830.40 |
$1,830.40 |
$1,830.40 |
$731.04
|
|
Treat hip dislocation
|
$1,723.20 |
$1,723.20 |
$1,723.20 |
$2,211.05
|
|
Treat humerus fracture
|
$1,650.40 |
$1,650.40 |
$1,650.40 |
$1,790.00
|
|
Treat humerus fracture
|
$474.40 |
$474.40 |
$474.40 |
$1,790.00
|
|
Treat knee fracture 27530
|
$561.60 |
$561.60 |
$561.60 |
$550.73
|
|
Treat knee fracture(s)
|
$669.60 |
$669.60 |
$669.60 |
$643.26
|
|
Treat lower leg dislocation
|
$314.40 |
$314.40 |
$314.40 |
$532.60
|
|
Treatment of ankle fracture 27786
|
$580.00 |
$580.00 |
$580.00 |
$523.20
|
|
Treatment of fibula fracture 27780
|
$552.80 |
$552.80 |
$552.80 |
$501.20
|
|
Treatment of heel fracture 28400
|
$538.40 |
$538.40 |
$538.40 |
$473.00
|
|
Treatment of thigh fracture
|
$739.20 |
$739.20 |
$739.20 |
$477.75
|
|
Treatment of thigh fracture
|
$570.40 |
$570.40 |
$570.40 |
$549.00
|
|
Treatment of toe fracture 28510
|
$416.00 |
$416.00 |
$416.00 |
$371.40
|
|
Treat midfoot fracture each
|
$280.80 |
$280.80 |
$280.80 |
$1,884.74
|
|
Treat sternum fracture
|
$576.80 |
$576.80 |
$576.80 |
$423.00
|
|
Treat thigh fracture
|
$648.00 |
$648.00 |
$648.00 |
$661.00
|
|
Treat thigh fracture
|
$1,650.40 |
$1,650.40 |
$1,650.40 |
$1,893.86
|
|
Treat thigh fracture
|
$740.80 |
$740.80 |
$740.80 |
$618.80
|
|
Treat thigh fx growth plate
|
$296.00 |
$296.00 |
$296.00 |
$478.40
|
|
Treat ulnar fracture
|
$805.60 |
$805.60 |
$805.60 |
$1,677.20
|
|
Treat wrist bone fracture
|
$1,703.20 |
$1,703.20 |
$1,703.20 |
$1,703.20
|
|
Treat wrist dislocation
|
$745.60 |
$745.60 |
$745.60 |
$656.25
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$56.48 |
$56.48 |
$56.48 |
$43.09
|
|
Trmt of fracture (femoral shaft) 27500
|
$771.20 |
$771.20 |
$771.20 |
$754.80
|
|
Tx closed hip disl traumatic without anes
|
$784.00 |
$784.00 |
$784.00 |
$586.40
|
|
Tx closed tib shaft fx without manip
|
$608.80 |
$608.80 |
$608.80 |
$535.60
|
|
Tx tarsal bone fx without manip 28450
|
$510.40 |
$510.40 |
$510.40 |
$419.04
|
|
Ultrasound pregnant uterus follow up per fetus
|
$460.80 |
$460.80 |
$460.80 |
$425.60
|
|
Unlisted px foot/toes
|
$206.40 |
$206.40 |
$206.40 |
$1,239.20
|
|
Unlisted px forearm/wrist
|
$206.40 |
$206.40 |
$206.40 |
$859.50
|
|
Unlisted px hands/fingers
|
$206.40 |
$206.40 |
$206.40 |
$354.20
|
|
Unlisted px leg/ankle
|
$1,323.20 |
$1,323.20 |
$1,323.20 |
$882.30
|
|
Unlisted px pelvis/hip joint
|
$206.40 |
$206.40 |
$206.40 |
$3,251.90
|
|
Unlisted ultrasound procedure
|
$452.80 |
$452.80 |
$452.80 |
$332.16
|
|
Upper Arm (Humerus) X-ray (left side)
|
$532.80 |
$532.80 |
$532.80 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$2,369.60 |
$2,369.60 |
$2,369.60 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,924.00 |
$1,924.00 |
$1,924.00 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,034.40 |
$4,034.40 |
$4,034.40 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,460.80 |
$3,460.80 |
$3,460.80 |
$2,369.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,976.00 |
$2,976.00 |
$2,976.00 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$405.60 |
$405.60 |
$405.60 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$529.60 |
$529.60 |
$529.60 |
$381.60
|
|
Urinalysis (without microscopy)
|
$9.60 |
$9.60 |
$9.60 |
$36.00
|
|
Vaccine Administration (one shot)
|
$96.80 |
$96.80 |
$96.80 |
$67.70
|
|
Vaccine dtap < 7 years im
|
$74.75 |
$74.75 |
$74.75 |
$71.17
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$79.76 |
$79.76 |
$79.76 |
$155.16
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$61.20 |
$61.20 |
$61.20 |
$149.21
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$132.04 |
$132.04 |
$132.04 |
$252.87
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$248.57 |
$248.57 |
$248.57 |
$397.11
|
|
Vaccine rabies im
|
$401.36 |
$401.36 |
$401.36 |
$858.95
|
|
Vaccine tdap >=7 years im
|
$88.80 |
$88.80 |
$88.80 |
$131.34
|
|
Vancomycin 1,000 mg intravenous injection
|
$63.00 |
$63.00 |
$63.00 |
$259.05
|
|
Vancomycin 750 mg intravenous solution
|
$70.40 |
$70.40 |
$70.40 |
$90.33
|
|
Ventilator each subsequent day
|
$1,047.20 |
$1,047.20 |
$1,047.20 |
$1,184.00
|
|
Ventilator Management (first day)
|
$1,037.60 |
$1,037.60 |
$1,037.60 |
$1,434.60
|
|
Walking (Gait) Training (each 15 minutes)
|
$116.00 |
$116.00 |
$116.00 |
$87.50
|
|
Whfo w/joint(s) custom fab
|
$680.12 |
$680.12 |
$680.12 |
$452.38
|
|
Whole-Body Bone Scan (Nuclear Medicine)
|
$1,857.60 |
$1,857.60 |
$1,857.60 |
$1,570.65
|
|
Whole Skeleton X-ray Survey
|
$954.40 |
$954.40 |
$954.40 |
$639.93
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$176.00 |
$176.00 |
$176.00 |
$284.70
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$340.00 |
$340.00 |
$340.00 |
$442.22
|
|
Wrist X-ray
|
$510.40 |
$510.40 |
$510.40 |
$349.70
|
|
Wrist X-ray (2 views, both wrists)
|
$349.60 |
$349.60 |
$349.60 |
$291.20
|
|
X-ray abdomen >=3 views
|
$536.00 |
$536.00 |
$536.00 |
$344.12
|
|
X-ray bone survey infant
|
$496.00 |
$496.00 |
$496.00 |
$394.80
|
|
X-ray exam entire spi 4/5 vw
|
$621.60 |
$621.60 |
$621.60 |
$450.24
|
|
X-ray exam entire spi 6/> vw
|
$612.00 |
$612.00 |
$612.00 |
$519.00
|
|
X-ray exam of arm infant
|
$385.60 |
$385.60 |
$385.60 |
$248.82
|
|
X-ray exam of femur 1
|
$561.60 |
$561.60 |
$561.60 |
$237.60
|
|
X-ray exam of jaw joint
|
$287.20 |
$287.20 |
$287.20 |
$193.39
|
|
X-ray eye detection foreign body (both sides)
|
$324.80 |
$324.80 |
$324.80 |
$238.29
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$469.60 |
$469.60 |
$469.60 |
$376.80
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$639.20 |
$639.20 |
$639.20 |
$512.80
|
