|
Treat wrist bone fracture
|
$1,980.00 |
$1,980.00 |
$1,980.00 |
|
|
Treat wrist dislocation
|
$386.40 |
$386.40 |
$386.40 |
|
|
Treponema pallidum antibody
|
$89.60 |
$89.60 |
$89.60 |
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$81.03 |
$81.03 |
$81.03 |
|
|
Triamcinolone a inj prs-free
|
$148.46 |
$148.46 |
$148.46 |
|
|
Trichinella antibody
|
$68.00 |
$68.00 |
$68.00 |
|
|
Triglycerides
|
$21.60 |
$21.60 |
$54.40 |
|
|
Trim nail(s)
|
$34.40 |
$34.40 |
$34.40 |
|
|
Trim nondyst nails
|
$20.80 |
$20.80 |
$119.20 |
|
|
Trmt of fracture (femoral shaft) 27500
|
$286.40 |
$286.40 |
$286.40 |
|
|
Trnscath plc stent crv crtd w/prtct
|
$21,281.60 |
$21,281.60 |
$21,281.60 |
|
|
Trnscath plc stnt ante carotid art
|
$18,008.00 |
$18,008.00 |
$18,008.00 |
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$10,851.20 |
$10,851.20 |
$10,851.20 |
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$10,851.20 |
$10,851.20 |
$10,851.20 |
|
|
Trnscath plc vas stent w/s&i ini vein
|
$24,267.20 |
$24,267.20 |
$24,267.20 |
|
|
Trnscath retrv pq vasc fb w/guide
|
$6,367.20 |
$6,367.20 |
$6,367.20 |
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$6,307.20 |
$6,307.20 |
$6,307.20 |
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$3,214.40 |
$3,214.40 |
$3,214.40 |
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$3,214.40 |
$3,214.40 |
$3,214.40 |
|
|
Trnscath tx thromblytc vein ini day
|
$6,307.20 |
$6,307.20 |
$6,307.20 |
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$4,689.60 |
$4,689.60 |
$4,689.60 |
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$5,564.80 |
$5,564.80 |
$5,564.80 |
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$1,152.80 |
$1,152.80 |
$2,488.00 |
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$1,496.80 |
$1,496.80 |
$2,488.00 |
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$1,305.60 |
$1,305.60 |
$1,305.60 |
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$1,189.60 |
$1,189.60 |
$1,189.60 |
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$957.60 |
$957.60 |
$957.60 |
|
|
Troponin quantitative
|
$69.60 |
$69.60 |
$124.80 |
|
|
Tte w or without contr, cont ecg
|
$1,011.20 |
$1,011.20 |
$1,432.00 |
|
|
Tte w or without fol w/con,stres
|
$1,011.20 |
$1,011.20 |
$1,633.60 |
|
|
Tte w or without fol w/cont, com
|
$1,011.20 |
$1,011.20 |
$1,633.60 |
|
|
Tte w or without fol w/cont, f/u
|
$1,011.20 |
$1,011.20 |
$1,432.00 |
|
|
Tubal Ligation (Laparoscopic)
|
$550.40 |
$550.40 |
$550.40 |
|
|
Tube trach disp innr can 5 xlt
|
$512.12 |
$512.12 |
$512.12 |
|
|
Tvh >250 gms 58290
|
$1,700.80 |
$1,700.80 |
$1,700.80 |
|
|
Tvh w/mmk 58267
|
$1,582.40 |
$1,582.40 |
$1,582.40 |
|
|
Tx atrial fib pulm vein isol
|
$24,150.40 |
$24,150.40 |
$24,150.40 |
|
|
Tx closed hip disl traumatic without anes
|
$264.80 |
$264.80 |
$382.40 |
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$920.80 |
$920.80 |
$4,868.80 |
|
|
Tx closed tib shaft fx without manip
|
$286.40 |
$286.40 |
$544.80 |
|
|
Tx contour defects 1.1-5.0cc 11951
|
$164.00 |
$164.00 |
$164.00 |
|
|
Tx ectopic pregnancy abdl pregnancy 59130
|
$1,400.80 |
$1,400.80 |
$1,400.80 |
|
|
Tx l/r atrial fib addl
|
$24,150.40 |
$24,150.40 |
$24,150.40 |
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$1,096.00 |
$1,096.00 |
$4,108.00 |
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$743.20 |
$743.20 |
$4,108.00 |
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$4,108.00 |
$4,108.00 |
$4,108.00 |
|
|
Tx open nsl fx uncomp
|
$3,926.40 |
$3,926.40 |
$3,926.40 |
|
|
Tx open nsl sptl fx
|
$4,289.60 |
$4,289.60 |
$4,289.60 |
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$879.20 |
$879.20 |
$4,108.00 |
|
|
Tx septic abortion surgical 59830
|
$696.00 |
$696.00 |
$696.00 |
|
|
Tx tarsal bone fx without manip 28450
|
$286.40 |
$286.40 |
$286.40 |
|
|
Tympanic membrane repair
|
$567.20 |
$567.20 |
$567.20 |
|
|
Tympanometry & reflex thresh
|
$32.80 |
$32.80 |
$32.80 |
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$300.00 |
$300.00 |
$300.00 |
|
|
Ua w/micro/comp poc
|
$19.20 |
$19.20 |
$19.20 |
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$29,603.24 |
$29,603.24 |
$29,603.24 |
|
|
Ultrasound abdomen aorta screening study aaa
|
$287.20 |
$287.20 |
$338.40 |
|
|
Ultrasound breast complete
|
$187.20 |
$187.20 |
$453.60 |
|
|
Ultrasound breast unilateral limited (both sides)
|
$187.20 |
$187.20 |
$275.20 |
|
|
Ultrasound chest
|
$477.60 |
$477.60 |
$580.80 |
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$95.20 |
$95.20 |
$104.80 |
|
|
Ultrasound elastography parenchyma
|
$396.00 |
$396.00 |
$827.20 |
|
|
Ultrasound encephalogram
|
$187.20 |
$187.20 |
$253.60 |
|
|
Ultrasound exam k transpl w/doppler
|
$508.00 |
$508.00 |
$601.60 |
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$327.20 |
$327.20 |
$466.40 |
|
|
Ultrasound guidance for vascular access
|
$202.40 |
$202.40 |
$497.60 |
|
|
Ultrasound guided needle placement supervision & interpretation
|
$255.20 |
$255.20 |
$455.20 |
|
|
Ultrasound guide intraoperative
|
$657.60 |
$657.60 |
$673.60 |
|
|
Ultrasound guide tissue ablation
|
$640.80 |
$640.80 |
$640.80 |
|
|
Ultrasound hips infant dynamic
|
$414.40 |
$414.40 |
$491.20 |
|
|
Ultrasound infant hips ltd without stress
|
$178.40 |
$178.40 |
$192.80 |
|
|
Ultrasound joint complete left
|
$292.80 |
$292.80 |
$500.80 |
|
|
Ultrasound joint/nonvascular extremity limited left
|
$191.20 |
$191.20 |
$450.40 |
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$238.40 |
$238.40 |
$238.40 |
|
|
Ultrasound ob >=14wks ea addl gest
|
$284.80 |
$284.80 |
$379.20 |
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$208.80 |
$208.80 |
$274.40 |
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$844.00 |
$844.00 |
$853.60 |
|
|
Ultrasound pregnant uterus follow up per fetus
|
$340.80 |
$340.80 |
$374.40 |
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$280.80 |
$280.80 |
$394.40 |
|
|
Ultrasound pregnant uterus transvaginal
|
$436.00 |
$436.00 |
$544.00 |
|
|
Ultrasound prostate/transrectal
|
$645.60 |
$645.60 |
$645.60 |
|
|
Ultrasound retroperitoneal limited
|
$434.40 |
$434.40 |
$469.60 |
|
|
Ultrasound scrotum and contents
|
$450.40 |
$450.40 |
$477.60 |
|
|
Ultrasound spinal canal and contents
|
$776.00 |
$776.00 |
$892.00 |
|
|
Ultrasound transabd ea addl gest
|
$512.80 |
$512.80 |
$589.60 |
|
|
Ultrasound transvaginal non obstetric
|
$436.00 |
$436.00 |
$457.60 |
|
|
Umbilical artery cath newborn 36660
|
$100.00 |
$100.00 |
$100.00 |
|
|
Unlisted chemotherapy px
|
$86.40 |
$86.40 |
$104.80 |
|
|
Unlisted laparoscopic procedure 49659
|
$651.20 |
$651.20 |
$651.20 |
|
|
Unlisted mr procedure
|
$462.40 |
$462.40 |
$462.40 |
|
|
Unlisted procedure microbiology
|
$2,585.60 |
$2,585.60 |
$2,585.60 |
|
|
Unlisted procedure rectum
|
$1,197.60 |
$1,197.60 |
$1,197.60 |
|
|
Unlisted px hands/fingers
|
$248.80 |
$248.80 |
$248.80 |
|
|
Unlisted px salivry glnd/dux
|
$287.20 |
$287.20 |
$287.20 |
|
|
Unlisted px small intestine
|
$1,189.60 |
$1,189.60 |
$1,189.60 |
|
|
Unlisted transfusion med px
|
$200.80 |
$200.80 |
$200.80 |
|
|
Unlisted ultrasound procedure
|
$136.00 |
$136.00 |
$182.40 |
|
|
Unsched dialysis esrd pt hos
|
$1,296.00 |
$1,296.00 |
$1,296.00 |
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,860.80 |
$2,860.80 |
$2,889.60 |
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,895.20 |
$1,895.20 |
$2,183.20 |
|