|
Treat big toe fracture
|
$2,945.88 |
$2,945.88 |
$2,945.88 |
$4,307.52
|
|
Treat clavicle dislocation 23545
|
$309.54 |
$309.54 |
$309.54 |
$705.60
|
|
Treat elbow dislocation
|
$1,488.48 |
$1,488.48 |
$1,488.48 |
$2,223.20
|
|
Treat finger fracture each
|
$1,029.00 |
$1,029.00 |
$1,029.00 |
$1,536.00
|
|
Treat foot dislocation
|
$193.20 |
$193.20 |
$193.20 |
$396.30
|
|
Treat foot dislocation
|
$149.94 |
$149.94 |
$149.94 |
$445.80
|
|
Treat fracture of radius
|
$1,029.00 |
$1,029.00 |
$1,029.00 |
$1,790.00
|
|
Treat fracture of radius
|
$1,135.68 |
$1,135.68 |
$1,135.68 |
$1,849.00
|
|
Treat fracture of ulna
|
$318.78 |
$318.78 |
$318.78 |
$726.05
|
|
Treat hip dislocation
|
$872.34 |
$872.34 |
$872.34 |
$2,192.80
|
|
Treat hip dislocation
|
$1,092.42 |
$1,092.42 |
$1,092.42 |
$2,641.60
|
|
Treat humerus fracture
|
$1,029.00 |
$1,029.00 |
$1,029.00 |
$1,771.43
|
|
Treat humerus fracture
|
$1,029.00 |
$1,029.00 |
$1,029.00 |
$1,771.43
|
|
Treat kneecap dislocation
|
$1,068.06 |
$1,068.06 |
$1,068.06 |
$1,068.90
|
|
Treat knee fracture 27530
|
$1,005.90 |
$1,005.90 |
$1,005.90 |
$550.00
|
|
Treat knuckle dislocation
|
$1,083.18 |
$1,083.18 |
$1,083.18 |
$1,523.90
|
|
Treatment incomplete abortion completed surgically any trimester
|
$1,640.10 |
$1,640.10 |
$1,640.10 |
$3,916.04
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$190.68 |
$190.68 |
$190.68 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$102.06 |
$102.06 |
$102.06 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$101.64 |
$101.64 |
$101.64 |
$203.35
|
|
Treatment of ankle fracture 27786
|
$399.00 |
$399.00 |
$399.00 |
$520.80
|
|
Treatment of fibula fracture 27780
|
$244.86 |
$244.86 |
$244.86 |
$491.50
|
|
Treatment of heel fracture 28400
|
$244.86 |
$244.86 |
$244.86 |
$473.00
|
|
Treatment of thigh fracture
|
$1,554.00 |
$1,554.00 |
$1,554.00 |
$1,748.40
|
|
Treatment of thigh fracture
|
$736.26 |
$736.26 |
$736.26 |
$548.90
|
|
Treatment of thigh fracture
|
$1,029.00 |
$1,029.00 |
$1,029.00 |
$1,772.97
|
|
Treatment of tibia fracture
|
$5,166.00 |
$5,166.00 |
$5,166.00 |
$7,087.60
|
|
Treatment of toe fracture 28510
|
$109.62 |
$109.62 |
$109.62 |
$369.70
|
|
Treatment radiation delivery level 2
|
$472.08 |
$472.08 |
$472.08 |
$767.65
|
|
Treat metacarpal fracture
|
$7,337.40 |
$7,337.40 |
$7,337.40 |
$5,464.97
|
|
Treat spinal cord lesion
|
$737.94 |
$737.94 |
$737.94 |
$1,337.00
|
|
Treat ulnar fracture
|
$1,029.00 |
$1,029.00 |
$1,029.00 |
$1,662.00
|
|
Treat vaginal bleeding
|
$147.84 |
$147.84 |
$147.84 |
$379.60
|
|
Treat wrist bone fracture
|
$250.74 |
$250.74 |
$250.74 |
$1,548.40
|
|
Treat wrist dislocation
|
$474.60 |
$474.60 |
$474.60 |
$656.25
|
|
Treponema pallidum antibody
|
$41.16 |
$41.16 |
$41.16 |
$70.40
|
|
Treprostinil injection
|
$33,423.60 |
$33,423.60 |
$33,423.60 |
$19,071.84
|
|
Treprostinil, non-comp unit
|
$34,177.33 |
$34,177.33 |
$34,177.33 |
$3,894.40
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$136.29 |
$136.29 |
$136.29 |
$43.21
|
|
Triamcinolone a inj prs-free
|
$303.54 |
$303.54 |
$303.54 |
$223.56
|
|
Trichinella antibody
|
$72.24 |
$72.24 |
$72.24 |
$70.20
|
|
Triglycerides
|
$60.90 |
$60.90 |
$60.90 |
$58.05
|
|
Trilaciclib 300 mg intravenous solution
|
$3,328.55 |
$3,328.55 |
$3,328.55 |
$4,043.12
|
|
Trimethobenzamide hcl inj
|
$107.13 |
$107.13 |
$107.13 |
$117.49
|
|
Trim nondyst nails
|
$48.72 |
$48.72 |
$48.72 |
$113.40
|
|
Triptorelin pamoate
|
$1,256.94 |
$1,256.94 |
$1,256.94 |
$4,619.39
|
|
Trnscath plc stent crv crtd without prtct
|
$2,169.30 |
$2,169.30 |
$2,169.30 |
$7,795.71
|
|
Trnscath plc stent crv crtd w/prtct
|
$4,661.58 |
$4,661.58 |
$4,661.58 |
$9,767.25
|
|
Trnscath plc stnt ante carotid art
|
$4,302.90 |
$4,302.90 |
$4,302.90 |
$6,069.00
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$6,272.70 |
$6,272.70 |
$6,272.70 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$3,536.82 |
$3,536.82 |
$3,536.82 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$11,051.88 |
$11,051.88 |
$11,051.88 |
$15,330.11
|
|
Trnscath retrv pq vasc fb w/guide
|
$4,375.56 |
$4,375.56 |
$4,375.56 |
$4,523.96
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$3,578.82 |
$3,578.82 |
$3,578.82 |
$5,069.50
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$2,970.66 |
$2,970.66 |
$2,970.66 |
$4,250.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$2,970.66 |
$2,970.66 |
$2,970.66 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$1,145.34 |
$1,145.34 |
$1,145.34 |
$3,866.70
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$1,282.26 |
$1,282.26 |
$1,282.26 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$1,380.96 |
$1,380.96 |
$1,380.96 |
$3,078.00
|
|
Troponin quantitative
|
$165.06 |
$165.06 |
$165.06 |
$127.20
|
|
Tte w or without contr, cont ecg
|
$2,318.40 |
$2,318.40 |
$2,318.40 |
$2,012.40
|
|
Tte w or without fol w/con,stres
|
$2,318.40 |
$2,318.40 |
$2,318.40 |
$1,632.80
|
|
Tube trach disp innr can 5 xlt
|
$264.48 |
$264.48 |
$264.48 |
$445.99
|
|
Tube trach fen sz 6 uncuffed
|
$107.39 |
$107.39 |
$107.39 |
$155.98
|
|
Tx atrial fib pulm vein isol
|
$19,162.92 |
$19,162.92 |
$19,162.92 |
$29,030.54
|
|
Tx closed hip disl traumatic without anes
|
$238.56 |
$238.56 |
$238.56 |
$581.07
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$1,256.64 |
$1,256.64 |
$1,256.64 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$342.30 |
$342.30 |
$342.30 |
$535.60
|
|
Tx l/r atrial fib addl
|
$8,048.46 |
$8,048.46 |
$8,048.46 |
$6,769.00
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$3,286.50 |
$3,286.50 |
$3,286.50 |
$4,468.55
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$4,212.18 |
$4,212.18 |
$4,212.18 |
$4,421.00
|
|
Ua w/micro/comp poc
|
$36.12 |
$36.12 |
$36.12 |
$23.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$21,992.26 |
$21,992.26 |
$21,992.26 |
$20,945.01
|
|
Ultrasound abdomen aorta screening study aaa
|
$199.50 |
$199.50 |
$199.50 |
$394.20
|
|
Ultrasound breast complete
|
$139.02 |
$139.02 |
$139.02 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$139.02 |
$139.02 |
$139.02 |
$449.35
|
|
Ultrasound chest
|
$171.78 |
$171.78 |
$171.78 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$143.64 |
$143.64 |
$143.64 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$27.30 |
$27.30 |
$27.30 |
$296.80
|
|
Ultrasound elastography ea l target les
|
$113.82 |
$113.82 |
$113.82 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$119.70 |
$119.70 |
$119.70 |
$307.00
|
|
Ultrasound encephalogram
|
$385.14 |
$385.14 |
$385.14 |
$488.80
|
|
Ultrasound exam follow-up
|
$226.38 |
$226.38 |
$226.38 |
$226.38
|
|
Ultrasound exam k transpl w/doppler
|
$60.48 |
$60.48 |
$60.48 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$279.72 |
$279.72 |
$279.72 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$460.74 |
$460.74 |
$460.74 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$448.14 |
$448.14 |
$448.14 |
$720.15
|
|
Ultrasound guide intraoperative
|
$622.02 |
$622.02 |
$622.02 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$238.98 |
$238.98 |
$238.98 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$314.58 |
$314.58 |
$314.58 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$292.74 |
$292.74 |
$292.74 |
$311.25
|
|
Ultrasound joint complete left
|
$380.10 |
$380.10 |
$380.10 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$316.68 |
$316.68 |
$316.68 |
$425.45
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$402.36 |
$402.36 |
$402.36 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$279.72 |
$279.72 |
$279.72 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$279.72 |
$279.72 |
$279.72 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$490.98 |
$490.98 |
$490.98 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$251.16 |
$251.16 |
$251.16 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$251.16 |
$251.16 |
$251.16 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$398.58 |
$398.58 |
$398.58 |
$497.12
|
