|
Treat hip dislocation
|
$1,420.35 |
$1,420.35 |
$1,420.35 |
$2,641.60
|
|
Treat humerus fracture
|
$1,458.60 |
$1,458.60 |
$1,458.60 |
$1,771.43
|
|
Treat humerus fracture
|
$1,279.25 |
$1,279.25 |
$1,279.25 |
$1,771.43
|
|
Treat kneecap dislocation
|
$2,100.35 |
$2,100.35 |
$2,100.35 |
$1,068.90
|
|
Treat knee fracture 27530
|
$868.70 |
$868.70 |
$868.70 |
$550.00
|
|
Treatment incomplete abortion completed surgically any trimester
|
$834.70 |
$834.70 |
$834.70 |
$3,916.04
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$151.30 |
$151.30 |
$151.30 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$144.50 |
$144.50 |
$144.50 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$161.50 |
$161.50 |
$161.50 |
$203.35
|
|
Treatment mouth roof lesion
|
$1,662.60 |
$1,662.60 |
$1,662.60 |
$4,256.70
|
|
Treatment of ankle fracture 27786
|
$748.85 |
$748.85 |
$748.85 |
$520.80
|
|
Treatment of fibula fracture 27780
|
$736.95 |
$736.95 |
$736.95 |
$491.50
|
|
Treatment of heel fracture 28400
|
$589.05 |
$589.05 |
$589.05 |
$473.00
|
|
Treatment of retinal lesion
|
$565.25 |
$565.25 |
$565.25 |
$1,033.14
|
|
Treatment of thigh fracture
|
$1,238.45 |
$1,238.45 |
$1,238.45 |
$548.90
|
|
Treatment of thigh fracture
|
$289.85 |
$289.85 |
$289.85 |
$1,772.97
|
|
Treatment of toe fracture 28510
|
$287.30 |
$287.30 |
$287.30 |
$369.70
|
|
Treat ulnar fracture
|
$1,099.90 |
$1,099.90 |
$1,099.90 |
$1,662.00
|
|
Treat vaginal bleeding
|
$522.75 |
$522.75 |
$522.75 |
$379.60
|
|
Treat wrist dislocation
|
$1,064.20 |
$1,064.20 |
$1,064.20 |
$656.25
|
|
Treponema pallidum antibody
|
$216.75 |
$216.75 |
$216.75 |
$70.40
|
|
Treprostinil injection
|
$67,643.00 |
$67,643.00 |
$67,643.00 |
$19,071.84
|
|
Treprostinil, non-comp unit
|
$69,168.40 |
$69,168.40 |
$69,168.40 |
$3,894.40
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$275.83 |
$275.83 |
$275.83 |
$43.21
|
|
Triamcinolone a inj prs-free
|
$614.30 |
$614.30 |
$614.30 |
$223.56
|
|
Trichinella antibody
|
$124.95 |
$124.95 |
$124.95 |
$70.20
|
|
Triglycerides
|
$118.15 |
$118.15 |
$118.15 |
$58.05
|
|
Trilaciclib 300 mg intravenous solution
|
$6,736.34 |
$6,736.34 |
$6,736.34 |
$4,043.12
|
|
Trimethobenzamide hcl inj
|
$216.80 |
$216.80 |
$216.80 |
$117.49
|
|
Triptorelin pamoate
|
$2,543.80 |
$2,543.80 |
$2,543.80 |
$4,619.39
|
|
Trnscath plc stnt ante carotid art
|
$63.75 |
$63.75 |
$63.75 |
$6,069.00
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$1,926.95 |
$1,926.95 |
$1,926.95 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$2,351.10 |
$2,351.10 |
$2,351.10 |
$3,078.00
|
|
Troponin quantitative
|
$258.40 |
$258.40 |
$258.40 |
$127.20
|
|
Tte w or without contr, cont ecg
|
$2,761.65 |
$2,761.65 |
$2,761.65 |
$2,012.40
|
|
Tte w or without fol w/con,stres
|
$2,761.65 |
$2,761.65 |
$2,761.65 |
$1,632.80
|
|
Tube trach disp innr can 5 xlt
|
$535.25 |
$535.25 |
$535.25 |
$445.99
|
|
Tube trach fen sz 6 uncuffed
|
$217.34 |
$217.34 |
$217.34 |
$155.98
|
|
Tx closed hip disl traumatic without anes
|
$411.40 |
$411.40 |
$411.40 |
$581.07
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$1,778.20 |
$1,778.20 |
$1,778.20 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$825.35 |
$825.35 |
$825.35 |
$535.60
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$3,218.95 |
$3,218.95 |
$3,218.95 |
$4,468.55
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$6,113.20 |
$6,113.20 |
$6,113.20 |
$4,421.00
|
|
Tympanic membrane repair
|
$1,624.35 |
$1,624.35 |
$1,624.35 |
$2,638.87
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$259.25 |
$259.25 |
$259.25 |
$911.43
|
|
Ua w/micro/comp poc
|
$61.20 |
$61.20 |
$61.20 |
$23.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$44,508.14 |
$44,508.14 |
$44,508.14 |
$20,945.01
|
|
Ultrasound abdomen aorta screening study aaa
|
$199.75 |
$199.75 |
$199.75 |
$394.20
|
|
Ultrasound breast complete
|
$181.90 |
$181.90 |
$181.90 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$181.90 |
$181.90 |
$181.90 |
$449.35
|
|
Ultrasound chest
|
$467.50 |
$467.50 |
$467.50 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$300.90 |
$300.90 |
$300.90 |
$338.00
|
|
Ultrasound exam follow-up
|
$354.45 |
$354.45 |
$354.45 |
$226.38
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$515.10 |
$515.10 |
$515.10 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$759.90 |
$759.90 |
$759.90 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$661.30 |
$661.30 |
$661.30 |
$720.15
|
|
Ultrasound guide intraoperative
|
$542.30 |
$542.30 |
$542.30 |
$632.85
|
|
Ultrasound hips infant dynamic
|
$317.90 |
$317.90 |
$317.90 |
$403.88
|
|
Ultrasound joint complete left
|
$680.85 |
$680.85 |
$680.85 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$607.75 |
$607.75 |
$607.75 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$731.00 |
$731.00 |
$731.00 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$642.60 |
$642.60 |
$642.60 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,256.30 |
$1,256.30 |
$1,256.30 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$309.40 |
$309.40 |
$309.40 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$447.10 |
$447.10 |
$447.10 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$687.65 |
$687.65 |
$687.65 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$1,140.70 |
$1,140.70 |
$1,140.70 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$628.15 |
$628.15 |
$628.15 |
$486.50
|
|
Ultrasound scrotum and contents
|
$523.60 |
$523.60 |
$523.60 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$1,382.95 |
$1,382.95 |
$1,382.95 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$1,256.30 |
$1,256.30 |
$1,256.30 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$729.30 |
$729.30 |
$729.30 |
$558.35
|
|
Unlisted orl service/px
|
$108.80 |
$108.80 |
$108.80 |
$132.60
|
|
Unlisted px casting/strpg
|
$279.65 |
$279.65 |
$279.65 |
$219.70
|
|
Unlisted px hands/fingers
|
$200.60 |
$200.60 |
$200.60 |
$354.20
|
|
Unlisted px small intestine
|
$2,556.80 |
$2,556.80 |
$2,556.80 |
$2,102.10
|
|
Unlisted px tongue flr mouth
|
$175.95 |
$175.95 |
$175.95 |
$282.50
|
|
Unlisted transfusion med px
|
$236.30 |
$236.30 |
$236.30 |
$147.50
|
|
Unlisted ultrasound procedure
|
$272.00 |
$272.00 |
$272.00 |
$321.20
|
|
Unlisted urinalysis px
|
$353.60 |
$353.60 |
$353.60 |
$25.72
|
|
Unsched dialysis esrd pt hos
|
$845.75 |
$845.75 |
$845.75 |
$1,268.17
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,323.10 |
$4,323.10 |
$4,323.10 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$4,089.35 |
$4,089.35 |
$4,089.35 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,894.70 |
$3,894.70 |
$3,894.70 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$2,068.05 |
$2,068.05 |
$2,068.05 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$2,108.00 |
$2,108.00 |
$2,108.00 |
$1,768.00
|
|
Upper ext fx orthosis rad/ul
|
$33.79 |
$33.79 |
$33.79 |
$619.49
|
|
Uppr gi scope w/submuc inj
|
$997.90 |
$997.90 |
$997.90 |
$1,872.00
|
|
Urea nitrogen
|
$78.20 |
$78.20 |
$78.20 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$98.60 |
$98.60 |
$98.60 |
$51.75
|
|
Urethrcystgrphy rtrgrde s&i
|
$510.00 |
$510.00 |
$510.00 |
$579.73
|
|
Urethrocystography void s&i
|
$425.85 |
$425.85 |
$425.85 |
$622.35
|
|
Uric acid blood
|
$113.90 |
$113.90 |
$113.90 |
$48.75
|
|
Uric acid urine
|
$128.35 |
$128.35 |
$128.35 |
$44.33
|
|
Urinalysis microscopic only
|
$64.60 |
$64.60 |
$64.60 |
$26.35
|
|
Urinalysis (with microscopy)
|
$86.70 |
$86.70 |
$86.70 |
$55.00
|
|
Urinalysis (without microscopy)
|
$54.40 |
$54.40 |
$54.40 |
$35.75
|
|
Urine Culture Test
|
$181.05 |
$181.05 |
$181.05 |
$81.50
|
|
Urine pregnancy test
|
$113.05 |
$113.05 |
$113.05 |
$67.20
|
|
Urography, antegrade
|
$1,161.95 |
$1,161.95 |
$1,161.95 |
$622.35
|
