|
Treat vaginal bleeding
|
$329.60 |
$329.60 |
$329.60 |
$379.60
|
|
Treat wrist dislocation
|
$484.00 |
$484.00 |
$484.00 |
$656.25
|
|
Treprostinil injection
|
$155,071.80 |
$155,071.80 |
$155,071.80 |
$19,071.84
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$32.33 |
$32.33 |
$32.33 |
$43.00
|
|
Trilaciclib 300 mg intravenous solution
|
$2,239.11 |
$2,239.11 |
$2,239.11 |
$4,043.12
|
|
Trim nail(s)
|
$415.20 |
$415.20 |
$415.20 |
$78.40
|
|
Trim nondyst nails
|
$109.60 |
$109.60 |
$109.60 |
$114.48
|
|
Triptorelin pamoate
|
$5,449.60 |
$5,449.60 |
$5,449.60 |
$4,619.39
|
|
Trnscath plc stent crv crtd without prtct
|
$15,398.40 |
$15,398.40 |
$15,398.40 |
$7,795.71
|
|
Trnscath plc stent crv crtd w/prtct
|
$13,612.80 |
$13,612.80 |
$13,612.80 |
$9,767.25
|
|
Trnscath plc stnt ante carotid art
|
$8,948.80 |
$8,948.80 |
$8,948.80 |
$6,046.25
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$11,256.00 |
$11,256.00 |
$11,256.00 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$13,533.60 |
$13,533.60 |
$13,533.60 |
$8,790.54
|
|
Trnscath plc vas stent w/s&i ini vein
|
$20,748.80 |
$20,748.80 |
$20,748.80 |
$14,558.70
|
|
Trnscath retrv pq vasc fb w/guide
|
$6,597.60 |
$6,597.60 |
$6,597.60 |
$4,766.40
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$8,816.00 |
$8,816.00 |
$8,816.00 |
$5,139.20
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$8,474.40 |
$8,474.40 |
$8,474.40 |
$4,350.00
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$8,474.40 |
$8,474.40 |
$8,474.40 |
$4,379.34
|
|
Trnscath tx thromblytc vein ini day
|
$8,124.00 |
$8,124.00 |
$8,124.00 |
$3,866.70
|
|
Truss single with standard pad
|
$78.34 |
$78.34 |
$78.34 |
$128.80
|
|
Tte w or without contr, cont ecg
|
$1,771.20 |
$1,771.20 |
$1,771.20 |
$2,075.90
|
|
Tte w or without fol w/con,stres
|
$2,520.00 |
$2,520.00 |
$2,520.00 |
$1,632.80
|
|
Tte w or without fol w/cont, com
|
$2,068.00 |
$2,068.00 |
$2,068.00 |
$1,254.50
|
|
Tte w or without fol w/cont, f/u
|
$1,785.60 |
$1,785.60 |
$1,785.60 |
$1,178.00
|
|
Tx atrial fib pulm vein isol
|
$36,755.20 |
$36,755.20 |
$36,755.20 |
$29,030.54
|
|
Tx closed distal humerus fx
|
$406.40 |
$406.40 |
$406.40 |
$594.88
|
|
Tx closed hip disl traumatic without anes
|
$394.40 |
$394.40 |
$394.40 |
$586.80
|
|
Tx closed tib shaft fx without manip
|
$388.00 |
$388.00 |
$388.00 |
$535.60
|
|
Tx l/r atrial fib addl
|
$16,795.20 |
$16,795.20 |
$16,795.20 |
$6,986.85
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$4,538.40 |
$4,538.40 |
$4,538.40 |
$4,499.12
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$5,886.40 |
$5,886.40 |
$5,886.40 |
$4,529.60
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$898.40 |
$898.40 |
$898.40 |
$911.43
|
|
Ultrasound breast complete
|
$431.20 |
$431.20 |
$431.20 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$358.40 |
$358.40 |
$358.40 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$240.00 |
$240.00 |
$240.00 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$377.60 |
$377.60 |
$377.60 |
$296.80
|
|
Ultrasound encephalogram
|
$488.80 |
$488.80 |
$488.80 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$610.40 |
$610.40 |
$610.40 |
$575.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$401.60 |
$401.60 |
$401.60 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$799.20 |
$799.20 |
$799.20 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$180.80 |
$180.80 |
$180.80 |
$388.08
|
|
Ultrasound guide tissue ablation
|
$388.80 |
$388.80 |
$388.80 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$433.60 |
$433.60 |
$433.60 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$392.00 |
$392.00 |
$392.00 |
$311.25
|
|
Ultrasound joint complete left
|
$390.40 |
$390.40 |
$390.40 |
$557.99
|
|
Ultrasound ob >=14wks ea addl gest
|
$431.20 |
$431.20 |
$431.20 |
$409.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$269.60 |
$269.60 |
$269.60 |
$335.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$653.60 |
$653.60 |
$653.60 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$468.80 |
$468.80 |
$468.80 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$588.00 |
$588.00 |
$588.00 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$429.60 |
$429.60 |
$429.60 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$410.40 |
$410.40 |
$410.40 |
$421.00
|
|
Umbilical artery cath newborn 36660
|
$151.20 |
$151.20 |
$151.20 |
$223.80
|
|
Unlisted chemotherapy px
|
$288.00 |
$288.00 |
$288.00 |
$143.75
|
|
Unlisted dialysis procedure
|
$1,620.00 |
$1,620.00 |
$1,620.00 |
$1,144.00
|
|
Unlisted dx gi procedure
|
$1,206.40 |
$1,206.40 |
$1,206.40 |
$649.22
|
|
Unlisted fluoroscopic px
|
$226.40 |
$226.40 |
$226.40 |
$305.76
|
|
Unlisted laps px bladder
|
$1,131.20 |
$1,131.20 |
$1,131.20 |
$5,082.74
|
|
Unlisted mr procedure
|
$179.20 |
$179.20 |
$179.20 |
$1,163.00
|
|
Unlisted neurological dx px
|
$1,679.20 |
$1,679.20 |
$1,679.20 |
$242.50
|
|
Unlisted procedure larynx
|
$472.80 |
$472.80 |
$472.80 |
$924.00
|
|
Unlisted procedure liver
|
$1,984.80 |
$1,984.80 |
$1,984.80 |
$2,287.20
|
|
Unlisted procedure rectum
|
$1,466.40 |
$1,466.40 |
$1,466.40 |
$1,223.20
|
|
Unlisted px abdomen muscskel
|
$453.60 |
$453.60 |
$453.60 |
$1,956.50
|
|
Unlisted px foot/toes
|
$406.40 |
$406.40 |
$406.40 |
$1,239.20
|
|
Unlisted px forearm/wrist
|
$412.80 |
$412.80 |
$412.80 |
$859.50
|
|
Unlisted px hands/fingers
|
$406.40 |
$406.40 |
$406.40 |
$354.20
|
|
Unlisted px leg/ankle
|
$406.40 |
$406.40 |
$406.40 |
$882.30
|
|
Unlisted px male genital sys
|
$3,316.80 |
$3,316.80 |
$3,316.80 |
$387.84
|
|
Unlisted px neck/thorax
|
$2,188.80 |
$2,188.80 |
$2,188.80 |
$571.20
|
|
Unlisted px pelvis/hip joint
|
$5,344.00 |
$5,344.00 |
$5,344.00 |
$3,251.90
|
|
Unlisted px small intestine
|
$4,720.00 |
$4,720.00 |
$4,720.00 |
$2,118.35
|
|
Unlisted px tongue flr mouth
|
$408.00 |
$408.00 |
$408.00 |
$282.50
|
|
Unlisted reprod med lab proc
|
$56.80 |
$56.80 |
$56.80 |
$70.00
|
|
Unlisted resp px dx nuc med
|
$1,273.60 |
$1,273.60 |
$1,273.60 |
$670.60
|
|
Unlisted special svc px/rprt
|
$253.60 |
$253.60 |
$253.60 |
$90.00
|
|
Unlisted ultrasound procedure
|
$624.80 |
$624.80 |
$624.80 |
$335.00
|
|
Unsched dialysis esrd pt hos
|
$1,620.00 |
$1,620.00 |
$1,620.00 |
$1,296.00
|
|
Upgrade pm system
|
$20,794.40 |
$20,794.40 |
$20,794.40 |
$12,077.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$160.80 |
$160.80 |
$160.80 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$1,683.20 |
$1,683.20 |
$1,683.20 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,360.00 |
$1,360.00 |
$1,360.00 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,253.60 |
$3,253.60 |
$3,253.60 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,558.40 |
$2,558.40 |
$2,558.40 |
$2,392.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,352.80 |
$2,352.80 |
$2,352.80 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$237.60 |
$237.60 |
$237.60 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$284.00 |
$284.00 |
$284.00 |
$381.60
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,912.80 |
$1,912.80 |
$1,912.80 |
$1,768.00
|
|
Upper ext fx orthosis rad/ul
|
$308.00 |
$308.00 |
$308.00 |
$619.49
|
|
Upper GI Barium X-ray (barium and gas)
|
$492.00 |
$492.00 |
$492.00 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$421.60 |
$421.60 |
$421.60 |
$607.20
|
|
Ureteral embolization/occl
|
$3,464.00 |
$3,464.00 |
$3,464.00 |
$2,079.31
|
|
Ureteral reflux study
|
$884.00 |
$884.00 |
$884.00 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$797.60 |
$797.60 |
$797.60 |
$584.00
|
|
Urethrocystography void s&i
|
$464.00 |
$464.00 |
$464.00 |
$634.50
|
|
Urinary bldr retent nuc study
|
$303.20 |
$303.20 |
$303.20 |
$350.66
|
|
Urography, antegrade
|
$1,440.80 |
$1,440.80 |
$1,440.80 |
$622.35
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$2,600.02 |
$2,600.02 |
$2,600.02 |
$5,205.00
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$18,856.28 |
$18,856.28 |
$18,856.28 |
$51,633.07
|
|
Vaccine Administration (one shot)
|
$93.60 |
$93.60 |
$93.60 |
$67.74
|
