|
Transfusion blood/blood component(s)
|
$1,040.96 |
$1,040.96 |
$1,040.96 |
$988.24
|
|
Trastuzumab 150 mg intravenous solution
|
$328.31 |
$328.31 |
$328.31 |
$3,401.26
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$113.57 |
$113.57 |
$113.57 |
$7,620.16
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$87.00 |
$87.00 |
$87.00 |
$3,600.00
|
|
Treat ankle dislocation
|
$1,883.05 |
$1,883.05 |
$1,883.05 |
$2,207.20
|
|
Treat clavicle dislocation 23545
|
$160.19 |
$160.19 |
$160.19 |
$734.00
|
|
Treat elbow dislocation
|
$1,881.56 |
$1,881.56 |
$1,881.56 |
$2,326.40
|
|
Treat fracture of radius
|
$861.58 |
$861.58 |
$861.58 |
$2,030.33
|
|
Treat fracture of ulna
|
$134.40 |
$134.40 |
$134.40 |
$766.72
|
|
Treat lower leg dislocation
|
$137.38 |
$137.38 |
$137.38 |
$532.60
|
|
Treatment fx radial distal open w/internal fixation left (restricted method ii cah)
|
$3,898.51 |
$3,898.51 |
$3,898.51 |
$8,370.75
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$158.21 |
$158.21 |
$158.21 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$52.08 |
$52.08 |
$52.08 |
$149.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$154.24 |
$154.24 |
$154.24 |
$210.00
|
|
Treatment of ankle fracture 27786
|
$134.40 |
$134.40 |
$134.40 |
$580.00
|
|
Treatment of thigh fracture
|
$951.70 |
$951.70 |
$951.70 |
$2,055.00
|
|
Treatment radiation delivery level 2
|
$406.67 |
$406.67 |
$406.67 |
$735.00
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$195.35 |
$195.35 |
$195.35 |
$120,541.18
|
|
Treponema pallidum antibody
|
$77.87 |
$77.87 |
$77.87 |
$72.80
|
|
Treprostinil injection
|
$123.00 |
$123.00 |
$123.00 |
$528.60
|
|
Trg gene rearrangement anal
|
$202.84 |
$202.84 |
$202.84 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$24.31 |
$24.31 |
$24.31 |
$48.22
|
|
Trichinella antibody
|
$81.34 |
$81.34 |
$81.34 |
$70.65
|
|
Trichomonas assay w/optic
|
$43.65 |
$43.65 |
$43.65 |
$66.00
|
|
Triglycerides
|
$52.57 |
$52.57 |
$52.57 |
$54.60
|
|
Trimethobenzamide hcl inj
|
$40.18 |
$40.18 |
$40.18 |
$154.09
|
|
Trnscath plc stnt ante carotid art
|
$8,252.28 |
$8,252.28 |
$8,252.28 |
$9,114.56
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$3,981.33 |
$3,981.33 |
$3,981.33 |
$8,244.55
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$7,168.68 |
$7,168.68 |
$7,168.68 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$11,609.73 |
$11,609.73 |
$11,609.73 |
$15,408.00
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$2,028.86 |
$2,028.86 |
$2,028.86 |
$6,156.00
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$1,217.51 |
$1,217.51 |
$1,217.51 |
$4,505.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$628.84 |
$628.84 |
$628.84 |
$4,793.13
|
|
Trnscath tx thromblytc vein ini day
|
$1,765.02 |
$1,765.02 |
$1,765.02 |
$4,329.36
|
|
Troponin quantitative
|
$122.50 |
$122.50 |
$122.50 |
$123.75
|
|
Tte w or without contr, cont ecg
|
$1,301.82 |
$1,301.82 |
$1,301.82 |
$1,608.73
|
|
Tx atrial fib pulm vein isol
|
$19,298.64 |
$19,298.64 |
$19,298.64 |
$32,426.20
|
|
Tx closed hip disl traumatic without anes
|
$153.25 |
$153.25 |
$153.25 |
$657.28
|
|
Tx closed tib shaft fx without manip
|
$131.43 |
$131.43 |
$131.43 |
$635.46
|
|
Tx l/r atrial fib addl
|
$669.01 |
$669.01 |
$669.01 |
$7,717.80
|
|
Ua w/micro/comp poc
|
$52.08 |
$52.08 |
$52.08 |
$24.45
|
|
Ugt1a1 gene analy common variants
|
$421.05 |
$421.05 |
$421.05 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$395.76 |
$395.76 |
$395.76 |
$403.26
|
|
Ultrasound chest
|
$406.67 |
$406.67 |
$406.67 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$92.74 |
$92.74 |
$92.74 |
$340.14
|
|
Ultrasound dx ophth b-scan
|
$74.39 |
$74.39 |
$74.39 |
$330.40
|
|
Ultrasound encephalogram
|
$88.28 |
$88.28 |
$88.28 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$435.43 |
$435.43 |
$435.43 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$545.53 |
$545.53 |
$545.53 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$308.97 |
$308.97 |
$308.97 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$525.20 |
$525.20 |
$525.20 |
$701.35
|
|
Ultrasound guide intraoperative
|
$540.57 |
$540.57 |
$540.57 |
$632.90
|
|
Ultrasound hips infant dynamic
|
$46.13 |
$46.13 |
$46.13 |
$403.00
|
|
Ultrasound infant hips ltd without stress
|
$46.13 |
$46.13 |
$46.13 |
$321.35
|
|
Ultrasound ob >=14wks ea addl gest
|
$387.82 |
$387.82 |
$387.82 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$256.90 |
$256.90 |
$256.90 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$380.38 |
$380.38 |
$380.38 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$497.92 |
$497.92 |
$497.92 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$368.98 |
$368.98 |
$368.98 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$420.55 |
$420.55 |
$420.55 |
$485.48
|
|
Ultrasound retroperitoneal limited
|
$249.95 |
$249.95 |
$249.95 |
$498.00
|
|
Ultrasound scrotum and contents
|
$455.76 |
$455.76 |
$455.76 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$173.58 |
$173.58 |
$173.58 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$433.45 |
$433.45 |
$433.45 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$470.15 |
$470.15 |
$470.15 |
$567.44
|
|
Unlisted orl service/px
|
$34.72 |
$34.72 |
$34.72 |
$121.50
|
|
Unlisted procedure microbiology
|
$3,454.66 |
$3,454.66 |
$3,454.66 |
$487.50
|
|
Unlisted px salivry glnd/dux
|
$143.82 |
$143.82 |
$143.82 |
$486.72
|
|
Unlisted ultrasound procedure
|
$53.07 |
$53.07 |
$53.07 |
$321.20
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,599.96 |
$3,599.96 |
$3,599.96 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,070.81 |
$3,070.81 |
$3,070.81 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,117.63 |
$2,117.63 |
$2,117.63 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$510.81 |
$510.81 |
$510.81 |
$1,588.59
|
|
Upper Endoscopy (EGD, with biopsy)
|
$510.81 |
$510.81 |
$510.81 |
$1,656.60
|
|
Urea nitrogen
|
$59.52 |
$59.52 |
$59.52 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$61.00 |
$61.00 |
$61.00 |
$50.00
|
|
Urea nitrogen clearance
|
$75.39 |
$75.39 |
$75.39 |
$33.57
|
|
Ureteral reflux study
|
$509.33 |
$509.33 |
$509.33 |
$961.20
|
|
Urethrcystgrphy rtrgrde s&i
|
$229.12 |
$229.12 |
$229.12 |
$574.40
|
|
Urethrocystography void s&i
|
$402.70 |
$402.70 |
$402.70 |
$634.50
|
|
Uric acid blood
|
$53.57 |
$53.57 |
$53.57 |
$46.64
|
|
Uric acid urine
|
$62.99 |
$62.99 |
$62.99 |
$46.75
|
|
Urinalysis microscopic only
|
$28.27 |
$28.27 |
$28.27 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$68.44 |
$68.44 |
$68.44 |
$25.72
|
|
Urinalysis (with microscopy)
|
$56.05 |
$56.05 |
$56.05 |
$48.14
|
|
Urinalysis (without microscopy)
|
$33.73 |
$33.73 |
$33.73 |
$38.99
|
|
Urine Culture Test
|
$84.81 |
$84.81 |
$84.81 |
$84.81
|
|
Urine pregnancy test
|
$56.54 |
$56.54 |
$56.54 |
$66.40
|
|
Urography, antegrade
|
$519.24 |
$519.24 |
$519.24 |
$593.37
|
|
Urography inf drip &/or bolus
|
$1,079.65 |
$1,079.65 |
$1,079.65 |
$641.69
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$2,522.31 |
$2,522.31 |
$2,522.31 |
$6,892.54
|
|
Vaccine dtap < 7 years im
|
$43.27 |
$43.27 |
$43.27 |
$87.80
|
|
Vaccine dtap-hep b-ipv im
|
$67.95 |
$67.95 |
$67.95 |
$193.83
|
|
Vaccine dtap-ipv 4-6 years im
|
$49.10 |
$49.10 |
$49.10 |
$126.84
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$19.84 |
$19.84 |
$19.84 |
$45.33
|
|
Vaccine hepatitis a (hepa) adult im
|
$66.63 |
$66.63 |
$66.63 |
$178.07
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$118.53 |
$118.53 |
$118.53 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$33.73 |
$33.73 |
$33.73 |
$84.38
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$81.83 |
$81.83 |
$81.83 |
$173.98
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$48.61 |
$48.61 |
$48.61 |
$306.24
|
