|
Treat knuckle dislocation
|
$1,437.27 |
$1,437.27 |
$1,437.27 |
$3,705.22
|
|
Treat lower leg dislocation
|
$394.79 |
$394.79 |
$394.79 |
$571.27
|
|
Treatment incomplete abortion completed surgically any trimester
|
$2,974.25 |
$2,974.25 |
$2,974.25 |
$3,916.04
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$103.79 |
$103.79 |
$103.79 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$87.97 |
$87.97 |
$87.97 |
$140.04
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$29.88 |
$29.88 |
$29.88 |
$197.60
|
|
Treatment missed abortion completed surgically 1st trimester
|
$2,005.86 |
$2,005.86 |
$2,005.86 |
$3,820.53
|
|
Treatment of ankle fracture 27786
|
$283.05 |
$283.05 |
$283.05 |
$575.25
|
|
Treatment of fibula fracture 27780
|
$376.11 |
$376.11 |
$376.11 |
$558.75
|
|
Treatment of heel fracture 28400
|
$258.82 |
$258.82 |
$258.82 |
$469.60
|
|
Treatment of miscarriage
|
$2,388.81 |
$2,388.81 |
$2,388.81 |
$3,744.41
|
|
Treatment of thigh fracture
|
$394.98 |
$394.98 |
$394.98 |
$633.60
|
|
Treatment of thigh fracture
|
$227.74 |
$227.74 |
$227.74 |
$659.00
|
|
Treatment of thigh fracture
|
$2,628.48 |
$2,628.48 |
$2,628.48 |
$2,093.25
|
|
Treatment of toe fracture 28510
|
$376.11 |
$376.11 |
$376.11 |
$362.00
|
|
Treat thigh fracture
|
$394.98 |
$394.98 |
$394.98 |
$661.00
|
|
Treat thigh fracture
|
$2,289.56 |
$2,289.56 |
$2,289.56 |
$1,858.61
|
|
Treat thigh fracture
|
$376.11 |
$376.11 |
$376.11 |
$716.95
|
|
Treat thigh fx growth plate
|
$394.98 |
$394.98 |
$394.98 |
$421.50
|
|
Treat ulnar fracture
|
$2,628.48 |
$2,628.48 |
$2,628.48 |
$1,771.43
|
|
Treat vaginal bleeding
|
$142.27 |
$142.27 |
$142.27 |
$342.25
|
|
Treat wrist dislocation
|
$266.40 |
$266.40 |
$266.40 |
$760.00
|
|
Treponema pallidum antibody
|
$59.02 |
$59.02 |
$59.02 |
$74.40
|
|
Treprostinil injection
|
$4,774.98 |
$4,774.98 |
$4,774.98 |
$4,774.98
|
|
Trg gene rearrangement anal
|
$214.32 |
$214.32 |
$214.32 |
$474.50
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$27.12 |
$27.12 |
$27.12 |
$28.90
|
|
Triamcinolone a inj prs-free
|
$10.38 |
$10.38 |
$10.38 |
$696.00
|
|
Trichinella antibody
|
$41.07 |
$41.07 |
$41.07 |
$56.55
|
|
Trichomonas assay w/optic
|
$23.31 |
$23.31 |
$23.31 |
$68.90
|
|
Triglycerides
|
$19.80 |
$19.80 |
$19.80 |
$48.75
|
|
Trimethobenzamide hcl inj
|
$77.98 |
$77.98 |
$77.98 |
$105.89
|
|
Trim nail(s)
|
$132.92 |
$132.92 |
$132.92 |
$91.77
|
|
Trim nondyst nails
|
$120.25 |
$120.25 |
$120.25 |
$124.22
|
|
Trmt of fracture (femoral shaft) 27500
|
$754.80 |
$754.80 |
$754.80 |
$857.58
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$1,456.14 |
$1,456.14 |
$1,456.14 |
$2,986.34
|
|
Troponin quantitative
|
$119.05 |
$119.05 |
$119.05 |
$112.80
|
|
Tte w or without fol w/con,stres
|
$458.06 |
$458.06 |
$458.06 |
$1,108.76
|
|
Tte w or without fol w/cont, f/u
|
$941.56 |
$941.56 |
$941.56 |
$875.24
|
|
Tube trach disp innr can 5 xlt
|
$114.81 |
$114.81 |
$114.81 |
$416.99
|
|
Tube trach fen sz 6 uncuffed
|
$1,120.18 |
$1,120.18 |
$1,120.18 |
$132.40
|
|
Tx closed distal humerus fx
|
$135.14 |
$135.14 |
$135.14 |
$786.00
|
|
Tx closed hip disl traumatic without anes
|
$294.34 |
$294.34 |
$294.34 |
$650.45
|
|
Tx closed tib shaft fx without manip
|
$256.97 |
$256.97 |
$256.97 |
$643.75
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$1,679.52 |
$1,679.52 |
$1,679.52 |
$4,239.75
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$2,930.49 |
$2,930.49 |
$2,930.49 |
$4,468.55
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$3,238.80 |
$3,238.80 |
$3,238.80 |
$3,591.33
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$1,391.29 |
$1,391.29 |
$1,391.29 |
$3,743.15
|
|
Tx tarsal bone fx without manip 28450
|
$376.11 |
$376.11 |
$376.11 |
$414.00
|
|
Ultrasound breast complete
|
$695.23 |
$695.23 |
$695.23 |
$519.20
|
|
Ultrasound breast unilateral limited (both sides)
|
$695.23 |
$695.23 |
$695.23 |
$427.00
|
|
Ultrasound chest
|
$263.90 |
$263.90 |
$263.90 |
$430.10
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$340.03 |
$340.03 |
$340.03 |
$340.03
|
|
Ultrasound dx ophth b-scan
|
$256.50 |
$256.50 |
$256.50 |
$335.68
|
|
Ultrasound elastography ea l target les
|
$114.33 |
$114.33 |
$114.33 |
$136.11
|
|
Ultrasound elastography parenchyma
|
$114.33 |
$114.33 |
$114.33 |
$275.98
|
|
Ultrasound encephalogram
|
$226.26 |
$226.26 |
$226.26 |
$463.50
|
|
Ultrasound exam k transpl w/doppler
|
$398.49 |
$398.49 |
$398.49 |
$494.00
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$294.06 |
$294.06 |
$294.06 |
$428.68
|
|
Ultrasound guidance for vascular access
|
$155.49 |
$155.49 |
$155.49 |
$300.00
|
|
Ultrasound guided needle placement supervision & interpretation
|
$289.99 |
$289.99 |
$289.99 |
$629.64
|
|
Ultrasound guide intraoperative
|
$193.42 |
$193.42 |
$193.42 |
$628.80
|
|
Ultrasound hips infant dynamic
|
$175.75 |
$175.75 |
$175.75 |
$395.20
|
|
Ultrasound infant hips ltd without stress
|
$93.80 |
$93.80 |
$93.80 |
$311.25
|
|
Ultrasound joint complete left
|
$205.63 |
$205.63 |
$205.63 |
$534.00
|
|
Ultrasound joint/nonvascular extremity limited left
|
$154.75 |
$154.75 |
$154.75 |
$426.60
|
|
Ultrasound ob >=14wks ea addl gest
|
$192.22 |
$192.22 |
$192.22 |
$431.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$125.34 |
$125.34 |
$125.34 |
$304.80
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$479.89 |
$479.89 |
$479.89 |
$680.71
|
|
Ultrasound pregnant uterus follow up per fetus
|
$446.22 |
$446.22 |
$446.22 |
$393.32
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$350.02 |
$350.02 |
$350.02 |
$434.20
|
|
Ultrasound pregnant uterus transvaginal
|
$272.04 |
$272.04 |
$272.04 |
$477.10
|
|
Ultrasound prostate/transrectal
|
$295.45 |
$295.45 |
$295.45 |
$515.63
|
|
Ultrasound retroperitoneal limited
|
$277.13 |
$277.13 |
$277.13 |
$469.58
|
|
Ultrasound scrotum and contents
|
$299.15 |
$299.15 |
$299.15 |
$558.03
|
|
Ultrasound spinal canal and contents
|
$175.01 |
$175.01 |
$175.01 |
$415.00
|
|
Ultrasound transabd ea addl gest
|
$137.55 |
$137.55 |
$137.55 |
$424.80
|
|
Ultrasound transvaginal non obstetric
|
$378.88 |
$378.88 |
$378.88 |
$523.20
|
|
Umbilical artery cath newborn 36660
|
$293.78 |
$293.78 |
$293.78 |
$204.75
|
|
Unlisted procedure microbiology
|
$234.58 |
$234.58 |
$234.58 |
$384.15
|
|
Unlisted px male genital sys
|
$5,358.53 |
$5,358.53 |
$5,358.53 |
$1,925.04
|
|
Unlisted px pelvis/hip joint
|
$2,108.82 |
$2,108.82 |
$2,108.82 |
$8,660.60
|
|
Unlisted transfusion med px
|
$512.27 |
$512.27 |
$512.27 |
$113.36
|
|
Unlisted ultrasound procedure
|
$74.09 |
$74.09 |
$74.09 |
$335.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,390.28 |
$1,390.28 |
$1,390.28 |
$2,590.50
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$972.27 |
$972.27 |
$972.27 |
$2,001.87
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$976.62 |
$976.62 |
$976.62 |
$1,794.00
|
|
Urea nitrogen
|
$20.44 |
$20.44 |
$20.44 |
$38.25
|
|
Urea nitrogen 24 hour urine
|
$32.47 |
$32.47 |
$32.47 |
$42.90
|
|
Urea nitrogen clearance
|
$47.73 |
$47.73 |
$47.73 |
$33.57
|
|
Urethrcystgrphy rtrgrde s&i
|
$257.15 |
$257.15 |
$257.15 |
$554.28
|
|
Urethrocystography void s&i
|
$269.36 |
$269.36 |
$269.36 |
$586.50
|
|
Uric acid blood
|
$25.25 |
$25.25 |
$25.25 |
$44.00
|
|
Uric acid urine
|
$23.59 |
$23.59 |
$23.59 |
$43.20
|
|
Urinalysis microscopic only
|
$22.57 |
$22.57 |
$22.57 |
$25.72
|
|
Urinalysis (with microscopy)
|
$33.02 |
$33.02 |
$33.02 |
$37.39
|
|
Urinalysis (without microscopy)
|
$21.46 |
$21.46 |
$21.46 |
$33.00
|
|
Urine Culture Test
|
$47.82 |
$47.82 |
$47.82 |
$63.84
|
|
Urine pregnancy test
|
$27.01 |
$27.01 |
$27.01 |
$57.00
|
|
Urography, antegrade
|
$297.67 |
$297.67 |
$297.67 |
$593.37
|
|
Urography inf drip &/or bolus
|
$292.12 |
$292.12 |
$292.12 |
$599.82
|
