|
Treat slipped epiphysis
|
$1,715.52 |
$1,715.52 |
$1,715.52 |
$3,342.87
|
|
Treat thigh fracture
|
$764.16 |
$764.16 |
$764.16 |
$661.00
|
|
Treat thigh fracture
|
$1,395.84 |
$1,395.84 |
$1,395.84 |
$6,510.40
|
|
Treat thigh fracture
|
$1,831.20 |
$1,831.20 |
$1,831.20 |
$4,083.00
|
|
Treat thigh fracture
|
$1,880.16 |
$1,880.16 |
$1,880.16 |
$4,726.80
|
|
Treat thigh fracture
|
$612.96 |
$612.96 |
$612.96 |
$618.80
|
|
Treat thigh fracture
|
$1,882.56 |
$1,882.56 |
$1,882.56 |
$3,580.50
|
|
Treat thumb fracture
|
$754.56 |
$754.56 |
$754.56 |
$2,508.80
|
|
Treat thumb fracture
|
$974.88 |
$974.88 |
$974.88 |
$3,786.00
|
|
Treat toe dislocation
|
$546.24 |
$546.24 |
$546.24 |
$3,839.54
|
|
Treat toe fracture
|
$874.08 |
$874.08 |
$874.08 |
$3,839.54
|
|
Treat ulnar fracture
|
$3,031.20 |
$3,031.20 |
$3,031.20 |
$1,662.00
|
|
Treat ulnar fracture
|
$1,016.16 |
$1,016.16 |
$1,016.16 |
$5,926.25
|
|
Treat wrist bone fracture
|
$740.16 |
$740.16 |
$740.16 |
$1,548.40
|
|
Treat wrist dislocation
|
$725.28 |
$725.28 |
$725.28 |
$656.25
|
|
Treponema pallidum antibody
|
$41.21 |
$41.21 |
$41.21 |
$70.40
|
|
Trg gene rearrangement anal
|
$207.08 |
$207.08 |
$207.08 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$68.67 |
$68.67 |
$68.67 |
$43.21
|
|
Triglycerides
|
$38.16 |
$38.16 |
$38.16 |
$58.05
|
|
Trim nail(s)
|
$36.96 |
$36.96 |
$36.96 |
$79.00
|
|
Trim nondyst nails
|
$114.48 |
$114.48 |
$114.48 |
$113.40
|
|
Triptorelin pamoate
|
$1,843.64 |
$1,843.64 |
$1,843.64 |
$4,619.39
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$1,658.40 |
$1,658.40 |
$1,658.40 |
$4,713.66
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$325.92 |
$325.92 |
$325.92 |
$2,357.04
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$3,189.12 |
$3,189.12 |
$3,189.12 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$3,985.92 |
$3,985.92 |
$3,985.92 |
$3,078.00
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$978.72 |
$978.72 |
$978.72 |
$2,406.77
|
|
Troponin quantitative
|
$65.64 |
$65.64 |
$65.64 |
$127.20
|
|
Trurl dstrj prst8 tiss rf wv
|
$2,529.12 |
$2,529.12 |
$2,529.12 |
$4,228.00
|
|
Tubal Ligation (Laparoscopic)
|
$572.64 |
$572.64 |
$572.64 |
$4,323.20
|
|
Tvh >250 gms 58290
|
$1,762.56 |
$1,762.56 |
$1,762.56 |
$6,872.92
|
|
Tx atrial fib pulm vein isol
|
$1,409.28 |
$1,409.28 |
$1,409.28 |
$29,030.54
|
|
Tx closed distal humerus fx
|
$439.20 |
$439.20 |
$439.20 |
$594.88
|
|
Tx closed hip disl traumatic without anes
|
$439.20 |
$439.20 |
$439.20 |
$581.07
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$2,050.08 |
$2,050.08 |
$2,050.08 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$553.92 |
$553.92 |
$553.92 |
$535.60
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$1,149.60 |
$1,149.60 |
$1,149.60 |
$4,499.12
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$5,679.36 |
$5,679.36 |
$5,679.36 |
$4,468.55
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$927.36 |
$927.36 |
$927.36 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$334.08 |
$334.08 |
$334.08 |
$416.16
|
|
Tympanic membrane repair
|
$589.44 |
$589.44 |
$589.44 |
$2,638.87
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$311.04 |
$311.04 |
$311.04 |
$911.43
|
|
Ua w/micro/comp poc
|
$33.07 |
$33.07 |
$33.07 |
$23.00
|
|
Ugt1a1 gene analy common variants
|
$459.84 |
$459.84 |
$459.84 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$214.71 |
$214.71 |
$214.71 |
$394.20
|
|
Ultrasound breast complete
|
$277.92 |
$277.92 |
$277.92 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$214.71 |
$214.71 |
$214.71 |
$449.35
|
|
Ultrasound chest
|
$214.71 |
$214.71 |
$214.71 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$68.64 |
$68.64 |
$68.64 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$46.08 |
$46.08 |
$46.08 |
$296.80
|
|
Ultrasound encephalogram
|
$118.55 |
$118.55 |
$118.55 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$214.71 |
$214.71 |
$214.71 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$167.90 |
$167.90 |
$167.90 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$1,075.20 |
$1,075.20 |
$1,075.20 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$471.36 |
$471.36 |
$471.36 |
$720.15
|
|
Ultrasound guide intraoperative
|
$507.84 |
$507.84 |
$507.84 |
$632.85
|
|
Ultrasound hips infant dynamic
|
$90.57 |
$90.57 |
$90.57 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$68.69 |
$68.69 |
$68.69 |
$311.25
|
|
Ultrasound joint complete left
|
$594.72 |
$594.72 |
$594.72 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$281.28 |
$281.28 |
$281.28 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$234.56 |
$234.56 |
$234.56 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$151.11 |
$151.11 |
$151.11 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$134.88 |
$134.88 |
$134.88 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$168.00 |
$168.00 |
$168.00 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$206.06 |
$206.06 |
$206.06 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$218.78 |
$218.78 |
$218.78 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$307.68 |
$307.68 |
$307.68 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$195.38 |
$195.38 |
$195.38 |
$486.50
|
|
Ultrasound scrotum and contents
|
$408.96 |
$408.96 |
$408.96 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$94.08 |
$94.08 |
$94.08 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$165.12 |
$165.12 |
$165.12 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$242.40 |
$242.40 |
$242.40 |
$558.35
|
|
Unlisted chemotherapy px
|
$78.86 |
$78.86 |
$78.86 |
$150.00
|
|
Unlisted hematology&coagj px
|
$6.54 |
$6.54 |
$6.54 |
$39.52
|
|
Unlisted laparoscopic liver biopy 47379
|
$1,792.32 |
$1,792.32 |
$1,792.32 |
$5,419.00
|
|
Unlisted laparoscopic procedure 49659
|
$939.36 |
$939.36 |
$939.36 |
$6,838.32
|
|
Unlisted laparoscopic reduction intestine 44238
|
$2,189.28 |
$2,189.28 |
$2,189.28 |
$5,419.00
|
|
Unlisted laps px bladder
|
$977.28 |
$977.28 |
$977.28 |
$5,082.74
|
|
Unlisted misc path test
|
$36.12 |
$36.12 |
$36.12 |
$89.40
|
|
Unlisted px arthroscopy
|
$1,815.36 |
$1,815.36 |
$1,815.36 |
$2,765.60
|
|
Unlisted px foot/toes
|
$1,814.88 |
$1,814.88 |
$1,814.88 |
$1,225.50
|
|
Unlisted px leg/ankle
|
$1,478.88 |
$1,478.88 |
$1,478.88 |
$811.00
|
|
Unlisted px male genital sys
|
$1,222.56 |
$1,222.56 |
$1,222.56 |
$343.55
|
|
Unlisted px palate uvula
|
$382.56 |
$382.56 |
$382.56 |
$274.80
|
|
Unlisted transfusion med px
|
$23.91 |
$23.91 |
$23.91 |
$147.50
|
|
Unlisted ultrasound procedure
|
$139.92 |
$139.92 |
$139.92 |
$321.20
|
|
Unlisted urinalysis px
|
$10.68 |
$10.68 |
$10.68 |
$25.72
|
|
Upgrade pm system
|
$719.04 |
$719.04 |
$719.04 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,934.40 |
$1,934.40 |
$1,934.40 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,440.48 |
$1,440.48 |
$1,440.48 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,359.36 |
$1,359.36 |
$1,359.36 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,556.64 |
$1,556.64 |
$1,556.64 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,279.68 |
$1,279.68 |
$1,279.68 |
$1,768.00
|
|
Uppr gi scope w/submuc inj
|
$612.00 |
$612.00 |
$612.00 |
$1,872.00
|
|
Urea nitrogen
|
$20.35 |
$20.35 |
$20.35 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$10.93 |
$10.93 |
$10.93 |
$51.75
|
|
Ureteral reflux study
|
$403.68 |
$403.68 |
$403.68 |
$952.50
|
|
Ureter endoscopy & biopsy
|
$650.40 |
$650.40 |
$650.40 |
$5,696.72
|
|
Ureter endoscopy & treatment
|
$592.80 |
$592.80 |
$592.80 |
$5,631.74
|
|
Ureteroureterostomy 50760
|
$1,716.00 |
$1,716.00 |
$1,716.00 |
$2,999.40
|
