|
Treat hip socket fracture
|
$7,571.40 |
$7,571.40 |
$7,571.40 |
$1,344.00
|
|
Treat hip wall fracture
|
$11,046.00 |
$11,046.00 |
$11,046.00 |
$7,413.38
|
|
Treat humerus fracture
|
$2,425.80 |
$2,425.80 |
$2,425.80 |
$1,790.00
|
|
Treat humerus fracture
|
$4,522.80 |
$4,522.80 |
$4,522.80 |
$1,790.00
|
|
Treatment incomplete abortion completed surgically any trimester
|
$5,077.80 |
$5,077.80 |
$5,077.80 |
$3,928.20
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$110.40 |
$110.40 |
$110.40 |
$228.00
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$110.40 |
$110.40 |
$110.40 |
$147.48
|
|
Treatment missed abortion completed surgically 1st trimester
|
$8,746.80 |
$8,746.80 |
$8,746.80 |
$4,230.80
|
|
Treatment of thigh fracture
|
$5,383.80 |
$5,383.80 |
$5,383.80 |
$1,749.06
|
|
Treatment of thigh fracture
|
$2,275.20 |
$2,275.20 |
$2,275.20 |
$1,790.00
|
|
Treatment radiation delivery level 2
|
$1,172.40 |
$1,172.40 |
$1,172.40 |
$830.70
|
|
Treat metacarpal fracture
|
$6,045.00 |
$6,045.00 |
$6,045.00 |
$5,741.00
|
|
Treat ulnar fracture
|
$3,384.00 |
$3,384.00 |
$3,384.00 |
$1,678.55
|
|
Treat vaginal bleeding
|
$445.20 |
$445.20 |
$445.20 |
$379.60
|
|
Treat wrist bone fracture
|
$2,310.00 |
$2,310.00 |
$2,310.00 |
$1,679.04
|
|
Treat wrist dislocation
|
$3,378.00 |
$3,378.00 |
$3,378.00 |
$656.25
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$258.60 |
$258.60 |
$258.60 |
$73,346.25
|
|
Treponema pallidum antibody
|
$121.80 |
$121.80 |
$121.80 |
$72.05
|
|
Trg gene rearrangement anal
|
$950.40 |
$950.40 |
$950.40 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$10.20 |
$10.20 |
$10.20 |
$43.00
|
|
Trichinella antibody
|
$169.20 |
$169.20 |
$169.20 |
$70.65
|
|
Triglycerides
|
$106.20 |
$106.20 |
$106.20 |
$58.05
|
|
Trimethobenzamide hcl inj
|
$99.20 |
$99.20 |
$99.20 |
$117.49
|
|
Trim nail(s)
|
$117.60 |
$117.60 |
$117.60 |
$78.40
|
|
Trim nondyst nails
|
$190.20 |
$190.20 |
$190.20 |
$114.48
|
|
Trnscath plc stent crv crtd without prtct
|
$13,863.00 |
$13,863.00 |
$13,863.00 |
$7,795.71
|
|
Trnscath plc stent crv crtd w/prtct
|
$14,392.80 |
$14,392.80 |
$14,392.80 |
$9,767.25
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$10,359.60 |
$10,359.60 |
$10,359.60 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$9,866.40 |
$9,866.40 |
$9,866.40 |
$8,790.54
|
|
Trnscath plc vas stent w/s&i ini vein
|
$10,473.00 |
$10,473.00 |
$10,473.00 |
$14,558.70
|
|
Trnscath retrv pq vasc fb w/guide
|
$5,317.20 |
$5,317.20 |
$5,317.20 |
$4,766.40
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$2,252.40 |
$2,252.40 |
$2,252.40 |
$5,139.20
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$5,954.40 |
$5,954.40 |
$5,954.40 |
$4,350.00
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$814.20 |
$814.20 |
$814.20 |
$4,379.34
|
|
Trnscath tx thromblytc vein ini day
|
$3,718.80 |
$3,718.80 |
$3,718.80 |
$3,866.70
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$5,152.80 |
$5,152.80 |
$5,152.80 |
$2,527.20
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$4,493.40 |
$4,493.40 |
$4,493.40 |
$2,406.77
|
|
Troponin quantitative
|
$57.00 |
$57.00 |
$57.00 |
$127.20
|
|
Tte w or without contr, cont ecg
|
$1,977.00 |
$1,977.00 |
$1,977.00 |
$2,075.90
|
|
Tte w or without fol w/con,stres
|
$1,360.80 |
$1,360.80 |
$1,360.80 |
$1,632.80
|
|
Tte w or without fol w/cont, com
|
$3,003.60 |
$3,003.60 |
$3,003.60 |
$1,254.50
|
|
Tte w or without fol w/cont, f/u
|
$2,227.20 |
$2,227.20 |
$2,227.20 |
$1,178.00
|
|
Tube trach disp innr can 5 xlt
|
$289.20 |
$289.20 |
$289.20 |
$445.99
|
|
Tube trach disp innr can 6 xlt
|
$77.40 |
$77.40 |
$77.40 |
$16.80
|
|
Tube trach fen sz 6 uncuffed
|
$96.00 |
$96.00 |
$96.00 |
$155.98
|
|
Tx atrial fib pulm vein isol
|
$11,199.60 |
$11,199.60 |
$11,199.60 |
$29,030.54
|
|
Tx closed distal humerus fx
|
$121.20 |
$121.20 |
$121.20 |
$594.88
|
|
Tx closed hip disl traumatic without anes
|
$2,275.20 |
$2,275.20 |
$2,275.20 |
$586.80
|
|
Tx l/r atrial fib addl
|
$5,599.20 |
$5,599.20 |
$5,599.20 |
$6,986.85
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$6,497.40 |
$6,497.40 |
$6,497.40 |
$4,529.60
|
|
Ua w/micro/comp poc
|
$4.80 |
$4.80 |
$4.80 |
$23.00
|
|
Ugt1a1 gene analy common variants
|
$1,138.80 |
$1,138.80 |
$1,138.80 |
$438.75
|
|
Ultrasound breast complete
|
$460.80 |
$460.80 |
$460.80 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$253.80 |
$253.80 |
$253.80 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$187.80 |
$187.80 |
$187.80 |
$338.00
|
|
Ultrasound exam k transpl w/doppler
|
$255.00 |
$255.00 |
$255.00 |
$575.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$348.60 |
$348.60 |
$348.60 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$234.00 |
$234.00 |
$234.00 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$153.60 |
$153.60 |
$153.60 |
$388.08
|
|
Ultrasound guide intraoperative
|
$315.60 |
$315.60 |
$315.60 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$1,134.00 |
$1,134.00 |
$1,134.00 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$652.20 |
$652.20 |
$652.20 |
$403.88
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$387.60 |
$387.60 |
$387.60 |
$335.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,995.60 |
$1,995.60 |
$1,995.60 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$351.60 |
$351.60 |
$351.60 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$723.60 |
$723.60 |
$723.60 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$777.00 |
$777.00 |
$777.00 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$633.60 |
$633.60 |
$633.60 |
$421.00
|
|
Unlisted CT procedure
|
$624.00 |
$624.00 |
$624.00 |
$732.70
|
|
Unlisted hematology&coagj px
|
$56.40 |
$56.40 |
$56.40 |
$39.52
|
|
Unlisted mr procedure
|
$869.40 |
$869.40 |
$869.40 |
$1,163.00
|
|
Unlisted procedure microbiology
|
$124.80 |
$124.80 |
$124.80 |
$530.00
|
|
Unlisted procedure rectum
|
$121.80 |
$121.80 |
$121.80 |
$1,223.20
|
|
Unlisted px ant segment eye
|
$120.00 |
$120.00 |
$120.00 |
$2,698.92
|
|
Unlisted px hands/fingers
|
$5,153.40 |
$5,153.40 |
$5,153.40 |
$354.20
|
|
Unlisted px leg/ankle
|
$115.80 |
$115.80 |
$115.80 |
$882.30
|
|
Unlisted px male genital sys
|
$120.00 |
$120.00 |
$120.00 |
$387.84
|
|
Unlisted px posterior segmnt
|
$3,997.80 |
$3,997.80 |
$3,997.80 |
$3,173.34
|
|
Unlisted px small intestine
|
$2,283.60 |
$2,283.60 |
$2,283.60 |
$2,118.35
|
|
Unsched dialysis esrd pt hos
|
$1,635.00 |
$1,635.00 |
$1,635.00 |
$1,296.00
|
|
Upgrade pm system
|
$14,761.80 |
$14,761.80 |
$14,761.80 |
$12,077.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$151.20 |
$151.20 |
$151.20 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$1,405.80 |
$1,405.80 |
$1,405.80 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,209.00 |
$1,209.00 |
$1,209.00 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,604.00 |
$2,604.00 |
$2,604.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,810.80 |
$1,810.80 |
$1,810.80 |
$2,392.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,699.20 |
$1,699.20 |
$1,699.20 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$130.20 |
$130.20 |
$130.20 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$151.20 |
$151.20 |
$151.20 |
$381.60
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,675.80 |
$1,675.80 |
$1,675.80 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,675.80 |
$1,675.80 |
$1,675.80 |
$1,768.00
|
|
Upper GI Barium X-ray (barium and gas)
|
$372.60 |
$372.60 |
$372.60 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$372.60 |
$372.60 |
$372.60 |
$607.20
|
|
Uppr gi scope w/submuc inj
|
$1,675.80 |
$1,675.80 |
$1,675.80 |
$1,872.00
|
|
Urea nitrogen
|
$50.40 |
$50.40 |
$50.40 |
$42.01
|
|
Urea nitrogen 24 hour urine
|
$42.00 |
$42.00 |
$42.00 |
$51.84
|
|
Urea nitrogen clearance
|
$87.00 |
$87.00 |
$87.00 |
$34.02
|
|
Urethrcystgrphy rtrgrde s&i
|
$536.40 |
$536.40 |
$536.40 |
$584.00
|
|
Urethrocystography void s&i
|
$272.40 |
$272.40 |
$272.40 |
$634.50
|
|
Uric acid blood
|
$73.80 |
$73.80 |
$73.80 |
$49.32
|
