|
Treat metacarpal fracture
|
$917.40 |
$917.40 |
$917.40 |
$4,289.60
|
|
Treat metacarpal fracture
|
$845.40 |
$845.40 |
$845.40 |
$5,741.00
|
|
Treat metatarsal fracture
|
$574.20 |
$574.20 |
$574.20 |
$3,839.54
|
|
Treat metatarsal fracture
|
$955.80 |
$955.80 |
$955.80 |
$8,241.00
|
|
Treat midfoot fracture each
|
$425.40 |
$425.40 |
$425.40 |
$1,884.74
|
|
Treat midfoot fracture each
|
$1,100.40 |
$1,100.40 |
$1,100.40 |
$6,445.00
|
|
Treat pelvic fracture(s)
|
$960.60 |
$960.60 |
$960.60 |
$1,506.40
|
|
Treat penis lesion graft
|
$1,390.80 |
$1,390.80 |
$1,390.80 |
$5,986.78
|
|
Treat radius fracture
|
$969.60 |
$969.60 |
$969.60 |
$7,907.11
|
|
Treat radius fracture
|
$1,296.00 |
$1,296.00 |
$1,296.00 |
$9,791.00
|
|
Treat slipped epiphysis
|
$1,713.60 |
$1,713.60 |
$1,713.60 |
$3,359.20
|
|
Treat slipped epiphysis
|
$2,014.80 |
$2,014.80 |
$2,014.80 |
$3,342.87
|
|
Treat sternum fracture
|
$1,266.00 |
$1,266.00 |
$1,266.00 |
$423.00
|
|
Treat thigh fracture
|
$1,519.20 |
$1,519.20 |
$1,519.20 |
$661.00
|
|
Treat thigh fracture
|
$1,744.80 |
$1,744.80 |
$1,744.80 |
$6,510.40
|
|
Treat thigh fracture
|
$1,621.80 |
$1,621.80 |
$1,621.80 |
$3,933.60
|
|
Treat thigh fracture
|
$1,496.40 |
$1,496.40 |
$1,496.40 |
$2,008.18
|
|
Treat thumb fracture
|
$821.40 |
$821.40 |
$821.40 |
$2,508.80
|
|
Treat toe dislocation
|
$349.80 |
$349.80 |
$349.80 |
$3,839.54
|
|
Treat toe dislocation
|
$1,266.00 |
$1,266.00 |
$1,266.00 |
$756.00
|
|
Treat ulnar fracture
|
$1,157.40 |
$1,157.40 |
$1,157.40 |
$6,653.00
|
|
Treat vaginal bleeding
|
$1,266.00 |
$1,266.00 |
$1,266.00 |
$379.60
|
|
Treat wrist dislocation
|
$1,367.40 |
$1,367.40 |
$1,367.40 |
$656.25
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$101,032.80 |
$101,032.80 |
$101,032.80 |
$73,346.25
|
|
Treponema pallidum antibody
|
$97.80 |
$97.80 |
$97.80 |
$72.05
|
|
Trg gene rearrangement anal
|
$908.40 |
$908.40 |
$908.40 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$13.80 |
$13.80 |
$13.80 |
$43.00
|
|
Triamcinolone diacetate inj
|
$13.80 |
$13.80 |
$13.80 |
$3.60
|
|
Triamcinolone hexacetonl inj
|
$12.60 |
$12.60 |
$12.60 |
$21.36
|
|
Trichomonas assay w/optic
|
$54.00 |
$54.00 |
$54.00 |
$57.40
|
|
Triglycerides
|
$42.60 |
$42.60 |
$42.60 |
$58.05
|
|
Trim nondyst nails
|
$66.60 |
$66.60 |
$66.60 |
$114.48
|
|
Trmt of fracture (femoral shaft) 27500
|
$1,656.00 |
$1,656.00 |
$1,656.00 |
$754.80
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$1,420.20 |
$1,420.20 |
$1,420.20 |
$4,727.52
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$361.80 |
$361.80 |
$361.80 |
$2,377.62
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$1,197.00 |
$1,197.00 |
$1,197.00 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$1,684.80 |
$1,684.80 |
$1,684.80 |
$3,091.20
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$1,421.40 |
$1,421.40 |
$1,421.40 |
$2,527.20
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$1,053.00 |
$1,053.00 |
$1,053.00 |
$2,486.75
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$675.00 |
$675.00 |
$675.00 |
$2,406.77
|
|
Troponin quantitative
|
$82.80 |
$82.80 |
$82.80 |
$127.20
|
|
Tubal Ligation (Laparoscopic)
|
$678.00 |
$678.00 |
$678.00 |
$4,323.20
|
|
Tx closed hip disl traumatic without anes
|
$1,266.00 |
$1,266.00 |
$1,266.00 |
$586.80
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$2,162.40 |
$2,162.40 |
$2,162.40 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$1,266.00 |
$1,266.00 |
$1,266.00 |
$535.60
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$904.80 |
$904.80 |
$904.80 |
$4,499.12
|
|
Tx open nsl fx uncomp
|
$2,391.60 |
$2,391.60 |
$2,391.60 |
$3,837.72
|
|
Tx open nsl sptl fx
|
$1,135.20 |
$1,135.20 |
$1,135.20 |
$4,308.40
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$918.60 |
$918.60 |
$918.60 |
$4,529.60
|
|
Tx tarsal bone fx without manip 28450
|
$682.80 |
$682.80 |
$682.80 |
$419.73
|
|
Tympanic membrane repair
|
$549.60 |
$549.60 |
$549.60 |
$2,638.87
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$270.60 |
$270.60 |
$270.60 |
$911.43
|
|
Ua w/micro/comp poc
|
$24.00 |
$24.00 |
$24.00 |
$23.00
|
|
Ultrasound bone density measure
|
$111.60 |
$111.60 |
$111.60 |
$143.75
|
|
Ultrasound breast complete
|
$274.20 |
$274.20 |
$274.20 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$209.40 |
$209.40 |
$209.40 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$93.60 |
$93.60 |
$93.60 |
$338.00
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$198.00 |
$198.00 |
$198.00 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$432.60 |
$432.60 |
$432.60 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$239.40 |
$239.40 |
$239.40 |
$388.08
|
|
Ultrasound guide intraoperative
|
$481.80 |
$481.80 |
$481.80 |
$632.85
|
|
Ultrasound hips infant dynamic
|
$311.40 |
$311.40 |
$311.40 |
$403.88
|
|
Ultrasound joint complete left
|
$333.60 |
$333.60 |
$333.60 |
$557.99
|
|
Ultrasound ob >=14wks ea addl gest
|
$702.60 |
$702.60 |
$702.60 |
$409.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$532.20 |
$532.20 |
$532.20 |
$335.00
|
|
Ultrasound pregnant uterus follow up per fetus
|
$468.60 |
$468.60 |
$468.60 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$301.80 |
$301.80 |
$301.80 |
$557.40
|
|
Unlisted px casting/strpg
|
$72.60 |
$72.60 |
$72.60 |
$222.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$128.40 |
$128.40 |
$128.40 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$897.60 |
$897.60 |
$897.60 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$751.80 |
$751.80 |
$751.80 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,926.00 |
$1,926.00 |
$1,926.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,250.40 |
$1,250.40 |
$1,250.40 |
$2,392.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,042.20 |
$1,042.20 |
$1,042.20 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$165.60 |
$165.60 |
$165.60 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$170.40 |
$170.40 |
$170.40 |
$381.60
|
|
Upper Endoscopy (EGD, diagnostic)
|
$878.40 |
$878.40 |
$878.40 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$637.20 |
$637.20 |
$637.20 |
$1,768.00
|
|
Upper GI Barium X-ray (barium and gas)
|
$406.20 |
$406.20 |
$406.20 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$321.00 |
$321.00 |
$321.00 |
$607.20
|
|
Uppr gi scope w/submuc inj
|
$384.60 |
$384.60 |
$384.60 |
$1,872.00
|
|
Urea nitrogen
|
$30.60 |
$30.60 |
$30.60 |
$42.01
|
|
Urethrcystgrphy rtrgrde s&i
|
$257.40 |
$257.40 |
$257.40 |
$584.00
|
|
Urethrocystography void s&i
|
$250.20 |
$250.20 |
$250.20 |
$634.50
|
|
Uric acid blood
|
$35.40 |
$35.40 |
$35.40 |
$49.32
|
|
Uric acid urine
|
$24.00 |
$24.00 |
$24.00 |
$44.52
|
|
Urinalysis qual/semiquant excpt ia
|
$22.80 |
$22.80 |
$22.80 |
$25.72
|
|
Urinalysis (with microscopy)
|
$34.20 |
$34.20 |
$34.20 |
$55.20
|
|
Urinalysis (without microscopy)
|
$19.20 |
$19.20 |
$19.20 |
$35.91
|
|
Urine Culture Test
|
$57.60 |
$57.60 |
$57.60 |
$82.32
|
|
Urine pregnancy test
|
$37.80 |
$37.80 |
$37.80 |
$68.21
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$5,277.60 |
$5,277.60 |
$5,277.60 |
$5,205.00
|
|
Vaccine Administration (one shot)
|
$103.20 |
$103.20 |
$103.20 |
$67.74
|
|
Vaccine hepatitis a (hepa) adult im
|
$262.80 |
$262.80 |
$262.80 |
$166.62
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$112.20 |
$112.20 |
$112.20 |
$155.16
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$105.60 |
$105.60 |
$105.60 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$247.20 |
$247.20 |
$247.20 |
$576.48
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$25.80 |
$25.80 |
$25.80 |
$149.21
|
|
Vaccine influenza nos 0.5ml dose im
|
$22.80 |
$22.80 |
$22.80 |
$24.20
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$29.40 |
$29.40 |
$29.40 |
$48.59
|
