|
Treat knee fracture 27530
|
$428.00 |
$428.00 |
$428.00 |
$550.73
|
|
Treat knee fracture(s)
|
$577.60 |
$577.60 |
$577.60 |
$643.26
|
|
Treat lower leg dislocation
|
$1,067.20 |
$1,067.20 |
$1,067.20 |
$532.60
|
|
Treatment incomplete abortion completed surgically any trimester
|
$3,915.20 |
$3,915.20 |
$3,915.20 |
$3,928.20
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$387.20 |
$387.20 |
$387.20 |
$227.70
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$182.40 |
$182.40 |
$182.40 |
$147.48
|
|
Treatment of ankle fracture 27786
|
$416.00 |
$416.00 |
$416.00 |
$523.20
|
|
Treatment of fibula fracture 27780
|
$358.40 |
$358.40 |
$358.40 |
$501.20
|
|
Treatment of heel fracture 28400
|
$376.80 |
$376.80 |
$376.80 |
$473.00
|
|
Treatment of thigh fracture
|
$522.40 |
$522.40 |
$522.40 |
$477.75
|
|
Treatment of thigh fracture
|
$451.20 |
$451.20 |
$451.20 |
$549.00
|
|
Treatment of toe fracture 28510
|
$319.20 |
$319.20 |
$319.20 |
$371.40
|
|
Treat midfoot fracture each
|
$2,656.00 |
$2,656.00 |
$2,656.00 |
$1,884.74
|
|
Treat sternum fracture
|
$458.40 |
$458.40 |
$458.40 |
$423.00
|
|
Treat thigh fracture
|
$425.60 |
$425.60 |
$425.60 |
$661.00
|
|
Treat thigh fracture
|
$1,465.60 |
$1,465.60 |
$1,465.60 |
$1,893.86
|
|
Treat thigh fracture
|
$368.80 |
$368.80 |
$368.80 |
$618.80
|
|
Treat thigh fx growth plate
|
$240.00 |
$240.00 |
$240.00 |
$478.40
|
|
Treat ulnar fracture
|
$1,329.60 |
$1,329.60 |
$1,329.60 |
$1,677.20
|
|
Treat vaginal bleeding
|
$411.20 |
$411.20 |
$411.20 |
$379.60
|
|
Treat wrist bone fracture
|
$1,207.20 |
$1,207.20 |
$1,207.20 |
$1,703.20
|
|
Treat wrist dislocation
|
$484.80 |
$484.80 |
$484.80 |
$656.25
|
|
Trmt of fracture (femoral shaft) 27500
|
$432.00 |
$432.00 |
$432.00 |
$754.80
|
|
Trnscath plc stent crv crtd without prtct
|
$6,353.60 |
$6,353.60 |
$6,353.60 |
$7,795.71
|
|
Trnscath plc stent crv crtd w/prtct
|
$6,353.60 |
$6,353.60 |
$6,353.60 |
$9,767.25
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$10,031.20 |
$10,031.20 |
$10,031.20 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$14,371.20 |
$14,371.20 |
$14,371.20 |
$8,776.32
|
|
Trnscath plc vas stent w/s&i ini vein
|
$18,909.60 |
$18,909.60 |
$18,909.60 |
$14,461.50
|
|
Trnscath retrv pq vasc fb w/guide
|
$3,631.20 |
$3,631.20 |
$3,631.20 |
$4,766.40
|
|
Tte w or without contr, cont ecg
|
$2,799.20 |
$2,799.20 |
$2,799.20 |
$2,067.00
|
|
Tte w or without fol w/con,stres
|
$2,323.20 |
$2,323.20 |
$2,323.20 |
$1,632.80
|
|
Tx closed distal humerus fx
|
$3,175.20 |
$3,175.20 |
$3,175.20 |
$594.88
|
|
Tx closed hip disl traumatic without anes
|
$568.00 |
$568.00 |
$568.00 |
$586.40
|
|
Tx closed tib shaft fx without manip
|
$416.00 |
$416.00 |
$416.00 |
$535.60
|
|
Tx tarsal bone fx without manip 28450
|
$328.80 |
$328.80 |
$328.80 |
$419.04
|
|
Ultrasound breast complete
|
$569.60 |
$569.60 |
$569.60 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$574.40 |
$574.40 |
$574.40 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$464.00 |
$464.00 |
$464.00 |
$338.00
|
|
Ultrasound encephalogram
|
$651.20 |
$651.20 |
$651.20 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$848.00 |
$848.00 |
$848.00 |
$578.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$741.60 |
$741.60 |
$741.60 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$909.60 |
$909.60 |
$909.60 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$530.40 |
$530.40 |
$530.40 |
$388.08
|
|
Ultrasound guide intraoperative
|
$1,017.60 |
$1,017.60 |
$1,017.60 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$524.00 |
$524.00 |
$524.00 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$564.00 |
$564.00 |
$564.00 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$643.20 |
$643.20 |
$643.20 |
$311.25
|
|
Ultrasound joint complete left
|
$783.20 |
$783.20 |
$783.20 |
$557.99
|
|
Ultrasound ob >=14wks ea addl gest
|
$613.60 |
$613.60 |
$613.60 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$508.80 |
$508.80 |
$508.80 |
$334.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,072.00 |
$1,072.00 |
$1,072.00 |
$698.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$537.60 |
$537.60 |
$537.60 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$692.00 |
$692.00 |
$692.00 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$620.00 |
$620.00 |
$620.00 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$811.20 |
$811.20 |
$811.20 |
$419.50
|
|
Unlisted mr procedure
|
$2,656.80 |
$2,656.80 |
$2,656.80 |
$1,165.00
|
|
Unlisted procedure liver
|
$899.20 |
$899.20 |
$899.20 |
$2,287.20
|
|
Unlisted procedure spine
|
$4,299.20 |
$4,299.20 |
$4,299.20 |
$4,659.85
|
|
Unlisted px abdomen muscskel
|
$2,718.40 |
$2,718.40 |
$2,718.40 |
$1,956.50
|
|
Unlisted px foot/toes
|
$2,611.20 |
$2,611.20 |
$2,611.20 |
$1,239.20
|
|
Unlisted px forearm/wrist
|
$3,995.20 |
$3,995.20 |
$3,995.20 |
$859.50
|
|
Unlisted px hands/fingers
|
$2,385.60 |
$2,385.60 |
$2,385.60 |
$354.20
|
|
Unlisted px leg/ankle
|
$3,088.80 |
$3,088.80 |
$3,088.80 |
$882.30
|
|
Unlisted px neck/thorax
|
$2,014.40 |
$2,014.40 |
$2,014.40 |
$571.20
|
|
Unlisted px pelvis/hip joint
|
$5,661.60 |
$5,661.60 |
$5,661.60 |
$3,251.90
|
|
Unlisted px small intestine
|
$3,385.60 |
$3,385.60 |
$3,385.60 |
$2,118.35
|
|
Unlisted ultrasound procedure
|
$464.00 |
$464.00 |
$464.00 |
$332.16
|
|
Upgrade pm system
|
$3,384.00 |
$3,384.00 |
$3,384.00 |
$12,077.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$268.00 |
$268.00 |
$268.00 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$2,464.80 |
$2,464.80 |
$2,464.80 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$2,178.40 |
$2,178.40 |
$2,178.40 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,230.40 |
$4,230.40 |
$4,230.40 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,348.00 |
$3,348.00 |
$3,348.00 |
$2,369.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,253.60 |
$3,253.60 |
$3,253.60 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$400.80 |
$400.80 |
$400.80 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$493.60 |
$493.60 |
$493.60 |
$381.60
|
|
Upper GI Barium X-ray (barium and gas)
|
$950.40 |
$950.40 |
$950.40 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$955.20 |
$955.20 |
$955.20 |
$607.20
|
|
Ureteral reflux study
|
$1,182.40 |
$1,182.40 |
$1,182.40 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$848.80 |
$848.80 |
$848.80 |
$584.00
|
|
Urethrocystography void s&i
|
$908.00 |
$908.00 |
$908.00 |
$631.40
|
|
Urography, antegrade
|
$931.20 |
$931.20 |
$931.20 |
$622.35
|
|
Vaccine Administration (one shot)
|
$82.40 |
$82.40 |
$82.40 |
$67.70
|
|
Vaccine influenza inactivated adjuvant im
|
$49.24 |
$49.24 |
$49.24 |
$110.25
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$26.71 |
$26.71 |
$26.71 |
$82.71
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$108.72 |
$108.72 |
$108.72 |
$252.87
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$373.11 |
$373.11 |
$373.11 |
$397.11
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$359.92 |
$359.92 |
$359.92 |
$414.46
|
|
Vein x-ray kidney
|
$3,856.00 |
$3,856.00 |
$3,856.00 |
$2,870.00
|
|
Vein x-ray liver w/hemodynam
|
$3,492.00 |
$3,492.00 |
$3,492.00 |
$3,610.20
|
|
Vein x-ray liver w/hemodynam
|
$4,777.60 |
$4,777.60 |
$4,777.60 |
$3,662.50
|
|
Vein x-ray liver without hemodyn
|
$3,120.80 |
$3,120.80 |
$3,120.80 |
$2,452.80
|
|
Vein x-ray skull
|
$2,863.20 |
$2,863.20 |
$2,863.20 |
$2,236.50
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$234.40 |
$234.40 |
$234.40 |
$188.83
|
|
Venogram ext bil s&i
|
$2,602.40 |
$2,602.40 |
$2,602.40 |
$1,829.42
|
|
Venogram extremity supervision & interpretation unilateral
|
$2,213.60 |
$2,213.60 |
$2,213.60 |
$1,382.58
|
|
Venous mech thrombectomy
|
$6,353.60 |
$6,353.60 |
$6,353.60 |
$8,184.00
|
|
Venous m-thrombectomy add-on
|
$5,993.60 |
$5,993.60 |
$5,993.60 |
$5,094.75
|
|
Venous sampling s&i
|
$4,510.40 |
$4,510.40 |
$4,510.40 |
$4,200.00
|
|
Ven thrombosis images bilat
|
$1,549.60 |
$1,549.60 |
$1,549.60 |
$796.50
|
