|
Treat thigh fracture
|
$1,700.00 |
$1,700.00 |
$1,700.00 |
$1,893.86
|
|
Treat thigh fracture
|
$396.00 |
$396.00 |
$396.00 |
$618.80
|
|
Treat thigh fracture
|
$1,735.20 |
$1,735.20 |
$1,735.20 |
$2,008.18
|
|
Treat thigh fx growth plate
|
$244.00 |
$244.00 |
$244.00 |
$475.68
|
|
Treat ulnar fracture
|
$1,861.60 |
$1,861.60 |
$1,861.60 |
$1,678.55
|
|
Treat wrist bone fracture
|
$1,767.20 |
$1,767.20 |
$1,767.20 |
$1,679.04
|
|
Treat wrist dislocation
|
$656.00 |
$656.00 |
$656.00 |
$656.25
|
|
Treprostinil injection
|
$38,319.60 |
$38,319.60 |
$38,319.60 |
$19,071.84
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$318.09 |
$318.09 |
$318.09 |
$43.00
|
|
Triamcinolone a inj prs-free
|
$2,749.74 |
$2,749.74 |
$2,749.74 |
$223.56
|
|
Trim nail(s)
|
$78.40 |
$78.40 |
$78.40 |
$78.40
|
|
Trim nondyst nails
|
$113.60 |
$113.60 |
$113.60 |
$114.48
|
|
Trmt of fracture (femoral shaft) 27500
|
$396.00 |
$396.00 |
$396.00 |
$754.80
|
|
Trnscath plc stent crv crtd without prtct
|
$13,072.00 |
$13,072.00 |
$13,072.00 |
$7,795.71
|
|
Trnscath plc stent crv crtd w/prtct
|
$13,093.60 |
$13,093.60 |
$13,093.60 |
$9,767.25
|
|
Trnscath plc stnt ante carotid art
|
$10,829.60 |
$10,829.60 |
$10,829.60 |
$6,046.25
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$13,661.60 |
$13,661.60 |
$13,661.60 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$14,264.00 |
$14,264.00 |
$14,264.00 |
$8,790.54
|
|
Trnscath plc vas stent w/s&i ini vein
|
$19,110.40 |
$19,110.40 |
$19,110.40 |
$14,558.70
|
|
Trnscath retrv pq vasc fb w/guide
|
$6,986.40 |
$6,986.40 |
$6,986.40 |
$4,766.40
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$6,701.60 |
$6,701.60 |
$6,701.60 |
$5,139.20
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$6,483.20 |
$6,483.20 |
$6,483.20 |
$4,350.00
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$8,341.60 |
$8,341.60 |
$8,341.60 |
$4,379.34
|
|
Trnscath tx thromblytc vein ini day
|
$5,180.00 |
$5,180.00 |
$5,180.00 |
$3,866.70
|
|
Truss single with standard pad
|
$55.20 |
$55.20 |
$55.20 |
$128.80
|
|
Tte w or without contr, cont ecg
|
$2,196.00 |
$2,196.00 |
$2,196.00 |
$2,075.90
|
|
Tte w or without fol w/con,stres
|
$2,382.40 |
$2,382.40 |
$2,382.40 |
$1,632.80
|
|
Tte w or without fol w/cont, com
|
$2,401.60 |
$2,401.60 |
$2,401.60 |
$1,254.50
|
|
Tte w or without fol w/cont, f/u
|
$1,640.00 |
$1,640.00 |
$1,640.00 |
$1,178.00
|
|
Tx atrial fib pulm vein isol
|
$42,380.00 |
$42,380.00 |
$42,380.00 |
$29,030.54
|
|
Tx closed distal humerus fx
|
$3,812.00 |
$3,812.00 |
$3,812.00 |
$594.88
|
|
Tx closed hip disl traumatic without anes
|
$424.80 |
$424.80 |
$424.80 |
$586.80
|
|
Tx closed tib shaft fx without manip
|
$584.00 |
$584.00 |
$584.00 |
$535.60
|
|
Tx l/r atrial fib addl
|
$13,837.60 |
$13,837.60 |
$13,837.60 |
$6,986.85
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$4,404.00 |
$4,404.00 |
$4,404.00 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$481.60 |
$481.60 |
$481.60 |
$419.73
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$27,521.17 |
$27,521.17 |
$27,521.17 |
$21,992.26
|
|
Ultrasound breast complete
|
$522.40 |
$522.40 |
$522.40 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$455.20 |
$455.20 |
$455.20 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$511.20 |
$511.20 |
$511.20 |
$338.00
|
|
Ultrasound encephalogram
|
$756.00 |
$756.00 |
$756.00 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$910.40 |
$910.40 |
$910.40 |
$575.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$768.00 |
$768.00 |
$768.00 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$970.40 |
$970.40 |
$970.40 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$817.60 |
$817.60 |
$817.60 |
$388.08
|
|
Ultrasound guide intraoperative
|
$1,184.80 |
$1,184.80 |
$1,184.80 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$498.40 |
$498.40 |
$498.40 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$785.60 |
$785.60 |
$785.60 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$752.00 |
$752.00 |
$752.00 |
$311.25
|
|
Ultrasound joint complete left
|
$648.00 |
$648.00 |
$648.00 |
$557.99
|
|
Ultrasound ob >=14wks ea addl gest
|
$1,336.00 |
$1,336.00 |
$1,336.00 |
$409.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$497.60 |
$497.60 |
$497.60 |
$335.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$973.60 |
$973.60 |
$973.60 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$503.20 |
$503.20 |
$503.20 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$785.60 |
$785.60 |
$785.60 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$672.00 |
$672.00 |
$672.00 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$552.80 |
$552.80 |
$552.80 |
$421.00
|
|
Unlisted CT procedure
|
$150.40 |
$150.40 |
$150.40 |
$732.70
|
|
Unlisted dialysis procedure
|
$1,620.00 |
$1,620.00 |
$1,620.00 |
$1,144.00
|
|
Unlisted dx gi procedure
|
$1,855.20 |
$1,855.20 |
$1,855.20 |
$649.22
|
|
Unlisted fluoroscopic px
|
$277.60 |
$277.60 |
$277.60 |
$305.76
|
|
Unlisted mr procedure
|
$2,541.60 |
$2,541.60 |
$2,541.60 |
$1,163.00
|
|
Unlisted procedure colon
|
$2,812.00 |
$2,812.00 |
$2,812.00 |
$1,839.55
|
|
Unlisted procedure liver
|
$7,991.20 |
$7,991.20 |
$7,991.20 |
$2,287.20
|
|
Unlisted procedure spine
|
$3,893.60 |
$3,893.60 |
$3,893.60 |
$4,659.85
|
|
Unlisted psychiatric service/proc 90899
|
$142.40 |
$142.40 |
$142.40 |
$277.76
|
|
Unlisted px abdomen muscskel
|
$3,265.60 |
$3,265.60 |
$3,265.60 |
$1,956.50
|
|
Unlisted px ant segment eye
|
$3,574.40 |
$3,574.40 |
$3,574.40 |
$2,698.92
|
|
Unlisted px casting/strpg
|
$332.00 |
$332.00 |
$332.00 |
$222.00
|
|
Unlisted px foot/toes
|
$3,752.00 |
$3,752.00 |
$3,752.00 |
$1,239.20
|
|
Unlisted px forearm/wrist
|
$333.60 |
$333.60 |
$333.60 |
$859.50
|
|
Unlisted px hands/fingers
|
$259.20 |
$259.20 |
$259.20 |
$354.20
|
|
Unlisted px leg/ankle
|
$4,147.20 |
$4,147.20 |
$4,147.20 |
$882.30
|
|
Unlisted px med radj physics
|
$640.80 |
$640.80 |
$640.80 |
$462.35
|
|
Unlisted px neck/thorax
|
$2,385.60 |
$2,385.60 |
$2,385.60 |
$571.20
|
|
Unlisted px pelvis/hip joint
|
$8,036.80 |
$8,036.80 |
$8,036.80 |
$3,251.90
|
|
Unlisted px small intestine
|
$3,053.60 |
$3,053.60 |
$3,053.60 |
$2,118.35
|
|
Unlisted reprod med lab proc
|
$61.60 |
$61.60 |
$61.60 |
$70.00
|
|
Unlisted ultrasound procedure
|
$619.20 |
$619.20 |
$619.20 |
$335.00
|
|
Unsched dialysis esrd pt hos
|
$1,640.00 |
$1,640.00 |
$1,640.00 |
$1,296.00
|
|
Upgrade pm system
|
$19,753.60 |
$19,753.60 |
$19,753.60 |
$12,077.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$404.00 |
$404.00 |
$404.00 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$2,824.80 |
$2,824.80 |
$2,824.80 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$2,585.60 |
$2,585.60 |
$2,585.60 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$5,039.20 |
$5,039.20 |
$5,039.20 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,152.80 |
$3,152.80 |
$3,152.80 |
$2,392.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,687.20 |
$3,687.20 |
$3,687.20 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$502.40 |
$502.40 |
$502.40 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$613.60 |
$613.60 |
$613.60 |
$381.60
|
|
Upper Endoscopy (EGD, diagnostic)
|
$2,539.20 |
$2,539.20 |
$2,539.20 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$2,540.00 |
$2,540.00 |
$2,540.00 |
$1,768.00
|
|
Upper ext fx orthosis rad/ul
|
$206.40 |
$206.40 |
$206.40 |
$619.49
|
|
Upper GI Barium X-ray (barium and gas)
|
$1,072.80 |
$1,072.80 |
$1,072.80 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$1,040.00 |
$1,040.00 |
$1,040.00 |
$607.20
|
|
Ureteral embolization/occl
|
$1,822.40 |
$1,822.40 |
$1,822.40 |
$2,079.31
|
|
Ureteral reflux study
|
$1,284.00 |
$1,284.00 |
$1,284.00 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$846.40 |
$846.40 |
$846.40 |
$584.00
|
|
Urethrocystography void s&i
|
$1,463.20 |
$1,463.20 |
$1,463.20 |
$634.50
|
|
Urinary bldr retent nuc study
|
$229.60 |
$229.60 |
$229.60 |
$350.66
|
|
Urography, antegrade
|
$939.20 |
$939.20 |
$939.20 |
$622.35
|