|
Treat humerus fracture
|
$2,009.60 |
$2,009.60 |
$2,009.60 |
|
|
Treat kneecap dislocation
|
$569.60 |
$569.60 |
$596.80 |
|
|
Treat knee dislocation
|
$2,976.80 |
$2,976.80 |
$3,655.20 |
|
|
Treat knee fracture 27530
|
$412.80 |
$428.00 |
$503.20 |
|
|
Treat knee fracture(s)
|
$396.00 |
$396.00 |
$577.60 |
|
|
Treat knuckle dislocation
|
$1,884.00 |
$1,884.00 |
$1,884.00 |
|
|
Treat lower leg dislocation
|
$341.60 |
$977.60 |
$1,067.20 |
|
|
Treatment incomplete abortion completed surgically any trimester
|
$960.00 |
$3,348.80 |
$3,915.20 |
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$387.20 |
$387.20 |
$503.20 |
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$182.40 |
$182.40 |
$202.40 |
|
|
Treatment of ankle fracture 27786
|
$400.80 |
$416.00 |
$480.00 |
|
|
Treatment of fibula fracture 27780
|
$345.60 |
$358.40 |
$620.80 |
|
|
Treatment of foot infection
|
$3,114.40 |
$3,114.40 |
$3,114.40 |
|
|
Treatment of heel fracture 28400
|
$362.40 |
$376.80 |
$524.80 |
|
|
Treatment of mouth lesion physical 40820
|
$3,127.20 |
$3,127.20 |
$3,127.20 |
|
|
Treatment of thigh fracture
|
$396.00 |
$396.00 |
$522.40 |
|
|
Treatment of thigh fracture
|
$1,833.60 |
$1,833.60 |
$1,833.60 |
|
|
Treatment of thigh fracture
|
$396.00 |
$396.00 |
$451.20 |
|
|
Treatment of thigh fracture
|
$1,880.00 |
$1,880.00 |
$1,918.40 |
|
|
Treatment of toe fracture 28510
|
$306.40 |
$319.20 |
$456.80 |
|
|
Treatment radiation delivery level 2
|
$2,852.80 |
$2,852.80 |
$2,852.80 |
|
|
Treat midfoot fracture each
|
$2,632.00 |
$2,656.00 |
$2,816.80 |
|
|
Treat sternum fracture
|
$357.60 |
$357.60 |
$458.40 |
|
|
Treat thigh fracture
|
$396.00 |
$396.00 |
$425.60 |
|
|
Treat thigh fracture
|
$1,465.60 |
$1,465.60 |
$1,700.00 |
|
|
Treat thigh fracture
|
$368.80 |
$368.80 |
$396.00 |
|
|
Treat thigh fracture
|
$1,735.20 |
$1,735.20 |
$1,735.20 |
|
|
Treat thigh fx growth plate
|
$240.00 |
$240.00 |
$244.00 |
|
|
Treat ulnar fracture
|
$1,329.60 |
$1,492.00 |
$1,861.60 |
|
|
Treat vaginal bleeding
|
$411.20 |
$411.20 |
$411.20 |
|
|
Treat wrist bone fracture
|
$1,207.20 |
$1,207.20 |
$1,767.20 |
|
|
Treat wrist dislocation
|
$484.80 |
$484.80 |
$656.00 |
|
|
Treponema pallidum antibody
|
$68.80 |
$70.40 |
$132.00 |
|
|
Treprostinil injection
|
$38,319.60 |
$38,319.60 |
$38,319.60 |
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$61.42 |
$65.65 |
$318.09 |
|
|
Triamcinolone a inj prs-free
|
$282.40 |
$282.40 |
$2,749.74 |
|
|
Triglycerides
|
$28.80 |
$58.40 |
$72.00 |
|
|
Trim nail(s)
|
$78.40 |
$78.40 |
$78.40 |
|
|
Trim nondyst nails
|
$113.60 |
$113.60 |
$113.60 |
|
|
Trmt of fracture (femoral shaft) 27500
|
$381.60 |
$396.00 |
$432.00 |
|
|
Trnscath plc stent crv crtd without prtct
|
$6,353.60 |
$6,353.60 |
$13,072.00 |
|
|
Trnscath plc stent crv crtd w/prtct
|
$6,353.60 |
$6,353.60 |
$13,093.60 |
|
|
Trnscath plc stnt ante carotid art
|
$10,829.60 |
$10,829.60 |
$10,829.60 |
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$10,031.20 |
$10,031.20 |
$13,661.60 |
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$14,264.00 |
$14,264.00 |
$14,371.20 |
|
|
Trnscath plc vas stent w/s&i ini vein
|
$18,909.60 |
$18,909.60 |
$19,110.40 |
|
|
Trnscath retrv pq vasc fb w/guide
|
$3,631.20 |
$3,631.20 |
$6,986.40 |
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$6,701.60 |
$6,701.60 |
$6,701.60 |
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$6,483.20 |
$6,483.20 |
$6,483.20 |
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$8,341.60 |
$8,341.60 |
$8,341.60 |
|
|
Trnscath tx thromblytc vein ini day
|
$5,180.00 |
$5,180.00 |
$5,180.00 |
|
|
Troponin quantitative
|
$82.40 |
$140.00 |
$232.00 |
|
|
Truss single with standard pad
|
$55.20 |
$55.20 |
$55.20 |
|
|
Tte w or without contr, cont ecg
|
$2,196.00 |
$2,196.00 |
$2,799.20 |
|
|
Tte w or without fol w/con,stres
|
$2,323.20 |
$2,323.20 |
$2,382.40 |
|
|
Tte w or without fol w/cont, com
|
$2,401.60 |
$2,401.60 |
$2,401.60 |
|
|
Tte w or without fol w/cont, f/u
|
$1,640.00 |
$1,640.00 |
$1,640.00 |
|
|
Tx atrial fib pulm vein isol
|
$42,380.00 |
$42,380.00 |
$42,380.00 |
|
|
Tx closed distal humerus fx
|
$3,175.20 |
$3,175.20 |
$3,812.00 |
|
|
Tx closed hip disl traumatic without anes
|
$424.80 |
$537.60 |
$568.00 |
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$3,708.00 |
$3,708.00 |
$3,708.00 |
|
|
Tx closed tib shaft fx without manip
|
$400.80 |
$416.00 |
$584.00 |
|
|
Tx l/r atrial fib addl
|
$13,837.60 |
$13,837.60 |
$13,837.60 |
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$4,404.00 |
$4,404.00 |
$4,404.00 |
|
|
Tx tarsal bone fx without manip 28450
|
$316.80 |
$328.80 |
$481.60 |
|
|
Ua w/micro/comp poc
|
$35.20 |
$35.20 |
$52.80 |
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$16,727.20 |
$16,727.20 |
$27,521.17 |
|
|
Ultrasound breast complete
|
$466.40 |
$522.40 |
$574.40 |
|
|
Ultrasound breast unilateral limited (both sides)
|
$455.20 |
$468.80 |
$574.40 |
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$408.80 |
$464.00 |
$511.20 |
|
|
Ultrasound encephalogram
|
$576.80 |
$629.60 |
$756.00 |
|
|
Ultrasound exam k transpl w/doppler
|
$840.80 |
$845.60 |
$910.40 |
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$647.20 |
$674.40 |
$768.00 |
|
|
Ultrasound Guidance for a Needle Procedure
|
$909.60 |
$931.20 |
$970.40 |
|
|
Ultrasound guidance for vascular access
|
$530.40 |
$572.80 |
$817.60 |
|
|
Ultrasound guide intraoperative
|
$844.00 |
$1,017.60 |
$1,184.80 |
|
|
Ultrasound guide tissue ablation
|
$498.40 |
$498.40 |
$524.00 |
|
|
Ultrasound hips infant dynamic
|
$558.40 |
$588.00 |
$785.60 |
|
|
Ultrasound infant hips ltd without stress
|
$643.20 |
$643.20 |
$752.00 |
|
|
Ultrasound joint complete left
|
$503.20 |
$623.20 |
$783.20 |
|
|
Ultrasound ob >=14wks ea addl gest
|
$431.20 |
$630.40 |
$1,336.00 |
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$456.00 |
$497.60 |
$532.80 |
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$973.60 |
$1,038.40 |
$1,072.00 |
|
|
Ultrasound pregnant uterus follow up per fetus
|
$400.00 |
$531.20 |
$568.80 |
|
|
Ultrasound prostate/transrectal
|
$682.40 |
$687.20 |
$785.60 |
|
|
Ultrasound spinal canal and contents
|
$620.00 |
$662.40 |
$672.00 |
|
|
Ultrasound transabd ea addl gest
|
$550.40 |
$552.80 |
$811.20 |
|
|
Unlisted CT procedure
|
$150.40 |
$150.40 |
$150.40 |
|
|
Unlisted dialysis procedure
|
$1,620.00 |
$1,620.00 |
$1,620.00 |
|
|
Unlisted dx gi procedure
|
$1,855.20 |
$1,855.20 |
$1,855.20 |
|
|
Unlisted fluoroscopic px
|
$277.60 |
$277.60 |
$277.60 |
|
|
Unlisted gi px dx nuc med
|
$643.20 |
$643.20 |
$643.20 |
|
|
Unlisted mr procedure
|
$2,541.60 |
$2,541.60 |
$2,656.80 |
|
|
Unlisted procedure colon
|
$2,812.00 |
$2,812.00 |
$2,812.00 |
|
|
Unlisted procedure liver
|
$899.20 |
$899.20 |
$7,991.20 |
|
|
Unlisted procedure spine
|
$3,893.60 |
$3,893.60 |
$4,299.20 |
|
|
Unlisted psychiatric service/proc 90899
|
$142.40 |
$142.40 |
$142.40 |
|
|
Unlisted px abdomen muscskel
|
$2,718.40 |
$2,718.40 |
$3,265.60 |
|
|
Unlisted px ant segment eye
|
$3,574.40 |
$3,574.40 |
$3,574.40 |
|
|
Unlisted px casting/strpg
|
$332.00 |
$332.00 |
$332.00 |
|
