|
Treatment of ankle fracture 27786
|
$84.00 |
$84.00 |
$84.00 |
$580.00
|
|
Treatment of fibula fracture
|
$1,903.30 |
$1,903.30 |
$1,903.30 |
$7,069.90
|
|
Treatment of fibula fracture 27780
|
$69.65 |
$69.65 |
$69.65 |
$558.75
|
|
Treatment of heel fracture 28400
|
$78.05 |
$78.05 |
$78.05 |
$494.00
|
|
Treatment of mouth lesion physical 40820
|
$59.50 |
$59.50 |
$59.50 |
$3,544.29
|
|
Treatment of thigh fracture
|
$123.73 |
$123.73 |
$123.73 |
$467.25
|
|
Treatment of thigh fracture
|
$545.30 |
$545.30 |
$545.30 |
$1,893.86
|
|
Treatment of thigh fracture
|
$78.05 |
$78.05 |
$78.05 |
$659.00
|
|
Treatment of thigh fracture
|
$95.38 |
$95.38 |
$95.38 |
$2,055.00
|
|
Treatment of toe fracture 28510
|
$48.65 |
$48.65 |
$48.65 |
$371.40
|
|
Treatment radiation delivery level 2
|
$104.13 |
$104.13 |
$104.13 |
$735.00
|
|
Treat midfoot fracture each
|
$43.40 |
$43.40 |
$43.40 |
$1,893.86
|
|
Treat sternum fracture
|
$123.73 |
$123.73 |
$123.73 |
$423.00
|
|
Treat thigh fracture
|
$78.05 |
$78.05 |
$78.05 |
$661.00
|
|
Treat thigh fracture
|
$69.65 |
$69.65 |
$69.65 |
$2,021.04
|
|
Treat thigh fracture
|
$69.65 |
$69.65 |
$69.65 |
$716.95
|
|
Treat thigh fx growth plate
|
$94.68 |
$94.68 |
$94.68 |
$421.50
|
|
Treat thigh fx growth plate
|
$110.60 |
$110.60 |
$110.60 |
$1,938.38
|
|
Treat ulnar fracture
|
$610.58 |
$610.58 |
$610.58 |
$1,861.60
|
|
Treat vaginal bleeding
|
$298.03 |
$298.03 |
$298.03 |
$400.86
|
|
Treat wrist bone fracture
|
$69.65 |
$69.65 |
$69.65 |
$1,907.64
|
|
Treat wrist dislocation
|
$81.03 |
$81.03 |
$81.03 |
$760.00
|
|
Treponema pallidum antibody
|
$26.25 |
$26.25 |
$26.25 |
$72.80
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$0.70 |
$0.70 |
$0.70 |
$55.80
|
|
#tricyclicantidprssnt
|
$3.68 |
$3.68 |
$3.68 |
$57.08
|
|
Triglycerides
|
$39.38 |
$39.38 |
$39.38 |
$54.60
|
|
Trim nondyst nails
|
$20.48 |
$20.48 |
$20.48 |
$124.22
|
|
Trmt of fracture (femoral shaft) 27500
|
$78.05 |
$78.05 |
$78.05 |
$777.00
|
|
Trnscath plc stent crv crtd w/prtct
|
$3,425.63 |
$3,425.63 |
$3,425.63 |
$11,099.98
|
|
Trnscath plc stnt ante carotid art
|
$3,172.93 |
$3,172.93 |
$3,172.93 |
$9,114.56
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$1,577.10 |
$1,577.10 |
$1,577.10 |
$8,244.55
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$1,577.10 |
$1,577.10 |
$1,577.10 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$3,362.45 |
$3,362.45 |
$3,362.45 |
$15,408.00
|
|
Trnscath retrv pq vasc fb w/guide
|
$1,334.90 |
$1,334.90 |
$1,334.90 |
$4,969.90
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$1,383.73 |
$1,383.73 |
$1,383.73 |
$6,156.00
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$794.33 |
$794.33 |
$794.33 |
$4,505.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$562.80 |
$562.80 |
$562.80 |
$4,793.13
|
|
Trnscath tx thromblytc vein ini day
|
$1,289.23 |
$1,289.23 |
$1,289.23 |
$4,329.36
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$188.30 |
$188.30 |
$188.30 |
$2,986.34
|
|
Troponin quantitative
|
$46.73 |
$46.73 |
$46.73 |
$123.75
|
|
Tube trach disp innr can 5 xlt
|
$392.88 |
$392.88 |
$392.88 |
$460.58
|
|
Tube trach fen sz 6 uncuffed
|
$222.08 |
$222.08 |
$222.08 |
$132.40
|
|
Tx atrial fib pulm vein isol
|
$12,806.85 |
$12,806.85 |
$12,806.85 |
$32,426.20
|
|
Tx closed hip disl traumatic without anes
|
$120.93 |
$120.93 |
$120.93 |
$657.28
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$1,241.28 |
$1,241.28 |
$1,241.28 |
$3,874.79
|
|
Tx closed tib shaft fx without manip
|
$74.03 |
$74.03 |
$74.03 |
$635.46
|
|
Tx l/r atrial fib addl
|
$4,098.33 |
$4,098.33 |
$4,098.33 |
$7,717.80
|
|
Tx tarsal bone fx without manip 28450
|
$72.10 |
$72.10 |
$72.10 |
$469.20
|
|
Tympanic membrane repair
|
$104.13 |
$104.13 |
$104.13 |
$1,856.00
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$54.25 |
$54.25 |
$54.25 |
$911.43
|
|
Ua w/micro/comp poc
|
$2.63 |
$2.63 |
$2.63 |
$24.45
|
|
Ultrasound abdomen aorta screening study aaa
|
$176.58 |
$176.58 |
$176.58 |
$403.26
|
|
Ultrasound breast unilateral limited (both sides)
|
$221.20 |
$221.20 |
$221.20 |
$449.35
|
|
Ultrasound chest
|
$180.08 |
$180.08 |
$180.08 |
$459.55
|
|
Ultrasound encephalogram
|
$177.28 |
$177.28 |
$177.28 |
$481.60
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$301.53 |
$301.53 |
$301.53 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$192.85 |
$192.85 |
$192.85 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$763.88 |
$763.88 |
$763.88 |
$701.35
|
|
Ultrasound guide intraoperative
|
$163.28 |
$163.28 |
$163.28 |
$632.90
|
|
Ultrasound hips infant dynamic
|
$183.93 |
$183.93 |
$183.93 |
$403.00
|
|
Ultrasound joint complete left
|
$203.53 |
$203.53 |
$203.53 |
$556.14
|
|
Ultrasound ob >=14wks ea addl gest
|
$210.70 |
$210.70 |
$210.70 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$144.90 |
$144.90 |
$144.90 |
$326.54
|
|
Ultrasound pregnant uterus follow up per fetus
|
$339.68 |
$339.68 |
$339.68 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$249.73 |
$249.73 |
$249.73 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$284.73 |
$284.73 |
$284.73 |
$485.48
|
|
Ultrasound retroperitoneal limited
|
$266.35 |
$266.35 |
$266.35 |
$498.00
|
|
Ultrasound spinal canal and contents
|
$103.25 |
$103.25 |
$103.25 |
$450.60
|
|
Ultrasound transvaginal non obstetric
|
$196.35 |
$196.35 |
$196.35 |
$567.44
|
|
Unlisted all/immlg svc/px
|
$9.45 |
$9.45 |
$9.45 |
$28.98
|
|
Unlisted chemotherapy px
|
$84.18 |
$84.18 |
$84.18 |
$153.85
|
|
Unlisted CT procedure
|
$39.03 |
$39.03 |
$39.03 |
$1,043.00
|
|
Unlisted mr procedure
|
$35.18 |
$35.18 |
$35.18 |
$1,032.20
|
|
Unlisted px abdomen muscskel
|
$290.15 |
$290.15 |
$290.15 |
$2,633.80
|
|
Unlisted px casting/strpg
|
$42.00 |
$42.00 |
$42.00 |
$224.93
|
|
Unlisted resp px dx nuc med
|
$389.03 |
$389.03 |
$389.03 |
$545.61
|
|
Unlisted transfusion med px
|
$18.20 |
$18.20 |
$18.20 |
$141.35
|
|
Unlisted ultrasound procedure
|
$164.68 |
$164.68 |
$164.68 |
$321.20
|
|
Upgrade pm system
|
$2,254.70 |
$2,254.70 |
$2,254.70 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,250.03 |
$1,250.03 |
$1,250.03 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$910.53 |
$910.53 |
$910.53 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$827.75 |
$827.75 |
$827.75 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$393.75 |
$393.75 |
$393.75 |
$1,588.59
|
|
Urea nitrogen
|
$16.10 |
$16.10 |
$16.10 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$25.90 |
$25.90 |
$25.90 |
$50.00
|
|
Ureteral reflux study
|
$351.05 |
$351.05 |
$351.05 |
$961.20
|
|
Urethrcystgrphy rtrgrde s&i
|
$364.88 |
$364.88 |
$364.88 |
$574.40
|
|
Urethrocystography void s&i
|
$364.88 |
$364.88 |
$364.88 |
$634.50
|
|
Uric acid blood
|
$39.03 |
$39.03 |
$39.03 |
$46.64
|
|
Uric acid urine
|
$19.43 |
$19.43 |
$19.43 |
$46.75
|
|
Urinalysis microscopic only
|
$6.83 |
$6.83 |
$6.83 |
$26.35
|
|
Urinalysis (with microscopy)
|
$58.28 |
$58.28 |
$58.28 |
$48.14
|
|
Urinary reflex study
|
$52.33 |
$52.33 |
$52.33 |
$152.00
|
|
Urine Culture Test
|
$31.85 |
$31.85 |
$31.85 |
$84.81
|
|
Urine flow measurement 51736
|
$4.55 |
$4.55 |
$4.55 |
$152.54
|
|
Urine pregnancy test
|
$76.13 |
$76.13 |
$76.13 |
$66.40
|
|
Urography, antegrade
|
$383.95 |
$383.95 |
$383.95 |
$593.37
|
|
Urography inf drip &/or bolus
|
$191.98 |
$191.98 |
$191.98 |
$641.69
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$307.82 |
$307.82 |
$307.82 |
$5,521.54
|
|
Vaccine dtap < 7 years im
|
$6.13 |
$6.13 |
$6.13 |
$87.80
|
