|
Treatment of ankle fracture 27786
|
$417.90 |
$417.90 |
$417.90 |
$580.00
|
|
Treatment of fibula fracture
|
$8,797.32 |
$8,797.32 |
$8,797.32 |
$7,069.90
|
|
Treatment of fibula fracture 27780
|
$275.52 |
$275.52 |
$275.52 |
$558.75
|
|
Treatment of heel fracture 28400
|
$275.52 |
$275.52 |
$275.52 |
$494.00
|
|
Treatment of miscarriage
|
$3,760.68 |
$3,760.68 |
$3,760.68 |
$4,146.69
|
|
Treatment of mouth lesion physical 40820
|
$191.52 |
$191.52 |
$191.52 |
$3,544.29
|
|
Treatment of thigh fracture
|
$275.52 |
$275.52 |
$275.52 |
$467.25
|
|
Treatment of thigh fracture
|
$1,907.64 |
$1,907.64 |
$1,907.64 |
$1,893.86
|
|
Treatment of thigh fracture
|
$275.52 |
$275.52 |
$275.52 |
$659.00
|
|
Treatment of thigh fracture
|
$8,797.32 |
$8,797.32 |
$8,797.32 |
$6,651.45
|
|
Treatment of thigh fracture
|
$2,044.14 |
$2,044.14 |
$2,044.14 |
$2,055.00
|
|
Treatment of tibia fracture
|
$8,797.32 |
$8,797.32 |
$8,797.32 |
$6,183.84
|
|
Treatment of toe fracture 28510
|
$275.52 |
$275.52 |
$275.52 |
$371.40
|
|
Treat metacarpal fracture
|
$3,958.50 |
$3,958.50 |
$3,958.50 |
$3,958.50
|
|
Treat metacarpal fracture
|
$3,958.50 |
$3,958.50 |
$3,958.50 |
$4,627.00
|
|
Treat metatarsal fracture
|
$8,797.32 |
$8,797.32 |
$8,797.32 |
$7,913.97
|
|
Treat midfoot fracture each
|
$1,907.64 |
$1,907.64 |
$1,907.64 |
$1,893.86
|
|
Treat sternum fracture
|
$275.52 |
$275.52 |
$275.52 |
$423.00
|
|
Treat thigh fracture
|
$120.96 |
$120.96 |
$120.96 |
$661.00
|
|
Treat thigh fracture
|
$8,797.32 |
$8,797.32 |
$8,797.32 |
$7,372.60
|
|
Treat thigh fracture
|
$1,134.84 |
$1,134.84 |
$1,134.84 |
$2,021.04
|
|
Treat thigh fracture
|
$275.52 |
$275.52 |
$275.52 |
$716.95
|
|
Treat thigh fx growth plate
|
$275.52 |
$275.52 |
$275.52 |
$421.50
|
|
Treat toe dislocation
|
$319.20 |
$319.20 |
$319.20 |
$855.66
|
|
Treat toe fracture
|
$3,958.50 |
$3,958.50 |
$3,958.50 |
$3,981.06
|
|
Treat ulnar fracture
|
$1,907.64 |
$1,907.64 |
$1,907.64 |
$1,861.60
|
|
Treat vaginal bleeding
|
$236.88 |
$236.88 |
$236.88 |
$400.86
|
|
Treat wrist bone fracture
|
$1,907.64 |
$1,907.64 |
$1,907.64 |
$1,907.64
|
|
Treat wrist dislocation
|
$489.72 |
$489.72 |
$489.72 |
$760.00
|
|
Treponema pallidum antibody
|
$101.64 |
$101.64 |
$101.64 |
$72.80
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$56.70 |
$56.70 |
$56.70 |
$55.80
|
|
Triglycerides
|
$31.08 |
$31.08 |
$31.08 |
$54.60
|
|
Trim nondyst nails
|
$76.44 |
$76.44 |
$76.44 |
$124.22
|
|
Trmt of fracture (femoral shaft) 27500
|
$275.52 |
$275.52 |
$275.52 |
$777.00
|
|
Trnscath tx thromblytc vein ini day
|
$3,961.86 |
$3,961.86 |
$3,961.86 |
$4,329.36
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$4,326.42 |
$4,326.42 |
$4,326.42 |
$4,805.85
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$2,163.42 |
$2,163.42 |
$2,163.42 |
$2,343.60
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$2,295.30 |
$2,295.30 |
$2,295.30 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$2,295.30 |
$2,295.30 |
$2,295.30 |
$3,322.20
|
|
Troponin quantitative
|
$67.20 |
$67.20 |
$67.20 |
$123.75
|
|
Tube trach disp innr can 5 xlt
|
$872.21 |
$872.21 |
$872.21 |
$460.58
|
|
Tx closed hip disl traumatic without anes
|
$417.90 |
$417.90 |
$417.90 |
$657.28
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$5,294.94 |
$5,294.94 |
$5,294.94 |
$3,874.79
|
|
Tx closed tib shaft fx without manip
|
$275.52 |
$275.52 |
$275.52 |
$635.46
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$3,958.50 |
$3,958.50 |
$3,958.50 |
$4,449.44
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$5,294.94 |
$5,294.94 |
$5,294.94 |
$4,499.12
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$3,958.50 |
$3,958.50 |
$3,958.50 |
$4,281.00
|
|
Tx open nsl fx uncomp
|
$3,783.78 |
$3,783.78 |
$3,783.78 |
$4,007.22
|
|
Tx open nsl sptl fx
|
$3,958.50 |
$3,958.50 |
$3,958.50 |
$4,289.04
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$5,294.94 |
$5,294.94 |
$5,294.94 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$275.52 |
$275.52 |
$275.52 |
$469.20
|
|
Ultrasound abdomen aorta screening study aaa
|
$270.06 |
$270.06 |
$270.06 |
$403.26
|
|
Ultrasound breast complete
|
$270.06 |
$270.06 |
$270.06 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$200.76 |
$200.76 |
$200.76 |
$449.35
|
|
Ultrasound chest
|
$270.06 |
$270.06 |
$270.06 |
$459.55
|
|
Ultrasound encephalogram
|
$270.06 |
$270.06 |
$270.06 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$270.06 |
$270.06 |
$270.06 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$270.06 |
$270.06 |
$270.06 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$138.18 |
$138.18 |
$138.18 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$464.52 |
$464.52 |
$464.52 |
$701.35
|
|
Ultrasound guide intraoperative
|
$341.04 |
$341.04 |
$341.04 |
$632.90
|
|
Ultrasound hips infant dynamic
|
$250.74 |
$250.74 |
$250.74 |
$403.00
|
|
Ultrasound infant hips ltd without stress
|
$250.74 |
$250.74 |
$250.74 |
$321.35
|
|
Ultrasound joint complete left
|
$270.06 |
$270.06 |
$270.06 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$270.06 |
$270.06 |
$270.06 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$114.24 |
$114.24 |
$114.24 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$70.14 |
$70.14 |
$70.14 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$737.94 |
$737.94 |
$737.94 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$270.06 |
$270.06 |
$270.06 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$270.06 |
$270.06 |
$270.06 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$270.06 |
$270.06 |
$270.06 |
$485.48
|
|
Ultrasound retroperitoneal limited
|
$270.06 |
$270.06 |
$270.06 |
$498.00
|
|
Ultrasound scrotum and contents
|
$270.06 |
$270.06 |
$270.06 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$270.06 |
$270.06 |
$270.06 |
$450.60
|
|
Ultrasound transvaginal non obstetric
|
$270.06 |
$270.06 |
$270.06 |
$567.44
|
|
Umbilical artery cath newborn 36660
|
$442.26 |
$442.26 |
$442.26 |
$265.85
|
|
Unlisted chemotherapy px
|
$59.64 |
$59.64 |
$59.64 |
$153.85
|
|
Unlisted procedure rectum
|
$1,105.02 |
$1,105.02 |
$1,105.02 |
$1,278.72
|
|
Unlisted px hands/fingers
|
$275.52 |
$275.52 |
$275.52 |
$379.44
|
|
Unlisted px salivry glnd/dux
|
$276.36 |
$276.36 |
$276.36 |
$486.72
|
|
Unlisted px small intestine
|
$1,097.88 |
$1,097.88 |
$1,097.88 |
$2,118.35
|
|
Unlisted ultrasound procedure
|
$200.76 |
$200.76 |
$200.76 |
$321.20
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,066.82 |
$2,066.82 |
$2,066.82 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,024.82 |
$2,024.82 |
$2,024.82 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$676.62 |
$676.62 |
$676.62 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$954.66 |
$954.66 |
$954.66 |
$1,588.59
|
|
Upper Endoscopy (EGD, with biopsy)
|
$954.66 |
$954.66 |
$954.66 |
$1,656.60
|
|
Urea nitrogen
|
$21.42 |
$21.42 |
$21.42 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$29.82 |
$29.82 |
$29.82 |
$50.00
|
|
Urethrcystgrphy rtrgrde s&i
|
$400.68 |
$400.68 |
$400.68 |
$574.40
|
|
Urethrocystography void s&i
|
$400.68 |
$400.68 |
$400.68 |
$634.50
|
|
Uric acid blood
|
$24.36 |
$24.36 |
$24.36 |
$46.64
|
|
Uric acid urine
|
$27.30 |
$27.30 |
$27.30 |
$46.75
|
|
Urinalysis microscopic only
|
$36.54 |
$36.54 |
$36.54 |
$26.35
|
|
Urinalysis (with microscopy)
|
$33.18 |
$33.18 |
$33.18 |
$48.14
|
|
Urinalysis (without microscopy)
|
$23.52 |
$23.52 |
$23.52 |
$38.99
|
|
Urine Culture Test
|
$48.72 |
$48.72 |
$48.72 |
$84.81
|
|
Urine pregnancy test
|
$103.74 |
$103.74 |
$103.74 |
$66.40
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$122.57 |
$122.57 |
$122.57 |
$223.08
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$122.57 |
$122.57 |
$122.57 |
$218.88
|