|
Trmt of fracture (femoral shaft) 27500
|
$520.80 |
$520.80 |
$520.80 |
$754.80
|
|
Trnscath plc stent crv crtd without prtct
|
$19,103.10 |
$19,103.10 |
$19,103.10 |
$7,795.71
|
|
Trnscath plc stent crv crtd w/prtct
|
$19,103.10 |
$19,103.10 |
$19,103.10 |
$9,767.25
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$11,631.90 |
$11,631.90 |
$11,631.90 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$11,631.90 |
$11,631.90 |
$11,631.90 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$11,631.90 |
$11,631.90 |
$11,631.90 |
$15,330.11
|
|
Trnscath retrv pq vasc fb w/guide
|
$5,398.35 |
$5,398.35 |
$5,398.35 |
$4,523.96
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$3,267.30 |
$3,267.30 |
$3,267.30 |
$5,069.50
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$4,250.25 |
$4,250.25 |
$4,250.25 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$3,866.70 |
$3,866.70 |
$3,866.70 |
$3,866.70
|
|
Troponin quantitative
|
$353.40 |
$353.40 |
$353.40 |
$127.20
|
|
Truskin, per sq centimeter
|
$230.63 |
$230.63 |
$230.63 |
$230.63
|
|
Tte w or without contr, cont ecg
|
$1,802.10 |
$1,802.10 |
$1,802.10 |
$2,012.40
|
|
Tte w or without fol w/con,stres
|
$1,375.35 |
$1,375.35 |
$1,375.35 |
$1,632.80
|
|
Tube drain vert dev st 5-40f
|
$27.60 |
$27.60 |
$27.60 |
$29.40
|
|
Tube trach disp innr can 5 xlt
|
$1,217.70 |
$1,217.70 |
$1,217.70 |
$445.99
|
|
Tube trach disp innr can 6 xlt
|
$329.64 |
$329.64 |
$329.64 |
$16.80
|
|
Tube trach fen sz 6 uncuffed
|
$846.24 |
$846.24 |
$846.24 |
$155.98
|
|
Tubular dressing
|
$139.53 |
$139.53 |
$139.53 |
$28.46
|
|
Tx atrial fib pulm vein isol
|
$14,791.50 |
$14,791.50 |
$14,791.50 |
$29,030.54
|
|
Tx closed hip disl traumatic without anes
|
$279.90 |
$279.90 |
$279.90 |
$581.07
|
|
Tx l/r atrial fib addl
|
$7,396.05 |
$7,396.05 |
$7,396.05 |
$6,769.00
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$3,331.35 |
$3,331.35 |
$3,331.35 |
$4,468.55
|
|
Tx open nsl fx uncomp
|
$5,143.95 |
$5,143.95 |
$5,143.95 |
$3,837.72
|
|
Ultrasound abdomen aorta screening study aaa
|
$356.70 |
$356.70 |
$356.70 |
$394.20
|
|
Ultrasound breast complete
|
$766.05 |
$766.05 |
$766.05 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$766.05 |
$766.05 |
$766.05 |
$449.35
|
|
Ultrasound chest
|
$484.95 |
$484.95 |
$484.95 |
$460.85
|
|
Ultrasound elastography ea l target les
|
$545.55 |
$545.55 |
$545.55 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$545.55 |
$545.55 |
$545.55 |
$307.00
|
|
Ultrasound encephalogram
|
$762.60 |
$762.60 |
$762.60 |
$488.80
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$469.50 |
$469.50 |
$469.50 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$532.95 |
$532.95 |
$532.95 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$720.15 |
$720.15 |
$720.15 |
$720.15
|
|
Ultrasound guide intraoperative
|
$632.85 |
$632.85 |
$632.85 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$2,068.50 |
$2,068.50 |
$2,068.50 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$484.95 |
$484.95 |
$484.95 |
$403.88
|
|
Ultrasound joint complete left
|
$484.95 |
$484.95 |
$484.95 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$277.80 |
$277.80 |
$277.80 |
$425.45
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$277.80 |
$277.80 |
$277.80 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$317.85 |
$317.85 |
$317.85 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$317.85 |
$317.85 |
$317.85 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$641.40 |
$641.40 |
$641.40 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$254.70 |
$254.70 |
$254.70 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$381.75 |
$381.75 |
$381.75 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$589.80 |
$589.80 |
$589.80 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$557.40 |
$557.40 |
$557.40 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$381.75 |
$381.75 |
$381.75 |
$486.50
|
|
Ultrasound scrotum and contents
|
$568.35 |
$568.35 |
$568.35 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$545.55 |
$545.55 |
$545.55 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$417.15 |
$417.15 |
$417.15 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$589.80 |
$589.80 |
$589.80 |
$558.35
|
|
Unlistd noninvas vasc dx std
|
$1,105.80 |
$1,105.80 |
$1,105.80 |
$528.80
|
|
Unlisted procedure rectum
|
$543.60 |
$543.60 |
$543.60 |
$1,220.35
|
|
Unlisted px inner ear
|
$1,476.90 |
$1,476.90 |
$1,476.90 |
$571.20
|
|
Unlisted px small intestine
|
$2,163.45 |
$2,163.45 |
$2,163.45 |
$2,102.10
|
|
Unlisted px tongue flr mouth
|
$211.95 |
$211.95 |
$211.95 |
$282.50
|
|
Unlisted px vestibule mouth
|
$646.20 |
$646.20 |
$646.20 |
$456.96
|
|
Unlisted special svc px/rprt
|
$90.00 |
$90.00 |
$90.00 |
$90.00
|
|
Unlisted transfusion med px
|
$204.60 |
$204.60 |
$204.60 |
$147.50
|
|
Unsched dialysis esrd pt hos
|
$2,127.45 |
$2,127.45 |
$2,127.45 |
$1,268.17
|
|
Upgrade pm system
|
$18,019.35 |
$18,019.35 |
$18,019.35 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,264.90 |
$3,264.90 |
$3,264.90 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,612.85 |
$2,612.85 |
$2,612.85 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,394.15 |
$2,394.15 |
$2,394.15 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,824.75 |
$1,824.75 |
$1,824.75 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$731.70 |
$731.70 |
$731.70 |
$1,768.00
|
|
Upper ext fx orthosis rad/ul
|
$760.76 |
$760.76 |
$760.76 |
$619.49
|
|
Uppr gi scope w/submuc inj
|
$731.70 |
$731.70 |
$731.70 |
$1,872.00
|
|
Urea nitrogen
|
$133.20 |
$133.20 |
$133.20 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$111.45 |
$111.45 |
$111.45 |
$51.75
|
|
Ureteral reflux study
|
$820.20 |
$820.20 |
$820.20 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$622.35 |
$622.35 |
$622.35 |
$579.73
|
|
Urethrocystography void s&i
|
$622.35 |
$622.35 |
$622.35 |
$622.35
|
|
Uric acid blood
|
$130.65 |
$130.65 |
$130.65 |
$48.75
|
|
Uric acid urine
|
$130.65 |
$130.65 |
$130.65 |
$44.33
|
|
Urinalysis microscopic only
|
$43.50 |
$43.50 |
$43.50 |
$26.35
|
|
Urinalysis (with microscopy)
|
$107.85 |
$107.85 |
$107.85 |
$55.00
|
|
Urinalysis (without microscopy)
|
$107.85 |
$107.85 |
$107.85 |
$35.75
|
|
Urine Culture Test
|
$210.00 |
$210.00 |
$210.00 |
$81.50
|
|
Urine ost pouch w faucet/tap
|
$2.00 |
$2.00 |
$2.00 |
$2.00
|
|
Urine pregnancy test
|
$187.20 |
$187.20 |
$187.20 |
$67.20
|
|
Urography, antegrade
|
$622.35 |
$622.35 |
$622.35 |
$622.35
|
|
Use 1st target lesion
|
$545.55 |
$545.55 |
$545.55 |
$332.00
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$4,008.54 |
$4,008.54 |
$4,008.54 |
$5,184.34
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$55,128.85 |
$55,128.85 |
$55,128.85 |
$51,633.07
|
|
Vaccine dtap < 7 years im
|
$68.19 |
$68.19 |
$68.19 |
$68.19
|
|
Vaccine dtap-ipv/hib im
|
$221.24 |
$221.24 |
$221.24 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$72.98 |
$72.98 |
$72.98 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$33.30 |
$33.30 |
$33.30 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$192.15 |
$192.15 |
$192.15 |
$166.62
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$93.90 |
$93.90 |
$93.90 |
$79.15
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$160.86 |
$160.86 |
$160.86 |
$155.16
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$69.74 |
$69.74 |
$69.74 |
$75.39
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$149.21 |
$149.21 |
$149.21 |
$143.20
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$54.84 |
$54.84 |
$54.84 |
$33.60
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$149.21 |
$149.21 |
$149.21 |
$72.00
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$409.35 |
$409.35 |
$409.35 |
$409.35
|
|
Vaccine mmr live subcutaneous
|
$194.93 |
$194.93 |
$194.93 |
$211.68
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$252.90 |
$252.90 |
$252.90 |
$251.64
|
