|
Treat humerus fracture
|
$1,325.10 |
$1,325.10 |
$1,325.10 |
$1,950.60
|
|
Treat knee dislocation
|
$1,325.10 |
$1,325.10 |
$1,325.10 |
$2,592.08
|
|
Treat knee fracture 27530
|
$133.00 |
$133.00 |
$133.00 |
$580.20
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$247.10 |
$247.10 |
$526.20 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$193.90 |
$193.90 |
$374.72 |
$149.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$203.35 |
$203.35 |
$203.35 |
$210.00
|
|
Treatment of ankle fracture 27786
|
$130.20 |
$130.20 |
$130.20 |
$580.00
|
|
Treatment of fibula fracture 27780
|
$128.10 |
$128.10 |
$128.10 |
$558.75
|
|
Treatment of heel fracture 28400
|
$128.10 |
$128.10 |
$128.10 |
$494.00
|
|
Treatment of thigh fracture
|
$1,325.10 |
$1,325.10 |
$1,325.10 |
$2,055.00
|
|
Treatment of toe fracture 28510
|
$80.15 |
$80.15 |
$80.15 |
$371.40
|
|
Treatment radiation delivery level 2
|
$421.40 |
$421.40 |
$421.40 |
$735.00
|
|
Treat ulnar fracture
|
$1,255.10 |
$1,255.10 |
$1,255.10 |
$1,861.60
|
|
Treat wrist bone fracture
|
$1,325.10 |
$1,325.10 |
$1,325.10 |
$1,907.64
|
|
Treat wrist dislocation
|
$125.30 |
$125.30 |
$125.30 |
$760.00
|
|
Treponema pallidum antibody
|
$56.70 |
$56.70 |
$56.70 |
$72.80
|
|
Treprostinil injection
|
$23,471.48 |
$23,471.48 |
$23,471.48 |
$528.60
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$36.78 |
$36.78 |
$36.78 |
$48.22
|
|
Triamcinolone a inj prs-free
|
$40.43 |
$40.43 |
$40.43 |
$225.43
|
|
#tricyclicantidprssnt
|
$65.40 |
$65.40 |
$65.40 |
$57.08
|
|
Triglycerides
|
$91.35 |
$91.35 |
$91.35 |
$54.60
|
|
Trimethobenzamide hcl inj
|
$84.51 |
$84.51 |
$84.51 |
$154.09
|
|
Trim nondyst nails
|
$34.30 |
$34.30 |
$34.30 |
$124.22
|
|
Trnscath plc stent crv crtd without prtct
|
$4,196.85 |
$4,196.85 |
$4,196.85 |
$7,944.75
|
|
Trnscath plc stent crv crtd w/prtct
|
$5,910.80 |
$5,910.80 |
$31,411.77 |
$11,099.98
|
|
Trnscath plc stnt ante carotid art
|
$6,046.25 |
$6,046.25 |
$6,046.25 |
$9,114.56
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$2,484.30 |
$2,484.30 |
$2,484.30 |
$8,244.55
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$2,769.55 |
$2,769.55 |
$2,769.55 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$6,294.40 |
$6,294.40 |
$6,294.40 |
$15,408.00
|
|
Trnscath retrv pq vasc fb w/guide
|
$1,960.70 |
$1,960.70 |
$16,600.91 |
$4,969.90
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$2,649.85 |
$2,649.85 |
$2,649.85 |
$6,156.00
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$1,590.05 |
$1,590.05 |
$3,359.16 |
$4,505.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$1,192.45 |
$1,192.45 |
$1,850.14 |
$4,793.13
|
|
Trnscath tx thromblytc vein ini day
|
$1,881.60 |
$1,881.60 |
$1,881.60 |
$4,329.36
|
|
Troponin quantitative
|
$135.45 |
$135.45 |
$135.45 |
$123.75
|
|
Tte w or without contr, cont ecg
|
$2,739.10 |
$2,739.10 |
$2,739.10 |
$1,608.73
|
|
Tte w or without fol w/cont, f/u
|
$575.40 |
$575.40 |
$575.40 |
$934.93
|
|
Tx atrial fib pulm vein isol
|
$26,592.65 |
$26,592.65 |
$123,329.09 |
$32,426.20
|
|
Tx closed hip disl traumatic without anes
|
$180.60 |
$180.60 |
$180.60 |
$657.28
|
|
Tx closed tib shaft fx without manip
|
$133.35 |
$133.35 |
$133.35 |
$635.46
|
|
Tx l/r atrial fib addl
|
$8,509.90 |
$8,509.90 |
$59,288.95 |
$7,717.80
|
|
Ugt1a1 gene analy common variants
|
$300.30 |
$300.30 |
$300.30 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$698.25 |
$698.25 |
$1,097.55 |
$403.26
|
|
Ultrasound breast complete
|
$980.35 |
$980.35 |
$7,088.62 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$754.95 |
$754.95 |
$754.95 |
$449.35
|
|
Ultrasound chest
|
$612.15 |
$612.15 |
$612.15 |
$459.55
|
|
Ultrasound elastography ea l target les
|
$54.25 |
$54.25 |
$54.25 |
$136.11
|
|
Ultrasound elastography parenchyma
|
$899.85 |
$899.85 |
$899.85 |
$284.25
|
|
Ultrasound encephalogram
|
$198.10 |
$198.10 |
$3,859.46 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$750.05 |
$750.05 |
$750.05 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$413.70 |
$413.70 |
$413.70 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$952.70 |
$952.70 |
$952.70 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$1,246.35 |
$1,246.35 |
$1,246.35 |
$701.35
|
|
Ultrasound guide intraoperative
|
$788.55 |
$788.55 |
$2,753.24 |
$632.90
|
|
Ultrasound guide tissue ablation
|
$921.90 |
$921.90 |
$921.90 |
$498.40
|
|
Ultrasound hips infant dynamic
|
$105.35 |
$105.35 |
$105.35 |
$403.00
|
|
Ultrasound joint complete left
|
$616.00 |
$616.00 |
$616.00 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$1,044.05 |
$1,044.05 |
$1,044.05 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$694.40 |
$694.40 |
$694.40 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$478.80 |
$478.80 |
$478.80 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$329.35 |
$329.35 |
$3,200.34 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$845.95 |
$845.95 |
$2,172.01 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$618.45 |
$618.45 |
$618.45 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$710.85 |
$710.85 |
$710.85 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$512.75 |
$512.75 |
$2,023.47 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$877.10 |
$877.10 |
$877.10 |
$498.00
|
|
Ultrasound scrotum and contents
|
$908.25 |
$908.25 |
$908.25 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$212.80 |
$212.80 |
$212.80 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$261.45 |
$261.45 |
$1,468.21 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$705.25 |
$705.25 |
$705.25 |
$567.44
|
|
Unit mobile power mpu
|
$27,224.40 |
$27,224.40 |
$27,224.40 |
$17,052.34
|
|
Unlisted chemotherapy px
|
$39.90 |
$39.90 |
$39.90 |
$153.85
|
|
Unlisted CT procedure
|
$63.70 |
$63.70 |
$63.70 |
$1,043.00
|
|
Unlisted mr procedure
|
$1,262.80 |
$1,262.80 |
$1,262.80 |
$1,032.20
|
|
Unlisted orl service/px
|
$143.85 |
$143.85 |
$143.85 |
$121.50
|
|
Unlisted procedure liver
|
$385.35 |
$385.35 |
$385.35 |
$2,694.00
|
|
Unlisted procedure rectum
|
$349.65 |
$349.65 |
$349.65 |
$1,278.72
|
|
Unlisted procedure spine
|
$107.80 |
$107.80 |
$107.80 |
$4,706.35
|
|
Unlisted px hands/fingers
|
$423.50 |
$423.50 |
$423.50 |
$379.44
|
|
Unlisted px med radj physics
|
$1,106.00 |
$1,106.00 |
$1,106.00 |
$376.03
|
|
Unlisted resp px dx nuc med
|
$670.60 |
$670.60 |
$670.60 |
$545.61
|
|
Unlisted ultrasound procedure
|
$113.05 |
$113.05 |
$113.05 |
$321.20
|
|
Upgrade pm system
|
$3,911.95 |
$3,911.95 |
$62,103.08 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,984.45 |
$2,984.45 |
$38,955.65 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,536.80 |
$2,536.80 |
$2,536.80 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,760.85 |
$1,760.85 |
$21,388.91 |
$2,013.08
|
|
Urea nitrogen
|
$24.50 |
$24.50 |
$534.71 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$71.40 |
$71.40 |
$681.47 |
$50.00
|
|
Urethrcystgrphy rtrgrde s&i
|
$463.75 |
$463.75 |
$4,203.39 |
$574.40
|
|
Urethrocystography void s&i
|
$463.75 |
$463.75 |
$5,208.65 |
$634.50
|
|
Uric acid blood
|
$154.00 |
$154.00 |
$985.36 |
$46.64
|
|
Uric acid urine
|
$24.15 |
$24.15 |
$24.15 |
$46.75
|
|
Urinalysis microscopic only
|
$8.40 |
$8.40 |
$664.90 |
$26.35
|
|
Urinalysis (with microscopy)
|
$91.70 |
$91.70 |
$91.70 |
$48.14
|
|
Urinalysis (without microscopy)
|
$53.90 |
$53.90 |
$53.90 |
$38.99
|
|
Urine Culture Test
|
$173.25 |
$173.25 |
$1,759.26 |
$84.81
|
|
Urine pregnancy test
|
$143.50 |
$143.50 |
$143.50 |
$66.40
|
|
Urography, antegrade
|
$1,771.70 |
$1,771.70 |
$1,771.70 |
$593.37
|
|
Use 1st target lesion
|
$108.15 |
$108.15 |
$108.15 |
$245.30
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$5,224.38 |
$5,224.38 |
$5,224.38 |
$6,892.54
|
