|
Treatment of fibula fracture 27780
|
$221.40 |
$221.40 |
$221.40 |
$491.50
|
|
Treatment of thigh fracture
|
$629.10 |
$629.10 |
$629.10 |
$1,748.40
|
|
Treatment radiation delivery level 2
|
$173.40 |
$173.40 |
$173.40 |
$767.65
|
|
Treat midfoot fracture each
|
$76.05 |
$76.05 |
$76.05 |
$1,851.78
|
|
Treat thigh fx growth plate
|
$96.75 |
$96.75 |
$96.75 |
$475.68
|
|
Treat ulnar fracture
|
$211.95 |
$211.95 |
$211.95 |
$1,662.00
|
|
Treat wrist bone fracture
|
$211.95 |
$211.95 |
$211.95 |
$1,548.40
|
|
Treat wrist dislocation
|
$211.95 |
$211.95 |
$211.95 |
$656.25
|
|
Treponema pallidum antibody
|
$23.10 |
$23.10 |
$23.10 |
$70.40
|
|
Trg gene rearrangement anal
|
$352.80 |
$352.80 |
$352.80 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$22.89 |
$22.89 |
$22.89 |
$43.21
|
|
#tricyclicantidprssnt
|
$29.70 |
$29.70 |
$29.70 |
$50.86
|
|
Triglycerides
|
$10.05 |
$10.05 |
$10.05 |
$58.05
|
|
Trim nail(s)
|
$12.15 |
$12.15 |
$12.15 |
$79.00
|
|
Trim nondyst nails
|
$12.15 |
$12.15 |
$12.15 |
$113.40
|
|
Trnscath plc stent crv crtd without prtct
|
$2,812.05 |
$2,812.05 |
$2,812.05 |
$7,795.71
|
|
Trnscath plc stent crv crtd w/prtct
|
$2,812.05 |
$2,812.05 |
$2,812.05 |
$9,767.25
|
|
Trnscath plc stnt ante carotid art
|
$5,874.15 |
$5,874.15 |
$5,874.15 |
$6,069.00
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$3,699.90 |
$3,699.90 |
$3,699.90 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$2,708.70 |
$2,708.70 |
$2,708.70 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$4,660.20 |
$4,660.20 |
$4,660.20 |
$15,330.11
|
|
Trnscath retrv pq vasc fb w/guide
|
$1,487.10 |
$1,487.10 |
$1,487.10 |
$4,523.96
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$1,516.20 |
$1,516.20 |
$1,516.20 |
$5,069.50
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$1,401.75 |
$1,401.75 |
$1,401.75 |
$4,250.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$1,401.75 |
$1,401.75 |
$1,401.75 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$1,516.20 |
$1,516.20 |
$1,516.20 |
$3,866.70
|
|
Troponin quantitative
|
$17.10 |
$17.10 |
$17.10 |
$127.20
|
|
Tx atrial fib pulm vein isol
|
$4,032.60 |
$4,032.60 |
$4,032.60 |
$29,030.54
|
|
Tx closed hip disl traumatic without anes
|
$245.85 |
$245.85 |
$245.85 |
$581.07
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$1,394.10 |
$1,394.10 |
$1,394.10 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$191.10 |
$191.10 |
$191.10 |
$535.60
|
|
Tx l/r atrial fib addl
|
$513.90 |
$513.90 |
$513.90 |
$6,769.00
|
|
Tx tarsal bone fx without manip 28450
|
$63.30 |
$63.30 |
$63.30 |
$416.16
|
|
U2af1 gene common variants
|
$248.10 |
$248.10 |
$248.10 |
$243.34
|
|
Ugt1a1 gene analy common variants
|
$157.80 |
$157.80 |
$157.80 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$101.55 |
$101.55 |
$101.55 |
$394.20
|
|
Ultrasound breast complete
|
$101.55 |
$101.55 |
$101.55 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$96.45 |
$96.45 |
$96.45 |
$449.35
|
|
Ultrasound chest
|
$101.55 |
$101.55 |
$101.55 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$101.55 |
$101.55 |
$101.55 |
$338.00
|
|
Ultrasound elastography parenchyma
|
$101.55 |
$101.55 |
$101.55 |
$307.00
|
|
Ultrasound encephalogram
|
$101.55 |
$101.55 |
$101.55 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$101.55 |
$101.55 |
$101.55 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$101.55 |
$101.55 |
$101.55 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$101.55 |
$101.55 |
$101.55 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$101.55 |
$101.55 |
$101.55 |
$720.15
|
|
Ultrasound guide intraoperative
|
$101.55 |
$101.55 |
$101.55 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$91.65 |
$91.65 |
$91.65 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$101.55 |
$101.55 |
$101.55 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$96.45 |
$96.45 |
$96.45 |
$311.25
|
|
Ultrasound joint complete left
|
$101.55 |
$101.55 |
$101.55 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$101.55 |
$101.55 |
$101.55 |
$425.45
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$101.55 |
$101.55 |
$101.55 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$50.70 |
$50.70 |
$50.70 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$50.70 |
$50.70 |
$50.70 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$101.55 |
$101.55 |
$101.55 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$101.55 |
$101.55 |
$101.55 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$101.55 |
$101.55 |
$101.55 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$101.55 |
$101.55 |
$101.55 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$101.55 |
$101.55 |
$101.55 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$96.45 |
$96.45 |
$96.45 |
$486.50
|
|
Ultrasound scrotum and contents
|
$101.55 |
$101.55 |
$101.55 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$101.55 |
$101.55 |
$101.55 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$50.70 |
$50.70 |
$50.70 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$101.55 |
$101.55 |
$101.55 |
$558.35
|
|
Unlisted chemotherapy px
|
$16.95 |
$16.95 |
$16.95 |
$150.00
|
|
Unlisted CT procedure
|
$559.65 |
$559.65 |
$559.65 |
$732.70
|
|
Unlisted dialysis procedure
|
$301.05 |
$301.05 |
$301.05 |
$1,144.00
|
|
Unlisted procedure microbiology
|
$51.75 |
$51.75 |
$51.75 |
$523.50
|
|
Unlisted px casting/strpg
|
$54.30 |
$54.30 |
$54.30 |
$219.70
|
|
Unlisted px small intestine
|
$1,100.70 |
$1,100.70 |
$1,100.70 |
$2,102.10
|
|
Unlisted spec derm svc/px
|
$86.85 |
$86.85 |
$86.85 |
$223.08
|
|
Unlisted special svc px/rprt
|
$1.20 |
$1.20 |
$1.20 |
$90.00
|
|
Unlisted transfusion med px
|
$12.30 |
$12.30 |
$12.30 |
$147.50
|
|
Unsched dialysis esrd pt hos
|
$166.80 |
$166.80 |
$166.80 |
$1,268.17
|
|
Upgrade pm system
|
$4,780.35 |
$4,780.35 |
$4,780.35 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$668.55 |
$668.55 |
$668.55 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$636.75 |
$636.75 |
$636.75 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$604.95 |
$604.95 |
$604.95 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$426.60 |
$426.60 |
$426.60 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$384.60 |
$384.60 |
$384.60 |
$1,768.00
|
|
Urea nitrogen
|
$6.90 |
$6.90 |
$6.90 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$7.95 |
$7.95 |
$7.95 |
$51.75
|
|
Ureteral reflux study
|
$182.70 |
$182.70 |
$182.70 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$119.55 |
$119.55 |
$119.55 |
$579.73
|
|
Urethrocystography void s&i
|
$119.55 |
$119.55 |
$119.55 |
$622.35
|
|
Uric acid blood
|
$7.95 |
$7.95 |
$7.95 |
$48.75
|
|
Uric acid urine
|
$8.40 |
$8.40 |
$8.40 |
$44.33
|
|
Urinalysis microscopic only
|
$5.40 |
$5.40 |
$5.40 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$3.75 |
$3.75 |
$3.75 |
$25.72
|
|
Urinalysis (with microscopy)
|
$5.70 |
$5.70 |
$5.70 |
$55.00
|
|
Urinalysis (without microscopy)
|
$3.90 |
$3.90 |
$3.90 |
$35.75
|
|
Urine Culture Test
|
$13.95 |
$13.95 |
$13.95 |
$81.50
|
|
Urine pregnancy test
|
$11.10 |
$11.10 |
$11.10 |
$67.20
|
|
Urography, antegrade
|
$119.55 |
$119.55 |
$119.55 |
$622.35
|
|
Vaccine dtap < 7 years im
|
$57.05 |
$57.05 |
$57.05 |
$68.19
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$57.08 |
$57.08 |
$57.08 |
$155.16
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$55.58 |
$55.58 |
$55.58 |
$75.39
|
|
Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im
|
$56.09 |
$56.09 |
$56.09 |
$72.80
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$23.12 |
$23.12 |
$23.12 |
$33.60
|
