|
Treatment of ankle fracture
|
$40,208.59 |
$40,208.59 |
$40,208.59 |
$8,412.89
|
|
Treatment of ankle fracture
|
$43,820.13 |
$43,820.13 |
$43,820.13 |
$8,453.60
|
|
Treatment of ankle fracture
|
$56,227.04 |
$56,227.04 |
$56,227.04 |
$7,913.97
|
|
Treatment of thigh fracture
|
$1,195.80 |
$1,195.80 |
$1,195.80 |
$1,748.40
|
|
Treatment of thigh fracture
|
$1,965.00 |
$1,965.00 |
$1,965.00 |
$1,772.97
|
|
Treat radius fracture
|
$39,807.47 |
$39,807.47 |
$39,807.47 |
$7,807.24
|
|
Treat thigh fracture
|
$658.20 |
$658.20 |
$658.20 |
$618.80
|
|
Treat ulnar fracture
|
$1,195.80 |
$1,195.80 |
$1,195.80 |
$1,662.00
|
|
Treat wrist dislocation
|
$172.80 |
$172.80 |
$172.80 |
$656.25
|
|
Treponema pallidum antibody
|
$95.40 |
$95.40 |
$95.40 |
$70.40
|
|
Treprostinil, non-comp unit
|
$6,973.95 |
$6,973.95 |
$6,973.95 |
$3,894.40
|
|
Trg gene rearrangement anal
|
$1,093.20 |
$1,093.20 |
$1,093.20 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$80.33 |
$80.33 |
$80.33 |
$43.21
|
|
Triglycerides
|
$53.40 |
$53.40 |
$53.40 |
$58.05
|
|
Trim nondyst nails
|
$96.00 |
$96.00 |
$96.00 |
$113.40
|
|
Trluml dil aq o/f can without st
|
$22,469.23 |
$22,469.23 |
$22,469.23 |
$5,419.00
|
|
Trnscath plc stent crv crtd w/prtct
|
$12,703.80 |
$12,703.80 |
$12,703.80 |
$9,767.25
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$12,603.60 |
$12,603.60 |
$12,603.60 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ini vein
|
$14,173.20 |
$14,173.20 |
$14,173.20 |
$15,330.11
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$2,383.20 |
$2,383.20 |
$2,383.20 |
$5,069.50
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$5,314.80 |
$5,314.80 |
$5,314.80 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$2,483.40 |
$2,483.40 |
$2,483.40 |
$3,866.70
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$13,177.20 |
$13,177.20 |
$13,177.20 |
$4,713.66
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$9,560.26 |
$9,560.26 |
$9,560.26 |
$2,357.04
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$10,367.09 |
$10,367.09 |
$10,367.09 |
$3,078.00
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$7,064.35 |
$7,064.35 |
$7,064.35 |
$2,371.50
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$19,708.70 |
$19,708.70 |
$19,708.70 |
$2,371.50
|
|
Troponin quantitative
|
$74.40 |
$74.40 |
$74.40 |
$127.20
|
|
Tube trach disp innr can 5 xlt
|
$883.57 |
$883.57 |
$883.57 |
$445.99
|
|
Tx atrial fib pulm vein isol
|
$27,578.40 |
$27,578.40 |
$27,578.40 |
$29,030.54
|
|
Tx closed hip disl traumatic without anes
|
$172.80 |
$172.80 |
$172.80 |
$581.07
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$4,878.00 |
$4,878.00 |
$4,878.00 |
$3,977.49
|
|
Tx l/r atrial fib addl
|
$8,718.60 |
$8,718.60 |
$8,718.60 |
$6,769.00
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$25,614.09 |
$25,614.09 |
$25,614.09 |
$4,499.12
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$31,711.76 |
$31,711.76 |
$31,711.76 |
$4,468.55
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$18,568.09 |
$18,568.09 |
$18,568.09 |
$4,499.12
|
|
Ua w/micro/comp poc
|
$13.80 |
$13.80 |
$13.80 |
$23.00
|
|
Ultrasound abdomen aorta screening study aaa
|
$1,010.40 |
$1,010.40 |
$1,010.40 |
$394.20
|
|
Ultrasound breast complete
|
$717.00 |
$717.00 |
$717.00 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$583.20 |
$583.20 |
$583.20 |
$449.35
|
|
Ultrasound chest
|
$1,002.00 |
$1,002.00 |
$1,002.00 |
$460.85
|
|
Ultrasound elastography parenchyma
|
$425.40 |
$425.40 |
$425.40 |
$307.00
|
|
Ultrasound encephalogram
|
$1,581.60 |
$1,581.60 |
$1,581.60 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$1,762.80 |
$1,762.80 |
$1,762.80 |
$573.54
|
|
Ultrasound guidance for vascular access
|
$701.40 |
$701.40 |
$701.40 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$1,174.80 |
$1,174.80 |
$1,174.80 |
$720.15
|
|
Ultrasound guide tissue ablation
|
$500.40 |
$500.40 |
$500.40 |
$560.00
|
|
Ultrasound joint complete left
|
$696.00 |
$696.00 |
$696.00 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$615.60 |
$615.60 |
$615.60 |
$425.45
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$829.80 |
$829.80 |
$829.80 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$1,838.40 |
$1,838.40 |
$1,838.40 |
$497.12
|
|
Ultrasound retroperitoneal limited
|
$855.60 |
$855.60 |
$855.60 |
$486.50
|
|
Ultrasound scrotum and contents
|
$1,823.40 |
$1,823.40 |
$1,823.40 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$964.20 |
$964.20 |
$964.20 |
$463.00
|
|
Ultrasound transvaginal non obstetric
|
$1,605.00 |
$1,605.00 |
$1,605.00 |
$558.35
|
|
Umbilical artery cath newborn 36660
|
$3,078.00 |
$3,078.00 |
$3,078.00 |
$206.64
|
|
Unlisted dx gi procedure
|
$4,806.18 |
$4,806.18 |
$4,806.18 |
$649.22
|
|
Unlisted hystsc px uterus
|
$12,787.92 |
$12,787.92 |
$12,787.92 |
$2,803.60
|
|
Unlisted laparoscopic liver biopy 47379
|
$22,974.11 |
$22,974.11 |
$22,974.11 |
$5,419.00
|
|
Unlisted laparoscopic reduction intestine 44238
|
$13,753.13 |
$13,753.13 |
$13,753.13 |
$5,419.00
|
|
Unlisted laps px bladder
|
$26,213.59 |
$26,213.59 |
$26,213.59 |
$5,082.74
|
|
Unlisted maaa
|
$141.60 |
$141.60 |
$141.60 |
$235.20
|
|
Unlisted procedure rectum
|
$19,780.91 |
$19,780.91 |
$19,780.91 |
$1,220.35
|
|
Unlisted px hands/fingers
|
$453.60 |
$453.60 |
$453.60 |
$354.20
|
|
Unlisted px pelvis/hip joint
|
$23,839.55 |
$23,839.55 |
$23,839.55 |
$3,118.44
|
|
Unlisted px tongue flr mouth
|
$174.00 |
$174.00 |
$174.00 |
$282.50
|
|
Unlisted px vestibule mouth
|
$461.40 |
$461.40 |
$461.40 |
$456.96
|
|
Unlstd laps px sprmatic cord
|
$17,663.69 |
$17,663.69 |
$17,663.69 |
$4,713.11
|
|
Unsched dialysis esrd pt hos
|
$1,419.60 |
$1,419.60 |
$1,419.60 |
$1,268.17
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,525.00 |
$3,525.00 |
$3,525.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,852.20 |
$1,852.20 |
$1,852.20 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,289.60 |
$2,289.60 |
$2,289.60 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$5,076.73 |
$5,076.73 |
$5,076.73 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$7,215.41 |
$7,215.41 |
$7,215.41 |
$1,768.00
|
|
Uppr gi scope w/submuc inj
|
$8,915.83 |
$8,915.83 |
$8,915.83 |
$1,872.00
|
|
Urea nitrogen
|
$28.80 |
$28.80 |
$28.80 |
$41.46
|
|
Uric acid blood
|
$41.40 |
$41.40 |
$41.40 |
$48.75
|
|
Uric acid urine
|
$43.20 |
$43.20 |
$43.20 |
$44.33
|
|
Urinalysis microscopic only
|
$12.60 |
$12.60 |
$12.60 |
$26.35
|
|
Urinalysis (with microscopy)
|
$163.20 |
$163.20 |
$163.20 |
$55.00
|
|
Urinalysis (without microscopy)
|
$67.80 |
$67.80 |
$67.80 |
$35.75
|
|
Urine Culture Test
|
$156.00 |
$156.00 |
$156.00 |
$81.50
|
|
Urine pregnancy test
|
$124.80 |
$124.80 |
$124.80 |
$67.20
|
|
Urography, antegrade
|
$945.00 |
$945.00 |
$945.00 |
$622.35
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$24,418.37 |
$24,418.37 |
$24,418.37 |
$5,184.34
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$83,956.27 |
$83,956.27 |
$83,956.27 |
$51,633.07
|
|
Vaccine dtap < 7 years im
|
$110.97 |
$110.97 |
$110.97 |
$68.19
|
|
Vaccine dtap-ipv 4-6 years im
|
$61.80 |
$61.80 |
$61.80 |
$105.95
|
|
Vaccine dtap-ipv-hib-hepb im
|
$145.20 |
$145.20 |
$145.20 |
$174.72
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$118.03 |
$118.03 |
$118.03 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$50.27 |
$50.27 |
$50.27 |
$43.12
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$87.60 |
$87.60 |
$87.60 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$47.40 |
$47.40 |
$47.40 |
$79.15
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$97.20 |
$97.20 |
$97.20 |
$155.16
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$98.76 |
$98.76 |
$98.76 |
$75.39
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$65.40 |
$65.40 |
$65.40 |
$143.20
|
|
Vaccine influenza inactivated adjuvant im
|
$67.80 |
$67.80 |
$67.80 |
$109.50
|
|
Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im
|
$81.00 |
$81.00 |
$81.00 |
$72.80
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$18.00 |
$18.00 |
$18.00 |
$33.60
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$63.60 |
$63.60 |
$63.60 |
$72.00
|
