|
Treatment of ankle fracture
|
$55,693.99 |
$55,693.99 |
$55,693.99 |
$8,453.60
|
|
Treatment of ankle fracture
|
$49,685.91 |
$49,685.91 |
$49,685.91 |
$7,907.11
|
|
Treatment of thigh fracture
|
$1,507.80 |
$1,507.80 |
$1,507.80 |
$1,748.40
|
|
Treatment of thigh fracture
|
$1,507.80 |
$1,507.80 |
$1,507.80 |
$1,772.97
|
|
Treatment radiation delivery level 2
|
$1,005.00 |
$1,005.00 |
$1,005.00 |
$767.65
|
|
Treat metacarpal fracture
|
$33,562.41 |
$33,562.41 |
$33,562.41 |
$3,977.49
|
|
Treat metacarpal fracture
|
$26,307.25 |
$26,307.25 |
$26,307.25 |
$5,464.97
|
|
Treat metatarsal fracture
|
$39,863.38 |
$39,863.38 |
$39,863.38 |
$8,453.60
|
|
Treat spinal cord lesion
|
$1,987.80 |
$1,987.80 |
$1,987.80 |
$1,337.00
|
|
Treat thigh fracture
|
$445.80 |
$445.80 |
$445.80 |
$618.80
|
|
Treat ulnar fracture
|
$1,507.80 |
$1,507.80 |
$1,507.80 |
$1,662.00
|
|
Treat wrist dislocation
|
$445.80 |
$445.80 |
$445.80 |
$656.25
|
|
Treponema pallidum antibody
|
$84.60 |
$84.60 |
$84.60 |
$70.40
|
|
Trg gene rearrangement anal
|
$929.40 |
$929.40 |
$929.40 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$33.38 |
$33.38 |
$33.38 |
$43.21
|
|
Trichinella antibody
|
$27.00 |
$27.00 |
$27.00 |
$70.20
|
|
#tricyclicantidprssnt
|
$111.60 |
$111.60 |
$111.60 |
$50.86
|
|
Triglycerides
|
$61.20 |
$61.20 |
$61.20 |
$58.05
|
|
Trim nondyst nails
|
$64.80 |
$64.80 |
$64.80 |
$113.40
|
|
Trnscath plc stent crv crtd w/prtct
|
$11,109.00 |
$11,109.00 |
$11,109.00 |
$9,767.25
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$9,810.60 |
$9,810.60 |
$9,810.60 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$10,301.40 |
$10,301.40 |
$10,301.40 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$27,872.40 |
$27,872.40 |
$27,872.40 |
$15,330.11
|
|
Trnscath retrv pq vasc fb w/guide
|
$5,362.80 |
$5,362.80 |
$5,362.80 |
$4,523.96
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$4,245.00 |
$4,245.00 |
$4,245.00 |
$5,069.50
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$4,221.00 |
$4,221.00 |
$4,221.00 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$6,027.00 |
$6,027.00 |
$6,027.00 |
$3,866.70
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$52,488.25 |
$52,488.25 |
$52,488.25 |
$4,713.66
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$36,788.53 |
$36,788.53 |
$36,788.53 |
$2,357.04
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$22,509.06 |
$22,509.06 |
$22,509.06 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$41,482.04 |
$41,482.04 |
$41,482.04 |
$2,371.50
|
|
Troponin quantitative
|
$54.60 |
$54.60 |
$54.60 |
$127.20
|
|
Tte w or without fol w/con,stres
|
$1,886.40 |
$1,886.40 |
$1,886.40 |
$1,632.80
|
|
Tube trach disp innr can 5 xlt
|
$733.67 |
$733.67 |
$733.67 |
$445.99
|
|
Tx atrial fib pulm vein isol
|
$25,746.00 |
$25,746.00 |
$25,746.00 |
$29,030.54
|
|
Tx closed hip disl traumatic without anes
|
$445.80 |
$445.80 |
$445.80 |
$581.07
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$4,135.80 |
$4,135.80 |
$4,135.80 |
$3,977.49
|
|
Tx l/r atrial fib addl
|
$9,617.40 |
$9,617.40 |
$9,617.40 |
$6,769.00
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$48,124.81 |
$48,124.81 |
$48,124.81 |
$4,499.12
|
|
Ugt1a1 gene analy common variants
|
$243.60 |
$243.60 |
$243.60 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$829.20 |
$829.20 |
$829.20 |
$394.20
|
|
Ultrasound breast complete
|
$570.60 |
$570.60 |
$570.60 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$456.60 |
$456.60 |
$456.60 |
$449.35
|
|
Ultrasound chest
|
$554.40 |
$554.40 |
$554.40 |
$460.85
|
|
Ultrasound elastography parenchyma
|
$455.40 |
$455.40 |
$455.40 |
$307.00
|
|
Ultrasound exam k transpl w/doppler
|
$280.80 |
$280.80 |
$280.80 |
$573.54
|
|
Ultrasound guidance for vascular access
|
$914.40 |
$914.40 |
$914.40 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$878.40 |
$878.40 |
$878.40 |
$720.15
|
|
Ultrasound guide intraoperative
|
$492.00 |
$492.00 |
$492.00 |
$632.85
|
|
Ultrasound joint complete left
|
$630.00 |
$630.00 |
$630.00 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$426.00 |
$426.00 |
$426.00 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$431.40 |
$431.40 |
$431.40 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$12.00 |
$12.00 |
$12.00 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$970.20 |
$970.20 |
$970.20 |
$707.20
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$541.20 |
$541.20 |
$541.20 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$624.00 |
$624.00 |
$624.00 |
$497.12
|
|
Ultrasound retroperitoneal limited
|
$523.80 |
$523.80 |
$523.80 |
$486.50
|
|
Ultrasound scrotum and contents
|
$743.40 |
$743.40 |
$743.40 |
$608.90
|
|
Ultrasound transvaginal non obstetric
|
$714.60 |
$714.60 |
$714.60 |
$558.35
|
|
Unlisted cranfcl&maxlfcl px
|
$15,444.64 |
$15,444.64 |
$15,444.64 |
$571.20
|
|
Unlisted laparoscopic liver biopy 47379
|
$45,307.86 |
$45,307.86 |
$45,307.86 |
$5,419.00
|
|
Unlisted laparoscopic reduction intestine 44238
|
$28,676.83 |
$28,676.83 |
$28,676.83 |
$5,419.00
|
|
Unlisted maaa
|
$141.60 |
$141.60 |
$141.60 |
$235.20
|
|
Unlisted mr procedure
|
$1,428.00 |
$1,428.00 |
$1,428.00 |
$1,163.00
|
|
Unlisted procedure spine
|
$97,547.30 |
$97,547.30 |
$97,547.30 |
$4,659.85
|
|
Unlisted px arthroscopy
|
$50,872.69 |
$50,872.69 |
$50,872.69 |
$2,765.60
|
|
Unlisted px hands/fingers
|
$453.60 |
$453.60 |
$453.60 |
$354.20
|
|
Unlisted px pelvis/hip joint
|
$29,401.70 |
$29,401.70 |
$29,401.70 |
$3,118.44
|
|
Unlisted px tongue flr mouth
|
$289.20 |
$289.20 |
$289.20 |
$282.50
|
|
Unlisted px vestibule mouth
|
$461.40 |
$461.40 |
$461.40 |
$456.96
|
|
Unlisted ultrasound procedure
|
$181.20 |
$181.20 |
$181.20 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$1,174.80 |
$1,174.80 |
$1,174.80 |
$1,268.17
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$5,152.20 |
$5,152.20 |
$5,152.20 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$4,140.60 |
$4,140.60 |
$4,140.60 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,602.40 |
$3,602.40 |
$3,602.40 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$4,261.53 |
$4,261.53 |
$4,261.53 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$5,207.63 |
$5,207.63 |
$5,207.63 |
$1,768.00
|
|
Uppr gi scope w/submuc inj
|
$6,257.85 |
$6,257.85 |
$6,257.85 |
$1,872.00
|
|
Urea nitrogen
|
$52.20 |
$52.20 |
$52.20 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$60.60 |
$60.60 |
$60.60 |
$51.75
|
|
Urea nitrogen clearance
|
$67.20 |
$67.20 |
$67.20 |
$42.25
|
|
Urethrcystgrphy rtrgrde s&i
|
$665.40 |
$665.40 |
$665.40 |
$579.73
|
|
Uric acid blood
|
$70.20 |
$70.20 |
$70.20 |
$48.75
|
|
Uric acid urine
|
$55.80 |
$55.80 |
$55.80 |
$44.33
|
|
Urinalysis microscopic only
|
$43.20 |
$43.20 |
$43.20 |
$26.35
|
|
Urinalysis (with microscopy)
|
$1,158.00 |
$1,158.00 |
$1,158.00 |
$55.00
|
|
Urinalysis (without microscopy)
|
$40.80 |
$40.80 |
$40.80 |
$35.75
|
|
Urine Culture Test
|
$75.60 |
$75.60 |
$75.60 |
$81.50
|
|
Urine pregnancy test
|
$91.80 |
$91.80 |
$91.80 |
$67.20
|
|
Urography, antegrade
|
$987.00 |
$987.00 |
$987.00 |
$622.35
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$15,897.38 |
$15,897.38 |
$15,897.38 |
$5,184.34
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$54,659.03 |
$54,659.03 |
$54,659.03 |
$51,633.07
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$66.36 |
$66.36 |
$66.36 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$84.60 |
$84.60 |
$84.60 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$75.00 |
$75.00 |
$75.00 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$25.80 |
$25.80 |
$25.80 |
$79.15
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$46.20 |
$46.20 |
$46.20 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$190.20 |
$190.20 |
$190.20 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$0.01 |
$0.01 |
$0.01 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$155.40 |
$155.40 |
$155.40 |
$576.48
|
