|
Tlh w/t/o 250 g or less
|
$16,562.31 |
$16,562.31 |
$16,562.31 |
$10,799.26
|
|
Tlh w/t/o uterus over 250 g
|
$18,214.68 |
$18,214.68 |
$18,214.68 |
$10,700.71
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$247.00 |
$247.00 |
$247.00 |
$72.00
|
|
Tobramycin peak therapeutic drug level
|
$73.45 |
$73.45 |
$73.45 |
$117.00
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$6,048.49 |
$6,048.49 |
$6,048.49 |
$2,743.02
|
|
Tomosynthesis breast diagnostic left
|
$63.70 |
$63.70 |
$63.70 |
$53.92
|
|
Tomosynthesis breast screen bilateral
|
$73.45 |
$73.45 |
$73.45 |
$77.46
|
|
Tonsillectomy (age 12+)
|
$3,618.35 |
$3,618.35 |
$3,618.35 |
$3,544.29
|
|
Tonsillectomy (child under 12)
|
$2,979.01 |
$2,979.01 |
$2,979.01 |
$4,182.80
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$325.00 |
$325.00 |
$325.00 |
$200.93
|
|
Toripalimab-tpzi 240 mg/6 ml (40 mg/ml) intravenous solution
|
$22,204.24 |
$22,204.24 |
$22,204.24 |
$39.50
|
|
Total hysterectomy
|
$8,783.60 |
$8,783.60 |
$8,783.60 |
$2,520.80
|
|
Toxoplasma antibody igg
|
$34.45 |
$34.45 |
$34.45 |
$83.20
|
|
Toxoplasma antibody igm
|
$72.80 |
$72.80 |
$72.80 |
$85.80
|
|
Tpmt gene com vrnts
|
$393.90 |
$393.90 |
$393.90 |
$402.35
|
|
Tprnl plmt biodegrdabl matrl
|
$9,652.16 |
$9,652.16 |
$9,652.16 |
$7,438.40
|
|
Trabectedin 1 mg intravenous solution
|
$8,987.27 |
$8,987.27 |
$8,987.27 |
$2,653.88
|
|
Trabeculoplasty laser surg
|
$828.75 |
$828.75 |
$828.75 |
$1,224.00
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$119.60 |
$119.60 |
$119.60 |
$90.35
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$64.84 |
$64.84 |
$64.84 |
$77.65
|
|
Transcatheter bx s&i
|
$1,326.65 |
$1,326.65 |
$1,326.65 |
$1,795.70
|
|
Transferrin
|
$28.60 |
$28.60 |
$28.60 |
$83.07
|
|
Transfusion blood/blood component(s)
|
$1,828.77 |
$1,828.77 |
$1,828.77 |
$988.24
|
|
Trastuzumab 150 mg intravenous solution
|
$3,551.91 |
$3,551.91 |
$3,551.91 |
$934.80
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$8,670.11 |
$8,670.11 |
$8,670.11 |
$43.28
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$7,721.21 |
$7,721.21 |
$7,721.21 |
$108.27
|
|
Trauma partial team response w/critical care services level 4
|
$3,452.80 |
$3,452.80 |
$3,452.80 |
$4,523.04
|
|
Treat ectopic pregnancy
|
$7,020.05 |
$7,020.05 |
$7,020.05 |
$6,000.90
|
|
Treatment incomplete abortion completed surgically any trimester
|
$4,089.57 |
$4,089.57 |
$4,089.57 |
$3,916.04
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$86.45 |
$86.45 |
$86.45 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$86.45 |
$86.45 |
$86.45 |
$140.04
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$105.95 |
$105.95 |
$105.95 |
$197.60
|
|
Treatment missed abortion completed surgically 1st trimester
|
$3,975.19 |
$3,975.19 |
$3,975.19 |
$3,820.53
|
|
Treatment of urethra lesion
|
$4,815.27 |
$4,815.27 |
$4,815.27 |
$2,267.41
|
|
Treatment radiation delivery level 2
|
$29,071.90 |
$29,071.90 |
$29,071.90 |
$737.25
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$96,516.06 |
$96,516.06 |
$96,516.06 |
$200.64
|
|
Treponema pallidum antibody
|
$81.90 |
$81.90 |
$81.90 |
$74.40
|
|
Trg gene rearrangement anal
|
$111.80 |
$111.80 |
$111.80 |
$474.50
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$24.98 |
$24.98 |
$24.98 |
$28.90
|
|
Trichinella antibody
|
$59.15 |
$59.15 |
$59.15 |
$56.55
|
|
Trichomonas assay w/optic
|
$42.25 |
$42.25 |
$42.25 |
$68.90
|
|
#tricyclicantidprssnt
|
$96.85 |
$96.85 |
$96.85 |
$38.73
|
|
Triglycerides
|
$57.85 |
$57.85 |
$57.85 |
$48.75
|
|
Trilaciclib 300 mg intravenous solution
|
$4,043.12 |
$4,043.12 |
$4,043.12 |
$5.39
|
|
Trimethobenzamide hcl inj
|
$204.03 |
$204.03 |
$204.03 |
$105.89
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$30,686.66 |
$30,686.66 |
$30,686.66 |
$9,418.42
|
|
Trnscath plc vas stent w/s&i ini vein
|
$19,390.58 |
$19,390.58 |
$19,390.58 |
$15,873.70
|
|
Trnscath retrv pq vasc fb w/guide
|
$4,455.75 |
$4,455.75 |
$4,455.75 |
$5,555.55
|
|
Troponin quantitative
|
$170.30 |
$170.30 |
$170.30 |
$112.80
|
|
Tte w or without contr, cont ecg
|
$1,669.20 |
$1,669.20 |
$1,669.20 |
$1,613.95
|
|
Tx atrial fib pulm vein isol
|
$34,596.25 |
$34,596.25 |
$34,596.25 |
$32,426.20
|
|
Tx l/r atrial fib addl
|
$6,028.75 |
$6,028.75 |
$6,028.75 |
$6,986.85
|
|
Tympanic membrane repair
|
$2,303.49 |
$2,303.49 |
$2,303.49 |
$1,856.00
|
|
Ua w/micro/comp poc
|
$55.25 |
$55.25 |
$55.25 |
$25.72
|
|
Ugt1a1 gene analy common variants
|
$715.65 |
$715.65 |
$715.65 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$286.65 |
$286.65 |
$286.65 |
$394.20
|
|
Ultrasound bone density measure
|
$100.75 |
$100.75 |
$100.75 |
$116.22
|
|
Ultrasound breast complete
|
$460.20 |
$460.20 |
$460.20 |
$519.20
|
|
Ultrasound breast unilateral limited (both sides)
|
$312.00 |
$312.00 |
$312.00 |
$427.00
|
|
Ultrasound chest
|
$430.30 |
$430.30 |
$430.30 |
$430.10
|
|
Ultrasound encephalogram
|
$440.05 |
$440.05 |
$440.05 |
$463.50
|
|
Ultrasound exam k transpl w/doppler
|
$478.40 |
$478.40 |
$478.40 |
$494.00
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$245.05 |
$245.05 |
$245.05 |
$428.68
|
|
Ultrasound guidance for vascular access
|
$269.10 |
$269.10 |
$269.10 |
$300.00
|
|
Ultrasound guided needle placement supervision & interpretation
|
$533.65 |
$533.65 |
$533.65 |
$629.64
|
|
Ultrasound guide intraoperative
|
$514.15 |
$514.15 |
$514.15 |
$628.80
|
|
Ultrasound guide tissue ablation
|
$377.00 |
$377.00 |
$377.00 |
$463.50
|
|
Ultrasound hips infant dynamic
|
$247.65 |
$247.65 |
$247.65 |
$395.20
|
|
Ultrasound infant hips ltd without stress
|
$161.20 |
$161.20 |
$161.20 |
$311.25
|
|
Ultrasound joint complete left
|
$557.05 |
$557.05 |
$557.05 |
$534.00
|
|
Ultrasound joint/nonvascular extremity limited left
|
$612.30 |
$612.30 |
$612.30 |
$426.60
|
|
Ultrasound ob >=14wks ea addl gest
|
$325.00 |
$325.00 |
$325.00 |
$431.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$209.30 |
$209.30 |
$209.30 |
$304.80
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$413.40 |
$413.40 |
$413.40 |
$680.71
|
|
Ultrasound pregnant uterus follow up per fetus
|
$228.15 |
$228.15 |
$228.15 |
$393.32
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$310.70 |
$310.70 |
$310.70 |
$434.20
|
|
Ultrasound pregnant uterus transvaginal
|
$356.20 |
$356.20 |
$356.20 |
$477.10
|
|
Ultrasound prostate/transrectal
|
$278.20 |
$278.20 |
$278.20 |
$515.63
|
|
Ultrasound retroperitoneal limited
|
$193.70 |
$193.70 |
$193.70 |
$469.58
|
|
Ultrasound scrotum and contents
|
$411.45 |
$411.45 |
$411.45 |
$558.03
|
|
Ultrasound spinal canal and contents
|
$414.70 |
$414.70 |
$414.70 |
$415.00
|
|
Ultrasound transabd ea addl gest
|
$340.60 |
$340.60 |
$340.60 |
$424.80
|
|
Ultrasound transvaginal non obstetric
|
$312.65 |
$312.65 |
$312.65 |
$523.20
|
|
Unlisted laparoscopic liver biopy 47379
|
$8,603.64 |
$8,603.64 |
$8,603.64 |
$6,307.38
|
|
Unlisted laparoscopic reduction intestine 44238
|
$6,658.92 |
$6,658.92 |
$6,658.92 |
$4,981.62
|
|
Unlisted laparoscopy procedure biliary tract 47579
|
$10,057.79 |
$10,057.79 |
$10,057.79 |
$8,312.83
|
|
Unlisted laps px appendix
|
$6,322.02 |
$6,322.02 |
$6,322.02 |
$3,617.40
|
|
Unlisted laps px ovidct ovry
|
$14,120.77 |
$14,120.77 |
$14,120.77 |
$4,713.11
|
|
Unlisted mr procedure
|
$1,032.20 |
$1,032.20 |
$1,032.20 |
$1,249.50
|
|
Unlisted neurological dx px
|
$138.45 |
$138.45 |
$138.45 |
$176.93
|
|
Unlisted procedure microbiology
|
$99.45 |
$99.45 |
$99.45 |
$384.15
|
|
Unlisted procedure rectum
|
$18,088.92 |
$18,088.92 |
$18,088.92 |
$1,395.50
|
|
Unlisted px arthroscopy
|
$13,085.92 |
$13,085.92 |
$13,085.92 |
$11,433.76
|
|
Unlisted px small intestine
|
$4,691.21 |
$4,691.21 |
$4,691.21 |
$2,493.00
|
|
Unsched dialysis esrd pt hos
|
$1,316.90 |
$1,316.90 |
$1,316.90 |
$980.20
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,886.00 |
$2,886.00 |
$2,886.00 |
$2,590.50
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,338.70 |
$2,338.70 |
$2,338.70 |
$2,001.87
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,976.00 |
$1,976.00 |
$1,976.00 |
$1,794.00
|
|
Upper Endoscopy (EGD, diagnostic)
|
$3,620.53 |
$3,620.53 |
$3,620.53 |
$1,760.00
|
|
Upper Endoscopy (EGD, with biopsy)
|
$4,093.84 |
$4,093.84 |
$4,093.84 |
$1,760.00
|