|
St treatment swallow dysfunction/oral
|
$198.39 |
$198.39 |
$198.39 |
$261.60
|
|
Subq njx fil matrl 5.1-10cc
|
$175.95 |
$175.95 |
$175.95 |
$748.14
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$84.15 |
$84.15 |
$84.15 |
$49.13
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$84.15 |
$84.15 |
$84.15 |
$151.29
|
|
Support clav 29.6-40.5in med
|
$43.87 |
$43.87 |
$43.87 |
$94.19
|
|
Surgical pathology level 1 gross examination only
|
$64.26 |
$64.26 |
$64.26 |
$92.59
|
|
Surgical pathology level 2 gross & microscopic examination
|
$64.26 |
$64.26 |
$64.26 |
$149.76
|
|
Surgical pathology level 3 gross & microscopic examination
|
$119.34 |
$119.34 |
$119.34 |
$192.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$119.34 |
$119.34 |
$119.34 |
$253.75
|
|
Surgical pathology level 5 gross & microscopic examination
|
$520.20 |
$520.20 |
$520.20 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,281.63 |
$1,281.63 |
$1,281.63 |
$790.00
|
|
Susceptibility agar dilution per agent
|
$42.33 |
$42.33 |
$42.33 |
$40.30
|
|
Susceptibility mic per plate
|
$72.42 |
$72.42 |
$72.42 |
$94.38
|
|
System cardiomems hosp electronics
|
$31,602.15 |
$31,602.15 |
$31,602.15 |
$41,639.82
|
|
System pacing micra av
|
$19,920.60 |
$19,920.60 |
$19,920.60 |
$24,469.57
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$6,120.00 |
$6,120.00 |
$6,120.00 |
$10,980.00
|
|
System sealant biosentry tract
|
$824.67 |
$824.67 |
$824.67 |
$900.00
|
|
T3 (triiodothyronine) free
|
$77.52 |
$77.52 |
$77.52 |
$89.82
|
|
T4 (thyroxine) free
|
$66.30 |
$66.30 |
$66.30 |
$81.60
|
|
T4 (thyroxine) total
|
$56.61 |
$56.61 |
$56.61 |
$73.64
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$5.61 |
$5.61 |
$5.61 |
$12.25
|
|
Tacrolimus therapeutic drug level
|
$106.59 |
$106.59 |
$106.59 |
$122.40
|
|
Telehealth original site facility fee
|
$70.38 |
$70.38 |
$70.38 |
$60.80
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$16,531.64 |
$16,531.64 |
$16,531.64 |
$16,531.64
|
|
Tenodesis biceps tdn at elbw
|
$1,309.68 |
$1,309.68 |
$1,309.68 |
$5,886.74
|
|
Tenosynovectomy radic 26145
|
$690.03 |
$690.03 |
$690.03 |
$1,893.86
|
|
Tenotomy length/rls abductor hallucis musc 28240
|
$3,657.72 |
$3,657.72 |
$3,657.72 |
$3,839.54
|
|
Tenotomy open tndn flxr toe sgl tndn spx
|
$1,881.90 |
$1,881.90 |
$1,881.90 |
$2,139.67
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$84.15 |
$84.15 |
$84.15 |
$46.10
|
|
Test stress cardiovascular tracing only
|
$464.61 |
$464.61 |
$464.61 |
$1,001.55
|
|
Therapeutic procd strg endur
|
$221.85 |
$221.85 |
$221.85 |
$85.80
|
|
Ther/proph/diag inj ia
|
$210.63 |
$210.63 |
$210.63 |
$247.33
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$84.15 |
$84.15 |
$84.15 |
$35.72
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$2,204.22 |
$2,204.22 |
$2,204.22 |
$1,804.00
|
|
Thoracotomy w/expl
|
$4,570.62 |
$4,570.62 |
$4,570.62 |
$2,045.17
|
|
Thoracotomy with cardiac massage
|
$2,652.51 |
$2,652.51 |
$2,652.51 |
$2,926.56
|
|
Thyroid (TSH) Test
|
$137.70 |
$137.70 |
$137.70 |
$120.00
|
|
Thyroid Ultrasound
|
$467.16 |
$467.16 |
$467.16 |
$589.96
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$4,163.47 |
$4,163.47 |
$4,163.47 |
$2,516.07
|
|
Tissue surgimend prs meshed 20 cm x 10 cm - cost per 0.5cm
|
$1,180.36 |
$1,180.36 |
$1,180.36 |
$2,085.14
|
|
Tlh w/t/o 250 g or less
|
$1,699.83 |
$1,699.83 |
$1,699.83 |
$10,799.26
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$84.15 |
$84.15 |
$84.15 |
$141.75
|
|
Tobramycin peak therapeutic drug level
|
$189.72 |
$189.72 |
$189.72 |
$121.55
|
|
Tomosynthesis breast screen bilateral
|
$70.89 |
$70.89 |
$70.89 |
$73.45
|
|
Total Hip Replacement
|
$2,032.86 |
$2,032.86 |
$2,032.86 |
$6,675.20
|
|
Total Knee Replacement
|
$2,101.20 |
$2,101.20 |
$2,101.20 |
$6,668.80
|
|
Tracheobrnchsc thru est trachs incisn
|
$787.44 |
$787.44 |
$787.44 |
$1,459.48
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$84.15 |
$84.15 |
$84.15 |
$77.65
|
|
Transferrin
|
$152.49 |
$152.49 |
$152.49 |
$87.30
|
|
Transfusion blood/blood component(s)
|
$534.48 |
$534.48 |
$534.48 |
$988.24
|
|
Transplant forearm tendon
|
$1,120.98 |
$1,120.98 |
$1,120.98 |
$3,762.00
|
|
Transplant hand tendon
|
$1,724.31 |
$1,724.31 |
$1,724.31 |
$3,821.05
|
|
Tray bonemarrw oncontrol 102mm
|
$4,207.50 |
$4,207.50 |
$4,207.50 |
$1,013.83
|
|
Treat ankle dislocation
|
$1,763.07 |
$1,763.07 |
$1,763.07 |
$2,207.20
|
|
Treat ankle dislocation
|
$6,746.79 |
$6,746.79 |
$6,746.79 |
$7,807.24
|
|
Treat big toe fracture
|
$3,657.72 |
$3,657.72 |
$3,657.72 |
$3,981.06
|
|
Treat clavicle dislocation 23545
|
$254.49 |
$254.49 |
$254.49 |
$734.00
|
|
Treat elbow dislocation
|
$3,324.18 |
$3,324.18 |
$3,324.18 |
$2,326.40
|
|
Treat elbow fracture
|
$1,763.07 |
$1,763.07 |
$1,763.07 |
$2,125.60
|
|
Treat elbow fracture
|
$4,010.13 |
$4,010.13 |
$4,010.13 |
$8,453.60
|
|
Treat eyelid by injection
|
$500.82 |
$500.82 |
$500.82 |
$472.21
|
|
Treat finger fracture each
|
$3,657.72 |
$3,657.72 |
$3,657.72 |
$4,108.00
|
|
Treat finger fracture each
|
$1,143.93 |
$1,143.93 |
$1,143.93 |
$1,815.75
|
|
Treat foot dislocation
|
$715.02 |
$715.02 |
$715.02 |
$435.60
|
|
Treat foot dislocation
|
$3,657.72 |
$3,657.72 |
$3,657.72 |
$3,935.24
|
|
Treat foot dislocation
|
$254.49 |
$254.49 |
$254.49 |
$527.28
|
|
Treat foot dislocation
|
$254.49 |
$254.49 |
$254.49 |
$478.40
|
|
Treat foot dislocation
|
$254.49 |
$254.49 |
$254.49 |
$404.04
|
|
Treat fracture of radius
|
$2,394.45 |
$2,394.45 |
$2,394.45 |
$2,030.33
|
|
Treat fracture of radius
|
$1,463.19 |
$1,463.19 |
$1,463.19 |
$2,316.75
|
|
Treat fracture of ulna
|
$468.18 |
$468.18 |
$468.18 |
$766.72
|
|
Treat hand dislocation
|
$1,763.07 |
$1,763.07 |
$1,763.07 |
$1,893.86
|
|
Treat hip dislocation
|
$1,463.19 |
$1,463.19 |
$1,463.19 |
$2,561.90
|
|
Treat hip dislocation
|
$1,763.07 |
$1,763.07 |
$1,763.07 |
$3,152.05
|
|
Treat humerus fracture
|
$8,038.62 |
$8,038.62 |
$8,038.62 |
$11,850.08
|
|
Treat humerus fracture
|
$1,763.07 |
$1,763.07 |
$1,763.07 |
$1,950.60
|
|
Treat humerus fracture
|
$7,328.19 |
$7,328.19 |
$7,328.19 |
$12,653.00
|
|
Treat humerus fracture
|
$1,763.07 |
$1,763.07 |
$1,763.07 |
$2,045.35
|
|
Treat humerus fracture
|
$1,369.35 |
$1,369.35 |
$1,369.35 |
$14,061.89
|
|
Treat kneecap dislocation
|
$1,338.75 |
$1,338.75 |
$1,338.75 |
$1,351.35
|
|
Treat kneecap fracture
|
$1,455.54 |
$1,455.54 |
$1,455.54 |
$5,741.00
|
|
Treat knee dislocation
|
$1,463.19 |
$1,463.19 |
$1,463.19 |
$2,592.08
|
|
Treat knee fracture
|
$1,324.47 |
$1,324.47 |
$1,324.47 |
$4,424.00
|
|
Treat knee fracture 27530
|
$613.02 |
$613.02 |
$613.02 |
$580.20
|
|
Treat knee fracture(s)
|
$254.49 |
$254.49 |
$254.49 |
$642.00
|
|
Treat knuckle dislocation
|
$3,324.18 |
$3,324.18 |
$3,324.18 |
$1,893.86
|
|
Treat lower leg dislocation
|
$254.49 |
$254.49 |
$254.49 |
$532.60
|
|
Treat lower leg dislocation
|
$3,657.72 |
$3,657.72 |
$3,657.72 |
$4,350.00
|
|
Treat lower leg fracture
|
$8,191.62 |
$8,191.62 |
$8,191.62 |
$12,905.86
|
|
Treat lower leg fracture
|
$7,767.30 |
$7,767.30 |
$7,767.30 |
$12,653.00
|
|
Treat lower leg joint
|
$4,208.01 |
$4,208.01 |
$4,208.01 |
$7,807.24
|
|
Treatment fx radial distal open w/internal fixation 2 frag left (restricted method ii cah)
|
$3,846.93 |
$3,846.93 |
$3,846.93 |
$8,370.75
|
|
Treatment fx radial distal open w/internal fixation 3+ frag left (restricted method ii cah)
|
$3,846.93 |
$3,846.93 |
$3,846.93 |
$8,370.75
|
|
Treatment fx radial distal open w/internal fixation left (restricted method ii cah)
|
$4,657.32 |
$4,657.32 |
$4,657.32 |
$8,370.75
|
|
Treatment incomplete abortion completed surgically any trimester
|
$3,474.63 |
$3,474.63 |
$3,474.63 |
$3,806.40
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$225.42 |
$225.42 |
$225.42 |
$210.00
|
|
Treatment missed abortion completed surgically 1st trimester
|
$3,474.63 |
$3,474.63 |
$3,474.63 |
$3,820.53
|
|
Treatment mouth roof lesion
|
$3,496.05 |
$3,496.05 |
$3,496.05 |
$4,350.00
|
|
Treatment of ankle fracture
|
$5,178.03 |
$5,178.03 |
$5,178.03 |
$7,907.11
|
|
Treatment of ankle fracture
|
$4,312.56 |
$4,312.56 |
$4,312.56 |
$7,907.11
|
