|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$106.36 |
$106.36 |
$106.36 |
$5,258.52
|
|
Tomosynthesis breast screen bilateral
|
$54.78 |
$54.78 |
$54.78 |
$72.68
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$106.28 |
$106.28 |
$106.28 |
$325.00
|
|
Total Knee Replacement
|
$2,895.04 |
$2,895.04 |
$2,895.04 |
$14,543.50
|
|
Toxoplasma antibody igg
|
$50.63 |
$50.63 |
$50.63 |
$89.40
|
|
Toxoplasma antibody igm
|
$68.06 |
$68.06 |
$68.06 |
$87.00
|
|
Tpmt gene com vrnts
|
$189.24 |
$189.24 |
$189.24 |
$371.80
|
|
Trabectedin 1 mg intravenous solution
|
$2,570.75 |
$2,570.75 |
$2,570.75 |
$6,827.00
|
|
Transferrin
|
$115.37 |
$115.37 |
$115.37 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$1,743.83 |
$1,743.83 |
$1,743.83 |
$983.00
|
|
Transparent film <= 16 sq in
|
$1.27 |
$1.27 |
$1.27 |
$4.50
|
|
Trastuzumab 150 mg intravenous solution
|
$1,293.49 |
$1,293.49 |
$1,293.49 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$2,896.24 |
$2,896.24 |
$2,896.24 |
$7,540.20
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$1,790.05 |
$1,790.05 |
$1,790.05 |
$5,835.15
|
|
Tray bonemarrw oncontrol 102mm
|
$996.00 |
$996.00 |
$996.00 |
$940.80
|
|
Treat ankle dislocation
|
$1,290.65 |
$1,290.65 |
$1,290.65 |
$2,358.40
|
|
Treat clavicle dislocation 23545
|
$812.57 |
$812.57 |
$812.57 |
$705.60
|
|
Treat elbow dislocation
|
$1,440.88 |
$1,440.88 |
$1,440.88 |
$2,223.20
|
|
Treat finger fracture each
|
$869.01 |
$869.01 |
$869.01 |
$1,536.00
|
|
Treat foot bone lesion
|
$2,856.03 |
$2,856.03 |
$2,856.03 |
$3,839.54
|
|
Treat foot dislocation
|
$458.99 |
$458.99 |
$458.99 |
$396.30
|
|
Treat fracture of radius
|
$1,167.81 |
$1,167.81 |
$1,167.81 |
$1,790.00
|
|
Treat fracture of radius
|
$1,961.29 |
$1,961.29 |
$1,961.29 |
$1,849.00
|
|
Treat fracture of ulna
|
$332.00 |
$332.00 |
$332.00 |
$726.05
|
|
Treat hip dislocation
|
$1,717.27 |
$1,717.27 |
$1,717.27 |
$2,192.80
|
|
Treat hip dislocation
|
$1,542.14 |
$1,542.14 |
$1,542.14 |
$2,641.60
|
|
Treat humerus fracture
|
$1,424.28 |
$1,424.28 |
$1,424.28 |
$1,771.43
|
|
Treat humerus fracture
|
$1,249.15 |
$1,249.15 |
$1,249.15 |
$1,771.43
|
|
Treat knee fracture 27530
|
$942.88 |
$942.88 |
$942.88 |
$550.00
|
|
Treatment incomplete abortion completed surgically any trimester
|
$815.06 |
$815.06 |
$815.06 |
$3,916.04
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$206.67 |
$206.67 |
$206.67 |
$203.35
|
|
Treatment mouth roof lesion
|
$1,805.25 |
$1,805.25 |
$1,805.25 |
$4,256.70
|
|
Treatment of ankle fracture 27786
|
$731.23 |
$731.23 |
$731.23 |
$520.80
|
|
Treatment of fibula fracture 27780
|
$719.61 |
$719.61 |
$719.61 |
$491.50
|
|
Treatment of heel fracture 28400
|
$575.19 |
$575.19 |
$575.19 |
$473.00
|
|
Treatment of thigh fracture
|
$1,209.31 |
$1,209.31 |
$1,209.31 |
$548.90
|
|
Treatment of thigh fracture
|
$314.57 |
$314.57 |
$314.57 |
$1,772.97
|
|
Treatment of toe fracture 28510
|
$306.27 |
$306.27 |
$306.27 |
$369.70
|
|
Treat ulnar fracture
|
$1,074.02 |
$1,074.02 |
$1,074.02 |
$1,662.00
|
|
Treat vaginal bleeding
|
$567.72 |
$567.72 |
$567.72 |
$379.60
|
|
Treat wrist dislocation
|
$1,039.16 |
$1,039.16 |
$1,039.16 |
$656.25
|
|
Treponema pallidum antibody
|
$140.27 |
$140.27 |
$140.27 |
$70.40
|
|
Treprostinil injection
|
$660.52 |
$660.52 |
$660.52 |
$19,071.84
|
|
Treprostinil, non-comp unit
|
$4,053.72 |
$4,053.72 |
$4,053.72 |
$3,894.40
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$7.22 |
$7.22 |
$7.22 |
$43.21
|
|
Triglycerides
|
$54.78 |
$54.78 |
$54.78 |
$58.05
|
|
Trilaciclib 300 mg intravenous solution
|
$1,315.57 |
$1,315.57 |
$1,315.57 |
$4,043.12
|
|
Trimethobenzamide hcl inj
|
$21.17 |
$21.17 |
$21.17 |
$117.49
|
|
Trim nondyst nails
|
$81.34 |
$81.34 |
$81.34 |
$113.40
|
|
Triptorelin pamoate
|
$496.79 |
$496.79 |
$496.79 |
$4,619.39
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$2,013.58 |
$2,013.58 |
$2,013.58 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$2,295.78 |
$2,295.78 |
$2,295.78 |
$3,078.00
|
|
Troponin quantitative
|
$217.46 |
$217.46 |
$217.46 |
$127.20
|
|
Tube trach disp innr can 5 xlt
|
$522.66 |
$522.66 |
$522.66 |
$445.99
|
|
Tube trach fen sz 6 uncuffed
|
$212.23 |
$212.23 |
$212.23 |
$155.98
|
|
Tx closed hip disl traumatic without anes
|
$401.72 |
$401.72 |
$401.72 |
$581.07
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$1,930.58 |
$1,930.58 |
$1,930.58 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$805.93 |
$805.93 |
$805.93 |
$535.60
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$3,494.30 |
$3,494.30 |
$3,494.30 |
$4,468.55
|
|
Tx open iphlngl jt disl internal fixation sngl
|
$6,636.68 |
$6,636.68 |
$6,636.68 |
$4,421.00
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$470.61 |
$470.61 |
$470.61 |
$911.43
|
|
Ua w/micro/comp poc
|
$8.30 |
$8.30 |
$8.30 |
$23.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$1,448.70 |
$1,448.70 |
$1,448.70 |
$20,945.01
|
|
Ultrasound abdomen aorta screening study aaa
|
$448.20 |
$448.20 |
$448.20 |
$394.20
|
|
Ultrasound breast complete
|
$485.55 |
$485.55 |
$485.55 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$425.79 |
$425.79 |
$425.79 |
$449.35
|
|
Ultrasound chest
|
$451.52 |
$451.52 |
$451.52 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$332.00 |
$332.00 |
$332.00 |
$338.00
|
|
Ultrasound encephalogram
|
$472.27 |
$472.27 |
$472.27 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$585.15 |
$585.15 |
$585.15 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$582.66 |
$582.66 |
$582.66 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$588.47 |
$588.47 |
$588.47 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$830.00 |
$830.00 |
$830.00 |
$720.15
|
|
Ultrasound hips infant dynamic
|
$413.34 |
$413.34 |
$413.34 |
$403.88
|
|
Ultrasound joint complete left
|
$665.66 |
$665.66 |
$665.66 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$524.56 |
$524.56 |
$524.56 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$665.66 |
$665.66 |
$665.66 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$816.72 |
$816.72 |
$816.72 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,339.62 |
$1,339.62 |
$1,339.62 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$512.11 |
$512.11 |
$512.11 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$483.06 |
$483.06 |
$483.06 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$742.02 |
$742.02 |
$742.02 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$77.19 |
$77.19 |
$77.19 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$532.03 |
$532.03 |
$532.03 |
$486.50
|
|
Ultrasound scrotum and contents
|
$707.99 |
$707.99 |
$707.99 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$508.79 |
$508.79 |
$508.79 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$1,339.62 |
$1,339.62 |
$1,339.62 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$646.57 |
$646.57 |
$646.57 |
$558.35
|
|
Ultraviolet therapy
|
$31.54 |
$31.54 |
$31.54 |
$39.76
|
|
Unlisted orl service/px
|
$118.69 |
$118.69 |
$118.69 |
$132.60
|
|
Unlisted px casting/strpg
|
$132.80 |
$132.80 |
$132.80 |
$219.70
|
|
Unlisted px hands/fingers
|
$218.29 |
$218.29 |
$218.29 |
$354.20
|
|
Unlisted px small intestine
|
$2,774.69 |
$2,774.69 |
$2,774.69 |
$2,102.10
|
|
Unlisted px tongue flr mouth
|
$191.73 |
$191.73 |
$191.73 |
$282.50
|
|
Unlisted urinalysis px
|
$30.71 |
$30.71 |
$30.71 |
$25.72
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,142.53 |
$4,142.53 |
$4,142.53 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,697.50 |
$2,697.50 |
$2,697.50 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,211.27 |
$3,211.27 |
$3,211.27 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$2,244.32 |
$2,244.32 |
$2,244.32 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$2,244.32 |
$2,244.32 |
$2,244.32 |
$1,768.00
|