|
Tlh w/t/o 250 g or less
|
$12,320.22 |
$12,320.22 |
$12,320.22 |
$12,320.22
|
|
Tlh w/t/o uterus over 250 g
|
$12,320.22 |
$12,320.22 |
$12,320.22 |
$12,320.22
|
|
Tnot opn elbw to sho ea tdn
|
$3,839.54 |
$3,839.54 |
$3,839.54 |
$2,564.80
|
|
Tobramycin peak therapeutic drug level
|
$16.13 |
$16.13 |
$16.13 |
$120.60
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$5.96 |
$5.96 |
$5.96 |
$5,258.52
|
|
Toe X-ray (both feet)
|
$104.19 |
$104.19 |
$104.19 |
$259.50
|
|
Tomosynthesis breast diagnostic left
|
$48.76 |
$48.76 |
$48.76 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$58.42 |
$58.42 |
$58.42 |
$74.10
|
|
Tone decay hearing test
|
$46.45 |
$46.45 |
$46.45 |
$90.37
|
|
Tongue base vol reduction
|
$3,837.72 |
$3,837.72 |
$3,837.72 |
$3,837.72
|
|
Tongue biopsy; posterior one-third 41105
|
$3,837.72 |
$3,837.72 |
$3,837.72 |
$3,592.74
|
|
Tongue suspension
|
$7,000.36 |
$7,000.36 |
$7,000.36 |
$4,082.40
|
|
Tongue to lip surgery
|
$3,837.72 |
$3,837.72 |
$3,837.72 |
$3,837.72
|
|
Tonsillectomy (age 12+)
|
$3,837.72 |
$3,837.72 |
$3,837.72 |
$4,558.89
|
|
Tonsillectomy (child under 12)
|
$7,000.36 |
$7,000.36 |
$7,000.36 |
$6,056.50
|
|
Toripalimab-tpzi 240 mg/6 ml (40 mg/ml) intravenous solution
|
$38.87 |
$38.87 |
$38.87 |
$15,383.12
|
|
Total Hip Replacement
|
$15,226.08 |
$15,226.08 |
$15,226.08 |
$9,161.60
|
|
Total Knee Replacement
|
$15,226.08 |
$15,226.08 |
$15,226.08 |
$14,061.89
|
|
Tot disc arthrp 1ntrspc crv
|
$21,762.05 |
$21,762.05 |
$21,762.05 |
$20,154.40
|
|
Tot estradiol response panel
|
$55.89 |
$55.89 |
$55.89 |
$140.80
|
|
Toxoplasma antibody igg
|
$14.39 |
$14.39 |
$14.39 |
$90.00
|
|
Toxoplasma antibody igm
|
$14.41 |
$14.41 |
$14.41 |
$89.05
|
|
Tp53 gene full gene sequence
|
$641.85 |
$641.85 |
$641.85 |
$706.04
|
|
Tp53 gene known famil vrnt
|
$308.00 |
$308.00 |
$308.00 |
$395.40
|
|
Tp53 gene trgt sequence alys
|
$329.51 |
$329.51 |
$329.51 |
$790.68
|
|
Tpmt gene com vrnts
|
$174.81 |
$174.81 |
$174.81 |
$371.80
|
|
Tprnl balo cntnc dev adjmt
|
$287.81 |
$287.81 |
$287.81 |
$551.20
|
|
Tprnl balo cntnc dev bi
|
$15,374.71 |
$15,374.71 |
$15,374.71 |
$15,403.70
|
|
Tprnl balo cntnc dev rmvl ea
|
$4,081.37 |
$4,081.37 |
$4,081.37 |
$5,419.00
|
|
Tprnl balo cntnc dev uni
|
$10,942.71 |
$10,942.71 |
$10,942.71 |
$9,945.60
|
|
Tprnl plmt biodegrdabl matrl
|
$6,015.75 |
$6,015.75 |
$6,015.75 |
$7,144.80
|
|
Trabectedin 1 mg intravenous solution
|
$362.82 |
$362.82 |
$362.82 |
$6,684.23
|
|
Trabeculoplasty laser surg
|
$649.19 |
$649.19 |
$649.19 |
$1,180.80
|
|
Trachelectomy (cervicectomy) 57530
|
$5,841.60 |
$5,841.60 |
$5,841.60 |
$4,933.66
|
|
Tracheobrnchsc thru est trachs incisn
|
$602.63 |
$602.63 |
$602.63 |
$1,437.45
|
|
Tracheostoma revision; simple, without flap rotation
|
$3,837.72 |
$3,837.72 |
$3,837.72 |
$3,837.72
|
|
Train for caregiver add 15
|
$26.42 |
$26.42 |
$26.42 |
$47.60
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$59.95 |
$59.95 |
$59.95 |
$101.25
|
|
Transabdom amnioinfus w/us
|
$359.97 |
$359.97 |
$359.97 |
$678.70
|
|
Transcath biopsy
|
$6,396.89 |
$6,396.89 |
$6,396.89 |
$4,285.93
|
|
Transcath closure of asd
|
$21,249.26 |
$21,249.26 |
$21,249.26 |
$17,352.58
|
|
Transcath closure of vsd
|
$21,249.26 |
$21,249.26 |
$21,249.26 |
$17,458.00
|
|
Transcath occlusion non-cns
|
$13,419.98 |
$13,419.98 |
$13,419.98 |
$10,452.00
|
|
Transcath rmvl perm ldss pmkr rv
|
$3,724.63 |
$3,724.63 |
$3,724.63 |
$4,822.00
|
|
Transcrv abltj utrn fibrd rf
|
$8,750.72 |
$8,750.72 |
$8,750.72 |
$8,750.72
|
|
Transcutaneous carboxyhb
|
$9.37 |
$9.37 |
$9.37 |
$31.85
|
|
Transcutaneous hgb 88738
|
$5.02 |
$5.02 |
$5.02 |
$13.20
|
|
Transcutaneous methb
|
$9.37 |
$9.37 |
$9.37 |
$19.20
|
|
Transfer of abdominal muscle
|
$8,453.60 |
$8,453.60 |
$8,453.60 |
$5,886.74
|
|
Transfer of embryo
|
$359.97 |
$359.97 |
$359.97 |
$587.60
|
|
Transfer of iliopsoas muscle
|
$8,453.60 |
$8,453.60 |
$8,453.60 |
$6,311.00
|
|
Transfer of iliopsoas muscle
|
$3,839.54 |
$3,839.54 |
$3,839.54 |
$4,432.00
|
|
Transfer of spinal muscle
|
$3,839.54 |
$3,839.54 |
$3,839.54 |
$4,268.80
|
|
Transferrin
|
$12.76 |
$12.76 |
$12.76 |
$82.00
|
|
Transfer skin pedicle flap
|
$2,164.64 |
$2,164.64 |
$2,164.64 |
$3,189.12
|
|
Transfer tendon to pelvis
|
$3,839.54 |
$3,839.54 |
$3,839.54 |
$3,839.54
|
|
Transorl lwr esophgl myotomy
|
$7,044.32 |
$7,044.32 |
$7,044.32 |
$6,594.64
|
|
Transperi needle place pros
|
$6,015.75 |
$6,015.75 |
$6,015.75 |
$6,203.00
|
|
Transplant forearm tendon
|
$3,839.54 |
$3,839.54 |
$3,839.54 |
$3,624.06
|
|
Transplant forearm tendon
|
$3,839.54 |
$3,839.54 |
$3,839.54 |
$3,839.54
|
|
Transplant/graft hand tendon
|
$3,839.54 |
$3,839.54 |
$3,839.54 |
$3,594.44
|
|
Transplant/graft palm tendon
|
$3,839.54 |
$3,839.54 |
$3,839.54 |
$3,839.54
|
|
Transplant hand tendon
|
$3,839.54 |
$3,839.54 |
$3,839.54 |
$3,839.54
|
|
Transplant of thigh tendon
|
$8,453.60 |
$8,453.60 |
$8,453.60 |
$7,507.19
|
|
Transplant palm tendon
|
$3,839.54 |
$3,839.54 |
$3,839.54 |
$3,839.54
|
|
Transplants of thigh tendons
|
$8,453.60 |
$8,453.60 |
$8,453.60 |
$7,913.97
|
|
Transplj hematopoietic boost
|
$1,939.86 |
$1,939.86 |
$1,939.86 |
$2,667.20
|
|
Transplt allo hct/donor
|
$69,986.67 |
$69,986.67 |
$69,986.67 |
$29,206.10
|
|
Transplt allo lymphocytes
|
$1,939.86 |
$1,939.86 |
$1,939.86 |
$2,751.65
|
|
Transplt autol hct/donor
|
$1,939.86 |
$1,939.86 |
$1,939.86 |
$3,986.00
|
|
Transposition of vein valve
|
$6,396.89 |
$6,396.89 |
$6,396.89 |
$6,366.08
|
|
Transurethral rf treatment
|
$2,424.12 |
$2,424.12 |
$2,424.12 |
$3,281.20
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$125.84 |
$125.84 |
$125.84 |
$558.35
|
|
Transvaginal Pregnancy Ultrasound
|
$125.84 |
$125.84 |
$125.84 |
$501.60
|
|
Trastuzumab 150 mg intravenous solution
|
$77.94 |
$77.94 |
$77.94 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$24.33 |
$24.33 |
$24.33 |
$7,540.20
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$19.17 |
$19.17 |
$19.17 |
$5,846.40
|
|
Trauma partial team response w/critical care services level 4
|
$1,565.79 |
$1,565.79 |
$1,565.79 |
$4,523.04
|
|
Trb@ gene rearrange dirprobe
|
$49.59 |
$49.59 |
$49.59 |
$73.46
|
|
Treat ankle dislocation
|
$1,893.86 |
$1,893.86 |
$1,893.86 |
$2,358.40
|
|
Treat ankle dislocation
|
$8,453.60 |
$8,453.60 |
$8,453.60 |
$7,913.97
|
|
Treat ankle dislocation
|
$8,453.60 |
$8,453.60 |
$8,453.60 |
$5,741.00
|
|
Treat ankle fracture
|
$8,453.60 |
$8,453.60 |
$8,453.60 |
$5,488.00
|
|
Treat big toe fracture
|
$3,839.54 |
$3,839.54 |
$3,839.54 |
$4,454.10
|
|
Treat cheek bone fracturemalar 21360
|
$7,000.36 |
$7,000.36 |
$7,000.36 |
$6,489.73
|
|
Treat clavicle dislocation 23545
|
$283.86 |
$283.86 |
$283.86 |
$692.80
|
|
Treat ectopic pregnancy
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
$3,986.00
|
|
Treat ectopic pregnancy
|
$6,904.15 |
$6,904.15 |
$6,904.15 |
$6,707.99
|
|
Treat elbow dislocation
|
$1,893.86 |
$1,893.86 |
$1,893.86 |
$2,322.40
|
|
Treat elbow dislocation
|
$8,453.60 |
$8,453.60 |
$8,453.60 |
$7,292.92
|
|
Treat elbow fracture
|
$15,226.08 |
$15,226.08 |
$15,226.08 |
$9,791.00
|
|
Treat elbow fracture
|
$1,893.86 |
$1,893.86 |
$1,893.86 |
$2,055.00
|
|
Treat elbow fracture
|
$8,453.60 |
$8,453.60 |
$8,453.60 |
$6,839.00
|
|
Treat eyelid by injection
|
$472.21 |
$472.21 |
$472.21 |
$472.21
|
|
Treat eyelid lesion 67850
|
$1,146.13 |
$1,146.13 |
$1,146.13 |
$1,146.13
|
|
Treat finger fracture each
|
$3,839.54 |
$3,839.54 |
$3,839.54 |
$4,192.86
|
|
Treat finger fracture each
|
$1,893.86 |
$1,893.86 |
$1,893.86 |
$1,592.00
|
|
Treat foot bone lesion
|
$3,839.54 |
$3,839.54 |
$3,839.54 |
$3,839.54
|
|
Treat foot dislocation
|
$283.86 |
$283.86 |
$283.86 |
$410.00
|
|
Treat foot dislocation
|
$3,839.54 |
$3,839.54 |
$3,839.54 |
$4,192.86
|