|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$3,033.50 |
$3,033.50 |
$3,033.50 |
$4,112.43
|
|
Tibial arthroscopy/surgery
|
$879.50 |
$879.50 |
$879.50 |
$5,801.60
|
|
Tissue culture skin/biopsy
|
$110.00 |
$110.00 |
$110.00 |
$484.00
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$133.50 |
$133.50 |
$133.50 |
$1,134.00
|
|
Tissue transglutaminase iga
|
$80.00 |
$80.00 |
$80.00 |
$44.16
|
|
Tlh uterus 250 g or less
|
$887.00 |
$887.00 |
$887.00 |
$11,533.76
|
|
Tlh w/t/o 250 g or less
|
$1,010.50 |
$1,010.50 |
$1,010.50 |
$12,320.22
|
|
Tlh w/t/o uterus over 250 g
|
$1,351.00 |
$1,351.00 |
$1,351.00 |
$12,320.22
|
|
Tomosynthesis breast diagnostic left
|
$84.00 |
$84.00 |
$84.00 |
$73.00
|
|
Tomosynthesis breast screen bilateral
|
$84.00 |
$84.00 |
$84.00 |
$72.68
|
|
Tonsillectomy (age 12+)
|
$278.50 |
$278.50 |
$278.50 |
$4,424.11
|
|
Tonsillectomy (child under 12)
|
$292.00 |
$292.00 |
$292.00 |
$5,339.00
|
|
Total hip arthroplasty
|
$1,828.00 |
$1,828.00 |
$1,828.00 |
$7,347.60
|
|
Total Hip Replacement
|
$1,411.00 |
$1,411.00 |
$1,411.00 |
$9,161.60
|
|
Total hysterectomy
|
$1,140.00 |
$1,140.00 |
$1,140.00 |
$3,001.70
|
|
Total Knee Replacement
|
$1,409.00 |
$1,409.00 |
$1,409.00 |
$14,543.50
|
|
Total tau
|
$431.00 |
$431.00 |
$431.00 |
$312.50
|
|
Toxoplasma antibody igg
|
$46.50 |
$46.50 |
$46.50 |
$89.40
|
|
Toxoplasma antibody igm
|
$55.00 |
$55.00 |
$55.00 |
$87.00
|
|
Tp53 gene full gene sequence
|
$126.00 |
$126.00 |
$126.00 |
$709.80
|
|
Tpmt gene com vrnts
|
$175.00 |
$175.00 |
$175.00 |
$371.80
|
|
Tprnl plmt biodegrdabl matrl
|
$175.00 |
$175.00 |
$175.00 |
$7,144.80
|
|
Trabeculoplasty laser surg
|
$207.00 |
$207.00 |
$207.00 |
$1,180.80
|
|
Trachelectomy (cervicectomy) 57530
|
$409.50 |
$409.50 |
$409.50 |
$4,933.66
|
|
Tracheostoma revision; simple, without flap rotation
|
$3,175.50 |
$3,175.50 |
$3,175.50 |
$3,837.72
|
|
Transab esoph hiat hern repair 43332
|
$1,319.00 |
$1,319.00 |
$1,319.00 |
$2,835.20
|
|
Transab esoph hiat hern rpr
|
$1,439.00 |
$1,439.00 |
$1,439.00 |
$3,096.80
|
|
Transferrin
|
$70.00 |
$70.00 |
$70.00 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$518.00 |
$518.00 |
$518.00 |
$983.00
|
|
Transplant forearm tendon
|
$801.50 |
$801.50 |
$801.50 |
$3,591.33
|
|
Transplant forearm tendon
|
$800.00 |
$800.00 |
$800.00 |
$3,821.05
|
|
Trauma partial team response w/critical care services level 4
|
$1,240.50 |
$1,240.50 |
$1,240.50 |
$4,523.04
|
|
Treat ankle dislocation
|
$588.50 |
$588.50 |
$588.50 |
$2,358.40
|
|
Treat ankle fracture
|
$1,181.00 |
$1,181.00 |
$1,181.00 |
$5,488.00
|
|
Treat big toe fracture
|
$567.00 |
$567.00 |
$567.00 |
$4,307.52
|
|
Treat ectopic pregnancy
|
$872.50 |
$872.50 |
$872.50 |
$4,350.00
|
|
Treat ectopic pregnancy
|
$850.50 |
$850.50 |
$850.50 |
$6,707.99
|
|
Treat elbow dislocation
|
$572.00 |
$572.00 |
$572.00 |
$2,223.20
|
|
Treat elbow dislocation
|
$801.00 |
$801.00 |
$801.00 |
$7,292.92
|
|
Treat elbow fracture
|
$1,197.50 |
$1,197.50 |
$1,197.50 |
$11,488.80
|
|
Treat elbow fracture
|
$680.00 |
$680.00 |
$680.00 |
$1,919.13
|
|
Treat eyelid by injection
|
$35.00 |
$35.00 |
$35.00 |
$481.44
|
|
Treat finger fracture each
|
$545.00 |
$545.00 |
$545.00 |
$4,132.02
|
|
Treat finger fracture each
|
$2,505.50 |
$2,505.50 |
$2,505.50 |
$1,536.00
|
|
Treat foot bone lesion
|
$648.00 |
$648.00 |
$648.00 |
$3,839.54
|
|
Treat foot dislocation
|
$203.50 |
$203.50 |
$203.50 |
$396.30
|
|
Treat foot dislocation
|
$188.00 |
$188.00 |
$188.00 |
$445.80
|
|
Treat fracture of radius
|
$584.50 |
$584.50 |
$584.50 |
$1,790.00
|
|
Treat fracture of radius
|
$636.00 |
$636.00 |
$636.00 |
$1,849.00
|
|
Treat fracture of ulna
|
$540.50 |
$540.50 |
$540.50 |
$726.05
|
|
Treat hand dislocation
|
$499.50 |
$499.50 |
$499.50 |
$1,749.06
|
|
Treat heel fracture
|
$1,265.00 |
$1,265.00 |
$1,265.00 |
$8,269.81
|
|
Treat hip dislocation
|
$868.50 |
$868.50 |
$868.50 |
$2,192.80
|
|
Treat hip dislocation
|
$400.00 |
$400.00 |
$400.00 |
$2,641.60
|
|
Treat hip socket fracture
|
$267.00 |
$267.00 |
$267.00 |
$1,392.00
|
|
Treat humerus fracture
|
$991.00 |
$991.00 |
$991.00 |
$13,278.70
|
|
Treat humerus fracture
|
$963.50 |
$963.50 |
$963.50 |
$12,896.80
|
|
Treat humerus fracture
|
$675.50 |
$675.50 |
$675.50 |
$1,771.43
|
|
Treat humerus fracture
|
$1,038.50 |
$1,038.50 |
$1,038.50 |
$12,653.00
|
|
Treat humerus fracture
|
$1,153.00 |
$1,153.00 |
$1,153.00 |
$10,742.40
|
|
Treat humerus fracture
|
$835.00 |
$835.00 |
$835.00 |
$11,250.40
|
|
Treat humerus fracture
|
$940.00 |
$940.00 |
$940.00 |
$10,629.07
|
|
Treat kneecap dislocation
|
$569.50 |
$569.50 |
$569.50 |
$1,068.90
|
|
Treat kneecap fracture
|
$850.00 |
$850.00 |
$850.00 |
$6,311.00
|
|
Treat knee dislocation
|
$1,543.00 |
$1,543.00 |
$1,543.00 |
$2,220.89
|
|
Treat knee fracture
|
$988.50 |
$988.50 |
$988.50 |
$3,486.60
|
|
Treat knee fracture
|
$1,320.50 |
$1,320.50 |
$1,320.50 |
$4,521.40
|
|
Treat knee fracture
|
$919.50 |
$919.50 |
$919.50 |
$2,938.00
|
|
Treat knee fracture 27530
|
$355.50 |
$355.50 |
$355.50 |
$550.00
|
|
Treat knee fracture(s)
|
$536.50 |
$536.50 |
$536.50 |
$642.00
|
|
Treat knuckle dislocation
|
$471.50 |
$471.50 |
$471.50 |
$1,523.90
|
|
Treat knuckle dislocation
|
$652.00 |
$652.00 |
$652.00 |
$4,332.00
|
|
Treat lower leg fracture
|
$1,266.50 |
$1,266.50 |
$1,266.50 |
$14,241.77
|
|
Treat lower leg fracture
|
$1,483.50 |
$1,483.50 |
$1,483.50 |
$12,653.00
|
|
Treat lower leg joint
|
$805.50 |
$805.50 |
$805.50 |
$7,807.24
|
|
Treatment fx radial distal open w/internal fixation 2 frag left (restricted method ii cah)
|
$928.50 |
$928.50 |
$928.50 |
$8,370.75
|
|
Treatment fx radial distal open w/internal fixation 3+ frag left (restricted method ii cah)
|
$1,167.00 |
$1,167.00 |
$1,167.00 |
$8,590.40
|
|
Treatment fx radial distal open w/internal fixation left (restricted method ii cah)
|
$837.00 |
$837.00 |
$837.00 |
$8,370.75
|
|
Treatment incomplete abortion completed surgically any trimester
|
$340.00 |
$340.00 |
$340.00 |
$3,916.04
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$127.50 |
$127.50 |
$127.50 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$50.00 |
$50.00 |
$50.00 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$805.00 |
$805.00 |
$805.00 |
$203.35
|
|
Treatment missed abortion completed surgically 1st trimester
|
$424.50 |
$424.50 |
$424.50 |
$3,982.44
|
|
Treatment of anal fissure w/dilat 46940
|
$165.50 |
$165.50 |
$165.50 |
$3,245.23
|
|
Treatment of ankle fracture
|
$731.00 |
$731.00 |
$731.00 |
$8,412.89
|
|
Treatment of ankle fracture
|
$861.50 |
$861.50 |
$861.50 |
$8,453.60
|
|
Treatment of ankle fracture
|
$991.50 |
$991.50 |
$991.50 |
$7,907.11
|
|
Treatment of ankle fracture
|
$1,110.00 |
$1,110.00 |
$1,110.00 |
$7,913.97
|
|
Treatment of ankle fracture 27786
|
$348.00 |
$348.00 |
$348.00 |
$520.80
|
|
Treatment of corneal lesion
|
$343.00 |
$343.00 |
$343.00 |
$856.80
|
|
Treatment of fibula fracture
|
$809.50 |
$809.50 |
$809.50 |
$6,311.00
|
|
Treatment of fibula fracture 27780
|
$422.00 |
$422.00 |
$422.00 |
$491.50
|
|
Treatment of foot infection
|
$156.00 |
$156.00 |
$156.00 |
$2,614.25
|
|
Treatment of heel fracture 28400
|
$277.00 |
$277.00 |
$277.00 |
$473.00
|
|
Treatment of penis lesion
|
$480.00 |
$480.00 |
$480.00 |
$3,515.40
|
|
Treatment of retinal lesion
|
$513.00 |
$513.00 |
$513.00 |
$1,033.14
|
|
Treatment of thigh fracture
|
$1,481.50 |
$1,481.50 |
$1,481.50 |
$5,109.00
|
|
Treatment of thigh fracture
|
$585.00 |
$585.00 |
$585.00 |
$548.90
|
|
Treatment of thigh fracture
|
$780.50 |
$780.50 |
$780.50 |
$6,389.60
|
|
Treatment of thigh fracture
|
$811.00 |
$811.00 |
$811.00 |
$1,772.97
|
