|
Tlso full corset
|
$1,522.28 |
$1,522.28 |
$1,522.28 |
$377.78
|
|
Tlso r fram soft ant pre cst
|
$3,305.14 |
$3,305.14 |
$3,305.14 |
$801.11
|
|
Tlso r fram soft pre ots
|
$3,305.14 |
$3,305.14 |
$3,305.14 |
$1,019.13
|
|
Tlso rig fram pelvic pre cst
|
$4,142.03 |
$4,142.03 |
$4,142.03 |
$999.43
|
|
Tlso rig fram pelvic pre ots
|
$4,142.03 |
$4,142.03 |
$4,142.03 |
$1,230.29
|
|
Tlso rigid frame pre subclav
|
$4,674.93 |
$4,674.93 |
$4,674.93 |
$1,382.98
|
|
Tlso rigid lined custom fab
|
$5,830.43 |
$5,830.43 |
$5,830.43 |
$2,831.21
|
|
Tlso rigid lined pre one pie
|
$7,132.49 |
$7,132.49 |
$7,132.49 |
$2,110.02
|
|
Tlso rigid plastic custom fa
|
$6,110.08 |
$6,110.08 |
$6,110.08 |
$2,788.42
|
|
Tlso rigid plastic pre one
|
$2,464.19 |
$2,464.19 |
$2,464.19 |
$594.61
|
|
Tlso trnk sj-t9 pre cst
|
$4,115.85 |
$4,115.85 |
$4,115.85 |
$523.94
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$936.00 |
$936.00 |
$936.00 |
$152.36
|
|
Tobramycin non-comp unit
|
$82.14 |
$82.14 |
$82.14 |
$105.75
|
|
Tobramycin peak therapeutic drug level
|
$88.80 |
$88.80 |
$88.80 |
$121.55
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$5,139.06 |
$5,139.06 |
$5,139.06 |
$5,258.52
|
|
Tonsillectomy (age 12+)
|
$21,756.36 |
$21,756.36 |
$21,756.36 |
$3,986.00
|
|
Tonsillectomy (child under 12)
|
$17,520.07 |
$17,520.07 |
$17,520.07 |
$5,152.50
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$196.20 |
$196.20 |
$196.20 |
$312.65
|
|
Torsion ank & half solid sti
|
$1,071.86 |
$1,071.86 |
$1,071.86 |
$291.13
|
|
Torsion straight knee joint
|
$934.57 |
$934.57 |
$934.57 |
$253.84
|
|
Total Hip Replacement
|
$51,657.04 |
$51,657.04 |
$51,657.04 |
$9,161.60
|
|
Total Knee Replacement
|
$89,464.01 |
$89,464.01 |
$89,464.01 |
$14,254.12
|
|
Total tau
|
$339.00 |
$339.00 |
$339.00 |
$312.00
|
|
Toxoplasma antibody igg
|
$93.00 |
$93.00 |
$93.00 |
$89.57
|
|
Toxoplasma antibody igm
|
$68.40 |
$68.40 |
$68.40 |
$87.00
|
|
Tp53 gene full gene sequence
|
$1,058.40 |
$1,058.40 |
$1,058.40 |
$706.04
|
|
Tp53 gene trgt sequence alys
|
$1,305.60 |
$1,305.60 |
$1,305.60 |
$823.00
|
|
Tpmt gene com vrnts
|
$453.00 |
$453.00 |
$453.00 |
$373.00
|
|
Tprnl plmt biodegrdabl matrl
|
$26,691.71 |
$26,691.71 |
$26,691.71 |
$7,144.80
|
|
Trabectedin 1 mg intravenous solution
|
$14,720.52 |
$14,720.52 |
$14,720.52 |
$6,684.23
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$245.70 |
$245.70 |
$245.70 |
$56.38
|
|
Transcath biopsy
|
$4,851.00 |
$4,851.00 |
$4,851.00 |
$4,285.93
|
|
Transcatheter bx s&i
|
$849.60 |
$849.60 |
$849.60 |
$1,973.01
|
|
Transcath mv repair addl prosthesis
|
$5,598.60 |
$5,598.60 |
$5,598.60 |
$4,417.94
|
|
Transcath mv repair init prosthesis
|
$10,798.80 |
$10,798.80 |
$10,798.80 |
$12,623.60
|
|
Transferrin
|
$58.20 |
$58.20 |
$58.20 |
$81.60
|
|
Trans shoe caliper plate new
|
$875.24 |
$875.24 |
$875.24 |
$217.22
|
|
Trans shoe calip plate exist
|
$664.72 |
$664.72 |
$664.72 |
$164.98
|
|
Trans shoe solid stirrup exi
|
$664.72 |
$664.72 |
$664.72 |
$141.41
|
|
Trans shoe solid stirrup new
|
$875.24 |
$875.24 |
$875.24 |
$217.22
|
|
Trapezius sling
|
$977.27 |
$977.27 |
$977.27 |
$242.54
|
|
Trastuzumab 150 mg intravenous solution
|
$5,730.24 |
$5,730.24 |
$5,730.24 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$15,194.64 |
$15,194.64 |
$15,194.64 |
$7,540.20
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$13,530.42 |
$13,530.42 |
$13,530.42 |
$5,525.09
|
|
Tray bonemarrw oncontrol 102mm
|
$12,196.03 |
$12,196.03 |
$12,196.03 |
$940.80
|
|
Treat ectopic pregnancy
|
$28,243.24 |
$28,243.24 |
$28,243.24 |
$6,707.99
|
|
Treat foot bone lesion
|
$57,097.06 |
$57,097.06 |
$57,097.06 |
$3,839.54
|
|
Treat kneecap fracture
|
$22,106.82 |
$22,106.82 |
$22,106.82 |
$6,301.00
|
|
Treat lower leg fracture
|
$31,067.41 |
$31,067.41 |
$31,067.41 |
$14,061.89
|
|
Treat lower leg joint
|
$45,580.96 |
$45,580.96 |
$45,580.96 |
$7,807.24
|
|
Treatment fx radial distal open w/internal fixation left (restricted method ii cah)
|
$45,901.15 |
$45,901.15 |
$45,901.15 |
$8,370.75
|
|
Treatment incomplete abortion completed surgically any trimester
|
$13,830.18 |
$13,830.18 |
$13,830.18 |
$3,928.20
|
|
Treatment missed abortion completed surgically 1st trimester
|
$14,509.62 |
$14,509.62 |
$14,509.62 |
$4,056.00
|
|
Treatment of ankle fracture
|
$64,481.96 |
$64,481.96 |
$64,481.96 |
$8,453.60
|
|
Treatment radiation delivery level 2
|
$1,290.00 |
$1,290.00 |
$1,290.00 |
$830.70
|
|
Treat metatarsal fracture
|
$43,034.12 |
$43,034.12 |
$43,034.12 |
$8,412.89
|
|
Treponema pallidum antibody
|
$70.20 |
$70.20 |
$70.20 |
$70.40
|
|
Treprostinil injection
|
$74,489.22 |
$74,489.22 |
$74,489.22 |
$19,071.84
|
|
Trg gene rearrangement anal
|
$432.60 |
$432.60 |
$432.60 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$109.56 |
$109.56 |
$109.56 |
$43.09
|
|
Triamcinolone a inj prs-free
|
$1,104.48 |
$1,104.48 |
$1,104.48 |
$239.62
|
|
Trichinella antibody
|
$177.60 |
$177.60 |
$177.60 |
$70.65
|
|
Trichomonas assay w/optic
|
$66.60 |
$66.60 |
$66.60 |
$56.70
|
|
Triglycerides
|
$32.40 |
$32.40 |
$32.40 |
$57.85
|
|
Trilaciclib 300 mg intravenous solution
|
$6,242.46 |
$6,242.46 |
$6,242.46 |
$3,903.74
|
|
Trim nondyst nails
|
$127.80 |
$127.80 |
$127.80 |
$115.70
|
|
Trluml dil aq o/f can without st
|
$23,870.86 |
$23,870.86 |
$23,870.86 |
$5,419.00
|
|
Trnscath plc stent crv crtd without prtct
|
$5,875.20 |
$5,875.20 |
$5,875.20 |
$7,795.71
|
|
Trnscath plc stent crv crtd w/prtct
|
$5,875.20 |
$5,875.20 |
$5,875.20 |
$9,767.25
|
|
Trnscath plc stnt ante carotid art
|
$28,258.20 |
$28,258.20 |
$28,258.20 |
$6,311.00
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$10,411.80 |
$10,411.80 |
$10,411.80 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$13,188.60 |
$13,188.60 |
$13,188.60 |
$8,753.00
|
|
Trnscath plc vas stent w/s&i ini vein
|
$12,121.20 |
$12,121.20 |
$12,121.20 |
$14,819.58
|
|
Trnscath retrv pq vasc fb w/guide
|
$10,495.80 |
$10,495.80 |
$10,495.80 |
$4,735.50
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$5,971.80 |
$5,971.80 |
$5,971.80 |
$5,190.00
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$6,201.00 |
$6,201.00 |
$6,201.00 |
$4,250.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$6,201.00 |
$6,201.00 |
$6,201.00 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$5,971.80 |
$5,971.80 |
$5,971.80 |
$3,866.70
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$17,865.60 |
$17,865.60 |
$17,865.60 |
$4,872.75
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$19,300.26 |
$19,300.26 |
$19,300.26 |
$2,357.04
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$14,381.46 |
$14,381.46 |
$14,381.46 |
$2,986.34
|
|
Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm
|
$14,573.46 |
$14,573.46 |
$14,573.46 |
$3,078.00
|
|
Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm
|
$14,649.66 |
$14,649.66 |
$14,649.66 |
$2,371.50
|
|
Troponin quantitative
|
$61.20 |
$61.20 |
$61.20 |
$127.20
|
|
Trurl dstrj prst8 tiss rf wv
|
$18,984.74 |
$18,984.74 |
$18,984.74 |
$4,228.00
|
|
Tube trach disp innr can 5 xlt
|
$1,641.99 |
$1,641.99 |
$1,641.99 |
$445.99
|
|
Ua w/micro/comp poc
|
$58.80 |
$58.80 |
$58.80 |
$24.45
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$42,995.76 |
$42,995.76 |
$42,995.76 |
$17,921.01
|
|
Ugt1a1 gene analy common variants
|
$619.20 |
$619.20 |
$619.20 |
$438.75
|
|
Ultrasound infant hips ltd without stress
|
$735.00 |
$735.00 |
$735.00 |
$311.25
|
|
Umbilicoplasty 15847
|
$33,366.66 |
$33,366.66 |
$33,366.66 |
$4,172.97
|
|
Unlisted cytogenetic study
|
$391.20 |
$391.20 |
$391.20 |
$172.42
|
|
Unlisted laparoscopic liver biopy 47379
|
$54,473.60 |
$54,473.60 |
$54,473.60 |
$5,323.76
|
|
Unlisted laps px bladder
|
$68,970.13 |
$68,970.13 |
$68,970.13 |
$5,082.74
|
|
Unlisted maaa
|
$228.00 |
$228.00 |
$228.00 |
$228.00
|
|
Unlisted misc path test
|
$27.60 |
$27.60 |
$27.60 |
$89.40
|
|
Unlisted procedure larynx
|
$36,223.68 |
$36,223.68 |
$36,223.68 |
$924.00
|
|
Unlisted procedure microbiology
|
$2,238.00 |
$2,238.00 |
$2,238.00 |
$490.70
|
|
Unlisted px foot/toes
|
$47,162.12 |
$47,162.12 |
$47,162.12 |
$1,225.50
|
|
Unlisted px small intestine
|
$1,873.20 |
$1,873.20 |
$1,873.20 |
$1,918.15
|
