|
Transfusion blood/blood component(s)
|
$447.84 |
$447.84 |
$447.84 |
$983.00
|
|
Transplant forearm tendon
|
$966.24 |
$966.24 |
$966.24 |
$3,591.33
|
|
Transplant forearm tendon
|
$1,111.68 |
$1,111.68 |
$1,111.68 |
$3,821.05
|
|
Transplant hand tendon
|
$1,214.88 |
$1,214.88 |
$1,214.88 |
$3,821.05
|
|
Trastuzumab 150 mg intravenous solution
|
$3,489.00 |
$3,489.00 |
$3,489.00 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$7,359.71 |
$7,359.71 |
$7,359.71 |
$7,540.20
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$7,535.51 |
$7,535.51 |
$7,535.51 |
$5,835.15
|
|
Trauma partial team response w/critical care services level 4
|
$817.44 |
$817.44 |
$817.44 |
$4,523.04
|
|
Treat ankle dislocation
|
$768.96 |
$768.96 |
$768.96 |
$2,358.40
|
|
Treat ankle dislocation
|
$1,216.32 |
$1,216.32 |
$1,216.32 |
$5,886.74
|
|
Treat ankle fracture
|
$1,613.28 |
$1,613.28 |
$1,613.28 |
$5,488.00
|
|
Treat big toe fracture
|
$998.88 |
$998.88 |
$998.88 |
$4,307.52
|
|
Treat clavicle dislocation 23545
|
$575.04 |
$575.04 |
$575.04 |
$705.60
|
|
Treat ectopic pregnancy
|
$1,222.56 |
$1,222.56 |
$1,222.56 |
$4,350.00
|
|
Treat ectopic pregnancy
|
$1,195.68 |
$1,195.68 |
$1,195.68 |
$6,707.99
|
|
Treat ectopic pregnancy
|
$646.08 |
$646.08 |
$646.08 |
$420.60
|
|
Treat elbow dislocation
|
$750.24 |
$750.24 |
$750.24 |
$2,223.20
|
|
Treat elbow fracture
|
$1,670.40 |
$1,670.40 |
$1,670.40 |
$11,488.80
|
|
Treat elbow fracture
|
$2,758.56 |
$2,758.56 |
$2,758.56 |
$1,919.13
|
|
Treat elbow fracture
|
$1,048.80 |
$1,048.80 |
$1,048.80 |
$6,316.80
|
|
Treat finger fracture each
|
$744.48 |
$744.48 |
$744.48 |
$4,132.02
|
|
Treat finger fracture each
|
$2,684.64 |
$2,684.64 |
$2,684.64 |
$1,536.00
|
|
Treat foot bone lesion
|
$876.96 |
$876.96 |
$876.96 |
$3,839.54
|
|
Treat foot dislocation
|
$490.08 |
$490.08 |
$490.08 |
$4,192.86
|
|
Treat foot dislocation
|
$439.20 |
$439.20 |
$439.20 |
$527.28
|
|
Treat foot dislocation
|
$293.76 |
$293.76 |
$293.76 |
$445.80
|
|
Treat foot dislocation
|
$541.92 |
$541.92 |
$541.92 |
$446.60
|
|
Treat foot dislocation
|
$610.56 |
$610.56 |
$610.56 |
$3,839.54
|
|
Treat fracture of radius
|
$2,684.64 |
$2,684.64 |
$2,684.64 |
$1,790.00
|
|
Treat fracture of ulna
|
$783.84 |
$783.84 |
$783.84 |
$726.05
|
|
Treat/graft heel fracture
|
$1,994.88 |
$1,994.88 |
$1,994.88 |
$10,629.07
|
|
Treat hand bone lesion
|
$859.20 |
$859.20 |
$859.20 |
$3,073.20
|
|
Treat heel fracture
|
$1,723.68 |
$1,723.68 |
$1,723.68 |
$8,269.81
|
|
Treat hip dislocation
|
$1,155.36 |
$1,155.36 |
$1,155.36 |
$2,192.80
|
|
Treat hip dislocation
|
$555.84 |
$555.84 |
$555.84 |
$2,641.60
|
|
Treat hip dislocation
|
$1,445.28 |
$1,445.28 |
$1,445.28 |
$3,342.87
|
|
Treat hip socket fracture
|
$149.59 |
$149.59 |
$149.59 |
$1,392.00
|
|
Treat humerus fracture
|
$1,359.84 |
$1,359.84 |
$1,359.84 |
$13,278.70
|
|
Treat humerus fracture
|
$1,324.80 |
$1,324.80 |
$1,324.80 |
$12,896.80
|
|
Treat humerus fracture
|
$2,736.96 |
$2,736.96 |
$2,736.96 |
$1,771.43
|
|
Treat humerus fracture
|
$1,431.84 |
$1,431.84 |
$1,431.84 |
$12,653.00
|
|
Treat humerus fracture
|
$1,137.12 |
$1,137.12 |
$1,137.12 |
$11,250.40
|
|
Treat humerus fracture
|
$1,291.20 |
$1,291.20 |
$1,291.20 |
$10,629.07
|
|
Treat kneecap dislocation
|
$768.48 |
$768.48 |
$768.48 |
$1,068.90
|
|
Treat kneecap fracture
|
$1,164.96 |
$1,164.96 |
$1,164.96 |
$6,311.00
|
|
Treat knee dislocation
|
$987.84 |
$987.84 |
$987.84 |
$2,220.89
|
|
Treat knee fracture
|
$1,376.16 |
$1,376.16 |
$1,376.16 |
$3,486.60
|
|
Treat knee fracture
|
$1,824.00 |
$1,824.00 |
$1,824.00 |
$4,521.40
|
|
Treat knee fracture
|
$1,256.64 |
$1,256.64 |
$1,256.64 |
$2,938.00
|
|
Treat knee fracture 27530
|
$491.04 |
$491.04 |
$491.04 |
$550.00
|
|
Treat knee fracture(s)
|
$762.72 |
$762.72 |
$762.72 |
$642.00
|
|
Treat knuckle dislocation
|
$694.56 |
$694.56 |
$694.56 |
$1,523.90
|
|
Treat lower leg bone lesion
|
$924.00 |
$924.00 |
$924.00 |
$3,977.49
|
|
Treat lower leg dislocation
|
$618.24 |
$618.24 |
$618.24 |
$530.75
|
|
Treat lower leg fracture
|
$1,317.12 |
$1,317.12 |
$1,317.12 |
$6,475.41
|
|
Treat lower leg fracture
|
$1,724.64 |
$1,724.64 |
$1,724.64 |
$14,241.77
|
|
Treat lower leg fracture
|
$2,038.08 |
$2,038.08 |
$2,038.08 |
$12,653.00
|
|
Treat lower leg joint
|
$1,092.96 |
$1,092.96 |
$1,092.96 |
$7,807.24
|
|
Treatment fx radial distal open w/internal fixation 2 frag left (restricted method ii cah)
|
$1,284.00 |
$1,284.00 |
$1,284.00 |
$8,370.75
|
|
Treatment fx radial distal open w/internal fixation 3+ frag left (restricted method ii cah)
|
$1,625.76 |
$1,625.76 |
$1,625.76 |
$8,590.40
|
|
Treatment fx radial distal open w/internal fixation left (restricted method ii cah)
|
$1,150.08 |
$1,150.08 |
$1,150.08 |
$8,370.75
|
|
Treatment incomplete abortion completed surgically any trimester
|
$5,155.68 |
$5,155.68 |
$5,155.68 |
$3,916.04
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$109.90 |
$109.90 |
$109.90 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$153.15 |
$153.15 |
$153.15 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$140.43 |
$140.43 |
$140.43 |
$203.35
|
|
Treatment missed abortion completed surgically 1st trimester
|
$680.64 |
$680.64 |
$680.64 |
$3,982.44
|
|
Treatment of ankle fracture
|
$998.40 |
$998.40 |
$998.40 |
$8,412.89
|
|
Treatment of ankle fracture
|
$1,180.32 |
$1,180.32 |
$1,180.32 |
$8,453.60
|
|
Treatment of ankle fracture
|
$1,347.36 |
$1,347.36 |
$1,347.36 |
$7,907.11
|
|
Treatment of ankle fracture
|
$1,516.80 |
$1,516.80 |
$1,516.80 |
$7,913.97
|
|
Treatment of ankle fracture 27786
|
$498.72 |
$498.72 |
$498.72 |
$520.80
|
|
Treatment of fibula fracture
|
$1,107.36 |
$1,107.36 |
$1,107.36 |
$6,311.00
|
|
Treatment of fibula fracture 27780
|
$493.44 |
$493.44 |
$493.44 |
$491.50
|
|
Treatment of foot infection
|
$374.88 |
$374.88 |
$374.88 |
$2,614.25
|
|
Treatment of foot infection
|
$575.52 |
$575.52 |
$575.52 |
$3,821.05
|
|
Treatment of heel fracture 28400
|
$392.16 |
$392.16 |
$392.16 |
$473.00
|
|
Treatment of penis lesion
|
$702.72 |
$702.72 |
$702.72 |
$3,515.40
|
|
Treatment of thigh fracture
|
$2,052.96 |
$2,052.96 |
$2,052.96 |
$5,109.00
|
|
Treatment of thigh fracture
|
$824.64 |
$824.64 |
$824.64 |
$548.90
|
|
Treatment of thigh fracture
|
$1,046.88 |
$1,046.88 |
$1,046.88 |
$6,389.60
|
|
Treatment of thigh fracture
|
$1,525.92 |
$1,525.92 |
$1,525.92 |
$3,409.00
|
|
Treatment of thigh fracture
|
$1,484.64 |
$1,484.64 |
$1,484.64 |
$3,764.80
|
|
Treatment of thigh fracture
|
$1,887.36 |
$1,887.36 |
$1,887.36 |
$5,505.50
|
|
Treatment of thigh fracture
|
$1,479.84 |
$1,479.84 |
$1,479.84 |
$3,796.00
|
|
Treatment of tibia fracture
|
$898.08 |
$898.08 |
$898.08 |
$6,183.84
|
|
Treatment of tibia fracture
|
$1,382.88 |
$1,382.88 |
$1,382.88 |
$8,665.60
|
|
Treatment of tibia fracture
|
$1,533.12 |
$1,533.12 |
$1,533.12 |
$7,087.60
|
|
Treatment of toe fracture 28510
|
$191.52 |
$191.52 |
$191.52 |
$369.70
|
|
Treatment of urethra lesion
|
$318.24 |
$318.24 |
$318.24 |
$3,817.53
|
|
Treatment of urethra lesion
|
$352.32 |
$352.32 |
$352.32 |
$2,874.36
|
|
Treatment radiation delivery level 2
|
$410.88 |
$410.88 |
$410.88 |
$767.65
|
|
Treat metacarpal fracture
|
$755.52 |
$755.52 |
$755.52 |
$3,977.49
|
|
Treat metacarpal fracture
|
$897.12 |
$897.12 |
$897.12 |
$5,464.97
|
|
Treat metatarsal fracture
|
$603.36 |
$603.36 |
$603.36 |
$3,839.54
|
|
Treat metatarsal fracture
|
$872.16 |
$872.16 |
$872.16 |
$8,453.60
|
|
Treat midfoot fracture each
|
$991.20 |
$991.20 |
$991.20 |
$6,192.78
|
|
Treat penis lesion graft
|
$1,422.24 |
$1,422.24 |
$1,422.24 |
$10,235.30
|
|
Treat radius fracture
|
$1,021.92 |
$1,021.92 |
$1,021.92 |
$7,807.24
|
|
Treat sesamoid bone fracture
|
$504.96 |
$504.96 |
$504.96 |
$7,907.11
|
|
Treat slipped epiphysis
|
$1,421.76 |
$1,421.76 |
$1,421.76 |
$4,499.12
|