|
Tibial length sock fx or equ
|
$106.50 |
$106.50 |
$106.50 |
|
|
Tib/per revasc stent & ather 37231
|
$19,932.50 |
$21,954.00 |
$41,200.00 |
|
|
Tib/per revasc stnt & ather
|
$5,421.50 |
$5,421.50 |
$14,315.50 |
|
|
Tib/per revasc w/ather add-on 37233
|
$11,509.00 |
$14,315.50 |
$31,358.00 |
|
|
Tigecycline injection
|
$994.00 |
$994.00 |
$994.00 |
|
|
Tilt table study
|
$438.00 |
$1,173.00 |
$2,562.50 |
|
|
Tirofiban 12.5 mg/50 ml
|
$1,986.09 |
$1,986.09 |
$2,222.70 |
|
|
Tis cgen car anomal 1st shnt
|
$11,898.00 |
$11,898.00 |
$11,898.00 |
|
|
Tisotumab vedotin-tftv 40 mg intravenous solution
|
$36,855.98 |
$36,855.98 |
$42,184.56 |
|
|
Tissue amnio epifix inj 100mg
|
$18,186.14 |
$18,186.14 |
$18,186.14 |
|
|
Tissue culture placenta
|
$330.50 |
$472.80 |
$2,070.00 |
|
|
Tissue culture skin/biopsy
|
$412.50 |
$560.50 |
$1,791.00 |
|
|
Tissue culture tumor
|
$479.50 |
$645.50 |
$949.50 |
|
|
Tissue exam koh skin/hair/nails
|
$52.00 |
$72.00 |
$187.00 |
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$243.50 |
$243.50 |
$79,744.75 |
|
|
Tissue matrix xcm thk 20x30cm -cost per sq cm
|
$36.00 |
$57.00 |
$87.00 |
|
|
Tissue surgimend prs meshed 20 cm x 10 cm - cost per 0.5cm
|
$17.50 |
$17.50 |
$6,980.00 |
|
|
Tissue transglutaminase iga
|
$34.80 |
$90.00 |
$385.00 |
|
|
Tixagev and cilgav inj
|
$327.00 |
$433.50 |
$677.50 |
|
|
Tlh uterus 250 g or less
|
$31,113.84 |
$31,113.84 |
$31,113.84 |
|
|
Tlh w/t/o 250 g or less
|
$28,745.43 |
$28,745.43 |
$28,745.43 |
|
|
Tlh w/t/o uterus over 250 g
|
$32,796.58 |
$32,796.58 |
$32,796.58 |
|
|
Tlso 2mod symphis-xipho pre
|
$5,041.90 |
$5,041.90 |
$5,041.90 |
|
|
Tlso 2 piece rigid shell
|
$1,451.00 |
$1,451.00 |
$4,341.66 |
|
|
Tlso 2 shl symphys-stern cst
|
$2,183.00 |
$2,183.00 |
$5,161.97 |
|
|
Tlso 3mod sacro-scap pre
|
$2,359.50 |
$2,359.50 |
$6,420.86 |
|
|
Tlso 3 piece rigid shell
|
$2,827.21 |
$2,827.21 |
$2,827.21 |
|
|
Tlso corset front
|
$246.00 |
$246.00 |
$604.12 |
|
|
Tlso flex trnk sj-t9 pre ots
|
$1,960.63 |
$1,960.63 |
$1,960.63 |
|
|
Tlso full corset
|
$987.90 |
$987.90 |
$987.90 |
|
|
Tlso r fram soft ant pre cst
|
$2,144.90 |
$2,144.90 |
$2,144.90 |
|
|
Tlso r fram soft pre ots
|
$1,046.00 |
$1,046.00 |
$2,144.90 |
|
|
Tlso rig fram pelvic pre cst
|
$2,688.01 |
$2,688.01 |
$2,688.01 |
|
|
Tlso rig fram pelvic pre ots
|
$2,688.01 |
$2,688.01 |
$2,688.01 |
|
|
Tlso rigid frame pre subclav
|
$3,719.62 |
$3,719.62 |
$3,719.62 |
|
|
Tlso rigid lined custom fab
|
$1,899.00 |
$3,279.00 |
$8,148.18 |
|
|
Tlso rigid lined pre one pie
|
$5,674.98 |
$5,674.98 |
$5,674.98 |
|
|
Tlso rigid plastic cust fab
|
$4,290.50 |
$4,290.50 |
$4,290.50 |
|
|
Tlso rigid plastic custom fa
|
$2,254.50 |
$2,254.50 |
$8,538.99 |
|
|
Tlso rigid plastic pre one
|
$1,599.16 |
$1,599.16 |
$1,599.16 |
|
|
Tlso trnk sj-t9 pre cst
|
$2,671.02 |
$2,671.02 |
$2,671.02 |
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$598.32 |
$598.32 |
$669.60 |
|
|
Tobramycin non-comp unit
|
$50.00 |
$50.00 |
$87.07 |
|
|
Tobramycin peak therapeutic drug level
|
$95.50 |
$135.00 |
$471.00 |
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$11,154.44 |
$11,154.44 |
$12,747.94 |
|
|
Toe X-ray (both feet)
|
$111.50 |
$253.00 |
$466.00 |
|
|
Tomosynthesis breast diagnostic left
|
$47.40 |
$47.40 |
$79.95 |
|
|
Tomosynthesis breast screen bilateral
|
$47.40 |
$358.00 |
$358.50 |
|
|
Tongue base vol reduction
|
$2,954.00 |
$4,084.00 |
$4,084.00 |
|
|
Tongue biopsy; posterior one-third 41105
|
$2,015.00 |
$2,786.00 |
$2,786.00 |
|
|
Tonsillectomy (age 12+)
|
$10,435.55 |
$10,435.55 |
$10,518.88 |
|
|
Tonsillectomy (child under 12)
|
$7,932.46 |
$7,932.46 |
$13,399.31 |
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$690.03 |
$789.79 |
$14,228.00 |
|
|
Torsion ank & half solid sti
|
$695.59 |
$695.59 |
$695.59 |
|
|
Torsion straight knee joint
|
$606.50 |
$606.50 |
$606.50 |
|
|
Total Hip Replacement
|
$54,599.40 |
$54,599.40 |
$61,600.23 |
|
|
Total hysterectomy
|
$27,795.52 |
$27,795.52 |
$27,795.52 |
|
|
Total Knee Replacement
|
$48,513.27 |
$48,513.27 |
$56,983.52 |
|
|
Total tau
|
$544.20 |
$569.40 |
$844.00 |
|
|
Tot disc arthrp 1ntrspc crv
|
$46,429.16 |
$46,429.16 |
$46,429.16 |
|
|
Toxoplasma antibody igg
|
$89.50 |
$129.00 |
$382.00 |
|
|
Toxoplasma antibody igm
|
$136.80 |
$157.00 |
$563.00 |
|
|
Tp53 gene trgt sequence alys
|
$304.50 |
$486.00 |
$988.20 |
|
|
Tpmt gene com vrnts
|
$427.00 |
$427.00 |
$524.40 |
|
|
Tprnl plmt biodegrdabl matrl
|
$5,042.00 |
$6,845.00 |
$7,705.00 |
|
|
Trabectedin 1 mg intravenous solution
|
$18,372.92 |
$18,372.92 |
$21,029.24 |
|
|
Trabeculoplasty laser surg
|
$227.00 |
$336.50 |
$336.50 |
|
|
Tracheobrnchsc thru est trachs incisn
|
$720.50 |
$1,195.50 |
$1,811.50 |
|
|
Tracheostoma revision; simple, without flap rotation
|
$2,476.00 |
$3,423.50 |
$3,423.50 |
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$38.50 |
$68.50 |
$89.70 |
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$29.90 |
$45.00 |
$1,988.00 |
|
|
Transabdom amnioinfus w/us
|
$358.50 |
$487.00 |
$487.00 |
|
|
Transcath biopsy
|
$1,871.00 |
$3,572.00 |
$10,019.50 |
|
|
Transcath closure of asd
|
$9,428.00 |
$16,467.50 |
$87,092.00 |
|
|
Transcath closure of vsd
|
$14,584.00 |
$18,005.00 |
$18,005.00 |
|
|
Transcatheter bx s&i
|
$1,054.00 |
$1,748.50 |
$13,118.00 |
|
|
Transcath mv repair addl prosthesis
|
$618.00 |
$1,028.00 |
$1,396.00 |
|
|
Transcath mv repair init prosthesis
|
$1,644.00 |
$2,444.00 |
$3,374.00 |
|
|
Transcath occlusion cns
|
$2,144.50 |
$2,911.50 |
$138,586.00 |
|
|
Transcath occlusion non-cns
|
$5,808.50 |
$9,808.00 |
$38,618.00 |
|
|
Trans cath replace aortic valve 33366
|
$14,799.50 |
$16,546.00 |
$20,427.00 |
|
|
Transcath rmvl perm ldss pmkr rv
|
$2,103.00 |
$2,596.00 |
$2,596.00 |
|
|
Transcrv abltj utrn fibrd rf
|
$36,325.19 |
$36,325.19 |
$36,325.19 |
|
|
Transcutaneous hgb 88738
|
$15.00 |
$17.00 |
$17.50 |
|
|
Transferrin
|
$55.00 |
$98.80 |
$319.50 |
|
|
Transparent film >16<=48 in
|
$86.00 |
$124.50 |
$144.00 |
|
|
Transplant forearm tendon
|
$43,947.14 |
$43,947.14 |
$43,947.14 |
|
|
Transplj hematopoietic boost
|
$1,522.00 |
$1,522.00 |
$1,522.00 |
|
|
Transplt allo hct/donor
|
$1,669.00 |
$2,308.00 |
$2,308.00 |
|
|
Transplt allo lymphocytes
|
$1,989.50 |
$2,456.00 |
$2,456.00 |
|
|
Transplt autol hct/donor
|
$2,094.50 |
$2,843.50 |
$6,262.80 |
|
|
Trans shoe caliper plate new
|
$568.00 |
$568.00 |
$568.00 |
|
|
Trans shoe calip plate exist
|
$431.38 |
$431.38 |
$431.38 |
|
|
Trans shoe solid stirrup exi
|
$431.38 |
$431.38 |
$431.38 |
|
|
Trans shoe solid stirrup new
|
$568.00 |
$568.00 |
$568.00 |
|
|
Transthor cath for stent
|
$5,704.00 |
$7,042.00 |
$7,042.00 |
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$338.00 |
$533.00 |
$1,496.50 |
|
|
Transvaginal Pregnancy Ultrasound
|
$202.50 |
$533.50 |
$1,496.50 |
|
|
Trapezius sling
|
$634.21 |
$634.21 |
$634.21 |
|
|
Trastuzumab 150 mg intravenous solution
|
$7,815.20 |
$7,815.20 |
$8,945.12 |
|
