|
Tlso rigid plastic cust fab
|
$5,853.60 |
$5,853.60 |
$5,853.60 |
$2,347.16
|
|
Tlso rigid plastic custom fa
|
$2,788.42 |
$2,788.42 |
$2,788.42 |
$2,788.42
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$175.50 |
$175.50 |
$175.50 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$362.70 |
$362.70 |
$362.70 |
$120.60
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$5,258.52 |
$5,258.52 |
$5,258.52 |
$5,258.52
|
|
Tomosynthesis breast diagnostic left
|
$71.40 |
$71.40 |
$71.40 |
$73.00
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$507.60 |
$507.60 |
$507.60 |
$325.00
|
|
Torsion ank & half solid sti
|
$292.47 |
$292.47 |
$292.47 |
$291.13
|
|
Torsion straight knee joint
|
$318.65 |
$318.65 |
$318.65 |
$253.84
|
|
Toxoplasma antibody igg
|
$176.55 |
$176.55 |
$176.55 |
$89.40
|
|
Toxoplasma antibody igm
|
$23.85 |
$23.85 |
$23.85 |
$87.00
|
|
Trabectedin 1 mg intravenous solution
|
$6,827.00 |
$6,827.00 |
$6,827.00 |
$6,827.00
|
|
Tracheostoma stent/stud/bttn
|
$452.64 |
$452.64 |
$452.64 |
$333.29
|
|
Trach/laryn tube plug/stop
|
$9.18 |
$9.18 |
$9.18 |
$9.18
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$144.60 |
$144.60 |
$144.60 |
$101.25
|
|
Transferrin
|
$243.00 |
$243.00 |
$243.00 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$2,352.15 |
$2,352.15 |
$2,352.15 |
$983.00
|
|
Transparent film >16<=48 in
|
$18.02 |
$18.02 |
$18.02 |
$12.95
|
|
Transparent film <= 16 sq in
|
$14.78 |
$14.78 |
$14.78 |
$4.50
|
|
Trastuzumab 150 mg intravenous solution
|
$3,085.68 |
$3,085.68 |
$3,085.68 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$7,540.20 |
$7,540.20 |
$7,540.20 |
$7,540.20
|
|
Trauma partial team response w/critical care services level 4
|
$2,902.05 |
$2,902.05 |
$2,902.05 |
$4,523.04
|
|
Tray bonemarrw oncontrol 102mm
|
$1,019.25 |
$1,019.25 |
$1,019.25 |
$940.80
|
|
Treat ankle dislocation
|
$1,292.70 |
$1,292.70 |
$1,292.70 |
$2,358.40
|
|
Treat clavicle dislocation 23545
|
$520.80 |
$520.80 |
$520.80 |
$705.60
|
|
Treat elbow dislocation
|
$1,408.80 |
$1,408.80 |
$1,408.80 |
$2,223.20
|
|
Treat elbow fracture
|
$1,650.90 |
$1,650.90 |
$1,650.90 |
$1,919.13
|
|
Treat finger fracture each
|
$1,862.25 |
$1,862.25 |
$1,862.25 |
$1,536.00
|
|
Treat foot dislocation
|
$345.75 |
$345.75 |
$345.75 |
$396.30
|
|
Treat fracture of radius
|
$1,862.25 |
$1,862.25 |
$1,862.25 |
$1,790.00
|
|
Treat fracture of radius
|
$1,023.90 |
$1,023.90 |
$1,023.90 |
$1,849.00
|
|
Treat fracture of ulna
|
$343.95 |
$343.95 |
$343.95 |
$726.05
|
|
Treat hip dislocation
|
$1,408.80 |
$1,408.80 |
$1,408.80 |
$2,192.80
|
|
Treat hip dislocation
|
$1,292.70 |
$1,292.70 |
$1,292.70 |
$2,641.60
|
|
Treat humerus fracture
|
$2,327.55 |
$2,327.55 |
$2,327.55 |
$1,771.43
|
|
Treat humerus fracture
|
$2,327.55 |
$2,327.55 |
$2,327.55 |
$1,771.43
|
|
Treat kneecap dislocation
|
$1,440.30 |
$1,440.30 |
$1,440.30 |
$1,068.90
|
|
Treat knee dislocation
|
$1,292.70 |
$1,292.70 |
$1,292.70 |
$2,220.89
|
|
Treat knee fracture 27530
|
$256.95 |
$256.95 |
$256.95 |
$550.00
|
|
Treat knuckle dislocation
|
$1,894.05 |
$1,894.05 |
$1,894.05 |
$1,523.90
|
|
Treat knuckle dislocation
|
$5,611.05 |
$5,611.05 |
$5,611.05 |
$4,332.00
|
|
Treatment fx radial distal open w/internal fixation 2 frag left (restricted method ii cah)
|
$12,184.35 |
$12,184.35 |
$12,184.35 |
$8,370.75
|
|
Treatment fx radial distal open w/internal fixation 3+ frag left (restricted method ii cah)
|
$12,184.35 |
$12,184.35 |
$12,184.35 |
$8,590.40
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$202.80 |
$202.80 |
$202.80 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$154.65 |
$154.65 |
$154.65 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$310.80 |
$310.80 |
$310.80 |
$203.35
|
|
Treatment missed abortion completed surgically 1st trimester
|
$1,858.95 |
$1,858.95 |
$1,858.95 |
$3,982.44
|
|
Treatment of ankle fracture 27786
|
$279.90 |
$279.90 |
$279.90 |
$520.80
|
|
Treatment of fibula fracture 27780
|
$256.95 |
$256.95 |
$256.95 |
$491.50
|
|
Treatment of heel fracture 28400
|
$279.90 |
$279.90 |
$279.90 |
$473.00
|
|
Treatment of thigh fracture
|
$380.85 |
$380.85 |
$380.85 |
$548.90
|
|
Treatment of thigh fracture
|
$2,327.55 |
$2,327.55 |
$2,327.55 |
$1,772.97
|
|
Treatment of toe fracture 28510
|
$211.95 |
$211.95 |
$211.95 |
$369.70
|
|
Treat metacarpal fracture
|
$3,409.05 |
$3,409.05 |
$3,409.05 |
$5,464.97
|
|
Treat toe dislocation
|
$389.40 |
$389.40 |
$389.40 |
$756.39
|
|
Treat ulnar fracture
|
$2,327.55 |
$2,327.55 |
$2,327.55 |
$1,662.00
|
|
Treat vaginal bleeding
|
$306.90 |
$306.90 |
$306.90 |
$379.60
|
|
Treat wrist bone fracture
|
$2,327.55 |
$2,327.55 |
$2,327.55 |
$1,548.40
|
|
Treat wrist dislocation
|
$429.45 |
$429.45 |
$429.45 |
$656.25
|
|
Treponema pallidum antibody
|
$175.20 |
$175.20 |
$175.20 |
$70.40
|
|
Treprostinil injection
|
$25,211.74 |
$25,211.74 |
$25,211.74 |
$19,071.84
|
|
Trg gene rearrangement anal
|
$265.20 |
$265.20 |
$265.20 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$25.61 |
$25.61 |
$25.61 |
$43.21
|
|
Triamcinolone a inj prs-free
|
$1,869.12 |
$1,869.12 |
$1,869.12 |
$223.56
|
|
Triglycerides
|
$265.20 |
$265.20 |
$265.20 |
$58.05
|
|
Trimethobenzamide hcl inj
|
$117.49 |
$117.49 |
$117.49 |
$117.49
|
|
Trim nondyst nails
|
$84.15 |
$84.15 |
$84.15 |
$113.40
|
|
Triptorelin pamoate
|
$1,706.82 |
$1,706.82 |
$1,706.82 |
$4,619.39
|
|
Trmt of fracture (femoral shaft) 27500
|
$520.80 |
$520.80 |
$520.80 |
$754.80
|
|
Troponin quantitative
|
$353.40 |
$353.40 |
$353.40 |
$127.20
|
|
Truskin, per sq centimeter
|
$230.63 |
$230.63 |
$230.63 |
$230.63
|
|
Tte w or without fol w/con,stres
|
$1,375.35 |
$1,375.35 |
$1,375.35 |
$1,632.80
|
|
Tube drain vert dev st 5-40f
|
$27.60 |
$27.60 |
$27.60 |
$29.40
|
|
Tube trach disp innr can 5 xlt
|
$1,217.70 |
$1,217.70 |
$1,217.70 |
$445.99
|
|
Tube trach disp innr can 6 xlt
|
$329.64 |
$329.64 |
$329.64 |
$16.80
|
|
Tube trach fen sz 6 uncuffed
|
$846.24 |
$846.24 |
$846.24 |
$155.98
|
|
Tubular dressing
|
$139.53 |
$139.53 |
$139.53 |
$28.46
|
|
Tx closed hip disl traumatic without anes
|
$279.90 |
$279.90 |
$279.90 |
$581.07
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$4,829.55 |
$4,829.55 |
$4,829.55 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$256.95 |
$256.95 |
$256.95 |
$535.60
|
|
Tx open art fx mcp/iphlngl jnt incl int fixtn ea
|
$3,331.35 |
$3,331.35 |
$3,331.35 |
$4,499.12
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$3,331.35 |
$3,331.35 |
$3,331.35 |
$4,468.55
|
|
Tx open nsl fx uncomp
|
$5,143.95 |
$5,143.95 |
$5,143.95 |
$3,837.72
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$2,911.20 |
$2,911.20 |
$2,911.20 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$256.95 |
$256.95 |
$256.95 |
$416.16
|
|
Ultrasound breast complete
|
$766.05 |
$766.05 |
$766.05 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$766.05 |
$766.05 |
$766.05 |
$449.35
|
|
Ultrasound chest
|
$484.95 |
$484.95 |
$484.95 |
$460.85
|
|
Ultrasound encephalogram
|
$762.60 |
$762.60 |
$762.60 |
$488.80
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$469.50 |
$469.50 |
$469.50 |
$469.50
|
|
Ultrasound guided needle placement supervision & interpretation
|
$720.15 |
$720.15 |
$720.15 |
$720.15
|
|
Ultrasound guide intraoperative
|
$632.85 |
$632.85 |
$632.85 |
$632.85
|
|
Ultrasound joint complete left
|
$484.95 |
$484.95 |
$484.95 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$277.80 |
$277.80 |
$277.80 |
$425.45
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$277.80 |
$277.80 |
$277.80 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$317.85 |
$317.85 |
$317.85 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$317.85 |
$317.85 |
$317.85 |
$331.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$254.70 |
$254.70 |
$254.70 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$422.55 |
$422.55 |
$422.55 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$589.80 |
$589.80 |
$589.80 |
$497.12
|
