|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$0.15 |
$0.15 |
$0.15 |
$56.38
|
|
Transcutaneous carboxyhb
|
$10.00 |
$10.00 |
$10.00 |
$33.57
|
|
Transferrin
|
$20.00 |
$20.00 |
$20.00 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$776.40 |
$776.40 |
$776.40 |
$983.00
|
|
Trans shoe solid stirrup exi
|
$46.80 |
$46.80 |
$46.80 |
$141.41
|
|
Trastuzumab 150 mg intravenous solution
|
$205.85 |
$205.85 |
$205.85 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$167.69 |
$167.69 |
$167.69 |
$7,540.20
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$106.48 |
$106.48 |
$106.48 |
$5,835.15
|
|
Trauma partial team response w/critical care services level 4
|
$2,632.40 |
$2,632.40 |
$2,632.40 |
$4,523.04
|
|
Tray bonemarrw oncontrol 102mm
|
$865.60 |
$865.60 |
$865.60 |
$940.80
|
|
Treat elbow fracture
|
$1,768.80 |
$1,768.80 |
$1,768.80 |
$1,919.13
|
|
Treat foot dislocation
|
$270.40 |
$270.40 |
$270.40 |
$396.30
|
|
Treat fracture of radius
|
$1,768.80 |
$1,768.80 |
$1,768.80 |
$1,790.00
|
|
Treat hand dislocation
|
$1,768.80 |
$1,768.80 |
$1,768.80 |
$1,749.06
|
|
Treatment incomplete abortion completed surgically any trimester
|
$3,804.40 |
$3,804.40 |
$3,804.40 |
$3,916.04
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$268.80 |
$268.80 |
$268.80 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$215.60 |
$215.60 |
$215.60 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$254.40 |
$254.40 |
$254.40 |
$203.35
|
|
Treatment of ankle fracture 27786
|
$270.40 |
$270.40 |
$270.40 |
$520.80
|
|
Treatment of fibula fracture 27780
|
$270.40 |
$270.40 |
$270.40 |
$491.50
|
|
Treatment of thigh fracture
|
$1,768.80 |
$1,768.80 |
$1,768.80 |
$1,748.40
|
|
Treatment of thigh fracture
|
$270.40 |
$270.40 |
$270.40 |
$548.90
|
|
Treatment of thigh fracture
|
$1,768.80 |
$1,768.80 |
$1,768.80 |
$1,772.97
|
|
Treatment of toe fracture 28510
|
$270.40 |
$270.40 |
$270.40 |
$369.70
|
|
Treatment radiation delivery level 2
|
$736.00 |
$736.00 |
$736.00 |
$767.65
|
|
Treat wrist dislocation
|
$270.40 |
$270.40 |
$270.40 |
$656.25
|
|
Treponema pallidum antibody
|
$30.80 |
$30.80 |
$30.80 |
$70.40
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$33.22 |
$33.22 |
$33.22 |
$43.21
|
|
Trichomonas assay w/optic
|
$21.20 |
$21.20 |
$21.20 |
$55.50
|
|
Triglycerides
|
$26.00 |
$26.00 |
$26.00 |
$58.05
|
|
Trim nondyst nails
|
$70.80 |
$70.80 |
$70.80 |
$113.40
|
|
Trmt of fracture (femoral shaft) 27500
|
$270.40 |
$270.40 |
$270.40 |
$754.80
|
|
Trnscath plc stent crv crtd without prtct
|
$2,805.60 |
$2,805.60 |
$2,805.60 |
$7,795.71
|
|
Trnscath plc stent crv crtd w/prtct
|
$6,790.00 |
$6,790.00 |
$6,790.00 |
$9,767.25
|
|
Trnscath plc stnt ante carotid art
|
$5,551.60 |
$5,551.60 |
$5,551.60 |
$6,069.00
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$7,252.80 |
$7,252.80 |
$7,252.80 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$3,346.00 |
$3,346.00 |
$3,346.00 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$7,252.80 |
$7,252.80 |
$7,252.80 |
$15,330.11
|
|
Trnscath retrv pq vasc fb w/guide
|
$3,636.00 |
$3,636.00 |
$3,636.00 |
$4,523.96
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$7,252.80 |
$7,252.80 |
$7,252.80 |
$5,069.50
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$1,782.40 |
$1,782.40 |
$1,782.40 |
$4,250.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$3,263.60 |
$3,263.60 |
$3,263.60 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$3,551.20 |
$3,551.20 |
$3,551.20 |
$3,866.70
|
|
Troponin quantitative
|
$86.40 |
$86.40 |
$86.40 |
$127.20
|
|
Tube trach disp innr can 5 xlt
|
$352.00 |
$352.00 |
$352.00 |
$445.99
|
|
Tube trach fen sz 6 uncuffed
|
$244.80 |
$244.80 |
$244.80 |
$155.98
|
|
Tx atrial fib pulm vein isol
|
$13,833.20 |
$13,833.20 |
$13,833.20 |
$29,030.54
|
|
Tx closed hip disl traumatic without anes
|
$270.40 |
$270.40 |
$270.40 |
$581.07
|
|
Tx closed tib shaft fx without manip
|
$270.40 |
$270.40 |
$270.40 |
$535.60
|
|
Tx l/r atrial fib addl
|
$1,244.80 |
$1,244.80 |
$1,244.80 |
$6,769.00
|
|
Ultrasound abdomen aorta screening study aaa
|
$228.80 |
$228.80 |
$228.80 |
$394.20
|
|
Ultrasound breast complete
|
$310.80 |
$310.80 |
$310.80 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$254.80 |
$254.80 |
$254.80 |
$449.35
|
|
Ultrasound chest
|
$164.40 |
$164.40 |
$164.40 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$181.60 |
$181.60 |
$181.60 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$159.20 |
$159.20 |
$159.20 |
$296.80
|
|
Ultrasound elastography parenchyma
|
$362.80 |
$362.80 |
$362.80 |
$307.00
|
|
Ultrasound encephalogram
|
$170.00 |
$170.00 |
$170.00 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$168.80 |
$168.80 |
$168.80 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$311.20 |
$311.20 |
$311.20 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$134.40 |
$134.40 |
$134.40 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$532.40 |
$532.40 |
$532.40 |
$720.15
|
|
Ultrasound guide intraoperative
|
$300.40 |
$300.40 |
$300.40 |
$632.85
|
|
Ultrasound hips infant dynamic
|
$219.60 |
$219.60 |
$219.60 |
$403.88
|
|
Ultrasound joint complete left
|
$325.60 |
$325.60 |
$325.60 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$279.20 |
$279.20 |
$279.20 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$263.60 |
$263.60 |
$263.60 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$182.80 |
$182.80 |
$182.80 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$292.40 |
$292.40 |
$292.40 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$376.00 |
$376.00 |
$376.00 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$278.40 |
$278.40 |
$278.40 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$314.80 |
$314.80 |
$314.80 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$299.60 |
$299.60 |
$299.60 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$234.00 |
$234.00 |
$234.00 |
$486.50
|
|
Ultrasound scrotum and contents
|
$474.80 |
$474.80 |
$474.80 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$147.20 |
$147.20 |
$147.20 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$128.40 |
$128.40 |
$128.40 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$334.80 |
$334.80 |
$334.80 |
$558.35
|
|
Umbilical artery cath newborn 36660
|
$462.00 |
$462.00 |
$462.00 |
$206.64
|
|
Unit mobile power mpu
|
$9,331.20 |
$9,331.20 |
$9,331.20 |
$14,612.80
|
|
Unlisted chemotherapy px
|
$50.80 |
$50.80 |
$50.80 |
$150.00
|
|
Unlisted fluoroscopic px
|
$220.00 |
$220.00 |
$220.00 |
$305.76
|
|
Unlisted maaa
|
$224.00 |
$224.00 |
$224.00 |
$235.20
|
|
Unlisted procedure microbiology
|
$16.40 |
$16.40 |
$16.40 |
$523.50
|
|
Unlisted special svc px/rprt
|
$59.20 |
$59.20 |
$59.20 |
$90.00
|
|
Unlisted surgical path px
|
$64.40 |
$64.40 |
$64.40 |
$217.75
|
|
Unlisted ultrasound procedure
|
$136.00 |
$136.00 |
$136.00 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$1,028.80 |
$1,028.80 |
$1,028.80 |
$1,268.17
|
|
Upgrade pm system
|
$17,123.60 |
$17,123.60 |
$17,123.60 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,076.00 |
$2,076.00 |
$2,076.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,666.80 |
$1,666.80 |
$1,666.80 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,515.20 |
$1,515.20 |
$1,515.20 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,028.40 |
$1,028.40 |
$1,028.40 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$1,906.40 |
$1,906.40 |
$1,906.40 |
$1,768.00
|
|
Urea nitrogen
|
$32.80 |
$32.80 |
$32.80 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$34.80 |
$34.80 |
$34.80 |
$51.75
|
|
Urea nitrogen clearance
|
$11.60 |
$11.60 |
$11.60 |
$42.25
|
|
Ureteral reflux study
|
$518.40 |
$518.40 |
$518.40 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$353.20 |
$353.20 |
$353.20 |
$579.73
|
|
Urethrocystography void s&i
|
$335.60 |
$335.60 |
$335.60 |
$622.35
|
