|
Tlh w/t/o uterus over 250 g
|
$2,062.40 |
$2,062.40 |
$2,062.40 |
$12,320.22
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$15.55 |
$15.55 |
$15.55 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$41.60 |
$41.60 |
$41.60 |
$120.60
|
|
Tomosynthesis breast diagnostic left
|
$68.80 |
$68.80 |
$68.80 |
$73.00
|
|
Tomosynthesis breast screen bilateral
|
$68.80 |
$68.80 |
$68.80 |
$72.68
|
|
Tonsillectomy (age 12+)
|
$412.00 |
$412.00 |
$412.00 |
$4,424.11
|
|
Tonsillectomy (child under 12)
|
$431.20 |
$431.20 |
$431.20 |
$5,339.00
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$61.24 |
$61.24 |
$61.24 |
$325.00
|
|
Total hip arthroplasty
|
$2,776.80 |
$2,776.80 |
$2,776.80 |
$7,347.60
|
|
Total Hip Replacement
|
$16,480.80 |
$16,480.80 |
$16,480.80 |
$9,161.60
|
|
Total hysterectomy
|
$7,155.20 |
$7,155.20 |
$7,155.20 |
$3,001.70
|
|
Total Knee Replacement
|
$12,493.60 |
$12,493.60 |
$12,493.60 |
$14,543.50
|
|
Total tau
|
$689.60 |
$689.60 |
$689.60 |
$312.50
|
|
Toxoplasma antibody igg
|
$32.80 |
$32.80 |
$32.80 |
$89.40
|
|
Toxoplasma antibody igm
|
$52.00 |
$52.00 |
$52.00 |
$87.00
|
|
Tpmt gene com vrnts
|
$280.00 |
$280.00 |
$280.00 |
$371.80
|
|
Tprnl plmt biodegrdabl matrl
|
$262.40 |
$262.40 |
$262.40 |
$7,144.80
|
|
Trabeculoplasty laser surg
|
$304.00 |
$304.00 |
$304.00 |
$1,180.80
|
|
Trachelectomy (cervicectomy) 57530
|
$613.60 |
$613.60 |
$613.60 |
$4,933.66
|
|
Tracheostoma revision; simple, without flap rotation
|
$5,080.80 |
$5,080.80 |
$5,080.80 |
$3,837.72
|
|
Transab esoph hiat hern repair 43332
|
$2,036.80 |
$2,036.80 |
$2,036.80 |
$2,835.20
|
|
Transab esoph hiat hern rpr
|
$2,225.60 |
$2,225.60 |
$2,225.60 |
$3,096.80
|
|
Transferrin
|
$27.20 |
$27.20 |
$27.20 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$360.80 |
$360.80 |
$360.80 |
$983.00
|
|
Transplant forearm tendon
|
$1,192.00 |
$1,192.00 |
$1,192.00 |
$3,591.33
|
|
Transplant forearm tendon
|
$1,198.40 |
$1,198.40 |
$1,198.40 |
$3,821.05
|
|
Transplant hand tendon
|
$4,529.60 |
$4,529.60 |
$4,529.60 |
$3,821.05
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$9,286.20 |
$9,286.20 |
$9,286.20 |
$7,540.20
|
|
Trauma partial team response w/critical care services level 4
|
$2,303.20 |
$2,303.20 |
$2,303.20 |
$4,523.04
|
|
Treat ankle dislocation
|
$2,779.20 |
$2,779.20 |
$2,779.20 |
$2,358.40
|
|
Treat ankle fracture
|
$1,772.80 |
$1,772.80 |
$1,772.80 |
$5,488.00
|
|
Treat big toe fracture
|
$839.20 |
$839.20 |
$839.20 |
$4,307.52
|
|
Treat ectopic pregnancy
|
$1,363.20 |
$1,363.20 |
$1,363.20 |
$4,350.00
|
|
Treat ectopic pregnancy
|
$5,663.20 |
$5,663.20 |
$5,663.20 |
$6,707.99
|
|
Treat elbow dislocation
|
$848.80 |
$848.80 |
$848.80 |
$2,223.20
|
|
Treat elbow dislocation
|
$1,202.40 |
$1,202.40 |
$1,202.40 |
$7,292.92
|
|
Treat elbow fracture
|
$1,806.40 |
$1,806.40 |
$1,806.40 |
$11,488.80
|
|
Treat elbow fracture
|
$1,012.00 |
$1,012.00 |
$1,012.00 |
$1,919.13
|
|
Treat eyelid by injection
|
$51.20 |
$51.20 |
$51.20 |
$481.44
|
|
Treat finger fracture each
|
$3,814.40 |
$3,814.40 |
$3,814.40 |
$4,132.02
|
|
Treat finger fracture each
|
$600.80 |
$600.80 |
$600.80 |
$1,536.00
|
|
Treat foot bone lesion
|
$958.40 |
$958.40 |
$958.40 |
$3,839.54
|
|
Treat foot dislocation
|
$396.00 |
$396.00 |
$396.00 |
$396.30
|
|
Treat foot dislocation
|
$272.80 |
$272.80 |
$272.80 |
$445.80
|
|
Treat fracture of radius
|
$865.60 |
$865.60 |
$865.60 |
$1,790.00
|
|
Treat fracture of radius
|
$944.80 |
$944.80 |
$944.80 |
$1,849.00
|
|
Treat fracture of ulna
|
$800.80 |
$800.80 |
$800.80 |
$726.05
|
|
Treat hand dislocation
|
$740.00 |
$740.00 |
$740.00 |
$1,749.06
|
|
Treat heel fracture
|
$1,889.60 |
$1,889.60 |
$1,889.60 |
$8,269.81
|
|
Treat hip dislocation
|
$1,311.20 |
$1,311.20 |
$1,311.20 |
$2,192.80
|
|
Treat hip dislocation
|
$2,641.60 |
$2,641.60 |
$2,641.60 |
$2,641.60
|
|
Treat humerus fracture
|
$1,488.80 |
$1,488.80 |
$1,488.80 |
$13,278.70
|
|
Treat humerus fracture
|
$1,451.20 |
$1,451.20 |
$1,451.20 |
$12,896.80
|
|
Treat humerus fracture
|
$1,005.60 |
$1,005.60 |
$1,005.60 |
$1,771.43
|
|
Treat humerus fracture
|
$1,563.20 |
$1,563.20 |
$1,563.20 |
$12,653.00
|
|
Treat humerus fracture
|
$1,737.60 |
$1,737.60 |
$1,737.60 |
$10,742.40
|
|
Treat humerus fracture
|
$1,248.80 |
$1,248.80 |
$1,248.80 |
$11,250.40
|
|
Treat humerus fracture
|
$4,450.14 |
$4,450.14 |
$4,450.14 |
$10,629.07
|
|
Treat kneecap dislocation
|
$848.00 |
$848.00 |
$848.00 |
$1,068.90
|
|
Treat kneecap fracture
|
$14,423.20 |
$14,423.20 |
$14,423.20 |
$6,311.00
|
|
Treat knee dislocation
|
$1,087.20 |
$1,087.20 |
$1,087.20 |
$2,220.89
|
|
Treat knee fracture
|
$11,684.80 |
$11,684.80 |
$11,684.80 |
$3,486.60
|
|
Treat knee fracture
|
$1,995.20 |
$1,995.20 |
$1,995.20 |
$4,521.40
|
|
Treat knee fracture
|
$1,382.40 |
$1,382.40 |
$1,382.40 |
$2,938.00
|
|
Treat knee fracture 27530
|
$518.40 |
$518.40 |
$518.40 |
$550.00
|
|
Treat knee fracture(s)
|
$793.60 |
$793.60 |
$793.60 |
$642.00
|
|
Treat knuckle dislocation
|
$2,641.60 |
$2,641.60 |
$2,641.60 |
$1,523.90
|
|
Treat knuckle dislocation
|
$968.00 |
$968.00 |
$968.00 |
$4,332.00
|
|
Treat lower leg fracture
|
$12,901.60 |
$12,901.60 |
$12,901.60 |
$14,241.77
|
|
Treat lower leg fracture
|
$23,601.60 |
$23,601.60 |
$23,601.60 |
$12,653.00
|
|
Treat lower leg joint
|
$2,423.73 |
$2,423.73 |
$2,423.73 |
$7,807.24
|
|
Treatment fx radial distal open w/internal fixation 2 frag left (restricted method ii cah)
|
$1,389.60 |
$1,389.60 |
$1,389.60 |
$8,370.75
|
|
Treatment fx radial distal open w/internal fixation 3+ frag left (restricted method ii cah)
|
$4,887.20 |
$4,887.20 |
$4,887.20 |
$8,590.40
|
|
Treatment fx radial distal open w/internal fixation left (restricted method ii cah)
|
$17,522.40 |
$17,522.40 |
$17,522.40 |
$8,370.75
|
|
Treatment incomplete abortion completed surgically any trimester
|
$2,030.40 |
$2,030.40 |
$2,030.40 |
$3,916.04
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$252.00 |
$252.00 |
$252.00 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$32.00 |
$32.00 |
$32.00 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$2,688.00 |
$2,688.00 |
$2,688.00 |
$203.35
|
|
Treatment missed abortion completed surgically 1st trimester
|
$2,256.00 |
$2,256.00 |
$2,256.00 |
$3,982.44
|
|
Treatment of anal fissure w/dilat 46940
|
$248.00 |
$248.00 |
$248.00 |
$3,245.23
|
|
Treatment of ankle fracture
|
$1,091.20 |
$1,091.20 |
$1,091.20 |
$8,412.89
|
|
Treatment of ankle fracture
|
$9,407.20 |
$9,407.20 |
$9,407.20 |
$8,453.60
|
|
Treatment of ankle fracture
|
$11,920.00 |
$11,920.00 |
$11,920.00 |
$7,907.11
|
|
Treatment of ankle fracture
|
$1,659.20 |
$1,659.20 |
$1,659.20 |
$7,913.97
|
|
Treatment of ankle fracture 27786
|
$509.60 |
$509.60 |
$509.60 |
$520.80
|
|
Treatment of corneal lesion
|
$496.00 |
$496.00 |
$496.00 |
$856.80
|
|
Treatment of fibula fracture
|
$1,211.20 |
$1,211.20 |
$1,211.20 |
$6,311.00
|
|
Treatment of fibula fracture 27780
|
$516.00 |
$516.00 |
$516.00 |
$491.50
|
|
Treatment of foot infection
|
$232.80 |
$232.80 |
$232.80 |
$2,614.25
|
|
Treatment of heel fracture 28400
|
$403.20 |
$403.20 |
$403.20 |
$473.00
|
|
Treatment of penis lesion
|
$715.20 |
$715.20 |
$715.20 |
$3,515.40
|
|
Treatment of retinal lesion
|
$748.00 |
$748.00 |
$748.00 |
$1,033.14
|
|
Treatment of thigh fracture
|
$2,239.20 |
$2,239.20 |
$2,239.20 |
$5,109.00
|
|
Treatment of thigh fracture
|
$871.20 |
$871.20 |
$871.20 |
$548.90
|
|
Treatment of thigh fracture
|
$1,160.00 |
$1,160.00 |
$1,160.00 |
$6,389.60
|
|
Treatment of thigh fracture
|
$2,641.60 |
$2,641.60 |
$2,641.60 |
$1,772.97
|
|
Treatment of thigh fracture
|
$1,659.20 |
$1,659.20 |
$1,659.20 |
$3,409.00
|
|
Treatment of thigh fracture
|
$1,622.40 |
$1,622.40 |
$1,622.40 |
$3,764.80
|
|
Treatment of thigh fracture
|
$2,048.80 |
$2,048.80 |
$2,048.80 |
$5,505.50
|
|
Treatment of thigh fracture
|
$1,610.40 |
$1,610.40 |
$1,610.40 |
$3,796.00
|
