|
Strapping of elbow or wrist 29260
|
$135.80 |
$135.80 |
$135.80 |
$158.20
|
|
Strapping of hand or finger
|
$135.80 |
$135.80 |
$135.80 |
$177.45
|
|
Strapping of hip
|
$294.00 |
$294.00 |
$294.00 |
$165.90
|
|
Strapping of knee
|
$294.00 |
$294.00 |
$294.00 |
$210.50
|
|
Strapping of toes 29550
|
$319.90 |
$319.90 |
$319.90 |
$176.80
|
|
Strep a ag ia
|
$141.40 |
$141.40 |
$141.40 |
$79.68
|
|
Strep b assay w/optic
|
$107.10 |
$107.10 |
$107.10 |
$82.68
|
|
Strep b dna amp probe
|
$324.10 |
$324.10 |
$324.10 |
$122.43
|
|
Stress test pulmonary
|
$609.00 |
$609.00 |
$609.00 |
$319.24
|
|
Stress tte complete
|
$2,112.60 |
$2,112.60 |
$2,112.60 |
$1,855.02
|
|
St treatment speech individual
|
$291.90 |
$291.90 |
$291.90 |
$253.80
|
|
St treatment swallow dysfunction/oral
|
$329.70 |
$329.70 |
$329.70 |
$245.00
|
|
Surgical pathology level 1 gross examination only
|
$203.00 |
$203.00 |
$203.00 |
$80.34
|
|
Surgical pathology level 2 gross & microscopic examination
|
$207.90 |
$207.90 |
$207.90 |
$146.00
|
|
Surgical pathology level 3 gross & microscopic examination
|
$370.30 |
$370.30 |
$370.30 |
$184.50
|
|
Surgical pathology level 4 gross & microscopic examination
|
$416.50 |
$416.50 |
$416.50 |
$252.75
|
|
Surgical pathology level 5 gross & microscopic examination
|
$861.70 |
$861.70 |
$861.70 |
$489.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,117.20 |
$1,117.20 |
$1,117.20 |
$730.20
|
|
Susceptibility agar dilution per agent
|
$66.50 |
$66.50 |
$66.50 |
$43.20
|
|
Susceptibility enzyme detection per enzyme
|
$63.70 |
$63.70 |
$63.70 |
$35.40
|
|
Susceptibility mic per plate
|
$80.50 |
$80.50 |
$80.50 |
$105.75
|
|
Suscept studies macrobroth dilution ea
|
$56.00 |
$56.00 |
$56.00 |
$59.28
|
|
Svc venogram s&i
|
$7,067.90 |
$7,067.90 |
$7,067.90 |
$1,934.62
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$52.50 |
$52.50 |
$52.50 |
$42.24
|
|
T3 (triiodothyronine) free
|
$157.50 |
$157.50 |
$157.50 |
$101.00
|
|
T3 (triiodothyronine) total
|
$138.60 |
$138.60 |
$138.60 |
$94.50
|
|
T4 (thyroxine) free
|
$132.30 |
$132.30 |
$132.30 |
$88.44
|
|
T4 (thyroxine) total
|
$84.70 |
$84.70 |
$84.70 |
$70.05
|
|
Tacrolimus therapeutic drug level
|
$185.50 |
$185.50 |
$185.50 |
$122.50
|
|
Target gsa panel organ neop
|
$4,054.40 |
$4,054.40 |
$4,054.40 |
$1,680.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$380.80 |
$380.80 |
$380.80 |
$175.00
|
|
T cells absolute cd4/cd8 including ratio
|
$344.40 |
$344.40 |
$344.40 |
$179.40
|
|
T cells absolute cd 4 count
|
$182.70 |
$182.70 |
$182.70 |
$111.20
|
|
T cells total count
|
$282.80 |
$282.80 |
$282.80 |
$123.00
|
|
Telehealth original site facility fee
|
$49.70 |
$49.70 |
$49.70 |
$49.70
|
|
Test stress cardiovascular tracing only
|
$653.80 |
$653.80 |
$653.80 |
$955.71
|
|
Theophylline therapeutic drug level
|
$166.60 |
$166.60 |
$166.60 |
$109.20
|
|
Therapeutic procd strg endur
|
$30.10 |
$30.10 |
$30.10 |
$85.68
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$60.20 |
$60.20 |
$60.20 |
$56.80
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$52.50 |
$52.50 |
$52.50 |
$50.00
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,298.50 |
$1,298.50 |
$1,298.50 |
$1,724.25
|
|
Thrombectmy crnry perq mechanical
|
$361.90 |
$361.90 |
$361.90 |
$3,580.00
|
|
Thrombin time
|
$70.70 |
$70.70 |
$70.70 |
$53.76
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$136.50 |
$136.50 |
$136.50 |
$61.20
|
|
Thyroglobulin antibody
|
$105.70 |
$105.70 |
$105.70 |
$83.00
|
|
Thyroid imaging
|
$1,336.30 |
$1,336.30 |
$1,336.30 |
$695.60
|
|
Thyroid (TSH) Test
|
$139.30 |
$139.30 |
$139.30 |
$112.98
|
|
Thyroid Ultrasound
|
$819.00 |
$819.00 |
$819.00 |
$601.05
|
|
Thyroxine binding globulin (tbg)
|
$99.40 |
$99.40 |
$99.40 |
$64.35
|
|
Tilt table study
|
$1,225.70 |
$1,225.70 |
$1,225.70 |
$1,576.10
|
|
Tissue exam koh skin/hair/nails
|
$60.20 |
$60.20 |
$60.20 |
$47.52
|
|
Tissue transglutaminase iga
|
$106.40 |
$106.40 |
$106.40 |
$45.24
|
|
Tomosynthesis breast diagnostic left
|
$548.10 |
$548.10 |
$548.10 |
$71.40
|
|
Tomosynthesis breast screen bilateral
|
$84.00 |
$84.00 |
$84.00 |
$69.60
|
|
Toxoplasma antibody igg
|
$193.90 |
$193.90 |
$193.90 |
$93.60
|
|
Toxoplasma antibody igm
|
$184.10 |
$184.10 |
$184.10 |
$89.10
|
|
Transferrin
|
$144.20 |
$144.20 |
$144.20 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$918.40 |
$918.40 |
$918.40 |
$936.80
|
|
Treat elbow fracture
|
$3,651.90 |
$3,651.90 |
$3,651.90 |
$1,893.86
|
|
Treat fracture of ulna
|
$547.40 |
$547.40 |
$547.40 |
$725.92
|
|
Treat hip dislocation
|
$4,017.30 |
$4,017.30 |
$4,017.30 |
$2,144.80
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$210.00 |
$210.00 |
$210.00 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$203.00 |
$203.00 |
$203.00 |
$143.48
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$213.50 |
$213.50 |
$213.50 |
$203.35
|
|
Treatment of ankle fracture 27786
|
$649.60 |
$649.60 |
$649.60 |
$520.80
|
|
Treatment of fibula fracture 27780
|
$547.40 |
$547.40 |
$547.40 |
$490.70
|
|
Treatment of foot infection
|
$3,248.70 |
$3,248.70 |
$3,248.70 |
$2,398.34
|
|
Treatment of heel fracture 28400
|
$547.40 |
$547.40 |
$547.40 |
$473.00
|
|
Treatment of toe fracture 28510
|
$547.40 |
$547.40 |
$547.40 |
$362.00
|
|
Treat thigh fracture
|
$547.40 |
$547.40 |
$547.40 |
$618.80
|
|
Treat wrist dislocation
|
$547.40 |
$547.40 |
$547.40 |
$656.25
|
|
Treponema pallidum antibody
|
$121.10 |
$121.10 |
$121.10 |
$72.80
|
|
Triglycerides
|
$78.40 |
$78.40 |
$78.40 |
$59.25
|
|
Trim nail(s)
|
$122.50 |
$122.50 |
$122.50 |
$77.60
|
|
Trim nondyst nails
|
$122.50 |
$122.50 |
$122.50 |
$115.70
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$2,322.60 |
$2,322.60 |
$2,322.60 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$3,348.80 |
$3,348.80 |
$3,348.80 |
$8,753.00
|
|
Trnscath plc vas stent w/s&i ini vein
|
$26,196.80 |
$26,196.80 |
$26,196.80 |
$14,461.50
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$11,351.90 |
$11,351.90 |
$11,351.90 |
$5,080.92
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$6,610.10 |
$6,610.10 |
$6,610.10 |
$4,250.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$6,610.10 |
$6,610.10 |
$6,610.10 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$6,610.10 |
$6,610.10 |
$6,610.10 |
$3,866.70
|
|
Troponin quantitative
|
$163.10 |
$163.10 |
$163.10 |
$129.15
|
|
Tte w or without contr, cont ecg
|
$2,112.60 |
$2,112.60 |
$2,112.60 |
$2,002.00
|
|
Ultrasound abdomen aorta screening study aaa
|
$744.10 |
$744.10 |
$744.10 |
$395.20
|
|
Ultrasound breast complete
|
$1,116.50 |
$1,116.50 |
$1,116.50 |
$546.60
|
|
Ultrasound breast unilateral limited (both sides)
|
$678.30 |
$678.30 |
$678.30 |
$467.46
|
|
Ultrasound chest
|
$744.10 |
$744.10 |
$744.10 |
$461.40
|
|
Ultrasound elastography ea l target les
|
$380.10 |
$380.10 |
$380.10 |
$178.56
|
|
Ultrasound elastography parenchyma
|
$819.00 |
$819.00 |
$819.00 |
$285.75
|
|
Ultrasound encephalogram
|
$744.10 |
$744.10 |
$744.10 |
$496.36
|
|
Ultrasound exam k transpl w/doppler
|
$744.10 |
$744.10 |
$744.10 |
$585.15
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$819.00 |
$819.00 |
$819.00 |
$477.10
|
|
Ultrasound guided needle placement supervision & interpretation
|
$382.90 |
$382.90 |
$382.90 |
$720.15
|
|
Ultrasound joint/nonvascular extremity limited left
|
$819.00 |
$819.00 |
$819.00 |
$426.60
|
|
Ultrasound ob >=14wks ea addl gest
|
$557.90 |
$557.90 |
$557.90 |
$397.15
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$428.40 |
$428.40 |
$428.40 |
$330.75
|
|
Ultrasound pregnant uterus follow up per fetus
|
$819.00 |
$819.00 |
$819.00 |
$428.25
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$819.00 |
$819.00 |
$819.00 |
$451.00
|
|
Ultrasound pregnant uterus transvaginal
|
$819.00 |
$819.00 |
$819.00 |
$492.80
|
