|
Telehealth original site facility fee
|
$32.50 |
$32.50 |
$32.50 |
|
|
Telethx isodose plan cplx
|
$209.60 |
$209.60 |
$22,692.15 |
|
|
Telethx isodose plan simple
|
$674.05 |
$674.05 |
$674.05 |
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$19,442.56 |
$19,442.56 |
$19,442.56 |
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$16.90 |
$16.90 |
$16.90 |
|
|
Test stress cardiovascular tracing only
|
$338.40 |
$403.60 |
$521.30 |
|
|
Tetanus immune globulin inj
|
$2,770.16 |
$2,770.16 |
$2,770.16 |
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$8,207.80 |
$8,207.80 |
$8,207.80 |
|
|
Theophylline therapeutic drug level
|
$66.40 |
$72.80 |
$88.40 |
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$22.00 |
$24.40 |
$76.05 |
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$24.40 |
$24.80 |
$70.85 |
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$36.07 |
$36.07 |
$36.07 |
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$737.20 |
$737.20 |
$3,616.60 |
|
|
Thrombectmy crnry perq mechanical
|
$3,165.60 |
$3,165.60 |
$4,398.55 |
|
|
Thrombectomy/inf pq dialysis circuit
|
$4,390.00 |
$4,390.00 |
$4,390.00 |
|
|
Thrombin time
|
$28.80 |
$40.80 |
$40.95 |
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$44.40 |
$62.40 |
$78.65 |
|
|
Thyroglobulin antibody
|
$81.60 |
$98.00 |
$148.20 |
|
|
Thyroid mets imag whole body
|
$628.40 |
$628.40 |
$628.40 |
|
|
Thyroid (TSH) Test
|
$48.40 |
$101.20 |
$138.45 |
|
|
Thyroid Ultrasound
|
$337.20 |
$560.80 |
$572.65 |
|
|
Thyroid uptake measurement
|
$440.40 |
$440.40 |
$440.40 |
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$3,694.65 |
$3,694.65 |
$3,694.65 |
|
|
Thyroxine binding globulin (tbg)
|
$72.80 |
$72.80 |
$111.80 |
|
|
Tilt table study
|
$719.55 |
$719.55 |
$836.80 |
|
|
Tisotumab vedotin-tftv 40 mg intravenous solution
|
$13,236.73 |
$13,236.73 |
$13,236.73 |
|
|
Tissue culture skin/biopsy
|
$444.00 |
$444.00 |
$444.00 |
|
|
Tissue exam koh skin/hair/nails
|
$38.35 |
$38.35 |
$45.60 |
|
|
Tissue transglutaminase iga
|
$59.60 |
$59.60 |
$105.95 |
|
|
Tlh uterus 250 g or less
|
$16,642.09 |
$16,642.09 |
$16,642.09 |
|
|
Tlh w/t/o 250 g or less
|
$19,493.54 |
$19,493.54 |
$19,493.54 |
|
|
Tlh w/t/o uterus over 250 g
|
$20,996.61 |
$20,996.61 |
$20,996.61 |
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$352.79 |
$352.79 |
$352.79 |
|
|
Tobramycin peak therapeutic drug level
|
$105.20 |
$110.00 |
$124.80 |
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$957.25 |
$957.25 |
$957.25 |
|
|
Tomosynthesis breast diagnostic left
|
$34.45 |
$34.45 |
$34.45 |
|
|
Tomosynthesis breast screen bilateral
|
$40.80 |
$43.20 |
$73.45 |
|
|
Tonsillectomy (age 12+)
|
$12,331.00 |
$12,331.00 |
$12,331.00 |
|
|
Total hysterectomy
|
$18,122.32 |
$18,122.32 |
$18,122.32 |
|
|
Toxoplasma antibody igg
|
$34.40 |
$47.60 |
$116.35 |
|
|
Toxoplasma antibody igm
|
$32.40 |
$70.80 |
$117.00 |
|
|
Tprnl plmt biodegrdabl matrl
|
$18,966.30 |
$18,966.30 |
$18,966.30 |
|
|
Trabectedin 1 mg intravenous solution
|
$7,064.12 |
$7,064.12 |
$7,064.12 |
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$88.72 |
$88.72 |
$88.72 |
|
|
Transferrin
|
$69.60 |
$82.80 |
$143.65 |
|
|
Transfusion blood/blood component(s)
|
$358.00 |
$484.80 |
$2,174.90 |
|
|
Transperi needle place pros
|
$44,048.86 |
$44,048.86 |
$44,048.86 |
|
|
Trastuzumab 150 mg intravenous solution
|
$2,793.48 |
$2,793.48 |
$2,793.48 |
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$6,814.92 |
$6,814.92 |
$6,814.92 |
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$2,172.64 |
$2,172.64 |
$2,172.64 |
|
|
Trauma partial team response w/critical care services level 4
|
$1,407.90 |
$1,407.90 |
$1,407.90 |
|
|
Treat knuckle dislocation
|
$404.80 |
$404.80 |
$404.80 |
|
|
Treatment incomplete abortion completed surgically any trimester
|
$10,047.45 |
$10,047.45 |
$10,047.45 |
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$100.10 |
$110.80 |
$140.80 |
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$48.10 |
$48.10 |
$48.10 |
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$114.80 |
$123.20 |
$158.60 |
|
|
Treatment missed abortion completed surgically 1st trimester
|
$10,146.74 |
$10,146.74 |
$10,146.74 |
|
|
Treatment of ankle fracture 27786
|
$68.00 |
$68.00 |
$68.00 |
|
|
Treatment of fibula fracture 27780
|
$723.20 |
$723.20 |
$723.20 |
|
|
Treatment of toe fracture 28510
|
$63.20 |
$63.20 |
$63.20 |
|
|
Treatment radiation delivery level 2
|
$148.00 |
$148.00 |
$7,753.85 |
|
|
Treponema pallidum antibody
|
$40.80 |
$75.20 |
$119.60 |
|
|
Trg gene rearrangement anal
|
$116.40 |
$116.40 |
$116.40 |
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$35.91 |
$35.91 |
$35.91 |
|
|
#tricyclicantidprssnt
|
$47.60 |
$47.60 |
$47.60 |
|
|
Triglycerides
|
$32.40 |
$50.80 |
$85.15 |
|
|
Troponin quantitative
|
$53.20 |
$89.60 |
$118.30 |
|
|
Trurl dstrj prst8 tiss rf wv
|
$8,767.53 |
$8,767.53 |
$8,767.53 |
|
|
Tte w or without contr, cont ecg
|
$1,196.00 |
$1,196.00 |
$1,196.00 |
|
|
Tx atrial fib pulm vein isol
|
$29,148.60 |
$29,148.60 |
$29,148.60 |
|
|
Tx l/r atrial fib addl
|
$8,259.55 |
$8,259.55 |
$8,259.55 |
|
|
Tympanic membrane repair
|
$8,789.38 |
$8,789.38 |
$8,789.38 |
|
|
Ua w/micro/comp poc
|
$37.60 |
$37.60 |
$37.60 |
|
|
Ugt1a1 gene analy common variants
|
$264.40 |
$264.40 |
$264.40 |
|
|
Ultrasound abdomen aorta screening study aaa
|
$325.20 |
$483.60 |
$485.20 |
|
|
Ultrasound breast complete
|
$697.45 |
$697.45 |
$697.45 |
|
|
Ultrasound breast unilateral limited (both sides)
|
$290.80 |
$376.40 |
$697.45 |
|
|
Ultrasound chest
|
$242.40 |
$255.20 |
$323.05 |
|
|
Ultrasound encephalogram
|
$353.60 |
$353.60 |
$353.60 |
|
|
Ultrasound exam k transpl w/doppler
|
$325.60 |
$325.60 |
$325.60 |
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$502.40 |
$502.40 |
$644.80 |
|
|
Ultrasound guidance for vascular access
|
$418.80 |
$418.80 |
$418.80 |
|
|
Ultrasound guided needle placement supervision & interpretation
|
$290.80 |
$475.60 |
$595.40 |
|
|
Ultrasound guide intraoperative
|
$461.20 |
$461.20 |
$461.20 |
|
|
Ultrasound hips infant dynamic
|
$776.80 |
$776.80 |
$776.80 |
|
|
Ultrasound infant hips ltd without stress
|
$420.40 |
$420.40 |
$420.40 |
|
|
Ultrasound joint complete left
|
$280.40 |
$440.05 |
$484.80 |
|
|
Ultrasound joint/nonvascular extremity limited left
|
$239.20 |
$280.40 |
$769.60 |
|
|
Ultrasound ob >=14wks ea addl gest
|
$430.30 |
$430.30 |
$450.80 |
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$319.20 |
$319.20 |
$428.35 |
|
|
Ultrasound pregnant uterus follow up per fetus
|
$414.40 |
$414.40 |
$479.70 |
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$127.60 |
$286.00 |
$434.20 |
|
|
Ultrasound pregnant uterus transvaginal
|
$96.00 |
$345.60 |
$571.35 |
|
|
Ultrasound retroperitoneal limited
|
$236.00 |
$323.05 |
$335.20 |
|
|
Ultrasound scrotum and contents
|
$340.00 |
$533.20 |
$548.60 |
|
|
Ultrasound spinal canal and contents
|
$136.80 |
$136.80 |
$377.65 |
|
|
Ultrasound transvaginal non obstetric
|
$234.80 |
$404.40 |
$491.40 |
|
|
Unlisted fluoroscopic px
|
$414.00 |
$414.00 |
$414.00 |
|
|
Unlisted misc path test
|
$30.80 |
$30.80 |
$30.80 |
|
|
Unlisted neurological dx px
|
$478.40 |
$478.40 |
$478.40 |
|