|
Synch audio-only new high 60
|
$156.50 |
$156.50 |
$156.50 |
$200.30
|
|
Synch audio-only new low 30
|
$77.00 |
$77.00 |
$77.00 |
$117.00
|
|
Synch audio-only new mod 45
|
$118.50 |
$118.50 |
$118.50 |
$163.38
|
|
Synch audio-only new sf 15
|
$44.50 |
$44.50 |
$44.50 |
$67.80
|
|
Synvisc or synvisc-one
|
$1,274.94 |
$1,274.94 |
$1,274.94 |
$1,274.94
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$19.50 |
$19.50 |
$19.50 |
$41.60
|
|
T3 (triiodothyronine) free
|
$64.50 |
$64.50 |
$64.50 |
$99.20
|
|
T3 (triiodothyronine) total
|
$50.50 |
$50.50 |
$50.50 |
$93.52
|
|
T4 (thyroxine) free
|
$67.50 |
$67.50 |
$67.50 |
$85.20
|
|
T4 (thyroxine) total
|
$69.00 |
$69.00 |
$69.00 |
$69.00
|
|
Tacrol envarsus ex rel oral
|
$2.50 |
$2.50 |
$2.50 |
$15.60
|
|
Tacrolimus therapeutic drug level
|
$103.00 |
$103.00 |
$103.00 |
$122.40
|
|
Tap block bilat cont infusion 64489
|
$2,774.00 |
$2,774.00 |
$2,774.00 |
$1,407.60
|
|
Tap block uni by cont infusion 64487
|
$1,011.50 |
$1,011.50 |
$1,011.50 |
$869.40
|
|
Target gsa panel hmtlmph neop
|
$2,600.00 |
$2,600.00 |
$2,600.00 |
$2,246.30
|
|
Target gsa panel organ neop
|
$1,100.00 |
$1,100.00 |
$1,100.00 |
$1,655.52
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$139.00 |
$139.00 |
$139.00 |
$194.35
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$124.00 |
$124.00 |
$124.00 |
$177.65
|
|
Tc-99m labeled rbc
|
$483.00 |
$483.00 |
$483.00 |
$302.40
|
|
Tc-99m maa
|
$311.00 |
$311.00 |
$311.00 |
$292.80
|
|
Tc-99m mebrofenin
|
$92.00 |
$92.00 |
$92.00 |
$157.65
|
|
Tc-99m medronate
|
$64.50 |
$64.50 |
$64.50 |
$111.01
|
|
Tc-99m mertiatide
|
$627.50 |
$627.50 |
$627.50 |
$756.00
|
|
Tc-99m pentetate dtpa aerosol
|
$319.50 |
$319.50 |
$319.50 |
$190.80
|
|
Tc-99m pertechnetate per mci
|
$2.50 |
$2.50 |
$2.50 |
$22.10
|
|
Tc-99m sestamibi p study dose
|
$727.00 |
$727.00 |
$727.00 |
$274.45
|
|
Tc-99m sulfur colloid
|
$137.00 |
$137.00 |
$137.00 |
$240.50
|
|
T cells absolute cd 4 count
|
$32.00 |
$32.00 |
$32.00 |
$111.20
|
|
Teaec w/wo patch graft iliofemoral
|
$1,131.00 |
$1,131.00 |
$1,131.00 |
$5,163.60
|
|
Telehealth original site facility fee
|
$56.50 |
$56.50 |
$56.50 |
$51.00
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$11,434.04 |
$11,434.04 |
$11,434.04 |
$15,245.38
|
|
Tenodesis biceps tdn at elbw
|
$655.00 |
$655.00 |
$655.00 |
$5,886.74
|
|
Tenolysis extensor tendon hand/finger each
|
$642.00 |
$642.00 |
$642.00 |
$2,811.20
|
|
Tenosynovectomy radic 26145
|
$542.50 |
$542.50 |
$542.50 |
$1,893.86
|
|
Tenotomy open tndn flxr toe sgl tndn spx
|
$2,267.50 |
$2,267.50 |
$2,267.50 |
$2,139.67
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$0.44 |
$0.44 |
$0.44 |
$39.33
|
|
Test stress cardiovascular tracing only
|
$711.50 |
$711.50 |
$711.50 |
$949.70
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$7,012.76 |
$7,012.76 |
$7,012.76 |
$8,737.05
|
|
Theophylline therapeutic drug level
|
$92.50 |
$92.50 |
$92.50 |
$108.00
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$182.50 |
$182.50 |
$182.50 |
$57.31
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$73.00 |
$73.00 |
$73.00 |
$50.00
|
|
Therapy photodnmc lght dstr lsn skn by staff rx per day
|
$329.00 |
$329.00 |
$329.00 |
$314.50
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$4.96 |
$4.96 |
$4.96 |
$25.54
|
|
Thorabd diaphr hern repair
|
$1,619.50 |
$1,619.50 |
$1,619.50 |
$3,542.40
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$3,116.00 |
$3,116.00 |
$3,116.00 |
$1,687.50
|
|
Thrombectomy/inf pq dialysis circuit
|
$380.00 |
$380.00 |
$380.00 |
$8,084.00
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$455.50 |
$455.50 |
$455.50 |
$14,277.20
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$526.00 |
$526.00 |
$526.00 |
$21,413.60
|
|
Thromb/endar/neck inc/car/vert/subc35301
|
$1,238.00 |
$1,238.00 |
$1,238.00 |
$5,520.00
|
|
Thrombin time
|
$15.50 |
$15.50 |
$15.50 |
$53.76
|
|
Thromboendarterectomy common femoral
|
$892.50 |
$892.50 |
$892.50 |
$3,980.60
|
|
Thromboendarterectomy including patch graft if preformed;
|
$992.00 |
$992.00 |
$992.00 |
$5,994.11
|
|
Thromboendarterectomy including patch graft; iliac 35351
|
$1,416.00 |
$1,416.00 |
$1,416.00 |
$4,585.00
|
|
Thromboendarterectomy sfa
|
$1,225.00 |
$1,225.00 |
$1,225.00 |
$4,185.30
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$101.50 |
$101.50 |
$101.50 |
$61.52
|
|
Thyroglobulin antibody
|
$19.50 |
$19.50 |
$19.50 |
$82.00
|
|
Thyroidectomy inc substrnl split/trans approch 60270
|
$1,436.50 |
$1,436.50 |
$1,436.50 |
$2,616.00
|
|
Thyroid (TSH) Test
|
$76.50 |
$76.50 |
$76.50 |
$111.00
|
|
Thyroid Ultrasound
|
$301.50 |
$301.50 |
$301.50 |
$588.50
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$3,033.50 |
$3,033.50 |
$3,033.50 |
$4,112.43
|
|
Thyroxine binding globulin (tbg)
|
$25.00 |
$25.00 |
$25.00 |
$64.35
|
|
Tibial arthroscopy/surgery
|
$825.00 |
$825.00 |
$825.00 |
$5,801.60
|
|
Tissue culture skin/biopsy
|
$600.50 |
$600.50 |
$600.50 |
$484.00
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$1,134.00
|
|
Tissue transglutaminase iga
|
$142.50 |
$142.50 |
$142.50 |
$44.16
|
|
Tlh uterus 250 g or less
|
$7,098.00 |
$7,098.00 |
$7,098.00 |
$11,533.76
|
|
Tlh w/t/o 250 g or less
|
$15,097.50 |
$15,097.50 |
$15,097.50 |
$12,320.22
|
|
Tlh w/t/o uterus over 250 g
|
$1,289.00 |
$1,289.00 |
$1,289.00 |
$12,320.22
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$3,983.73 |
$3,983.73 |
$3,983.73 |
$5,258.52
|
|
Tomosynthesis breast diagnostic left
|
$75.50 |
$75.50 |
$75.50 |
$73.00
|
|
Tomosynthesis breast screen bilateral
|
$69.00 |
$69.00 |
$69.00 |
$72.68
|
|
Tonsillectomy (age 12+)
|
$3,520.00 |
$3,520.00 |
$3,520.00 |
$4,424.11
|
|
Tonsillectomy (child under 12)
|
$290.50 |
$290.50 |
$290.50 |
$5,339.00
|
|
Total hip arthroplasty
|
$1,735.50 |
$1,735.50 |
$1,735.50 |
$7,347.60
|
|
Total Hip Replacement
|
$1,338.50 |
$1,338.50 |
$1,338.50 |
$9,161.60
|
|
Total hysterectomy
|
$17,952.00 |
$17,952.00 |
$17,952.00 |
$3,001.70
|
|
Total Knee Replacement
|
$1,336.00 |
$1,336.00 |
$1,336.00 |
$14,543.50
|
|
Total tau
|
$431.00 |
$431.00 |
$431.00 |
$312.50
|
|
Toxoplasma antibody igg
|
$63.50 |
$63.50 |
$63.50 |
$89.40
|
|
Toxoplasma antibody igm
|
$14.50 |
$14.50 |
$14.50 |
$87.00
|
|
Tp53 gene full gene sequence
|
$126.00 |
$126.00 |
$126.00 |
$709.80
|
|
Tpmt gene com vrnts
|
$175.00 |
$175.00 |
$175.00 |
$371.80
|
|
Tprnl plmt biodegrdabl matrl
|
$164.00 |
$164.00 |
$164.00 |
$7,144.80
|
|
Trabeculoplasty laser surg
|
$1,449.00 |
$1,449.00 |
$1,449.00 |
$1,180.80
|
|
Trachelectomy (cervicectomy) 57530
|
$383.50 |
$383.50 |
$383.50 |
$4,933.66
|
|
Tracheostoma revision; simple, without flap rotation
|
$3,175.50 |
$3,175.50 |
$3,175.50 |
$3,837.72
|
|
Transab esoph hiat hern repair 43332
|
$1,273.00 |
$1,273.00 |
$1,273.00 |
$2,835.20
|
|
Transab esoph hiat hern rpr
|
$1,391.00 |
$1,391.00 |
$1,391.00 |
$3,096.80
|
|
Transcutaneous carboxyhb
|
$21.00 |
$21.00 |
$21.00 |
$33.57
|
|
Transferrin
|
$71.00 |
$71.00 |
$71.00 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$563.50 |
$563.50 |
$563.50 |
$983.00
|
|
Transplant forearm tendon
|
$745.00 |
$745.00 |
$745.00 |
$3,591.33
|
|
Transplant forearm tendon
|
$749.00 |
$749.00 |
$749.00 |
$3,821.05
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$11,355.29 |
$11,355.29 |
$11,355.29 |
$7,540.20
|
|
Trauma partial team response w/critical care services level 4
|
$1,087.00 |
$1,087.00 |
$1,087.00 |
$4,523.04
|
|
Treat ankle dislocation
|
$548.50 |
$548.50 |
$548.50 |
$2,358.40
|
|
Treat ankle fracture
|
$1,108.00 |
$1,108.00 |
$1,108.00 |
$5,488.00
|
|
Treat big toe fracture
|
$524.50 |
$524.50 |
$524.50 |
$4,307.52
|
|
Treat ectopic pregnancy
|
$852.00 |
$852.00 |
$852.00 |
$4,350.00
|
|
Treat ectopic pregnancy
|
$12,936.00 |
$12,936.00 |
$12,936.00 |
$6,707.99
|
