|
Tc-99m sulfur colloid
|
$308.50 |
$308.50 |
$308.50 |
$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
|
$63.00 |
$63.00 |
$63.00 |
$51.00
|
|
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
|
$254.50 |
$254.50 |
$254.50 |
$2,139.67
|
|
Test stress cardiovascular tracing only
|
$207.00 |
$207.00 |
$207.00 |
$949.70
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$33.50 |
$33.50 |
$33.50 |
$8,737.05
|
|
Theophylline therapeutic drug level
|
$59.00 |
$59.00 |
$59.00 |
$108.00
|
|
Therapy activity per session >= 45 minutes
|
$79.00 |
$79.00 |
$79.00 |
$191.50
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$2.50 |
$2.50 |
$2.50 |
$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)
|
$601.00 |
$601.00 |
$601.00 |
$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
|
$13.00 |
$13.00 |
$13.00 |
$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
|
$40.00 |
$40.00 |
$40.00 |
$61.52
|
|
Thyroglobulin antibody
|
$39.00 |
$39.00 |
$39.00 |
$82.00
|
|
Thyroidectomy inc substrnl split/trans approch 60270
|
$1,436.50 |
$1,436.50 |
$1,436.50 |
$2,616.00
|
|
Thyroid (TSH) Test
|
$53.00 |
$53.00 |
$53.00 |
$111.00
|
|
Thyroid Ultrasound
|
$309.50 |
$309.50 |
$309.50 |
$588.50
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$3,033.50 |
$3,033.50 |
$3,033.50 |
$4,112.43
|
|
Tibial arthroscopy/surgery
|
$825.00 |
$825.00 |
$825.00 |
$5,801.60
|
|
Tissue culture skin/biopsy
|
$110.00 |
$110.00 |
$110.00 |
$484.00
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$136.00 |
$136.00 |
$136.00 |
$1,134.00
|
|
Tissue transglutaminase iga
|
$61.50 |
$61.50 |
$61.50 |
$44.16
|
|
Tlh uterus 250 g or less
|
$842.00 |
$842.00 |
$842.00 |
$11,533.76
|
|
Tlh w/t/o 250 g or less
|
$961.50 |
$961.50 |
$961.50 |
$12,320.22
|
|
Tlh w/t/o uterus over 250 g
|
$1,289.00 |
$1,289.00 |
$1,289.00 |
$12,320.22
|
|
Tomosynthesis breast diagnostic left
|
$77.00 |
$77.00 |
$77.00 |
$73.00
|
|
Tomosynthesis breast screen bilateral
|
$79.00 |
$79.00 |
$79.00 |
$72.68
|
|
Tonsillectomy (age 12+)
|
$257.50 |
$257.50 |
$257.50 |
$4,424.11
|
|
Tonsillectomy (child under 12)
|
$269.50 |
$269.50 |
$269.50 |
$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
|
$1,086.50 |
$1,086.50 |
$1,086.50 |
$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
|
$14.00 |
$14.00 |
$14.00 |
$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
|
$190.00 |
$190.00 |
$190.00 |
$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
|
|
Transferrin
|
$47.50 |
$47.50 |
$47.50 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$439.50 |
$439.50 |
$439.50 |
$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
|
|
Trauma partial team response w/critical care services level 4
|
$1,395.50 |
$1,395.50 |
$1,395.50 |
$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
|
$831.50 |
$831.50 |
$831.50 |
$6,707.99
|
|
Treat elbow dislocation
|
$530.50 |
$530.50 |
$530.50 |
$2,223.20
|
|
Treat elbow dislocation
|
$751.50 |
$751.50 |
$751.50 |
$7,292.92
|
|
Treat elbow fracture
|
$1,129.00 |
$1,129.00 |
$1,129.00 |
$11,488.80
|
|
Treat elbow fracture
|
$632.50 |
$632.50 |
$632.50 |
$1,919.13
|
|
Treat eyelid by injection
|
$32.00 |
$32.00 |
$32.00 |
$481.44
|
|
Treat finger fracture each
|
$503.50 |
$503.50 |
$503.50 |
$4,132.02
|
|
Treat finger fracture each
|
$375.50 |
$375.50 |
$375.50 |
$1,536.00
|
|
Treat foot bone lesion
|
$599.00 |
$599.00 |
$599.00 |
$3,839.54
|
|
Treat foot dislocation
|
$184.50 |
$184.50 |
$184.50 |
$396.30
|
|
Treat foot dislocation
|
$170.50 |
$170.50 |
$170.50 |
$445.80
|
|
Treat fracture of radius
|
$2,278.50 |
$2,278.50 |
$2,278.50 |
$1,790.00
|
|
Treat fracture of radius
|
$590.50 |
$590.50 |
$590.50 |
$1,849.00
|
|
Treat fracture of ulna
|
$500.50 |
$500.50 |
$500.50 |
$726.05
|
|
Treat hand dislocation
|
$462.50 |
$462.50 |
$462.50 |
$1,749.06
|
|
Treat heel fracture
|
$1,181.00 |
$1,181.00 |
$1,181.00 |
$8,269.81
|
|
Treat hip dislocation
|
$819.50 |
$819.50 |
$819.50 |
$2,192.80
|
|
Treat hip dislocation
|
$378.50 |
$378.50 |
$378.50 |
$2,641.60
|
|
Treat hip socket fracture
|
$249.50 |
$249.50 |
$249.50 |
$1,392.00
|
|
Treat humerus fracture
|
$930.50 |
$930.50 |
$930.50 |
$13,278.70
|
|
Treat humerus fracture
|
$907.00 |
$907.00 |
$907.00 |
$12,896.80
|
|
Treat humerus fracture
|
$628.50 |
$628.50 |
$628.50 |
$1,771.43
|
|
Treat humerus fracture
|
$977.00 |
$977.00 |
$977.00 |
$12,653.00
|
|
Treat humerus fracture
|
$1,086.00 |
$1,086.00 |
$1,086.00 |
$10,742.40
|
|
Treat humerus fracture
|
$780.50 |
$780.50 |
$780.50 |
$11,250.40
|
|
Treat humerus fracture
|
$881.50 |
$881.50 |
$881.50 |
$10,629.07
|
|
Treat kneecap dislocation
|
$530.00 |
$530.00 |
$530.00 |
$1,068.90
|
|
Treat kneecap fracture
|
$797.50 |
$797.50 |
$797.50 |
$6,311.00
|
|
Treat knee dislocation
|
$1,540.50 |
$1,540.50 |
$1,540.50 |
$2,220.89
|
|
Treat knee fracture
|
$935.50 |
$935.50 |
$935.50 |
$3,486.60
|
|
Treat knee fracture
|
$1,247.00 |
$1,247.00 |
$1,247.00 |
$4,521.40
|
|
Treat knee fracture
|
$864.00 |
$864.00 |
$864.00 |
$2,938.00
|
|
Treat knee fracture 27530
|
$425.00 |
$425.00 |
$425.00 |
$550.00
|
|
Treat knee fracture(s)
|
$496.00 |
$496.00 |
$496.00 |
$642.00
|
|
Treat knuckle dislocation
|
$435.50 |
$435.50 |
$435.50 |
$1,523.90
|
