|
Telehealth original site facility fee
|
$59.00 |
$59.00 |
$59.00 |
$51.00
|
|
Tenotomy open tndn flxr toe sgl tndn spx
|
$254.50 |
$254.50 |
$254.50 |
$2,139.67
|
|
Test stress cardiovascular tracing only
|
$496.50 |
$496.50 |
$496.50 |
$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
|
$119.50 |
$119.50 |
$119.50 |
$108.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$2.50 |
$2.50 |
$2.50 |
$25.54
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$601.00 |
$601.00 |
$601.00 |
$1,687.50
|
|
Thrombin time
|
$20.50 |
$20.50 |
$20.50 |
$53.76
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$132.50 |
$132.50 |
$132.50 |
$61.52
|
|
Thyroglobulin antibody
|
$25.00 |
$25.00 |
$25.00 |
$82.00
|
|
Thyroid (TSH) Test
|
$65.00 |
$65.00 |
$65.00 |
$111.00
|
|
Thyroid Ultrasound
|
$440.50 |
$440.50 |
$440.50 |
$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
|
|
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
|
$35.00 |
$35.00 |
$35.00 |
$44.16
|
|
Tobramycin peak therapeutic drug level
|
$136.50 |
$136.50 |
$136.50 |
$120.60
|
|
Tomosynthesis breast diagnostic left
|
$88.00 |
$88.00 |
$88.00 |
$73.00
|
|
Tomosynthesis breast screen bilateral
|
$82.00 |
$82.00 |
$82.00 |
$72.68
|
|
Total Hip Replacement
|
$6,331.50 |
$6,331.50 |
$6,331.50 |
$9,161.60
|
|
Total tau
|
$431.00 |
$431.00 |
$431.00 |
$312.50
|
|
Toxoplasma antibody igg
|
$32.00 |
$32.00 |
$32.00 |
$89.40
|
|
Toxoplasma antibody igm
|
$17.00 |
$17.00 |
$17.00 |
$87.00
|
|
Tpmt gene com vrnts
|
$175.00 |
$175.00 |
$175.00 |
$371.80
|
|
Trabeculoplasty laser surg
|
$190.00 |
$190.00 |
$190.00 |
$1,180.80
|
|
Tracheostoma revision; simple, without flap rotation
|
$3,175.50 |
$3,175.50 |
$3,175.50 |
$3,837.72
|
|
Transcutaneous carboxyhb
|
$26.50 |
$26.50 |
$26.50 |
$33.57
|
|
Transferrin
|
$82.50 |
$82.50 |
$82.50 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$645.50 |
$645.50 |
$645.50 |
$983.00
|
|
Trauma partial team response w/critical care services level 4
|
$973.00 |
$973.00 |
$973.00 |
$4,523.04
|
|
Treat ankle dislocation
|
$548.50 |
$548.50 |
$548.50 |
$2,358.40
|
|
Treat elbow dislocation
|
$2,272.50 |
$2,272.50 |
$2,272.50 |
$2,223.20
|
|
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
|
$375.50 |
$375.50 |
$375.50 |
$1,536.00
|
|
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
|
$541.00 |
$541.00 |
$541.00 |
$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 hip dislocation
|
$819.50 |
$819.50 |
$819.50 |
$2,192.80
|
|
Treat humerus fracture
|
$2,218.50 |
$2,218.50 |
$2,218.50 |
$1,771.43
|
|
Treat kneecap dislocation
|
$530.00 |
$530.00 |
$530.00 |
$1,068.90
|
|
Treat knee dislocation
|
$679.50 |
$679.50 |
$679.50 |
$2,220.89
|
|
Treat knee fracture 27530
|
$324.00 |
$324.00 |
$324.00 |
$550.00
|
|
Treat knee fracture(s)
|
$496.00 |
$496.00 |
$496.00 |
$642.00
|
|
Treat knuckle dislocation
|
$1,591.00 |
$1,591.00 |
$1,591.00 |
$1,523.90
|
|
Treat lower leg fracture
|
$1,183.50 |
$1,183.50 |
$1,183.50 |
$14,241.77
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$282.00 |
$282.00 |
$282.00 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$53.50 |
$53.50 |
$53.50 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$127.00 |
$127.00 |
$127.00 |
$203.35
|
|
Treatment of ankle fracture 27786
|
$318.50 |
$318.50 |
$318.50 |
$520.80
|
|
Treatment of corneal lesion
|
$310.00 |
$310.00 |
$310.00 |
$856.80
|
|
Treatment of fibula fracture 27780
|
$322.50 |
$322.50 |
$322.50 |
$491.50
|
|
Treatment of heel fracture 28400
|
$252.00 |
$252.00 |
$252.00 |
$473.00
|
|
Treatment of retinal lesion
|
$467.50 |
$467.50 |
$467.50 |
$1,033.14
|
|
Treatment of thigh fracture
|
$544.50 |
$544.50 |
$544.50 |
$548.90
|
|
Treatment of thigh fracture
|
$763.00 |
$763.00 |
$763.00 |
$1,772.97
|
|
Treatment of tibia fracture
|
$1,048.00 |
$1,048.00 |
$1,048.00 |
$7,087.60
|
|
Treatment of toe fracture 28510
|
$133.00 |
$133.00 |
$133.00 |
$369.70
|
|
Treat metacarpal fracture
|
$608.00 |
$608.00 |
$608.00 |
$5,464.97
|
|
Treat thigh fracture
|
$1,248.00 |
$1,248.00 |
$1,248.00 |
$4,083.00
|
|
Treat thigh fracture
|
$421.00 |
$421.00 |
$421.00 |
$618.80
|
|
Treat toe dislocation
|
$133.00 |
$133.00 |
$133.00 |
$756.39
|
|
Treat ulnar fracture
|
$467.50 |
$467.50 |
$467.50 |
$1,662.00
|
|
Treat wrist bone fracture
|
$464.00 |
$464.00 |
$464.00 |
$1,548.40
|
|
Treat wrist dislocation
|
$535.00 |
$535.00 |
$535.00 |
$656.25
|
|
Treponema pallidum antibody
|
$32.50 |
$32.50 |
$32.50 |
$70.40
|
|
Trg gene rearrangement anal
|
$200.00 |
$200.00 |
$200.00 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$3.50 |
$3.50 |
$3.50 |
$43.21
|
|
Triamcinolone a inj prs-free
|
$25.00 |
$25.00 |
$25.00 |
$223.56
|
|
Triglycerides
|
$51.00 |
$51.00 |
$51.00 |
$58.05
|
|
Trim nail(s)
|
$7.50 |
$7.50 |
$7.50 |
$79.00
|
|
Trim nondyst nails
|
$7.50 |
$7.50 |
$7.50 |
$113.40
|
|
Triptorelin pamoate
|
$1,158.00 |
$1,158.00 |
$1,158.00 |
$4,619.39
|
|
Trml dstrj ios bvn 1st 2 l/s
|
$6,332.00 |
$6,332.00 |
$6,332.00 |
$15,226.08
|
|
Trmt of fracture (femoral shaft) 27500
|
$522.00 |
$522.00 |
$522.00 |
$754.80
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$870.00 |
$870.00 |
$870.00 |
$4,713.66
|
|
Troponin quantitative
|
$67.00 |
$67.00 |
$67.00 |
$127.20
|
|
Tx closed distal humerus fx
|
$954.50 |
$954.50 |
$954.50 |
$594.88
|
|
Tx closed hip disl traumatic without anes
|
$212.00 |
$212.00 |
$212.00 |
$581.07
|
|
Tx closed tib shaft fx without manip
|
$363.00 |
$363.00 |
$363.00 |
$535.60
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$628.00 |
$628.00 |
$628.00 |
$4,499.12
|
|
Tx tarsal bone fx without manip 28450
|
$209.50 |
$209.50 |
$209.50 |
$416.16
|
|
Ua w/micro/comp poc
|
$17.00 |
$17.00 |
$17.00 |
$23.00
|
|
Ultrasound abdomen aorta screening study aaa
|
$420.00 |
$420.00 |
$420.00 |
$394.20
|
|
Ultrasound breast complete
|
$270.00 |
$270.00 |
$270.00 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$272.50 |
$272.50 |
$272.50 |
$449.35
|
|
Ultrasound chest
|
$436.50 |
$436.50 |
$436.50 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$27.00 |
$27.00 |
$27.00 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$33.00 |
$33.00 |
$33.00 |
$296.80
|
|
Ultrasound encephalogram
|
$33.00 |
$33.00 |
$33.00 |
$488.80
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$415.50 |
$415.50 |
$415.50 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$162.50 |
$162.50 |
$162.50 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$35.00 |
$35.00 |
$35.00 |
$720.15
|
|
Ultrasound joint complete left
|
$48.00 |
$48.00 |
$48.00 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$325.50 |
$325.50 |
$325.50 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$273.00 |
$273.00 |
$273.00 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$299.50 |
$299.50 |
$299.50 |
$331.50
|
