|
Tc-99m medronate
|
$148.20 |
$148.20 |
$148.20 |
$120.35
|
|
Tc-99m mertiatide
|
$429.00 |
$429.00 |
$429.00 |
$757.25
|
|
Tc-99m oxidronate
|
$141.05 |
$141.05 |
$141.05 |
$132.05
|
|
Tc-99m pentetate dtpa aerosol
|
$169.65 |
$169.65 |
$169.65 |
$231.60
|
|
Tc-99m pertechnetate per mci
|
$31.20 |
$31.20 |
$31.20 |
$22.10
|
|
Tc-99m sestamibi p study dose
|
$333.45 |
$333.45 |
$333.45 |
$221.60
|
|
Tc-99m sulfur colloid
|
$226.20 |
$226.20 |
$226.20 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$323.05 |
$323.05 |
$323.05 |
$198.05
|
|
T cells absolute cd4/cd8 including ratio
|
$182.00 |
$182.00 |
$182.00 |
$189.60
|
|
T cells absolute cd 4 count
|
$137.80 |
$137.80 |
$137.80 |
$120.25
|
|
T cells total count
|
$144.95 |
$144.95 |
$144.95 |
$126.90
|
|
Telehealth original site facility fee
|
$35.10 |
$35.10 |
$35.10 |
$55.65
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$16,720.61 |
$16,720.61 |
$16,720.61 |
$16,233.59
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$12.09 |
$12.09 |
$12.09 |
$39.33
|
|
Test for porphobilinogen
|
$46.80 |
$46.80 |
$46.80 |
$33.57
|
|
Testicular imaging w/vasc flow
|
$663.65 |
$663.65 |
$663.65 |
$586.96
|
|
Test pathogen(s) for platelets reference
|
$50.70 |
$50.70 |
$50.70 |
$52.00
|
|
Test stress cardiovascular tracing only
|
$655.85 |
$655.85 |
$655.85 |
$1,016.00
|
|
Tetanus immune globulin inj
|
$1,981.73 |
$1,981.73 |
$1,981.73 |
$1,073.02
|
|
Theophylline therapeutic drug level
|
$135.85 |
$135.85 |
$135.85 |
$101.40
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$39.00 |
$39.00 |
$39.00 |
$50.40
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$35.75 |
$35.75 |
$35.75 |
$47.50
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$25.80 |
$25.80 |
$25.80 |
$25.80
|
|
Thrombin time
|
$56.55 |
$56.55 |
$56.55 |
$53.50
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$85.80 |
$85.80 |
$85.80 |
$56.93
|
|
Thyroglobulin antibody
|
$100.75 |
$100.75 |
$100.75 |
$86.40
|
|
Thyroid imaging
|
$536.25 |
$536.25 |
$536.25 |
$577.80
|
|
Thyroid (TSH) Test
|
$125.45 |
$125.45 |
$125.45 |
$101.40
|
|
Thyroid Ultrasound
|
$522.60 |
$522.60 |
$522.60 |
$553.80
|
|
Thyroxine binding globulin (tbg)
|
$79.95 |
$79.95 |
$79.95 |
$75.00
|
|
Tirofiban 12.5 mg/50 ml
|
$722.38 |
$722.38 |
$722.38 |
$696.08
|
|
Tissue culture placenta
|
$416.00 |
$416.00 |
$416.00 |
$470.00
|
|
Tissue culture skin/biopsy
|
$428.35 |
$428.35 |
$428.35 |
$626.77
|
|
Tissue exam koh skin/hair/nails
|
$44.20 |
$44.20 |
$44.20 |
$45.23
|
|
Tissue transglutaminase iga
|
$177.45 |
$177.45 |
$177.45 |
$48.57
|
|
Tl-201 thallium diag per mci
|
$113.75 |
$113.75 |
$113.75 |
$78.40
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$241.80 |
$241.80 |
$241.80 |
$72.00
|
|
Tobramycin peak therapeutic drug level
|
$118.30 |
$118.30 |
$118.30 |
$117.00
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$5,790.85 |
$5,790.85 |
$5,790.85 |
$2,743.02
|
|
Tomosynthesis breast screen bilateral
|
$62.40 |
$62.40 |
$62.40 |
$77.46
|
|
Toxoplasma antibody igg
|
$73.45 |
$73.45 |
$73.45 |
$83.20
|
|
Toxoplasma antibody igm
|
$73.45 |
$73.45 |
$73.45 |
$85.80
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$76.70 |
$76.70 |
$76.70 |
$90.35
|
|
Transferrin
|
$114.40 |
$114.40 |
$114.40 |
$83.07
|
|
Transfusion blood/blood component(s)
|
$1,136.85 |
$1,136.85 |
$1,136.85 |
$988.24
|
|
Trastuzumab 150 mg intravenous solution
|
$3,401.26 |
$3,401.26 |
$3,401.26 |
$934.80
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$8,300.12 |
$8,300.12 |
$8,300.12 |
$43.28
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$2,644.97 |
$2,644.97 |
$2,644.97 |
$108.27
|
|
Treat ankle dislocation
|
$1,014.00 |
$1,014.00 |
$1,014.00 |
$2,132.50
|
|
Treat elbow dislocation
|
$1,180.40 |
$1,180.40 |
$1,180.40 |
$2,326.40
|
|
Treat finger fracture each
|
$666.90 |
$666.90 |
$666.90 |
$1,808.00
|
|
Treat fracture of radius
|
$809.25 |
$809.25 |
$809.25 |
$1,884.74
|
|
Treat fracture of ulna
|
$1,014.00 |
$1,014.00 |
$1,014.00 |
$806.13
|
|
Treat kneecap dislocation
|
$950.95 |
$950.95 |
$950.95 |
$1,931.40
|
|
Treat knee fracture 27530
|
$847.60 |
$847.60 |
$847.60 |
$576.13
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$107.25 |
$107.25 |
$107.25 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$107.25 |
$107.25 |
$107.25 |
$140.04
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$107.25 |
$107.25 |
$107.25 |
$197.60
|
|
Treatment of ankle fracture 27786
|
$625.95 |
$625.95 |
$625.95 |
$575.25
|
|
Treatment of fibula fracture 27780
|
$515.45 |
$515.45 |
$515.45 |
$558.75
|
|
Treatment of foot infection
|
$695.50 |
$695.50 |
$695.50 |
$1,872.75
|
|
Treatment of heel fracture 28400
|
$468.65 |
$468.65 |
$468.65 |
$469.60
|
|
Treatment of toe fracture 28510
|
$287.95 |
$287.95 |
$287.95 |
$362.00
|
|
Treat sternum fracture
|
$263.25 |
$263.25 |
$263.25 |
$423.00
|
|
Treat thigh fracture
|
$1,174.55 |
$1,174.55 |
$1,174.55 |
$1,858.61
|
|
Treat toe fracture
|
$926.90 |
$926.90 |
$926.90 |
$3,591.33
|
|
Treponema pallidum antibody
|
$83.20 |
$83.20 |
$83.20 |
$74.40
|
|
Trg gene rearrangement anal
|
$422.50 |
$422.50 |
$422.50 |
$474.50
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$25.69 |
$25.69 |
$25.69 |
$28.90
|
|
#tricyclicantidprssnt
|
$130.65 |
$130.65 |
$130.65 |
$38.73
|
|
Triglycerides
|
$64.35 |
$64.35 |
$64.35 |
$48.75
|
|
Troponin quantitative
|
$117.00 |
$117.00 |
$117.00 |
$112.80
|
|
Tx closed hip disl traumatic without anes
|
$958.10 |
$958.10 |
$958.10 |
$650.45
|
|
Tx closed tib shaft fx without manip
|
$799.50 |
$799.50 |
$799.50 |
$643.75
|
|
Tx tarsal bone fx without manip 28450
|
$471.90 |
$471.90 |
$471.90 |
$414.00
|
|
Ugt1a1 gene analy common variants
|
$645.45 |
$645.45 |
$645.45 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$330.20 |
$330.20 |
$330.20 |
$394.20
|
|
Ultrasound breast unilateral limited (both sides)
|
$265.85 |
$265.85 |
$265.85 |
$427.00
|
|
Ultrasound chest
|
$419.90 |
$419.90 |
$419.90 |
$430.10
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$428.35 |
$428.35 |
$428.35 |
$428.68
|
|
Ultrasound guidance for vascular access
|
$258.05 |
$258.05 |
$258.05 |
$300.00
|
|
Ultrasound guided needle placement supervision & interpretation
|
$538.85 |
$538.85 |
$538.85 |
$629.64
|
|
Ultrasound guide intraoperative
|
$606.45 |
$606.45 |
$606.45 |
$628.80
|
|
Ultrasound joint complete left
|
$651.30 |
$651.30 |
$651.30 |
$534.00
|
|
Ultrasound joint/nonvascular extremity limited left
|
$592.80 |
$592.80 |
$592.80 |
$426.60
|
|
Ultrasound ob >=14wks ea addl gest
|
$523.25 |
$523.25 |
$523.25 |
$431.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$362.70 |
$362.70 |
$362.70 |
$304.80
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$332.80 |
$332.80 |
$332.80 |
$434.20
|
|
Ultrasound pregnant uterus transvaginal
|
$410.80 |
$410.80 |
$410.80 |
$477.10
|
|
Ultrasound prostate/transrectal
|
$462.15 |
$462.15 |
$462.15 |
$515.63
|
|
Ultrasound retroperitoneal limited
|
$447.85 |
$447.85 |
$447.85 |
$469.58
|
|
Ultrasound scrotum and contents
|
$538.20 |
$538.20 |
$538.20 |
$558.03
|
|
Ultrasound transvaginal non obstetric
|
$494.00 |
$494.00 |
$494.00 |
$523.20
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,301.65 |
$2,301.65 |
$2,301.65 |
$2,590.50
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,139.80 |
$2,139.80 |
$2,139.80 |
$2,001.87
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,841.45 |
$1,841.45 |
$1,841.45 |
$1,794.00
|
|
Upper Endoscopy (EGD, diagnostic)
|
$2,856.94 |
$2,856.94 |
$2,856.94 |
$1,760.00
|
|
Upper Endoscopy (EGD, with biopsy)
|
$3,066.91 |
$3,066.91 |
$3,066.91 |
$1,760.00
|
|
Urea nitrogen
|
$48.75 |
$48.75 |
$48.75 |
$38.25
|
|
Urea nitrogen 24 hour urine
|
$50.70 |
$50.70 |
$50.70 |
$42.90
|
