|
Tc-99m pertechnetate per mci
|
$88.80 |
$88.80 |
$88.80 |
$22.10
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$274.68 |
$274.68 |
$274.68 |
$136.40
|
|
Tc-99m sestamibi p study dose
|
$150.50 |
$150.50 |
$150.50 |
$274.45
|
|
Tc-99m succimer (dmsa)
|
$1,732.16 |
$1,732.16 |
$1,732.16 |
$1,128.40
|
|
Tc-99m sulfur colloid
|
$335.12 |
$335.12 |
$335.12 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$150.50 |
$150.50 |
$150.50 |
$190.80
|
|
Tc-99m tilmanocept diag
|
$1,602.65 |
$1,602.65 |
$1,602.65 |
$955.60
|
|
Tcd emboli detect without inj
|
$580.00 |
$580.00 |
$580.00 |
$475.28
|
|
T cells absolute cd4/cd8 including ratio
|
$217.50 |
$217.50 |
$217.50 |
$176.40
|
|
T cells total count
|
$169.00 |
$169.00 |
$169.00 |
$126.90
|
|
Telavancin injection
|
$1,710.70 |
$1,710.70 |
$1,710.70 |
$1,191.80
|
|
Telehealth original site facility fee
|
$37.50 |
$37.50 |
$37.50 |
$51.00
|
|
Temozolomide
|
$10.74 |
$10.74 |
$10.74 |
$588.46
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$2,197.78 |
$2,197.78 |
$2,197.78 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$18,255.45 |
$18,255.45 |
$18,255.45 |
$15,245.38
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$29.20 |
$29.20 |
$29.20 |
$39.33
|
|
Test pathogen(s) for platelets reference
|
$52.00 |
$52.00 |
$52.00 |
$70.00
|
|
Test stress cardiovascular tracing only
|
$622.50 |
$622.50 |
$622.50 |
$949.70
|
|
Tetanus immune globulin inj
|
$1,913.96 |
$1,913.96 |
$1,913.96 |
$1,285.36
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$10,424.22 |
$10,424.22 |
$10,424.22 |
$8,737.05
|
|
Theophylline therapeutic drug level
|
$170.00 |
$170.00 |
$170.00 |
$108.00
|
|
Therapeutic procd strg endur
|
$161.00 |
$161.00 |
$161.00 |
$85.68
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$33.00 |
$33.00 |
$33.00 |
$57.31
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$33.00 |
$33.00 |
$33.00 |
$50.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$37.04 |
$37.04 |
$37.04 |
$25.54
|
|
Thiotepa injection
|
$810.10 |
$810.10 |
$810.10 |
$1,485.00
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$2,990.00 |
$2,990.00 |
$2,990.00 |
$1,687.50
|
|
Thrombin time
|
$34.50 |
$34.50 |
$34.50 |
$53.76
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$68.00 |
$68.00 |
$68.00 |
$61.52
|
|
Thyroglobulin antibody
|
$82.00 |
$82.00 |
$82.00 |
$82.00
|
|
Thyroid mets imag whole body
|
$1,542.00 |
$1,542.00 |
$1,542.00 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$88.00 |
$88.00 |
$88.00 |
$111.00
|
|
Thyroid Ultrasound
|
$428.50 |
$428.50 |
$428.50 |
$588.50
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$5,213.25 |
$5,213.25 |
$5,213.25 |
$4,112.43
|
|
Thyroxine binding globulin (tbg)
|
$143.00 |
$143.00 |
$143.00 |
$64.35
|
|
Tigecycline injection
|
$197.14 |
$197.14 |
$197.14 |
$234.00
|
|
Tirofiban 12.5 mg/50 ml
|
$578.62 |
$578.62 |
$578.62 |
$458.85
|
|
Tisotumab vedotin-tftv 40 mg intravenous solution
|
$17,166.00 |
$17,166.00 |
$17,166.00 |
$13,339.20
|
|
Tissue exam koh skin/hair/nails
|
$47.50 |
$47.50 |
$47.50 |
$47.20
|
|
Tissue transglutaminase iga
|
$68.00 |
$68.00 |
$68.00 |
$44.16
|
|
Tl-201 thallium diag per mci
|
$567.22 |
$567.22 |
$567.22 |
$78.40
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$568.61 |
$568.61 |
$568.61 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$200.50 |
$200.50 |
$200.50 |
$120.60
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$6,433.20 |
$6,433.20 |
$6,433.20 |
$5,258.52
|
|
Tomosynthesis breast screen bilateral
|
$39.00 |
$39.00 |
$39.00 |
$72.68
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$114.92 |
$114.92 |
$114.92 |
$325.00
|
|
Toripalimab-tpzi 240 mg/6 ml (40 mg/ml) intravenous solution
|
$22,700.68 |
$22,700.68 |
$22,700.68 |
$15,383.12
|
|
Total tau
|
$236.50 |
$236.50 |
$236.50 |
$312.50
|
|
Toxoplasma antibody igg
|
$123.00 |
$123.00 |
$123.00 |
$89.40
|
|
Toxoplasma antibody igm
|
$135.00 |
$135.00 |
$135.00 |
$87.00
|
|
Tpmt gene com vrnts
|
$399.00 |
$399.00 |
$399.00 |
$371.80
|
|
Trabectedin 1 mg intravenous solution
|
$8,645.95 |
$8,645.95 |
$8,645.95 |
$6,827.00
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$72.50 |
$72.50 |
$72.50 |
$101.25
|
|
Transferrin
|
$66.00 |
$66.00 |
$66.00 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$1,165.00 |
$1,165.00 |
$1,165.00 |
$983.00
|
|
Trastuzumab 150 mg intravenous solution
|
$3,921.88 |
$3,921.88 |
$3,921.88 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$9,169.45 |
$9,169.45 |
$9,169.45 |
$7,540.20
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$5,316.26 |
$5,316.26 |
$5,316.26 |
$5,835.15
|
|
Tray bonemarrw oncontrol 102mm
|
$1,799.44 |
$1,799.44 |
$1,799.44 |
$940.80
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$48.00 |
$48.00 |
$48.00 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$48.00 |
$48.00 |
$48.00 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$120.00 |
$120.00 |
$120.00 |
$203.35
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$99,476.00 |
$99,476.00 |
$99,476.00 |
$73,346.25
|
|
Treponema pallidum antibody
|
$94.00 |
$94.00 |
$94.00 |
$70.40
|
|
Treprostinil injection
|
$10,371.45 |
$10,371.45 |
$10,371.45 |
$19,071.84
|
|
Treprostinil, non-comp unit
|
$7,365.50 |
$7,365.50 |
$7,365.50 |
$3,894.40
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$82.74 |
$82.74 |
$82.74 |
$43.21
|
|
Triamcinolone a inj prs-free
|
$3,116.36 |
$3,116.36 |
$3,116.36 |
$223.56
|
|
Triglycerides
|
$35.00 |
$35.00 |
$35.00 |
$58.05
|
|
Trilaciclib 300 mg intravenous solution
|
$3,903.74 |
$3,903.74 |
$3,903.74 |
$4,043.12
|
|
Trimethobenzamide hcl inj
|
$262.24 |
$262.24 |
$262.24 |
$117.49
|
|
Trim nail(s)
|
$258.50 |
$258.50 |
$258.50 |
$79.00
|
|
Triptorelin pamoate
|
$10,504.62 |
$10,504.62 |
$10,504.62 |
$4,619.39
|
|
Troponin quantitative
|
$149.50 |
$149.50 |
$149.50 |
$127.20
|
|
Tte w or without contr, cont ecg
|
$2,252.00 |
$2,252.00 |
$2,252.00 |
$2,012.40
|
|
Tympanometry & reflex thresh
|
$347.50 |
$347.50 |
$347.50 |
$170.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$26,207.26 |
$26,207.26 |
$26,207.26 |
$20,945.01
|
|
Ultrasound abdomen aorta screening study aaa
|
$258.00 |
$258.00 |
$258.00 |
$394.20
|
|
Ultrasound breast complete
|
$600.50 |
$600.50 |
$600.50 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$479.50 |
$479.50 |
$479.50 |
$449.35
|
|
Ultrasound chest
|
$361.00 |
$361.00 |
$361.00 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$372.00 |
$372.00 |
$372.00 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$335.50 |
$335.50 |
$335.50 |
$296.80
|
|
Ultrasound elastography parenchyma
|
$204.00 |
$204.00 |
$204.00 |
$307.00
|
|
Ultrasound encephalogram
|
$556.00 |
$556.00 |
$556.00 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$497.00 |
$497.00 |
$497.00 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$402.50 |
$402.50 |
$402.50 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$295.50 |
$295.50 |
$295.50 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$393.00 |
$393.00 |
$393.00 |
$720.15
|
|
Ultrasound guide intraoperative
|
$510.50 |
$510.50 |
$510.50 |
$632.85
|
|
Ultrasound hips infant dynamic
|
$588.50 |
$588.50 |
$588.50 |
$403.88
|
|
Ultrasound joint/nonvascular extremity limited left
|
$440.50 |
$440.50 |
$440.50 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$345.00 |
$345.00 |
$345.00 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$331.50 |
$331.50 |
$331.50 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$800.00 |
$800.00 |
$800.00 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$534.00 |
$534.00 |
$534.00 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$513.50 |
$513.50 |
$513.50 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$436.50 |
$436.50 |
$436.50 |
$497.12
|
|
Ultrasound retroperitoneal limited
|
$339.00 |
$339.00 |
$339.00 |
$486.50
|
|
Ultrasound scrotum and contents
|
$402.50 |
$402.50 |
$402.50 |
$608.90
|
