|
Tc-99m disofenin
|
$95.04 |
$95.04 |
$95.04 |
$124.32
|
|
Tc-99m exametazime diag
|
$2,550.72 |
$2,550.72 |
$2,550.72 |
$2,033.20
|
|
Tc-99m labeled rbc
|
$252.00 |
$252.00 |
$252.00 |
$302.40
|
|
Tc-99m maa
|
$302.88 |
$302.88 |
$302.88 |
$292.80
|
|
Tc-99m mebrofenin
|
$57.12 |
$57.12 |
$57.12 |
$157.65
|
|
Tc-99m medronate
|
$82.08 |
$82.08 |
$82.08 |
$111.01
|
|
Tc-99m mertiatide
|
$541.92 |
$541.92 |
$541.92 |
$756.00
|
|
Tc-99m oxidronate
|
$69.12 |
$69.12 |
$69.12 |
$105.60
|
|
Tc-99m pentetate dtpa
|
$242.40 |
$242.40 |
$242.40 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$276.00 |
$276.00 |
$276.00 |
$190.80
|
|
Tc-99m pertechnetate per mci
|
$1.44 |
$1.44 |
$1.44 |
$22.10
|
|
Tc-99m sestamibi p study dose
|
$535.20 |
$535.20 |
$535.20 |
$274.45
|
|
Tc-99m succimer (dmsa)
|
$134.88 |
$134.88 |
$134.88 |
$1,128.40
|
|
Tc-99m sulfur colloid
|
$283.68 |
$283.68 |
$283.68 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$68.16 |
$68.16 |
$68.16 |
$190.80
|
|
T cells absolute cd4/cd8 including ratio
|
$133.44 |
$133.44 |
$133.44 |
$176.40
|
|
T cells absolute cd 4 count
|
$78.24 |
$78.24 |
$78.24 |
$111.20
|
|
T cells total count
|
$133.44 |
$133.44 |
$133.44 |
$126.90
|
|
Team conf w/pat by hc prof
|
$172.32 |
$172.32 |
$172.32 |
$107.10
|
|
Telavancin injection
|
$856.42 |
$856.42 |
$856.42 |
$1,191.80
|
|
Telehealth original site facility fee
|
$27.36 |
$27.36 |
$27.36 |
$51.00
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$4,390.78 |
$4,390.78 |
$4,390.78 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$19,216.47 |
$19,216.47 |
$19,216.47 |
$15,245.38
|
|
Tenotomy open tndn flxr toe sgl tndn spx
|
$511.68 |
$511.68 |
$511.68 |
$2,139.67
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$47.76 |
$47.76 |
$47.76 |
$39.33
|
|
Test for porphobilinogen
|
$55.20 |
$55.20 |
$55.20 |
$33.57
|
|
Testicular imaging w/vasc flow
|
$689.28 |
$689.28 |
$689.28 |
$842.56
|
|
Testosterone undecanoate 1mg
|
$4,973.96 |
$4,973.96 |
$4,973.96 |
$3,528.08
|
|
Test stress cardiovascular tracing only
|
$790.08 |
$790.08 |
$790.08 |
$949.70
|
|
Test urine for porphyrins
|
$47.04 |
$47.04 |
$47.04 |
$49.98
|
|
Test urine urobilinogen
|
$19.20 |
$19.20 |
$19.20 |
$9.75
|
|
Tetanus immune globulin inj
|
$1,078.76 |
$1,078.76 |
$1,078.76 |
$1,285.36
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$9,986.19 |
$9,986.19 |
$9,986.19 |
$8,737.05
|
|
Theophylline therapeutic drug level
|
$86.88 |
$86.88 |
$86.88 |
$108.00
|
|
Therapeutic procd strg endur
|
$53.76 |
$53.76 |
$53.76 |
$85.68
|
|
Therapy activity per session >= 45 minutes
|
$173.28 |
$173.28 |
$173.28 |
$191.50
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$18.72 |
$18.72 |
$18.72 |
$57.31
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$17.28 |
$17.28 |
$17.28 |
$50.00
|
|
Ther/proph/diag inj ia
|
$242.40 |
$242.40 |
$242.40 |
$240.35
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$47.76 |
$47.76 |
$47.76 |
$25.54
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$701.76 |
$701.76 |
$701.76 |
$1,687.50
|
|
Thrombectomy/inf pq dialysis circuit
|
$6,987.84 |
$6,987.84 |
$6,987.84 |
$8,084.00
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$10,699.20 |
$10,699.20 |
$10,699.20 |
$14,277.20
|
|
Thrombin time
|
$64.80 |
$64.80 |
$64.80 |
$53.76
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$66.24 |
$66.24 |
$66.24 |
$61.52
|
|
Thyroglobulin antibody
|
$88.32 |
$88.32 |
$88.32 |
$82.00
|
|
Thyroidectomy inc substrnl split/trans approch 60270
|
$1,781.28 |
$1,781.28 |
$1,781.28 |
$2,616.00
|
|
Thyroid imaging
|
$329.28 |
$329.28 |
$329.28 |
$695.02
|
|
Thyroid met imaging
|
$419.04 |
$419.04 |
$419.04 |
$838.25
|
|
Thyroid mets imag whole body
|
$1,077.60 |
$1,077.60 |
$1,077.60 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$84.48 |
$84.48 |
$84.48 |
$111.00
|
|
Thyroid Ultrasound
|
$342.24 |
$342.24 |
$342.24 |
$588.50
|
|
Thyroid uptake measurement
|
$449.28 |
$449.28 |
$449.28 |
$591.25
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$4,745.38 |
$4,745.38 |
$4,745.38 |
$4,112.43
|
|
Thyroxine binding globulin (tbg)
|
$32.64 |
$32.64 |
$32.64 |
$64.35
|
|
Tigecycline injection
|
$230.49 |
$230.49 |
$230.49 |
$234.00
|
|
Tilt table study
|
$1,231.20 |
$1,231.20 |
$1,231.20 |
$1,507.01
|
|
Tirofiban 12.5 mg/50 ml
|
$524.40 |
$524.40 |
$524.40 |
$458.85
|
|
Tisotumab vedotin-tftv 40 mg intravenous solution
|
$15,244.80 |
$15,244.80 |
$15,244.80 |
$13,339.20
|
|
Tissue amnio epifix inj 100mg
|
$3,228.67 |
$3,228.67 |
$3,228.67 |
$4,834.73
|
|
Tissue culture placenta
|
$473.28 |
$473.28 |
$473.28 |
$457.00
|
|
Tissue culture skin/biopsy
|
$455.04 |
$455.04 |
$455.04 |
$484.00
|
|
Tissue culture tumor
|
$483.36 |
$483.36 |
$483.36 |
$483.36
|
|
Tissue exam koh skin/hair/nails
|
$55.20 |
$55.20 |
$55.20 |
$47.20
|
|
Tissue transglutaminase iga
|
$101.76 |
$101.76 |
$101.76 |
$44.16
|
|
Tixagev and cilgav inj
|
$106.56 |
$106.56 |
$106.56 |
$224.55
|
|
Tl-201 thallium diag per mci
|
$32.64 |
$32.64 |
$32.64 |
$78.40
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$1,014.10 |
$1,014.10 |
$1,014.10 |
$152.36
|
|
Tobramycin non-comp unit
|
$32.57 |
$32.57 |
$32.57 |
$108.42
|
|
Tobramycin peak therapeutic drug level
|
$99.84 |
$99.84 |
$99.84 |
$120.60
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$6,150.92 |
$6,150.92 |
$6,150.92 |
$5,258.52
|
|
Tomosynthesis breast screen bilateral
|
$64.80 |
$64.80 |
$64.80 |
$72.68
|
|
Tongue biopsy; posterior one-third 41105
|
$1,175.04 |
$1,175.04 |
$1,175.04 |
$3,544.29
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$307.30 |
$307.30 |
$307.30 |
$325.00
|
|
Total Knee Replacement
|
$1,674.24 |
$1,674.24 |
$1,674.24 |
$14,543.50
|
|
Toxoplasma antibody igg
|
$72.48 |
$72.48 |
$72.48 |
$89.40
|
|
Toxoplasma antibody igm
|
$72.48 |
$72.48 |
$72.48 |
$87.00
|
|
Tpmt gene com vrnts
|
$561.60 |
$561.60 |
$561.60 |
$371.80
|
|
Trabectedin 1 mg intravenous solution
|
$7,433.48 |
$7,433.48 |
$7,433.48 |
$6,827.00
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$37.92 |
$37.92 |
$37.92 |
$101.25
|
|
Transferrin
|
$36.00 |
$36.00 |
$36.00 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$699.36 |
$699.36 |
$699.36 |
$983.00
|
|
Transparent film <= 16 sq in
|
$0.74 |
$0.74 |
$0.74 |
$4.50
|
|
Trastuzumab 150 mg intravenous solution
|
$10,040.21 |
$10,040.21 |
$10,040.21 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$8,374.66 |
$8,374.66 |
$8,374.66 |
$7,540.20
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$5,176.04 |
$5,176.04 |
$5,176.04 |
$5,835.15
|
|
Trauma partial team response w/critical care services level 4
|
$1,375.68 |
$1,375.68 |
$1,375.68 |
$4,523.04
|
|
Tray bonemarrw oncontrol 102mm
|
$576.00 |
$576.00 |
$576.00 |
$940.80
|
|
Treat ankle dislocation
|
$671.52 |
$671.52 |
$671.52 |
$2,358.40
|
|
Treat clavicle dislocation 23545
|
$469.92 |
$469.92 |
$469.92 |
$705.60
|
|
Treat elbow dislocation
|
$749.28 |
$749.28 |
$749.28 |
$2,223.20
|
|
Treat eyelid lesion 67850
|
$631.68 |
$631.68 |
$631.68 |
$1,146.13
|
|
Treat finger fracture each
|
$502.56 |
$502.56 |
$502.56 |
$1,536.00
|
|
Treat foot dislocation
|
$265.44 |
$265.44 |
$265.44 |
$396.30
|
|
Treat fracture of radius
|
$675.36 |
$675.36 |
$675.36 |
$1,790.00
|
|
Treat fracture of ulna
|
$663.84 |
$663.84 |
$663.84 |
$726.05
|
|
Treat hip dislocation
|
$993.12 |
$993.12 |
$993.12 |
$2,192.80
|
|
Treat hip dislocation
|
$802.08 |
$802.08 |
$802.08 |
$2,641.60
|
|
Treat humerus fracture
|
$823.68 |
$823.68 |
$823.68 |
$1,771.43
|
|
Treat humerus fracture
|
$722.40 |
$722.40 |
$722.40 |
$1,771.43
|
