|
Tc-99m pertechnetate per mci
|
$99.30 |
$99.30 |
$99.30 |
$18.67
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$335.80 |
$335.80 |
$335.80 |
$141.00
|
|
Tc-99m sestamibi p study dose
|
$221.60 |
$221.60 |
$221.60 |
$287.20
|
|
Tc-99m succimer (dmsa)
|
$2,988.10 |
$2,988.10 |
$2,988.10 |
$1,128.40
|
|
Tc-99m sulfur colloid
|
$855.40 |
$855.40 |
$855.40 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$198.05 |
$198.05 |
$198.05 |
$193.28
|
|
Tc-99m tilmanocept diag
|
$2,740.00 |
$2,740.00 |
$2,740.00 |
$985.60
|
|
T cells absolute cd4/cd8 including ratio
|
$99.45 |
$99.45 |
$99.45 |
$184.00
|
|
T cells total count
|
$91.65 |
$91.65 |
$91.65 |
$130.20
|
|
Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution
|
$107,550.00 |
$107,550.00 |
$107,550.00 |
$40,114.80
|
|
Telavancin injection
|
$3,365.50 |
$3,365.50 |
$3,365.50 |
$1,191.80
|
|
Telehealth original site facility fee
|
$52.00 |
$52.00 |
$52.00 |
$51.00
|
|
Temozolomide 100 mg intravenous solution
|
$5,015.55 |
$5,015.55 |
$5,015.55 |
$1,867.28
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$10,501.70 |
$10,501.70 |
$10,501.70 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$23,582.35 |
$23,582.35 |
$23,582.35 |
$14,951.87
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$92.00 |
$92.00 |
$92.00 |
$39.33
|
|
Test pathogen(s) for platelets reference
|
$73.45 |
$73.45 |
$73.45 |
$70.00
|
|
Tetanus immune globulin inj
|
$2,622.15 |
$2,622.15 |
$2,622.15 |
$1,285.36
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$22,937.05 |
$22,937.05 |
$22,937.05 |
$8,737.05
|
|
Theophylline therapeutic drug level
|
$117.00 |
$117.00 |
$117.00 |
$108.00
|
|
Therapy Activity Training (each 15 minutes)
|
$128.70 |
$128.70 |
$128.70 |
$101.38
|
|
Therapy Exercise Session (each 15 minutes)
|
$129.35 |
$129.35 |
$129.35 |
$98.58
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$8.30 |
$8.30 |
$8.30 |
$25.54
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$403.65 |
$403.65 |
$403.65 |
$313.60
|
|
Thiotepa 15 mg solution for injection
|
$1,090.00 |
$1,090.00 |
$1,090.00 |
$1,090.00
|
|
Thrombin time
|
$33.80 |
$33.80 |
$33.80 |
$54.18
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$41.60 |
$41.60 |
$41.60 |
$62.01
|
|
Thyroglobulin antibody
|
$122.20 |
$122.20 |
$122.20 |
$82.50
|
|
Thyroid (TSH) Test
|
$124.80 |
$124.80 |
$124.80 |
$112.70
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$10,828.50 |
$10,828.50 |
$10,828.50 |
$4,152.21
|
|
Tisotumab vedotin-tftv 40 mg intravenous solution
|
$22,202.40 |
$22,202.40 |
$22,202.40 |
$13,339.20
|
|
Tissue amnio epifix inj 100mg
|
$2,555.89 |
$2,555.89 |
$2,555.89 |
$4,201.20
|
|
Tissue dermagraft 2x3in 37.5sqcm-cost per sq cm
|
$67.73 |
$67.73 |
$67.73 |
$67.73
|
|
Tissue exam koh skin/hair/nails
|
$28.60 |
$28.60 |
$28.60 |
$47.40
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$271.69 |
$271.69 |
$271.69 |
$537.50
|
|
Tissue matrix xcm thk 20x30cm -cost per sq cm
|
$49.04 |
$49.04 |
$49.04 |
$830.41
|
|
Tissue surgimend prs meshed 20 cm x 10 cm - cost per 0.5cm
|
$38.88 |
$38.88 |
$38.88 |
$1,403.42
|
|
Tissue transglutaminase iga
|
$176.80 |
$176.80 |
$176.80 |
$44.80
|
|
Tl-201 thallium diag per mci
|
$80.10 |
$80.10 |
$80.10 |
$80.10
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$354.15 |
$354.15 |
$354.15 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$121.55 |
$121.55 |
$121.55 |
$120.60
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$12,214.20 |
$12,214.20 |
$12,214.20 |
$5,258.52
|
|
Toe X-ray (both feet)
|
$270.40 |
$270.40 |
$270.40 |
$258.65
|
|
Tomosynthesis breast diagnostic left
|
$221.65 |
$221.65 |
$221.65 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$78.00 |
$78.00 |
$78.00 |
$74.10
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$188.75 |
$188.75 |
$188.75 |
$316.84
|
|
Toripalimab-tpzi 240 mg/6 ml (40 mg/ml) intravenous solution
|
$48,786.25 |
$48,786.25 |
$48,786.25 |
$15,383.12
|
|
Toxoplasma antibody igg
|
$79.30 |
$79.30 |
$79.30 |
$91.65
|
|
Toxoplasma antibody igm
|
$62.40 |
$62.40 |
$62.40 |
$87.75
|
|
Trabectedin 1 mg intravenous solution
|
$11,842.80 |
$11,842.80 |
$11,842.80 |
$6,684.23
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$27.60 |
$27.60 |
$27.60 |
$56.38
|
|
Transferrin
|
$109.85 |
$109.85 |
$109.85 |
$82.00
|
|
Trastuzumab 150 mg intravenous solution
|
$4,708.00 |
$4,708.00 |
$4,708.00 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$10,508.35 |
$10,508.35 |
$10,508.35 |
$7,540.20
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$9,357.40 |
$9,357.40 |
$9,357.40 |
$5,846.40
|
|
Trauma partial team response w/critical care services level 4
|
$2,798.25 |
$2,798.25 |
$2,798.25 |
$4,523.04
|
|
Tray bonemarrw oncontrol 102mm
|
$699.55 |
$699.55 |
$699.55 |
$940.80
|
|
Tray trach basic clean/care ster
|
$0.55 |
$0.55 |
$0.55 |
$0.57
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$241.15 |
$241.15 |
$241.15 |
$227.70
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$158.60 |
$158.60 |
$158.60 |
$147.48
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$127,265.40 |
$127,265.40 |
$127,265.40 |
$73,346.25
|
|
Treponema pallidum antibody
|
$130.00 |
$130.00 |
$130.00 |
$72.05
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$39.10 |
$39.10 |
$39.10 |
$43.09
|
|
Triglycerides
|
$50.05 |
$50.05 |
$50.05 |
$58.50
|
|
Trilaciclib 300 mg intravenous solution
|
$8,065.15 |
$8,065.15 |
$8,065.15 |
$4,043.12
|
|
Troponin quantitative
|
$1,290.57 |
$1,290.57 |
$1,290.57 |
$127.60
|
|
Tube drain vert dev st 5-40f
|
$17.68 |
$17.68 |
$17.68 |
$27.60
|
|
Tube trach disp innr can 5 xlt
|
$425.24 |
$425.24 |
$425.24 |
$445.99
|
|
Tube trach disp innr can 6 xlt
|
$2.78 |
$2.78 |
$2.78 |
$16.80
|
|
Tube trach fen sz 6 uncuffed
|
$128.15 |
$128.15 |
$128.15 |
$160.88
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$35,496.45 |
$35,496.45 |
$35,496.45 |
$21,992.26
|
|
Unit mobile power mpu
|
$11,821.68 |
$11,821.68 |
$11,821.68 |
$14,359.52
|
|
Unlisted procedure microbiology
|
$2,388.75 |
$2,388.75 |
$2,388.75 |
$530.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$201.50 |
$201.50 |
$201.50 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,330.55 |
$1,330.55 |
$1,330.55 |
$1,425.85
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$261.30 |
$261.30 |
$261.30 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$333.45 |
$333.45 |
$333.45 |
$381.60
|
|
Urea nitrogen
|
$42.25 |
$42.25 |
$42.25 |
$42.25
|
|
Urea nitrogen 24 hour urine
|
$54.60 |
$54.60 |
$54.60 |
$52.00
|
|
Uric acid blood
|
$57.85 |
$57.85 |
$57.85 |
$49.44
|
|
Uric acid urine
|
$66.30 |
$66.30 |
$66.30 |
$45.36
|
|
Urinalysis microscopic only
|
$31.85 |
$31.85 |
$31.85 |
$26.46
|
|
Urinalysis (with microscopy)
|
$44.20 |
$44.20 |
$44.20 |
$55.20
|
|
Urinalysis (without microscopy)
|
$39.65 |
$39.65 |
$39.65 |
$36.00
|
|
Urine Culture Test
|
$58.50 |
$58.50 |
$58.50 |
$83.00
|
|
Urine pregnancy test
|
$42.25 |
$42.25 |
$42.25 |
$68.78
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$6,677.00 |
$6,677.00 |
$6,677.00 |
$5,205.00
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$45,913.60 |
$45,913.60 |
$45,913.60 |
$51,633.07
|
|
Vaccine Administration (one shot)
|
$95.55 |
$95.55 |
$95.55 |
$67.70
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$273.00 |
$273.00 |
$273.00 |
$224.25
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$533.00 |
$533.00 |
$533.00 |
$209.40
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$98.15 |
$98.15 |
$98.15 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$65.65 |
$65.65 |
$65.65 |
$123.20
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$49.40 |
$49.40 |
$49.40 |
$80.15
|
|
Vaccine dtap < 7 years im
|
$142.05 |
$142.05 |
$142.05 |
$71.17
|
|
Vaccine dtap-hep b-ipv im
|
$95.55 |
$95.55 |
$95.55 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$54.60 |
$54.60 |
$54.60 |
$105.95
|
|
Vaccine dtap-ipv-hib-hepb im
|
$128.70 |
$128.70 |
$128.70 |
$174.72
|
|
Vaccine dtap-ipv/hib im
|
$98.15 |
$98.15 |
$98.15 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$37.05 |
$37.05 |
$37.05 |
$70.53
|