|
Thrombin time
|
$76.80 |
$76.80 |
$76.80 |
$53.76
|
|
Thromboplastin inhibition
|
$46.80 |
$46.80 |
$46.80 |
$53.30
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$195.60 |
$195.60 |
$195.60 |
$61.52
|
|
Thyroglobulin antibody
|
$511.20 |
$511.20 |
$511.20 |
$82.00
|
|
Thyroid imaging
|
$656.40 |
$656.40 |
$656.40 |
$695.02
|
|
Thyroid (TSH) Test
|
$181.20 |
$181.20 |
$181.20 |
$111.00
|
|
Thyroid Ultrasound
|
$702.00 |
$702.00 |
$702.00 |
$588.50
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$6,846.00 |
$6,846.00 |
$6,846.00 |
$4,112.43
|
|
Thyroxine binding globulin (tbg)
|
$214.20 |
$214.20 |
$214.20 |
$64.35
|
|
Tilt table study
|
$712.20 |
$712.20 |
$712.20 |
$1,507.01
|
|
Tirofiban 12.5 mg/50 ml
|
$961.20 |
$961.20 |
$961.20 |
$458.85
|
|
Tisotumab vedotin-tftv 40 mg intravenous solution
|
$26,524.80 |
$26,524.80 |
$26,524.80 |
$13,339.20
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$152.63 |
$152.63 |
$152.63 |
$1,134.00
|
|
Tissue matrix xcm thk 20x30cm -cost per sq cm
|
$830.41 |
$830.41 |
$830.41 |
$18,999.96
|
|
Tissue transglutaminase iga
|
$21.60 |
$21.60 |
$21.60 |
$44.16
|
|
Tl-201 thallium diag per mci
|
$40.80 |
$40.80 |
$40.80 |
$78.40
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$7,282.20 |
$7,282.20 |
$7,282.20 |
$5,258.52
|
|
Tomosynthesis breast diagnostic left
|
$43.20 |
$43.20 |
$43.20 |
$73.00
|
|
Tomosynthesis breast screen bilateral
|
$64.80 |
$64.80 |
$64.80 |
$72.68
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$456.00 |
$456.00 |
$456.00 |
$325.00
|
|
Toxoplasma antibody igg
|
$213.00 |
$213.00 |
$213.00 |
$89.40
|
|
Toxoplasma antibody igm
|
$472.80 |
$472.80 |
$472.80 |
$87.00
|
|
Tpmt gene com vrnts
|
$619.20 |
$619.20 |
$619.20 |
$371.80
|
|
Tprnl plmt biodegrdabl matrl
|
$5,285.40 |
$5,285.40 |
$5,285.40 |
$7,144.80
|
|
Transferrin
|
$120.00 |
$120.00 |
$120.00 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$574.80 |
$574.80 |
$574.80 |
$983.00
|
|
Trastuzumab 150 mg intravenous solution
|
$5,196.60 |
$5,196.60 |
$5,196.60 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$13,574.40 |
$13,574.40 |
$13,574.40 |
$7,540.20
|
|
Trauma partial team response w/critical care services level 4
|
$1,602.60 |
$1,602.60 |
$1,602.60 |
$4,523.04
|
|
Treat ankle dislocation
|
$2,823.00 |
$2,823.00 |
$2,823.00 |
$2,358.40
|
|
Treat clavicle dislocation 23545
|
$999.60 |
$999.60 |
$999.60 |
$705.60
|
|
Treat elbow dislocation
|
$2,823.00 |
$2,823.00 |
$2,823.00 |
$2,223.20
|
|
Treat fracture of radius
|
$999.60 |
$999.60 |
$999.60 |
$1,790.00
|
|
Treat fracture of ulna
|
$286.80 |
$286.80 |
$286.80 |
$726.05
|
|
Treat hip dislocation
|
$2,823.00 |
$2,823.00 |
$2,823.00 |
$2,192.80
|
|
Treat hip dislocation
|
$2,823.00 |
$2,823.00 |
$2,823.00 |
$2,641.60
|
|
Treat kneecap dislocation
|
$2,823.00 |
$2,823.00 |
$2,823.00 |
$1,068.90
|
|
Treat knee fracture(s)
|
$172.80 |
$172.80 |
$172.80 |
$642.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$266.40 |
$266.40 |
$266.40 |
$203.35
|
|
Treatment of thigh fracture
|
$4,821.60 |
$4,821.60 |
$4,821.60 |
$6,389.60
|
|
Treatment of thigh fracture
|
$999.60 |
$999.60 |
$999.60 |
$1,772.97
|
|
Treat toe dislocation
|
$2,823.00 |
$2,823.00 |
$2,823.00 |
$756.39
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$156,756.60 |
$156,756.60 |
$156,756.60 |
$73,346.25
|
|
Treponema pallidum antibody
|
$188.40 |
$188.40 |
$188.40 |
$70.40
|
|
Trg gene rearrangement anal
|
$627.00 |
$627.00 |
$627.00 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$239.40 |
$239.40 |
$239.40 |
$43.21
|
|
Triglycerides
|
$93.00 |
$93.00 |
$93.00 |
$58.05
|
|
Trilaciclib 300 mg intravenous solution
|
$5,202.60 |
$5,202.60 |
$5,202.60 |
$4,043.12
|
|
Trim nondyst nails
|
$34.20 |
$34.20 |
$34.20 |
$113.40
|
|
Triptorelin pamoate
|
$8,134.80 |
$8,134.80 |
$8,134.80 |
$4,619.39
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$17,764.20 |
$17,764.20 |
$17,764.20 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ini vein
|
$18,447.60 |
$18,447.60 |
$18,447.60 |
$15,330.11
|
|
Trnscath retrv pq vasc fb w/guide
|
$5,332.80 |
$5,332.80 |
$5,332.80 |
$4,523.96
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$3,538.20 |
$3,538.20 |
$3,538.20 |
$5,069.50
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$4,198.80 |
$4,198.80 |
$4,198.80 |
$4,250.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$4,201.20 |
$4,201.20 |
$4,201.20 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$1,884.60 |
$1,884.60 |
$1,884.60 |
$3,866.70
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$787.80 |
$787.80 |
$787.80 |
$2,406.77
|
|
Troponin quantitative
|
$169.20 |
$169.20 |
$169.20 |
$127.20
|
|
Tx atrial fib pulm vein isol
|
$26,674.80 |
$26,674.80 |
$26,674.80 |
$29,030.54
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$3,783.60 |
$3,783.60 |
$3,783.60 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$202.80 |
$202.80 |
$202.80 |
$535.60
|
|
Tx l/r atrial fib addl
|
$13,335.60 |
$13,335.60 |
$13,335.60 |
$6,769.00
|
|
Ua w/micro/comp poc
|
$34.20 |
$34.20 |
$34.20 |
$23.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$42,093.60 |
$42,093.60 |
$42,093.60 |
$20,945.01
|
|
Ultrasound abdomen aorta screening study aaa
|
$440.40 |
$440.40 |
$440.40 |
$394.20
|
|
Ultrasound breast complete
|
$784.80 |
$784.80 |
$784.80 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$394.20 |
$394.20 |
$394.20 |
$449.35
|
|
Ultrasound chest
|
$933.00 |
$933.00 |
$933.00 |
$460.85
|
|
Ultrasound elastography parenchyma
|
$127.20 |
$127.20 |
$127.20 |
$307.00
|
|
Ultrasound encephalogram
|
$783.00 |
$783.00 |
$783.00 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$289.20 |
$289.20 |
$289.20 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$946.80 |
$946.80 |
$946.80 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$447.60 |
$447.60 |
$447.60 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$985.80 |
$985.80 |
$985.80 |
$720.15
|
|
Ultrasound hips infant dynamic
|
$714.00 |
$714.00 |
$714.00 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$96.00 |
$96.00 |
$96.00 |
$311.25
|
|
Ultrasound joint complete left
|
$500.40 |
$500.40 |
$500.40 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$327.00 |
$327.00 |
$327.00 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$304.80 |
$304.80 |
$304.80 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$304.80 |
$304.80 |
$304.80 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,299.60 |
$1,299.60 |
$1,299.60 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$883.80 |
$883.80 |
$883.80 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$702.00 |
$702.00 |
$702.00 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$883.80 |
$883.80 |
$883.80 |
$497.12
|
|
Ultrasound retroperitoneal limited
|
$440.40 |
$440.40 |
$440.40 |
$486.50
|
|
Ultrasound scrotum and contents
|
$883.80 |
$883.80 |
$883.80 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$439.20 |
$439.20 |
$439.20 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$883.80 |
$883.80 |
$883.80 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$883.80 |
$883.80 |
$883.80 |
$558.35
|
|
Unlisted chemotherapy px
|
$60.00 |
$60.00 |
$60.00 |
$150.00
|
|
Unsched dialysis esrd pt hos
|
$1,500.00 |
$1,500.00 |
$1,500.00 |
$1,268.17
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,926.60 |
$4,926.60 |
$4,926.60 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,242.40 |
$3,242.40 |
$3,242.40 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,243.60 |
$3,243.60 |
$3,243.60 |
$2,034.41
|
|
Urea nitrogen
|
$73.20 |
$73.20 |
$73.20 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$86.40 |
$86.40 |
$86.40 |
$51.75
|
|
Urethrocystography void s&i
|
$340.80 |
$340.80 |
$340.80 |
$622.35
|
|
Uric acid blood
|
$66.00 |
$66.00 |
$66.00 |
$48.75
|
|
Uric acid urine
|
$73.20 |
$73.20 |
$73.20 |
$44.33
|
