|
Tc-99m succimer (dmsa)
|
$4,043.85 |
$4,043.85 |
$4,043.85 |
$1,128.40
|
|
Tc-99m sulfur colloid
|
$972.75 |
$972.75 |
$972.75 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$523.85 |
$523.85 |
$523.85 |
$193.28
|
|
T cells absolute cd4/cd8 including ratio
|
$67.20 |
$67.20 |
$67.20 |
$184.00
|
|
T cells total count
|
$62.55 |
$62.55 |
$62.55 |
$130.20
|
|
Team conf without pat by phys
|
$139.05 |
$139.05 |
$139.05 |
$140.25
|
|
Team conf w/pat by hc prof
|
$193.15 |
$193.15 |
$193.15 |
$107.10
|
|
Telehealth original site facility fee
|
$83.75 |
$83.75 |
$83.75 |
$51.00
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$10,251.27 |
$10,251.27 |
$10,251.27 |
$14,951.87
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$99.23 |
$99.23 |
$99.23 |
$39.33
|
|
Test stress cardiovascular tracing only
|
$535.70 |
$535.70 |
$535.70 |
$953.40
|
|
Tetanus immune globulin inj
|
$2,221.14 |
$2,221.14 |
$2,221.14 |
$1,285.36
|
|
Theophylline therapeutic drug level
|
$283.20 |
$283.20 |
$283.20 |
$108.00
|
|
Therapeutic procd strg endur
|
$75.70 |
$75.70 |
$75.70 |
$85.68
|
|
Therapy Activity Training (each 15 minutes)
|
$122.30 |
$122.30 |
$122.30 |
$101.38
|
|
Therapy Exercise Session (each 15 minutes)
|
$144.60 |
$144.60 |
$144.60 |
$98.58
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$115.75 |
$115.75 |
$115.75 |
$57.50
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$98.75 |
$98.75 |
$98.75 |
$50.40
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$50.12 |
$50.12 |
$50.12 |
$25.54
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$200.25 |
$200.25 |
$200.25 |
$313.60
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,841.90 |
$1,841.90 |
$1,841.90 |
$1,724.25
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$3,836.80 |
$3,836.80 |
$3,836.80 |
$1,703.45
|
|
Thrombin time
|
$101.75 |
$101.75 |
$101.75 |
$54.18
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$247.80 |
$247.80 |
$247.80 |
$62.01
|
|
Thyroglobulin antibody
|
$62.55 |
$62.55 |
$62.55 |
$82.50
|
|
Thyroid imaging
|
$1,292.15 |
$1,292.15 |
$1,292.15 |
$695.60
|
|
Thyroid (TSH) Test
|
$214.55 |
$214.55 |
$214.55 |
$112.70
|
|
Thyroid Ultrasound
|
$634.90 |
$634.90 |
$634.90 |
$588.50
|
|
Thyroid uptake measurement
|
$535.70 |
$535.70 |
$535.70 |
$591.25
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$3,074.85 |
$3,074.85 |
$3,074.85 |
$4,152.21
|
|
Thyroxine binding globulin (tbg)
|
$73.05 |
$73.05 |
$73.05 |
$64.51
|
|
Tilt table study
|
$1,729.85 |
$1,729.85 |
$1,729.85 |
$1,561.82
|
|
Tissue culture placenta
|
$390.80 |
$390.80 |
$390.80 |
$453.00
|
|
Tissue culture skin/biopsy
|
$1,353.70 |
$1,353.70 |
$1,353.70 |
$488.74
|
|
Tissue exam koh skin/hair/nails
|
$27.00 |
$27.00 |
$27.00 |
$47.40
|
|
Tissue transglutaminase iga
|
$34.25 |
$34.25 |
$34.25 |
$44.80
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$17.08 |
$17.08 |
$17.08 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$143.35 |
$143.35 |
$143.35 |
$120.60
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$2,019.22 |
$2,019.22 |
$2,019.22 |
$5,258.52
|
|
Toe X-ray (both feet)
|
$214.05 |
$214.05 |
$214.05 |
$258.65
|
|
Tomosynthesis breast screen bilateral
|
$84.75 |
$84.75 |
$84.75 |
$74.10
|
|
Total tau
|
$149.40 |
$149.40 |
$149.40 |
$312.50
|
|
Toxoplasma antibody igg
|
$21.90 |
$21.90 |
$21.90 |
$91.65
|
|
Toxoplasma antibody igm
|
$21.90 |
$21.90 |
$21.90 |
$87.75
|
|
Tp53 gene full gene sequence
|
$1,604.65 |
$1,604.65 |
$1,604.65 |
$706.04
|
|
Transcath occlusion cns
|
$6,256.60 |
$6,256.60 |
$6,256.60 |
$7,337.20
|
|
Transcath occlusion non-cns
|
$5,077.35 |
$5,077.35 |
$5,077.35 |
$10,270.00
|
|
Transferrin
|
$100.45 |
$100.45 |
$100.45 |
$82.00
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$736.30 |
$736.30 |
$736.30 |
$561.60
|
|
Transvaginal Pregnancy Ultrasound
|
$1,087.65 |
$1,087.65 |
$1,087.65 |
$499.20
|
|
Treat knee fracture(s)
|
$585.45 |
$585.45 |
$585.45 |
$643.26
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$227.20 |
$227.20 |
$227.20 |
$227.70
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$227.20 |
$227.20 |
$227.20 |
$147.48
|
|
Treponema pallidum antibody
|
$57.25 |
$57.25 |
$57.25 |
$72.05
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$42.82 |
$42.82 |
$42.82 |
$43.09
|
|
Triglycerides
|
$133.20 |
$133.20 |
$133.20 |
$58.50
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$14,807.30 |
$14,807.30 |
$14,807.30 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$15,253.05 |
$15,253.05 |
$15,253.05 |
$8,776.32
|
|
Trnscath plc vas stent w/s&i ini vein
|
$31,540.80 |
$31,540.80 |
$31,540.80 |
$14,461.50
|
|
Trnscath retrv pq vasc fb w/guide
|
$8,113.50 |
$8,113.50 |
$8,113.50 |
$4,766.40
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$5,879.30 |
$5,879.30 |
$5,879.30 |
$5,139.20
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$6,654.00 |
$6,654.00 |
$6,654.00 |
$4,341.66
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$6,654.00 |
$6,654.00 |
$6,654.00 |
$4,354.35
|
|
Trnscath tx thromblytc vein ini day
|
$2,038.95 |
$2,038.95 |
$2,038.95 |
$3,866.70
|
|
Troponin quantitative
|
$161.25 |
$161.25 |
$161.25 |
$127.60
|
|
Ua w/micro/comp poc
|
$21.00 |
$21.00 |
$21.00 |
$23.00
|
|
Ultrasound breast complete
|
$567.30 |
$567.30 |
$567.30 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$540.45 |
$540.45 |
$540.45 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$483.75 |
$483.75 |
$483.75 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$330.40 |
$330.40 |
$330.40 |
$296.80
|
|
Ultrasound elastography parenchyma
|
$323.75 |
$323.75 |
$323.75 |
$313.95
|
|
Ultrasound encephalogram
|
$924.60 |
$924.60 |
$924.60 |
$494.92
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$744.60 |
$744.60 |
$744.60 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$1,121.65 |
$1,121.65 |
$1,121.65 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$626.70 |
$626.70 |
$626.70 |
$388.08
|
|
Ultrasound guide intraoperative
|
$924.60 |
$924.60 |
$924.60 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$1,121.65 |
$1,121.65 |
$1,121.65 |
$560.00
|
|
Ultrasound joint complete left
|
$924.60 |
$924.60 |
$924.60 |
$557.99
|
|
Ultrasound ob >=14wks ea addl gest
|
$604.95 |
$604.95 |
$604.95 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$701.40 |
$701.40 |
$701.40 |
$334.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$604.95 |
$604.95 |
$604.95 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$924.60 |
$924.60 |
$924.60 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$529.50 |
$529.50 |
$529.50 |
$463.00
|
|
Unlisted laparoscopic liver biopy 47379
|
$1,942.00 |
$1,942.00 |
$1,942.00 |
$6,307.38
|
|
Unlisted ultrasound procedure
|
$507.10 |
$507.10 |
$507.10 |
$332.16
|
|
Upgrade pm system
|
$41,076.90 |
$41,076.90 |
$41,076.90 |
$12,077.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$236.55 |
$236.55 |
$236.55 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$2,233.90 |
$2,233.90 |
$2,233.90 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,038.10 |
$1,038.10 |
$1,038.10 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,191.75 |
$2,191.75 |
$2,191.75 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,864.50 |
$1,864.50 |
$1,864.50 |
$2,369.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,296.25 |
$1,296.25 |
$1,296.25 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$240.05 |
$240.05 |
$240.05 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$564.00 |
$564.00 |
$564.00 |
$381.60
|
|
Upper GI Barium X-ray (barium and gas)
|
$1,120.50 |
$1,120.50 |
$1,120.50 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$1,503.55 |
$1,503.55 |
$1,503.55 |
$607.20
|
|
Urea nitrogen
|
$90.80 |
$90.80 |
$90.80 |
$42.25
|
|
Urea nitrogen 24 hour urine
|
$144.30 |
$144.30 |
$144.30 |
$52.00
|
|
Urea nitrogen clearance
|
$18.00 |
$18.00 |
$18.00 |
$38.35
|
|
Urethrcystgrphy rtrgrde s&i
|
$1,507.90 |
$1,507.90 |
$1,507.90 |
$584.00
|
