|
Tacrolimus therapeutic drug level
|
$28.60 |
$28.60 |
$52.00 |
$122.40
|
|
Tafasitamab-cxix 200 mg intravenous solution
|
$1,806.42 |
$1,806.42 |
$3,284.40 |
$2,762.00
|
|
Target gsa panel hmtlmph neop
|
$530.64 |
$530.64 |
$964.80 |
$2,246.30
|
|
Target gsa panel organ/hmtlmph neop
|
$1,168.64 |
$1,168.64 |
$2,124.80 |
$3,746.70
|
|
Target gsa panel organ neop
|
$274.56 |
$274.56 |
$499.20 |
$1,655.52
|
|
Tbs techl calculation only
|
$98.12 |
$98.12 |
$178.40 |
$153.60
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$34.10 |
$34.10 |
$62.00 |
$177.65
|
|
Tc-99m disofenin
|
$98.65 |
$98.65 |
$179.37 |
$124.32
|
|
Tc-99m mebrofenin
|
$34.65 |
$34.65 |
$63.00 |
$157.65
|
|
Tc-99m medronate
|
$27.85 |
$27.85 |
$50.64 |
$111.01
|
|
Tc-99m mertiatide
|
$232.32 |
$232.32 |
$422.40 |
$756.00
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$105.53 |
$105.53 |
$191.87 |
$136.40
|
|
Tc-99m sestamibi p study dose
|
$47.54 |
$47.54 |
$86.44 |
$274.45
|
|
Tc-99m tilmanocept diag
|
$344.52 |
$344.52 |
$626.40 |
$955.60
|
|
T cells absolute cd4/cd8 including ratio
|
$17.38 |
$17.38 |
$31.60 |
$176.40
|
|
T cells absolute cd 4 count
|
$36.52 |
$36.52 |
$66.40 |
$111.20
|
|
T cells total count
|
$17.38 |
$17.38 |
$31.60 |
$126.90
|
|
Telehealth original site facility fee
|
$15.18 |
$15.18 |
$27.60 |
$51.00
|
|
Telethx isodose plan cplx
|
$197.12 |
$197.12 |
$358.40 |
$1,526.85
|
|
Telethx isodose plan simple
|
$212.74 |
$212.74 |
$386.80 |
$873.62
|
|
Temozolomide
|
$308.43 |
$308.43 |
$560.78 |
$588.46
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$1,750.14 |
$1,750.14 |
$3,182.06 |
$3,723.60
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$22.00 |
$22.00 |
$40.00 |
$39.33
|
|
Test stress cardiovascular tracing only
|
$250.80 |
$250.80 |
$456.00 |
$949.70
|
|
Theophylline therapeutic drug level
|
$32.56 |
$32.56 |
$59.20 |
$108.00
|
|
Therapeutic procd strg endur
|
$17.82 |
$17.82 |
$32.40 |
$85.68
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$25.30 |
$25.30 |
$46.00 |
$57.31
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$14.74 |
$14.74 |
$26.80 |
$50.00
|
|
Ther radiology tx plng cplx
|
$92.40 |
$92.40 |
$168.00 |
$332.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$30.37 |
$30.37 |
$55.22 |
$25.54
|
|
Thiotepa injection
|
$2,869.67 |
$2,869.67 |
$5,217.58 |
$1,485.00
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$658.24 |
$658.24 |
$1,196.80 |
$1,687.50
|
|
Thrombectomy/inf pq dialysis circuit
|
$2,395.14 |
$2,395.14 |
$4,354.80 |
$8,084.00
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$5,034.48 |
$5,034.48 |
$9,153.60 |
$14,277.20
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$7,631.14 |
$7,631.14 |
$13,874.80 |
$21,413.60
|
|
Thrombin time
|
$18.26 |
$18.26 |
$33.20 |
$53.76
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$19.80 |
$19.80 |
$36.00 |
$61.52
|
|
Thyroglobulin antibody
|
$17.60 |
$17.60 |
$32.00 |
$82.00
|
|
Thyroid mets imag whole body
|
$211.20 |
$211.20 |
$384.00 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$12.76 |
$12.76 |
$23.20 |
$111.00
|
|
Thyroid Ultrasound
|
$76.12 |
$76.12 |
$138.40 |
$588.50
|
|
Thyroxine binding globulin (tbg)
|
$11.88 |
$11.88 |
$21.60 |
$64.35
|
|
Tib/per revasc stent & ather 37231
|
$5,300.46 |
$5,300.46 |
$9,637.20 |
$21,249.26
|
|
Tib/per revasc w/ather add-on 37233
|
$4,191.22 |
$4,191.22 |
$7,620.40 |
$9,769.65
|
|
Tigecycline injection
|
$320.69 |
$320.69 |
$583.07 |
$234.00
|
|
Tilt table study
|
$282.92 |
$282.92 |
$514.40 |
$1,507.01
|
|
Tirofiban 12.5 mg/50 ml
|
$277.20 |
$277.20 |
$504.00 |
$458.85
|
|
Tissue exam koh skin/hair/nails
|
$3.52 |
$3.52 |
$6.40 |
$47.20
|
|
Tissue transglutaminase iga
|
$8.36 |
$8.36 |
$15.20 |
$44.16
|
|
Tixagev and cilgav inj
|
$53.02 |
$53.02 |
$96.40 |
$224.55
|
|
Tl-201 thallium diag per mci
|
$75.86 |
$75.86 |
$137.92 |
$78.40
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$235.07 |
$235.07 |
$427.39 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$29.48 |
$29.48 |
$53.60 |
$120.60
|
|
Tomosynthesis breast screen bilateral
|
$70.40 |
$70.40 |
$128.00 |
$72.68
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$284.90 |
$284.90 |
$518.00 |
$325.00
|
|
Toxoplasma antibody igg
|
$27.28 |
$27.28 |
$49.60 |
$89.40
|
|
Toxoplasma antibody igm
|
$15.40 |
$15.40 |
$28.00 |
$87.00
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$45.54 |
$45.54 |
$82.80 |
$101.25
|
|
Transferrin
|
$11.44 |
$11.44 |
$20.80 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$179.08 |
$179.08 |
$325.60 |
$983.00
|
|
Trauma partial team response w/critical care services level 4
|
$983.84 |
$983.84 |
$1,788.80 |
$4,523.04
|
|
Treat fracture of radius
|
$947.98 |
$947.98 |
$1,723.60 |
$1,849.00
|
|
Treat hip dislocation
|
$572.00 |
$572.00 |
$1,040.00 |
$2,192.80
|
|
Treat humerus fracture
|
$500.72 |
$500.72 |
$910.40 |
$1,771.43
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$65.12 |
$65.12 |
$118.40 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$34.32 |
$34.32 |
$62.40 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$99.22 |
$99.22 |
$180.40 |
$203.35
|
|
Treponema pallidum antibody
|
$82.06 |
$82.06 |
$149.20 |
$70.40
|
|
Treprostinil injection
|
$13,994.03 |
$13,994.03 |
$25,443.70 |
$19,071.84
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$189.29 |
$189.29 |
$344.16 |
$43.21
|
|
Trichomonas assay w/optic
|
$10.12 |
$10.12 |
$18.40 |
$55.50
|
|
Triglycerides
|
$24.20 |
$24.20 |
$44.00 |
$58.05
|
|
Trim nail(s)
|
$19.80 |
$19.80 |
$36.00 |
$79.00
|
|
Trim nondyst nails
|
$19.36 |
$19.36 |
$35.20 |
$113.40
|
|
Trml dstrj ios bvn 1st 2 l/s
|
$4,370.08 |
$4,370.08 |
$7,945.60 |
$15,226.08
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$1,728.54 |
$1,728.54 |
$3,142.80 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$5,034.48 |
$5,034.48 |
$9,153.60 |
$15,330.11
|
|
Trnscath retrv pq vasc fb w/guide
|
$1,841.62 |
$1,841.62 |
$3,348.40 |
$4,523.96
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$2,251.04 |
$2,251.04 |
$4,092.80 |
$5,069.50
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$2,883.98 |
$2,883.98 |
$5,243.60 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$2,883.98 |
$2,883.98 |
$5,243.60 |
$3,866.70
|
|
Trnspl rej kdn mrna qpcr 139
|
$2,138.40 |
$2,138.40 |
$3,888.00 |
$3,232.32
|
|
Troponin quantitative
|
$70.84 |
$70.84 |
$128.80 |
$127.20
|
|
Tx closed hip disl traumatic without anes
|
$78.76 |
$78.76 |
$143.20 |
$581.07
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$1,909.60 |
$1,909.60 |
$3,472.00 |
$3,977.49
|
|
Tx closed tib shaft fx without manip
|
$500.72 |
$500.72 |
$910.40 |
$535.60
|
|
Ultrasound abdomen aorta screening study aaa
|
$67.98 |
$67.98 |
$123.60 |
$394.20
|
|
Ultrasound breast complete
|
$79.20 |
$79.20 |
$144.00 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$59.18 |
$59.18 |
$107.60 |
$449.35
|
|
Ultrasound chest
|
$70.18 |
$70.18 |
$127.60 |
$460.85
|
|
Ultrasound dx ophth b-scan
|
$36.74 |
$36.74 |
$66.80 |
$296.80
|
|
Ultrasound elastography parenchyma
|
$69.52 |
$69.52 |
$126.40 |
$307.00
|
|
Ultrasound encephalogram
|
$69.52 |
$69.52 |
$126.40 |
$488.80
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$166.76 |
$166.76 |
$303.20 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$243.98 |
$243.98 |
$443.60 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$315.48 |
$315.48 |
$573.60 |
$720.15
|
|
Ultrasound guide intraoperative
|
$315.48 |
$315.48 |
$573.60 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$62.92 |
$62.92 |
$114.40 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$57.20 |
$57.20 |
$104.00 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$47.08 |
$47.08 |
$85.60 |
$311.25
|
