|
Tc-99m pertechnetate per mci
|
$27.95 |
$28.60 |
$50.05 |
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$153.40 |
$153.40 |
$153.40 |
|
|
Tc-99m sestamibi p study dose
|
$226.20 |
$306.15 |
$495.95 |
|
|
Tc-99m succimer (dmsa)
|
$1,194.70 |
$1,194.70 |
$1,194.70 |
|
|
Tc-99m sulfur colloid
|
$217.10 |
$249.60 |
$468.00 |
|
|
Tc-99m tetrofosmin p study dose
|
$302.90 |
$344.50 |
$378.95 |
|
|
Tc-99m tilmanocept diag
|
$748.15 |
$748.15 |
$1,620.45 |
|
|
Tcd emboli detect w/inj
|
$923.00 |
$923.00 |
$923.00 |
|
|
T cells absolute cd4/cd8 including ratio
|
$179.40 |
$204.75 |
$373.10 |
|
|
T cells absolute cd 4 count
|
$102.70 |
$109.50 |
$210.60 |
|
|
T cells total count
|
$131.95 |
$141.05 |
$217.10 |
|
|
Teaec w/wo patch graft iliofemoral
|
$12,164.10 |
$12,164.10 |
$12,164.10 |
|
|
Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution
|
$6,998.55 |
$6,998.55 |
$6,998.55 |
|
|
Telehealth original site facility fee
|
$30.55 |
$35.75 |
$52.65 |
|
|
Telethx isodose plan cplx
|
$14,041.30 |
$14,041.30 |
$22,783.80 |
|
|
Telethx isodose plan simple
|
$1,450.80 |
$1,450.80 |
$1,450.80 |
|
|
Temozolomide
|
$66.62 |
$66.62 |
$119.16 |
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$2,816.54 |
$2,816.54 |
$5,081.76 |
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$16,233.59 |
$16,665.05 |
$20,224.57 |
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$7.15 |
$13.00 |
$1,190.86 |
|
|
Test for porphobilinogen
|
$57.20 |
$59.15 |
$101.40 |
|
|
Testicular imaging w/vasc flow
|
$1,015.95 |
$1,015.95 |
$1,015.95 |
|
|
Test pathogen(s) for platelets reference
|
$48.75 |
$49.40 |
$56.55 |
|
|
Test stress cardiovascular tracing only
|
$490.75 |
$603.85 |
$1,144.65 |
|
|
Tetanus immune globulin inj
|
$281.25 |
$1,981.73 |
$2,770.16 |
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$7,462.34 |
$9,996.89 |
$11,994.05 |
|
|
Theophylline therapeutic drug level
|
$41.25 |
$135.85 |
$220.35 |
|
|
Therapeutic procd strg endur
|
$46.80 |
$46.80 |
$79.95 |
|
|
Therapy activation ipnss
|
$951.60 |
$951.60 |
$951.60 |
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$36.40 |
$40.30 |
$48.10 |
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$27.30 |
$40.30 |
$40.30 |
|
|
Ther fx nasal inf turbinate
|
$13,920.68 |
$13,920.68 |
$13,920.68 |
|
|
Ther nma rdctj intus/obstrcj
|
$897.65 |
$897.65 |
$897.65 |
|
|
Ther/proph/diag inj ia
|
$54.60 |
$98.15 |
$224.90 |
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$7.15 |
$30.08 |
$42.04 |
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$453.70 |
$2,466.10 |
$2,830.05 |
|
|
Thoracotomy with cardiac massage
|
$13,084.50 |
$13,084.50 |
$13,084.50 |
|
|
Thrombectmy crnry perq mechanical
|
$4,241.25 |
$4,241.25 |
$4,241.25 |
|
|
Thrombectomy/inf pq dialysis circuit
|
$13,263.06 |
$13,263.06 |
$13,263.06 |
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$13,915.82 |
$13,915.82 |
$28,412.46 |
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$23,337.42 |
$23,337.42 |
$61,480.50 |
|
|
Thrombin time
|
$45.50 |
$60.45 |
$74.10 |
|
|
Thromboendarterectomy common femoral
|
$13,380.25 |
$13,380.25 |
$13,380.25 |
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$39.65 |
$58.50 |
$94.90 |
|
|
Thymectomy prtl/tot transcervical appr 60520
|
$10,461.20 |
$10,461.20 |
$10,461.20 |
|
|
Thyroglobulin antibody
|
$72.15 |
$119.60 |
$227.50 |
|
|
Thyroid imaging
|
$497.90 |
$577.20 |
$670.80 |
|
|
Thyroid met imaging
|
$876.20 |
$876.20 |
$1,279.85 |
|
|
Thyroid mets imag whole body
|
$1,561.95 |
$1,561.95 |
$1,735.50 |
|
|
Thyroid (TSH) Test
|
$50.25 |
$120.90 |
$189.80 |
|
|
Thyroid Ultrasound
|
$33.75 |
$564.85 |
$823.55 |
|
|
Thyroid uptake measurement
|
$420.55 |
$459.55 |
$767.00 |
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$3,359.48 |
$3,359.48 |
$4,499.05 |
|
|
Thyroxine binding globulin (tbg)
|
$81.25 |
$105.30 |
$165.75 |
|
|
Tigecycline injection
|
$268.12 |
$302.25 |
$317.36 |
|
|
Tilt table study
|
$1,840.15 |
$1,840.15 |
$2,084.55 |
|
|
Tirofiban 12.5 mg/50 ml
|
$278.07 |
$278.07 |
$722.38 |
|
|
Tisotumab vedotin-tftv 40 mg intravenous solution
|
$19,345.44 |
$19,345.44 |
$19,345.44 |
|
|
Tissue culture placenta
|
$313.30 |
$410.80 |
$424.45 |
|
|
Tissue culture skin/biopsy
|
$386.75 |
$419.90 |
$620.10 |
|
|
Tissue exam koh skin/hair/nails
|
$9.75 |
$40.30 |
$55.25 |
|
|
Tissue transglutaminase iga
|
$37.70 |
$87.75 |
$131.95 |
|
|
Tl-201 thallium diag per mci
|
$121.55 |
$136.50 |
$172.25 |
|
|
Tlh uterus 250 g or less
|
$24,801.20 |
$24,801.20 |
$24,801.20 |
|
|
Tlh uterus over 250 g
|
$21,131.78 |
$21,131.78 |
$21,131.78 |
|
|
Tlh w/t/o 250 g or less
|
$25,643.46 |
$25,643.46 |
$40,402.32 |
|
|
Tlh w/t/o uterus over 250 g
|
$27,965.00 |
$27,965.00 |
$63,022.06 |
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$6.75 |
$250.25 |
$338.00 |
|
|
Tobramycin peak therapeutic drug level
|
$119.60 |
$143.00 |
$222.95 |
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$3,573.41 |
$5,480.12 |
$6,946.81 |
|
|
Tomosynthesis breast diagnostic left
|
$66.95 |
$68.90 |
$169.65 |
|
|
Tomosynthesis breast screen bilateral
|
$57.20 |
$68.90 |
$163.15 |
|
|
Tongue biopsy; posterior one-third 41105
|
$9,192.64 |
$9,192.64 |
$9,192.64 |
|
|
Tonsillectomy (age 12+)
|
$8,443.47 |
$8,443.47 |
$8,443.47 |
|
|
Tonsillectomy (child under 12)
|
$7,365.28 |
$7,365.28 |
$7,365.28 |
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$240.84 |
$312.65 |
$381.89 |
|
|
Total hysterectomy
|
$2,754.00 |
$2,754.00 |
$29,564.72 |
|
|
Total Knee Replacement
|
$2,115.75 |
$2,115.75 |
$2,115.75 |
|
|
Total tau
|
$377.00 |
$377.00 |
$377.00 |
|
|
Toxoplasma antibody igg
|
$61.10 |
$82.50 |
$166.40 |
|
|
Toxoplasma antibody igm
|
$61.10 |
$76.05 |
$199.55 |
|
|
Tp53 gene trgt sequence alys
|
$1,022.45 |
$1,022.45 |
$1,022.45 |
|
|
Tpmt gene com vrnts
|
$194.35 |
$334.75 |
$462.15 |
|
|
Tprnl plmt biodegrdabl matrl
|
$21,390.64 |
$21,390.64 |
$38,212.85 |
|
|
Trabectedin 1 mg intravenous solution
|
$8,603.68 |
$8,603.68 |
$9,630.06 |
|
|
Trabeculoplasty laser surg
|
$1,474.20 |
$1,474.20 |
$1,474.20 |
|
|
Tracheobrnchsc thru est trachs incisn
|
$5,456.13 |
$5,456.13 |
$5,456.13 |
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$77.35 |
$85.80 |
$144.30 |
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$63.47 |
$63.47 |
$68.25 |
|
|
Transcath biopsy
|
$13,568.92 |
$13,568.92 |
$13,568.92 |
|
|
Transcath closure of asd
|
$14,353.30 |
$14,353.30 |
$27,812.85 |
|
|
Transcath closure of vsd
|
$18,798.65 |
$18,798.65 |
$18,798.65 |
|
|
Transcatheter bx s&i
|
$1,812.20 |
$1,812.20 |
$2,388.75 |
|
|
Transcath mv repair addl prosthesis
|
$16,446.30 |
$16,446.30 |
$16,446.30 |
|
|
Transcath mv repair init prosthesis
|
$27,691.30 |
$27,691.30 |
$27,691.30 |
|
|
Transcath occlusion cns
|
$60,052.10 |
$60,052.10 |
$60,052.10 |
|
|
Transcath occlusion non-cns
|
$16,601.00 |
$16,601.00 |
$16,601.00 |
|
|
Trans cath replace aortic valve 33366
|
$35,815.65 |
$35,815.65 |
$35,815.65 |
|
|
Transcath rmvl perm ldss pmkr rv
|
$4,519.45 |
$4,519.45 |
$4,519.45 |
|
|
Transferrin
|
$39.00 |
$118.30 |
$149.50 |
|
