|
T3 (triiodothyronine) total
|
$91.20 |
$91.20 |
$91.20 |
|
|
T4 (thyroxine) free
|
$40.80 |
$40.80 |
$127.20 |
|
|
T4 (thyroxine) total
|
$94.40 |
$94.40 |
$94.40 |
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$10.70 |
$10.70 |
$26.31 |
|
|
Tacrolimus therapeutic drug level
|
$196.80 |
$196.80 |
$196.80 |
|
|
Target gsa panel hmtlmph neop
|
$1,637.60 |
$1,637.60 |
$1,637.60 |
|
|
Tavr perq femoral
|
$10,833.60 |
$10,833.60 |
$10,833.60 |
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$289.60 |
$289.60 |
$289.60 |
|
|
Tca peel dermal 15789
|
$776.80 |
$776.80 |
$776.80 |
|
|
T cells absolute cd4/cd8 including ratio
|
$163.20 |
$163.20 |
$189.60 |
|
|
T cells absolute cd 4 count
|
$117.60 |
$117.60 |
$117.60 |
|
|
T cells total count
|
$156.80 |
$156.80 |
$156.80 |
|
|
Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution
|
$27,568.26 |
$27,568.26 |
$27,568.26 |
|
|
Tee w or without fol w/cont,cong
|
$1,011.20 |
$1,011.20 |
$1,432.00 |
|
|
Telehealth original site facility fee
|
$31.20 |
$31.20 |
$39.20 |
|
|
Telethx isodose plan cplx
|
$224.00 |
$224.00 |
$224.00 |
|
|
Telethx isodose plan simple
|
$224.00 |
$224.00 |
$224.00 |
|
|
Temozolomide
|
$23.87 |
$23.87 |
$23.87 |
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$2,420.99 |
$2,420.99 |
$2,420.99 |
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$20,393.69 |
$20,393.69 |
$20,393.69 |
|
|
Tenodesis biceps tdn at elbw
|
$915.20 |
$915.20 |
$915.20 |
|
|
Tenosynovectomy radic 26145
|
$794.40 |
$794.40 |
$794.40 |
|
|
Tenotomy length/rls abductor hallucis musc 28240
|
$4,108.00 |
$4,108.00 |
$4,108.00 |
|
|
Tenotomy open tndn flxr toe sgl tndn spx
|
$556.80 |
$556.80 |
$556.80 |
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$69.99 |
$69.99 |
$69.99 |
|
|
Test for urine cystines
|
$34.40 |
$34.40 |
$34.40 |
|
|
Test stress cardiovascular tracing only
|
$403.20 |
$403.20 |
$538.40 |
|
|
Tetanus immune globulin inj
|
$1,461.98 |
$1,461.98 |
$1,461.98 |
|
|
Theophylline therapeutic drug level
|
$149.60 |
$149.60 |
$149.60 |
|
|
Therapeutic procd strg endur
|
$46.40 |
$46.40 |
$66.40 |
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$36.80 |
$36.80 |
$66.40 |
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$27.20 |
$27.20 |
$50.40 |
|
|
Therapy photodnmc lght dstr lsn skn by staff rx per day
|
$196.00 |
$196.00 |
$196.00 |
|
|
Ther fx nasal inf turbinate
|
$172.80 |
$172.80 |
$172.80 |
|
|
Ther/proph/diag inj ia
|
$470.40 |
$470.40 |
$470.40 |
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$79.74 |
$79.74 |
$79.74 |
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,165.60 |
$1,165.60 |
$1,737.60 |
|
|
Thoracoscopy surgical 32650
|
$991.20 |
$991.20 |
$991.20 |
|
|
Thoracostomy w/flap drng 32036
|
$1,167.20 |
$1,167.20 |
$1,167.20 |
|
|
Thoracotomy opn free adhesions 32124
|
$1,368.00 |
$1,368.00 |
$1,368.00 |
|
|
Thoracotomy w/expl
|
$23,178.40 |
$23,178.40 |
$23,178.40 |
|
|
Thoracotomy with cardiac massage
|
$3,482.40 |
$3,482.40 |
$7,533.60 |
|
|
Thrombectmy crnry perq mechanical
|
$7,224.00 |
$7,224.00 |
$7,224.00 |
|
|
Thrombectomy/inf pq dialysis circuit
|
$11,866.40 |
$11,866.40 |
$11,866.40 |
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$23,983.20 |
$23,983.20 |
$23,983.20 |
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$36,353.60 |
$36,353.60 |
$36,353.60 |
|
|
Thrombin time
|
$114.40 |
$114.40 |
$114.40 |
|
|
Thromboendarterectomy sfa
|
$2,299.20 |
$2,299.20 |
$2,299.20 |
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$172.00 |
$172.00 |
$172.00 |
|
|
Thyroglobulin antibody
|
$158.40 |
$158.40 |
$158.40 |
|
|
Thyroid mets imag whole body
|
$1,313.60 |
$1,313.60 |
$1,313.60 |
|
|
Thyroid (TSH) Test
|
$74.40 |
$74.40 |
$136.00 |
|
|
Thyroid Ultrasound
|
$433.60 |
$433.60 |
$453.60 |
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$5,468.87 |
$5,468.87 |
$5,468.87 |
|
|
Thyroxine binding globulin (tbg)
|
$140.80 |
$140.80 |
$140.80 |
|
|
Tib/per revasc w/ather add-on 37233
|
$21,672.80 |
$21,672.80 |
$21,672.80 |
|
|
Tigecycline injection
|
$200.18 |
$200.18 |
$411.85 |
|
|
Tilt table study
|
$1,473.60 |
$1,473.60 |
$1,473.60 |
|
|
Tissue culture placenta
|
$664.00 |
$664.00 |
$664.00 |
|
|
Tissue culture skin/biopsy
|
$384.00 |
$384.00 |
$384.00 |
|
|
Tissue exam koh skin/hair/nails
|
$43.20 |
$43.20 |
$54.40 |
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$3,649.64 |
$3,649.64 |
$3,649.64 |
|
|
Tissue surgimend prs meshed 20 cm x 10 cm - cost per 0.5cm
|
$1,054.94 |
$1,054.94 |
$1,054.94 |
|
|
Tissue transglutaminase iga
|
$80.00 |
$80.00 |
$80.00 |
|
|
Tnot opn elbw to sho ea tdn
|
$705.60 |
$705.60 |
$705.60 |
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$71.50 |
$71.50 |
$71.50 |
|
|
Tobramycin non-comp unit
|
$475.46 |
$475.46 |
$475.46 |
|
|
Tobramycin peak therapeutic drug level
|
$288.00 |
$288.00 |
$288.00 |
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$3,318.01 |
$3,318.01 |
$6,570.26 |
|
|
Tomosynthesis breast diagnostic left
|
$62.40 |
$62.40 |
$74.40 |
|
|
Tomosynthesis breast screen bilateral
|
$62.40 |
$62.40 |
$74.40 |
|
|
Tongue biopsy; posterior one-third 41105
|
$278.40 |
$278.40 |
$278.40 |
|
|
Tonsillectomy (age 12+)
|
$375.20 |
$375.20 |
$375.20 |
|
|
Tonsillectomy (child under 12)
|
$394.40 |
$394.40 |
$394.40 |
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$384.16 |
$384.16 |
$497.65 |
|
|
Total Hip Replacement
|
$1,886.40 |
$1,886.40 |
$1,886.40 |
|
|
Total hysterectomy
|
$1,491.20 |
$1,491.20 |
$1,491.20 |
|
|
Total Knee Replacement
|
$1,884.00 |
$1,884.00 |
$1,884.00 |
|
|
Toxoplasma antibody igg
|
$142.40 |
$142.40 |
$142.40 |
|
|
Toxoplasma antibody igm
|
$71.20 |
$71.20 |
$71.20 |
|
|
Tpmt gene com vrnts
|
$533.60 |
$533.60 |
$533.60 |
|
|
Trabectedin 1 mg intravenous solution
|
$4,845.57 |
$4,845.57 |
$4,845.57 |
|
|
Tracheobrnchsc thru est trachs incisn
|
$256.00 |
$256.00 |
$560.80 |
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$104.00 |
$104.00 |
$104.00 |
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$163.97 |
$163.97 |
$283.39 |
|
|
Transcath biopsy
|
$1,931.20 |
$1,931.20 |
$1,931.20 |
|
|
Transcath closure of asd
|
$17,088.00 |
$17,088.00 |
$17,088.00 |
|
|
Transcath closure of vsd
|
$26,973.60 |
$26,973.60 |
$26,973.60 |
|
|
Transcatheter bx s&i
|
$1,048.80 |
$1,048.80 |
$1,048.80 |
|
|
Transcath mv repair addl prosthesis
|
$6,190.40 |
$6,190.40 |
$6,190.40 |
|
|
Transcath mv repair init prosthesis
|
$12,381.60 |
$12,381.60 |
$12,381.60 |
|
|
Transcath occlusion cns
|
$8,229.60 |
$8,229.60 |
$8,229.60 |
|
|
Transcath occlusion non-cns
|
$16,768.00 |
$16,768.00 |
$16,768.00 |
|
|
Transferrin
|
$102.40 |
$102.40 |
$102.40 |
|
|
Transfusion blood/blood component(s)
|
$295.20 |
$295.20 |
$359.20 |
|
|
Trastuzumab 150 mg intravenous solution
|
$2,046.82 |
$2,046.82 |
$2,046.82 |
|
|
Trauma partial team response w/critical care services level 4
|
$961.60 |
$961.60 |
$6,621.60 |
|
|
Tray bonemarrw oncontrol 102mm
|
$3,700.00 |
$3,700.00 |
$3,700.00 |
|
|
Treat ankle dislocation
|
$1,414.40 |
$1,414.40 |
$1,760.00 |
|
|
Treat ankle dislocation
|
$9,533.60 |
$9,533.60 |
$9,533.60 |
|