|
Tc-99m bicisate
|
$4,935.84 |
$4,935.84 |
$4,935.84 |
$1,969.45
|
|
Tc-99m depreotide
|
$1,377.60 |
$1,377.60 |
$1,377.60 |
$1,486.80
|
|
Tc-99m disofenin
|
$166.32 |
$166.32 |
$166.32 |
$124.32
|
|
Tc-99m exametazime diag
|
$4,463.76 |
$4,463.76 |
$4,463.76 |
$2,033.20
|
|
Tc-99m labeled rbc
|
$441.00 |
$441.00 |
$441.00 |
$302.40
|
|
Tc-99m maa
|
$530.04 |
$530.04 |
$530.04 |
$292.80
|
|
Tc-99m mebrofenin
|
$99.96 |
$99.96 |
$99.96 |
$157.65
|
|
Tc-99m medronate
|
$143.64 |
$143.64 |
$143.64 |
$111.01
|
|
Tc-99m mertiatide
|
$948.36 |
$948.36 |
$948.36 |
$756.00
|
|
Tc-99m oxidronate
|
$120.96 |
$120.96 |
$120.96 |
$105.60
|
|
Tc-99m pentetate dtpa
|
$424.20 |
$424.20 |
$424.20 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$483.00 |
$483.00 |
$483.00 |
$190.80
|
|
Tc-99m pertechnetate per mci
|
$2.52 |
$2.52 |
$2.52 |
$22.10
|
|
Tc-99m sestamibi p study dose
|
$936.60 |
$936.60 |
$936.60 |
$274.45
|
|
Tc-99m succimer (dmsa)
|
$236.04 |
$236.04 |
$236.04 |
$1,128.40
|
|
Tc-99m sulfur colloid
|
$496.44 |
$496.44 |
$496.44 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$119.28 |
$119.28 |
$119.28 |
$190.80
|
|
T cells absolute cd4/cd8 including ratio
|
$233.52 |
$233.52 |
$233.52 |
$176.40
|
|
T cells absolute cd 4 count
|
$136.92 |
$136.92 |
$136.92 |
$111.20
|
|
T cells total count
|
$233.52 |
$233.52 |
$233.52 |
$126.90
|
|
Team conf w/pat by hc prof
|
$301.56 |
$301.56 |
$301.56 |
$107.10
|
|
Telavancin injection
|
$1,498.73 |
$1,498.73 |
$1,498.73 |
$1,191.80
|
|
Telehealth original site facility fee
|
$47.88 |
$47.88 |
$47.88 |
$51.00
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$7,683.86 |
$7,683.86 |
$7,683.86 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$33,628.82 |
$33,628.82 |
$33,628.82 |
$15,245.38
|
|
Tenotomy open tndn flxr toe sgl tndn spx
|
$895.44 |
$895.44 |
$895.44 |
$2,139.67
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$83.58 |
$83.58 |
$83.58 |
$39.33
|
|
Test for porphobilinogen
|
$96.60 |
$96.60 |
$96.60 |
$33.57
|
|
Testicular imaging w/vasc flow
|
$1,206.24 |
$1,206.24 |
$1,206.24 |
$842.56
|
|
Testosterone undecanoate 1mg
|
$8,704.43 |
$8,704.43 |
$8,704.43 |
$3,528.08
|
|
Test stress cardiovascular tracing only
|
$1,382.64 |
$1,382.64 |
$1,382.64 |
$949.70
|
|
Test urine for porphyrins
|
$82.32 |
$82.32 |
$82.32 |
$49.98
|
|
Test urine urobilinogen
|
$33.60 |
$33.60 |
$33.60 |
$9.75
|
|
Tetanus immune globulin inj
|
$1,887.82 |
$1,887.82 |
$1,887.82 |
$1,285.36
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$17,475.84 |
$17,475.84 |
$17,475.84 |
$8,737.05
|
|
Theophylline therapeutic drug level
|
$152.04 |
$152.04 |
$152.04 |
$108.00
|
|
Therapeutic procd strg endur
|
$94.08 |
$94.08 |
$94.08 |
$85.68
|
|
Therapy activity per session >= 45 minutes
|
$303.24 |
$303.24 |
$303.24 |
$191.50
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$32.76 |
$32.76 |
$32.76 |
$57.31
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$30.24 |
$30.24 |
$30.24 |
$50.00
|
|
Ther/proph/diag inj ia
|
$424.20 |
$424.20 |
$424.20 |
$240.35
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$83.58 |
$83.58 |
$83.58 |
$25.54
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,228.08 |
$1,228.08 |
$1,228.08 |
$1,687.50
|
|
Thrombectomy/inf pq dialysis circuit
|
$12,228.72 |
$12,228.72 |
$12,228.72 |
$8,084.00
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$18,723.60 |
$18,723.60 |
$18,723.60 |
$14,277.20
|
|
Thrombin time
|
$113.40 |
$113.40 |
$113.40 |
$53.76
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$115.92 |
$115.92 |
$115.92 |
$61.52
|
|
Thyroglobulin antibody
|
$154.56 |
$154.56 |
$154.56 |
$82.00
|
|
Thyroidectomy inc substrnl split/trans approch 60270
|
$3,117.24 |
$3,117.24 |
$3,117.24 |
$2,616.00
|
|
Thyroid imaging
|
$576.24 |
$576.24 |
$576.24 |
$695.02
|
|
Thyroid met imaging
|
$733.32 |
$733.32 |
$733.32 |
$838.25
|
|
Thyroid mets imag whole body
|
$1,885.80 |
$1,885.80 |
$1,885.80 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$147.84 |
$147.84 |
$147.84 |
$111.00
|
|
Thyroid Ultrasound
|
$598.92 |
$598.92 |
$598.92 |
$588.50
|
|
Thyroid uptake measurement
|
$786.24 |
$786.24 |
$786.24 |
$591.25
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$8,304.41 |
$8,304.41 |
$8,304.41 |
$4,112.43
|
|
Thyroxine binding globulin (tbg)
|
$57.12 |
$57.12 |
$57.12 |
$64.35
|
|
Tigecycline injection
|
$403.35 |
$403.35 |
$403.35 |
$234.00
|
|
Tilt table study
|
$2,154.60 |
$2,154.60 |
$2,154.60 |
$1,507.01
|
|
Tirofiban 12.5 mg/50 ml
|
$917.70 |
$917.70 |
$917.70 |
$458.85
|
|
Tisotumab vedotin-tftv 40 mg intravenous solution
|
$26,678.40 |
$26,678.40 |
$26,678.40 |
$13,339.20
|
|
Tissue amnio epifix inj 100mg
|
$5,650.16 |
$5,650.16 |
$5,650.16 |
$4,834.73
|
|
Tissue culture placenta
|
$828.24 |
$828.24 |
$828.24 |
$457.00
|
|
Tissue culture skin/biopsy
|
$796.32 |
$796.32 |
$796.32 |
$484.00
|
|
Tissue culture tumor
|
$845.88 |
$845.88 |
$845.88 |
$483.36
|
|
Tissue exam koh skin/hair/nails
|
$96.60 |
$96.60 |
$96.60 |
$47.20
|
|
Tissue transglutaminase iga
|
$178.08 |
$178.08 |
$178.08 |
$44.16
|
|
Tixagev and cilgav inj
|
$186.48 |
$186.48 |
$186.48 |
$224.55
|
|
Tl-201 thallium diag per mci
|
$57.12 |
$57.12 |
$57.12 |
$78.40
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$1,774.66 |
$1,774.66 |
$1,774.66 |
$152.36
|
|
Tobramycin non-comp unit
|
$56.99 |
$56.99 |
$56.99 |
$108.42
|
|
Tobramycin peak therapeutic drug level
|
$174.72 |
$174.72 |
$174.72 |
$120.60
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$10,764.10 |
$10,764.10 |
$10,764.10 |
$5,258.52
|
|
Tomosynthesis breast screen bilateral
|
$113.40 |
$113.40 |
$113.40 |
$72.68
|
|
Tongue biopsy; posterior one-third 41105
|
$2,056.32 |
$2,056.32 |
$2,056.32 |
$3,544.29
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$537.77 |
$537.77 |
$537.77 |
$325.00
|
|
Total Knee Replacement
|
$2,929.92 |
$2,929.92 |
$2,929.92 |
$14,543.50
|
|
Toxoplasma antibody igg
|
$126.84 |
$126.84 |
$126.84 |
$89.40
|
|
Toxoplasma antibody igm
|
$126.84 |
$126.84 |
$126.84 |
$87.00
|
|
Tpmt gene com vrnts
|
$982.80 |
$982.80 |
$982.80 |
$371.80
|
|
Trabectedin 1 mg intravenous solution
|
$13,008.58 |
$13,008.58 |
$13,008.58 |
$6,827.00
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$66.36 |
$66.36 |
$66.36 |
$101.25
|
|
Transferrin
|
$63.00 |
$63.00 |
$63.00 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$1,223.88 |
$1,223.88 |
$1,223.88 |
$983.00
|
|
Transparent film <= 16 sq in
|
$1.29 |
$1.29 |
$1.29 |
$4.50
|
|
Trastuzumab 150 mg intravenous solution
|
$17,570.37 |
$17,570.37 |
$17,570.37 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$14,655.65 |
$14,655.65 |
$14,655.65 |
$7,540.20
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$9,058.06 |
$9,058.06 |
$9,058.06 |
$5,835.15
|
|
Trauma partial team response w/critical care services level 4
|
$2,407.44 |
$2,407.44 |
$2,407.44 |
$4,523.04
|
|
Tray bonemarrw oncontrol 102mm
|
$1,008.00 |
$1,008.00 |
$1,008.00 |
$940.80
|
|
Treat ankle dislocation
|
$1,175.16 |
$1,175.16 |
$1,175.16 |
$2,358.40
|
|
Treat clavicle dislocation 23545
|
$822.36 |
$822.36 |
$822.36 |
$705.60
|
|
Treat elbow dislocation
|
$1,311.24 |
$1,311.24 |
$1,311.24 |
$2,223.20
|
|
Treat eyelid lesion 67850
|
$1,105.44 |
$1,105.44 |
$1,105.44 |
$1,146.13
|
|
Treat finger fracture each
|
$879.48 |
$879.48 |
$879.48 |
$1,536.00
|
|
Treat foot dislocation
|
$464.52 |
$464.52 |
$464.52 |
$396.30
|
|
Treat fracture of radius
|
$1,181.88 |
$1,181.88 |
$1,181.88 |
$1,790.00
|
|
Treat fracture of ulna
|
$1,161.72 |
$1,161.72 |
$1,161.72 |
$726.05
|
|
Treat hip dislocation
|
$1,737.96 |
$1,737.96 |
$1,737.96 |
$2,192.80
|
|
Treat hip dislocation
|
$1,403.64 |
$1,403.64 |
$1,403.64 |
$2,641.60
|
