|
Tc-99m pentetate dtpa
|
$54.12 |
$54.12 |
$54.12 |
$245.85
|
|
Tc-99m pertechnetate per mci
|
$33.21 |
$33.21 |
$33.21 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$113.37 |
$113.37 |
$113.37 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$112.34 |
$112.34 |
$112.34 |
$221.60
|
|
Tc-99m sulfur colloid
|
$174.66 |
$174.66 |
$174.66 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$104.55 |
$104.55 |
$104.55 |
$198.05
|
|
Tc-99m tilmanocept diag
|
$354.24 |
$354.24 |
$354.24 |
$930.54
|
|
Tcd emboli detect w/inj
|
$276.55 |
$276.55 |
$276.55 |
$404.68
|
|
Tcd emboli detect without inj
|
$268.14 |
$268.14 |
$268.14 |
$397.15
|
|
T cells absolute cd4/cd8 including ratio
|
$35.26 |
$35.26 |
$35.26 |
$186.00
|
|
T cells absolute cd 4 count
|
$27.68 |
$27.68 |
$27.68 |
$120.25
|
|
T cells total count
|
$35.26 |
$35.26 |
$35.26 |
$124.11
|
|
Telehealth original site facility fee
|
$16.61 |
$16.61 |
$16.61 |
$60.80
|
|
Telethx isodose plan cplx
|
$78.11 |
$78.11 |
$78.11 |
$1,617.00
|
|
Temozolomide
|
$259.74 |
$259.74 |
$259.74 |
$374.66
|
|
Temozolomide 100 mg intravenous solution
|
$749.28 |
$749.28 |
$749.28 |
$3,129.70
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$920.45 |
$920.45 |
$920.45 |
$3,957.79
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$2,804.40 |
$2,804.40 |
$2,804.40 |
$16,531.64
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$28.91 |
$28.91 |
$28.91 |
$46.10
|
|
Testicular imaging w/vasc flow
|
$602.29 |
$602.29 |
$602.29 |
$780.48
|
|
Test stress cardiovascular tracing only
|
$592.45 |
$592.45 |
$592.45 |
$1,001.55
|
|
Tetanus immune globulin inj
|
$417.18 |
$417.18 |
$417.18 |
$1,204.50
|
|
Theophylline therapeutic drug level
|
$75.24 |
$75.24 |
$75.24 |
$108.00
|
|
Ther/proph/diag inj ia
|
$76.06 |
$76.06 |
$76.06 |
$247.33
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$11.48 |
$11.48 |
$11.48 |
$35.72
|
|
Thiotepa injection
|
$920.45 |
$920.45 |
$920.45 |
$1,255.50
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,406.10 |
$1,406.10 |
$1,406.10 |
$1,804.00
|
|
Throat x-ray & fluoroscopy
|
$137.56 |
$137.56 |
$137.56 |
$188.00
|
|
Thrombectmy crnry perq mechanical
|
$1,714.21 |
$1,714.21 |
$1,714.21 |
$3,580.00
|
|
Thrombectomy/inf pq dialysis circuit
|
$3,138.76 |
$3,138.76 |
$3,138.76 |
$7,828.60
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$6,405.43 |
$6,405.43 |
$6,405.43 |
$15,185.00
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$9,736.27 |
$9,736.27 |
$9,736.27 |
$24,605.30
|
|
Thrombin time
|
$40.59 |
$40.59 |
$40.59 |
$48.75
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$9.23 |
$9.23 |
$9.23 |
$56.93
|
|
Thromboxane urine
|
$26.65 |
$26.65 |
$26.65 |
$52.22
|
|
Th/wght bear quad-lat brim m
|
$1,158.25 |
$1,158.25 |
$1,158.25 |
$1,367.84
|
|
Thyroglobulin antibody
|
$12.30 |
$12.30 |
$12.30 |
$84.00
|
|
Thyroid imaging
|
$614.59 |
$614.59 |
$614.59 |
$670.80
|
|
Thyroid mets imag whole body
|
$878.63 |
$878.63 |
$878.63 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$257.07 |
$257.07 |
$257.07 |
$120.00
|
|
Thyroid Ultrasound
|
$679.17 |
$679.17 |
$679.17 |
$589.96
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$920.45 |
$920.45 |
$920.45 |
$4,319.71
|
|
Thyroxine binding globulin (tbg)
|
$10.25 |
$10.25 |
$10.25 |
$63.60
|
|
Tib/per revasc stent & ather 37231
|
$9,083.35 |
$9,083.35 |
$9,083.35 |
$21,900.00
|
|
Tib/per revasc stnt & ather
|
$4,541.78 |
$4,541.78 |
$4,541.78 |
$11,121.63
|
|
Tib/per revasc w/ather add-on 37233
|
$3,883.52 |
$3,883.52 |
$3,883.52 |
$10,406.14
|
|
Tigecycline injection
|
$107.63 |
$107.63 |
$107.63 |
$277.31
|
|
Tilt table study
|
$813.85 |
$813.85 |
$813.85 |
$1,495.00
|
|
Tissue amnio epifix inj 100mg
|
$2,981.93 |
$2,981.93 |
$2,981.93 |
$3,846.61
|
|
Tissue culture placenta
|
$184.50 |
$184.50 |
$184.50 |
$520.91
|
|
Tissue culture skin/biopsy
|
$172.20 |
$172.20 |
$172.20 |
$558.87
|
|
Tissue exam koh skin/hair/nails
|
$21.12 |
$21.12 |
$21.12 |
$47.40
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$3,877.17 |
$3,877.17 |
$3,877.17 |
$2,516.07
|
|
Tissue transglutaminase iga
|
$13.53 |
$13.53 |
$13.53 |
$48.57
|
|
Tl-201 thallium diag per mci
|
$31.57 |
$31.57 |
$31.57 |
$77.22
|
|
Tlso 2 shl symphys-stern cst
|
$1,042.63 |
$1,042.63 |
$1,042.63 |
$1,535.15
|
|
Tlso rigid lined custom fab
|
$1,356.08 |
$1,356.08 |
$1,356.08 |
$2,547.21
|
|
Tlso rigid lined pre one pie
|
$1,158.25 |
$1,158.25 |
$1,158.25 |
$1,604.40
|
|
Tlso rigid plastic custom fa
|
$1,042.63 |
$1,042.63 |
$1,042.63 |
$1,454.60
|
|
Tlso trnk sj-t9 pre cst
|
$471.91 |
$471.91 |
$471.91 |
$522.56
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$294.59 |
$294.59 |
$294.59 |
$141.75
|
|
Tobramycin peak therapeutic drug level
|
$37.72 |
$37.72 |
$37.72 |
$121.55
|
|
Tocilizumab for covid-19
|
$920.45 |
$920.45 |
$920.45 |
$21.60
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$329.85 |
$329.85 |
$329.85 |
$404.20
|
|
Torsion straight knee joint
|
$163.80 |
$163.80 |
$163.80 |
$218.87
|
|
Total tau
|
$307.50 |
$307.50 |
$307.50 |
$293.00
|
|
Toxoplasma antibody igg
|
$32.39 |
$32.39 |
$32.39 |
$84.35
|
|
Toxoplasma antibody igm
|
$39.16 |
$39.16 |
$39.16 |
$83.20
|
|
Tp53 gene full gene sequence
|
$115.62 |
$115.62 |
$115.62 |
$706.04
|
|
Tp53 gene trgt sequence alys
|
$615.00 |
$615.00 |
$615.00 |
$919.10
|
|
Tpmt gene com vrnts
|
$107.63 |
$107.63 |
$107.63 |
$381.55
|
|
Transcath biopsy
|
$1,621.55 |
$1,621.55 |
$1,621.55 |
$4,298.05
|
|
Transcath closure of asd
|
$12,204.68 |
$12,204.68 |
$12,204.68 |
$18,772.00
|
|
Transcath closure of vsd
|
$7,302.92 |
$7,302.92 |
$7,302.92 |
$18,837.00
|
|
Transcatheter bx s&i
|
$585.07 |
$585.07 |
$585.07 |
$1,875.96
|
|
Transcath mv repair addl prosthesis
|
$8,752.07 |
$8,752.07 |
$8,752.07 |
$5,118.10
|
|
Transcath mv repair init prosthesis
|
$8,335.30 |
$8,335.30 |
$8,335.30 |
$17,106.18
|
|
Transcath occlusion cns
|
$3,541.38 |
$3,541.38 |
$3,541.38 |
$8,944.39
|
|
Transcath occlusion non-cns
|
$4,817.50 |
$4,817.50 |
$4,817.50 |
$12,427.79
|
|
Transferrin
|
$20.50 |
$20.50 |
$20.50 |
$87.30
|
|
Transfusion blood/blood component(s)
|
$298.07 |
$298.07 |
$298.07 |
$988.24
|
|
Trastuzumab 150 mg intravenous solution
|
$920.45 |
$920.45 |
$920.45 |
$3,900.04
|
|
Tray bonemarrw oncontrol 102mm
|
$614.59 |
$614.59 |
$614.59 |
$977.62
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$157.24 |
$157.24 |
$157.24 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$68.27 |
$68.27 |
$68.27 |
$149.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$79.13 |
$79.13 |
$79.13 |
$210.00
|
|
Treponema pallidum antibody
|
$33.62 |
$33.62 |
$33.62 |
$72.80
|
|
Trg gene rearrangement anal
|
$314.88 |
$314.88 |
$314.88 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$12.30 |
$12.30 |
$12.30 |
$55.80
|
|
Trichinella antibody
|
$41.41 |
$41.41 |
$41.41 |
$70.65
|
|
Triglycerides
|
$136.53 |
$136.53 |
$136.53 |
$54.60
|
|
Trimethobenzamide hcl inj
|
$28.29 |
$28.29 |
$28.29 |
$128.00
|
|
Trim nondyst nails
|
$39.36 |
$39.36 |
$39.36 |
$124.22
|
|
Trnscath plc stent crv crtd without prtct
|
$1,064.77 |
$1,064.77 |
$1,064.77 |
$7,944.75
|
|
Trnscath plc stent crv crtd w/prtct
|
$2,087.93 |
$2,087.93 |
$2,087.93 |
$11,099.98
|
|
Trnscath plc stnt ante carotid art
|
$501.23 |
$501.23 |
$501.23 |
$9,114.56
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$2,844.99 |
$2,844.99 |
$2,844.99 |
$8,244.55
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$2,386.41 |
$2,386.41 |
$2,386.41 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$4,971.46 |
$4,971.46 |
$4,971.46 |
$15,408.00
|
|
Trnscath retrv pq vasc fb w/guide
|
$1,688.59 |
$1,688.59 |
$1,688.59 |
$4,969.90
|
