|
Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution
|
$19,240.00 |
$19,240.00 |
$19,240.00 |
$40,114.80
|
|
Telavancin injection
|
$1,102.88 |
$1,102.88 |
$1,102.88 |
$1,191.80
|
|
Telehealth original site facility fee
|
$66.40 |
$66.40 |
$66.40 |
$51.00
|
|
Telethx isodose plan cplx
|
$451.20 |
$451.20 |
$451.20 |
$1,526.85
|
|
Telethx isodose plan simple
|
$248.80 |
$248.80 |
$248.80 |
$877.09
|
|
Temozolomide
|
$369.71 |
$369.71 |
$369.71 |
$540.06
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$1,804.60 |
$1,804.60 |
$1,804.60 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$8,691.56 |
$8,691.56 |
$8,691.56 |
$14,951.87
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$25.21 |
$25.21 |
$25.21 |
$39.33
|
|
Testicular imaging w/vasc flow
|
$900.00 |
$900.00 |
$900.00 |
$842.56
|
|
Testosterone undecanoate 1mg
|
$2,885.18 |
$2,885.18 |
$2,885.18 |
$3,528.08
|
|
Test pathogen(s) for platelets reference
|
$64.80 |
$64.80 |
$64.80 |
$70.00
|
|
Test stress cardiovascular tracing only
|
$733.60 |
$733.60 |
$733.60 |
$953.40
|
|
Tetanus immune globulin inj
|
$736.80 |
$736.80 |
$736.80 |
$1,285.36
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$7,939.04 |
$7,939.04 |
$7,939.04 |
$8,737.05
|
|
Thawing cryopresrved sperm
|
$56.80 |
$56.80 |
$56.80 |
$117.61
|
|
Therapeutic procd strg endur
|
$90.40 |
$90.40 |
$90.40 |
$85.68
|
|
Therapy Activity Training (each 15 minutes)
|
$121.60 |
$121.60 |
$121.60 |
$101.85
|
|
Therapy Exercise Session (each 15 minutes)
|
$105.60 |
$105.60 |
$105.60 |
$98.58
|
|
Ther nma rdctj intus/obstrcj
|
$612.80 |
$612.80 |
$612.80 |
$538.88
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$30.44 |
$30.44 |
$30.44 |
$25.54
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$172.00 |
$172.00 |
$172.00 |
$314.50
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,467.20 |
$1,467.20 |
$1,467.20 |
$1,733.65
|
|
Thoracotomy w/expl
|
$1,380.00 |
$1,380.00 |
$1,380.00 |
$2,045.17
|
|
Thoracotomy with cardiac massage
|
$1,841.60 |
$1,841.60 |
$1,841.60 |
$2,138.76
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$1,572.00 |
$1,572.00 |
$1,572.00 |
$1,684.80
|
|
Thrombectmy crnry perq mechanical
|
$7,453.60 |
$7,453.60 |
$7,453.60 |
$3,836.00
|
|
Thrombectomy/inf pq dialysis circuit
|
$11,667.20 |
$11,667.20 |
$11,667.20 |
$8,084.00
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$19,988.00 |
$19,988.00 |
$19,988.00 |
$14,465.94
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$28,365.60 |
$28,365.60 |
$28,365.60 |
$21,413.60
|
|
Thromboendarterectomy common femoral
|
$8,058.40 |
$8,058.40 |
$8,058.40 |
$3,987.20
|
|
Thromboendarterectomy sfa
|
$7,325.60 |
$7,325.60 |
$7,325.60 |
$5,472.00
|
|
Thyroid imaging
|
$856.00 |
$856.00 |
$856.00 |
$696.75
|
|
Thyroid mets imag whole body
|
$1,508.80 |
$1,508.80 |
$1,508.80 |
$1,524.99
|
|
Thyroid met uptake
|
$452.80 |
$452.80 |
$452.80 |
$407.40
|
|
Thyroid Ultrasound
|
$581.60 |
$581.60 |
$581.60 |
$588.50
|
|
Thyroid uptake measurement
|
$653.60 |
$653.60 |
$653.60 |
$591.25
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$2,286.95 |
$2,286.95 |
$2,286.95 |
$4,152.21
|
|
Tigecycline injection
|
$201.93 |
$201.93 |
$201.93 |
$235.29
|
|
Tilt table study
|
$1,090.40 |
$1,090.40 |
$1,090.40 |
$1,561.82
|
|
Tisotumab vedotin-tftv 40 mg intravenous solution
|
$6,885.00 |
$6,885.00 |
$6,885.00 |
$13,339.20
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$51.92 |
$51.92 |
$51.92 |
$537.50
|
|
Tissue matrix xcm thk 20x30cm -cost per sq cm
|
$45.30 |
$45.30 |
$45.30 |
$830.41
|
|
Tl-201 thallium diag per mci
|
$180.80 |
$180.80 |
$180.80 |
$80.10
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$134.53 |
$134.53 |
$134.53 |
$152.36
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$3,041.88 |
$3,041.88 |
$3,041.88 |
$5,258.52
|
|
Toe X-ray (both feet)
|
$160.80 |
$160.80 |
$160.80 |
$258.65
|
|
Tomosynthesis breast diagnostic left
|
$60.00 |
$60.00 |
$60.00 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$60.00 |
$60.00 |
$60.00 |
$74.10
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$195.53 |
$195.53 |
$195.53 |
$316.84
|
|
Trabectedin 1 mg intravenous solution
|
$3,234.00 |
$3,234.00 |
$3,234.00 |
$6,684.23
|
|
Tracheobrnchsc thru est trachs incisn
|
$1,784.00 |
$1,784.00 |
$1,784.00 |
$1,420.44
|
|
Trach/laryn tube plug/stop
|
$287.78 |
$287.78 |
$287.78 |
$9.18
|
|
Transabdom amnioinfus w/us
|
$543.20 |
$543.20 |
$543.20 |
$678.70
|
|
Transcath biopsy
|
$7,949.60 |
$7,949.60 |
$7,949.60 |
$4,285.93
|
|
Transcath closure of asd
|
$30,207.20 |
$30,207.20 |
$30,207.20 |
$17,088.00
|
|
Transcatheter bx s&i
|
$2,182.40 |
$2,182.40 |
$2,182.40 |
$1,950.85
|
|
Transcath occlusion cns
|
$17,950.40 |
$17,950.40 |
$17,950.40 |
$7,337.20
|
|
Transcath occlusion non-cns
|
$17,949.60 |
$17,949.60 |
$17,949.60 |
$10,270.00
|
|
Trans cath replace aortic valve 33366
|
$25,038.40 |
$25,038.40 |
$25,038.40 |
$14,593.50
|
|
Transcath rmvl perm ldss pmkr rv
|
$6,531.20 |
$6,531.20 |
$6,531.20 |
$4,822.00
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$529.60 |
$529.60 |
$529.60 |
$560.92
|
|
Transvaginal Pregnancy Ultrasound
|
$430.40 |
$430.40 |
$430.40 |
$501.60
|
|
Trastuzumab 150 mg intravenous solution
|
$2,038.36 |
$2,038.36 |
$2,038.36 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$4,012.63 |
$4,012.63 |
$4,012.63 |
$7,540.20
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$3,415.31 |
$3,415.31 |
$3,415.31 |
$5,846.40
|
|
Trauma partial team response w/critical care services level 4
|
$5,540.80 |
$5,540.80 |
$5,540.80 |
$4,471.50
|
|
Tray bonemarrw oncontrol 102mm
|
$1,307.13 |
$1,307.13 |
$1,307.13 |
$940.80
|
|
Treat ankle dislocation
|
$2,358.40 |
$2,358.40 |
$2,358.40 |
$2,358.40
|
|
Treat big toe fracture
|
$5,032.00 |
$5,032.00 |
$5,032.00 |
$4,454.10
|
|
Treat elbow dislocation
|
$2,784.80 |
$2,784.80 |
$2,784.80 |
$2,311.20
|
|
Treat eyelid by injection
|
$640.80 |
$640.80 |
$640.80 |
$481.44
|
|
Treat finger fracture each
|
$5,458.40 |
$5,458.40 |
$5,458.40 |
$4,192.86
|
|
Treat finger fracture each
|
$2,040.80 |
$2,040.80 |
$2,040.80 |
$1,592.00
|
|
Treat foot dislocation
|
$312.00 |
$312.00 |
$312.00 |
$405.60
|
|
Treat foot dislocation
|
$592.00 |
$592.00 |
$592.00 |
$527.28
|
|
Treat fracture of radius
|
$2,558.40 |
$2,558.40 |
$2,558.40 |
$1,821.60
|
|
Treat fracture of ulna
|
$526.40 |
$526.40 |
$526.40 |
$726.05
|
|
Treat hip dislocation
|
$2,340.00 |
$2,340.00 |
$2,340.00 |
$2,211.05
|
|
Treat hip socket fracture
|
$1,913.60 |
$1,913.60 |
$1,913.60 |
$1,344.00
|
|
Treat humerus fracture
|
$2,001.60 |
$2,001.60 |
$2,001.60 |
$1,790.00
|
|
Treat humerus fracture
|
$2,270.40 |
$2,270.40 |
$2,270.40 |
$1,790.00
|
|
Treat kneecap dislocation
|
$1,352.00 |
$1,352.00 |
$1,352.00 |
$1,068.06
|
|
Treat knee fracture 27530
|
$398.40 |
$398.40 |
$398.40 |
$550.73
|
|
Treat lower leg dislocation
|
$406.40 |
$406.40 |
$406.40 |
$532.60
|
|
Treatment incomplete abortion completed surgically any trimester
|
$3,801.60 |
$3,801.60 |
$3,801.60 |
$3,928.20
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$216.00 |
$216.00 |
$216.00 |
$228.00
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$132.80 |
$132.80 |
$132.80 |
$147.48
|
|
Treatment of ankle fracture 27786
|
$398.40 |
$398.40 |
$398.40 |
$528.00
|
|
Treatment of fibula fracture 27780
|
$398.40 |
$398.40 |
$398.40 |
$515.45
|
|
Treatment of foot infection
|
$4,069.60 |
$4,069.60 |
$4,069.60 |
$2,928.60
|
|
Treatment of heel fracture 28400
|
$380.00 |
$380.00 |
$380.00 |
$473.00
|
|
Treatment of thigh fracture
|
$388.00 |
$388.00 |
$388.00 |
$548.90
|
|
Treatment of toe fracture 28510
|
$398.40 |
$398.40 |
$398.40 |
$371.40
|
|
Treatment of urethra lesion
|
$5,097.60 |
$5,097.60 |
$5,097.60 |
$2,874.36
|
|
Treatment radiation delivery level 2
|
$1,025.60 |
$1,025.60 |
$1,025.60 |
$830.70
|
|
Treatment x10sv retinopathy
|
$1,147.20 |
$1,147.20 |
$1,147.20 |
$1,513.20
|
|
Treat spinal cord lesion
|
$1,736.00 |
$1,736.00 |
$1,736.00 |
$1,142.50
|
|
Treat toe dislocation
|
$1,030.40 |
$1,030.40 |
$1,030.40 |
$756.00
|
|
Treat ulnar fracture
|
$1,784.80 |
$1,784.80 |
$1,784.80 |
$1,678.55
|