|
Surgical pathology level 4 gross & microscopic examination
|
$105.60 |
$105.60 |
$105.60 |
$248.17
|
|
Surgical pathology level 5 gross & microscopic examination
|
$522.40 |
$522.40 |
$522.40 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$732.80 |
$732.80 |
$732.80 |
$720.75
|
|
Svc venogram s&i
|
$2,959.20 |
$2,959.20 |
$2,959.20 |
$1,994.00
|
|
Swallowing Evaluation (Bedside)
|
$366.40 |
$366.40 |
$366.40 |
$316.55
|
|
Swallowing Therapy Session
|
$292.80 |
$292.80 |
$292.80 |
$232.56
|
|
Synvisc or synvisc-one
|
$504.68 |
$504.68 |
$504.68 |
$1,242.63
|
|
System cardiomems hosp electronics
|
$43,200.00 |
$43,200.00 |
$43,200.00 |
$38,234.70
|
|
System pacing micra av
|
$30,542.54 |
$30,542.54 |
$30,542.54 |
$24,316.50
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$21,171.84 |
$21,171.84 |
$21,171.84 |
$12,003.00
|
|
System recell skin grafting/harvesting
|
$14,400.00 |
$14,400.00 |
$14,400.00 |
$11,183.00
|
|
System sealant biosentry tract
|
$1,235.14 |
$1,235.14 |
$1,235.14 |
$889.35
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$27.09 |
$27.09 |
$27.09 |
$9.93
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$692.18 |
$692.18 |
$692.18 |
$596.76
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$376.80 |
$376.80 |
$376.80 |
$289.20
|
|
Talquetamab-tgvs 2 mg/ml subcutaneous solution
|
$12,807.21 |
$12,807.21 |
$12,807.21 |
$21,745.13
|
|
Tarlatamab-dlle 10 mg intravenous solution
|
$3,403.24 |
$3,403.24 |
$3,403.24 |
$24,217.20
|
|
Tavr perq femoral
|
$17,088.00 |
$17,088.00 |
$17,088.00 |
$15,454.40
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$739.75 |
$739.75 |
$739.75 |
$937.50
|
|
Tc-99m exame autol wbc diag per dose
|
$4,508.00 |
$4,508.00 |
$4,508.00 |
$2,503.15
|
|
Tc-99m exametazime diag
|
$3,443.20 |
$3,443.20 |
$3,443.20 |
$2,135.70
|
|
Tc-99m labeled rbc
|
$428.00 |
$428.00 |
$428.00 |
$306.00
|
|
Tc-99m maa
|
$936.80 |
$936.80 |
$936.80 |
$312.06
|
|
Tc-99m mebrofenin
|
$178.40 |
$178.40 |
$178.40 |
$157.65
|
|
Tc-99m medronate
|
$133.60 |
$133.60 |
$133.60 |
$111.01
|
|
Tc-99m mertiatide
|
$756.00 |
$756.00 |
$756.00 |
$756.00
|
|
Tc-99m oxidronate
|
$168.00 |
$168.00 |
$168.00 |
$108.00
|
|
Tc-99m pentetate dtpa
|
$388.80 |
$388.80 |
$388.80 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$388.80 |
$388.80 |
$388.80 |
$191.50
|
|
Tc-99m pertechnetate per mci
|
$108.00 |
$108.00 |
$108.00 |
$18.67
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$186.40 |
$186.40 |
$186.40 |
$141.00
|
|
Tc-99m sestamibi p study dose
|
$352.00 |
$352.00 |
$352.00 |
$287.20
|
|
Tc-99m succimer (dmsa)
|
$5,364.80 |
$5,364.80 |
$5,364.80 |
$1,128.40
|
|
Tc-99m sulfur colloid
|
$308.00 |
$308.00 |
$308.00 |
$245.70
|
|
Tc-99m tilmanocept diag
|
$1,171.20 |
$1,171.20 |
$1,171.20 |
$985.60
|
|
Tcd emboli detect without inj
|
$928.00 |
$928.00 |
$928.00 |
$475.28
|
|
T-cell depletion of harvest
|
$20,656.80 |
$20,656.80 |
$20,656.80 |
$2,475.20
|
|
Teaec w/wo patch graft iliofemoral
|
$3,793.60 |
$3,793.60 |
$3,793.60 |
$6,120.00
|
|
Tee w or without fol w/cont,cong
|
$1,977.60 |
$1,977.60 |
$1,977.60 |
$2,101.65
|
|
Telehealth original site facility fee
|
$47.20 |
$47.20 |
$47.20 |
$51.00
|
|
Telethx isodose plan cplx
|
$2,169.60 |
$2,169.60 |
$2,169.60 |
$1,526.85
|
|
Telethx isodose plan simple
|
$1,082.40 |
$1,082.40 |
$1,082.40 |
$877.09
|
|
Temozolomide
|
$149.00 |
$149.00 |
$149.00 |
$540.06
|
|
Temozolomide 100 mg intravenous solution
|
$1,153.02 |
$1,153.02 |
$1,153.02 |
$1,867.28
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$3,001.51 |
$3,001.51 |
$3,001.51 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$10,346.96 |
$10,346.96 |
$10,346.96 |
$14,951.87
|
|
Tenolysis extensor tendon hand/finger each
|
$3,068.80 |
$3,068.80 |
$3,068.80 |
$2,811.20
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$16.80 |
$16.80 |
$16.80 |
$39.33
|
|
Test stress cardiovascular tracing only
|
$1,322.40 |
$1,322.40 |
$1,322.40 |
$953.40
|
|
Tetanus immune globulin inj
|
$1,552.28 |
$1,552.28 |
$1,552.28 |
$1,285.36
|
|
Thawing cryopresrved embryo
|
$720.00 |
$720.00 |
$720.00 |
$326.15
|
|
Thawing cryopresrved sperm
|
$56.00 |
$56.00 |
$56.00 |
$117.61
|
|
Thaw preserved stem cells
|
$1,483.20 |
$1,483.20 |
$1,483.20 |
$1,136.85
|
|
Therapeutic procd strg endur
|
$124.80 |
$124.80 |
$124.80 |
$85.68
|
|
Therapy activity per session >= 45 minutes
|
$221.60 |
$221.60 |
$221.60 |
$191.50
|
|
Therapy Activity Training (each 15 minutes)
|
$109.60 |
$109.60 |
$109.60 |
$101.38
|
|
Therapy Exercise Session (each 15 minutes)
|
$119.20 |
$119.20 |
$119.20 |
$98.58
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$68.00 |
$68.00 |
$68.00 |
$57.50
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$63.20 |
$63.20 |
$63.20 |
$50.40
|
|
Ther nma rdctj intus/obstrcj
|
$726.40 |
$726.40 |
$726.40 |
$534.32
|
|
Ther/proph/diag inj ia
|
$284.80 |
$284.80 |
$284.80 |
$247.33
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$28.78 |
$28.78 |
$28.78 |
$25.54
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$379.20 |
$379.20 |
$379.20 |
$314.00
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,820.80 |
$1,820.80 |
$1,820.80 |
$1,733.65
|
|
Thoracotomy w/expl
|
$1,148.80 |
$1,148.80 |
$1,148.80 |
$2,045.17
|
|
Thoracotomy with cardiac massage
|
$700.80 |
$700.80 |
$700.80 |
$2,138.76
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$1,470.40 |
$1,470.40 |
$1,470.40 |
$1,696.10
|
|
Thrombectmy crnry perq mechanical
|
$5,600.80 |
$5,600.80 |
$5,600.80 |
$3,809.40
|
|
Thrombectomy/inf pq dialysis circuit
|
$11,819.20 |
$11,819.20 |
$11,819.20 |
$8,084.00
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$20,927.20 |
$20,927.20 |
$20,927.20 |
$14,465.94
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$25,200.00 |
$25,200.00 |
$25,200.00 |
$21,413.60
|
|
Thromboendarterectomy common femoral
|
$5,188.80 |
$5,188.80 |
$5,188.80 |
$3,987.20
|
|
Thromboendarterectomy including patch graft; iliac 35351
|
$2,155.20 |
$2,155.20 |
$2,155.20 |
$4,585.00
|
|
Thromboendarterectomy sfa
|
$6,388.00 |
$6,388.00 |
$6,388.00 |
$5,472.00
|
|
Thyroid imaging
|
$1,142.40 |
$1,142.40 |
$1,142.40 |
$696.75
|
|
Thyroid mets imag whole body
|
$2,178.40 |
$2,178.40 |
$2,178.40 |
$1,524.99
|
|
Thyroid met uptake
|
$604.00 |
$604.00 |
$604.00 |
$407.40
|
|
Thyroid Ultrasound
|
$646.40 |
$646.40 |
$646.40 |
$588.50
|
|
Thyroid uptake measurement
|
$1,069.60 |
$1,069.60 |
$1,069.60 |
$591.25
|
|
Tibial length sock fx or equ
|
$96.63 |
$96.63 |
$96.63 |
$88.92
|
|
Tigecycline injection
|
$412.36 |
$412.36 |
$412.36 |
$235.29
|
|
Tilt table study
|
$1,962.40 |
$1,962.40 |
$1,962.40 |
$1,551.60
|
|
Tirofiban 12.5 mg/50 ml
|
$686.44 |
$686.44 |
$686.44 |
$458.85
|
|
Tisagenlecleucel car-pos t
|
$1,705,363.20 |
$1,705,363.20 |
$1,705,363.20 |
$1,780,600.03
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$64.48 |
$64.48 |
$64.48 |
$537.50
|
|
Tissue matrix xcm thk 20x30cm -cost per sq cm
|
$51.27 |
$51.27 |
$51.27 |
$830.41
|
|
Tl-201 thallium diag per mci
|
$78.40 |
$78.40 |
$78.40 |
$80.10
|
|
Tlso rigid lined custom fab
|
$4,989.95 |
$4,989.95 |
$4,989.95 |
$2,831.21
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$190.50 |
$190.50 |
$190.50 |
$152.36
|
|
Tobramycin non-comp unit
|
$168.18 |
$168.18 |
$168.18 |
$108.42
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$4,163.79 |
$4,163.79 |
$4,163.79 |
$5,258.52
|
|
Toe X-ray (both feet)
|
$313.60 |
$313.60 |
$313.60 |
$258.65
|
|
Tomosynthesis breast diagnostic left
|
$86.40 |
$86.40 |
$86.40 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$84.00 |
$84.00 |
$84.00 |
$74.10
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$772.40 |
$772.40 |
$772.40 |
$316.84
|
|
Tracheobrnchsc thru est trachs incisn
|
$1,958.40 |
$1,958.40 |
$1,958.40 |
$1,421.00
|
|
Trach/laryn tube plug/stop
|
$94.80 |
$94.80 |
$94.80 |
$9.18
|
|
Transcath biopsy
|
$6,076.80 |
$6,076.80 |
$6,076.80 |
$4,285.93
|
|
Transcath closure of asd
|
$23,834.40 |
$23,834.40 |
$23,834.40 |
$17,041.80
|
|
Transcath closure of vsd
|
$22,131.20 |
$22,131.20 |
$22,131.20 |
$16,520.00
|
