|
Tc-99m mebrofenin
|
$1,248.75 |
$1,248.75 |
$1,248.75 |
$157.50
|
|
Tc-99m mertiatide
|
$4,717.50 |
$4,717.50 |
$4,717.50 |
$756.00
|
|
Tc-99m pentetate dtpa
|
$975.00 |
$975.00 |
$975.00 |
$222.60
|
|
Tc-99m sestamibi p study dose
|
$6,044.97 |
$6,044.97 |
$6,044.97 |
$287.20
|
|
Tc-99m sulfur colloid
|
$3,734.48 |
$3,734.48 |
$3,734.48 |
$240.50
|
|
Tcd emboli detect w/inj
|
$1,061.25 |
$1,061.25 |
$1,061.25 |
$475.80
|
|
Tcd emboli detect without inj
|
$1,269.00 |
$1,269.00 |
$1,269.00 |
$475.28
|
|
T cells total count
|
$108.00 |
$108.00 |
$108.00 |
$132.63
|
|
Tcranial magn stim tx deli
|
$354.00 |
$354.00 |
$354.00 |
$389.22
|
|
Tcranial magn stim tx plan
|
$354.00 |
$354.00 |
$354.00 |
$437.22
|
|
Tcran magn stim redetemine
|
$354.00 |
$354.00 |
$354.00 |
$457.60
|
|
Tee w or without fol w/cont,cong
|
$1,826.25 |
$1,826.25 |
$1,826.25 |
$2,101.65
|
|
Tee w or without fol w/cont, mon
|
$1,165.50 |
$1,165.50 |
$1,165.50 |
$1,692.44
|
|
Telavancin injection
|
$2,428.05 |
$2,428.05 |
$2,428.05 |
$1,191.80
|
|
Telehealth original site facility fee
|
$151.50 |
$151.50 |
$151.50 |
$51.00
|
|
Temozolomide
|
$1,918.68 |
$1,918.68 |
$1,918.68 |
$540.06
|
|
Temozolomide 100 mg intravenous solution
|
$3,438.61 |
$3,438.61 |
$3,438.61 |
$1,867.28
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$29,758.74 |
$29,758.74 |
$29,758.74 |
$14,951.87
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$68.57 |
$68.57 |
$68.57 |
$39.33
|
|
Tert gene targeted seq alys
|
$347.25 |
$347.25 |
$347.25 |
$335.00
|
|
Test for chlorohydrocarbons
|
$225.00 |
$225.00 |
$225.00 |
$61.60
|
|
Testicular imaging w/vasc flow
|
$1,209.75 |
$1,209.75 |
$1,209.75 |
$842.56
|
|
Testosterone response panel
|
$387.00 |
$387.00 |
$387.00 |
$129.60
|
|
Test stress cardiovascular tracing only
|
$1,012.50 |
$1,012.50 |
$1,012.50 |
$949.70
|
|
Tetanus immune globulin inj
|
$1,939.05 |
$1,939.05 |
$1,939.05 |
$1,285.36
|
|
Theophylline therapeutic drug level
|
$111.00 |
$111.00 |
$111.00 |
$108.00
|
|
Therapy activation ipnss
|
$108.00 |
$108.00 |
$108.00 |
$226.24
|
|
Therapy Activity Training (each 15 minutes)
|
$156.75 |
$156.75 |
$156.75 |
$101.38
|
|
Therapy Exercise Session (each 15 minutes)
|
$143.25 |
$143.25 |
$143.25 |
$98.40
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$65.25 |
$65.25 |
$65.25 |
$57.31
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$65.25 |
$65.25 |
$65.25 |
$50.00
|
|
Ther nma rdctj intus/obstrcj
|
$208.50 |
$208.50 |
$208.50 |
$534.32
|
|
Ther/proph/diag inj ia
|
$380.25 |
$380.25 |
$380.25 |
$247.33
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$23.67 |
$23.67 |
$23.67 |
$25.54
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$300.75 |
$300.75 |
$300.75 |
$311.15
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,687.50 |
$1,687.50 |
$1,687.50 |
$1,748.50
|
|
Thoracotomy with cardiac massage
|
$4,610.25 |
$4,610.25 |
$4,610.25 |
$2,138.76
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$2,543.25 |
$2,543.25 |
$2,543.25 |
$1,708.85
|
|
Thrombectmy crnry perq mechanical
|
$4,489.50 |
$4,489.50 |
$4,489.50 |
$3,720.00
|
|
Thrombectomy/inf pq dialysis circuit
|
$6,205.50 |
$6,205.50 |
$6,205.50 |
$8,084.00
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$10,103.25 |
$10,103.25 |
$10,103.25 |
$14,604.80
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$15,313.50 |
$15,313.50 |
$15,313.50 |
$21,413.60
|
|
Thrombin time
|
$87.00 |
$87.00 |
$87.00 |
$53.76
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$99.75 |
$99.75 |
$99.75 |
$61.52
|
|
Thyroglobulin antibody
|
$47.25 |
$47.25 |
$47.25 |
$83.25
|
|
Thyroid mets imag whole body
|
$2,506.50 |
$2,506.50 |
$2,506.50 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$136.50 |
$136.50 |
$136.50 |
$111.75
|
|
Thyroid Ultrasound
|
$885.75 |
$885.75 |
$885.75 |
$588.50
|
|
Thyroid uptake measurement
|
$856.50 |
$856.50 |
$856.50 |
$589.22
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$7,476.81 |
$7,476.81 |
$7,476.81 |
$4,152.21
|
|
Thyroxine binding globulin (tbg)
|
$58.50 |
$58.50 |
$58.50 |
$64.51
|
|
Tib/per revasc stent & ather 37231
|
$21,900.00 |
$21,900.00 |
$21,900.00 |
$21,249.26
|
|
Tigecycline injection
|
$534.77 |
$534.77 |
$534.77 |
$235.29
|
|
Tilt table study
|
$1,428.00 |
$1,428.00 |
$1,428.00 |
$1,507.01
|
|
Tisagenlecleucel car-pos t
|
$2,194,589.53 |
$2,194,589.53 |
$2,194,589.53 |
$1,780,600.03
|
|
Tisotumab vedotin-tftv 40 mg intravenous solution
|
$27,364.47 |
$27,364.47 |
$27,364.47 |
$13,339.20
|
|
Tissue culture placenta
|
$6,844.50 |
$6,844.50 |
$6,844.50 |
$453.00
|
|
Tissue culture skin/biopsy
|
$1,468.50 |
$1,468.50 |
$1,468.50 |
$498.40
|
|
Tissue culture tumor
|
$945.00 |
$945.00 |
$945.00 |
$486.50
|
|
Tissue exam koh skin/hair/nails
|
$66.00 |
$66.00 |
$66.00 |
$47.20
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$2,516.07 |
$2,516.07 |
$2,516.07 |
$537.50
|
|
Tissue matrix xcm thk 20x30cm -cost per sq cm
|
$1,679.65 |
$1,679.65 |
$1,679.65 |
$830.41
|
|
Tissue surgimend prs meshed 20 cm x 10 cm - cost per 0.5cm
|
$6,114.24 |
$6,114.24 |
$6,114.24 |
$1,403.42
|
|
Tissue transglutaminase iga
|
$42.75 |
$42.75 |
$42.75 |
$45.60
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$286.24 |
$286.24 |
$286.24 |
$152.36
|
|
Tobramycin non-comp unit
|
$124.14 |
$124.14 |
$124.14 |
$108.42
|
|
Tobramycin peak therapeutic drug level
|
$93.00 |
$93.00 |
$93.00 |
$120.60
|
|
Toe X-ray (both feet)
|
$375.75 |
$375.75 |
$375.75 |
$259.50
|
|
Tomosynthesis breast screen bilateral
|
$81.75 |
$81.75 |
$81.75 |
$74.10
|
|
Tongue biopsy; posterior one-third 41105
|
$2,845.50 |
$2,845.50 |
$2,845.50 |
$3,592.74
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$517.65 |
$517.65 |
$517.65 |
$316.84
|
|
Total tau
|
$504.00 |
$504.00 |
$504.00 |
$312.50
|
|
Tot estradiol response panel
|
$324.75 |
$324.75 |
$324.75 |
$140.80
|
|
Toxoplasma antibody igg
|
$60.00 |
$60.00 |
$60.00 |
$90.00
|
|
Toxoplasma antibody igm
|
$93.00 |
$93.00 |
$93.00 |
$89.05
|
|
Tpmt gene com vrnts
|
$1,022.25 |
$1,022.25 |
$1,022.25 |
$371.80
|
|
Trabectedin 1 mg intravenous solution
|
$13,641.34 |
$13,641.34 |
$13,641.34 |
$6,684.23
|
|
Trabeculoplasty laser surg
|
$671.25 |
$671.25 |
$671.25 |
$1,180.80
|
|
Tracheobrnchsc thru est trachs incisn
|
$2,597.25 |
$2,597.25 |
$2,597.25 |
$1,437.45
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$101.25 |
$101.25 |
$101.25 |
$101.25
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$77.65 |
$77.65 |
$77.65 |
$56.38
|
|
Transabdom amnioinfus w/us
|
$1,177.50 |
$1,177.50 |
$1,177.50 |
$678.70
|
|
Transcath biopsy
|
$4,294.50 |
$4,294.50 |
$4,294.50 |
$4,285.93
|
|
Transcath closure of asd
|
$16,096.50 |
$16,096.50 |
$16,096.50 |
$17,352.58
|
|
Transcath closure of vsd
|
$15,782.25 |
$15,782.25 |
$15,782.25 |
$17,458.00
|
|
Transcatheter bx s&i
|
$3,122.25 |
$3,122.25 |
$3,122.25 |
$1,954.55
|
|
Transcath mv repair init prosthesis
|
$19,213.50 |
$19,213.50 |
$19,213.50 |
$13,384.80
|
|
Transcath occlusion cns
|
$19,546.50 |
$19,546.50 |
$19,546.50 |
$7,337.20
|
|
Transcath occlusion non-cns
|
$16,788.75 |
$16,788.75 |
$16,788.75 |
$10,452.00
|
|
Transcath rmvl perm ldss pmkr rv
|
$3,696.00 |
$3,696.00 |
$3,696.00 |
$4,822.00
|
|
Transferrin
|
$136.50 |
$136.50 |
$136.50 |
$82.00
|
|
Transorl lwr esophgl myotomy
|
$6,978.00 |
$6,978.00 |
$6,978.00 |
$6,594.64
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$877.50 |
$877.50 |
$877.50 |
$558.35
|
|
Transvaginal Pregnancy Ultrasound
|
$765.75 |
$765.75 |
$765.75 |
$501.60
|
|
Trastuzumab 150 mg intravenous solution
|
$5,762.28 |
$5,762.28 |
$5,762.28 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$12,199.65 |
$12,199.65 |
$12,199.65 |
$7,540.20
|
|
Trauma partial team response w/critical care services level 4
|
$3,822.00 |
$3,822.00 |
$3,822.00 |
$4,523.04
|
|
Tray bonemarrw oncontrol 102mm
|
$1,094.25 |
$1,094.25 |
$1,094.25 |
$940.80
|
|
Treat ankle dislocation
|
$1,872.00 |
$1,872.00 |
$1,872.00 |
$2,358.40
|
|
Treat clavicle dislocation 23545
|
$261.75 |
$261.75 |
$261.75 |
$692.80
|
