|
Tc-99m labeled rbc
|
$280.80 |
$280.80 |
$280.80 |
$306.00
|
|
Tc-99m maa
|
$81.00 |
$81.00 |
$81.00 |
$312.06
|
|
Tc-99m mebrofenin
|
$198.00 |
$198.00 |
$198.00 |
$157.65
|
|
Tc-99m medronate
|
$163.20 |
$163.20 |
$163.20 |
$111.01
|
|
Tc-99m mertiatide
|
$1,634.40 |
$1,634.40 |
$1,634.40 |
$756.00
|
|
Tc-99m non-heu per study dose
|
$15.00 |
$15.00 |
$15.00 |
$6.50
|
|
Tc-99m oxidronate
|
$107.40 |
$107.40 |
$107.40 |
$108.00
|
|
Tc-99m pentetate dtpa aerosol
|
$539.40 |
$539.40 |
$539.40 |
$191.50
|
|
Tc-99m pertechnetate per mci
|
$0.60 |
$0.60 |
$0.60 |
$18.67
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$211.80 |
$211.80 |
$211.80 |
$141.00
|
|
Tc-99m sestamibi p study dose
|
$446.40 |
$446.40 |
$446.40 |
$287.20
|
|
Tc-99m succimer (dmsa)
|
$465.60 |
$465.60 |
$465.60 |
$1,128.40
|
|
Tc-99m sulfur colloid
|
$235.20 |
$235.20 |
$235.20 |
$245.70
|
|
Tc-99m tilmanocept diag
|
$5,135.40 |
$5,135.40 |
$5,135.40 |
$985.60
|
|
Tcd emboli detect w/inj
|
$927.00 |
$927.00 |
$927.00 |
$475.80
|
|
Tcd emboli detect without inj
|
$950.40 |
$950.40 |
$950.40 |
$475.28
|
|
T cells absolute cd4/cd8 including ratio
|
$356.40 |
$356.40 |
$356.40 |
$185.28
|
|
T cells absolute cd 4 count
|
$486.00 |
$486.00 |
$486.00 |
$111.20
|
|
T cells total count
|
$349.80 |
$349.80 |
$349.80 |
$130.35
|
|
Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution
|
$414.60 |
$414.60 |
$414.60 |
$40,114.80
|
|
Tee w or without fol w/cont,cong
|
$3,119.40 |
$3,119.40 |
$3,119.40 |
$2,101.65
|
|
Telavancin injection
|
$11.40 |
$11.40 |
$11.40 |
$1,191.80
|
|
Telehealth original site facility fee
|
$90.00 |
$90.00 |
$90.00 |
$51.00
|
|
Telethx isodose plan cplx
|
$3,151.20 |
$3,151.20 |
$3,151.20 |
$1,526.85
|
|
Telethx isodose plan simple
|
$2,462.40 |
$2,462.40 |
$2,462.40 |
$877.09
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$229.20 |
$229.20 |
$229.20 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$11,298.60 |
$11,298.60 |
$11,298.60 |
$14,951.87
|
|
Tenotomy open tndn flxr toe sgl tndn spx
|
$3,355.80 |
$3,355.80 |
$3,355.80 |
$2,175.00
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$7.60 |
$7.60 |
$7.60 |
$39.33
|
|
Test for chlorohydrocarbons
|
$80.40 |
$80.40 |
$80.40 |
$61.60
|
|
Test stress cardiovascular tracing only
|
$759.00 |
$759.00 |
$759.00 |
$953.40
|
|
Tetanus immune globulin inj
|
$1,585.60 |
$1,585.60 |
$1,585.60 |
$1,285.36
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$48.80 |
$48.80 |
$48.80 |
$8,737.05
|
|
Tgsap so/hl 51/< rna alys
|
$2,116.80 |
$2,116.80 |
$2,116.80 |
$4,563.00
|
|
Theophylline therapeutic drug level
|
$213.00 |
$213.00 |
$213.00 |
$108.00
|
|
Therapy Activity Training (each 15 minutes)
|
$113.40 |
$113.40 |
$113.40 |
$101.85
|
|
Therapy Exercise Session (each 15 minutes)
|
$121.80 |
$121.80 |
$121.80 |
$98.58
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$27.00 |
$27.00 |
$27.00 |
$57.50
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$20.40 |
$20.40 |
$20.40 |
$50.40
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$32.60 |
$32.60 |
$32.60 |
$25.54
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$181.20 |
$181.20 |
$181.20 |
$314.50
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,635.00 |
$1,635.00 |
$1,635.00 |
$1,733.65
|
|
Thoracotomy w/expl
|
$10,462.20 |
$10,462.20 |
$10,462.20 |
$2,045.17
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$1,362.60 |
$1,362.60 |
$1,362.60 |
$1,684.80
|
|
Thrombectmy crnry perq mechanical
|
$3,430.80 |
$3,430.80 |
$3,430.80 |
$3,836.00
|
|
Thrombin time
|
$139.20 |
$139.20 |
$139.20 |
$54.18
|
|
Thromboplastin inhibition
|
$105.60 |
$105.60 |
$105.60 |
$55.20
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$73.20 |
$73.20 |
$73.20 |
$61.52
|
|
Thyroglobulin antibody
|
$126.00 |
$126.00 |
$126.00 |
$82.73
|
|
Thyroid mets imag whole body
|
$703.80 |
$703.80 |
$703.80 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$126.00 |
$126.00 |
$126.00 |
$112.67
|
|
Thyroid Ultrasound
|
$572.40 |
$572.40 |
$572.40 |
$588.50
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$6,097.60 |
$6,097.60 |
$6,097.60 |
$4,152.21
|
|
Thyroxine binding globulin (tbg)
|
$208.20 |
$208.20 |
$208.20 |
$64.51
|
|
Tigecycline injection
|
$8.60 |
$8.60 |
$8.60 |
$235.29
|
|
Tilt table study
|
$1,418.40 |
$1,418.40 |
$1,418.40 |
$1,561.82
|
|
Tisotumab vedotin-tftv 40 mg intravenous solution
|
$321.60 |
$321.60 |
$321.60 |
$13,339.20
|
|
Tissue culture skin/biopsy
|
$1,299.00 |
$1,299.00 |
$1,299.00 |
$484.00
|
|
Tissue exam koh skin/hair/nails
|
$37.80 |
$37.80 |
$37.80 |
$47.40
|
|
Tissue transglutaminase iga
|
$336.60 |
$336.60 |
$336.60 |
$44.80
|
|
Tixagev and cilgav inj
|
$1,020.00 |
$1,020.00 |
$1,020.00 |
$241.92
|
|
Tobramycin comp unit
|
$644.00 |
$644.00 |
$644.00 |
$810.40
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$24.40 |
$24.40 |
$24.40 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$164.40 |
$164.40 |
$164.40 |
$119.40
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$5,029.20 |
$5,029.20 |
$5,029.20 |
$5,258.52
|
|
Toe X-ray (both feet)
|
$120.00 |
$120.00 |
$120.00 |
$258.65
|
|
Tomosynthesis breast diagnostic left
|
$123.00 |
$123.00 |
$123.00 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$45.00 |
$45.00 |
$45.00 |
$74.10
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$10.20 |
$10.20 |
$10.20 |
$316.84
|
|
Toripalimab-tpzi 240 mg/6 ml (40 mg/ml) intravenous solution
|
$70.20 |
$70.20 |
$70.20 |
$15,383.12
|
|
Total tau
|
$136.80 |
$136.80 |
$136.80 |
$312.50
|
|
Toxoplasma antibody igg
|
$129.00 |
$129.00 |
$129.00 |
$91.65
|
|
Toxoplasma antibody igm
|
$93.00 |
$93.00 |
$93.00 |
$88.00
|
|
Tp53 gene full gene sequence
|
$5,117.40 |
$5,117.40 |
$5,117.40 |
$709.80
|
|
Tpmt gene com vrnts
|
$472.80 |
$472.80 |
$472.80 |
$371.80
|
|
Trabectedin 1 mg intravenous solution
|
$1,065.60 |
$1,065.60 |
$1,065.60 |
$6,684.23
|
|
Transcath biopsy
|
$2,782.80 |
$2,782.80 |
$2,782.80 |
$4,285.93
|
|
Transcath closure of asd
|
$11,757.60 |
$11,757.60 |
$11,757.60 |
$17,088.00
|
|
Transcatheter bx s&i
|
$3,331.20 |
$3,331.20 |
$3,331.20 |
$1,950.85
|
|
Transcath occlusion non-cns
|
$10,416.60 |
$10,416.60 |
$10,416.60 |
$10,270.00
|
|
Transcutaneous hgb 88738
|
$66.60 |
$66.60 |
$66.60 |
$13.20
|
|
Transferrin
|
$115.80 |
$115.80 |
$115.80 |
$82.00
|
|
Transparent film >16<=48 in
|
$3.00 |
$3.00 |
$3.00 |
$12.95
|
|
Transparent film <= 16 sq in
|
$12.00 |
$12.00 |
$12.00 |
$4.50
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$561.60 |
$561.60 |
$561.60 |
$560.92
|
|
Transvaginal Pregnancy Ultrasound
|
$534.60 |
$534.60 |
$534.60 |
$501.60
|
|
Trastuzumab 150 mg intravenous solution
|
$290.40 |
$290.40 |
$290.40 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$282.60 |
$282.60 |
$282.60 |
$7,540.20
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$194.40 |
$194.40 |
$194.40 |
$5,846.40
|
|
Trauma partial team response w/critical care services level 4
|
$6,448.80 |
$6,448.80 |
$6,448.80 |
$4,471.50
|
|
Treat elbow dislocation
|
$4,522.80 |
$4,522.80 |
$4,522.80 |
$2,311.20
|
|
Treat elbow fracture
|
$2,027.40 |
$2,027.40 |
$2,027.40 |
$2,027.40
|
|
Treat finger fracture each
|
$3,184.80 |
$3,184.80 |
$3,184.80 |
$1,592.00
|
|
Treat foot dislocation
|
$1,363.80 |
$1,363.80 |
$1,363.80 |
$405.60
|
|
Treat foot dislocation
|
$510.60 |
$510.60 |
$510.60 |
$445.80
|
|
Treat fracture of radius
|
$2,425.80 |
$2,425.80 |
$2,425.80 |
$1,821.60
|
|
Treat fracture of radius
|
$3,505.20 |
$3,505.20 |
$3,505.20 |
$1,849.00
|
|
Treat fracture of ulna
|
$2,425.80 |
$2,425.80 |
$2,425.80 |
$726.05
|
|
Treat hip dislocation
|
$3,369.60 |
$3,369.60 |
$3,369.60 |
$2,211.05
|
|
Treat hip dislocation
|
$5,821.80 |
$5,821.80 |
$5,821.80 |
$2,612.00
|
