|
Surgical pathology level 4 gross & microscopic examination
|
$116.40 |
$116.40 |
$116.40 |
$248.00
|
|
Surgical pathology level 5 gross & microscopic examination
|
$664.80 |
$664.80 |
$664.80 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,472.40 |
$1,472.40 |
$1,472.40 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$25.80 |
$25.80 |
$25.80 |
$45.45
|
|
Susceptibility enzyme detection per enzyme
|
$25.80 |
$25.80 |
$25.80 |
$35.75
|
|
Susceptibility mic per plate
|
$48.60 |
$48.60 |
$48.60 |
$105.75
|
|
Svc venogram s&i
|
$1,344.60 |
$1,344.60 |
$1,344.60 |
$1,994.00
|
|
Swallowing Evaluation (Bedside)
|
$532.80 |
$532.80 |
$532.80 |
$316.55
|
|
Swallowing Therapy Session
|
$384.60 |
$384.60 |
$384.60 |
$240.31
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$24.60 |
$24.60 |
$24.60 |
$41.60
|
|
T3 (triiodothyronine) free
|
$86.40 |
$86.40 |
$86.40 |
$100.32
|
|
T3 (triiodothyronine) total
|
$72.00 |
$72.00 |
$72.00 |
$93.52
|
|
T4 (thyroxine) free
|
$45.60 |
$45.60 |
$45.60 |
$88.44
|
|
T4 (thyroxine) total
|
$34.20 |
$34.20 |
$34.20 |
$69.58
|
|
Tacrol astagraf ex rel oral
|
$16.80 |
$16.80 |
$16.80 |
$62.32
|
|
Tacrol envarsus ex rel oral
|
$15.60 |
$15.60 |
$15.60 |
$15.60
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$21.00 |
$21.00 |
$21.00 |
$9.93
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$148.20 |
$148.20 |
$148.20 |
$596.76
|
|
Tacrolimus therapeutic drug level
|
$98.40 |
$98.40 |
$98.40 |
$122.50
|
|
Tafasitamab-cxix 200 mg intravenous solution
|
$796.80 |
$796.80 |
$796.80 |
$2,762.00
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$188.40 |
$188.40 |
$188.40 |
$289.90
|
|
Talquetamab-tgvs 2 mg/ml subcutaneous solution
|
$6,216.00 |
$6,216.00 |
$6,216.00 |
$21,745.13
|
|
Tarlatamab-dlle 10 mg intravenous solution
|
$9,000.00 |
$9,000.00 |
$9,000.00 |
$24,217.20
|
|
Tavr perq femoral
|
$10,503.00 |
$10,503.00 |
$10,503.00 |
$15,454.40
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$357.60 |
$357.60 |
$357.60 |
$937.50
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$556.80 |
$556.80 |
$556.80 |
$200.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$345.00 |
$345.00 |
$345.00 |
$180.80
|
|
Tc-99m bicisate
|
$6,316.80 |
$6,316.80 |
$6,316.80 |
$2,070.00
|
|
Tc-99m diag per dose
|
$77.40 |
$77.40 |
$77.40 |
$470.40
|
|
Tc-99m exame autol wbc diag per dose
|
$7,144.80 |
$7,144.80 |
$7,144.80 |
$2,503.15
|
|
Tc-99m fanolesomab diag
|
$6,315.00 |
$6,315.00 |
$6,315.00 |
$2,115.12
|
|
Tc-99m labeled rbc
|
$590.40 |
$590.40 |
$590.40 |
$306.00
|
|
Tc-99m maa
|
$576.00 |
$576.00 |
$576.00 |
$312.06
|
|
Tc-99m mebrofenin
|
$94.80 |
$94.80 |
$94.80 |
$157.65
|
|
Tc-99m medronate
|
$54.60 |
$54.60 |
$54.60 |
$111.01
|
|
Tc-99m mertiatide
|
$1,284.60 |
$1,284.60 |
$1,284.60 |
$756.00
|
|
Tc-99m oxidronate
|
$88.80 |
$88.80 |
$88.80 |
$108.00
|
|
Tc-99m pentetate dtpa aerosol
|
$415.20 |
$415.20 |
$415.20 |
$191.50
|
|
Tc-99m pertechnetate per mci
|
$2.40 |
$2.40 |
$2.40 |
$18.67
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$232.20 |
$232.20 |
$232.20 |
$141.00
|
|
Tc-99m sestamibi p study dose
|
$201.00 |
$201.00 |
$201.00 |
$287.20
|
|
Tc-99m succimer (dmsa)
|
$1,749.60 |
$1,749.60 |
$1,749.60 |
$1,128.40
|
|
Tc-99m sulfur colloid
|
$469.20 |
$469.20 |
$469.20 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$247.20 |
$247.20 |
$247.20 |
$193.28
|
|
Tc-99m tilmanocept diag
|
$1,043.40 |
$1,043.40 |
$1,043.40 |
$985.60
|
|
Tcd emboli detect without inj
|
$240.60 |
$240.60 |
$240.60 |
$475.28
|
|
T cells absolute cd4/cd8 including ratio
|
$261.60 |
$261.60 |
$261.60 |
$185.28
|
|
T cells absolute cd 4 count
|
$148.80 |
$148.80 |
$148.80 |
$111.20
|
|
T cells total count
|
$210.00 |
$210.00 |
$210.00 |
$130.35
|
|
Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution
|
$24,312.00 |
$24,312.00 |
$24,312.00 |
$40,114.80
|
|
Telavancin injection
|
$367.80 |
$367.80 |
$367.80 |
$1,191.80
|
|
Telehealth original site facility fee
|
$84.60 |
$84.60 |
$84.60 |
$51.00
|
|
Telethx isodose plan cplx
|
$1,189.20 |
$1,189.20 |
$1,189.20 |
$1,526.85
|
|
Telethx isodose plan simple
|
$766.80 |
$766.80 |
$766.80 |
$877.09
|
|
Temozolomide 100 mg intravenous solution
|
$601.80 |
$601.80 |
$601.80 |
$1,867.28
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$1,200.00 |
$1,200.00 |
$1,200.00 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$4,559.40 |
$4,559.40 |
$4,559.40 |
$14,951.87
|
|
Tenotomy open tndn flxr toe sgl tndn spx
|
$5,153.40 |
$5,153.40 |
$5,153.40 |
$2,175.00
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$11.40 |
$11.40 |
$11.40 |
$39.33
|
|
Testicular imaging w/vasc flow
|
$1,228.80 |
$1,228.80 |
$1,228.80 |
$842.56
|
|
Test pathogen(s) for platelets reference
|
$51.00 |
$51.00 |
$51.00 |
$70.00
|
|
Test stress cardiovascular tracing only
|
$953.40 |
$953.40 |
$953.40 |
$953.40
|
|
Test urine for porphyrins
|
$48.60 |
$48.60 |
$48.60 |
$49.98
|
|
Tetanus immune globulin inj
|
$389.40 |
$389.40 |
$389.40 |
$1,285.36
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$1,269.00 |
$1,269.00 |
$1,269.00 |
$8,737.05
|
|
Theophylline therapeutic drug level
|
$101.40 |
$101.40 |
$101.40 |
$108.00
|
|
Therapeutic procd strg endur
|
$186.00 |
$186.00 |
$186.00 |
$85.68
|
|
Therapy Activity Training (each 15 minutes)
|
$80.40 |
$80.40 |
$80.40 |
$101.85
|
|
Therapy Exercise Session (each 15 minutes)
|
$73.80 |
$73.80 |
$73.80 |
$98.58
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$50.40 |
$50.40 |
$50.40 |
$57.50
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$50.40 |
$50.40 |
$50.40 |
$50.40
|
|
Ther nma rdctj intus/obstrcj
|
$389.40 |
$389.40 |
$389.40 |
$538.88
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$2.40 |
$2.40 |
$2.40 |
$25.54
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$188.40 |
$188.40 |
$188.40 |
$314.50
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$2,304.60 |
$2,304.60 |
$2,304.60 |
$1,733.65
|
|
Thoracotomy with cardiac massage
|
$3,385.80 |
$3,385.80 |
$3,385.80 |
$2,138.76
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$1,228.80 |
$1,228.80 |
$1,228.80 |
$1,684.80
|
|
Throat x-ray & fluoroscopy
|
$188.40 |
$188.40 |
$188.40 |
$259.60
|
|
Thrombectmy crnry perq mechanical
|
$6,847.20 |
$6,847.20 |
$6,847.20 |
$3,836.00
|
|
Thrombectomy/inf pq dialysis circuit
|
$12,394.80 |
$12,394.80 |
$12,394.80 |
$8,084.00
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$24,300.00 |
$24,300.00 |
$24,300.00 |
$14,465.94
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$24,300.00 |
$24,300.00 |
$24,300.00 |
$21,413.60
|
|
Thromb/endar/neck inc/car/vert/subc35301
|
$6,882.60 |
$6,882.60 |
$6,882.60 |
$6,422.91
|
|
Thrombin time
|
$29.40 |
$29.40 |
$29.40 |
$54.18
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$32.40 |
$32.40 |
$32.40 |
$61.52
|
|
Thyroglobulin antibody
|
$88.80 |
$88.80 |
$88.80 |
$82.73
|
|
Thyroid imaging
|
$1,228.80 |
$1,228.80 |
$1,228.80 |
$696.75
|
|
Thyroid met imaging
|
$1,228.80 |
$1,228.80 |
$1,228.80 |
$838.25
|
|
Thyroid met imaging/studies
|
$1,228.80 |
$1,228.80 |
$1,228.80 |
$767.93
|
|
Thyroid mets imag whole body
|
$1,574.40 |
$1,574.40 |
$1,574.40 |
$1,524.99
|
|
Thyroid met uptake
|
$407.40 |
$407.40 |
$407.40 |
$407.40
|
|
Thyroid (TSH) Test
|
$85.80 |
$85.80 |
$85.80 |
$112.67
|
|
Thyroid Ultrasound
|
$394.20 |
$394.20 |
$394.20 |
$588.50
|
|
Thyroid uptake measurement
|
$1,228.80 |
$1,228.80 |
$1,228.80 |
$591.25
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$1,186.20 |
$1,186.20 |
$1,186.20 |
$4,152.21
|
|
Thyroxine binding globulin (tbg)
|
$75.00 |
$75.00 |
$75.00 |
$64.51
|
|
Tib/per revasc stent & ather 37231
|
$66,098.40 |
$66,098.40 |
$66,098.40 |
$21,249.26
|
|
Tib/per revasc stnt & ather
|
$21,287.40 |
$21,287.40 |
$21,287.40 |
$11,078.70
|
|
Tib/per revasc w/ather add-on 37233
|
$14,982.00 |
$14,982.00 |
$14,982.00 |
$10,165.00
|
|
Tigecycline injection
|
$93.60 |
$93.60 |
$93.60 |
$235.29
|
