|
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 sestamibi p study dose
|
$352.00 |
$352.00 |
$352.00 |
$287.20
|
|
Tc-99m sulfur colloid
|
$308.00 |
$308.00 |
$308.00 |
$245.70
|
|
T cells absolute cd4/cd8 including ratio
|
$141.60 |
$141.60 |
$141.60 |
$184.00
|
|
T cells absolute cd 4 count
|
$204.00 |
$204.00 |
$204.00 |
$111.20
|
|
T cells total count
|
$113.60 |
$113.60 |
$113.60 |
$130.20
|
|
Telehealth original site facility fee
|
$64.80 |
$64.80 |
$64.80 |
$51.00
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$12,366.50 |
$12,366.50 |
$12,366.50 |
$14,951.87
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$63.10 |
$63.10 |
$63.10 |
$39.33
|
|
Test stress cardiovascular tracing only
|
$1,808.80 |
$1,808.80 |
$1,808.80 |
$953.40
|
|
Tetanus immune globulin inj
|
$598.64 |
$598.64 |
$598.64 |
$1,285.36
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$11,162.45 |
$11,162.45 |
$11,162.45 |
$8,737.05
|
|
Theophylline therapeutic drug level
|
$99.20 |
$99.20 |
$99.20 |
$108.00
|
|
Therapy Activity Training (each 15 minutes)
|
$126.40 |
$126.40 |
$126.40 |
$101.38
|
|
Therapy Exercise Session (each 15 minutes)
|
$130.40 |
$130.40 |
$130.40 |
$98.58
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$49.60 |
$49.60 |
$49.60 |
$57.50
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$62.40 |
$62.40 |
$62.40 |
$50.40
|
|
Ther/proph/diag inj ia
|
$275.20 |
$275.20 |
$275.20 |
$247.33
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$63.20 |
$63.20 |
$63.20 |
$25.54
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$369.60 |
$369.60 |
$369.60 |
$313.60
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,932.80 |
$1,932.80 |
$1,932.80 |
$1,724.25
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$2,013.60 |
$2,013.60 |
$2,013.60 |
$1,703.45
|
|
Thrombin time
|
$60.80 |
$60.80 |
$60.80 |
$54.18
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$91.20 |
$91.20 |
$91.20 |
$62.01
|
|
Thyroglobulin antibody
|
$136.00 |
$136.00 |
$136.00 |
$82.50
|
|
Thyroid imaging
|
$970.40 |
$970.40 |
$970.40 |
$695.60
|
|
Thyroid (TSH) Test
|
$144.00 |
$144.00 |
$144.00 |
$112.70
|
|
Thyroid Ultrasound
|
$682.40 |
$682.40 |
$682.40 |
$588.50
|
|
Thyroid uptake measurement
|
$921.60 |
$921.60 |
$921.60 |
$591.25
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$2,900.48 |
$2,900.48 |
$2,900.48 |
$4,152.21
|
|
Thyroxine binding globulin (tbg)
|
$48.80 |
$48.80 |
$48.80 |
$64.51
|
|
Tigecycline injection
|
$271.86 |
$271.86 |
$271.86 |
$235.29
|
|
Tirofiban 12.5 mg/50 ml
|
$340.64 |
$340.64 |
$340.64 |
$458.85
|
|
Tissue culture tumor
|
$605.60 |
$605.60 |
$605.60 |
$486.50
|
|
Tissue exam koh skin/hair/nails
|
$72.00 |
$72.00 |
$72.00 |
$47.40
|
|
Tissue transglutaminase iga
|
$44.80 |
$44.80 |
$44.80 |
$44.80
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$61.32 |
$61.32 |
$61.32 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$180.80 |
$180.80 |
$180.80 |
$120.60
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$3,538.50 |
$3,538.50 |
$3,538.50 |
$5,258.52
|
|
Toe X-ray (both feet)
|
$278.40 |
$278.40 |
$278.40 |
$258.65
|
|
Tomosynthesis breast diagnostic left
|
$101.60 |
$101.60 |
$101.60 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$92.80 |
$92.80 |
$92.80 |
$74.10
|
|
Toxoplasma antibody igg
|
$122.40 |
$122.40 |
$122.40 |
$91.65
|
|
Toxoplasma antibody igm
|
$122.40 |
$122.40 |
$122.40 |
$87.75
|
|
Transferrin
|
$148.00 |
$148.00 |
$148.00 |
$82.00
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$872.00 |
$872.00 |
$872.00 |
$561.60
|
|
Transvaginal Pregnancy Ultrasound
|
$758.40 |
$758.40 |
$758.40 |
$499.20
|
|
Trauma partial team response w/critical care services level 4
|
$1,946.40 |
$1,946.40 |
$1,946.40 |
$4,523.04
|
|
Treat elbow dislocation
|
$2,500.80 |
$2,500.80 |
$2,500.80 |
$2,272.50
|
|
Treat finger fracture each
|
$1,254.40 |
$1,254.40 |
$1,254.40 |
$1,592.00
|
|
Treat fracture of radius
|
$1,049.60 |
$1,049.60 |
$1,049.60 |
$1,790.00
|
|
Treat fracture of ulna
|
$1,512.00 |
$1,512.00 |
$1,512.00 |
$731.04
|
|
Treat hip dislocation
|
$2,192.80 |
$2,192.80 |
$2,192.80 |
$2,211.05
|
|
Treat hip dislocation
|
$1,674.40 |
$1,674.40 |
$1,674.40 |
$2,641.60
|
|
Treatment incomplete abortion completed surgically any trimester
|
$960.00 |
$960.00 |
$960.00 |
$3,928.20
|
|
Treatment of thigh fracture
|
$1,880.00 |
$1,880.00 |
$1,880.00 |
$1,790.00
|
|
Treponema pallidum antibody
|
$132.00 |
$132.00 |
$132.00 |
$72.05
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$65.43 |
$65.43 |
$65.43 |
$43.09
|
|
Triamcinolone a inj prs-free
|
$282.40 |
$282.40 |
$282.40 |
$223.56
|
|
Triglycerides
|
$72.00 |
$72.00 |
$72.00 |
$58.50
|
|
Troponin quantitative
|
$232.00 |
$232.00 |
$232.00 |
$127.60
|
|
Tx closed hip disl traumatic without anes
|
$537.60 |
$537.60 |
$537.60 |
$586.40
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$3,708.00 |
$3,708.00 |
$3,708.00 |
$3,977.49
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$16,727.20 |
$16,727.20 |
$16,727.20 |
$21,992.26
|
|
Ultrasound breast complete
|
$574.40 |
$574.40 |
$574.40 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$552.80 |
$552.80 |
$552.80 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$424.00 |
$424.00 |
$424.00 |
$338.00
|
|
Ultrasound encephalogram
|
$576.80 |
$576.80 |
$576.80 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$840.80 |
$840.80 |
$840.80 |
$578.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$709.60 |
$709.60 |
$709.60 |
$476.94
|
|
Ultrasound guidance for vascular access
|
$708.00 |
$708.00 |
$708.00 |
$388.08
|
|
Ultrasound hips infant dynamic
|
$646.40 |
$646.40 |
$646.40 |
$403.88
|
|
Ultrasound joint complete left
|
$639.20 |
$639.20 |
$639.20 |
$557.99
|
|
Ultrasound ob >=14wks ea addl gest
|
$816.80 |
$816.80 |
$816.80 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$488.00 |
$488.00 |
$488.00 |
$334.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,038.40 |
$1,038.40 |
$1,038.40 |
$698.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$565.60 |
$565.60 |
$565.60 |
$425.60
|
|
Ultrasound transabd ea addl gest
|
$550.40 |
$550.40 |
$550.40 |
$419.50
|
|
Upper Arm (Humerus) X-ray (left side)
|
$363.20 |
$363.20 |
$363.20 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$2,530.40 |
$2,530.40 |
$2,530.40 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$2,279.20 |
$2,279.20 |
$2,279.20 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,165.60 |
$4,165.60 |
$4,165.60 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,240.00 |
$3,240.00 |
$3,240.00 |
$2,369.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,043.20 |
$3,043.20 |
$3,043.20 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$420.80 |
$420.80 |
$420.80 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$513.60 |
$513.60 |
$513.60 |
$381.60
|
|
Urea nitrogen
|
$70.40 |
$70.40 |
$70.40 |
$42.25
|
|
Urea nitrogen 24 hour urine
|
$56.80 |
$56.80 |
$56.80 |
$52.00
|
|
Uric acid blood
|
$76.00 |
$76.00 |
$76.00 |
$49.44
|
|
Uric acid urine
|
$73.60 |
$73.60 |
$73.60 |
$45.36
|
|
Urinalysis microscopic only
|
$40.00 |
$40.00 |
$40.00 |
$26.46
|
|
Urinalysis qual/semiquant excpt ia
|
$13.60 |
$13.60 |
$13.60 |
$25.72
|
|
Urinalysis (with microscopy)
|
$80.80 |
$80.80 |
$80.80 |
$55.20
|
|
Urinalysis (without microscopy)
|
$40.00 |
$40.00 |
$40.00 |
$36.00
|
|
Urine Culture Test
|
$116.00 |
$116.00 |
$116.00 |
$83.00
|
