|
St treatment swallow dysfunction/oral
|
$63.69 |
$63.69 |
$63.69 |
$240.31
|
|
Sumatriptan 6 mg/0.5 ml subcutaneous solution
|
$4.36 |
$4.36 |
$4.36 |
$114.88
|
|
Support clav 29.6-40.5in med
|
$31.81 |
$31.81 |
$31.81 |
$94.19
|
|
Surgical pathology level 1 gross examination only
|
$12.21 |
$12.21 |
$12.21 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$27.06 |
$27.06 |
$27.06 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$32.34 |
$32.34 |
$32.34 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$139.92 |
$139.92 |
$139.92 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$211.86 |
$211.86 |
$211.86 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$297.00 |
$297.00 |
$297.00 |
$718.00
|
|
Susceptibility agar dilution per agent
|
$15.84 |
$15.84 |
$15.84 |
$45.45
|
|
Susceptibility enzyme detection per enzyme
|
$15.84 |
$15.84 |
$15.84 |
$35.70
|
|
Susceptibility mic per plate
|
$306.90 |
$306.90 |
$306.90 |
$106.00
|
|
Svc venogram s&i
|
$795.96 |
$795.96 |
$795.96 |
$1,934.62
|
|
Synvisc or synvisc-one
|
$1,540.32 |
$1,540.32 |
$1,540.32 |
$1,274.94
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$13.53 |
$13.53 |
$13.53 |
$41.60
|
|
System cardiomems hosp electronics
|
$33,082.50 |
$33,082.50 |
$33,082.50 |
$39,037.95
|
|
System pacing micra av
|
$20,163.00 |
$20,163.00 |
$20,163.00 |
$24,577.07
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$7,345.80 |
$7,345.80 |
$7,345.80 |
$12,003.00
|
|
T3 (triiodothyronine) free
|
$56.43 |
$56.43 |
$56.43 |
$99.20
|
|
T3 (triiodothyronine) total
|
$47.19 |
$47.19 |
$47.19 |
$93.52
|
|
T4 (thyroxine) free
|
$30.03 |
$30.03 |
$30.03 |
$85.20
|
|
T4 (thyroxine) total
|
$22.77 |
$22.77 |
$22.77 |
$69.00
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$19.47 |
$19.47 |
$19.47 |
$9.84
|
|
Tacrolimus therapeutic drug level
|
$31.68 |
$31.68 |
$31.68 |
$122.40
|
|
Tafasitamab-cxix 200 mg intravenous solution
|
$1,569.85 |
$1,569.85 |
$1,569.85 |
$2,762.00
|
|
Talquetamab-tgvs 2 mg/ml subcutaneous solution
|
$12,993.00 |
$12,993.00 |
$12,993.00 |
$21,745.13
|
|
Tarlatamab-dlle 10 mg intravenous solution
|
$16,869.60 |
$16,869.60 |
$16,869.60 |
$24,217.20
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$408.85 |
$408.85 |
$408.85 |
$937.50
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$32.01 |
$32.01 |
$32.01 |
$177.65
|
|
Tc-99m exame autol wbc diag per dose
|
$1,618.30 |
$1,618.30 |
$1,618.30 |
$2,435.36
|
|
Tc-99m exametazime diag
|
$1,281.04 |
$1,281.04 |
$1,281.04 |
$2,033.20
|
|
Tc-99m labeled rbc
|
$110.25 |
$110.25 |
$110.25 |
$302.40
|
|
Tc-99m maa
|
$98.58 |
$98.58 |
$98.58 |
$292.80
|
|
Tc-99m mebrofenin
|
$41.60 |
$41.60 |
$41.60 |
$157.65
|
|
Tc-99m medronate
|
$45.15 |
$45.15 |
$45.15 |
$111.01
|
|
Tc-99m mertiatide
|
$201.77 |
$201.77 |
$201.77 |
$756.00
|
|
Tc-99m pentetate dtpa
|
$155.27 |
$155.27 |
$155.27 |
$222.60
|
|
Tc-99m pertechnetate per mci
|
$34.80 |
$34.80 |
$34.80 |
$22.10
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$58.86 |
$58.86 |
$58.86 |
$136.40
|
|
Tc-99m sestamibi p study dose
|
$34.00 |
$34.00 |
$34.00 |
$274.45
|
|
Tc-99m sulfur colloid
|
$114.73 |
$114.73 |
$114.73 |
$240.50
|
|
Tc-99m tilmanocept diag
|
$535.66 |
$535.66 |
$535.66 |
$955.60
|
|
T cells absolute cd4/cd8 including ratio
|
$52.80 |
$52.80 |
$52.80 |
$176.40
|
|
T cells total count
|
$42.24 |
$42.24 |
$42.24 |
$126.90
|
|
Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution
|
$23,032.63 |
$23,032.63 |
$23,032.63 |
$40,114.80
|
|
Telavancin injection
|
$575.39 |
$575.39 |
$575.39 |
$1,191.80
|
|
Telehealth original site facility fee
|
$15.84 |
$15.84 |
$15.84 |
$51.00
|
|
Telethx isodose plan cplx
|
$476.19 |
$476.19 |
$476.19 |
$1,526.85
|
|
Telethx isodose plan simple
|
$257.40 |
$257.40 |
$257.40 |
$873.62
|
|
Temozolomide
|
$180.42 |
$180.42 |
$180.42 |
$588.46
|
|
Temozolomide 100 mg intravenous solution
|
$1,128.13 |
$1,128.13 |
$1,128.13 |
$1,867.28
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$2,249.64 |
$2,249.64 |
$2,249.64 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$9,331.43 |
$9,331.43 |
$9,331.43 |
$15,245.38
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$37.76 |
$37.76 |
$37.76 |
$39.33
|
|
Testicular imaging w/vasc flow
|
$202.29 |
$202.29 |
$202.29 |
$842.56
|
|
Test pathogen(s) for platelets reference
|
$34.65 |
$34.65 |
$34.65 |
$70.00
|
|
Test stress cardiovascular tracing only
|
$160.71 |
$160.71 |
$160.71 |
$949.70
|
|
Tetanus immune globulin inj
|
$625.75 |
$625.75 |
$625.75 |
$1,285.36
|
|
Theophylline therapeutic drug level
|
$47.19 |
$47.19 |
$47.19 |
$108.00
|
|
Ther/proph/diag inj ia
|
$107.58 |
$107.58 |
$107.58 |
$240.35
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$11.79 |
$11.79 |
$11.79 |
$25.54
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$974.16 |
$974.16 |
$974.16 |
$1,687.50
|
|
Thrombectmy crnry perq mechanical
|
$148.83 |
$148.83 |
$148.83 |
$3,580.00
|
|
Thrombectomy/inf pq dialysis circuit
|
$2,132.79 |
$2,132.79 |
$2,132.79 |
$8,084.00
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$4,311.12 |
$4,311.12 |
$4,311.12 |
$14,277.20
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$6,534.33 |
$6,534.33 |
$6,534.33 |
$21,413.60
|
|
Thrombin time
|
$65.01 |
$65.01 |
$65.01 |
$53.76
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$40.26 |
$40.26 |
$40.26 |
$61.52
|
|
Thyroglobulin antibody
|
$20.46 |
$20.46 |
$20.46 |
$82.00
|
|
Thyroid imaging
|
$202.29 |
$202.29 |
$202.29 |
$695.02
|
|
Thyroid mets imag whole body
|
$319.77 |
$319.77 |
$319.77 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$55.77 |
$55.77 |
$55.77 |
$111.00
|
|
Thyroid Ultrasound
|
$151.80 |
$151.80 |
$151.80 |
$588.50
|
|
Thyroid uptake measurement
|
$202.29 |
$202.29 |
$202.29 |
$591.25
|
|
Thyroxine binding globulin (tbg)
|
$22.44 |
$22.44 |
$22.44 |
$64.35
|
|
Tigecycline injection
|
$175.44 |
$175.44 |
$175.44 |
$234.00
|
|
Tilt table study
|
$434.94 |
$434.94 |
$434.94 |
$1,507.01
|
|
Tirofiban 12.5 mg/50 ml
|
$552.72 |
$552.72 |
$552.72 |
$458.85
|
|
Tisotumab vedotin-tftv 40 mg intravenous solution
|
$8,010.81 |
$8,010.81 |
$8,010.81 |
$13,339.20
|
|
Tissue culture placenta
|
$112.53 |
$112.53 |
$112.53 |
$457.00
|
|
Tissue culture skin/biopsy
|
$127.38 |
$127.38 |
$127.38 |
$484.00
|
|
Tissue culture tumor
|
$112.86 |
$112.86 |
$112.86 |
$483.36
|
|
Tissue transglutaminase iga
|
$10.56 |
$10.56 |
$10.56 |
$44.16
|
|
Tl-201 thallium diag per mci
|
$22.93 |
$22.93 |
$22.93 |
$78.40
|
|
Tlso 2 shl symphys-stern cst
|
$4,047.45 |
$4,047.45 |
$4,047.45 |
$1,808.59
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$94.05 |
$94.05 |
$94.05 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$53.46 |
$53.46 |
$53.46 |
$120.60
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$2,986.84 |
$2,986.84 |
$2,986.84 |
$5,258.52
|
|
Tomosynthesis breast diagnostic left
|
$11.55 |
$11.55 |
$11.55 |
$73.00
|
|
Tomosynthesis breast screen bilateral
|
$11.55 |
$11.55 |
$11.55 |
$72.68
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$335.75 |
$335.75 |
$335.75 |
$325.00
|
|
Toxoplasma antibody igg
|
$13.86 |
$13.86 |
$13.86 |
$89.40
|
|
Toxoplasma antibody igm
|
$13.53 |
$13.53 |
$13.53 |
$87.00
|
|
Trabectedin 1 mg intravenous solution
|
$3,877.89 |
$3,877.89 |
$3,877.89 |
$6,827.00
|
|
Transcath biopsy
|
$1,620.30 |
$1,620.30 |
$1,620.30 |
$4,285.93
|
|
Transcatheter bx s&i
|
$428.34 |
$428.34 |
$428.34 |
$1,915.00
|
|
Transcath occlusion cns
|
$574.53 |
$574.53 |
$574.53 |
$7,157.76
|
|
Transcath occlusion non-cns
|
$4,026.99 |
$4,026.99 |
$4,026.99 |
$10,031.28
|
|
Transferrin
|
$41.91 |
$41.91 |
$41.91 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$118.47 |
$118.47 |
$118.47 |
$983.00
|
