|
Tc-99m mebrofenin
|
$202.80 |
$202.80 |
$202.80 |
$157.50
|
|
Tc-99m medronate
|
$41.70 |
$41.70 |
$41.70 |
$111.00
|
|
Tc-99m pentetate dtpa aerosol
|
$139.65 |
$139.65 |
$139.65 |
$181.37
|
|
Tc-99m sestamibi p study dose
|
$408.45 |
$408.45 |
$408.45 |
$274.45
|
|
Tc-99m sulfur colloid
|
$86.70 |
$86.70 |
$86.70 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$366.60 |
$366.60 |
$366.60 |
$188.50
|
|
Tc-99m tilmanocept diag
|
$1,121.70 |
$1,121.70 |
$1,121.70 |
$955.60
|
|
T cells absolute cd4/cd8 including ratio
|
$246.00 |
$246.00 |
$246.00 |
$176.00
|
|
T cells absolute cd 4 count
|
$107.10 |
$107.10 |
$107.10 |
$111.20
|
|
Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution
|
$40,114.80 |
$40,114.80 |
$40,114.80 |
$40,114.80
|
|
Telavancin injection
|
$1,191.80 |
$1,191.80 |
$1,191.80 |
$1,191.80
|
|
Temozolomide
|
$647.64 |
$647.64 |
$647.64 |
$588.46
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$4,950.80 |
$4,950.80 |
$4,950.80 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$9,028.34 |
$9,028.34 |
$9,028.34 |
$15,245.38
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$10.95 |
$10.95 |
$10.95 |
$39.31
|
|
Test stress cardiovascular tracing only
|
$818.10 |
$818.10 |
$818.10 |
$949.70
|
|
Tetanus immune globulin inj
|
$1,285.36 |
$1,285.36 |
$1,285.36 |
$1,285.36
|
|
Theophylline therapeutic drug level
|
$276.75 |
$276.75 |
$276.75 |
$107.94
|
|
Therapeutic procd strg endur
|
$113.70 |
$113.70 |
$113.70 |
$85.68
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$86.40 |
$86.40 |
$86.40 |
$57.08
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$90.00 |
$90.00 |
$90.00 |
$50.00
|
|
Ther/proph/diag inj ia
|
$178.95 |
$178.95 |
$178.95 |
$240.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$13.62 |
$13.62 |
$13.62 |
$25.54
|
|
Thigh/wght bear lacer molded
|
$873.03 |
$873.03 |
$873.03 |
$873.03
|
|
Thigh/wght bear lacer non-mo
|
$464.92 |
$464.92 |
$464.92 |
$464.92
|
|
Thiotepa injection
|
$1,485.00 |
$1,485.00 |
$1,485.00 |
$1,485.00
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$938.70 |
$938.70 |
$938.70 |
$1,687.50
|
|
Thrombin time
|
$115.95 |
$115.95 |
$115.95 |
$53.76
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$154.65 |
$154.65 |
$154.65 |
$61.50
|
|
Thyroglobulin antibody
|
$12.30 |
$12.30 |
$12.30 |
$81.90
|
|
Thyroid imaging
|
$696.75 |
$696.75 |
$696.75 |
$695.02
|
|
Thyroid (TSH) Test
|
$324.00 |
$324.00 |
$324.00 |
$111.00
|
|
Thyroid Ultrasound
|
$601.05 |
$601.05 |
$601.05 |
$586.95
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$3,914.94 |
$3,914.94 |
$3,914.94 |
$4,062.19
|
|
Thyroxine binding globulin (tbg)
|
$119.25 |
$119.25 |
$119.25 |
$63.90
|
|
Tibial length sock fx or equ
|
$228.69 |
$228.69 |
$228.69 |
$83.13
|
|
Tigecycline injection
|
$216.00 |
$216.00 |
$216.00 |
$234.00
|
|
Tirofiban 12.5 mg/50 ml
|
$516.15 |
$516.15 |
$516.15 |
$458.85
|
|
Tissue amnio epifix inj 100mg
|
$4,201.20 |
$4,201.20 |
$4,201.20 |
$4,834.73
|
|
Tissue culture skin/biopsy
|
$757.20 |
$757.20 |
$757.20 |
$472.50
|
|
Tissue exam koh skin/hair/nails
|
$51.30 |
$51.30 |
$51.30 |
$47.20
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$293.82 |
$293.82 |
$293.82 |
$1,134.00
|
|
Tissue surgimend prs meshed 20 cm x 10 cm - cost per 0.5cm
|
$92.25 |
$92.25 |
$92.25 |
$1,403.42
|
|
Tissue transglutaminase iga
|
$36.90 |
$36.90 |
$36.90 |
$44.16
|
|
Tlso 2 shl symphys-stern cst
|
$2,095.23 |
$2,095.23 |
$2,095.23 |
$1,808.59
|
|
Tlso 3mod sacro-scap pre
|
$2,570.48 |
$2,570.48 |
$2,570.48 |
$2,117.57
|
|
Tlso r fram soft ant pre cst
|
$801.11 |
$801.11 |
$801.11 |
$801.11
|
|
Tlso rigid frame pre subclav
|
$1,193.13 |
$1,193.13 |
$1,193.13 |
$1,382.98
|
|
Tlso rigid lined custom fab
|
$2,831.21 |
$2,831.21 |
$2,831.21 |
$2,831.21
|
|
Tlso rigid lined pre one pie
|
$2,118.31 |
$2,118.31 |
$2,118.31 |
$2,110.02
|
|
Tlso rigid plastic cust fab
|
$5,853.60 |
$5,853.60 |
$5,853.60 |
$2,347.16
|
|
Tlso rigid plastic custom fa
|
$2,788.42 |
$2,788.42 |
$2,788.42 |
$2,788.42
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$175.50 |
$175.50 |
$175.50 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$362.70 |
$362.70 |
$362.70 |
$118.30
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$5,258.52 |
$5,258.52 |
$5,258.52 |
$5,258.52
|
|
Tomosynthesis breast diagnostic left
|
$71.40 |
$71.40 |
$71.40 |
$72.66
|
|
Tomosynthesis breast screen bilateral
|
$66.15 |
$66.15 |
$66.15 |
$72.68
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$507.60 |
$507.60 |
$507.60 |
$323.75
|
|
Torsion ank & half solid sti
|
$292.47 |
$292.47 |
$292.47 |
$291.13
|
|
Torsion straight knee joint
|
$318.65 |
$318.65 |
$318.65 |
$253.84
|
|
Toxoplasma antibody igg
|
$14.70 |
$14.70 |
$14.70 |
$89.40
|
|
Toxoplasma antibody igm
|
$23.85 |
$23.85 |
$23.85 |
$87.00
|
|
Trabectedin 1 mg intravenous solution
|
$6,827.00 |
$6,827.00 |
$6,827.00 |
$6,827.00
|
|
Tracheostoma stent/stud/bttn
|
$452.64 |
$452.64 |
$452.64 |
$333.29
|
|
Trach/laryn tube plug/stop
|
$9.18 |
$9.18 |
$9.18 |
$9.18
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$144.60 |
$144.60 |
$144.60 |
$101.25
|
|
Transferrin
|
$119.85 |
$119.85 |
$119.85 |
$81.85
|
|
Transfusion blood/blood component(s)
|
$2,352.15 |
$2,352.15 |
$2,352.15 |
$983.00
|
|
Transparent film >16<=48 in
|
$18.02 |
$18.02 |
$18.02 |
$12.95
|
|
Transparent film <= 16 sq in
|
$14.78 |
$14.78 |
$14.78 |
$4.50
|
|
Trastuzumab 150 mg intravenous solution
|
$3,085.68 |
$3,085.68 |
$3,085.68 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$7,540.20 |
$7,540.20 |
$7,540.20 |
$7,540.20
|
|
Trauma partial team response w/critical care services level 4
|
$2,902.05 |
$2,902.05 |
$2,902.05 |
$4,523.04
|
|
Tray bonemarrw oncontrol 102mm
|
$1,019.25 |
$1,019.25 |
$1,019.25 |
$940.80
|
|
Treat clavicle dislocation 23545
|
$520.80 |
$520.80 |
$520.80 |
$705.60
|
|
Treat elbow dislocation
|
$1,408.80 |
$1,408.80 |
$1,408.80 |
$2,223.20
|
|
Treat elbow fracture
|
$1,650.90 |
$1,650.90 |
$1,650.90 |
$1,919.13
|
|
Treat finger fracture each
|
$1,862.25 |
$1,862.25 |
$1,862.25 |
$1,536.00
|
|
Treat foot dislocation
|
$345.75 |
$345.75 |
$345.75 |
$396.30
|
|
Treat fracture of radius
|
$1,862.25 |
$1,862.25 |
$1,862.25 |
$1,790.00
|
|
Treat fracture of ulna
|
$343.95 |
$343.95 |
$343.95 |
$726.05
|
|
Treat hip dislocation
|
$1,408.80 |
$1,408.80 |
$1,408.80 |
$2,192.80
|
|
Treat hip dislocation
|
$1,292.70 |
$1,292.70 |
$1,292.70 |
$2,641.60
|
|
Treat humerus fracture
|
$2,327.55 |
$2,327.55 |
$2,327.55 |
$1,771.43
|
|
Treat humerus fracture
|
$2,327.55 |
$2,327.55 |
$2,327.55 |
$1,771.43
|
|
Treat kneecap dislocation
|
$1,440.30 |
$1,440.30 |
$1,440.30 |
$1,068.90
|
|
Treat knuckle dislocation
|
$1,894.05 |
$1,894.05 |
$1,894.05 |
$1,523.90
|
|
Treat knuckle dislocation
|
$5,611.05 |
$5,611.05 |
$5,611.05 |
$4,332.00
|
|
Treatment fx radial distal open w/internal fixation 2 frag left (restricted method ii cah)
|
$12,184.35 |
$12,184.35 |
$12,184.35 |
$8,370.75
|
|
Treatment fx radial distal open w/internal fixation 3+ frag left (restricted method ii cah)
|
$12,184.35 |
$12,184.35 |
$12,184.35 |
$8,590.40
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$202.80 |
$202.80 |
$202.80 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$154.65 |
$154.65 |
$154.65 |
$144.50
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$310.80 |
$310.80 |
$310.80 |
$203.35
|
|
Treatment missed abortion completed surgically 1st trimester
|
$1,858.95 |
$1,858.95 |
$1,858.95 |
$3,982.44
|
|
Treatment of ankle fracture 27786
|
$279.90 |
$279.90 |
$279.90 |
$520.80
|
|
Treatment of heel fracture 28400
|
$279.90 |
$279.90 |
$279.90 |
$473.00
|
|
Treatment of thigh fracture
|
$2,661.45 |
$2,661.45 |
$2,661.45 |
$1,748.40
|
|
Treatment of thigh fracture
|
$380.85 |
$380.85 |
$380.85 |
$548.90
|
|
Treatment of thigh fracture
|
$2,327.55 |
$2,327.55 |
$2,327.55 |
$1,772.97
|
|
Treatment of toe fracture 28510
|
$211.95 |
$211.95 |
$211.95 |
$369.70
|
