|
Tc-99m mebrofenin
|
$71.05 |
$71.05 |
$71.05 |
$169.53
|
|
Tc-99m medronate
|
$82.78 |
$82.78 |
$82.78 |
$122.46
|
|
Tc-99m mertiatide
|
$343.70 |
$343.70 |
$343.70 |
$757.25
|
|
Tc-99m oxidronate
|
$3.68 |
$3.68 |
$3.68 |
$124.23
|
|
Tc-99m pentetate dtpa
|
$54.95 |
$54.95 |
$54.95 |
$245.85
|
|
Tc-99m pertechnetate per mci
|
$58.98 |
$58.98 |
$58.98 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$54.95 |
$54.95 |
$54.95 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$130.90 |
$130.90 |
$130.90 |
$221.60
|
|
Tc-99m succimer (dmsa)
|
$106.75 |
$106.75 |
$106.75 |
$1,578.33
|
|
Tc-99m sulfur colloid
|
$101.68 |
$101.68 |
$101.68 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$97.30 |
$97.30 |
$97.30 |
$198.05
|
|
T cells absolute cd4/cd8 including ratio
|
$111.13 |
$111.13 |
$111.13 |
$186.00
|
|
T cells absolute cd 4 count
|
$71.23 |
$71.23 |
$71.23 |
$120.25
|
|
T cells total count
|
$90.65 |
$90.65 |
$90.65 |
$124.11
|
|
Telavancin injection
|
$76.19 |
$76.19 |
$76.19 |
$1,216.45
|
|
Telehealth original site facility fee
|
$12.95 |
$12.95 |
$12.95 |
$60.80
|
|
Telethx isodose plan cplx
|
$305.90 |
$305.90 |
$305.90 |
$1,617.00
|
|
Telethx isodose plan simple
|
$247.80 |
$247.80 |
$247.80 |
$848.72
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$229.75 |
$229.75 |
$229.75 |
$3,957.79
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$303.90 |
$303.90 |
$303.90 |
$16,531.64
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$0.70 |
$0.70 |
$0.70 |
$46.10
|
|
Test for urine cystines
|
$39.03 |
$39.03 |
$39.03 |
$26.00
|
|
Testicular imaging w/vasc flow
|
$500.15 |
$500.15 |
$500.15 |
$780.48
|
|
Test stress cardiovascular tracing only
|
$555.45 |
$555.45 |
$555.45 |
$1,001.55
|
|
Tetanus immune globulin inj
|
$78.66 |
$78.66 |
$78.66 |
$1,204.50
|
|
Theophylline therapeutic drug level
|
$33.25 |
$33.25 |
$33.25 |
$108.00
|
|
Therapeutic procd strg endur
|
$53.73 |
$53.73 |
$53.73 |
$85.80
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$22.58 |
$22.58 |
$22.58 |
$55.00
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$16.63 |
$16.63 |
$16.63 |
$50.40
|
|
Ther nma rdctj intus/obstrcj
|
$1,409.28 |
$1,409.28 |
$1,409.28 |
$534.32
|
|
Ther/proph/diag inj ia
|
$125.83 |
$125.83 |
$125.83 |
$247.33
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$0.92 |
$0.92 |
$0.92 |
$35.72
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$626.33 |
$626.33 |
$626.33 |
$1,804.00
|
|
Thrombectmy crnry perq mechanical
|
$1,496.25 |
$1,496.25 |
$1,496.25 |
$3,580.00
|
|
Thrombectomy/inf pq dialysis circuit
|
$8,559.08 |
$8,559.08 |
$8,559.08 |
$7,828.60
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$16,470.83 |
$16,470.83 |
$16,470.83 |
$15,185.00
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$26,252.63 |
$26,252.63 |
$26,252.63 |
$24,605.30
|
|
Thrombin time
|
$25.90 |
$25.90 |
$25.90 |
$48.75
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$35.35 |
$35.35 |
$35.35 |
$56.93
|
|
Thyroglobulin antibody
|
$40.95 |
$40.95 |
$40.95 |
$84.00
|
|
Thyroid imaging
|
$216.48 |
$216.48 |
$216.48 |
$670.80
|
|
Thyroid mets imag whole body
|
$809.03 |
$809.03 |
$809.03 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$60.73 |
$60.73 |
$60.73 |
$120.00
|
|
Thyroid uptake measurement
|
$145.78 |
$145.78 |
$145.78 |
$653.60
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$321.51 |
$321.51 |
$321.51 |
$4,319.71
|
|
Thyroxine binding globulin (tbg)
|
$35.70 |
$35.70 |
$35.70 |
$63.60
|
|
Tib/per revasc stent & ather 37231
|
$6,323.45 |
$6,323.45 |
$6,323.45 |
$21,900.00
|
|
Tib/per revasc stnt & ather
|
$3,161.73 |
$3,161.73 |
$3,161.73 |
$11,121.63
|
|
Tib/per revasc w/ather add-on 37233
|
$2,789.85 |
$2,789.85 |
$2,789.85 |
$10,406.14
|
|
Tilt table study
|
$683.38 |
$683.38 |
$683.38 |
$1,495.00
|
|
Tirofiban 12.5 mg/50 ml
|
$30.38 |
$30.38 |
$30.38 |
$384.17
|
|
Tissue culture skin/biopsy
|
$144.03 |
$144.03 |
$144.03 |
$558.87
|
|
Tissue culture tumor
|
$196.35 |
$196.35 |
$196.35 |
$529.23
|
|
Tissue exam koh skin/hair/nails
|
$9.28 |
$9.28 |
$9.28 |
$47.40
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$582.23 |
$582.23 |
$582.23 |
$2,516.07
|
|
Tissue matrix xcm thk 20x30cm -cost per sq cm
|
$5,971.88 |
$5,971.88 |
$5,971.88 |
$1,679.65
|
|
Tissue surgimend prs meshed 20 cm x 10 cm - cost per 0.5cm
|
$12,121.38 |
$12,121.38 |
$12,121.38 |
$2,085.14
|
|
Tl-201 thallium diag per mci
|
$33.78 |
$33.78 |
$33.78 |
$77.22
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$11.47 |
$11.47 |
$11.47 |
$141.75
|
|
Tobramycin peak therapeutic drug level
|
$60.55 |
$60.55 |
$60.55 |
$121.55
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$391.42 |
$391.42 |
$391.42 |
$4,711.84
|
|
Tomosynthesis breast diagnostic left
|
$19.78 |
$19.78 |
$19.78 |
$78.80
|
|
Tomosynthesis breast screen bilateral
|
$34.83 |
$34.83 |
$34.83 |
$73.45
|
|
Tongue biopsy; posterior one-third 41105
|
$38.50 |
$38.50 |
$38.50 |
$3,589.62
|
|
Tonsillectomy (age 12+)
|
$61.95 |
$61.95 |
$61.95 |
$3,837.72
|
|
Toxoplasma antibody igg
|
$48.13 |
$48.13 |
$48.13 |
$84.35
|
|
Toxoplasma antibody igm
|
$46.03 |
$46.03 |
$46.03 |
$83.20
|
|
Trabectedin 1 mg intravenous solution
|
$520.98 |
$520.98 |
$520.98 |
$7,403.70
|
|
Transcath biopsy
|
$2,128.00 |
$2,128.00 |
$2,128.00 |
$4,298.05
|
|
Transcath closure of asd
|
$4,916.28 |
$4,916.28 |
$4,916.28 |
$18,772.00
|
|
Transcatheter bx s&i
|
$168.53 |
$168.53 |
$168.53 |
$1,875.96
|
|
Transcath occlusion cns
|
$7,045.15 |
$7,045.15 |
$7,045.15 |
$8,944.39
|
|
Transcath occlusion non-cns
|
$2,413.43 |
$2,413.43 |
$2,413.43 |
$12,427.79
|
|
Transcath rmvl perm ldss pmkr rv
|
$1,196.30 |
$1,196.30 |
$1,196.30 |
$4,627.00
|
|
Transferrin
|
$36.58 |
$36.58 |
$36.58 |
$87.30
|
|
Transfusion blood/blood component(s)
|
$342.13 |
$342.13 |
$342.13 |
$988.24
|
|
Trastuzumab 150 mg intravenous solution
|
$257.07 |
$257.07 |
$257.07 |
$3,900.04
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$214.14 |
$214.14 |
$214.14 |
$7,191.23
|
|
Trauma partial team response w/critical care services level 4
|
$1,958.08 |
$1,958.08 |
$1,958.08 |
$5,455.00
|
|
Tray bonemarrw oncontrol 102mm
|
$455.18 |
$455.18 |
$455.18 |
$1,013.83
|
|
Treat clavicle dislocation 23545
|
$208.08 |
$208.08 |
$208.08 |
$734.00
|
|
Treat elbow dislocation
|
$586.08 |
$586.08 |
$586.08 |
$2,326.40
|
|
Treat elbow fracture
|
$774.73 |
$774.73 |
$774.73 |
$2,125.60
|
|
Treat finger fracture each
|
$545.30 |
$545.30 |
$545.30 |
$1,815.75
|
|
Treat foot dislocation
|
$48.65 |
$48.65 |
$48.65 |
$435.60
|
|
Treat foot dislocation
|
$94.68 |
$94.68 |
$94.68 |
$527.28
|
|
Treat foot dislocation
|
$94.68 |
$94.68 |
$94.68 |
$478.40
|
|
Treat fracture of radius
|
$754.95 |
$754.95 |
$754.95 |
$2,030.33
|
|
Treat fracture of radius
|
$110.60 |
$110.60 |
$110.60 |
$2,316.75
|
|
Treat fracture of ulna
|
$84.00 |
$84.00 |
$84.00 |
$766.72
|
|
Treat hip dislocation
|
$568.05 |
$568.05 |
$568.05 |
$3,152.05
|
|
Treat humerus fracture
|
$545.30 |
$545.30 |
$545.30 |
$1,950.60
|
|
Treat humerus fracture
|
$43.40 |
$43.40 |
$43.40 |
$2,045.35
|
|
Treat knee fracture 27530
|
$78.23 |
$78.23 |
$78.23 |
$580.20
|
|
Treat knee fracture(s)
|
$94.68 |
$94.68 |
$94.68 |
$642.00
|
|
Treat lower leg dislocation
|
$99.58 |
$99.58 |
$99.58 |
$532.60
|
|
Treatment incomplete abortion completed surgically any trimester
|
$878.85 |
$878.85 |
$878.85 |
$3,806.40
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$102.55 |
$102.55 |
$102.55 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$83.48 |
$83.48 |
$83.48 |
$149.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$93.98 |
$93.98 |
$93.98 |
$210.00
|
