|
Tc-99m pertechnetate per mci
|
$9.10 |
$9.10 |
$244.54 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$109.90 |
$109.90 |
$109.90 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$199.85 |
$199.85 |
$6,202.30 |
$221.60
|
|
Tc-99m succimer (dmsa)
|
$306.95 |
$306.95 |
$306.95 |
$1,578.33
|
|
Tc-99m sulfur colloid
|
$313.60 |
$313.60 |
$1,328.96 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$119.00 |
$119.00 |
$3,125.17 |
$198.05
|
|
Tc-99m tilmanocept diag
|
$1,279.60 |
$1,279.60 |
$4,513.82 |
$930.54
|
|
Tcd emboli detect w/inj
|
$315.70 |
$315.70 |
$315.70 |
$404.68
|
|
Tcd emboli detect without inj
|
$309.75 |
$309.75 |
$309.75 |
$397.15
|
|
T cells absolute cd4/cd8 including ratio
|
$376.25 |
$376.25 |
$376.25 |
$186.00
|
|
T cells absolute cd 4 count
|
$197.05 |
$197.05 |
$5,838.04 |
$120.25
|
|
T cells total count
|
$199.50 |
$199.50 |
$8,225.14 |
$124.11
|
|
Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution
|
$10,547.78 |
$10,547.78 |
$10,547.78 |
$10,547.78
|
|
Tee w or without fol w/cont, mon
|
$591.50 |
$591.50 |
$591.50 |
$934.93
|
|
Telavancin injection
|
$693.04 |
$693.04 |
$693.04 |
$1,216.45
|
|
Telehealth original site facility fee
|
$22.75 |
$22.75 |
$22.75 |
$44.85
|
|
Telethx isodose plan cplx
|
$2,987.25 |
$2,987.25 |
$2,987.25 |
$1,617.00
|
|
Telethx isodose plan simple
|
$3,902.50 |
$3,902.50 |
$3,902.50 |
$848.72
|
|
Temozolomide
|
$12.72 |
$12.72 |
$12.72 |
$438.51
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$4,837.48 |
$4,837.48 |
$4,837.48 |
$2,791.41
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$17,652.73 |
$17,652.73 |
$17,652.73 |
$17,652.73
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$25.46 |
$25.46 |
$25.46 |
$44.49
|
|
Teriparatide injection
|
$9,913.94 |
$9,913.94 |
$9,913.94 |
$3,072.72
|
|
Testicular imaging w/vasc flow
|
$913.85 |
$913.85 |
$2,583.68 |
$780.48
|
|
Test pathogen(s) for platelets reference
|
$75.95 |
$75.95 |
$3,463.25 |
$106.50
|
|
Test stress cardiovascular tracing only
|
$1,909.95 |
$1,909.95 |
$1,909.95 |
$1,001.55
|
|
Test urine for porphyrins
|
$252.30 |
$252.30 |
$252.30 |
$27.30
|
|
Test urine urobilinogen
|
$8.75 |
$8.75 |
$8.75 |
$6.17
|
|
Tetanus immune globulin inj
|
$811.66 |
$811.66 |
$7,747.20 |
$1,395.20
|
|
Theophylline therapeutic drug level
|
$42.70 |
$42.70 |
$526.99 |
$108.00
|
|
Therapeutic procd strg endur
|
$32.90 |
$32.90 |
$339.63 |
$81.36
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$37.45 |
$37.45 |
$37.45 |
$55.00
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$25.20 |
$25.20 |
$25.20 |
$50.40
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$20.51 |
$20.51 |
$20.51 |
$38.64
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,662.85 |
$1,662.85 |
$1,662.85 |
$1,804.00
|
|
Thoracotomy w/expl
|
$181.30 |
$181.30 |
$181.30 |
$2,045.17
|
|
Thrombectmy crnry perq mechanical
|
$2,133.95 |
$2,133.95 |
$2,133.95 |
$3,580.00
|
|
Thrombectomy/inf pq dialysis circuit
|
$16,079.48 |
$16,079.48 |
$18,447.80 |
$7,828.60
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$31,064.15 |
$31,064.15 |
$35,500.15 |
$15,185.00
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$48,158.88 |
$48,158.88 |
$56,583.10 |
$24,605.30
|
|
Thrombin time
|
$60.90 |
$60.90 |
$796.25 |
$48.75
|
|
Thromboendarterectomy common femoral
|
$9,124.15 |
$9,124.15 |
$9,124.15 |
$7,431.06
|
|
Thromboendarterectomy sfa
|
$7,990.15 |
$7,990.15 |
$7,990.15 |
$5,472.00
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$77.35 |
$77.35 |
$77.35 |
$56.93
|
|
Thyroglobulin antibody
|
$50.75 |
$50.75 |
$50.75 |
$84.00
|
|
Thyroid imaging
|
$568.75 |
$568.75 |
$568.75 |
$670.80
|
|
Thyroid met imaging
|
$838.25 |
$838.25 |
$838.25 |
$549.70
|
|
Thyroid mets imag whole body
|
$1,269.80 |
$1,269.80 |
$4,809.30 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$151.55 |
$151.55 |
$3,662.40 |
$120.00
|
|
Thyroid Ultrasound
|
$1,158.15 |
$1,158.15 |
$1,158.15 |
$589.96
|
|
Thyroid uptake measurement
|
$370.30 |
$370.30 |
$370.30 |
$653.60
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$5,107.76 |
$5,107.76 |
$5,107.76 |
$4,886.55
|
|
Thyroxine binding globulin (tbg)
|
$54.60 |
$54.60 |
$54.60 |
$63.60
|
|
Tib/per revasc stent & ather 37231
|
$11,093.25 |
$11,093.25 |
$11,093.25 |
$21,900.00
|
|
Tib/per revasc stnt & ather
|
$3,757.60 |
$3,757.60 |
$3,757.60 |
$11,121.63
|
|
Tib/per revasc w/ather add-on 37233
|
$3,315.55 |
$3,315.55 |
$3,315.55 |
$10,406.14
|
|
Tigecycline injection
|
$195.70 |
$195.70 |
$195.70 |
$308.75
|
|
Tilt table study
|
$2,480.10 |
$2,480.10 |
$2,480.10 |
$1,495.00
|
|
Tirofiban 12.5 mg/50 ml
|
$360.60 |
$360.60 |
$360.60 |
$360.60
|
|
Tissue culture skin/biopsy
|
$236.95 |
$236.95 |
$5,007.11 |
$558.87
|
|
Tissue culture tumor
|
$1,146.43 |
$1,146.43 |
$1,146.43 |
$529.23
|
|
Tissue exam koh skin/hair/nails
|
$13.65 |
$13.65 |
$854.00 |
$47.40
|
|
Tl-201 thallium diag per mci
|
$28.35 |
$28.35 |
$6,110.61 |
$77.22
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$131.70 |
$131.70 |
$131.70 |
$125.87
|
|
Tobramycin peak therapeutic drug level
|
$107.45 |
$107.45 |
$107.45 |
$121.55
|
|
Tomosynthesis breast diagnostic left
|
$55.30 |
$55.30 |
$55.30 |
$63.70
|
|
Tomosynthesis breast screen bilateral
|
$64.75 |
$64.75 |
$64.75 |
$73.45
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$3,703.29 |
$3,703.29 |
$3,703.29 |
$303.88
|
|
Toxoplasma antibody igg
|
$118.65 |
$118.65 |
$758.48 |
$84.35
|
|
Toxoplasma antibody igm
|
$146.65 |
$146.65 |
$758.48 |
$83.20
|
|
Tp53 gene trgt sequence alys
|
$518.35 |
$518.35 |
$518.35 |
$919.10
|
|
Tpmt gene com vrnts
|
$196.00 |
$196.00 |
$196.00 |
$381.55
|
|
Tprnl plmt biodegrdabl matrl
|
$3,335.50 |
$3,335.50 |
$3,335.50 |
$6,105.61
|
|
Trabectedin 1 mg intravenous solution
|
$8,995.31 |
$8,995.31 |
$8,995.31 |
$6,133.80
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$33.25 |
$33.25 |
$549.21 |
$93.75
|
|
Transcath biopsy
|
$2,479.05 |
$2,479.05 |
$11,888.63 |
$4,298.05
|
|
Transcath closure of asd
|
$10,888.85 |
$10,888.85 |
$27,255.09 |
$18,772.00
|
|
Transcath closure of vsd
|
$8,408.75 |
$8,408.75 |
$8,408.75 |
$18,837.00
|
|
Transcatheter bx s&i
|
$1,411.55 |
$1,411.55 |
$7,654.78 |
$1,875.96
|
|
Transcath mv repair addl prosthesis
|
$2,230.20 |
$2,230.20 |
$2,230.20 |
$5,118.10
|
|
Transcath mv repair init prosthesis
|
$4,460.40 |
$4,460.40 |
$4,460.40 |
$17,106.18
|
|
Transcath occlusion cns
|
$14,484.05 |
$14,484.05 |
$55,289.17 |
$8,944.39
|
|
Transcath occlusion non-cns
|
$3,621.10 |
$3,621.10 |
$55,289.17 |
$12,427.79
|
|
Trans cath replace aortic valve 33366
|
$8,982.40 |
$8,982.40 |
$8,982.40 |
$17,848.35
|
|
Transcath rmvl perm ldss pmkr rv
|
$15,403.85 |
$15,403.85 |
$15,403.85 |
$4,627.00
|
|
Transferrin
|
$99.75 |
$99.75 |
$2,781.68 |
$87.30
|
|
Transfusion blood/blood component(s)
|
$726.60 |
$726.60 |
$726.60 |
$988.24
|
|
Trastuzumab 150 mg intravenous solution
|
$10,885.56 |
$10,885.56 |
$10,885.56 |
$3,401.26
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$9,010.32 |
$9,010.32 |
$9,010.32 |
$7,620.16
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$6,163.72 |
$6,163.72 |
$6,163.72 |
$3,600.00
|
|
Tray bonemarrw oncontrol 102mm
|
$1,004.01 |
$1,004.01 |
$1,004.01 |
$1,094.25
|
|
Treat ankle dislocation
|
$1,325.10 |
$1,325.10 |
$1,325.10 |
$2,207.20
|
|
Treat elbow dislocation
|
$1,081.85 |
$1,081.85 |
$1,081.85 |
$2,326.40
|
|
Treat elbow fracture
|
$1,429.75 |
$1,429.75 |
$1,429.75 |
$2,125.60
|
|
Treat finger fracture each
|
$1,325.10 |
$1,325.10 |
$1,325.10 |
$1,815.75
|
|
Treat foot dislocation
|
$80.15 |
$80.15 |
$80.15 |
$435.60
|
|
Treat fracture of radius
|
$1,325.10 |
$1,325.10 |
$1,325.10 |
$2,030.33
|
|
Treat fracture of ulna
|
$138.25 |
$138.25 |
$138.25 |
$766.72
|
|
Treat hip dislocation
|
$984.90 |
$984.90 |
$984.90 |
$3,152.05
|
|
Treat hip socket fracture
|
$192.15 |
$192.15 |
$192.15 |
$1,340.10
|
