|
Tc-99m pentetate dtpa
|
$46.05 |
$46.05 |
$46.05 |
$222.60
|
|
Tc-99m pertechnetate per mci
|
$3.75 |
$3.75 |
$3.75 |
$22.10
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$121.65 |
$121.65 |
$121.65 |
$136.40
|
|
Tc-99m sestamibi p study dose
|
$46.95 |
$46.95 |
$46.95 |
$274.45
|
|
Tc-99m succimer (dmsa)
|
$157.35 |
$157.35 |
$157.35 |
$1,128.40
|
|
Tc-99m sulfur colloid
|
$45.75 |
$45.75 |
$45.75 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$154.35 |
$154.35 |
$154.35 |
$190.80
|
|
T cells absolute cd4/cd8 including ratio
|
$82.20 |
$82.20 |
$82.20 |
$176.40
|
|
T cells absolute cd 4 count
|
$46.80 |
$46.80 |
$46.80 |
$111.20
|
|
T cells total count
|
$66.00 |
$66.00 |
$66.00 |
$126.90
|
|
Telehealth original site facility fee
|
$22.95 |
$22.95 |
$22.95 |
$51.00
|
|
Telethx isodose plan cplx
|
$174.30 |
$174.30 |
$174.30 |
$1,526.85
|
|
Telethx isodose plan simple
|
$107.70 |
$107.70 |
$107.70 |
$873.62
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$7,670.27 |
$7,670.27 |
$7,670.27 |
$15,245.38
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$9.78 |
$9.78 |
$9.78 |
$39.33
|
|
Test for chlorohydrocarbons
|
$6.45 |
$6.45 |
$6.45 |
$65.00
|
|
Test for urine cystines
|
$8.85 |
$8.85 |
$8.85 |
$26.00
|
|
Testicular imaging w/vasc flow
|
$452.25 |
$452.25 |
$452.25 |
$842.56
|
|
Test pathogen(s) for platelets reference
|
$32.70 |
$32.70 |
$32.70 |
$70.00
|
|
Test stress cardiovascular tracing only
|
$223.95 |
$223.95 |
$223.95 |
$949.70
|
|
Tgsap so/hl 51/< rna alys
|
$965.85 |
$965.85 |
$965.85 |
$4,347.00
|
|
Theophylline therapeutic drug level
|
$24.90 |
$24.90 |
$24.90 |
$108.00
|
|
Therapeutic procd strg endur
|
$79.05 |
$79.05 |
$79.05 |
$85.68
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$15.75 |
$15.75 |
$15.75 |
$57.31
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$12.00 |
$12.00 |
$12.00 |
$50.00
|
|
Ther nma rdctj intus/obstrcj
|
$72.45 |
$72.45 |
$72.45 |
$529.08
|
|
Ther/proph/diag inj ia
|
$53.70 |
$53.70 |
$53.70 |
$240.35
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$6.08 |
$6.08 |
$6.08 |
$25.54
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$383.85 |
$383.85 |
$383.85 |
$1,687.50
|
|
Thoracotomy with cardiac massage
|
$1,912.95 |
$1,912.95 |
$1,912.95 |
$2,138.76
|
|
Thrombectmy crnry perq mechanical
|
$1,468.65 |
$1,468.65 |
$1,468.65 |
$3,580.00
|
|
Thrombectomy/inf pq dialysis circuit
|
$2,648.25 |
$2,648.25 |
$2,648.25 |
$8,084.00
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$5,352.15 |
$5,352.15 |
$5,352.15 |
$14,277.20
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$8,112.60 |
$8,112.60 |
$8,112.60 |
$21,413.60
|
|
Thrombin time
|
$10.05 |
$10.05 |
$10.05 |
$53.76
|
|
Thromboendarterectomy common femoral
|
$1,069.65 |
$1,069.65 |
$1,069.65 |
$3,980.60
|
|
Thromboplastin inhibition
|
$16.80 |
$16.80 |
$16.80 |
$53.30
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$11.40 |
$11.40 |
$11.40 |
$61.52
|
|
Thyroglobulin antibody
|
$27.75 |
$27.75 |
$27.75 |
$82.00
|
|
Thyroid imaging
|
$452.25 |
$452.25 |
$452.25 |
$695.02
|
|
Thyroid mets imag whole body
|
$452.25 |
$452.25 |
$452.25 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$29.40 |
$29.40 |
$29.40 |
$111.00
|
|
Thyroid Ultrasound
|
$101.55 |
$101.55 |
$101.55 |
$588.50
|
|
Thyroid uptake measurement
|
$452.25 |
$452.25 |
$452.25 |
$591.25
|
|
Thyroxine binding globulin (tbg)
|
$25.05 |
$25.05 |
$25.05 |
$64.35
|
|
Tib/per revasc stent & ather 37231
|
$7,850.85 |
$7,850.85 |
$7,850.85 |
$21,249.26
|
|
Tib/per revasc stnt & ather
|
$2,004.00 |
$2,004.00 |
$2,004.00 |
$11,078.70
|
|
Tib/per revasc w/ather add-on 37233
|
$3,739.95 |
$3,739.95 |
$3,739.95 |
$9,769.65
|
|
Tilt table study
|
$450.75 |
$450.75 |
$450.75 |
$1,507.01
|
|
Tissue culture skin/biopsy
|
$130.95 |
$130.95 |
$130.95 |
$484.00
|
|
Tissue exam koh skin/hair/nails
|
$7.20 |
$7.20 |
$7.20 |
$47.20
|
|
Tissue transglutaminase iga
|
$74.55 |
$74.55 |
$74.55 |
$44.16
|
|
Tl-201 thallium diag per mci
|
$44.85 |
$44.85 |
$44.85 |
$78.40
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$117.02 |
$117.02 |
$117.02 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$28.35 |
$28.35 |
$28.35 |
$120.60
|
|
Tomosynthesis breast diagnostic left
|
$74.10 |
$74.10 |
$74.10 |
$73.00
|
|
Tomosynthesis breast screen bilateral
|
$74.10 |
$74.10 |
$74.10 |
$72.68
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$253.57 |
$253.57 |
$253.57 |
$325.00
|
|
Total tau
|
$51.15 |
$51.15 |
$51.15 |
$312.50
|
|
Toxoplasma antibody igg
|
$25.20 |
$25.20 |
$25.20 |
$89.40
|
|
Toxoplasma antibody igm
|
$25.20 |
$25.20 |
$25.20 |
$87.00
|
|
Tp53 gene full gene sequence
|
$823.80 |
$823.80 |
$823.80 |
$709.80
|
|
Tp53 gene known famil vrnt
|
$395.40 |
$395.40 |
$395.40 |
$395.40
|
|
Tp53 gene trgt sequence alys
|
$422.85 |
$422.85 |
$422.85 |
$790.68
|
|
Tpmt gene com vrnts
|
$224.40 |
$224.40 |
$224.40 |
$371.80
|
|
Tprnl plmt biodegrdabl matrl
|
$1,163.70 |
$1,163.70 |
$1,163.70 |
$7,144.80
|
|
Tracheobrnchsc thru est trachs incisn
|
$269.70 |
$269.70 |
$269.70 |
$1,420.44
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$21.00 |
$21.00 |
$21.00 |
$101.25
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$12.64 |
$12.64 |
$12.64 |
$56.38
|
|
Transabdom amnioinfus w/us
|
$195.75 |
$195.75 |
$195.75 |
$678.70
|
|
Transcath biopsy
|
$1,384.20 |
$1,384.20 |
$1,384.20 |
$4,285.93
|
|
Transcath closure of asd
|
$3,076.95 |
$3,076.95 |
$3,076.95 |
$16,741.40
|
|
Transcatheter bx s&i
|
$347.25 |
$347.25 |
$347.25 |
$1,915.00
|
|
Transcath occlusion cns
|
$2,493.45 |
$2,493.45 |
$2,493.45 |
$7,157.76
|
|
Transcath occlusion non-cns
|
$2,110.35 |
$2,110.35 |
$2,110.35 |
$10,031.28
|
|
Transcutaneous carboxyhb
|
$4.80 |
$4.80 |
$4.80 |
$33.57
|
|
Transferrin
|
$22.05 |
$22.05 |
$22.05 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$119.40 |
$119.40 |
$119.40 |
$983.00
|
|
Trastuzumab 150 mg intravenous solution
|
$1,730.42 |
$1,730.42 |
$1,730.42 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$1,510.82 |
$1,510.82 |
$1,510.82 |
$7,540.20
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$3,759.45 |
$3,759.45 |
$3,759.45 |
$5,835.15
|
|
Trauma partial team response w/critical care services level 4
|
$988.65 |
$988.65 |
$988.65 |
$4,523.04
|
|
Tray bonemarrw oncontrol 102mm
|
$583.37 |
$583.37 |
$583.37 |
$940.80
|
|
Treat elbow dislocation
|
$723.45 |
$723.45 |
$723.45 |
$2,223.20
|
|
Treat elbow fracture
|
$723.45 |
$723.45 |
$723.45 |
$1,919.13
|
|
Treat finger fracture each
|
$63.30 |
$63.30 |
$63.30 |
$1,536.00
|
|
Treat foot dislocation
|
$101.55 |
$101.55 |
$101.55 |
$527.28
|
|
Treat fracture of radius
|
$205.50 |
$205.50 |
$205.50 |
$1,790.00
|
|
Treat fracture of ulna
|
$211.95 |
$211.95 |
$211.95 |
$726.05
|
|
Treat hip dislocation
|
$723.45 |
$723.45 |
$723.45 |
$2,192.80
|
|
Treat humerus fracture
|
$283.95 |
$283.95 |
$283.95 |
$1,771.43
|
|
Treat knee dislocation
|
$659.25 |
$659.25 |
$659.25 |
$2,220.89
|
|
Treat knee fracture 27530
|
$109.20 |
$109.20 |
$109.20 |
$550.00
|
|
Treat lower leg dislocation
|
$211.95 |
$211.95 |
$211.95 |
$530.75
|
|
Treatment incomplete abortion completed surgically any trimester
|
$834.75 |
$834.75 |
$834.75 |
$3,916.04
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$43.50 |
$43.50 |
$43.50 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$39.60 |
$39.60 |
$39.60 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$98.55 |
$98.55 |
$98.55 |
$203.35
|
|
Treatment of ankle fracture
|
$3,081.15 |
$3,081.15 |
$3,081.15 |
$8,453.60
|
|
Treatment of ankle fracture 27786
|
$241.50 |
$241.50 |
$241.50 |
$520.80
|
