|
Telehealth original site facility fee
|
$26.20 |
$55.60 |
$55.60 |
$51.00
|
|
Telethx isodose plan cplx
|
$1,023.20 |
$1,023.20 |
$1,282.67 |
$1,526.85
|
|
Telethx isodose plan simple
|
$951.32 |
$963.20 |
$963.20 |
$873.62
|
|
Temozolomide
|
$3.84 |
$3.84 |
$588.46 |
$588.46
|
|
Temozolomide 100 mg intravenous solution
|
$2,062.26 |
$2,062.26 |
$2,062.26 |
$1,867.28
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$2,178.46 |
$2,178.46 |
$2,178.46 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$222.33 |
$222.33 |
$12,849.38 |
$15,245.38
|
|
Tenotomy open tndn flxr toe sgl tndn spx
|
$1,202.29 |
$1,202.29 |
$1,202.29 |
$2,139.67
|
|
Tension based scoliosis orth
|
$1,957.20 |
$1,957.20 |
$1,957.20 |
$3,528.00
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$31.88 |
$37.00 |
$127.43 |
$39.33
|
|
Term dev, passive hand mitt
|
$206.00 |
$206.00 |
$206.00 |
$406.00
|
|
Term dev, sport/rec/work att
|
$391.20 |
$391.20 |
$391.20 |
$879.20
|
|
Tert gene targeted seq alys
|
$325.60 |
$325.60 |
$325.60 |
$335.00
|
|
Test for chlorohydrocarbons
|
$16.00 |
$16.00 |
$90.94 |
$65.00
|
|
Test for urine cystines
|
$14.40 |
$14.40 |
$14.40 |
$26.00
|
|
Testicular imaging w/vasc flow
|
$689.55 |
$1,052.00 |
$1,052.00 |
$842.56
|
|
Test pathogen(s) for platelets reference
|
$185.20 |
$185.20 |
$185.20 |
$70.00
|
|
Test socket below knee
|
$185.20 |
$185.20 |
$185.20 |
$535.15
|
|
Test socket symes
|
$194.80 |
$194.80 |
$194.80 |
$324.80
|
|
Test sock wrist disart/bel e
|
$148.40 |
$148.40 |
$148.40 |
$350.00
|
|
Test stress cardiovascular tracing only
|
$612.97 |
$739.60 |
$739.60 |
$949.70
|
|
Tetanus immune globulin inj
|
$964.12 |
$1,337.41 |
$2,414.43 |
$1,285.36
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$34.16 |
$34.16 |
$7,506.60 |
$8,737.05
|
|
Tgsap so neo 5-50 rna alys
|
$1,019.60 |
$1,019.60 |
$1,019.60 |
$1,019.60
|
|
Thaw preserved stem cells
|
$528.24 |
$938.00 |
$938.00 |
$1,136.85
|
|
Theophylline therapeutic drug level
|
$35.20 |
$35.20 |
$66.86 |
$108.00
|
|
Therapeutic procd strg endur
|
$54.24 |
$77.60 |
$77.60 |
$85.68
|
|
Therapy activity per session >= 45 minutes
|
$81.60 |
$81.60 |
$81.60 |
$191.50
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$54.00 |
$54.00 |
$62.16 |
$57.31
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$47.20 |
$47.20 |
$62.16 |
$50.00
|
|
Ther nma rdctj intus/obstrcj
|
$263.75 |
$591.20 |
$591.20 |
$529.08
|
|
Ther/proph/diag inj ia
|
$165.47 |
$527.60 |
$527.60 |
$240.35
|
|
Ther radiology tx plng cplx
|
$755.20 |
$755.20 |
$755.20 |
$332.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$8.93 |
$36.68 |
$37.56 |
$25.54
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$850.71 |
$1,302.00 |
$1,302.00 |
$1,687.50
|
|
Thoracic pad
|
$66.00 |
$66.00 |
$66.00 |
$234.19
|
|
Thoracotomy w/expl
|
$547.23 |
$547.23 |
$547.23 |
$2,045.17
|
|
Thoracotomy with cardiac massage
|
$900.60 |
$4,386.00 |
$4,386.00 |
$2,138.76
|
|
Thor rib belt custom fabrica
|
$75.20 |
$75.20 |
$75.20 |
$225.50
|
|
Throat x-ray & fluoroscopy
|
$138.48 |
$138.48 |
$138.48 |
$259.60
|
|
Thrombectmy crnry perq mechanical
|
$2,359.41 |
$9,761.60 |
$9,761.60 |
$3,580.00
|
|
Thrombectomy/inf pq dialysis circuit
|
$3,998.00 |
$3,998.00 |
$10,011.48 |
$8,084.00
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$7,905.60 |
$7,905.60 |
$10,162.03 |
$14,277.20
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$9,987.20 |
$9,987.20 |
$24,689.96 |
$21,413.60
|
|
Thrombin time
|
$14.40 |
$14.40 |
$46.63 |
$53.76
|
|
Thromboplastin inhibition
|
$41.50 |
$41.50 |
$41.50 |
$53.30
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$16.00 |
$16.00 |
$19.15 |
$61.52
|
|
Thromboxane urine
|
$49.20 |
$49.20 |
$51.19 |
$95.00
|
|
Th/wght bear quad-lat brim m
|
$472.80 |
$472.80 |
$472.80 |
$1,695.23
|
|
Thyroglobulin antibody
|
$39.60 |
$39.60 |
$52.73 |
$82.00
|
|
Thyroid imaging
|
$542.40 |
$542.40 |
$643.59 |
$695.02
|
|
Thyroid met imaging
|
$719.78 |
$719.78 |
$719.78 |
$838.25
|
|
Thyroid mets imag whole body
|
$1,216.52 |
$1,478.00 |
$1,478.00 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$42.00 |
$42.00 |
$79.65 |
$111.00
|
|
Thyroid Ultrasound
|
$405.06 |
$447.20 |
$447.20 |
$588.50
|
|
Thyroid uptake measurement
|
$345.22 |
$412.00 |
$412.00 |
$591.25
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$3,265.40 |
$3,265.40 |
$3,795.86 |
$4,112.43
|
|
Thyroxine binding globulin (tbg)
|
$20.40 |
$20.40 |
$63.90 |
$64.35
|
|
Tibial length sock fx or equ
|
$124.80 |
$124.80 |
$124.80 |
$88.92
|
|
Tigecycline injection
|
$1.32 |
$1.32 |
$323.35 |
$234.00
|
|
Tilt table study
|
$813.65 |
$1,256.00 |
$1,256.00 |
$1,507.01
|
|
Tirofiban 12.5 mg/50 ml
|
$5.79 |
$5.79 |
$891.57 |
$458.85
|
|
Tisotumab vedotin-tftv 40 mg intravenous solution
|
$474.70 |
$474.70 |
$57,878.06 |
$13,339.20
|
|
Tissue amnio epifix inj 100mg
|
$7,252.86 |
$7,252.86 |
$7,252.86 |
$4,834.73
|
|
Tissue culture placenta
|
$331.20 |
$331.20 |
$388.94 |
$457.00
|
|
Tissue culture skin/biopsy
|
$316.00 |
$316.00 |
$432.19 |
$484.00
|
|
Tissue culture tumor
|
$394.07 |
$394.07 |
$394.07 |
$483.36
|
|
Tissue exam koh skin/hair/nails
|
$11.20 |
$11.20 |
$22.54 |
$47.20
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$16,563.43 |
$17,883.60 |
$17,883.60 |
$1,134.00
|
|
Tissue transglutaminase iga
|
$12.61 |
$26.00 |
$26.00 |
$44.16
|
|
Tl-201 thallium diag per mci
|
$58.80 |
$58.80 |
$168.25 |
$78.40
|
|
Tlso 2mod symphis-xipho pre
|
$545.20 |
$545.20 |
$545.20 |
$1,874.66
|
|
Tlso 2 shl symphys-stern cst
|
$614.00 |
$614.00 |
$614.00 |
$1,808.59
|
|
Tlso rigid lined custom fab
|
$993.60 |
$993.60 |
$993.60 |
$2,831.21
|
|
Tlso rigid plastic cust fab
|
$1,041.20 |
$1,041.20 |
$1,041.20 |
$2,347.16
|
|
Tlso rigid plastic custom fa
|
$975.20 |
$975.20 |
$975.20 |
$2,788.42
|
|
Tlso trnk sj-t9 pre cst
|
$207.20 |
$207.20 |
$207.20 |
$523.94
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$32.08 |
$32.08 |
$1,274.45 |
$152.36
|
|
Tobramycin non-comp unit
|
$120.43 |
$120.43 |
$120.43 |
$108.42
|
|
Tobramycin peak therapeutic drug level
|
$40.00 |
$40.00 |
$60.41 |
$120.60
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$11.29 |
$11.29 |
$14.79 |
$5,258.52
|
|
Tocilizumab for covid-19
|
$3,869.72 |
$3,869.72 |
$3,869.72 |
$21.08
|
|
Tomosynthesis breast diagnostic left
|
$46.00 |
$46.00 |
$106.61 |
$73.00
|
|
Tomosynthesis breast screen bilateral
|
$46.00 |
$46.00 |
$94.53 |
$72.68
|
|
Tongue biopsy; posterior one-third 41105
|
$1,352.78 |
$1,352.78 |
$1,352.78 |
$3,544.29
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$42.16 |
$42.16 |
$630.06 |
$325.00
|
|
Torsion ank & half solid sti
|
$64.80 |
$64.80 |
$64.80 |
$291.13
|
|
Torsion straight knee joint
|
$71.60 |
$71.60 |
$71.60 |
$253.84
|
|
Toxoplasma antibody igg
|
$33.60 |
$33.60 |
$50.92 |
$89.40
|
|
Toxoplasma antibody igm
|
$36.00 |
$36.00 |
$256.59 |
$87.00
|
|
Tp53 gene full gene sequence
|
$233.83 |
$557.20 |
$557.20 |
$709.80
|
|
Tp53 gene trgt sequence alys
|
$585.20 |
$585.20 |
$585.20 |
$790.68
|
|
Tpmt gene com vrnts
|
$164.27 |
$246.00 |
$246.00 |
$371.80
|
|
Tprnl plmt biodegrdabl matrl
|
$4,193.20 |
$4,193.20 |
$4,193.20 |
$7,144.80
|
|
Trabectedin 1 mg intravenous solution
|
$15,773.00 |
$15,773.00 |
$15,773.00 |
$6,827.00
|
|
Trabeculoplasty laser surg
|
$1,180.80 |
$1,180.80 |
$1,180.80 |
$1,180.80
|
|
Tracheobrnchsc thru est trachs incisn
|
$1,788.40 |
$1,788.40 |
$1,788.40 |
$1,420.44
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$75.20 |
$75.20 |
$80.16 |
$101.25
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$1.10 |
$1.10 |
$1.77 |
$56.38
|
|
Transabdom amnioinfus w/us
|
$271.32 |
$271.32 |
$271.32 |
$678.70
|
