|
Tc-99m maa
|
$130.80 |
$130.80 |
$130.80 |
$292.80
|
|
Tc-99m mebrofenin
|
$96.60 |
$96.60 |
$96.60 |
$157.65
|
|
Tc-99m medronate
|
$19.20 |
$19.20 |
$19.20 |
$111.01
|
|
Tc-99m pentetate dtpa
|
$559.80 |
$559.80 |
$559.80 |
$222.60
|
|
Tc-99m pertechnetate per mci
|
$3.60 |
$3.60 |
$3.60 |
$22.10
|
|
Tc-99m sestamibi p study dose
|
$366.00 |
$366.00 |
$366.00 |
$274.45
|
|
Tc-99m sulfur colloid
|
$133.80 |
$133.80 |
$133.80 |
$240.50
|
|
T cells absolute cd4/cd8 including ratio
|
$266.40 |
$266.40 |
$266.40 |
$176.40
|
|
T cells absolute cd 4 count
|
$28.80 |
$28.80 |
$28.80 |
$111.20
|
|
Telehealth original site facility fee
|
$32.40 |
$32.40 |
$32.40 |
$51.00
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$21,126.00 |
$21,126.00 |
$21,126.00 |
$15,245.38
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$14.40 |
$14.40 |
$14.40 |
$39.33
|
|
Test stress cardiovascular tracing only
|
$540.00 |
$540.00 |
$540.00 |
$949.70
|
|
Tetanus immune globulin inj
|
$2,253.60 |
$2,253.60 |
$2,253.60 |
$1,285.36
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$14,011.20 |
$14,011.20 |
$14,011.20 |
$8,737.05
|
|
Theophylline therapeutic drug level
|
$137.40 |
$137.40 |
$137.40 |
$108.00
|
|
Ther fx nasal inf turbinate
|
$235.80 |
$235.80 |
$235.80 |
$3,786.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$17.40 |
$17.40 |
$17.40 |
$25.54
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$2,500.20 |
$2,500.20 |
$2,500.20 |
$1,687.50
|
|
Thrombectmy crnry perq mechanical
|
$7,528.80 |
$7,528.80 |
$7,528.80 |
$3,580.00
|
|
Thrombectomy/inf pq dialysis circuit
|
$2,337.60 |
$2,337.60 |
$2,337.60 |
$8,084.00
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$26,198.40 |
$26,198.40 |
$26,198.40 |
$21,413.60
|
|
Thromb/endar/neck inc/car/vert/subc35301
|
$2,668.20 |
$2,668.20 |
$2,668.20 |
$5,520.00
|
|
Thrombin time
|
$76.80 |
$76.80 |
$76.80 |
$53.76
|
|
Thromboendarterectomy common femoral
|
$1,550.40 |
$1,550.40 |
$1,550.40 |
$3,980.60
|
|
Thromboendarterectomy including patch graft if preformed;
|
$2,390.40 |
$2,390.40 |
$2,390.40 |
$5,994.11
|
|
Thromboplastin inhibition
|
$46.80 |
$46.80 |
$46.80 |
$53.30
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$195.60 |
$195.60 |
$195.60 |
$61.52
|
|
Thyroglobulin antibody
|
$511.20 |
$511.20 |
$511.20 |
$82.00
|
|
Thyroid (TSH) Test
|
$181.20 |
$181.20 |
$181.20 |
$111.00
|
|
Thyroid Ultrasound
|
$702.00 |
$702.00 |
$702.00 |
$588.50
|
|
Thyroid uptake measurement
|
$330.60 |
$330.60 |
$330.60 |
$591.25
|
|
Tirofiban 12.5 mg/50 ml
|
$961.20 |
$961.20 |
$961.20 |
$458.85
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$152.63 |
$152.63 |
$152.63 |
$1,134.00
|
|
Tissue matrix xcm thk 20x30cm -cost per sq cm
|
$830.41 |
$830.41 |
$830.41 |
$18,999.96
|
|
Tl-201 thallium diag per mci
|
$40.80 |
$40.80 |
$40.80 |
$78.40
|
|
Tlh uterus 250 g or less
|
$2,334.00 |
$2,334.00 |
$2,334.00 |
$11,533.76
|
|
Tlh w/t/o uterus over 250 g
|
$2,319.00 |
$2,319.00 |
$2,319.00 |
$12,320.22
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$12.00 |
$12.00 |
$12.00 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$190.20 |
$190.20 |
$190.20 |
$120.60
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$7,282.20 |
$7,282.20 |
$7,282.20 |
$5,258.52
|
|
Tomosynthesis breast diagnostic left
|
$43.20 |
$43.20 |
$43.20 |
$73.00
|
|
Tomosynthesis breast screen bilateral
|
$64.80 |
$64.80 |
$64.80 |
$72.68
|
|
Tongue biopsy; posterior one-third 41105
|
$1,218.00 |
$1,218.00 |
$1,218.00 |
$3,544.29
|
|
Tonsillectomy (age 12+)
|
$570.60 |
$570.60 |
$570.60 |
$4,424.11
|
|
Tonsillectomy (child under 12)
|
$526.80 |
$526.80 |
$526.80 |
$5,339.00
|
|
Total hysterectomy
|
$1,974.00 |
$1,974.00 |
$1,974.00 |
$3,001.70
|
|
Toxoplasma antibody igg
|
$213.00 |
$213.00 |
$213.00 |
$89.40
|
|
Toxoplasma antibody igm
|
$472.80 |
$472.80 |
$472.80 |
$87.00
|
|
Tpmt gene com vrnts
|
$619.20 |
$619.20 |
$619.20 |
$371.80
|
|
Transferrin
|
$120.00 |
$120.00 |
$120.00 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$574.80 |
$574.80 |
$574.80 |
$983.00
|
|
Trastuzumab 150 mg intravenous solution
|
$5,196.60 |
$5,196.60 |
$5,196.60 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$13,574.40 |
$13,574.40 |
$13,574.40 |
$7,540.20
|
|
Trauma partial team response w/critical care services level 4
|
$1,602.60 |
$1,602.60 |
$1,602.60 |
$4,523.04
|
|
Treat ankle dislocation
|
$2,823.00 |
$2,823.00 |
$2,823.00 |
$2,358.40
|
|
Treat elbow dislocation
|
$2,823.00 |
$2,823.00 |
$2,823.00 |
$2,223.20
|
|
Treat humerus fracture
|
$999.60 |
$999.60 |
$999.60 |
$1,771.43
|
|
Treat kneecap dislocation
|
$2,823.00 |
$2,823.00 |
$2,823.00 |
$1,068.90
|
|
Treat knee fracture 27530
|
$248.40 |
$248.40 |
$248.40 |
$550.00
|
|
Treat knee fracture(s)
|
$172.80 |
$172.80 |
$172.80 |
$642.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$261.00 |
$261.00 |
$261.00 |
$203.35
|
|
Treatment of ankle fracture 27786
|
$642.00 |
$642.00 |
$642.00 |
$520.80
|
|
Treatment of fibula fracture 27780
|
$361.20 |
$361.20 |
$361.20 |
$491.50
|
|
Treatment of heel fracture 28400
|
$278.40 |
$278.40 |
$278.40 |
$473.00
|
|
Treatment of thigh fracture
|
$346.80 |
$346.80 |
$346.80 |
$548.90
|
|
Treatment of toe fracture 28510
|
$577.80 |
$577.80 |
$577.80 |
$369.70
|
|
Treponema pallidum antibody
|
$188.40 |
$188.40 |
$188.40 |
$70.40
|
|
Trg gene rearrangement anal
|
$627.00 |
$627.00 |
$627.00 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$31.80 |
$31.80 |
$31.80 |
$43.21
|
|
Triglycerides
|
$93.00 |
$93.00 |
$93.00 |
$58.05
|
|
Trmt of fracture (femoral shaft) 27500
|
$346.80 |
$346.80 |
$346.80 |
$754.80
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$17,764.20 |
$17,764.20 |
$17,764.20 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$1,356.60 |
$1,356.60 |
$1,356.60 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$18,447.60 |
$18,447.60 |
$18,447.60 |
$15,330.11
|
|
Trnscath retrv pq vasc fb w/guide
|
$5,332.80 |
$5,332.80 |
$5,332.80 |
$4,523.96
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$3,538.20 |
$3,538.20 |
$3,538.20 |
$5,069.50
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$4,198.80 |
$4,198.80 |
$4,198.80 |
$4,250.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$4,201.20 |
$4,201.20 |
$4,201.20 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$1,884.60 |
$1,884.60 |
$1,884.60 |
$3,866.70
|
|
Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/<
|
$1,095.60 |
$1,095.60 |
$1,095.60 |
$2,986.34
|
|
Troponin quantitative
|
$169.20 |
$169.20 |
$169.20 |
$127.20
|
|
Tubal Ligation (Laparoscopic)
|
$1,158.00 |
$1,158.00 |
$1,158.00 |
$4,323.20
|
|
Tx closed tib shaft fx without manip
|
$248.40 |
$248.40 |
$248.40 |
$535.60
|
|
Tympanic membrane repair
|
$1,320.00 |
$1,320.00 |
$1,320.00 |
$2,638.87
|
|
Tympanostomy/ven tube/loc/top anes 69433
|
$301.80 |
$301.80 |
$301.80 |
$911.43
|
|
Tympp antrt/mastoid without ossic chain recnst 69635
|
$2,416.80 |
$2,416.80 |
$2,416.80 |
$7,000.36
|
|
Ua w/micro/comp poc
|
$34.20 |
$34.20 |
$34.20 |
$23.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$42,093.60 |
$42,093.60 |
$42,093.60 |
$20,945.01
|
|
Ultrasound abdomen aorta screening study aaa
|
$440.40 |
$440.40 |
$440.40 |
$394.20
|
|
Ultrasound breast complete
|
$784.80 |
$784.80 |
$784.80 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$394.20 |
$394.20 |
$394.20 |
$449.35
|
|
Ultrasound chest
|
$933.00 |
$933.00 |
$933.00 |
$460.85
|
|
Ultrasound elastography parenchyma
|
$127.20 |
$127.20 |
$127.20 |
$307.00
|
|
Ultrasound exam k transpl w/doppler
|
$289.20 |
$289.20 |
$289.20 |
$573.54
|
|
Ultrasound guidance for vascular access
|
$447.60 |
$447.60 |
$447.60 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$985.80 |
$985.80 |
$985.80 |
$720.15
|
|
Ultrasound joint complete left
|
$500.40 |
$500.40 |
$500.40 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$327.00 |
$327.00 |
$327.00 |
$425.45
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$304.80 |
$304.80 |
$304.80 |
$331.50
|
