|
Strapping of ankle and/or ft 29540
|
$178.20 |
$178.20 |
$178.20 |
$223.45
|
|
Strapping of elbow or wrist 29260
|
$260.71 |
$260.71 |
$260.71 |
$157.46
|
|
Strapping of hand or finger
|
$151.27 |
$151.27 |
$151.27 |
$177.45
|
|
Strapping of knee
|
$269.88 |
$269.88 |
$269.88 |
$205.20
|
|
Strep b dna amp probe
|
$59.36 |
$59.36 |
$59.36 |
$124.15
|
|
Stress test pulmonary
|
$306.19 |
$306.19 |
$306.19 |
$324.00
|
|
Str markers specimen anal
|
$1,653.89 |
$1,653.89 |
$1,653.89 |
$756.60
|
|
Sugars single quant
|
$34.22 |
$34.22 |
$34.22 |
$64.28
|
|
Sulfonylurea screen qn-sendout
|
$99.86 |
$99.86 |
$99.86 |
$158.75
|
|
Surg dx exam anorectal
|
$130.47 |
$130.47 |
$130.47 |
$3,480.50
|
|
Surg ect salp-oophorectomy 59120
|
$249.63 |
$249.63 |
$249.63 |
$1,632.60
|
|
Surgical pathology level 1 gross examination only
|
$31.54 |
$31.54 |
$31.54 |
$81.00
|
|
Surgical pathology level 2 gross & microscopic examination
|
$49.98 |
$49.98 |
$49.98 |
$143.55
|
|
Surgical pathology level 3 gross & microscopic examination
|
$67.83 |
$67.83 |
$67.83 |
$184.21
|
|
Surgical pathology level 4 gross & microscopic examination
|
$67.83 |
$67.83 |
$67.83 |
$250.20
|
|
Surgical pathology level 5 gross & microscopic examination
|
$453.39 |
$453.39 |
$453.39 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,018.64 |
$1,018.64 |
$1,018.64 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$36.96 |
$36.96 |
$36.96 |
$45.60
|
|
Susceptibility enzyme detection per enzyme
|
$31.36 |
$31.36 |
$31.36 |
$35.89
|
|
Susceptibility mic per plate
|
$121.80 |
$121.80 |
$121.80 |
$106.00
|
|
Suscept studies macrobroth dilution ea
|
$64.40 |
$64.40 |
$64.40 |
$59.28
|
|
Sutr lg intestine 1/mult perf without colostomy 44604
|
$1,308.44 |
$1,308.44 |
$1,308.44 |
$1,995.00
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$27.56 |
$27.56 |
$27.56 |
$42.24
|
|
System pacing micra av
|
$23,660.31 |
$23,660.31 |
$23,660.31 |
$24,316.50
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$73,932.72 |
$73,932.72 |
$73,932.72 |
$12,003.00
|
|
T3 (triiodothyronine) free
|
$39.83 |
$39.83 |
$39.83 |
$100.32
|
|
T3 (triiodothyronine) total
|
$24.12 |
$24.12 |
$24.12 |
$93.52
|
|
T4 (thyroxine) free
|
$37.03 |
$37.03 |
$37.03 |
$89.60
|
|
T4 (thyroxine) total
|
$31.42 |
$31.42 |
$31.42 |
$70.20
|
|
Tacrolimus therapeutic drug level
|
$31.98 |
$31.98 |
$31.98 |
$122.50
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$208.01 |
$208.01 |
$208.01 |
$289.20
|
|
Target gsa panel hmtlmph neop
|
$2,775.81 |
$2,775.81 |
$2,775.81 |
$2,246.30
|
|
Target gsa panel organ/hmtlmph neop
|
$10,151.68 |
$10,151.68 |
$10,151.68 |
$3,746.70
|
|
Target gsa panel organ neop
|
$2,079.25 |
$2,079.25 |
$2,079.25 |
$1,701.91
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$159.00 |
$159.00 |
$159.00 |
$200.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$98.58 |
$98.58 |
$98.58 |
$179.95
|
|
T cells absolute cd4/cd8 including ratio
|
$74.73 |
$74.73 |
$74.73 |
$184.00
|
|
T cells absolute cd 4 count
|
$42.93 |
$42.93 |
$42.93 |
$111.20
|
|
T cells total count
|
$60.42 |
$60.42 |
$60.42 |
$130.20
|
|
Telehealth original site facility fee
|
$28.36 |
$28.36 |
$28.36 |
$51.00
|
|
Test stress cardiovascular tracing only
|
$1,161.28 |
$1,161.28 |
$1,161.28 |
$953.40
|
|
Theophylline therapeutic drug level
|
$24.12 |
$24.12 |
$24.12 |
$108.00
|
|
Therapy Activity Training (each 15 minutes)
|
$65.32 |
$65.32 |
$65.32 |
$101.38
|
|
Therapy Exercise Session (each 15 minutes)
|
$87.67 |
$87.67 |
$87.67 |
$98.58
|
|
Ther nma rdctj intus/obstrcj
|
$505.54 |
$505.54 |
$505.54 |
$538.88
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$247.30 |
$247.30 |
$247.30 |
$313.60
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,055.45 |
$1,055.45 |
$1,055.45 |
$1,724.25
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$87.77 |
$87.77 |
$87.77 |
$1,703.45
|
|
Thrombin time
|
$30.69 |
$30.69 |
$30.69 |
$54.18
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$56.44 |
$56.44 |
$56.44 |
$62.01
|
|
Thyroglobulin antibody
|
$50.88 |
$50.88 |
$50.88 |
$82.50
|
|
Thyroid imaging
|
$31.73 |
$31.73 |
$31.73 |
$695.60
|
|
Thyroid (TSH) Test
|
$30.29 |
$30.29 |
$30.29 |
$112.70
|
|
Thyroid Ultrasound
|
$768.69 |
$768.69 |
$768.69 |
$588.50
|
|
Thyroid uptake measurement
|
$16.88 |
$16.88 |
$16.88 |
$591.25
|
|
Thyroxine binding globulin (tbg)
|
$25.25 |
$25.25 |
$25.25 |
$64.51
|
|
Tissue culture placenta
|
$304.50 |
$304.50 |
$304.50 |
$453.00
|
|
Tissue culture skin/biopsy
|
$285.59 |
$285.59 |
$285.59 |
$488.74
|
|
Tissue culture tumor
|
$299.10 |
$299.10 |
$299.10 |
$486.50
|
|
Tissue exam koh skin/hair/nails
|
$120.40 |
$120.40 |
$120.40 |
$47.40
|
|
Tissue transglutaminase iga
|
$31.27 |
$31.27 |
$31.27 |
$44.80
|
|
Tobramycin peak therapeutic drug level
|
$27.49 |
$27.49 |
$27.49 |
$120.60
|
|
Toe X-ray (both feet)
|
$179.68 |
$179.68 |
$179.68 |
$258.65
|
|
Tomosynthesis breast diagnostic left
|
$44.35 |
$44.35 |
$44.35 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$39.25 |
$39.25 |
$39.25 |
$74.10
|
|
Total hysterectomy
|
$1,782.42 |
$1,782.42 |
$1,782.42 |
$3,001.70
|
|
Total tau
|
$253.01 |
$253.01 |
$253.01 |
$312.50
|
|
Toxoplasma antibody igg
|
$33.39 |
$33.39 |
$33.39 |
$91.65
|
|
Toxoplasma antibody igm
|
$31.80 |
$31.80 |
$31.80 |
$87.75
|
|
Tpmt gene com vrnts
|
$608.48 |
$608.48 |
$608.48 |
$371.80
|
|
Transferrin
|
$21.88 |
$21.88 |
$21.88 |
$82.00
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$694.96 |
$694.96 |
$694.96 |
$561.60
|
|
Transvaginal Pregnancy Ultrasound
|
$585.46 |
$585.46 |
$585.46 |
$499.20
|
|
Trauma partial team response w/critical care services level 4
|
$2,394.86 |
$2,394.86 |
$2,394.86 |
$4,523.04
|
|
Tray bonemarrw oncontrol 102mm
|
$388.48 |
$388.48 |
$388.48 |
$940.80
|
|
Treat ectopic pregnancy
|
$242.56 |
$242.56 |
$242.56 |
$4,350.00
|
|
Treat ectopic pregnancy
|
$236.44 |
$236.44 |
$236.44 |
$6,707.99
|
|
Treat foot bone lesion
|
$707.44 |
$707.44 |
$707.44 |
$3,839.54
|
|
Treponema pallidum antibody
|
$39.22 |
$39.22 |
$39.22 |
$72.05
|
|
Trg gene rearrangement anal
|
$701.20 |
$701.20 |
$701.20 |
$455.70
|
|
Trichinella antibody
|
$36.57 |
$36.57 |
$36.57 |
$70.65
|
|
#tricyclicantidprssnt
|
$48.81 |
$48.81 |
$48.81 |
$50.54
|
|
Triglycerides
|
$30.29 |
$30.29 |
$30.29 |
$58.50
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$1,063.05 |
$1,063.05 |
$1,063.05 |
$4,872.75
|
|
Troponin quantitative
|
$21.32 |
$21.32 |
$21.32 |
$127.60
|
|
Tte w or without fol w/con,stres
|
$868.12 |
$868.12 |
$868.12 |
$1,632.80
|
|
Tte w or without fol w/cont, com
|
$809.95 |
$809.95 |
$809.95 |
$1,220.31
|
|
Tte w or without fol w/cont, f/u
|
$627.68 |
$627.68 |
$627.68 |
$1,178.00
|
|
Ugt1a1 gene analy common variants
|
$813.62 |
$813.62 |
$813.62 |
$438.75
|
|
Ultrasound breast complete
|
$797.16 |
$797.16 |
$797.16 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$706.64 |
$706.64 |
$706.64 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$237.25 |
$237.25 |
$237.25 |
$338.00
|
|
Ultrasound encephalogram
|
$470.85 |
$470.85 |
$470.85 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$411.72 |
$411.72 |
$411.72 |
$578.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$394.20 |
$394.20 |
$394.20 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$411.72 |
$411.72 |
$411.72 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$203.67 |
$203.67 |
$203.67 |
$388.08
|
|
Ultrasound guide intraoperative
|
$215.35 |
$215.35 |
$215.35 |
$632.85
|
|
Ultrasound hips infant dynamic
|
$283.24 |
$283.24 |
$283.24 |
$403.88
|
|
Ultrasound joint complete left
|
$449.68 |
$449.68 |
$449.68 |
$557.99
|
