|
Surgical pathology level 4 gross & microscopic examination
|
$4,461.69 |
$4,461.69 |
$4,461.69 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$357.50 |
$357.50 |
$357.50 |
$489.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$443.30 |
$443.30 |
$443.30 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$33.15 |
$33.15 |
$33.15 |
$38.58
|
|
Susceptibility enzyme detection per enzyme
|
$35.10 |
$35.10 |
$35.10 |
$31.85
|
|
Susceptibility mic per plate
|
$55.25 |
$55.25 |
$55.25 |
$89.70
|
|
Sweat collection by iontophoresis
|
$61.10 |
$61.10 |
$61.10 |
$100.20
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$60.45 |
$60.45 |
$60.45 |
$45.70
|
|
T3 (triiodothyronine) free
|
$63.70 |
$63.70 |
$63.70 |
$91.20
|
|
T3 (triiodothyronine) total
|
$73.45 |
$73.45 |
$73.45 |
$88.00
|
|
T4 (thyroxine) free
|
$51.35 |
$51.35 |
$51.35 |
$65.00
|
|
T4 (thyroxine) total
|
$52.65 |
$52.65 |
$52.65 |
$62.40
|
|
Tacrolimus therapeutic drug level
|
$145.60 |
$145.60 |
$145.60 |
$137.15
|
|
Tamoxifen 10 mg tabs 60 each bottle
|
$35.75 |
$35.75 |
$35.75 |
$35.75
|
|
Target gsa panel hmtlmph neop
|
$1,473.55 |
$1,473.55 |
$1,473.55 |
$1,928.40
|
|
Target gsa panel organ neop
|
$1,907.10 |
$1,907.10 |
$1,907.10 |
$1,913.00
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$165.75 |
$165.75 |
$165.75 |
$221.65
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$76.70 |
$76.70 |
$76.70 |
$178.40
|
|
T cells absolute cd4/cd8 including ratio
|
$114.40 |
$114.40 |
$114.40 |
$189.60
|
|
T cells absolute cd 4 count
|
$151.45 |
$151.45 |
$151.45 |
$120.25
|
|
T cells total count
|
$114.40 |
$114.40 |
$114.40 |
$126.90
|
|
Telehealth original site facility fee
|
$35.10 |
$35.10 |
$35.10 |
$55.65
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$16,718.98 |
$16,718.98 |
$16,718.98 |
$16,233.59
|
|
Test for porphobilinogen
|
$48.75 |
$48.75 |
$48.75 |
$33.57
|
|
Test pathogen(s) for platelets reference
|
$52.00 |
$52.00 |
$52.00 |
$52.00
|
|
Tetanus immune globulin inj
|
$2,024.35 |
$2,024.35 |
$2,024.35 |
$1,073.02
|
|
Theophylline therapeutic drug level
|
$101.40 |
$101.40 |
$101.40 |
$101.40
|
|
Ther/proph/diag inj ia
|
$94.90 |
$94.90 |
$94.90 |
$247.33
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$30.73 |
$30.73 |
$30.73 |
$25.80
|
|
Thrombin time
|
$43.55 |
$43.55 |
$43.55 |
$53.50
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$74.75 |
$74.75 |
$74.75 |
$56.93
|
|
Thyroglobulin antibody
|
$100.75 |
$100.75 |
$100.75 |
$86.40
|
|
Thyroid (TSH) Test
|
$55.25 |
$55.25 |
$55.25 |
$101.40
|
|
Thyroid Ultrasound
|
$454.35 |
$454.35 |
$454.35 |
$553.80
|
|
Thyroxine binding globulin (tbg)
|
$79.95 |
$79.95 |
$79.95 |
$75.00
|
|
Tigecycline injection
|
$308.75 |
$308.75 |
$308.75 |
$7.44
|
|
Tissue culture placenta
|
$416.00 |
$416.00 |
$416.00 |
$470.00
|
|
Tissue culture skin/biopsy
|
$382.85 |
$382.85 |
$382.85 |
$626.77
|
|
Tissue exam koh skin/hair/nails
|
$122.85 |
$122.85 |
$122.85 |
$45.23
|
|
Tissue transglutaminase iga
|
$162.50 |
$162.50 |
$162.50 |
$48.57
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$247.00 |
$247.00 |
$247.00 |
$72.00
|
|
Tobramycin peak therapeutic drug level
|
$72.15 |
$72.15 |
$72.15 |
$117.00
|
|
Toxoplasma antibody igg
|
$35.75 |
$35.75 |
$35.75 |
$83.20
|
|
Toxoplasma antibody igm
|
$75.40 |
$75.40 |
$75.40 |
$85.80
|
|
Tpmt gene com vrnts
|
$381.55 |
$381.55 |
$381.55 |
$402.35
|
|
Transferrin
|
$35.75 |
$35.75 |
$35.75 |
$83.07
|
|
Transfusion blood/blood component(s)
|
$841.10 |
$841.10 |
$841.10 |
$988.24
|
|
Treat fracture of radius
|
$753.35 |
$753.35 |
$753.35 |
$1,884.74
|
|
Treat fracture of ulna
|
$897.65 |
$897.65 |
$897.65 |
$806.13
|
|
Treat humerus fracture
|
$1,063.40 |
$1,063.40 |
$1,063.40 |
$2,055.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$75.40 |
$75.40 |
$75.40 |
$197.60
|
|
Treatment of ankle fracture 27786
|
$560.95 |
$560.95 |
$560.95 |
$575.25
|
|
Treatment of toe fracture 28510
|
$226.20 |
$226.20 |
$226.20 |
$362.00
|
|
Treat midfoot fracture each
|
$783.90 |
$783.90 |
$783.90 |
$1,417.44
|
|
Treponema pallidum antibody
|
$84.50 |
$84.50 |
$84.50 |
$74.40
|
|
Trg gene rearrangement anal
|
$403.00 |
$403.00 |
$403.00 |
$474.50
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$28.90 |
$28.90 |
$28.90 |
$28.90
|
|
Trichinella antibody
|
$50.70 |
$50.70 |
$50.70 |
$56.55
|
|
#tricyclicantidprssnt
|
$115.05 |
$115.05 |
$115.05 |
$38.73
|
|
Triglycerides
|
$48.75 |
$48.75 |
$48.75 |
$48.75
|
|
Troponin quantitative
|
$143.65 |
$143.65 |
$143.65 |
$112.80
|
|
Ua w/micro/comp poc
|
$53.95 |
$53.95 |
$53.95 |
$25.72
|
|
Ugt1a1 gene analy common variants
|
$740.35 |
$740.35 |
$740.35 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$325.00 |
$325.00 |
$325.00 |
$394.20
|
|
Ultrasound chest
|
$401.05 |
$401.05 |
$401.05 |
$430.10
|
|
Ultrasound joint complete left
|
$464.10 |
$464.10 |
$464.10 |
$534.00
|
|
Ultrasound joint/nonvascular extremity limited left
|
$596.05 |
$596.05 |
$596.05 |
$426.60
|
|
Ultrasound pregnant uterus transvaginal
|
$449.15 |
$449.15 |
$449.15 |
$477.10
|
|
Ultrasound retroperitoneal limited
|
$211.90 |
$211.90 |
$211.90 |
$469.58
|
|
Ultrasound scrotum and contents
|
$508.30 |
$508.30 |
$508.30 |
$558.03
|
|
Ultrasound transvaginal non obstetric
|
$359.45 |
$359.45 |
$359.45 |
$523.20
|
|
Unlisted ultrasound procedure
|
$209.30 |
$209.30 |
$209.30 |
$335.00
|
|
Upper Endoscopy (EGD, diagnostic)
|
$5,379.23 |
$5,379.23 |
$5,379.23 |
$1,760.00
|
|
Upper Endoscopy (EGD, with biopsy)
|
$4,770.18 |
$4,770.18 |
$4,770.18 |
$1,760.00
|
|
Uppr gi scope w/submuc inj
|
$693.55 |
$693.55 |
$693.55 |
$1,247.13
|
|
Urea nitrogen
|
$48.75 |
$48.75 |
$48.75 |
$38.25
|
|
Urea nitrogen 24 hour urine
|
$39.00 |
$39.00 |
$39.00 |
$42.90
|
|
Uric acid blood
|
$44.20 |
$44.20 |
$44.20 |
$44.00
|
|
Uric acid urine
|
$42.25 |
$42.25 |
$42.25 |
$43.20
|
|
Urinalysis microscopic only
|
$23.40 |
$23.40 |
$23.40 |
$25.72
|
|
Urinalysis (with microscopy)
|
$33.15 |
$33.15 |
$33.15 |
$37.39
|
|
Urinalysis (without microscopy)
|
$42.90 |
$42.90 |
$42.90 |
$33.00
|
|
Urine Culture Test
|
$47.45 |
$47.45 |
$47.45 |
$63.84
|
|
Urine pregnancy test
|
$63.70 |
$63.70 |
$63.70 |
$57.00
|
|
Vaccine dtap < 7 years im
|
$87.80 |
$87.80 |
$87.80 |
$66.69
|
|
Vaccine dtap-hep b-ipv im
|
$281.64 |
$281.64 |
$281.64 |
$169.85
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$88.04 |
$88.04 |
$88.04 |
$75.39
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$263.92 |
$263.92 |
$263.92 |
$130.67
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$60.95 |
$60.95 |
$60.95 |
$47.38
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$950.58 |
$950.58 |
$950.58 |
$579.50
|
|
Vaccine rabies im
|
$945.46 |
$945.46 |
$945.46 |
$800.00
|
|
Vaccine tdap >=7 years im
|
$150.76 |
$150.76 |
$150.76 |
$131.34
|
|
Valproic acid total therapeutic drug level
|
$97.50 |
$97.50 |
$97.50 |
$100.80
|
|
Vancomycin peak therapeutic drug level
|
$92.30 |
$92.30 |
$92.30 |
$116.00
|
|
Varicella zoster antibody igg
|
$65.65 |
$65.65 |
$65.65 |
$90.35
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$57.85 |
$57.85 |
$57.85 |
$123.00
|
|
Ventilator each subsequent day
|
$833.30 |
$833.30 |
$833.30 |
$1,138.50
|
|
Ventilator initial day
|
$910.00 |
$910.00 |
$910.00 |
$1,331.00
|
|
Very long chain fatty acids
|
$157.30 |
$157.30 |
$157.30 |
$157.30
|
|
Vital capacity test
|
$74.10 |
$74.10 |
$74.10 |
$170.00
|
