|
Surgical pathology level 1 gross examination only
|
$77.35 |
$77.35 |
$7,011.87 |
|
|
Surgical pathology level 2 gross & microscopic examination
|
$118.30 |
$150.80 |
$13,436.36 |
|
|
Surgical pathology level 3 gross & microscopic examination
|
$174.85 |
$4,673.60 |
$6,822.33 |
|
|
Surgical pathology level 4 gross & microscopic examination
|
$243.10 |
$2,974.53 |
$4,504.82 |
|
|
Surgical pathology level 5 gross & microscopic examination
|
$306.80 |
$357.50 |
$8,168.42 |
|
|
Surgical pathology level 6 gross & microscopic examination
|
$429.65 |
$443.30 |
$16,052.93 |
|
|
Susceptibility agar dilution per agent
|
$33.15 |
$33.15 |
$36.40 |
|
|
Susceptibility enzyme detection per enzyme
|
$34.45 |
$35.10 |
$40.95 |
|
|
Susceptibility mic per plate
|
$55.25 |
$55.25 |
$88.40 |
|
|
Suscept studies macrobroth dilution ea
|
$99.45 |
$99.45 |
$99.45 |
|
|
Svc venogram s&i
|
$1,251.25 |
$1,251.25 |
$1,251.25 |
|
|
Sweat collection by iontophoresis
|
$61.10 |
$61.10 |
$63.05 |
|
|
Synvisc or synvisc-one
|
$919.93 |
$919.93 |
$919.93 |
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$57.20 |
$60.45 |
$60.45 |
|
|
T3 (triiodothyronine) free
|
$60.45 |
$63.70 |
$131.30 |
|
|
T3 (triiodothyronine) total
|
$43.55 |
$73.45 |
$105.30 |
|
|
T4 (thyroxine) free
|
$48.10 |
$51.35 |
$105.30 |
|
|
T4 (thyroxine) total
|
$20.80 |
$52.65 |
$89.05 |
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$4.87 |
$4.87 |
$4.87 |
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$811.02 |
$811.02 |
$811.02 |
|
|
Tacrolimus therapeutic drug level
|
$122.20 |
$145.60 |
$167.05 |
|
|
Tafasitamab-cxix 200 mg intravenous solution
|
$3,246.10 |
$3,246.10 |
$3,246.10 |
|
|
Talquetamab-tgvs 2 mg/ml subcutaneous solution
|
$27,262.12 |
$27,262.12 |
$27,262.12 |
|
|
Tamoxifen 10 mg tabs 60 each bottle
|
$35.75 |
$35.75 |
$35.75 |
|
|
Target gsa panel hmtlmph neop
|
$1,361.10 |
$1,473.55 |
$1,740.05 |
|
|
Target gsa panel organ neop
|
$1,842.75 |
$1,907.10 |
$2,252.25 |
|
|
Tarlatamab-dlle 10 mg intravenous solution
|
$35,155.25 |
$35,155.25 |
$35,155.25 |
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$503.48 |
$782.39 |
$805.77 |
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$159.90 |
$165.75 |
$167.05 |
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$76.70 |
$76.70 |
$183.30 |
|
|
Tc-99m bicisate
|
$794.30 |
$794.30 |
$794.30 |
|
|
Tc-99m exame autol wbc diag per dose
|
$2,120.95 |
$2,120.95 |
$2,614.95 |
|
|
Tc-99m exametazime diag
|
$1,477.45 |
$1,477.45 |
$2,169.70 |
|
|
Tc-99m labeled rbc
|
$185.25 |
$185.25 |
$281.45 |
|
|
Tc-99m maa
|
$108.55 |
$108.55 |
$159.90 |
|
|
Tc-99m mebrofenin
|
$105.30 |
$105.30 |
$175.50 |
|
|
Tc-99m medronate
|
$38.35 |
$38.35 |
$148.20 |
|
|
Tc-99m mertiatide
|
$362.05 |
$362.05 |
$429.00 |
|
|
Tc-99m oxidronate
|
$105.30 |
$105.30 |
$141.05 |
|
|
Tc-99m pentetate dtpa
|
$91.65 |
$91.65 |
$91.65 |
|
|
Tc-99m pentetate dtpa aerosol
|
$169.65 |
$169.65 |
$169.65 |
|
|
Tc-99m pertechnetate per mci
|
$31.20 |
$31.20 |
$37.05 |
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$100.75 |
$100.75 |
$100.75 |
|
|
Tc-99m sestamibi p study dose
|
$230.10 |
$230.10 |
$333.45 |
|
|
Tc-99m succimer (dmsa)
|
$390.65 |
$390.65 |
$390.65 |
|
|
Tc-99m sulfur colloid
|
$226.20 |
$226.20 |
$265.20 |
|
|
Tc-99m tetrofosmin p study dose
|
$199.55 |
$199.55 |
$323.05 |
|
|
Tc-99m tilmanocept diag
|
$694.85 |
$694.85 |
$694.85 |
|
|
T cells absolute cd4/cd8 including ratio
|
$110.50 |
$114.40 |
$182.00 |
|
|
T cells absolute cd 4 count
|
$137.80 |
$151.45 |
$151.45 |
|
|
T cells total count
|
$110.50 |
$114.40 |
$144.95 |
|
|
Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution
|
$9,793.55 |
$9,793.55 |
$9,793.55 |
|
|
Telehealth original site facility fee
|
$35.10 |
$35.10 |
$37.70 |
|
|
Telethx isodose plan cplx
|
$30,207.45 |
$30,207.45 |
$30,207.45 |
|
|
Telethx isodose plan simple
|
$5,317.65 |
$5,317.65 |
$5,317.65 |
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$4,424.69 |
$4,424.69 |
$4,424.69 |
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$16,718.98 |
$16,718.98 |
$17,220.55 |
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$12.09 |
$12.35 |
$60.83 |
|
|
Test for porphobilinogen
|
$46.80 |
$48.75 |
$57.85 |
|
|
Testicular imaging w/vasc flow
|
$641.55 |
$641.55 |
$663.65 |
|
|
Test pathogen(s) for platelets reference
|
$50.70 |
$52.00 |
$60.45 |
|
|
Test stress cardiovascular tracing only
|
$655.85 |
$655.85 |
$966.55 |
|
|
Tetanus immune globulin inj
|
$1,981.73 |
$2,024.35 |
$2,024.35 |
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$10,442.86 |
$10,442.86 |
$10,442.86 |
|
|
Theophylline therapeutic drug level
|
$85.15 |
$101.40 |
$135.85 |
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$39.00 |
$44.20 |
$52.00 |
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$35.75 |
$44.20 |
$52.00 |
|
|
Ther nma rdctj intus/obstrcj
|
$757.25 |
$757.25 |
$757.25 |
|
|
Ther/proph/diag inj ia
|
$94.90 |
$94.90 |
$104.00 |
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$18.52 |
$26.36 |
$30.73 |
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$2,162.55 |
$2,162.55 |
$2,162.55 |
|
|
Thrombectomy/inf pq dialysis circuit
|
$7,541.62 |
$7,541.62 |
$7,541.62 |
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$7,591.58 |
$7,591.58 |
$7,591.58 |
|
|
Thrombin time
|
$43.55 |
$43.55 |
$56.55 |
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$71.50 |
$74.75 |
$85.80 |
|
|
Thyroglobulin antibody
|
$98.15 |
$100.75 |
$100.75 |
|
|
Thyroid imaging
|
$536.25 |
$536.25 |
$536.25 |
|
|
Thyroid mets imag whole body
|
$1,354.60 |
$1,354.60 |
$1,354.60 |
|
|
Thyroid (TSH) Test
|
$55.25 |
$55.25 |
$125.45 |
|
|
Thyroid Ultrasound
|
$403.65 |
$454.35 |
$522.60 |
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$4,698.85 |
$4,698.85 |
$4,698.85 |
|
|
Thyroxine binding globulin (tbg)
|
$78.00 |
$79.95 |
$79.95 |
|
|
Tigecycline injection
|
$254.72 |
$254.72 |
$308.75 |
|
|
Tilt table study
|
$1,633.45 |
$1,633.45 |
$1,633.45 |
|
|
Tirofiban 12.5 mg/50 ml
|
$284.05 |
$722.38 |
$737.91 |
|
|
Tisotumab vedotin-tftv 40 mg intravenous solution
|
$16,843.32 |
$16,843.32 |
$16,843.32 |
|
|
Tissue culture placenta
|
$416.00 |
$416.00 |
$427.05 |
|
|
Tissue culture skin/biopsy
|
$321.75 |
$382.85 |
$428.35 |
|
|
Tissue exam koh skin/hair/nails
|
$14.95 |
$122.85 |
$122.85 |
|
|
Tissue transglutaminase iga
|
$162.50 |
$162.50 |
$177.45 |
|
|
Tl-201 thallium diag per mci
|
$48.10 |
$48.10 |
$113.75 |
|
|
Tlh uterus 250 g or less
|
$20,561.34 |
$20,561.34 |
$20,561.34 |
|
|
Tlh w/t/o 250 g or less
|
$16,562.31 |
$16,562.31 |
$16,562.31 |
|
|
Tlh w/t/o uterus over 250 g
|
$18,214.68 |
$18,214.68 |
$18,214.68 |
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$7.15 |
$241.80 |
$247.00 |
|
|
Tobramycin peak therapeutic drug level
|
$72.15 |
$72.15 |
$118.30 |
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$5,790.85 |
$5,790.85 |
$6,048.49 |
|
|
Tomosynthesis breast diagnostic left
|
$63.70 |
$63.70 |
$63.70 |
|
|
Tomosynthesis breast screen bilateral
|
$62.40 |
$62.40 |
$73.45 |
|
|
Tonsillectomy (age 12+)
|
$654.55 |
$654.55 |
$3,618.35 |
|