|
Surg dx exam anorectal
|
$237.60 |
$237.60 |
$237.60 |
$3,245.23
|
|
Surg ect salp-oophorectomy 59120
|
$1,787.94 |
$1,787.94 |
$1,787.94 |
$1,632.60
|
|
Surg ect without salp-oophorectomy 59121
|
$1,787.28 |
$1,787.28 |
$1,787.28 |
$1,634.40
|
|
Surgical opening of stomach 43500
|
$1,747.68 |
$1,747.68 |
$1,747.68 |
$1,477.80
|
|
Surgical pathology level 1 gross examination only
|
$39.60 |
$39.60 |
$39.60 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$193.38 |
$193.38 |
$193.38 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$248.82 |
$248.82 |
$248.82 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$403.92 |
$403.92 |
$403.92 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$666.60 |
$666.60 |
$666.60 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,630.20 |
$1,630.20 |
$1,630.20 |
$718.00
|
|
Surgical repair stomach bleedin ulcer 43501
|
$2,961.42 |
$2,961.42 |
$2,961.42 |
$2,536.20
|
|
Surgical repair stomach gastric lac 43502
|
$3,344.88 |
$3,344.88 |
$3,344.88 |
$2,864.40
|
|
Surgical revision intestine
|
$2,366.76 |
$2,366.76 |
$2,366.76 |
$2,607.20
|
|
Surg tx anal fistula 2nd stage 46285
|
$989.34 |
$989.34 |
$989.34 |
$3,245.23
|
|
Susceptibility agar dilution per agent
|
$25.08 |
$25.08 |
$25.08 |
$45.45
|
|
Susceptibility enzyme detection per enzyme
|
$25.08 |
$25.08 |
$25.08 |
$35.70
|
|
Susceptibility mic per plate
|
$110.88 |
$110.88 |
$110.88 |
$106.00
|
|
Suspension of testis
|
$678.48 |
$678.48 |
$678.48 |
$4,061.71
|
|
Suspension of uterus 58400
|
$143.22 |
$143.22 |
$143.22 |
$1,136.00
|
|
Sutr lg intestine 1/mult perf without colostomy 44604
|
$2,313.30 |
$2,313.30 |
$2,313.30 |
$1,995.00
|
|
Suture bile duct injury 47900
|
$3,036.66 |
$3,036.66 |
$3,036.66 |
$3,036.66
|
|
Svc venogram s&i
|
$1,037.52 |
$1,037.52 |
$1,037.52 |
$1,934.62
|
|
Sympathectomy digital artery
|
$1,768.14 |
$1,768.14 |
$1,768.14 |
$2,310.83
|
|
Sympathectomy supfc palmar
|
$1,825.56 |
$1,825.56 |
$1,825.56 |
$3,880.00
|
|
Synvisc or synvisc-one
|
$727.98 |
$727.98 |
$727.98 |
$1,274.94
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$6.47 |
$6.47 |
$6.47 |
$41.60
|
|
System pacing micra av
|
$8,624.88 |
$8,624.88 |
$8,624.88 |
$24,577.07
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$10,530.30 |
$10,530.30 |
$10,530.30 |
$12,003.00
|
|
T3 (triiodothyronine) free
|
$9.88 |
$9.88 |
$9.88 |
$99.20
|
|
T3 (triiodothyronine) total
|
$87.78 |
$87.78 |
$87.78 |
$93.52
|
|
T4 (thyroxine) free
|
$88.44 |
$88.44 |
$88.44 |
$85.20
|
|
T4 (thyroxine) total
|
$5.30 |
$5.30 |
$5.30 |
$69.00
|
|
Tacrolimus therapeutic drug level
|
$8.06 |
$8.06 |
$8.06 |
$122.40
|
|
Tah w/mmk 58152
|
$2,762.76 |
$2,762.76 |
$2,762.76 |
$2,428.80
|
|
Tap block uni by cont infusion 64487
|
$132.00 |
$132.00 |
$132.00 |
$869.40
|
|
Target gsa panel hmtlmph neop
|
$1,617.00 |
$1,617.00 |
$1,617.00 |
$2,246.30
|
|
Target gsa panel organ/hmtlmph neop
|
$1,626.90 |
$1,626.90 |
$1,626.90 |
$3,746.70
|
|
Target gsa panel organ neop
|
$2,046.00 |
$2,046.00 |
$2,046.00 |
$1,655.52
|
|
Tbs dxa cal w/i&r fx risk
|
$109.56 |
$109.56 |
$109.56 |
$127.12
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$485.10 |
$485.10 |
$485.10 |
$194.35
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$35.81 |
$35.81 |
$35.81 |
$177.65
|
|
Tc-99m labeled rbc
|
$291.72 |
$291.72 |
$291.72 |
$302.40
|
|
Tc-99m maa
|
$147.84 |
$147.84 |
$147.84 |
$292.80
|
|
Tc-99m mebrofenin
|
$388.08 |
$388.08 |
$388.08 |
$157.65
|
|
Tc-99m medronate
|
$493.68 |
$493.68 |
$493.68 |
$111.01
|
|
Tc-99m mertiatide
|
$722.70 |
$722.70 |
$722.70 |
$756.00
|
|
Tc-99m oxidronate
|
$250.14 |
$250.14 |
$250.14 |
$105.60
|
|
Tc-99m pentetate dtpa
|
$230.34 |
$230.34 |
$230.34 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$265.32 |
$265.32 |
$265.32 |
$190.80
|
|
Tc-99m pertechnetate per mci
|
$234.30 |
$234.30 |
$234.30 |
$22.10
|
|
Tc-99m sestamibi p study dose
|
$897.60 |
$897.60 |
$897.60 |
$274.45
|
|
Tc-99m sulfur colloid
|
$315.48 |
$315.48 |
$315.48 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$95.70 |
$95.70 |
$95.70 |
$190.80
|
|
Tc-99m tilmanocept diag
|
$201.30 |
$201.30 |
$201.30 |
$955.60
|
|
Tca peel dermal 15789
|
$1,262.58 |
$1,262.58 |
$1,262.58 |
$1,324.80
|
|
T cells absolute cd4/cd8 including ratio
|
$27.42 |
$27.42 |
$27.42 |
$176.40
|
|
T cells absolute cd 4 count
|
$15.71 |
$15.71 |
$15.71 |
$111.20
|
|
T cells total count
|
$22.28 |
$22.28 |
$22.28 |
$126.90
|
|
Tcranial magn stim tx deli
|
$380.16 |
$380.16 |
$380.16 |
$389.22
|
|
Tcranial magn stim tx plan
|
$535.92 |
$535.92 |
$535.92 |
$437.22
|
|
Tcran magn stim redetemine
|
$437.58 |
$437.58 |
$437.58 |
$457.60
|
|
Teaec w/wo patch graft iliofemoral
|
$2,150.28 |
$2,150.28 |
$2,150.28 |
$5,163.60
|
|
Telehealth original site facility fee
|
$44.22 |
$44.22 |
$44.22 |
$51.00
|
|
Telethx isodose plan cplx
|
$843.48 |
$843.48 |
$843.48 |
$1,526.85
|
|
Telethx isodose plan simple
|
$195.36 |
$195.36 |
$195.36 |
$873.62
|
|
Tendon lngth upr a/e ea tdn
|
$1,360.26 |
$1,360.26 |
$1,360.26 |
$3,545.97
|
|
Tendon transfer with graft
|
$2,158.86 |
$2,158.86 |
$2,158.86 |
$3,786.00
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$14,128.57 |
$14,128.57 |
$14,128.57 |
$15,245.38
|
|
Tenodesis biceps tdn at elbw
|
$1,414.38 |
$1,414.38 |
$1,414.38 |
$5,886.74
|
|
Tenolysis extensor tendon hand/finger each
|
$1,432.20 |
$1,432.20 |
$1,432.20 |
$2,811.20
|
|
Tenosynovectomy radic 26145
|
$1,219.68 |
$1,219.68 |
$1,219.68 |
$1,893.86
|
|
Tenotomy hip flexor open
|
$1,669.14 |
$1,669.14 |
$1,669.14 |
$2,618.20
|
|
Tenotomy open tndn flxr toe sgl tndn spx
|
$883.74 |
$883.74 |
$883.74 |
$2,139.67
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$19.80 |
$19.80 |
$19.80 |
$39.33
|
|
Testicular imaging w/vasc flow
|
$587.40 |
$587.40 |
$587.40 |
$842.56
|
|
Test stress cardiovascular tracing only
|
$794.64 |
$794.64 |
$794.64 |
$949.70
|
|
Theophylline therapeutic drug level
|
$85.14 |
$85.14 |
$85.14 |
$108.00
|
|
Therapeutic pulpotomy
|
$184.14 |
$184.14 |
$184.14 |
$744.80
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$61.38 |
$61.38 |
$61.38 |
$57.31
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$54.12 |
$54.12 |
$54.12 |
$50.00
|
|
Ther fx nasal inf turbinate
|
$278.52 |
$278.52 |
$278.52 |
$3,786.00
|
|
Ther nma rdctj intus/obstrcj
|
$262.02 |
$262.02 |
$262.02 |
$529.08
|
|
Ther/proph/diag inj ia
|
$32.34 |
$32.34 |
$32.34 |
$240.35
|
|
Ther radiology tx plng cplx
|
$444.18 |
$444.18 |
$444.18 |
$332.00
|
|
Ther radiology tx plng intrm
|
$286.44 |
$286.44 |
$286.44 |
$224.00
|
|
Ther radiology tx plng smpl
|
$186.12 |
$186.12 |
$186.12 |
$148.80
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$27.16 |
$27.16 |
$27.16 |
$25.54
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$878.46 |
$878.46 |
$878.46 |
$1,687.50
|
|
Thoracic lymphadenect/thoracotomy 38746
|
$450.12 |
$450.12 |
$450.12 |
$499.80
|
|
Thoracoscopy diagnostic 32601
|
$661.32 |
$661.32 |
$661.32 |
$6,442.80
|
|
Thoracoscopy lymph node exc
|
$450.78 |
$450.78 |
$450.78 |
$1,071.20
|
|
Thoracoscopy remove cortex
|
$2,370.06 |
$2,370.06 |
$2,370.06 |
$5,332.80
|
|
Thoracoscopy remov fb/fibrin 32653
|
$2,302.08 |
$2,302.08 |
$2,302.08 |
$2,587.20
|
|
Thoracoscopy surgical 32650
|
$1,467.18 |
$1,467.18 |
$1,467.18 |
$2,815.80
|
|
Thoracoscopy w/bx med space
|
$985.38 |
$985.38 |
$985.38 |
$6,463.42
|
|
Thoracoscopy w/pleurectomy 32656
|
$280.50 |
$280.50 |
$280.50 |
$3,447.60
|
|
Thoracoscopy w/wedge resect
|
$1,892.88 |
$1,892.88 |
$1,892.88 |
$4,232.00
|
|
Thoracoscopy w w resect diag 32668
|
$328.68 |
$328.68 |
$328.68 |
$304.20
|
|
Thorax spine fusion
|
$2,882.22 |
$2,882.22 |
$2,882.22 |
$3,044.00
|
|
Thorax stereo rad targetw/tx
|
$447.48 |
$447.48 |
$447.48 |
$529.60
|
