|
Target gsa panel organ/hmtlmph neop
|
$2,697.77 |
$2,697.77 |
$2,697.77 |
$3,746.70
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$122.10 |
$122.10 |
$122.10 |
$200.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$75.70 |
$75.70 |
$75.70 |
$179.95
|
|
Tc-99m labeled rbc
|
$376.87 |
$376.87 |
$376.87 |
$306.00
|
|
Tc-99m maa
|
$112.98 |
$112.98 |
$112.98 |
$312.06
|
|
Tc-99m mebrofenin
|
$55.15 |
$55.15 |
$55.15 |
$157.65
|
|
Tc-99m medronate
|
$135.70 |
$135.70 |
$135.70 |
$111.01
|
|
Tc-99m mertiatide
|
$147.07 |
$147.07 |
$147.07 |
$756.00
|
|
Tc-99m pentetate dtpa
|
$55.15 |
$55.15 |
$55.15 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$92.69 |
$92.69 |
$92.69 |
$191.50
|
|
Tc-99m pertechnetate per mci
|
$5.36 |
$5.36 |
$5.36 |
$18.67
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$34.85 |
$34.85 |
$34.85 |
$141.00
|
|
Tc-99m sestamibi p study dose
|
$106.44 |
$106.44 |
$106.44 |
$287.20
|
|
Tc-99m sulfur colloid
|
$179.63 |
$179.63 |
$179.63 |
$245.70
|
|
Tc-99m tilmanocept diag
|
$919.01 |
$919.01 |
$919.01 |
$985.60
|
|
T cells absolute cd4/cd8 including ratio
|
$57.39 |
$57.39 |
$57.39 |
$184.00
|
|
T cells total count
|
$46.40 |
$46.40 |
$46.40 |
$130.20
|
|
Telethx isodose plan cplx
|
$491.35 |
$491.35 |
$491.35 |
$1,526.85
|
|
Telethx isodose plan simple
|
$326.61 |
$326.61 |
$326.61 |
$880.61
|
|
Test pathogen(s) for platelets reference
|
$126.72 |
$126.72 |
$126.72 |
$70.00
|
|
Test stress cardiovascular tracing only
|
$519.97 |
$519.97 |
$519.97 |
$953.40
|
|
Theophylline therapeutic drug level
|
$14.19 |
$14.19 |
$14.19 |
$108.00
|
|
Therapy Activity Training (each 15 minutes)
|
$65.17 |
$65.17 |
$65.17 |
$101.38
|
|
Therapy Exercise Session (each 15 minutes)
|
$87.12 |
$87.12 |
$87.12 |
$98.58
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$25.13 |
$25.13 |
$25.13 |
$57.50
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$23.59 |
$23.59 |
$23.59 |
$50.40
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$124.20 |
$124.20 |
$124.20 |
$313.60
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$742.52 |
$742.52 |
$742.52 |
$1,724.25
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$1,103.65 |
$1,103.65 |
$1,103.65 |
$1,703.45
|
|
Thrombin time
|
$18.76 |
$18.76 |
$18.76 |
$54.18
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$34.51 |
$34.51 |
$34.51 |
$62.01
|
|
Thyroglobulin antibody
|
$39.07 |
$39.07 |
$39.07 |
$82.50
|
|
Thyroid imaging
|
$386.86 |
$386.86 |
$386.86 |
$695.60
|
|
Thyroid mets imag whole body
|
$885.55 |
$885.55 |
$885.55 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$36.63 |
$36.63 |
$36.63 |
$112.70
|
|
Thyroid Ultrasound
|
$528.81 |
$528.81 |
$528.81 |
$588.50
|
|
Thyroid uptake measurement
|
$241.19 |
$241.19 |
$241.19 |
$591.25
|
|
Thyroxine binding globulin (tbg)
|
$14.85 |
$14.85 |
$14.85 |
$64.51
|
|
Tissue culture skin/biopsy
|
$189.50 |
$189.50 |
$189.50 |
$488.74
|
|
Tissue exam koh skin/hair/nails
|
$92.45 |
$92.45 |
$92.45 |
$47.40
|
|
Tissue transglutaminase iga
|
$24.01 |
$24.01 |
$24.01 |
$44.80
|
|
Tobramycin peak therapeutic drug level
|
$16.17 |
$16.17 |
$16.17 |
$120.60
|
|
Toe X-ray (both feet)
|
$115.65 |
$115.65 |
$115.65 |
$258.65
|
|
Tomosynthesis breast diagnostic left
|
$38.36 |
$38.36 |
$38.36 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$37.24 |
$37.24 |
$37.24 |
$74.10
|
|
Total tau
|
$148.83 |
$148.83 |
$148.83 |
$312.50
|
|
Toxoplasma antibody igg
|
$25.64 |
$25.64 |
$25.64 |
$91.65
|
|
Toxoplasma antibody igm
|
$24.42 |
$24.42 |
$24.42 |
$87.75
|
|
Tp53 gene trgt sequence alys
|
$304.61 |
$304.61 |
$304.61 |
$804.00
|
|
Tpmt gene com vrnts
|
$161.70 |
$161.70 |
$161.70 |
$371.80
|
|
Tprnl plmt biodegrdabl matrl
|
$3,883.88 |
$3,883.88 |
$3,883.88 |
$7,144.80
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$69.75 |
$69.75 |
$69.75 |
$102.27
|
|
Transferrin
|
$12.87 |
$12.87 |
$12.87 |
$82.00
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$464.06 |
$464.06 |
$464.06 |
$561.60
|
|
Transvaginal Pregnancy Ultrasound
|
$391.35 |
$391.35 |
$391.35 |
$499.20
|
|
Trauma partial team response w/critical care services level 4
|
$3,074.48 |
$3,074.48 |
$3,074.48 |
$4,523.04
|
|
Treatment radiation delivery level 2
|
$316.89 |
$316.89 |
$316.89 |
$830.70
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$34.13 |
$34.13 |
$34.13 |
$73,346.25
|
|
Treponema pallidum antibody
|
$30.12 |
$30.12 |
$30.12 |
$72.05
|
|
Trg gene rearrangement anal
|
$186.34 |
$186.34 |
$186.34 |
$455.70
|
|
Trichinella antibody
|
$28.08 |
$28.08 |
$28.08 |
$70.65
|
|
Triglycerides
|
$17.82 |
$17.82 |
$17.82 |
$58.50
|
|
Troponin quantitative
|
$45.54 |
$45.54 |
$45.54 |
$127.60
|
|
Tte w or without fol w/con,stres
|
$680.26 |
$680.26 |
$680.26 |
$1,632.80
|
|
Tte w or without fol w/cont, com
|
$566.32 |
$566.32 |
$566.32 |
$1,220.31
|
|
Tte w or without fol w/cont, f/u
|
$436.35 |
$436.35 |
$436.35 |
$1,178.00
|
|
Ugt1a1 gene analy common variants
|
$216.22 |
$216.22 |
$216.22 |
$438.75
|
|
Ultrasound breast complete
|
$603.22 |
$603.22 |
$603.22 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$495.30 |
$495.30 |
$495.30 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$169.83 |
$169.83 |
$169.83 |
$338.00
|
|
Ultrasound encephalogram
|
$294.79 |
$294.79 |
$294.79 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$268.66 |
$268.66 |
$268.66 |
$578.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$443.61 |
$443.61 |
$443.61 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$322.62 |
$322.62 |
$322.62 |
$720.15
|
|
Ultrasound guide intraoperative
|
$144.27 |
$144.27 |
$144.27 |
$632.85
|
|
Ultrasound hips infant dynamic
|
$224.36 |
$224.36 |
$224.36 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$163.58 |
$163.58 |
$163.58 |
$311.25
|
|
Ultrasound joint complete left
|
$516.31 |
$516.31 |
$516.31 |
$557.99
|
|
Ultrasound ob >=14wks ea addl gest
|
$234.02 |
$234.02 |
$234.02 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$160.18 |
$160.18 |
$160.18 |
$334.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$354.43 |
$354.43 |
$354.43 |
$698.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$308.42 |
$308.42 |
$308.42 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$341.37 |
$341.37 |
$341.37 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$231.18 |
$231.18 |
$231.18 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$396.46 |
$396.46 |
$396.46 |
$419.50
|
|
Unlisted hematology&coagj px
|
$19.10 |
$19.10 |
$19.10 |
$39.52
|
|
Unlisted transfusion med px
|
$141.50 |
$141.50 |
$141.50 |
$147.50
|
|
Unsched dialysis esrd pt hos
|
$1,015.42 |
$1,015.42 |
$1,015.42 |
$1,292.33
|
|
Upper Arm (Humerus) X-ray (left side)
|
$192.60 |
$192.60 |
$192.60 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$1,063.26 |
$1,063.26 |
$1,063.26 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$850.50 |
$850.50 |
$850.50 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$682.25 |
$682.25 |
$682.25 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$568.54 |
$568.54 |
$568.54 |
$2,369.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$454.83 |
$454.83 |
$454.83 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$221.85 |
$221.85 |
$221.85 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$229.95 |
$229.95 |
$229.95 |
$381.60
|
|
Upper GI Barium X-ray (barium and gas)
|
$397.80 |
$397.80 |
$397.80 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$299.70 |
$299.70 |
$299.70 |
$607.20
|
|
Urea nitrogen
|
$14.19 |
$14.19 |
$14.19 |
$42.25
|
|
Urea nitrogen 24 hour urine
|
$17.16 |
$17.16 |
$17.16 |
$52.00
|