|
Surgical pathology level 4 gross & microscopic examination
|
$165.60 |
$165.60 |
$165.60 |
$253.75
|
|
Surgical pathology level 5 gross & microscopic examination
|
$296.80 |
$296.80 |
$296.80 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$446.80 |
$446.80 |
$446.80 |
$790.00
|
|
Susceptibility enzyme detection per enzyme
|
$13.44 |
$13.44 |
$13.44 |
$34.48
|
|
Susceptibility mic per plate
|
$70.19 |
$70.19 |
$70.19 |
$94.38
|
|
Sweat collection by iontophoresis
|
$25.34 |
$25.34 |
$25.34 |
$105.21
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$109.69 |
$109.69 |
$109.69 |
$44.85
|
|
T3 (triiodothyronine) free
|
$49.75 |
$49.75 |
$49.75 |
$89.82
|
|
T3 (triiodothyronine) total
|
$149.51 |
$149.51 |
$149.51 |
$94.90
|
|
T4 (thyroxine) free
|
$156.86 |
$156.86 |
$156.86 |
$81.60
|
|
T4 (thyroxine) total
|
$83.60 |
$83.60 |
$83.60 |
$73.64
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$8.80 |
$8.80 |
$8.80 |
$9.99
|
|
Tacrolimus therapeutic drug level
|
$120.42 |
$120.42 |
$120.42 |
$122.40
|
|
Target gsa panel hmtlmph neop
|
$1,100.00 |
$1,100.00 |
$1,100.00 |
$1,928.40
|
|
Target gsa panel organ/hmtlmph neop
|
$1,508.00 |
$1,508.00 |
$1,508.00 |
$3,385.00
|
|
Target gsa panel organ neop
|
$720.00 |
$720.00 |
$720.00 |
$1,913.00
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$2.06 |
$2.06 |
$2.06 |
$959.55
|
|
Tbs techl calculation only
|
$147.60 |
$147.60 |
$147.60 |
$123.30
|
|
Tbs techl prep&transmis data
|
$147.60 |
$147.60 |
$147.60 |
$104.19
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$103.19 |
$103.19 |
$103.19 |
$166.46
|
|
Tc-99m disofenin
|
$109.60 |
$109.60 |
$109.60 |
$151.32
|
|
Tc-99m exame autol wbc diag per dose
|
$4,696.80 |
$4,696.80 |
$4,696.80 |
$2,393.40
|
|
Tc-99m exametazime diag
|
$3,029.60 |
$3,029.60 |
$3,029.60 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$324.40 |
$324.40 |
$324.40 |
$323.01
|
|
Tc-99m maa
|
$50.00 |
$50.00 |
$50.00 |
$312.06
|
|
Tc-99m mebrofenin
|
$194.00 |
$194.00 |
$194.00 |
$169.53
|
|
Tc-99m medronate
|
$106.00 |
$106.00 |
$106.00 |
$122.46
|
|
Tc-99m mertiatide
|
$655.20 |
$655.20 |
$655.20 |
$757.25
|
|
Tc-99m non-heu per study dose
|
$15.88 |
$15.88 |
$15.88 |
$10.00
|
|
Tc-99m oxidronate
|
$46.80 |
$46.80 |
$46.80 |
$124.23
|
|
Tc-99m pentetate dtpa
|
$85.20 |
$85.20 |
$85.20 |
$245.85
|
|
Tc-99m pentetate dtpa aerosol
|
$316.80 |
$316.80 |
$316.80 |
$244.02
|
|
Tc-99m pertechnetate per mci
|
$2.80 |
$2.80 |
$2.80 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$183.60 |
$183.60 |
$183.60 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$268.44 |
$268.44 |
$268.44 |
$221.60
|
|
Tc-99m succimer (dmsa)
|
$3,128.40 |
$3,128.40 |
$3,128.40 |
$1,578.33
|
|
Tc-99m tetrofosmin p study dose
|
$414.32 |
$414.32 |
$414.32 |
$198.05
|
|
T cells absolute cd4/cd8 including ratio
|
$27.75 |
$27.75 |
$27.75 |
$186.00
|
|
T cells absolute cd 4 count
|
$19.01 |
$19.01 |
$19.01 |
$120.25
|
|
T cells total count
|
$204.08 |
$204.08 |
$204.08 |
$124.11
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$103.02 |
$103.02 |
$103.02 |
$2,791.41
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$224.08 |
$224.08 |
$224.08 |
$17,652.73
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$39.48 |
$39.48 |
$39.48 |
$44.49
|
|
Tert gene targeted seq alys
|
$80.00 |
$80.00 |
$80.00 |
$304.59
|
|
Test for chlorohydrocarbons
|
$46.80 |
$46.80 |
$46.80 |
$71.04
|
|
Test for urine cystines
|
$18.48 |
$18.48 |
$18.48 |
$26.00
|
|
Test stress cardiovascular tracing only
|
$1,453.20 |
$1,453.20 |
$1,453.20 |
$1,001.55
|
|
Tetanus immune globulin inj
|
$409.18 |
$409.18 |
$409.18 |
$1,395.20
|
|
Theophylline therapeutic drug level
|
$94.52 |
$94.52 |
$94.52 |
$108.00
|
|
Ther nma rdctj intus/obstrcj
|
$781.60 |
$781.60 |
$781.60 |
$534.32
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$8.56 |
$8.56 |
$8.56 |
$38.64
|
|
Thrombin time
|
$153.95 |
$153.95 |
$153.95 |
$48.75
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$26.64 |
$26.64 |
$26.64 |
$56.93
|
|
Thyroglobulin antibody
|
$27.30 |
$27.30 |
$27.30 |
$84.00
|
|
Thyroid imaging
|
$1,165.20 |
$1,165.20 |
$1,165.20 |
$670.80
|
|
Thyroid mets imag whole body
|
$2,670.80 |
$2,670.80 |
$2,670.80 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$131.88 |
$131.88 |
$131.88 |
$120.00
|
|
Thyroid Ultrasound
|
$485.20 |
$485.20 |
$485.20 |
$589.96
|
|
Thyroid uptake measurement
|
$956.40 |
$956.40 |
$956.40 |
$653.60
|
|
Thyroxine binding globulin (tbg)
|
$24.49 |
$24.49 |
$24.49 |
$63.60
|
|
Tigecycline injection
|
$2.33 |
$2.33 |
$2.33 |
$308.75
|
|
Tirofiban 12.5 mg/50 ml
|
$14.49 |
$14.49 |
$14.49 |
$360.60
|
|
Tissue culture placenta
|
$144.00 |
$144.00 |
$144.00 |
$520.91
|
|
Tissue culture skin/biopsy
|
$144.00 |
$144.00 |
$144.00 |
$558.87
|
|
Tissue culture tumor
|
$144.00 |
$144.00 |
$144.00 |
$529.23
|
|
Tissue exam koh skin/hair/nails
|
$9.19 |
$9.19 |
$9.19 |
$47.40
|
|
Tissue transglutaminase iga
|
$19.26 |
$19.26 |
$19.26 |
$48.57
|
|
Tl-201 thallium diag per mci
|
$116.40 |
$116.40 |
$116.40 |
$77.22
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$77.60 |
$77.60 |
$77.60 |
$125.87
|
|
Tobramycin peak therapeutic drug level
|
$133.24 |
$133.24 |
$133.24 |
$121.55
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$10.44 |
$10.44 |
$10.44 |
$5,790.85
|
|
Tomosynthesis breast screen bilateral
|
$46.00 |
$46.00 |
$46.00 |
$73.45
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$12.90 |
$12.90 |
$12.90 |
$303.88
|
|
Toxoplasma antibody igg
|
$67.60 |
$67.60 |
$67.60 |
$84.35
|
|
Transferrin
|
$46.22 |
$46.22 |
$46.22 |
$87.30
|
|
Trastuzumab 150 mg intravenous solution
|
$108.59 |
$108.59 |
$108.59 |
$3,401.26
|
|
Treponema pallidum antibody
|
$43.66 |
$43.66 |
$43.66 |
$72.80
|
|
Trg gene rearrangement anal
|
$90.00 |
$90.00 |
$90.00 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$12.87 |
$12.87 |
$12.87 |
$48.22
|
|
Trichinella antibody
|
$18.35 |
$18.35 |
$18.35 |
$70.65
|
|
Triglycerides
|
$36.08 |
$36.08 |
$36.08 |
$54.60
|
|
Trimethobenzamide hcl inj
|
$39.77 |
$39.77 |
$39.77 |
$154.09
|
|
Troponin quantitative
|
$89.65 |
$89.65 |
$89.65 |
$123.75
|
|
Ua w/micro/comp poc
|
$4.54 |
$4.54 |
$4.54 |
$24.45
|
|
Ultrasound abdomen aorta screening study aaa
|
$292.00 |
$292.00 |
$292.00 |
$403.26
|
|
Ultrasound breast complete
|
$247.60 |
$247.60 |
$247.60 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$247.60 |
$247.60 |
$247.60 |
$449.35
|
|
Ultrasound chest
|
$267.20 |
$267.20 |
$267.20 |
$459.55
|
|
Ultrasound elastography ea l target les
|
$410.00 |
$410.00 |
$410.00 |
$136.11
|
|
Ultrasound elastography parenchyma
|
$438.40 |
$438.40 |
$438.40 |
$284.25
|
|
Ultrasound encephalogram
|
$451.20 |
$451.20 |
$451.20 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$359.20 |
$359.20 |
$359.20 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$268.00 |
$268.00 |
$268.00 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$132.80 |
$132.80 |
$132.80 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$196.00 |
$196.00 |
$196.00 |
$701.35
|
|
Ultrasound hips infant dynamic
|
$432.80 |
$432.80 |
$432.80 |
$403.00
|
|
Ultrasound infant hips ltd without stress
|
$304.00 |
$304.00 |
$304.00 |
$321.35
|
|
Ultrasound joint complete left
|
$233.60 |
$233.60 |
$233.60 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$146.40 |
$146.40 |
$146.40 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$286.40 |
$286.40 |
$286.40 |
$454.11
|
