|
Surgical pathology level 4 gross & microscopic examination
|
$463.46 |
$463.46 |
$463.46 |
$253.75
|
|
Surgical pathology level 5 gross & microscopic examination
|
$616.32 |
$616.32 |
$616.32 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,650.05 |
$1,650.05 |
$1,650.05 |
$790.00
|
|
Susceptibility agar dilution per agent
|
$15.35 |
$15.35 |
$15.35 |
$40.30
|
|
Susceptibility enzyme detection per enzyme
|
$52.11 |
$52.11 |
$52.11 |
$34.48
|
|
Susceptibility mic per plate
|
$587.37 |
$587.37 |
$587.37 |
$94.38
|
|
Svc venogram s&i
|
$2,871.70 |
$2,871.70 |
$2,871.70 |
$1,908.00
|
|
Synvisc or synvisc-one
|
$1,032.15 |
$1,032.15 |
$1,032.15 |
$1,232.66
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$15.00 |
$15.00 |
$15.00 |
$44.85
|
|
T3 (triiodothyronine) free
|
$184.73 |
$184.73 |
$184.73 |
$89.82
|
|
T3 (triiodothyronine) total
|
$48.00 |
$48.00 |
$48.00 |
$94.90
|
|
T4 (thyroxine) free
|
$70.60 |
$70.60 |
$70.60 |
$81.60
|
|
T4 (thyroxine) total
|
$171.68 |
$171.68 |
$171.68 |
$73.64
|
|
Tacrolimus therapeutic drug level
|
$35.77 |
$35.77 |
$35.77 |
$122.40
|
|
Target gsa panel hmtlmph neop
|
$7,579.69 |
$7,579.69 |
$7,579.69 |
$1,928.40
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$1,911.46 |
$1,911.46 |
$1,911.46 |
$957.09
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$304.21 |
$304.21 |
$304.21 |
$166.46
|
|
T cells absolute cd4/cd8 including ratio
|
$58.84 |
$58.84 |
$58.84 |
$186.00
|
|
T cells absolute cd 4 count
|
$157.37 |
$157.37 |
$157.37 |
$120.25
|
|
T cells total count
|
$315.17 |
$315.17 |
$315.17 |
$124.11
|
|
Telethx isodose plan cplx
|
$1,909.45 |
$1,909.45 |
$1,909.45 |
$1,617.00
|
|
Telethx isodose plan simple
|
$930.45 |
$930.45 |
$930.45 |
$848.72
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$16.82 |
$16.82 |
$16.82 |
$46.10
|
|
Test pathogen(s) for platelets reference
|
$128.39 |
$128.39 |
$128.39 |
$75.00
|
|
Test stress cardiovascular tracing only
|
$1,559.04 |
$1,559.04 |
$1,559.04 |
$1,001.55
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$21,576.20 |
$21,576.20 |
$21,576.20 |
$8,737.05
|
|
Theophylline therapeutic drug level
|
$101.31 |
$101.31 |
$101.31 |
$108.00
|
|
Therapeutic procd strg endur
|
$163.45 |
$163.45 |
$163.45 |
$85.80
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$94.00 |
$94.00 |
$94.00 |
$55.00
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$90.71 |
$90.71 |
$90.71 |
$50.40
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$83.14 |
$83.14 |
$83.14 |
$35.72
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$2,000.05 |
$2,000.05 |
$2,000.05 |
$1,804.00
|
|
Thrombectmy crnry perq mechanical
|
$5,807.66 |
$5,807.66 |
$5,807.66 |
$3,580.00
|
|
Thrombectomy/inf pq dialysis circuit
|
$14,070.86 |
$14,070.86 |
$14,070.86 |
$7,828.60
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$31,691.30 |
$31,691.30 |
$31,691.30 |
$15,185.00
|
|
Thrombin time
|
$16.71 |
$16.71 |
$16.71 |
$48.75
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$22.84 |
$22.84 |
$22.84 |
$56.93
|
|
Thyroglobulin antibody
|
$58.35 |
$58.35 |
$58.35 |
$84.00
|
|
Thyroid (TSH) Test
|
$127.92 |
$127.92 |
$127.92 |
$120.00
|
|
Thyroid Ultrasound
|
$951.48 |
$951.48 |
$951.48 |
$589.96
|
|
Thyroxine binding globulin (tbg)
|
$56.55 |
$56.55 |
$56.55 |
$63.60
|
|
Tilt table study
|
$2,456.38 |
$2,456.38 |
$2,456.38 |
$1,495.00
|
|
Tissue exam koh skin/hair/nails
|
$24.37 |
$24.37 |
$24.37 |
$47.40
|
|
Tissue transglutaminase iga
|
$31.78 |
$31.78 |
$31.78 |
$48.57
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$59.47 |
$59.47 |
$59.47 |
$139.53
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$3,881.18 |
$3,881.18 |
$3,881.18 |
$4,072.67
|
|
Tomosynthesis breast screen bilateral
|
$113.01 |
$113.01 |
$113.01 |
$73.45
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$213.35 |
$213.35 |
$213.35 |
$383.23
|
|
Toxoplasma antibody igg
|
$55.92 |
$55.92 |
$55.92 |
$84.35
|
|
Toxoplasma antibody igm
|
$41.71 |
$41.71 |
$41.71 |
$83.20
|
|
Tpmt gene com vrnts
|
$730.99 |
$730.99 |
$730.99 |
$381.55
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$91.20 |
$91.20 |
$91.20 |
$104.50
|
|
Transferrin
|
$81.85 |
$81.85 |
$81.85 |
$87.30
|
|
Transfusion blood/blood component(s)
|
$1,278.35 |
$1,278.35 |
$1,278.35 |
$988.24
|
|
Treat finger fracture each
|
$5,410.70 |
$5,410.70 |
$5,410.70 |
$1,815.75
|
|
Treat fracture of radius
|
$5,410.70 |
$5,410.70 |
$5,410.70 |
$2,030.33
|
|
Treat fracture of ulna
|
$800.66 |
$800.66 |
$800.66 |
$766.72
|
|
Treat hip dislocation
|
$5,410.70 |
$5,410.70 |
$5,410.70 |
$3,152.05
|
|
Treat humerus fracture
|
$5,410.70 |
$5,410.70 |
$5,410.70 |
$1,950.60
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$494.71 |
$494.71 |
$494.71 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$288.46 |
$288.46 |
$288.46 |
$149.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$245.54 |
$245.54 |
$245.54 |
$210.00
|
|
Treatment radiation delivery level 2
|
$523.31 |
$523.31 |
$523.31 |
$735.00
|
|
Treat toe dislocation
|
$937.15 |
$937.15 |
$937.15 |
$855.66
|
|
Treat wrist bone fracture
|
$5,410.70 |
$5,410.70 |
$5,410.70 |
$1,907.64
|
|
Treat wrist dislocation
|
$1,043.72 |
$1,043.72 |
$1,043.72 |
$760.00
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$210,521.05 |
$210,521.05 |
$210,521.05 |
$81,176.20
|
|
Treponema pallidum antibody
|
$146.13 |
$146.13 |
$146.13 |
$72.80
|
|
Trg gene rearrangement anal
|
$743.00 |
$743.00 |
$743.00 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$130.48 |
$130.48 |
$130.48 |
$49.63
|
|
Trichinella antibody
|
$76.53 |
$76.53 |
$76.53 |
$70.65
|
|
#tricyclicantidprssnt
|
$83.08 |
$83.08 |
$83.08 |
$57.08
|
|
Triglycerides
|
$130.92 |
$130.92 |
$130.92 |
$54.60
|
|
Trimethobenzamide hcl inj
|
$348.99 |
$348.99 |
$348.99 |
$128.00
|
|
Trim nondyst nails
|
$398.07 |
$398.07 |
$398.07 |
$124.22
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$14,806.64 |
$14,806.64 |
$14,806.64 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$18,577.94 |
$18,577.94 |
$18,577.94 |
$15,408.00
|
|
Trnscath retrv pq vasc fb w/guide
|
$8,861.08 |
$8,861.08 |
$8,861.08 |
$4,969.90
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$2,591.77 |
$2,591.77 |
$2,591.77 |
$6,156.00
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$7,838.41 |
$7,838.41 |
$7,838.41 |
$4,793.13
|
|
Trnscath tx thromblytc vein ini day
|
$3,513.04 |
$3,513.04 |
$3,513.04 |
$4,329.36
|
|
Troponin quantitative
|
$355.63 |
$355.63 |
$355.63 |
$123.75
|
|
Tx closed hip disl traumatic without anes
|
$994.01 |
$994.01 |
$994.01 |
$657.28
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$7,900.66 |
$7,900.66 |
$7,900.66 |
$4,499.12
|
|
Ultrasound abdomen aorta screening study aaa
|
$81.10 |
$81.10 |
$81.10 |
$403.26
|
|
Ultrasound breast complete
|
$433.95 |
$433.95 |
$433.95 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$404.46 |
$404.46 |
$404.46 |
$449.35
|
|
Ultrasound chest
|
$1,522.69 |
$1,522.69 |
$1,522.69 |
$459.55
|
|
Ultrasound dx ophth b-scan
|
$422.92 |
$422.92 |
$422.92 |
$330.40
|
|
Ultrasound elastography parenchyma
|
$381.47 |
$381.47 |
$381.47 |
$284.25
|
|
Ultrasound exam k transpl w/doppler
|
$1,425.60 |
$1,425.60 |
$1,425.60 |
$570.44
|
|
Ultrasound guidance for vascular access
|
$642.56 |
$642.56 |
$642.56 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$1,213.62 |
$1,213.62 |
$1,213.62 |
$701.35
|
|
Ultrasound guide intraoperative
|
$1,176.40 |
$1,176.40 |
$1,176.40 |
$632.90
|
|
Ultrasound guide tissue ablation
|
$947.90 |
$947.90 |
$947.90 |
$498.40
|
|
Ultrasound joint complete left
|
$755.68 |
$755.68 |
$755.68 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$488.69 |
$488.69 |
$488.69 |
$448.50
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$521.05 |
$521.05 |
$521.05 |
$326.54
|
|
Ultrasound pregnant uterus follow up per fetus
|
$422.92 |
$422.92 |
$422.92 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$610.04 |
$610.04 |
$610.04 |
$459.00
|
