|
Surgical pathology level 2 gross & microscopic examination
|
$215.00 |
$215.00 |
$215.00 |
$149.76
|
|
Surgical pathology level 3 gross & microscopic examination
|
$329.00 |
$329.00 |
$329.00 |
$192.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$538.31 |
$538.31 |
$538.31 |
$253.75
|
|
Surgical pathology level 5 gross & microscopic examination
|
$735.09 |
$735.09 |
$735.09 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,732.55 |
$1,732.55 |
$1,732.55 |
$790.00
|
|
Susceptibility agar dilution per agent
|
$63.96 |
$63.96 |
$63.96 |
$40.30
|
|
Susceptibility enzyme detection per enzyme
|
$67.32 |
$67.32 |
$67.32 |
$34.48
|
|
Susceptibility mic per plate
|
$631.08 |
$631.08 |
$631.08 |
$94.38
|
|
Svc venogram s&i
|
$5,744.91 |
$5,744.91 |
$5,744.91 |
$1,908.00
|
|
Synvisc or synvisc-one
|
$543.10 |
$543.10 |
$543.10 |
$1,415.99
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$26.78 |
$26.78 |
$26.78 |
$44.85
|
|
T3 (triiodothyronine) free
|
$215.52 |
$215.52 |
$215.52 |
$89.82
|
|
T3 (triiodothyronine) total
|
$111.23 |
$111.23 |
$111.23 |
$94.90
|
|
T4 (thyroxine) free
|
$111.23 |
$111.23 |
$111.23 |
$81.60
|
|
T4 (thyroxine) total
|
$200.29 |
$200.29 |
$200.29 |
$73.64
|
|
Tacrolimus therapeutic drug level
|
$171.62 |
$171.62 |
$171.62 |
$122.40
|
|
Target gsa panel hmtlmph neop
|
$7,958.67 |
$7,958.67 |
$7,958.67 |
$1,928.40
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$995.97 |
$995.97 |
$995.97 |
$959.55
|
|
Tbs techl calculation only
|
$220.51 |
$220.51 |
$220.51 |
$123.30
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$211.00 |
$211.00 |
$211.00 |
$166.46
|
|
T cells absolute cd4/cd8 including ratio
|
$63.15 |
$63.15 |
$63.15 |
$186.00
|
|
T cells absolute cd 4 count
|
$35.84 |
$35.84 |
$35.84 |
$120.25
|
|
T cells total count
|
$377.59 |
$377.59 |
$377.59 |
$124.11
|
|
Telethx isodose plan cplx
|
$579.11 |
$579.11 |
$579.11 |
$1,617.00
|
|
Telethx isodose plan simple
|
$579.11 |
$579.11 |
$579.11 |
$848.72
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$20.96 |
$20.96 |
$20.96 |
$44.49
|
|
Test pathogen(s) for platelets reference
|
$149.79 |
$149.79 |
$149.79 |
$106.50
|
|
Test stress cardiovascular tracing only
|
$2,689.05 |
$2,689.05 |
$2,689.05 |
$1,001.55
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$11,123.73 |
$11,123.73 |
$11,123.73 |
$12,080.29
|
|
Theophylline therapeutic drug level
|
$263.91 |
$263.91 |
$263.91 |
$108.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$59.58 |
$59.58 |
$59.58 |
$38.64
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$2,400.85 |
$2,400.85 |
$2,400.85 |
$1,804.00
|
|
Thrombectmy crnry perq mechanical
|
$10,641.02 |
$10,641.02 |
$10,641.02 |
$3,580.00
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$43,226.35 |
$43,226.35 |
$43,226.35 |
$15,185.00
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$65,519.87 |
$65,519.87 |
$65,519.87 |
$24,605.30
|
|
Thrombin time
|
$43.21 |
$43.21 |
$43.21 |
$48.75
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$337.48 |
$337.48 |
$337.48 |
$56.93
|
|
Thyroglobulin antibody
|
$70.21 |
$70.21 |
$70.21 |
$84.00
|
|
Thyroid mets imag whole body
|
$3,229.82 |
$3,229.82 |
$3,229.82 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$175.27 |
$175.27 |
$175.27 |
$120.00
|
|
Thyroid Ultrasound
|
$1,652.98 |
$1,652.98 |
$1,652.98 |
$589.96
|
|
Thyroxine binding globulin (tbg)
|
$23.89 |
$23.89 |
$23.89 |
$63.60
|
|
Tib/per revasc stent & ather 37231
|
$38,549.08 |
$38,549.08 |
$38,549.08 |
$21,900.00
|
|
Tib/per revasc w/ather add-on 37233
|
$69,068.11 |
$69,068.11 |
$69,068.11 |
$10,406.14
|
|
Tilt table study
|
$1,865.72 |
$1,865.72 |
$1,865.72 |
$1,495.00
|
|
Tissue culture skin/biopsy
|
$488.74 |
$488.74 |
$488.74 |
$558.87
|
|
Tissue exam koh skin/hair/nails
|
$29.88 |
$29.88 |
$29.88 |
$47.40
|
|
Tissue transglutaminase iga
|
$33.37 |
$33.37 |
$33.37 |
$48.57
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$44.20 |
$44.20 |
$44.20 |
$125.87
|
|
Tobramycin peak therapeutic drug level
|
$254.11 |
$254.11 |
$254.11 |
$121.55
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$2,010.42 |
$2,010.42 |
$2,010.42 |
$5,790.85
|
|
Tomosynthesis breast screen bilateral
|
$103.18 |
$103.18 |
$103.18 |
$73.45
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$114.37 |
$114.37 |
$114.37 |
$303.88
|
|
Toxoplasma antibody igg
|
$13.45 |
$13.45 |
$13.45 |
$84.35
|
|
Toxoplasma antibody igm
|
$13.45 |
$13.45 |
$13.45 |
$83.20
|
|
Tpmt gene com vrnts
|
$879.77 |
$879.77 |
$879.77 |
$381.55
|
|
Transcath biopsy
|
$5,541.77 |
$5,541.77 |
$5,541.77 |
$4,298.05
|
|
Transcatheter bx s&i
|
$4,066.43 |
$4,066.43 |
$4,066.43 |
$1,875.96
|
|
Transferrin
|
$95.49 |
$95.49 |
$95.49 |
$87.30
|
|
Transfusion blood/blood component(s)
|
$2,431.81 |
$2,431.81 |
$2,431.81 |
$988.24
|
|
Treat finger fracture each
|
$4,940.21 |
$4,940.21 |
$4,940.21 |
$1,815.75
|
|
Treat fracture of radius
|
$4,940.21 |
$4,940.21 |
$4,940.21 |
$2,030.33
|
|
Treat fracture of ulna
|
$731.04 |
$731.04 |
$731.04 |
$766.72
|
|
Treat hip dislocation
|
$4,940.21 |
$4,940.21 |
$4,940.21 |
$3,152.05
|
|
Treat humerus fracture
|
$4,940.21 |
$4,940.21 |
$4,940.21 |
$1,950.60
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$241.24 |
$241.24 |
$241.24 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$34.07 |
$34.07 |
$34.07 |
$149.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$235.37 |
$235.37 |
$235.37 |
$210.00
|
|
Treatment of ankle fracture 27786
|
$731.04 |
$731.04 |
$731.04 |
$580.00
|
|
Treatment of toe fracture 28510
|
$731.04 |
$731.04 |
$731.04 |
$371.40
|
|
Treatment radiation delivery level 2
|
$988.96 |
$988.96 |
$988.96 |
$735.00
|
|
Treat toe dislocation
|
$855.66 |
$855.66 |
$855.66 |
$855.66
|
|
Treat wrist dislocation
|
$1,154.25 |
$1,154.25 |
$1,154.25 |
$760.00
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$91,216.60 |
$91,216.60 |
$91,216.60 |
$120,541.18
|
|
Treponema pallidum antibody
|
$153.44 |
$153.44 |
$153.44 |
$72.80
|
|
Trg gene rearrangement anal
|
$699.79 |
$699.79 |
$699.79 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$83.57 |
$83.57 |
$83.57 |
$48.22
|
|
Triglycerides
|
$152.74 |
$152.74 |
$152.74 |
$54.60
|
|
Trimethobenzamide hcl inj
|
$204.72 |
$204.72 |
$204.72 |
$154.09
|
|
Trim nondyst nails
|
$197.43 |
$197.43 |
$197.43 |
$124.22
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$44,790.43 |
$44,790.43 |
$44,790.43 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$44,790.43 |
$44,790.43 |
$44,790.43 |
$15,408.00
|
|
Trnscath retrv pq vasc fb w/guide
|
$9,122.51 |
$9,122.51 |
$9,122.51 |
$4,969.90
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$4,302.29 |
$4,302.29 |
$4,302.29 |
$6,156.00
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$9,600.35 |
$9,600.35 |
$9,600.35 |
$4,505.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$9,600.35 |
$9,600.35 |
$9,600.35 |
$4,793.13
|
|
Troponin quantitative
|
$402.26 |
$402.26 |
$402.26 |
$123.75
|
|
Ugt1a1 gene analy common variants
|
$812.66 |
$812.66 |
$812.66 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$709.25 |
$709.25 |
$709.25 |
$403.26
|
|
Ultrasound breast complete
|
$525.95 |
$525.95 |
$525.95 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$426.60 |
$426.60 |
$426.60 |
$449.35
|
|
Ultrasound chest
|
$865.71 |
$865.71 |
$865.71 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$1,377.30 |
$1,377.30 |
$1,377.30 |
$340.14
|
|
Ultrasound dx ophth b-scan
|
$386.15 |
$386.15 |
$386.15 |
$330.40
|
|
Ultrasound exam k transpl w/doppler
|
$1,647.89 |
$1,647.89 |
$1,647.89 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$2,278.24 |
$2,278.24 |
$2,278.24 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$1,001.66 |
$1,001.66 |
$1,001.66 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$1,128.98 |
$1,128.98 |
$1,128.98 |
$701.35
|
|
Ultrasound guide tissue ablation
|
$987.53 |
$987.53 |
$987.53 |
$498.40
|
|
Ultrasound joint complete left
|
$1,506.90 |
$1,506.90 |
$1,506.90 |
$556.14
|