|
Stent iliac/open/perc/ea ad/ipsila 37223
|
$10,499.50 |
$10,499.50 |
$10,499.50 |
$9,276.80
|
|
Stent/tib/peroneal/unilat/initial 37230
|
$18,611.45 |
$18,611.45 |
$18,611.45 |
$19,765.20
|
|
St evaluate speech sound production
|
$294.25 |
$294.25 |
$294.25 |
$300.00
|
|
St evaluate speech sound production comprehensive/expressive
|
$790.35 |
$790.35 |
$790.35 |
$393.00
|
|
St evaluation motion fluoroscopic swallow function cine/video
|
$416.90 |
$416.90 |
$416.90 |
$406.40
|
|
St evaluation swallow function
|
$232.10 |
$232.10 |
$232.10 |
$336.60
|
|
Strapping of ankle and/or ft 29540
|
$226.60 |
$226.60 |
$226.60 |
$248.05
|
|
Strapping of elbow or wrist 29260
|
$84.15 |
$84.15 |
$84.15 |
$171.00
|
|
Strapping of hand or finger
|
$84.15 |
$84.15 |
$84.15 |
$194.40
|
|
Strapping of knee
|
$67.65 |
$67.65 |
$67.65 |
$224.80
|
|
Strep b assay w/optic
|
$107.25 |
$107.25 |
$107.25 |
$32.00
|
|
Stress test pulmonary
|
$242.55 |
$242.55 |
$242.55 |
$327.20
|
|
St treatment speech individual
|
$234.85 |
$234.85 |
$234.85 |
$254.15
|
|
St treatment swallow dysfunction/oral
|
$307.45 |
$307.45 |
$307.45 |
$261.60
|
|
Sugars single quant
|
$44.00 |
$44.00 |
$44.00 |
$52.47
|
|
Sulfonylurea screen qn-sendout
|
$111.10 |
$111.10 |
$111.10 |
$184.60
|
|
Surg dx exam anorectal
|
$2,263.80 |
$2,263.80 |
$2,263.80 |
$3,035.44
|
|
Surgical pathology level 1 gross examination only
|
$109.45 |
$109.45 |
$109.45 |
$92.59
|
|
Surgical pathology level 2 gross & microscopic examination
|
$268.95 |
$268.95 |
$268.95 |
$149.76
|
|
Surgical pathology level 3 gross & microscopic examination
|
$319.00 |
$319.00 |
$319.00 |
$192.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$458.70 |
$458.70 |
$458.70 |
$253.75
|
|
Surgical pathology level 5 gross & microscopic examination
|
$977.90 |
$977.90 |
$977.90 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,074.15 |
$1,074.15 |
$1,074.15 |
$790.00
|
|
Susceptibility agar dilution per agent
|
$78.65 |
$78.65 |
$78.65 |
$40.30
|
|
Susceptibility enzyme detection per enzyme
|
$47.30 |
$47.30 |
$47.30 |
$34.48
|
|
Susceptibility mic per plate
|
$86.35 |
$86.35 |
$86.35 |
$94.38
|
|
Suscept studies macrobroth dilution ea
|
$36.30 |
$36.30 |
$36.30 |
$48.30
|
|
Svc venogram s&i
|
$1,746.80 |
$1,746.80 |
$1,746.80 |
$1,908.00
|
|
Sweat collection by iontophoresis
|
$225.50 |
$225.50 |
$225.50 |
$105.21
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$79.20 |
$79.20 |
$79.20 |
$44.85
|
|
System pacing micra av
|
$10,195.78 |
$10,195.78 |
$10,195.78 |
$24,060.43
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$14,188.91 |
$14,188.91 |
$14,188.91 |
$10,785.32
|
|
T3 (triiodothyronine) free
|
$27.50 |
$27.50 |
$27.50 |
$89.82
|
|
T3 (triiodothyronine) total
|
$187.55 |
$187.55 |
$187.55 |
$94.90
|
|
T4 (thyroxine) free
|
$161.70 |
$161.70 |
$161.70 |
$81.60
|
|
T4 (thyroxine) total
|
$251.35 |
$251.35 |
$251.35 |
$73.64
|
|
Tacrolimus therapeutic drug level
|
$236.50 |
$236.50 |
$236.50 |
$122.40
|
|
Target gsa panel organ/hmtlmph neop
|
$6,590.65 |
$6,590.65 |
$6,590.65 |
$3,385.00
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$225.50 |
$225.50 |
$225.50 |
$200.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$310.20 |
$310.20 |
$310.20 |
$166.46
|
|
Tc-99m exame autol wbc diag per dose
|
$3,581.05 |
$3,581.05 |
$3,581.05 |
$2,393.40
|
|
Tc-99m exametazime diag
|
$2,493.70 |
$2,493.70 |
$2,493.70 |
$2,166.26
|
|
Tc-99m fanolesomab diag
|
$2,422.20 |
$2,422.20 |
$2,422.20 |
$2,860.65
|
|
Tc-99m labeled rbc
|
$561.00 |
$561.00 |
$561.00 |
$323.01
|
|
Tc-99m maa
|
$129.25 |
$129.25 |
$129.25 |
$312.06
|
|
Tc-99m mebrofenin
|
$169.95 |
$169.95 |
$169.95 |
$169.53
|
|
Tc-99m medronate
|
$113.85 |
$113.85 |
$113.85 |
$122.46
|
|
Tc-99m mertiatide
|
$818.40 |
$818.40 |
$818.40 |
$757.25
|
|
Tc-99m pentetate dtpa
|
$90.75 |
$90.75 |
$90.75 |
$245.85
|
|
Tc-99m pentetate dtpa aerosol
|
$261.25 |
$261.25 |
$261.25 |
$244.02
|
|
Tc-99m pertechnetate per mci
|
$151.80 |
$151.80 |
$151.80 |
$28.08
|
|
Tc-99m sestamibi p study dose
|
$792.00 |
$792.00 |
$792.00 |
$221.60
|
|
Tc-99m succimer (dmsa)
|
$390.50 |
$390.50 |
$390.50 |
$1,578.33
|
|
Tc-99m sulfur colloid
|
$216.15 |
$216.15 |
$216.15 |
$245.70
|
|
Tc-99m tilmanocept diag
|
$886.60 |
$886.60 |
$886.60 |
$930.54
|
|
T cells absolute cd4/cd8 including ratio
|
$192.50 |
$192.50 |
$192.50 |
$186.00
|
|
T cells absolute cd 4 count
|
$102.30 |
$102.30 |
$102.30 |
$120.25
|
|
T cells total count
|
$158.40 |
$158.40 |
$158.40 |
$124.11
|
|
Telehealth original site facility fee
|
$42.90 |
$42.90 |
$42.90 |
$57.75
|
|
Telethx isodose plan cplx
|
$1,617.00 |
$1,617.00 |
$1,617.00 |
$1,617.00
|
|
Telethx isodose plan simple
|
$470.80 |
$470.80 |
$470.80 |
$848.72
|
|
Testicular imaging w/vasc flow
|
$862.40 |
$862.40 |
$862.40 |
$780.48
|
|
Test pathogen(s) for platelets reference
|
$113.85 |
$113.85 |
$113.85 |
$75.95
|
|
Test stress cardiovascular tracing only
|
$1,749.55 |
$1,749.55 |
$1,749.55 |
$1,001.55
|
|
Theophylline therapeutic drug level
|
$194.70 |
$194.70 |
$194.70 |
$108.00
|
|
Therapeutic procd strg endur
|
$86.35 |
$86.35 |
$86.35 |
$85.80
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$55.00 |
$55.00 |
$55.00 |
$55.00
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$46.20 |
$46.20 |
$46.20 |
$50.40
|
|
Ther/proph/diag inj ia
|
$236.50 |
$236.50 |
$236.50 |
$247.33
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,646.15 |
$1,646.15 |
$1,646.15 |
$1,804.00
|
|
Thrombectmy crnry perq mechanical
|
$5,848.70 |
$5,848.70 |
$5,848.70 |
$3,580.00
|
|
Thrombectomy/inf pq dialysis circuit
|
$12,690.70 |
$12,690.70 |
$12,690.70 |
$7,828.60
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$25,296.15 |
$25,296.15 |
$25,296.15 |
$15,185.00
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$24,769.80 |
$24,769.80 |
$24,769.80 |
$24,605.30
|
|
Thrombin time
|
$118.25 |
$118.25 |
$118.25 |
$48.75
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$69.85 |
$69.85 |
$69.85 |
$56.93
|
|
Thyroglobulin antibody
|
$237.60 |
$237.60 |
$237.60 |
$84.00
|
|
Thyroid imaging
|
$926.20 |
$926.20 |
$926.20 |
$670.80
|
|
Thyroid mets imag whole body
|
$1,482.80 |
$1,482.80 |
$1,482.80 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$147.40 |
$147.40 |
$147.40 |
$120.00
|
|
Thyroid Ultrasound
|
$1,102.20 |
$1,102.20 |
$1,102.20 |
$589.96
|
|
Thyroid uptake measurement
|
$732.60 |
$732.60 |
$732.60 |
$653.60
|
|
Thyroxine binding globulin (tbg)
|
$215.60 |
$215.60 |
$215.60 |
$63.60
|
|
Tib/per revasc stent & ather 37231
|
$24,231.35 |
$24,231.35 |
$24,231.35 |
$21,900.00
|
|
Tib/per revasc stnt & ather
|
$15,762.45 |
$15,762.45 |
$15,762.45 |
$11,121.63
|
|
Tib/per revasc w/ather add-on 37233
|
$12,192.40 |
$12,192.40 |
$12,192.40 |
$10,406.14
|
|
Tilt table study
|
$880.00 |
$880.00 |
$880.00 |
$1,495.00
|
|
Tissue culture placenta
|
$2,742.85 |
$2,742.85 |
$2,742.85 |
$520.91
|
|
Tissue culture skin/biopsy
|
$847.00 |
$847.00 |
$847.00 |
$558.87
|
|
Tissue exam koh skin/hair/nails
|
$31.35 |
$31.35 |
$31.35 |
$47.40
|
|
Tissue transglutaminase iga
|
$27.50 |
$27.50 |
$27.50 |
$48.57
|
|
Tl-201 thallium diag per mci
|
$87.45 |
$87.45 |
$87.45 |
$77.22
|
|
Tobramycin peak therapeutic drug level
|
$225.50 |
$225.50 |
$225.50 |
$121.55
|
|
Tomosynthesis breast screen bilateral
|
$74.80 |
$74.80 |
$74.80 |
$73.45
|
|
Toxoplasma antibody igg
|
$185.90 |
$185.90 |
$185.90 |
$84.35
|
|
Toxoplasma antibody igm
|
$270.60 |
$270.60 |
$270.60 |
$83.20
|
|
Tp53 gene full gene sequence
|
$579.70 |
$579.70 |
$579.70 |
$706.04
|
|
Tp53 gene trgt sequence alys
|
$1,689.60 |
$1,689.60 |
$1,689.60 |
$919.10
|
|
Tpmt gene com vrnts
|
$637.45 |
$637.45 |
$637.45 |
$381.55
|
|
Tracheobrnchsc thru est trachs incisn
|
$642.40 |
$642.40 |
$642.40 |
$1,459.48
|
