|
Surgical pathology level 5 gross & microscopic examination
|
$653.76 |
$653.76 |
$653.76 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,029.60 |
$1,029.60 |
$1,029.60 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$25.92 |
$25.92 |
$25.92 |
$43.20
|
|
Susceptibility enzyme detection per enzyme
|
$75.60 |
$75.60 |
$75.60 |
$35.40
|
|
Susceptibility mic per plate
|
$164.88 |
$164.88 |
$164.88 |
$104.80
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$42.48 |
$42.48 |
$42.48 |
$40.11
|
|
T3 (triiodothyronine) free
|
$97.20 |
$97.20 |
$97.20 |
$99.50
|
|
T3 (triiodothyronine) total
|
$108.72 |
$108.72 |
$108.72 |
$93.52
|
|
T4 (thyroxine) free
|
$141.12 |
$141.12 |
$141.12 |
$85.20
|
|
T4 (thyroxine) total
|
$133.92 |
$133.92 |
$133.92 |
$67.60
|
|
Tacrolimus therapeutic drug level
|
$172.08 |
$172.08 |
$172.08 |
$121.39
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$126.00 |
$126.00 |
$126.00 |
$194.35
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$233.28 |
$233.28 |
$233.28 |
$177.65
|
|
Tc-99m non-heu per study dose
|
$18.72 |
$18.72 |
$18.72 |
$6.50
|
|
T cells absolute cd4/cd8 including ratio
|
$133.92 |
$133.92 |
$133.92 |
$175.00
|
|
T cells absolute cd 4 count
|
$33.84 |
$33.84 |
$33.84 |
$110.72
|
|
T cells total count
|
$86.40 |
$86.40 |
$86.40 |
$123.00
|
|
Telehealth original site facility fee
|
$66.96 |
$66.96 |
$66.96 |
$51.85
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$28,116.16 |
$28,116.16 |
$28,116.16 |
$15,245.38
|
|
Test stress cardiovascular tracing only
|
$792.00 |
$792.00 |
$792.00 |
$951.60
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$71.90 |
$71.90 |
$71.90 |
$8,737.05
|
|
Tgsap so neo 5-50 rna alys
|
$2,255.04 |
$2,255.04 |
$2,255.04 |
$1,019.60
|
|
Theophylline therapeutic drug level
|
$82.80 |
$82.80 |
$82.80 |
$108.00
|
|
Therapeutic procd strg endur
|
$52.56 |
$52.56 |
$52.56 |
$83.50
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$38.16 |
$38.16 |
$38.16 |
$55.98
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$38.16 |
$38.16 |
$38.16 |
$50.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$17.19 |
$17.19 |
$17.19 |
$25.54
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$667.44 |
$667.44 |
$667.44 |
$1,687.50
|
|
Thoracotomy with cardiac massage
|
$417.60 |
$417.60 |
$417.60 |
$2,138.76
|
|
Thrombin time
|
$41.76 |
$41.76 |
$41.76 |
$53.76
|
|
Thyroglobulin antibody
|
$185.04 |
$185.04 |
$185.04 |
$81.90
|
|
Thyroid imaging
|
$784.80 |
$784.80 |
$784.80 |
$695.02
|
|
Thyroid (TSH) Test
|
$132.48 |
$132.48 |
$132.48 |
$112.70
|
|
Thyroid Ultrasound
|
$984.96 |
$984.96 |
$984.96 |
$589.96
|
|
Thyroid uptake measurement
|
$1,361.52 |
$1,361.52 |
$1,361.52 |
$590.05
|
|
Thyroxine binding globulin (tbg)
|
$18.72 |
$18.72 |
$18.72 |
$64.51
|
|
Tissue culture skin/biopsy
|
$714.24 |
$714.24 |
$714.24 |
$499.20
|
|
Tissue exam koh skin/hair/nails
|
$88.56 |
$88.56 |
$88.56 |
$47.52
|
|
Tissue transglutaminase iga
|
$103.68 |
$103.68 |
$103.68 |
$44.80
|
|
Tobramycin peak therapeutic drug level
|
$121.68 |
$121.68 |
$121.68 |
$121.55
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$22.95 |
$22.95 |
$22.95 |
$5,258.52
|
|
Tomosynthesis breast diagnostic left
|
$99.36 |
$99.36 |
$99.36 |
$71.40
|
|
Tomosynthesis breast screen bilateral
|
$93.60 |
$93.60 |
$93.60 |
$68.90
|
|
Total tau
|
$511.20 |
$511.20 |
$511.20 |
$312.00
|
|
Toxoplasma antibody igg
|
$42.48 |
$42.48 |
$42.48 |
$89.57
|
|
Toxoplasma antibody igm
|
$42.48 |
$42.48 |
$42.48 |
$87.00
|
|
Tp53 gene trgt sequence alys
|
$1,349.28 |
$1,349.28 |
$1,349.28 |
$823.00
|
|
Tpmt gene com vrnts
|
$220.32 |
$220.32 |
$220.32 |
$373.00
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$68.40 |
$68.40 |
$68.40 |
$101.25
|
|
Transferrin
|
$137.52 |
$137.52 |
$137.52 |
$81.60
|
|
Transfusion blood/blood component(s)
|
$749.52 |
$749.52 |
$749.52 |
$936.80
|
|
Transparent film >16<=48 in
|
$6.48 |
$6.48 |
$6.48 |
$8.47
|
|
Treat finger fracture each
|
$1,728.72 |
$1,728.72 |
$1,728.72 |
$1,592.00
|
|
Treat foot dislocation
|
$274.32 |
$274.32 |
$274.32 |
$445.00
|
|
Treat fracture of radius
|
$1,728.72 |
$1,728.72 |
$1,728.72 |
$1,790.00
|
|
Treat fracture of ulna
|
$259.20 |
$259.20 |
$259.20 |
$731.04
|
|
Treat humerus fracture
|
$1,728.72 |
$1,728.72 |
$1,728.72 |
$1,771.43
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$342.00 |
$342.00 |
$342.00 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$134.64 |
$134.64 |
$134.64 |
$143.75
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$299.52 |
$299.52 |
$299.52 |
$203.49
|
|
Treatment of eyelid lesions
|
$322.56 |
$322.56 |
$322.56 |
$353.74
|
|
Treatment of penis lesion
|
$5,409.36 |
$5,409.36 |
$5,409.36 |
$3,515.40
|
|
Treatment of thigh fracture
|
$3,925.44 |
$3,925.44 |
$3,925.44 |
$1,698.58
|
|
Treat toe dislocation
|
$738.72 |
$738.72 |
$738.72 |
$763.50
|
|
Treat ulnar fracture
|
$1,728.72 |
$1,728.72 |
$1,728.72 |
$1,662.00
|
|
Treat wrist bone fracture
|
$1,728.72 |
$1,728.72 |
$1,728.72 |
$1,588.95
|
|
Treponema pallidum antibody
|
$210.96 |
$210.96 |
$210.96 |
$70.40
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$7.69 |
$7.69 |
$7.69 |
$43.09
|
|
Trichomonas assay w/optic
|
$146.88 |
$146.88 |
$146.88 |
$56.70
|
|
Triglycerides
|
$87.84 |
$87.84 |
$87.84 |
$57.85
|
|
Trim nondyst nails
|
$131.04 |
$131.04 |
$131.04 |
$115.70
|
|
Troponin quantitative
|
$175.68 |
$175.68 |
$175.68 |
$127.20
|
|
Tte w or without contr, cont ecg
|
$1,970.64 |
$1,970.64 |
$1,970.64 |
$2,006.88
|
|
Tte w or without fol w/con,stres
|
$1,285.20 |
$1,285.20 |
$1,285.20 |
$1,657.92
|
|
Tx closed hip disl traumatic without anes
|
$259.20 |
$259.20 |
$259.20 |
$581.07
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$3,504.24 |
$3,504.24 |
$3,504.24 |
$3,986.00
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$3,648.24 |
$3,648.24 |
$3,648.24 |
$4,499.12
|
|
Tx phalangeal shaft fx open prox/middle ea
|
$6,247.44 |
$6,247.44 |
$6,247.44 |
$4,499.12
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$255.97 |
$255.97 |
$255.97 |
$17,921.01
|
|
Ugt1a1 gene analy common variants
|
$529.20 |
$529.20 |
$529.20 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$378.72 |
$378.72 |
$378.72 |
$394.20
|
|
Ultrasound breast complete
|
$1,429.92 |
$1,429.92 |
$1,429.92 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$714.24 |
$714.24 |
$714.24 |
$452.00
|
|
Ultrasound chest
|
$387.36 |
$387.36 |
$387.36 |
$460.85
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$722.88 |
$722.88 |
$722.88 |
$477.10
|
|
Ultrasound guidance for vascular access
|
$171.36 |
$171.36 |
$171.36 |
$388.08
|
|
Ultrasound guided needle placement supervision & interpretation
|
$1,082.16 |
$1,082.16 |
$1,082.16 |
$720.15
|
|
Ultrasound guide intraoperative
|
$804.24 |
$804.24 |
$804.24 |
$625.15
|
|
Ultrasound joint complete left
|
$953.28 |
$953.28 |
$953.28 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$896.40 |
$896.40 |
$896.40 |
$424.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$679.68 |
$679.68 |
$679.68 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$316.08 |
$316.08 |
$316.08 |
$428.25
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$592.56 |
$592.56 |
$592.56 |
$452.10
|
|
Ultrasound pregnant uterus transvaginal
|
$802.80 |
$802.80 |
$802.80 |
$490.00
|
|
Ultrasound prostate/transrectal
|
$1,047.60 |
$1,047.60 |
$1,047.60 |
$549.95
|
|
Ultrasound retroperitoneal limited
|
$361.44 |
$361.44 |
$361.44 |
$479.60
|
|
Ultrasound scrotum and contents
|
$1,265.04 |
$1,265.04 |
$1,265.04 |
$612.55
|
|
Ultrasound transabd ea addl gest
|
$626.40 |
$626.40 |
$626.40 |
$424.80
|
|
Ultrasound transvaginal non obstetric
|
$738.00 |
$738.00 |
$738.00 |
$558.35
|
|
Unlisted hematology&coagj px
|
$6.48 |
$6.48 |
$6.48 |
$39.52
|