|
Surgical pathology level 4 gross & microscopic examination
|
$379.20 |
$379.20 |
$379.20 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$611.40 |
$611.40 |
$611.40 |
$489.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$942.00 |
$942.00 |
$942.00 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$258.00 |
$258.00 |
$258.00 |
$38.58
|
|
Susceptibility enzyme detection per enzyme
|
$97.20 |
$97.20 |
$97.20 |
$31.85
|
|
Susceptibility mic per plate
|
$162.60 |
$162.60 |
$162.60 |
$89.70
|
|
Svc venogram s&i
|
$1,908.00 |
$1,908.00 |
$1,908.00 |
$1,908.00
|
|
Sweat collection by iontophoresis
|
$85.20 |
$85.20 |
$85.20 |
$100.20
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$85.80 |
$85.80 |
$85.80 |
$45.70
|
|
T3 (triiodothyronine) free
|
$402.00 |
$402.00 |
$402.00 |
$91.20
|
|
T3 (triiodothyronine) total
|
$262.80 |
$262.80 |
$262.80 |
$88.00
|
|
T4 (thyroxine) free
|
$237.60 |
$237.60 |
$237.60 |
$65.00
|
|
T4 (thyroxine) total
|
$170.40 |
$170.40 |
$170.40 |
$62.40
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$2.47 |
$2.47 |
$2.47 |
$4.87
|
|
Tacrolimus therapeutic drug level
|
$501.60 |
$501.60 |
$501.60 |
$137.15
|
|
Target gsa panel hmtlmph neop
|
$1,939.20 |
$1,939.20 |
$1,939.20 |
$1,928.40
|
|
Target gsa panel organ/hmtlmph neop
|
$2,797.80 |
$2,797.80 |
$2,797.80 |
$3,567.96
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$649.43 |
$649.43 |
$649.43 |
$760.95
|
|
Tbs techl calculation only
|
$153.60 |
$153.60 |
$153.60 |
$119.66
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$266.40 |
$266.40 |
$266.40 |
$178.40
|
|
Tc-99m bicisate
|
$2,398.20 |
$2,398.20 |
$2,398.20 |
$2,398.20
|
|
Tc-99m disofenin
|
$72.00 |
$72.00 |
$72.00 |
$151.32
|
|
Tc-99m exame autol wbc diag per dose
|
$2,393.40 |
$2,393.40 |
$2,393.40 |
$2,393.40
|
|
Tc-99m labeled rbc
|
$302.40 |
$302.40 |
$302.40 |
$312.70
|
|
Tc-99m maa
|
$258.60 |
$258.60 |
$258.60 |
$306.60
|
|
Tc-99m mebrofenin
|
$58.80 |
$58.80 |
$58.80 |
$169.53
|
|
Tc-99m medronate
|
$69.00 |
$69.00 |
$69.00 |
$120.35
|
|
Tc-99m mertiatide
|
$465.60 |
$465.60 |
$465.60 |
$757.25
|
|
Tc-99m non-heu per study dose
|
$6.00 |
$6.00 |
$6.00 |
$10.00
|
|
Tc-99m oxidronate
|
$63.60 |
$63.60 |
$63.60 |
$132.05
|
|
Tc-99m pentetate dtpa aerosol
|
$190.80 |
$190.80 |
$190.80 |
$231.60
|
|
Tc-99m sestamibi p study dose
|
$55.80 |
$55.80 |
$55.80 |
$221.60
|
|
Tc-99m succimer (dmsa)
|
$2,315.40 |
$2,315.40 |
$2,315.40 |
$1,749.60
|
|
Tc-99m sulfur colloid
|
$239.40 |
$239.40 |
$239.40 |
$240.50
|
|
Tc-99m tilmanocept diag
|
$1,254.00 |
$1,254.00 |
$1,254.00 |
$1,007.79
|
|
T cells absolute cd4/cd8 including ratio
|
$381.60 |
$381.60 |
$381.60 |
$189.60
|
|
T cells absolute cd 4 count
|
$306.00 |
$306.00 |
$306.00 |
$120.25
|
|
T cells total count
|
$267.00 |
$267.00 |
$267.00 |
$126.90
|
|
Telethx isodose plan cplx
|
$1,236.60 |
$1,236.60 |
$1,236.60 |
$1,526.85
|
|
Telethx isodose plan simple
|
$687.00 |
$687.00 |
$687.00 |
$848.72
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$151.94 |
$151.94 |
$151.94 |
$116.48
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$240.21 |
$240.21 |
$240.21 |
$16,233.59
|
|
Tenotomy open tndn flxr toe sgl tndn spx
|
$2,238.60 |
$2,238.60 |
$2,238.60 |
$1,985.00
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$39.33 |
$39.33 |
$39.33 |
$39.33
|
|
Test for chlorohydrocarbons
|
$291.00 |
$291.00 |
$291.00 |
$71.04
|
|
Testicular imaging w/vasc flow
|
$831.60 |
$831.60 |
$831.60 |
$586.96
|
|
Test stress cardiovascular tracing only
|
$1,414.80 |
$1,414.80 |
$1,414.80 |
$1,016.00
|
|
Tetanus immune globulin inj
|
$1,073.02 |
$1,073.02 |
$1,073.02 |
$1,073.02
|
|
Theophylline therapeutic drug level
|
$214.80 |
$214.80 |
$214.80 |
$101.40
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$49.20 |
$49.20 |
$49.20 |
$50.40
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$49.20 |
$49.20 |
$49.20 |
$47.50
|
|
Ther nma rdctj intus/obstrcj
|
$258.00 |
$258.00 |
$258.00 |
$524.80
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$41.86 |
$41.86 |
$41.86 |
$25.80
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$2,560.80 |
$2,560.80 |
$2,560.80 |
$1,658.70
|
|
Thrombectomy/inf pq dialysis circuit
|
$29,242.20 |
$29,242.20 |
$29,242.20 |
$8,395.40
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$40,851.60 |
$40,851.60 |
$40,851.60 |
$15,640.00
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$58,512.00 |
$58,512.00 |
$58,512.00 |
$25,597.40
|
|
Thrombin time
|
$97.20 |
$97.20 |
$97.20 |
$53.50
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$100.80 |
$100.80 |
$100.80 |
$56.93
|
|
Thyroglobulin antibody
|
$222.00 |
$222.00 |
$222.00 |
$86.40
|
|
Thyroid imaging
|
$894.00 |
$894.00 |
$894.00 |
$577.80
|
|
Thyroid mets imag whole body
|
$2,442.00 |
$2,442.00 |
$2,442.00 |
$1,320.00
|
|
Thyroid (TSH) Test
|
$265.80 |
$265.80 |
$265.80 |
$101.40
|
|
Thyroid Ultrasound
|
$348.60 |
$348.60 |
$348.60 |
$553.80
|
|
Thyroid uptake measurement
|
$580.20 |
$580.20 |
$580.20 |
$580.20
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$3,167.70 |
$3,167.70 |
$3,167.70 |
$3,167.70
|
|
Thyrotropin releasing hormone
|
$410.40 |
$410.40 |
$410.40 |
$127.20
|
|
Thyroxine binding globulin (tbg)
|
$150.00 |
$150.00 |
$150.00 |
$75.00
|
|
Tib/per revasc stent & ather 37231
|
$37,528.80 |
$37,528.80 |
$37,528.80 |
$23,525.00
|
|
Tib/per revasc stnt & ather
|
$41,451.00 |
$41,451.00 |
$41,451.00 |
$13,321.00
|
|
Tib/per revasc w/ather add-on 37233
|
$21,611.40 |
$21,611.40 |
$21,611.40 |
$12,855.00
|
|
Tigecycline injection
|
$8.38 |
$8.38 |
$8.38 |
$7.44
|
|
Tilt table study
|
$532.80 |
$532.80 |
$532.80 |
$1,488.24
|
|
Tissue culture placenta
|
$261.60 |
$261.60 |
$261.60 |
$470.00
|
|
Tissue culture skin/biopsy
|
$1,004.40 |
$1,004.40 |
$1,004.40 |
$626.77
|
|
Tissue culture tumor
|
$905.40 |
$905.40 |
$905.40 |
$605.60
|
|
Tissue exam koh skin/hair/nails
|
$76.80 |
$76.80 |
$76.80 |
$45.23
|
|
Tissue surgimend prs meshed 20 cm x 10 cm - cost per 0.5cm
|
$6,727.80 |
$6,727.80 |
$6,727.80 |
$6,727.80
|
|
Tissue transglutaminase iga
|
$25.80 |
$25.80 |
$25.80 |
$48.57
|
|
Tl-201 thallium diag per mci
|
$24.60 |
$24.60 |
$24.60 |
$78.40
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$66.16 |
$66.16 |
$66.16 |
$72.00
|
|
Tobramycin peak therapeutic drug level
|
$292.80 |
$292.80 |
$292.80 |
$117.00
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$1,669.70 |
$1,669.70 |
$1,669.70 |
$2,743.02
|
|
Tomosynthesis breast screen bilateral
|
$53.40 |
$53.40 |
$53.40 |
$77.46
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$200.93 |
$200.93 |
$200.93 |
$200.93
|
|
Toxoplasma antibody igg
|
$154.20 |
$154.20 |
$154.20 |
$83.20
|
|
Toxoplasma antibody igm
|
$252.00 |
$252.00 |
$252.00 |
$85.80
|
|
Trabectedin 1 mg intravenous solution
|
$6,133.80 |
$6,133.80 |
$6,133.80 |
$2,653.88
|
|
Transcath biopsy
|
$2,998.80 |
$2,998.80 |
$2,998.80 |
$4,285.93
|
|
Transcatheter bx s&i
|
$2,151.00 |
$2,151.00 |
$2,151.00 |
$1,795.70
|
|
Transferrin
|
$229.80 |
$229.80 |
$229.80 |
$83.07
|
|
Transfusion blood/blood component(s)
|
$1,493.40 |
$1,493.40 |
$1,493.40 |
$988.24
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$15.70 |
$15.70 |
$15.70 |
$43.28
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$14.09 |
$14.09 |
$14.09 |
$108.27
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$399.00 |
$399.00 |
$399.00 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$200.40 |
$200.40 |
$200.40 |
$140.04
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$133.20 |
$133.20 |
$133.20 |
$197.60
|
|
Treatment radiation delivery level 2
|
$946.80 |
$946.80 |
$946.80 |
$737.25
|
|
Treponema pallidum antibody
|
$204.00 |
$204.00 |
$204.00 |
$74.40
|
|
Trg gene rearrangement anal
|
$407.40 |
$407.40 |
$407.40 |
$474.50
|
