|
Surgical pathology level 4 gross & microscopic examination
|
$164.00 |
$164.00 |
$164.00 |
$243.10
|
|
Surgical pathology level 5 gross & microscopic examination
|
$647.20 |
$647.20 |
$647.20 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$942.40 |
$942.40 |
$942.40 |
$720.75
|
|
Surgical repair stomach bleedin ulcer 43501
|
$3,304.80 |
$3,304.80 |
$3,304.80 |
$2,415.60
|
|
Surgical repair stomach gastric lac 43502
|
$3,736.80 |
$3,736.80 |
$3,736.80 |
$2,864.40
|
|
Surgical revision intestine
|
$2,607.20 |
$2,607.20 |
$2,607.20 |
$2,366.76
|
|
Surgical trays
|
$45.60 |
$45.60 |
$45.60 |
$694.80
|
|
Surg tx anal fistula 2nd stage 46285
|
$1,352.80 |
$1,352.80 |
$1,352.80 |
$3,245.23
|
|
Susceptibility agar dilution per agent
|
$38.58 |
$38.58 |
$38.58 |
$45.00
|
|
Susceptibility enzyme detection per enzyme
|
$38.58 |
$38.58 |
$38.58 |
$35.70
|
|
Susceptibility mic per plate
|
$38.58 |
$38.58 |
$38.58 |
$104.65
|
|
Suscept studies macrobroth dilution ea
|
$38.58 |
$38.58 |
$38.58 |
$59.28
|
|
Suspension of testis
|
$1,510.40 |
$1,510.40 |
$1,510.40 |
$4,055.01
|
|
Suspension of uterus 58400
|
$1,136.00 |
$1,136.00 |
$1,136.00 |
$856.80
|
|
Sutr lg intestine 1/mult perf without colostomy 44604
|
$2,600.80 |
$2,600.80 |
$2,600.80 |
$1,995.00
|
|
Suture bile duct injury 47900
|
$3,346.40 |
$3,346.40 |
$3,346.40 |
$2,559.60
|
|
Svc venogram s&i
|
$856.84 |
$856.84 |
$856.84 |
$1,994.00
|
|
Swallowing Evaluation (Bedside)
|
$283.08 |
$283.08 |
$283.08 |
$314.40
|
|
Swallowing Therapy Session
|
$195.20 |
$195.20 |
$195.20 |
$240.50
|
|
Sweat collection by iontophoresis
|
$70.00 |
$70.00 |
$70.00 |
$121.55
|
|
Sympathectomy cervical
|
$3,934.40 |
$3,934.40 |
$3,934.40 |
$3,934.40
|
|
Sympathectomy digital artery
|
$1,808.80 |
$1,808.80 |
$1,808.80 |
$2,310.83
|
|
Sympathectomy supfc palmar
|
$3,880.00 |
$3,880.00 |
$3,880.00 |
$3,839.54
|
|
Synch audio-only est high 40
|
$265.60 |
$265.60 |
$265.60 |
$190.77
|
|
Synch audio-only est low 20
|
$160.80 |
$160.80 |
$160.80 |
$90.60
|
|
Synch audio-only est mod 30
|
$192.00 |
$192.00 |
$192.00 |
$136.64
|
|
Synch audio-only est sf 10
|
$83.20 |
$83.20 |
$83.20 |
$53.20
|
|
Synch audio-only new high 60
|
$367.20 |
$367.20 |
$367.20 |
$207.64
|
|
Synch audio-only new low 30
|
$189.60 |
$189.60 |
$189.60 |
$117.00
|
|
Synch audio-only new mod 45
|
$289.60 |
$289.60 |
$289.60 |
$166.70
|
|
Synch audio-only new sf 15
|
$133.60 |
$133.60 |
$133.60 |
$67.80
|
|
Synthetic sentence id test
|
$80.80 |
$80.80 |
$80.80 |
$99.32
|
|
Synvisc or synvisc-one
|
$26.40 |
$26.40 |
$26.40 |
$1,242.63
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$48.57 |
$48.57 |
$48.57 |
$42.24
|
|
System pacing micra av
|
$24,701.52 |
$24,701.52 |
$24,701.52 |
$24,293.25
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$8,286.08 |
$8,286.08 |
$8,286.08 |
$12,003.00
|
|
T3 (triiodothyronine) free
|
$55.00 |
$55.00 |
$55.00 |
$100.00
|
|
T3 (triiodothyronine) total
|
$55.00 |
$55.00 |
$55.00 |
$93.52
|
|
T4 (thyroxine) free
|
$55.00 |
$55.00 |
$55.00 |
$87.30
|
|
T4 (thyroxine) total
|
$55.00 |
$55.00 |
$55.00 |
$68.40
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$1.92 |
$1.92 |
$1.92 |
$9.93
|
|
Tacrolimus therapeutic drug level
|
$66.43 |
$66.43 |
$66.43 |
$122.40
|
|
Tah rad debulk/lymph remove 58954
|
$5,380.00 |
$5,380.00 |
$5,380.00 |
$5,380.00
|
|
Tah rad dissect for debulk 58953
|
$4,964.80 |
$4,964.80 |
$4,964.80 |
$4,964.80
|
|
Tah w/mmk 58152
|
$3,129.60 |
$3,129.60 |
$3,129.60 |
$2,428.80
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$142.97 |
$142.97 |
$142.97 |
$288.60
|
|
Tap block bilat cont infusion 64489
|
$691.20 |
$691.20 |
$691.20 |
$1,541.40
|
|
Tap block uni by cont infusion 64487
|
$896.00 |
$896.00 |
$896.00 |
$868.40
|
|
Target gsa panel hmtlmph neop
|
$1,519.20 |
$1,519.20 |
$1,519.20 |
$2,246.30
|
|
Target gsa panel organ/hmtlmph neop
|
$5,839.20 |
$5,839.20 |
$5,839.20 |
$3,762.00
|
|
Target gsa panel organ neop
|
$1,196.00 |
$1,196.00 |
$1,196.00 |
$1,749.44
|
|
Tas congenital car anomal
|
$1,882.40 |
$1,882.40 |
$1,882.40 |
$6,003.27
|
|
Tattooing/intraderm 6.1-20.0 sq cm 11921
|
$520.00 |
$520.00 |
$520.00 |
$931.50
|
|
Tavr perq femoral
|
$26,190.65 |
$26,190.65 |
$26,190.65 |
$15,454.40
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$0.80 |
$0.80 |
$0.80 |
$937.50
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$200.00 |
$200.00 |
$200.00 |
$200.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$153.60 |
$153.60 |
$153.60 |
$181.80
|
|
Tc-99m apcitide diag
|
$1,591.74 |
$1,591.74 |
$1,591.74 |
$1,181.70
|
|
Tc-99m bicisate
|
$1,741.20 |
$1,741.20 |
$1,741.20 |
$1,984.80
|
|
Tc-99m exame autol wbc diag per dose
|
$3,895.87 |
$3,895.87 |
$3,895.87 |
$2,486.31
|
|
Tc-99m exametazime diag
|
$2,684.36 |
$2,684.36 |
$2,684.36 |
$2,135.70
|
|
Tc-99m labeled rbc
|
$330.41 |
$330.41 |
$330.41 |
$306.00
|
|
Tc-99m maa
|
$236.88 |
$236.88 |
$236.88 |
$306.60
|
|
Tc-99m mebrofenin
|
$194.06 |
$194.06 |
$194.06 |
$157.50
|
|
Tc-99m medronate
|
$111.01 |
$111.01 |
$111.01 |
$111.01
|
|
Tc-99m mertiatide
|
$966.40 |
$966.40 |
$966.40 |
$756.00
|
|
Tc-99m non-heu per study dose
|
$8.00 |
$8.00 |
$8.00 |
$6.50
|
|
Tc-99m oxidronate
|
$178.32 |
$178.32 |
$178.32 |
$108.04
|
|
Tc-99m pentetate dtpa
|
$182.69 |
$182.69 |
$182.69 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$92.80 |
$92.80 |
$92.80 |
$190.80
|
|
Tc-99m pertechnetate per mci
|
$6.40 |
$6.40 |
$6.40 |
$18.67
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$169.58 |
$169.58 |
$169.58 |
$141.00
|
|
Tc-99m sestamibi p study dose
|
$433.56 |
$433.56 |
$433.56 |
$287.20
|
|
Tc-99m succimer (dmsa)
|
$769.21 |
$769.21 |
$769.21 |
$1,128.40
|
|
Tc-99m sulfur colloid
|
$334.40 |
$334.40 |
$334.40 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$536.70 |
$536.70 |
$536.70 |
$192.08
|
|
Tc-99m tilmanocept diag
|
$500.87 |
$500.87 |
$500.87 |
$958.31
|
|
Tca peel dermal 15789
|
$1,324.80 |
$1,324.80 |
$1,324.80 |
$1,324.80
|
|
Tcd emboli detect w/inj
|
$764.80 |
$764.80 |
$764.80 |
$475.80
|
|
Tcd emboli detect without inj
|
$666.40 |
$666.40 |
$666.40 |
$475.28
|
|
T cells absolute cd4/cd8 including ratio
|
$110.00 |
$110.00 |
$110.00 |
$185.28
|
|
T cells absolute cd 4 count
|
$110.00 |
$110.00 |
$110.00 |
$111.20
|
|
T cells total count
|
$110.00 |
$110.00 |
$110.00 |
$132.63
|
|
Tcranial magn stim tx deli
|
$312.00 |
$312.00 |
$312.00 |
$389.22
|
|
Tcranial magn stim tx plan
|
$513.60 |
$513.60 |
$513.60 |
$437.22
|
|
Tcran magn stim redetemine
|
$635.20 |
$635.20 |
$635.20 |
$457.60
|
|
Tdh sdrl/ventr pnxr
|
$1,087.20 |
$1,087.20 |
$1,087.20 |
$1,087.20
|
|
Teaec w/wo patch graft iliofemoral
|
$5,030.40 |
$5,030.40 |
$5,030.40 |
$6,120.00
|
|
Team conf without pat by hc pro
|
$67.20 |
$67.20 |
$67.20 |
$110.62
|
|
Team conf without pat by phys
|
$102.40 |
$102.40 |
$102.40 |
$139.05
|
|
Team conf w/pat by hc prof
|
$78.40 |
$78.40 |
$78.40 |
$105.70
|
|
Tee w or without fol w/cont,cong
|
$1,707.38 |
$1,707.38 |
$1,707.38 |
$2,101.65
|
|
Telehealth original site facility fee
|
$61.60 |
$61.60 |
$61.60 |
$51.00
|
|
Telethx isodose plan cplx
|
$529.60 |
$529.60 |
$529.60 |
$1,526.85
|
|
Telethx isodose plan simple
|
$272.00 |
$272.00 |
$272.00 |
$889.80
|
|
Temperature gradient studies
|
$19.20 |
$19.20 |
$19.20 |
$242.25
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$77.60 |
$77.60 |
$77.60 |
$3,723.60
|
|
Tendon lengthening
|
$1,493.60 |
$1,493.60 |
$1,493.60 |
$3,986.00
|
|
Tendon lngth upr a/e ea tdn
|
$1,428.00 |
$1,428.00 |
$1,428.00 |
$3,591.33
|
|
Tendon shortening
|
$1,460.80 |
$1,460.80 |
$1,460.80 |
$3,786.00
|
