|
Tissue culture skin/biopsy
|
$347.76 |
$347.76 |
$347.76 |
$626.77
|
|
Tissue culture tumor
|
$493.92 |
$493.92 |
$493.92 |
$605.52
|
|
Tissue exam koh skin/hair/nails
|
$14.00 |
$14.00 |
$14.00 |
$45.23
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$96.88 |
$96.88 |
$96.88 |
$2,516.07
|
|
Tissue surgimend prs meshed 20 cm x 10 cm - cost per 0.5cm
|
$13,052.48 |
$13,052.48 |
$13,052.48 |
$6,727.80
|
|
Tl-201 thallium diag per mci
|
$164.08 |
$164.08 |
$164.08 |
$78.40
|
|
Tobramycin peak therapeutic drug level
|
$63.28 |
$63.28 |
$63.28 |
$118.30
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$4.03 |
$4.03 |
$4.03 |
$1,669.70
|
|
Tomosynthesis breast diagnostic left
|
$20.72 |
$20.72 |
$20.72 |
$53.92
|
|
Tomosynthesis breast screen bilateral
|
$20.72 |
$20.72 |
$20.72 |
$77.46
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$5.76 |
$5.76 |
$5.76 |
$200.93
|
|
Toxoplasma antibody igg
|
$95.76 |
$95.76 |
$95.76 |
$83.20
|
|
Toxoplasma antibody igm
|
$95.82 |
$95.82 |
$95.82 |
$84.80
|
|
Tpmt gene com vrnts
|
$146.16 |
$146.16 |
$146.16 |
$402.35
|
|
Tprnl plmt biodegrdabl matrl
|
$3,941.28 |
$3,941.28 |
$3,941.28 |
$7,438.40
|
|
Transcath biopsy
|
$3,483.20 |
$3,483.20 |
$3,483.20 |
$4,285.93
|
|
Transcath closure of asd
|
$32,629.52 |
$32,629.52 |
$32,629.52 |
$19,715.47
|
|
Transcath closure of vsd
|
$32,629.52 |
$32,629.52 |
$32,629.52 |
$18,837.00
|
|
Transcatheter bx s&i
|
$589.68 |
$589.68 |
$589.68 |
$1,795.70
|
|
Transcath mv repair addl prosthesis
|
$10,966.48 |
$10,966.48 |
$10,966.48 |
$4,499.00
|
|
Transcath mv repair init prosthesis
|
$6,823.60 |
$6,823.60 |
$6,823.60 |
$13,818.35
|
|
Transcath occlusion cns
|
$6,003.76 |
$6,003.76 |
$6,003.76 |
$8,944.39
|
|
Transcath occlusion non-cns
|
$10,487.68 |
$10,487.68 |
$10,487.68 |
$12,427.79
|
|
Transferrin
|
$42.56 |
$42.56 |
$42.56 |
$83.07
|
|
Transfusion blood/blood component(s)
|
$647.92 |
$647.92 |
$647.92 |
$988.24
|
|
Trauma partial team response w/critical care services level 4
|
$6,440.00 |
$6,440.00 |
$6,440.00 |
$4,523.04
|
|
Tray bonemarrw oncontrol 102mm
|
$172.48 |
$172.48 |
$172.48 |
$1,094.25
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$104.16 |
$104.16 |
$104.16 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$104.16 |
$104.16 |
$104.16 |
$140.04
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$95.76 |
$95.76 |
$95.76 |
$197.60
|
|
Treatment radiation delivery level 2
|
$454.16 |
$454.16 |
$454.16 |
$737.25
|
|
Treponema pallidum antibody
|
$20.72 |
$20.72 |
$20.72 |
$74.40
|
|
Treprostinil injection
|
$42.78 |
$42.78 |
$42.78 |
$4,774.98
|
|
Triamcinolone a inj prs-free
|
$154.00 |
$154.00 |
$154.00 |
$696.00
|
|
Triglycerides
|
$19.04 |
$19.04 |
$19.04 |
$48.75
|
|
Trim nail(s)
|
$77.84 |
$77.84 |
$77.84 |
$91.77
|
|
Trim nondyst nails
|
$58.24 |
$58.24 |
$58.24 |
$124.22
|
|
Trnscath plc stent crv crtd without prtct
|
$4,030.88 |
$4,030.88 |
$4,030.88 |
$7,944.75
|
|
Trnscath plc stent crv crtd w/prtct
|
$5,995.36 |
$5,995.36 |
$5,995.36 |
$9,699.95
|
|
Trnscath plc stnt ante carotid art
|
$9,114.56 |
$9,114.56 |
$9,114.56 |
$6,069.00
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$9,597.84 |
$9,597.84 |
$9,597.84 |
$9,418.42
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$9,597.84 |
$9,597.84 |
$9,597.84 |
$9,597.84
|
|
Trnscath plc vas stent w/s&i ini vein
|
$16,961.84 |
$16,961.84 |
$16,961.84 |
$15,873.70
|
|
Trnscath retrv pq vasc fb w/guide
|
$6,027.84 |
$6,027.84 |
$6,027.84 |
$5,555.55
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$5,465.04 |
$5,465.04 |
$5,465.04 |
$6,346.80
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$2,540.72 |
$2,540.72 |
$2,540.72 |
$4,770.98
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$2,913.68 |
$2,913.68 |
$2,913.68 |
$5,324.40
|
|
Trnscath tx thromblytc vein ini day
|
$5,465.04 |
$5,465.04 |
$5,465.04 |
$4,201.80
|
|
Troponin quantitative
|
$48.72 |
$48.72 |
$48.72 |
$112.80
|
|
Tte w or without contr, cont ecg
|
$785.68 |
$785.68 |
$785.68 |
$1,613.95
|
|
Tte w or without fol w/con,stres
|
$546.00 |
$546.00 |
$546.00 |
$1,108.76
|
|
Tte w or without fol w/cont, com
|
$868.56 |
$868.56 |
$868.56 |
$930.42
|
|
Tte w or without fol w/cont, f/u
|
$868.56 |
$868.56 |
$868.56 |
$875.24
|
|
Tube trach disp innr can 5 xlt
|
$116.48 |
$116.48 |
$116.48 |
$416.99
|
|
Tube trach fen sz 6 uncuffed
|
$103.04 |
$103.04 |
$103.04 |
$132.40
|
|
Tx atrial fib pulm vein isol
|
$21,589.68 |
$21,589.68 |
$21,589.68 |
$32,426.20
|
|
Tx l/r atrial fib addl
|
$4,221.84 |
$4,221.84 |
$4,221.84 |
$6,986.85
|
|
Tympanometry & reflex thresh
|
$114.24 |
$114.24 |
$114.24 |
$170.00
|
|
Ultrasound abdomen aorta screening study aaa
|
$122.64 |
$122.64 |
$122.64 |
$394.20
|
|
Ultrasound breast complete
|
$638.40 |
$638.40 |
$638.40 |
$513.65
|
|
Ultrasound breast unilateral limited (both sides)
|
$580.72 |
$580.72 |
$580.72 |
$427.00
|
|
Ultrasound chest
|
$80.64 |
$80.64 |
$80.64 |
$430.10
|
|
Ultrasound elastography parenchyma
|
$129.92 |
$129.92 |
$129.92 |
$275.98
|
|
Ultrasound encephalogram
|
$537.60 |
$537.60 |
$537.60 |
$463.50
|
|
Ultrasound exam k transpl w/doppler
|
$528.08 |
$528.08 |
$528.08 |
$494.00
|
|
Ultrasound guidance for vascular access
|
$41.44 |
$41.44 |
$41.44 |
$300.00
|
|
Ultrasound guided needle placement supervision & interpretation
|
$284.48 |
$284.48 |
$284.48 |
$629.64
|
|
Ultrasound hips infant dynamic
|
$164.08 |
$164.08 |
$164.08 |
$395.20
|
|
Ultrasound joint complete left
|
$957.60 |
$957.60 |
$957.60 |
$534.00
|
|
Ultrasound joint/nonvascular extremity limited left
|
$858.48 |
$858.48 |
$858.48 |
$426.60
|
|
Ultrasound ob >=14wks ea addl gest
|
$162.40 |
$162.40 |
$162.40 |
$431.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$58.24 |
$58.24 |
$58.24 |
$304.80
|
|
Ultrasound pregnant uterus follow up per fetus
|
$95.20 |
$95.20 |
$95.20 |
$393.32
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$115.36 |
$115.36 |
$115.36 |
$434.20
|
|
Ultrasound pregnant uterus transvaginal
|
$289.52 |
$289.52 |
$289.52 |
$476.40
|
|
Ultrasound prostate/transrectal
|
$308.56 |
$308.56 |
$308.56 |
$515.63
|
|
Ultrasound retroperitoneal limited
|
$200.48 |
$200.48 |
$200.48 |
$469.58
|
|
Ultrasound scrotum and contents
|
$353.36 |
$353.36 |
$353.36 |
$556.80
|
|
Ultrasound spinal canal and contents
|
$124.32 |
$124.32 |
$124.32 |
$415.00
|
|
Ultrasound transvaginal non obstetric
|
$118.72 |
$118.72 |
$118.72 |
$522.69
|
|
Unlisted orl service/px
|
$49.84 |
$49.84 |
$49.84 |
$153.60
|
|
Unlisted reprod med lab proc
|
$58.86 |
$58.86 |
$58.86 |
$67.63
|
|
Unlisted ultrasound procedure
|
$75.04 |
$75.04 |
$75.04 |
$335.00
|
|
Unsched dialysis esrd pt hos
|
$426.72 |
$426.72 |
$426.72 |
$980.20
|
|
Upgrade pm system
|
$14,580.72 |
$14,580.72 |
$14,580.72 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,312.08 |
$1,312.08 |
$1,312.08 |
$2,590.50
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,148.00 |
$1,148.00 |
$1,148.00 |
$2,001.87
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$983.92 |
$983.92 |
$983.92 |
$1,790.00
|
|
Urea nitrogen
|
$19.04 |
$19.04 |
$19.04 |
$38.25
|
|
Urea nitrogen 24 hour urine
|
$19.04 |
$19.04 |
$19.04 |
$42.00
|
|
Urea nitrogen clearance
|
$27.44 |
$27.44 |
$27.44 |
$33.57
|
|
Ureteral embolization/occl
|
$497.28 |
$497.28 |
$497.28 |
$3,041.22
|
|
Ureteral reflux study
|
$497.28 |
$497.28 |
$497.28 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$174.72 |
$174.72 |
$174.72 |
$554.28
|
|
Urethrocystography void s&i
|
$194.88 |
$194.88 |
$194.88 |
$586.50
|
|
Uric acid blood
|
$21.84 |
$21.84 |
$21.84 |
$44.00
|
|
Uric acid urine
|
$19.04 |
$19.04 |
$19.04 |
$43.20
|
|
Urinalysis microscopic only
|
$11.76 |
$11.76 |
$11.76 |
$25.72
|
|
Urinalysis qual/semiquant excpt ia
|
$12.32 |
$12.32 |
$12.32 |
$22.75
|
|
Urinalysis (with microscopy)
|
$25.76 |
$25.76 |
$25.76 |
$37.39
|
