|
Surgical pathology level 4 gross & microscopic examination
|
$292.00 |
$292.00 |
$292.00 |
$248.00
|
|
Surgical pathology level 5 gross & microscopic examination
|
$489.00 |
$489.00 |
$489.00 |
$480.60
|
|
Surgical pathology level 6 gross & microscopic examination
|
$815.00 |
$815.00 |
$815.00 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$17.00 |
$17.00 |
$17.00 |
$45.45
|
|
Susceptibility enzyme detection per enzyme
|
$22.00 |
$22.00 |
$22.00 |
$35.75
|
|
Susceptibility mic per plate
|
$58.00 |
$58.00 |
$58.00 |
$105.75
|
|
Svc venogram s&i
|
$2,293.00 |
$2,293.00 |
$2,293.00 |
$1,994.00
|
|
Swallowing Evaluation (Bedside)
|
$417.00 |
$417.00 |
$417.00 |
$316.55
|
|
Swallowing Therapy Session
|
$267.00 |
$267.00 |
$267.00 |
$240.31
|
|
Sweat collection by iontophoresis
|
$135.00 |
$135.00 |
$135.00 |
$123.78
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$51.00 |
$51.00 |
$51.00 |
$41.60
|
|
T3 (triiodothyronine) free
|
$68.00 |
$68.00 |
$68.00 |
$100.32
|
|
T3 (triiodothyronine) total
|
$56.00 |
$56.00 |
$56.00 |
$93.52
|
|
T4 (thyroxine) free
|
$37.00 |
$37.00 |
$37.00 |
$88.44
|
|
T4 (thyroxine) total
|
$22.00 |
$22.00 |
$22.00 |
$69.58
|
|
Tacrolimus therapeutic drug level
|
$97.00 |
$97.00 |
$97.00 |
$122.50
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$301.00 |
$301.00 |
$301.00 |
$289.90
|
|
Target gsa panel hmtlmph neop
|
$3,726.00 |
$3,726.00 |
$3,726.00 |
$2,246.30
|
|
Target gsa panel organ neop
|
$4,026.00 |
$4,026.00 |
$4,026.00 |
$1,681.28
|
|
Tas congenital car anomal
|
$6,242.00 |
$6,242.00 |
$6,242.00 |
$6,003.27
|
|
Tavr perq femoral
|
$14,721.00 |
$14,721.00 |
$14,721.00 |
$15,454.40
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$258.00 |
$258.00 |
$258.00 |
$180.80
|
|
Tc-99m bicisate
|
$7,175.05 |
$7,175.05 |
$7,175.05 |
$2,070.00
|
|
Tc-99m exame autol wbc diag per dose
|
$3,872.19 |
$3,872.19 |
$3,872.19 |
$2,503.15
|
|
Tc-99m labeled rbc
|
$534.11 |
$534.11 |
$534.11 |
$306.00
|
|
Tc-99m maa
|
$458.34 |
$458.34 |
$458.34 |
$312.06
|
|
Tc-99m mebrofenin
|
$129.99 |
$129.99 |
$129.99 |
$157.65
|
|
Tc-99m medronate
|
$120.30 |
$120.30 |
$120.30 |
$111.01
|
|
Tc-99m mertiatide
|
$1,044.51 |
$1,044.51 |
$1,044.51 |
$756.00
|
|
Tc-99m oxidronate
|
$133.35 |
$133.35 |
$133.35 |
$108.00
|
|
Tc-99m pentetate dtpa
|
$487.14 |
$487.14 |
$487.14 |
$222.60
|
|
Tc-99m pertechnetate per mci
|
$9.71 |
$9.71 |
$9.71 |
$18.67
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$193.44 |
$193.44 |
$193.44 |
$141.00
|
|
Tc-99m sestamibi p study dose
|
$89.55 |
$89.55 |
$89.55 |
$287.20
|
|
Tc-99m succimer (dmsa)
|
$4,785.00 |
$4,785.00 |
$4,785.00 |
$1,128.40
|
|
Tc-99m sulfur colloid
|
$265.26 |
$265.26 |
$265.26 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$93.84 |
$93.84 |
$93.84 |
$193.28
|
|
Tc-99m tilmanocept diag
|
$1,692.34 |
$1,692.34 |
$1,692.34 |
$985.60
|
|
T cells absolute cd4/cd8 including ratio
|
$328.00 |
$328.00 |
$328.00 |
$185.28
|
|
T cells absolute cd 4 count
|
$176.00 |
$176.00 |
$176.00 |
$111.20
|
|
T cells total count
|
$318.00 |
$318.00 |
$318.00 |
$130.35
|
|
Tee w or without fol w/cont,cong
|
$2,613.00 |
$2,613.00 |
$2,613.00 |
$2,101.65
|
|
Telehealth original site facility fee
|
$134.00 |
$134.00 |
$134.00 |
$51.00
|
|
Telethx isodose plan cplx
|
$1,878.00 |
$1,878.00 |
$1,878.00 |
$1,526.85
|
|
Test stress cardiovascular tracing only
|
$935.00 |
$935.00 |
$935.00 |
$953.40
|
|
Tgsap so/hl 51/< rna alys
|
$4,723.00 |
$4,723.00 |
$4,723.00 |
$4,563.00
|
|
Thaw preserved stem cells
|
$1,630.00 |
$1,630.00 |
$1,630.00 |
$1,136.85
|
|
Theophylline therapeutic drug level
|
$108.00 |
$108.00 |
$108.00 |
$108.00
|
|
Therapeutic procd strg endur
|
$163.00 |
$163.00 |
$163.00 |
$85.68
|
|
Therapy Activity Training (each 15 minutes)
|
$77.00 |
$77.00 |
$77.00 |
$101.85
|
|
Therapy Exercise Session (each 15 minutes)
|
$66.00 |
$66.00 |
$66.00 |
$98.58
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$67.00 |
$67.00 |
$67.00 |
$57.50
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$67.00 |
$67.00 |
$67.00 |
$50.40
|
|
Ther nma rdctj intus/obstrcj
|
$450.00 |
$450.00 |
$450.00 |
$538.88
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$672.00 |
$672.00 |
$672.00 |
$314.50
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$3,714.00 |
$3,714.00 |
$3,714.00 |
$1,733.65
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$1,205.00 |
$1,205.00 |
$1,205.00 |
$1,684.80
|
|
Throat x-ray & fluoroscopy
|
$419.00 |
$419.00 |
$419.00 |
$259.60
|
|
Thrombectmy crnry perq mechanical
|
$808.00 |
$808.00 |
$808.00 |
$3,836.00
|
|
Thrombectomy/inf pq dialysis circuit
|
$17,235.00 |
$17,235.00 |
$17,235.00 |
$8,084.00
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$26,089.00 |
$26,089.00 |
$26,089.00 |
$14,465.94
|
|
Thrombin time
|
$16.00 |
$16.00 |
$16.00 |
$54.18
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$30.00 |
$30.00 |
$30.00 |
$61.52
|
|
Thyroglobulin antibody
|
$93.00 |
$93.00 |
$93.00 |
$82.73
|
|
Thyroid imaging
|
$491.00 |
$491.00 |
$491.00 |
$696.75
|
|
Thyroid mets imag whole body
|
$1,109.00 |
$1,109.00 |
$1,109.00 |
$1,524.99
|
|
Thyroid met uptake
|
$216.00 |
$216.00 |
$216.00 |
$407.40
|
|
Thyroid (TSH) Test
|
$76.00 |
$76.00 |
$76.00 |
$112.67
|
|
Thyroid Ultrasound
|
$992.00 |
$992.00 |
$992.00 |
$588.50
|
|
Tilt table study
|
$688.00 |
$688.00 |
$688.00 |
$1,561.82
|
|
Tissue culture placenta
|
$810.00 |
$810.00 |
$810.00 |
$440.50
|
|
Tissue culture skin/biopsy
|
$890.00 |
$890.00 |
$890.00 |
$484.00
|
|
Tissue culture tumor
|
$890.00 |
$890.00 |
$890.00 |
$479.50
|
|
Tissue exam koh skin/hair/nails
|
$28.00 |
$28.00 |
$28.00 |
$47.40
|
|
Tissue transglutaminase iga
|
$109.00 |
$109.00 |
$109.00 |
$44.80
|
|
Tobramycin peak therapeutic drug level
|
$125.00 |
$125.00 |
$125.00 |
$119.40
|
|
Toe X-ray (both feet)
|
$608.00 |
$608.00 |
$608.00 |
$258.65
|
|
Tomosynthesis breast diagnostic left
|
$269.00 |
$269.00 |
$269.00 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$268.00 |
$268.00 |
$268.00 |
$74.10
|
|
Toxoplasma antibody igg
|
$147.00 |
$147.00 |
$147.00 |
$91.65
|
|
Toxoplasma antibody igm
|
$147.00 |
$147.00 |
$147.00 |
$88.00
|
|
Tprnl plmt biodegrdabl matrl
|
$9,744.00 |
$9,744.00 |
$9,744.00 |
$7,144.80
|
|
Tracheobrnchsc thru est trachs incisn
|
$1,971.00 |
$1,971.00 |
$1,971.00 |
$1,420.44
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$147.00 |
$147.00 |
$147.00 |
$103.20
|
|
Transabdom amnioinfus w/us
|
$672.00 |
$672.00 |
$672.00 |
$678.70
|
|
Transcath biopsy
|
$5,481.00 |
$5,481.00 |
$5,481.00 |
$4,285.93
|
|
Transcath closure of asd
|
$16,895.00 |
$16,895.00 |
$16,895.00 |
$17,088.00
|
|
Transcatheter bx s&i
|
$1,456.00 |
$1,456.00 |
$1,456.00 |
$1,950.85
|
|
Transcath mv repair addl prosthesis
|
$3,946.00 |
$3,946.00 |
$3,946.00 |
$4,499.00
|
|
Transcath mv repair init prosthesis
|
$15,787.00 |
$15,787.00 |
$15,787.00 |
$13,093.20
|
|
Transcath occlusion cns
|
$17,512.00 |
$17,512.00 |
$17,512.00 |
$7,337.20
|
|
Transcath occlusion non-cns
|
$14,430.00 |
$14,430.00 |
$14,430.00 |
$10,270.00
|
|
Transcutaneous carboxyhb
|
$20.00 |
$20.00 |
$20.00 |
$32.00
|
|
Transferrin
|
$47.00 |
$47.00 |
$47.00 |
$82.00
|
|
Transplt allo hct/donor
|
$44,370.34 |
$44,370.34 |
$44,370.34 |
$29,206.10
|
|
Transplt allo lymphocytes
|
$2,751.65 |
$2,751.65 |
$2,751.65 |
$2,751.65
|
|
Transplt autol hct/donor
|
$6,379.96 |
$6,379.96 |
$6,379.96 |
$3,986.00
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$992.00 |
$992.00 |
$992.00 |
$560.92
|
|
Transvaginal Pregnancy Ultrasound
|
$992.00 |
$992.00 |
$992.00 |
$501.60
|
|
Trauma partial team response w/critical care services level 4
|
$8,319.00 |
$8,319.00 |
$8,319.00 |
$4,471.50
|
