|
Target gsa panel organ/hmtlmph neop
|
$2,125.20 |
$2,125.20 |
$2,125.20 |
$3,567.96
|
|
Target gsa panel organ neop
|
$691.60 |
$691.60 |
$691.60 |
$1,913.00
|
|
Tas congenital car anomal
|
$5,583.76 |
$5,583.76 |
$5,583.76 |
$6,003.27
|
|
Tbs techl calculation only
|
$103.04 |
$103.04 |
$103.04 |
$119.66
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$80.08 |
$80.08 |
$80.08 |
$178.40
|
|
Tc-99m bicisate
|
$1,050.00 |
$1,050.00 |
$1,050.00 |
$2,398.20
|
|
Tc-99m exametazime diag
|
$1,412.32 |
$1,412.32 |
$1,412.32 |
$2,236.65
|
|
Tc-99m labeled rbc
|
$203.84 |
$203.84 |
$203.84 |
$312.70
|
|
Tc-99m maa
|
$218.40 |
$218.40 |
$218.40 |
$306.60
|
|
Tc-99m mebrofenin
|
$116.48 |
$116.48 |
$116.48 |
$169.53
|
|
Tc-99m medronate
|
$54.32 |
$54.32 |
$54.32 |
$120.35
|
|
Tc-99m mertiatide
|
$291.20 |
$291.20 |
$291.20 |
$757.25
|
|
Tc-99m oxidronate
|
$72.80 |
$72.80 |
$72.80 |
$132.05
|
|
Tc-99m pentetate dtpa
|
$87.36 |
$87.36 |
$87.36 |
$222.60
|
|
Tc-99m pertechnetate per mci
|
$6.72 |
$6.72 |
$6.72 |
$22.10
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$56.00 |
$56.00 |
$56.00 |
$137.01
|
|
Tc-99m sestamibi p study dose
|
$189.28 |
$189.28 |
$189.28 |
$221.60
|
|
Tc-99m succimer (dmsa)
|
$178.08 |
$178.08 |
$178.08 |
$1,749.60
|
|
Tc-99m sulfur colloid
|
$218.40 |
$218.40 |
$218.40 |
$240.50
|
|
Tc-99m tilmanocept diag
|
$351.68 |
$351.68 |
$351.68 |
$1,007.79
|
|
Tcd emboli detect w/inj
|
$328.72 |
$328.72 |
$328.72 |
$475.80
|
|
T cells absolute cd4/cd8 including ratio
|
$119.28 |
$119.28 |
$119.28 |
$189.60
|
|
T cells absolute cd 4 count
|
$42.56 |
$42.56 |
$42.56 |
$120.25
|
|
T cells total count
|
$94.08 |
$94.08 |
$94.08 |
$126.90
|
|
Telethx isodose plan cplx
|
$967.12 |
$967.12 |
$967.12 |
$1,526.85
|
|
Telethx isodose plan simple
|
$474.88 |
$474.88 |
$474.88 |
$848.72
|
|
Testicular imaging w/vasc flow
|
$309.12 |
$309.12 |
$309.12 |
$586.96
|
|
Test stress cardiovascular tracing only
|
$625.52 |
$625.52 |
$625.52 |
$1,016.00
|
|
Theophylline therapeutic drug level
|
$38.08 |
$38.08 |
$38.08 |
$101.40
|
|
Therapeutic procd strg endur
|
$241.36 |
$241.36 |
$241.36 |
$72.39
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,266.72 |
$1,266.72 |
$1,266.72 |
$1,658.70
|
|
Thrombectmy crnry perq mechanical
|
$2,304.40 |
$2,304.40 |
$2,304.40 |
$3,580.00
|
|
Thrombectomy/inf pq dialysis circuit
|
$21,033.60 |
$21,033.60 |
$21,033.60 |
$8,395.40
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$19,545.68 |
$19,545.68 |
$19,545.68 |
$15,640.00
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$24,618.16 |
$24,618.16 |
$24,618.16 |
$25,597.40
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$31.92 |
$31.92 |
$31.92 |
$56.93
|
|
Thyroglobulin antibody
|
$94.08 |
$94.08 |
$94.08 |
$86.40
|
|
Thyroid imaging
|
$328.72 |
$328.72 |
$328.72 |
$577.80
|
|
Thyroid met imaging
|
$509.60 |
$509.60 |
$509.60 |
$509.60
|
|
Thyroid mets imag whole body
|
$920.08 |
$920.08 |
$920.08 |
$1,320.00
|
|
Thyroid met uptake
|
$227.36 |
$227.36 |
$227.36 |
$380.00
|
|
Thyroid (TSH) Test
|
$49.84 |
$49.84 |
$49.84 |
$101.40
|
|
Thyroid Ultrasound
|
$243.60 |
$243.60 |
$243.60 |
$553.80
|
|
Thyroid uptake measurement
|
$254.80 |
$254.80 |
$254.80 |
$580.20
|
|
Thyroxine binding globulin (tbg)
|
$23.52 |
$23.52 |
$23.52 |
$75.00
|
|
Tilt table study
|
$1,728.72 |
$1,728.72 |
$1,728.72 |
$1,488.24
|
|
Tissue culture placenta
|
$89.60 |
$89.60 |
$89.60 |
$470.00
|
|
Tissue culture skin/biopsy
|
$119.84 |
$119.84 |
$119.84 |
$626.77
|
|
Tissue culture tumor
|
$66.64 |
$66.64 |
$66.64 |
$605.60
|
|
Tissue exam koh skin/hair/nails
|
$15.68 |
$15.68 |
$15.68 |
$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
|
|
Tissue transglutaminase iga
|
$14.56 |
$14.56 |
$14.56 |
$48.57
|
|
Tl-201 thallium diag per mci
|
$108.08 |
$108.08 |
$108.08 |
$78.40
|
|
Tobramycin peak therapeutic drug level
|
$16.80 |
$16.80 |
$16.80 |
$117.00
|
|
Tomosynthesis breast diagnostic left
|
$15.68 |
$15.68 |
$15.68 |
$53.92
|
|
Tomosynthesis breast screen bilateral
|
$15.68 |
$15.68 |
$15.68 |
$77.46
|
|
Toxoplasma antibody igg
|
$75.60 |
$75.60 |
$75.60 |
$83.20
|
|
Toxoplasma antibody igm
|
$75.60 |
$75.60 |
$75.60 |
$85.80
|
|
Tp53 gene trgt sequence alys
|
$369.04 |
$369.04 |
$369.04 |
$919.10
|
|
Transcath closure of asd
|
$33,806.64 |
$33,806.64 |
$33,806.64 |
$19,715.47
|
|
Transcath closure of vsd
|
$33,806.64 |
$33,806.64 |
$33,806.64 |
$18,837.00
|
|
Transcatheter bx s&i
|
$1,084.16 |
$1,084.16 |
$1,084.16 |
$1,795.70
|
|
Transcath mv repair addl prosthesis
|
$7,178.08 |
$7,178.08 |
$7,178.08 |
$4,499.00
|
|
Transcath mv repair init prosthesis
|
$9,204.72 |
$9,204.72 |
$9,204.72 |
$13,818.35
|
|
Transcath rmvl perm ldss pmkr rv
|
$4,798.64 |
$4,798.64 |
$4,798.64 |
$4,775.16
|
|
Transferrin
|
$46.48 |
$46.48 |
$46.48 |
$83.07
|
|
Transfusion blood/blood component(s)
|
$565.60 |
$565.60 |
$565.60 |
$988.24
|
|
Trauma partial team response w/critical care services level 4
|
$6,118.00 |
$6,118.00 |
$6,118.00 |
$4,523.04
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$137.76 |
$137.76 |
$137.76 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$137.76 |
$137.76 |
$137.76 |
$140.04
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$222.88 |
$222.88 |
$222.88 |
$197.60
|
|
Treponema pallidum antibody
|
$35.28 |
$35.28 |
$35.28 |
$74.40
|
|
Trg gene rearrangement anal
|
$225.68 |
$225.68 |
$225.68 |
$474.50
|
|
Triglycerides
|
$13.44 |
$13.44 |
$13.44 |
$48.75
|
|
Trim nail(s)
|
$89.60 |
$89.60 |
$89.60 |
$91.77
|
|
Trim nondyst nails
|
$89.60 |
$89.60 |
$89.60 |
$124.22
|
|
Trml dstrj ios bvn 1st 2 l/s
|
$7,422.24 |
$7,422.24 |
$7,422.24 |
$15,111.95
|
|
Trml dstrj ios bvn ea addl
|
$3,711.68 |
$3,711.68 |
$3,711.68 |
$10,173.00
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$8,776.32 |
$8,776.32 |
$8,776.32 |
$9,418.42
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$8,776.32 |
$8,776.32 |
$8,776.32 |
$9,565.92
|
|
Trnscath plc vas stent w/s&i ini vein
|
$17,077.76 |
$17,077.76 |
$17,077.76 |
$15,873.70
|
|
Trnscath retrv pq vasc fb w/guide
|
$5,897.92 |
$5,897.92 |
$5,897.92 |
$5,555.55
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$4,477.20 |
$4,477.20 |
$4,477.20 |
$6,354.94
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$3,589.60 |
$3,589.60 |
$3,589.60 |
$4,770.98
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$2,446.08 |
$2,446.08 |
$2,446.08 |
$5,324.40
|
|
Trnscath tx thromblytc vein ini day
|
$4,477.20 |
$4,477.20 |
$4,477.20 |
$4,201.80
|
|
Troponin quantitative
|
$42.56 |
$42.56 |
$42.56 |
$112.80
|
|
Tte w or without contr, cont ecg
|
$1,117.76 |
$1,117.76 |
$1,117.76 |
$1,613.95
|
|
Tte w or without fol w/con,stres
|
$1,051.68 |
$1,051.68 |
$1,051.68 |
$1,108.76
|
|
Tube trach disp innr can 5 xlt
|
$105.84 |
$105.84 |
$105.84 |
$416.99
|
|
Tube trach fen sz 6 uncuffed
|
$99.12 |
$99.12 |
$99.12 |
$132.40
|
|
Tx atrial fib pulm vein isol
|
$26,716.48 |
$26,716.48 |
$26,716.48 |
$32,426.20
|
|
Tx l/r atrial fib addl
|
$6,548.64 |
$6,548.64 |
$6,548.64 |
$6,986.85
|
|
Tympanometry & reflex thresh
|
$117.60 |
$117.60 |
$117.60 |
$170.00
|
|
Ua w/micro/comp poc
|
$6.72 |
$6.72 |
$6.72 |
$25.72
|
|
Ultrasound abdomen aorta screening study aaa
|
$140.00 |
$140.00 |
$140.00 |
$394.20
|
|
Ultrasound breast complete
|
$395.92 |
$395.92 |
$395.92 |
$519.20
|
|
Ultrasound breast unilateral limited (both sides)
|
$369.04 |
$369.04 |
$369.04 |
$427.00
|
|
Ultrasound chest
|
$179.76 |
$179.76 |
$179.76 |
$430.10
|
