|
Surgical pathology level 4 gross & microscopic examination
|
$3,052.40 |
$3,052.40 |
$3,052.40 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$6,346.46 |
$6,346.46 |
$6,346.46 |
$489.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$584.35 |
$584.35 |
$584.35 |
$720.75
|
|
Susceptibility agar dilution per agent
|
$40.30 |
$40.30 |
$40.30 |
$38.58
|
|
Susceptibility enzyme detection per enzyme
|
$35.75 |
$35.75 |
$35.75 |
$31.85
|
|
Susceptibility mic per plate
|
$100.75 |
$100.75 |
$100.75 |
$89.70
|
|
Synvisc or synvisc-one
|
$3,115.89 |
$3,115.89 |
$3,115.89 |
$1,053.54
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$50.70 |
$50.70 |
$50.70 |
$45.70
|
|
T3 (triiodothyronine) free
|
$118.30 |
$118.30 |
$118.30 |
$91.20
|
|
T3 (triiodothyronine) total
|
$65.00 |
$65.00 |
$65.00 |
$88.00
|
|
T4 (thyroxine) free
|
$74.10 |
$74.10 |
$74.10 |
$65.00
|
|
T4 (thyroxine) total
|
$67.60 |
$67.60 |
$67.60 |
$62.40
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$4.87 |
$4.87 |
$4.87 |
$4.87
|
|
Tacrolimus therapeutic drug level
|
$217.75 |
$217.75 |
$217.75 |
$137.15
|
|
Tamoxifen 10 mg tabs 60 each bottle
|
$35.75 |
$35.75 |
$35.75 |
$35.75
|
|
Target gsa panel hmtlmph neop
|
$1,495.65 |
$1,495.65 |
$1,495.65 |
$1,928.40
|
|
Target gsa panel organ neop
|
$2,178.80 |
$2,178.80 |
$2,178.80 |
$1,913.00
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$159.90 |
$159.90 |
$159.90 |
$221.65
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$195.00 |
$195.00 |
$195.00 |
$178.40
|
|
Tc-99m labeled rbc
|
$333.45 |
$333.45 |
$333.45 |
$312.70
|
|
Tc-99m maa
|
$231.40 |
$231.40 |
$231.40 |
$306.60
|
|
Tc-99m mebrofenin
|
$214.50 |
$214.50 |
$214.50 |
$169.53
|
|
Tc-99m medronate
|
$20.15 |
$20.15 |
$20.15 |
$120.35
|
|
Tc-99m pertechnetate per mci
|
$31.85 |
$31.85 |
$31.85 |
$22.10
|
|
Tc-99m sestamibi p study dose
|
$226.20 |
$226.20 |
$226.20 |
$221.60
|
|
Tc-99m sulfur colloid
|
$217.10 |
$217.10 |
$217.10 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$302.90 |
$302.90 |
$302.90 |
$198.05
|
|
T cells absolute cd4/cd8 including ratio
|
$195.65 |
$195.65 |
$195.65 |
$189.60
|
|
T cells total count
|
$131.95 |
$131.95 |
$131.95 |
$126.90
|
|
Telehealth original site facility fee
|
$35.75 |
$35.75 |
$35.75 |
$55.65
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$18,876.27 |
$18,876.27 |
$18,876.27 |
$16,233.59
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$16.90 |
$16.90 |
$16.90 |
$39.33
|
|
Test for porphobilinogen
|
$101.40 |
$101.40 |
$101.40 |
$33.57
|
|
Test pathogen(s) for platelets reference
|
$49.40 |
$49.40 |
$49.40 |
$52.00
|
|
Test stress cardiovascular tracing only
|
$602.55 |
$602.55 |
$602.55 |
$1,016.00
|
|
Tetanus immune globulin inj
|
$2,770.16 |
$2,770.16 |
$2,770.16 |
$1,073.02
|
|
Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe
|
$9,460.16 |
$9,460.16 |
$9,460.16 |
$6,935.61
|
|
Theophylline therapeutic drug level
|
$135.85 |
$135.85 |
$135.85 |
$101.40
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$43.55 |
$43.55 |
$43.55 |
$50.40
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$35.75 |
$35.75 |
$35.75 |
$47.50
|
|
Ther/proph/diag inj ia
|
$98.15 |
$98.15 |
$98.15 |
$247.33
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$42.04 |
$42.04 |
$42.04 |
$25.80
|
|
Thrombin time
|
$60.45 |
$60.45 |
$60.45 |
$53.50
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$39.65 |
$39.65 |
$39.65 |
$56.93
|
|
Thyroglobulin antibody
|
$124.15 |
$124.15 |
$124.15 |
$86.40
|
|
Thyroid imaging
|
$670.80 |
$670.80 |
$670.80 |
$577.80
|
|
Thyroid (TSH) Test
|
$74.75 |
$74.75 |
$74.75 |
$101.40
|
|
Thyroid Ultrasound
|
$475.80 |
$475.80 |
$475.80 |
$553.80
|
|
Thyroid uptake measurement
|
$459.55 |
$459.55 |
$459.55 |
$580.20
|
|
Thyroxine binding globulin (tbg)
|
$165.75 |
$165.75 |
$165.75 |
$75.00
|
|
Tissue culture placenta
|
$414.05 |
$414.05 |
$414.05 |
$470.00
|
|
Tissue culture skin/biopsy
|
$386.75 |
$386.75 |
$386.75 |
$626.77
|
|
Tissue exam koh skin/hair/nails
|
$40.30 |
$40.30 |
$40.30 |
$45.23
|
|
Tissue transglutaminase iga
|
$97.50 |
$97.50 |
$97.50 |
$48.57
|
|
Tl-201 thallium diag per mci
|
$172.25 |
$172.25 |
$172.25 |
$78.40
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$338.00 |
$338.00 |
$338.00 |
$72.00
|
|
Tobramycin peak therapeutic drug level
|
$213.20 |
$213.20 |
$213.20 |
$117.00
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$5,480.12 |
$5,480.12 |
$5,480.12 |
$2,743.02
|
|
Tomosynthesis breast diagnostic left
|
$66.95 |
$66.95 |
$66.95 |
$53.92
|
|
Tomosynthesis breast screen bilateral
|
$66.30 |
$66.30 |
$66.30 |
$77.46
|
|
Toxoplasma antibody igg
|
$107.25 |
$107.25 |
$107.25 |
$83.20
|
|
Toxoplasma antibody igm
|
$102.70 |
$102.70 |
$102.70 |
$85.80
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$77.35 |
$77.35 |
$77.35 |
$90.35
|
|
Transferrin
|
$132.60 |
$132.60 |
$132.60 |
$83.07
|
|
Transfusion blood/blood component(s)
|
$1,934.72 |
$1,934.72 |
$1,934.72 |
$988.24
|
|
Treat elbow dislocation
|
$1,094.60 |
$1,094.60 |
$1,094.60 |
$2,326.40
|
|
Treat finger fracture each
|
$820.95 |
$820.95 |
$820.95 |
$1,808.00
|
|
Treat fracture of radius
|
$759.85 |
$759.85 |
$759.85 |
$1,884.74
|
|
Treat kneecap dislocation
|
$1,063.40 |
$1,063.40 |
$1,063.40 |
$1,931.40
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$70.20 |
$70.20 |
$70.20 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$63.70 |
$63.70 |
$63.70 |
$140.04
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$70.20 |
$70.20 |
$70.20 |
$197.60
|
|
Treatment missed abortion completed surgically 1st trimester
|
$5,065.79 |
$5,065.79 |
$5,065.79 |
$3,820.53
|
|
Treatment of ankle fracture 27786
|
$575.25 |
$575.25 |
$575.25 |
$575.25
|
|
Treatment of fibula fracture 27780
|
$531.70 |
$531.70 |
$531.70 |
$558.75
|
|
Treatment of toe fracture 28510
|
$274.95 |
$274.95 |
$274.95 |
$362.00
|
|
Treat sternum fracture
|
$327.60 |
$327.60 |
$327.60 |
$423.00
|
|
Treat wrist dislocation
|
$808.60 |
$808.60 |
$808.60 |
$760.00
|
|
Treponema pallidum antibody
|
$74.10 |
$74.10 |
$74.10 |
$74.40
|
|
Trg gene rearrangement anal
|
$351.65 |
$351.65 |
$351.65 |
$474.50
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$35.91 |
$35.91 |
$35.91 |
$28.90
|
|
#tricyclicantidprssnt
|
$143.65 |
$143.65 |
$143.65 |
$38.73
|
|
Triglycerides
|
$85.15 |
$85.15 |
$85.15 |
$48.75
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$2,065.70 |
$2,065.70 |
$2,065.70 |
$4,667.00
|
|
Troponin quantitative
|
$70.20 |
$70.20 |
$70.20 |
$112.80
|
|
Tx closed hip disl traumatic without anes
|
$929.50 |
$929.50 |
$929.50 |
$650.45
|
|
Ua w/micro/comp poc
|
$39.65 |
$39.65 |
$39.65 |
$25.72
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$24,387.95 |
$24,387.95 |
$24,387.95 |
$71.90
|
|
Ugt1a1 gene analy common variants
|
$668.85 |
$668.85 |
$668.85 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$401.70 |
$401.70 |
$401.70 |
$394.20
|
|
Ultrasound breast complete
|
$139.75 |
$139.75 |
$139.75 |
$519.20
|
|
Ultrasound breast unilateral limited (both sides)
|
$458.25 |
$458.25 |
$458.25 |
$427.00
|
|
Ultrasound chest
|
$382.20 |
$382.20 |
$382.20 |
$430.10
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$312.65 |
$312.65 |
$312.65 |
$340.03
|
|
Ultrasound encephalogram
|
$314.60 |
$314.60 |
$314.60 |
$463.50
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$451.75 |
$451.75 |
$451.75 |
$428.68
|
|
Ultrasound guidance for vascular access
|
$351.00 |
$351.00 |
$351.00 |
$300.00
|
|
Ultrasound guided needle placement supervision & interpretation
|
$527.80 |
$527.80 |
$527.80 |
$629.64
|
|
Ultrasound joint complete left
|
$572.00 |
$572.00 |
$572.00 |
$534.00
|
|
Ultrasound joint/nonvascular extremity limited left
|
$484.25 |
$484.25 |
$484.25 |
$426.60
|
