|
Synch audio-only est high 40
|
$197.76 |
$197.76 |
$197.76 |
$190.77
|
|
Synch audio-only est low 20
|
$152.13 |
$152.13 |
$152.13 |
$90.60
|
|
Synch audio-only est mod 30
|
$187.00 |
$187.00 |
$187.00 |
$136.64
|
|
Synch audio-only est sf 10
|
$131.16 |
$131.16 |
$131.16 |
$53.20
|
|
Synch audio-only new high 60
|
$207.64 |
$207.64 |
$207.64 |
$207.64
|
|
Synch audio-only new low 30
|
$159.74 |
$159.74 |
$159.74 |
$117.00
|
|
Synch audio-only new mod 45
|
$196.35 |
$196.35 |
$196.35 |
$166.70
|
|
Synch audio-only new sf 15
|
$137.72 |
$137.72 |
$137.72 |
$67.80
|
|
Synvisc or synvisc-one
|
$28.03 |
$28.03 |
$28.03 |
$1,242.63
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$15.95 |
$15.95 |
$15.95 |
$41.60
|
|
T3 (triiodothyronine) free
|
$61.33 |
$61.33 |
$61.33 |
$100.32
|
|
T3 (triiodothyronine) total
|
$51.34 |
$51.34 |
$51.34 |
$93.52
|
|
T4 (thyroxine) free
|
$32.62 |
$32.62 |
$32.62 |
$88.44
|
|
T4 (thyroxine) total
|
$24.86 |
$24.86 |
$24.86 |
$69.58
|
|
Tacrolimus therapeutic drug level
|
$49.71 |
$49.71 |
$49.71 |
$122.50
|
|
Tailbone (Sacrum and Coccyx) X-ray
|
$201.75 |
$201.75 |
$201.75 |
$289.90
|
|
Target gsa panel hmtlmph neop
|
$4,979.87 |
$4,979.87 |
$4,979.87 |
$2,246.30
|
|
Target gsa panel organ/hmtlmph neop
|
$7,762.52 |
$7,762.52 |
$7,762.52 |
$3,746.70
|
|
Target gsa panel organ neop
|
$1,780.75 |
$1,780.75 |
$1,780.75 |
$1,681.28
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$293.13 |
$293.13 |
$293.13 |
$200.00
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$224.30 |
$224.30 |
$224.30 |
$180.80
|
|
Tc-99m bicisate
|
$3,383.26 |
$3,383.26 |
$3,383.26 |
$2,070.00
|
|
Tc-99m disofenin
|
$138.94 |
$138.94 |
$138.94 |
$124.32
|
|
Tc-99m labeled rbc
|
$398.04 |
$398.04 |
$398.04 |
$306.00
|
|
Tc-99m maa
|
$391.76 |
$391.76 |
$391.76 |
$312.06
|
|
Tc-99m mebrofenin
|
$140.12 |
$140.12 |
$140.12 |
$157.65
|
|
Tc-99m medronate
|
$110.53 |
$110.53 |
$110.53 |
$111.01
|
|
Tc-99m mertiatide
|
$752.37 |
$752.37 |
$752.37 |
$756.00
|
|
Tc-99m oxidronate
|
$112.42 |
$112.42 |
$112.42 |
$108.00
|
|
Tc-99m pentetate dtpa
|
$342.80 |
$342.80 |
$342.80 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$385.37 |
$385.37 |
$385.37 |
$191.50
|
|
Tc-99m pertechnetate per mci
|
$1.37 |
$1.37 |
$1.37 |
$18.67
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$101.55 |
$101.55 |
$101.55 |
$141.00
|
|
Tc-99m sestamibi p study dose
|
$67.60 |
$67.60 |
$67.60 |
$287.20
|
|
Tc-99m sulfur colloid
|
$922.89 |
$922.89 |
$922.89 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$101.34 |
$101.34 |
$101.34 |
$193.28
|
|
Tc-99m tilmanocept diag
|
$1,685.00 |
$1,685.00 |
$1,685.00 |
$985.60
|
|
T cells absolute cd4/cd8 including ratio
|
$170.05 |
$170.05 |
$170.05 |
$185.28
|
|
T cells absolute cd 4 count
|
$96.91 |
$96.91 |
$96.91 |
$111.20
|
|
T cells total count
|
$136.54 |
$136.54 |
$136.54 |
$130.35
|
|
Teaec w/wo patch graft iliofemoral
|
$10,013.41 |
$10,013.41 |
$10,013.41 |
$6,120.00
|
|
Telehealth original site facility fee
|
$73.28 |
$73.28 |
$73.28 |
$51.00
|
|
Telethx isodose plan cplx
|
$880.61 |
$880.61 |
$880.61 |
$1,526.85
|
|
Telethx isodose plan simple
|
$880.61 |
$880.61 |
$880.61 |
$877.09
|
|
Tert gene targeted seq alys
|
$492.40 |
$492.40 |
$492.40 |
$335.00
|
|
Test for chlorohydrocarbons
|
$12.51 |
$12.51 |
$12.51 |
$61.60
|
|
Test pathogen(s) for platelets reference
|
$103.27 |
$103.27 |
$103.27 |
$70.00
|
|
Test stress cardiovascular tracing only
|
$577.26 |
$577.26 |
$577.26 |
$953.40
|
|
Test urine urobilinogen
|
$13.09 |
$13.09 |
$13.09 |
$9.75
|
|
Tgsap so/hl 51/< rna alys
|
$7,305.90 |
$7,305.90 |
$7,305.90 |
$4,563.00
|
|
Theophylline therapeutic drug level
|
$51.18 |
$51.18 |
$51.18 |
$108.00
|
|
Therapeutic procd strg endur
|
$86.78 |
$86.78 |
$86.78 |
$85.68
|
|
Therapeutic pulpotomy
|
$71.50 |
$71.50 |
$71.50 |
$744.80
|
|
Therapy Activity Training (each 15 minutes)
|
$120.82 |
$120.82 |
$120.82 |
$101.85
|
|
Therapy Exercise Session (each 15 minutes)
|
$93.49 |
$93.49 |
$93.49 |
$98.58
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$78.65 |
$78.65 |
$78.65 |
$57.50
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$66.87 |
$66.87 |
$66.87 |
$50.40
|
|
Ther nma rdctj intus/obstrcj
|
$336.54 |
$336.54 |
$336.54 |
$538.88
|
|
Thigh Bone (Femur) X-ray (both sides)
|
$201.75 |
$201.75 |
$201.75 |
$314.50
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,562.18 |
$1,562.18 |
$1,562.18 |
$1,733.65
|
|
Thoracic lymphadenect/thoracotomy 38746
|
$10,282.70 |
$10,282.70 |
$10,282.70 |
$499.80
|
|
Thoracoscopy diagnostic 32601
|
$11,803.64 |
$11,803.64 |
$11,803.64 |
$6,442.80
|
|
Thoracoscopy surgical 32650
|
$3,409.02 |
$3,409.02 |
$3,409.02 |
$2,251.60
|
|
Thoracotomy w/expl
|
$3,529.88 |
$3,529.88 |
$3,529.88 |
$2,045.17
|
|
Three-Phase Bone Scan (Nuclear Medicine)
|
$812.30 |
$812.30 |
$812.30 |
$1,684.80
|
|
Thrombectomy/inf pq dialysis circuit
|
$9,623.59 |
$9,623.59 |
$9,623.59 |
$8,084.00
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$15,408.82 |
$15,408.82 |
$15,408.82 |
$14,465.94
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$19,656.21 |
$19,656.21 |
$19,656.21 |
$21,413.60
|
|
Thrombin time
|
$20.87 |
$20.87 |
$20.87 |
$54.18
|
|
Thromboendarterectomy common femoral
|
$11,729.85 |
$11,729.85 |
$11,729.85 |
$3,987.20
|
|
Thromboendarterectomy sfa
|
$11,729.85 |
$11,729.85 |
$11,729.85 |
$5,472.00
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$23.40 |
$23.40 |
$23.40 |
$61.52
|
|
Thyroglobulin antibody
|
$57.57 |
$57.57 |
$57.57 |
$82.73
|
|
Thyroid imaging
|
$812.30 |
$812.30 |
$812.30 |
$696.75
|
|
Thyroid mets imag whole body
|
$859.59 |
$859.59 |
$859.59 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$60.82 |
$60.82 |
$60.82 |
$112.67
|
|
Thyroid Ultrasound
|
$323.71 |
$323.71 |
$323.71 |
$588.50
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$4,112.43 |
$4,112.43 |
$4,112.43 |
$4,152.21
|
|
Thyroxine binding globulin (tbg)
|
$53.50 |
$53.50 |
$53.50 |
$64.51
|
|
Tib/per revasc stent & ather 37231
|
$20,150.88 |
$20,150.88 |
$20,150.88 |
$21,249.26
|
|
Tilt table study
|
$1,106.90 |
$1,106.90 |
$1,106.90 |
$1,561.82
|
|
Tissue culture placenta
|
$532.94 |
$532.94 |
$532.94 |
$440.50
|
|
Tissue culture skin/biopsy
|
$509.28 |
$509.28 |
$509.28 |
$484.00
|
|
Tissue exam koh skin/hair/nails
|
$15.44 |
$15.44 |
$15.44 |
$47.40
|
|
Tissue transglutaminase iga
|
$29.19 |
$29.19 |
$29.19 |
$44.80
|
|
Tixagev and cilgav inj
|
$381.09 |
$381.09 |
$381.09 |
$241.92
|
|
Tl-201 thallium diag per mci
|
$44.04 |
$44.04 |
$44.04 |
$80.10
|
|
Tlso 2 shl symphys-stern cst
|
$2,136.99 |
$2,136.99 |
$2,136.99 |
$1,808.59
|
|
Tlso 3mod sacro-scap pre
|
$2,338.05 |
$2,338.05 |
$2,338.05 |
$2,117.57
|
|
Tlso rigid lined custom fab
|
$3,437.06 |
$3,437.06 |
$3,437.06 |
$2,831.21
|
|
Tlso rigid plastic cust fab
|
$3,414.61 |
$3,414.61 |
$3,414.61 |
$2,347.16
|
|
Tlso rigid plastic custom fa
|
$3,084.14 |
$3,084.14 |
$3,084.14 |
$2,788.42
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$2.75 |
$2.75 |
$2.75 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$58.37 |
$58.37 |
$58.37 |
$119.40
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$26.02 |
$26.02 |
$26.02 |
$5,258.52
|
|
Toe X-ray (both feet)
|
$201.75 |
$201.75 |
$201.75 |
$258.65
|
|
Tomosynthesis breast diagnostic left
|
$80.17 |
$80.17 |
$80.17 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$80.17 |
$80.17 |
$80.17 |
$74.10
|
|
Total Knee Replacement
|
$13,931.12 |
$13,931.12 |
$13,931.12 |
$14,061.89
|
|
Total tau
|
$35.95 |
$35.95 |
$35.95 |
$312.50
|
