|
Susceptibility agar dilution per agent
|
$354.42 |
$354.42 |
$354.42 |
$42.70
|
|
Susceptibility enzyme detection per enzyme
|
$67.65 |
$67.65 |
$67.65 |
$35.10
|
|
Susceptibility mic per plate
|
$284.46 |
$284.46 |
$284.46 |
$104.00
|
|
Svc venogram s&i
|
$1,156.65 |
$1,156.65 |
$1,156.65 |
$1,934.62
|
|
Sweat collection by iontophoresis
|
$225.72 |
$225.72 |
$225.72 |
$123.78
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$80.52 |
$80.52 |
$80.52 |
$40.11
|
|
T3 (triiodothyronine) free
|
$121.77 |
$121.77 |
$121.77 |
$99.20
|
|
T3 (triiodothyronine) total
|
$132.33 |
$132.33 |
$132.33 |
$93.52
|
|
T4 (thyroxine) free
|
$127.05 |
$127.05 |
$127.05 |
$85.20
|
|
T4 (thyroxine) total
|
$143.22 |
$143.22 |
$143.22 |
$67.80
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$35.18 |
$35.18 |
$35.18 |
$10.03
|
|
Tacrolimus therapeutic drug level
|
$79.53 |
$79.53 |
$79.53 |
$120.60
|
|
Target gsa panel hmtlmph neop
|
$1,704.45 |
$1,704.45 |
$1,704.45 |
$2,160.00
|
|
Tavr perq femoral
|
$3,520.11 |
$3,520.11 |
$3,520.11 |
$14,800.00
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$1,759.32 |
$1,759.32 |
$1,759.32 |
$937.50
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$237.27 |
$237.27 |
$237.27 |
$175.00
|
|
Tc-99m apcitide diag
|
$879.12 |
$879.12 |
$879.12 |
$1,181.70
|
|
Tc-99m arcitumomab
|
$2,155.56 |
$2,155.56 |
$2,155.56 |
$2,229.36
|
|
Tc-99m bicisate
|
$2,510.64 |
$2,510.64 |
$2,510.64 |
$1,969.45
|
|
Tc-99m disofenin
|
$190.08 |
$190.08 |
$190.08 |
$131.30
|
|
Tc-99m exame autol wbc diag per dose
|
$2,743.62 |
$2,743.62 |
$2,743.62 |
$2,431.95
|
|
Tc-99m exametazime diag
|
$1,386.00 |
$1,386.00 |
$1,386.00 |
$2,033.20
|
|
Tc-99m labeled rbc
|
$2,759.99 |
$2,759.99 |
$2,759.99 |
$302.40
|
|
Tc-99m maa
|
$612.20 |
$612.20 |
$612.20 |
$283.41
|
|
Tc-99m mebrofenin
|
$348.48 |
$348.48 |
$348.48 |
$160.58
|
|
Tc-99m medronate
|
$360.11 |
$360.11 |
$360.11 |
$109.50
|
|
Tc-99m mertiatide
|
$1,394.58 |
$1,394.58 |
$1,394.58 |
$756.00
|
|
Tc-99m oxidronate
|
$265.65 |
$265.65 |
$265.65 |
$105.30
|
|
Tc-99m pertechnetate per mci
|
$183.15 |
$183.15 |
$183.15 |
$27.20
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$434.61 |
$434.61 |
$434.61 |
$136.40
|
|
Tc-99m sestamibi p study dose
|
$485.43 |
$485.43 |
$485.43 |
$293.73
|
|
Tc-99m sulfur colloid
|
$206.25 |
$206.25 |
$206.25 |
$239.40
|
|
Tc-99m tetrofosmin p study dose
|
$728.97 |
$728.97 |
$728.97 |
$188.50
|
|
Tc-99m tilmanocept diag
|
$1,683.93 |
$1,683.93 |
$1,683.93 |
$930.54
|
|
T cells absolute cd4/cd8 including ratio
|
$230.01 |
$230.01 |
$230.01 |
$175.00
|
|
T cells absolute cd 4 count
|
$102.96 |
$102.96 |
$102.96 |
$110.00
|
|
T cells total count
|
$184.47 |
$184.47 |
$184.47 |
$123.00
|
|
Tee w or without fol w/cont,cong
|
$2,135.76 |
$2,135.76 |
$2,135.76 |
$2,101.50
|
|
Telehealth original site facility fee
|
$279.51 |
$279.51 |
$279.51 |
$49.80
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$28,473.34 |
$28,473.34 |
$28,473.34 |
$15,600.75
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$86.67 |
$86.67 |
$86.67 |
$39.18
|
|
Testicular imaging w/vasc flow
|
$1,005.51 |
$1,005.51 |
$1,005.51 |
$842.56
|
|
Test stress cardiovascular tracing only
|
$1,255.32 |
$1,255.32 |
$1,255.32 |
$953.40
|
|
Theophylline therapeutic drug level
|
$167.64 |
$167.64 |
$167.64 |
$108.00
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$58.41 |
$58.41 |
$58.41 |
$57.50
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$49.83 |
$49.83 |
$49.83 |
$50.00
|
|
Ther nma rdctj intus/obstrcj
|
$302.28 |
$302.28 |
$302.28 |
$538.88
|
|
Ther/proph/diag inj ia
|
$181.83 |
$181.83 |
$181.83 |
$237.75
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$114.86 |
$114.86 |
$114.86 |
$25.54
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,776.72 |
$1,776.72 |
$1,776.72 |
$1,687.50
|
|
Thrombectmy crnry perq mechanical
|
$1,554.30 |
$1,554.30 |
$1,554.30 |
$3,552.50
|
|
Thrombectomy/inf pq dialysis circuit
|
$3,630.00 |
$3,630.00 |
$3,630.00 |
$7,594.40
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$7,337.55 |
$7,337.55 |
$7,337.55 |
$14,227.80
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$11,121.33 |
$11,121.33 |
$11,121.33 |
$21,249.26
|
|
Thrombin time
|
$34.32 |
$34.32 |
$34.32 |
$53.60
|
|
Thromboendarterectomy common femoral
|
$2,460.48 |
$2,460.48 |
$2,460.48 |
$3,666.00
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$127.05 |
$127.05 |
$127.05 |
$60.39
|
|
Thyroglobulin antibody
|
$104.28 |
$104.28 |
$104.28 |
$81.90
|
|
Thyroid imaging
|
$609.51 |
$609.51 |
$609.51 |
$673.01
|
|
Thyroid mets imag whole body
|
$2,261.16 |
$2,261.16 |
$2,261.16 |
$1,544.00
|
|
Thyroid (TSH) Test
|
$247.50 |
$247.50 |
$247.50 |
$112.00
|
|
Thyroid Ultrasound
|
$758.34 |
$758.34 |
$758.34 |
$589.96
|
|
Thyroid uptake measurement
|
$406.23 |
$406.23 |
$406.23 |
$580.20
|
|
Thyroxine binding globulin (tbg)
|
$137.28 |
$137.28 |
$137.28 |
$64.92
|
|
Tib/per revasc stent & ather 37231
|
$6,767.31 |
$6,767.31 |
$6,767.31 |
$21,249.26
|
|
Tib/per revasc stnt & ather
|
$5,318.61 |
$5,318.61 |
$5,318.61 |
$11,121.63
|
|
Tib/per revasc w/ather add-on 37233
|
$3,166.35 |
$3,166.35 |
$3,166.35 |
$10,103.80
|
|
Tilt table study
|
$4,195.95 |
$4,195.95 |
$4,195.95 |
$1,495.00
|
|
Tissue culture skin/biopsy
|
$793.98 |
$793.98 |
$793.98 |
$518.40
|
|
Tissue exam koh skin/hair/nails
|
$34.65 |
$34.65 |
$34.65 |
$47.40
|
|
Tissue transglutaminase iga
|
$154.11 |
$154.11 |
$154.11 |
$46.20
|
|
Tl-201 thallium diag per mci
|
$556.38 |
$556.38 |
$556.38 |
$80.10
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$343.72 |
$343.72 |
$343.72 |
$152.80
|
|
Tobramycin non-comp unit
|
$12.32 |
$12.32 |
$12.32 |
$105.75
|
|
Tobramycin peak therapeutic drug level
|
$123.09 |
$123.09 |
$123.09 |
$121.55
|
|
Tomosynthesis breast screen bilateral
|
$231.00 |
$231.00 |
$231.00 |
$70.89
|
|
Toxoplasma antibody igg
|
$33.99 |
$33.99 |
$33.99 |
$89.57
|
|
Toxoplasma antibody igm
|
$73.92 |
$73.92 |
$73.92 |
$87.00
|
|
Tracheobrnchsc thru est trachs incisn
|
$906.18 |
$906.18 |
$906.18 |
$1,371.84
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$92.39 |
$92.39 |
$92.39 |
$55.69
|
|
Transabdom amnioinfus w/us
|
$168.96 |
$168.96 |
$168.96 |
$791.05
|
|
Transcath biopsy
|
$1,424.61 |
$1,424.61 |
$1,424.61 |
$4,285.93
|
|
Transcath closure of asd
|
$7,725.63 |
$7,725.63 |
$7,725.63 |
$18,408.00
|
|
Transcath closure of vsd
|
$6,278.91 |
$6,278.91 |
$6,278.91 |
$16,369.51
|
|
Transcatheter bx s&i
|
$1,979.67 |
$1,979.67 |
$1,979.67 |
$1,973.01
|
|
Transcath occlusion cns
|
$5,271.75 |
$5,271.75 |
$5,271.75 |
$7,337.20
|
|
Transcath occlusion non-cns
|
$3,296.04 |
$3,296.04 |
$3,296.04 |
$10,416.60
|
|
Transcath rmvl perm ldss pmkr rv
|
$2,446.95 |
$2,446.95 |
$2,446.95 |
$4,775.16
|
|
Transferrin
|
$54.12 |
$54.12 |
$54.12 |
$81.60
|
|
Transfusion blood/blood component(s)
|
$941.82 |
$941.82 |
$941.82 |
$937.30
|
|
Trauma partial team response w/critical care services level 4
|
$14,622.63 |
$14,622.63 |
$14,622.63 |
$4,063.80
|
|
Treat clavicle dislocation 23545
|
$775.83 |
$775.83 |
$775.83 |
$705.60
|
|
Treat elbow dislocation
|
$3,029.40 |
$3,029.40 |
$3,029.40 |
$2,200.00
|
|
Treat elbow fracture
|
$2,719.86 |
$2,719.86 |
$2,719.86 |
$1,919.00
|
|
Treat finger fracture each
|
$1,086.03 |
$1,086.03 |
$1,086.03 |
$1,593.00
|
|
Treat fracture of radius
|
$484.44 |
$484.44 |
$484.44 |
$1,790.00
|
|
Treat fracture of radius
|
$1,679.04 |
$1,679.04 |
$1,679.04 |
$1,849.00
|
|
Treat fracture of ulna
|
$177.87 |
$177.87 |
$177.87 |
$716.95
|
|
Treat humerus fracture
|
$1,679.04 |
$1,679.04 |
$1,679.04 |
$1,772.97
|
|
Treat knee dislocation
|
$960.96 |
$960.96 |
$960.96 |
$2,126.80
|
