|
Surgical pathology level 1 gross examination only
|
$63.15 |
$63.15 |
$63.15 |
$79.50
|
|
Surgical pathology level 2 gross & microscopic examination
|
$107.85 |
$107.85 |
$107.85 |
$141.94
|
|
Surgical pathology level 3 gross & microscopic examination
|
$97.05 |
$97.05 |
$97.05 |
$181.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$576.00 |
$576.00 |
$576.00 |
$239.85
|
|
Surgical pathology level 5 gross & microscopic examination
|
$330.45 |
$330.45 |
$330.45 |
$480.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$490.20 |
$490.20 |
$490.20 |
$718.00
|
|
Susceptibility agar dilution per agent
|
$177.75 |
$177.75 |
$177.75 |
$45.45
|
|
Susceptibility enzyme detection per enzyme
|
$46.05 |
$46.05 |
$46.05 |
$35.70
|
|
Susceptibility mic per plate
|
$258.30 |
$258.30 |
$258.30 |
$106.00
|
|
Svc venogram s&i
|
$1,633.50 |
$1,633.50 |
$1,633.50 |
$1,934.62
|
|
Synvisc or synvisc-one
|
$2,711.85 |
$2,711.85 |
$2,711.85 |
$1,274.94
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$136.35 |
$136.35 |
$136.35 |
$41.60
|
|
System cardiomems hosp electronics
|
$30,006.00 |
$30,006.00 |
$30,006.00 |
$39,037.95
|
|
System pacing micra av
|
$34,155.00 |
$34,155.00 |
$34,155.00 |
$24,577.07
|
|
System pcmkr dual chamber leadless micra av2 intrdcr cath
|
$12,003.00 |
$12,003.00 |
$12,003.00 |
$12,003.00
|
|
System sealant biosentry tract
|
$904.05 |
$904.05 |
$904.05 |
$889.35
|
|
T3 (triiodothyronine) free
|
$324.00 |
$324.00 |
$324.00 |
$99.20
|
|
T3 (triiodothyronine) total
|
$188.70 |
$188.70 |
$188.70 |
$93.52
|
|
T4 (thyroxine) free
|
$296.10 |
$296.10 |
$296.10 |
$85.20
|
|
T4 (thyroxine) total
|
$110.40 |
$110.40 |
$110.40 |
$69.00
|
|
Tacrol envarsus ex rel oral
|
$10.86 |
$10.86 |
$10.86 |
$15.60
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$9.78 |
$9.78 |
$9.78 |
$9.84
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$534.82 |
$534.82 |
$534.82 |
$601.95
|
|
Tacrolimus therapeutic drug level
|
$239.40 |
$239.40 |
$239.40 |
$122.40
|
|
Tap block bilat cont infusion 64489
|
$1,541.40 |
$1,541.40 |
$1,541.40 |
$1,407.60
|
|
Tap block uni by cont infusion 64487
|
$771.00 |
$771.00 |
$771.00 |
$869.40
|
|
Target gsa panel hmtlmph neop
|
$1,860.00 |
$1,860.00 |
$1,860.00 |
$2,246.30
|
|
Target gsa panel organ/hmtlmph neop
|
$1,797.00 |
$1,797.00 |
$1,797.00 |
$3,746.70
|
|
Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe
|
$863.75 |
$863.75 |
$863.75 |
$937.50
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$184.80 |
$184.80 |
$184.80 |
$194.35
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$221.40 |
$221.40 |
$221.40 |
$177.65
|
|
Tc-99m exame autol wbc diag per dose
|
$2,431.95 |
$2,431.95 |
$2,431.95 |
$2,435.36
|
|
Tc-99m labeled rbc
|
$306.00 |
$306.00 |
$306.00 |
$302.40
|
|
Tc-99m maa
|
$74.55 |
$74.55 |
$74.55 |
$292.80
|
|
Tc-99m mebrofenin
|
$202.80 |
$202.80 |
$202.80 |
$157.65
|
|
Tc-99m medronate
|
$41.70 |
$41.70 |
$41.70 |
$111.01
|
|
Tc-99m oxidronate
|
$74.55 |
$74.55 |
$74.55 |
$105.60
|
|
Tc-99m pentetate dtpa aerosol
|
$139.65 |
$139.65 |
$139.65 |
$190.80
|
|
Tc-99m sestamibi p study dose
|
$408.45 |
$408.45 |
$408.45 |
$274.45
|
|
Tc-99m sulfur colloid
|
$347.10 |
$347.10 |
$347.10 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$366.60 |
$366.60 |
$366.60 |
$190.80
|
|
Tc-99m tilmanocept diag
|
$1,121.70 |
$1,121.70 |
$1,166.70 |
$955.60
|
|
T cells absolute cd4/cd8 including ratio
|
$246.00 |
$246.00 |
$246.00 |
$176.40
|
|
T cells absolute cd 4 count
|
$107.10 |
$107.10 |
$107.10 |
$111.20
|
|
T cells total count
|
$57.15 |
$57.15 |
$57.15 |
$126.90
|
|
Tebentafusp-tebn 100 mcg/0.5 ml intravenous solution
|
$40,114.80 |
$40,114.80 |
$40,114.80 |
$40,114.80
|
|
Telavancin injection
|
$1,191.80 |
$1,191.80 |
$1,191.80 |
$1,191.80
|
|
Telehealth original site facility fee
|
$46.35 |
$46.35 |
$46.35 |
$51.00
|
|
Telethx isodose plan cplx
|
$872.85 |
$872.85 |
$872.85 |
$1,526.85
|
|
Temozolomide
|
$647.64 |
$647.64 |
$647.64 |
$588.46
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$4,950.80 |
$4,950.80 |
$4,950.80 |
$3,723.60
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$9,028.34 |
$9,028.34 |
$9,028.34 |
$15,245.38
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$10.95 |
$10.95 |
$10.95 |
$39.33
|
|
Test stress cardiovascular tracing only
|
$926.25 |
$926.25 |
$926.25 |
$949.70
|
|
Tetanus immune globulin inj
|
$1,285.36 |
$1,285.36 |
$1,285.36 |
$1,285.36
|
|
Theophylline therapeutic drug level
|
$276.75 |
$276.75 |
$276.75 |
$108.00
|
|
Therapeutic procd strg endur
|
$113.70 |
$113.70 |
$113.70 |
$85.68
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$86.40 |
$86.40 |
$86.40 |
$57.31
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$90.00 |
$90.00 |
$90.00 |
$50.00
|
|
Ther/proph/diag inj ia
|
$178.95 |
$178.95 |
$178.95 |
$240.35
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$13.62 |
$13.62 |
$13.62 |
$25.54
|
|
Thigh/wght bear lacer molded
|
$873.03 |
$873.03 |
$873.03 |
$873.03
|
|
Thigh/wght bear lacer non-mo
|
$464.92 |
$464.92 |
$464.92 |
$464.92
|
|
Thiotepa injection
|
$1,485.00 |
$1,485.00 |
$1,485.00 |
$1,485.00
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$938.70 |
$938.70 |
$938.70 |
$1,687.50
|
|
Thoracotomy with cardiac massage
|
$1,981.05 |
$1,981.05 |
$1,981.05 |
$2,138.76
|
|
Thrombectmy crnry perq mechanical
|
$3,422.10 |
$3,422.10 |
$3,422.10 |
$3,580.00
|
|
Thrombectomy/inf pq dialysis circuit
|
$9,720.45 |
$9,720.45 |
$9,720.45 |
$8,084.00
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$11,787.75 |
$11,787.75 |
$11,787.75 |
$14,277.20
|
|
Thrombectomy/inf pq dialysis circuit w/stent plcmnt
|
$17,867.40 |
$17,867.40 |
$17,867.40 |
$21,413.60
|
|
Thrombin time
|
$115.95 |
$115.95 |
$115.95 |
$53.76
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$154.65 |
$154.65 |
$154.65 |
$61.52
|
|
Thyroglobulin antibody
|
$12.30 |
$12.30 |
$12.30 |
$82.00
|
|
Thyroid imaging
|
$696.75 |
$696.75 |
$696.75 |
$695.02
|
|
Thyroid mets imag whole body
|
$1,132.80 |
$1,132.80 |
$1,132.80 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$324.00 |
$324.00 |
$324.00 |
$111.00
|
|
Thyroid Ultrasound
|
$601.05 |
$601.05 |
$601.05 |
$588.50
|
|
Thyroid uptake measurement
|
$382.95 |
$382.95 |
$382.95 |
$591.25
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$3,914.94 |
$3,914.94 |
$3,914.94 |
$4,112.43
|
|
Thyroxine binding globulin (tbg)
|
$119.25 |
$119.25 |
$119.25 |
$64.35
|
|
Tibial length sock fx or equ
|
$228.69 |
$228.69 |
$228.69 |
$88.92
|
|
Tib/per revasc stent & ather 37231
|
$22,970.40 |
$22,970.40 |
$22,970.40 |
$21,249.26
|
|
Tib/per revasc stnt & ather
|
$10,012.80 |
$10,012.80 |
$10,012.80 |
$11,078.70
|
|
Tib/per revasc w/ather add-on 37233
|
$13,263.75 |
$13,263.75 |
$13,263.75 |
$9,769.65
|
|
Tigecycline injection
|
$216.00 |
$216.00 |
$216.00 |
$234.00
|
|
Tirofiban 12.5 mg/50 ml
|
$516.15 |
$516.15 |
$516.15 |
$458.85
|
|
Tissue amnio epifix inj 100mg
|
$4,201.20 |
$4,201.20 |
$4,201.20 |
$4,834.73
|
|
Tissue culture placenta
|
$365.40 |
$365.40 |
$365.40 |
$457.00
|
|
Tissue culture skin/biopsy
|
$757.20 |
$757.20 |
$757.20 |
$484.00
|
|
Tissue culture tumor
|
$738.00 |
$738.00 |
$738.00 |
$483.36
|
|
Tissue exam koh skin/hair/nails
|
$51.30 |
$51.30 |
$51.30 |
$47.20
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$293.82 |
$293.82 |
$293.82 |
$1,134.00
|
|
Tissue surgimend prs meshed 20 cm x 10 cm - cost per 0.5cm
|
$92.25 |
$92.25 |
$92.25 |
$1,403.42
|
|
Tissue transglutaminase iga
|
$36.90 |
$36.90 |
$36.90 |
$44.16
|
|
Tlso 2 shl symphys-stern cst
|
$2,095.23 |
$2,095.23 |
$2,095.23 |
$1,808.59
|
|
Tlso 3mod sacro-scap pre
|
$2,570.48 |
$2,570.48 |
$2,570.48 |
$2,117.57
|
|
Tlso r fram soft ant pre cst
|
$801.11 |
$801.11 |
$801.11 |
$801.11
|
|
Tlso rigid frame pre subclav
|
$1,193.13 |
$1,193.13 |
$1,193.13 |
$1,382.98
|
|
Tlso rigid lined custom fab
|
$2,831.21 |
$2,831.21 |
$2,831.21 |
$2,831.21
|
|
Tlso rigid lined pre one pie
|
$2,118.31 |
$2,118.31 |
$2,118.31 |
$2,110.02
|
