|
Surgical pathology level 3 gross & microscopic examination
|
$44.39 |
$44.39 |
$44.39 |
$184.50
|
|
Surgical pathology level 4 gross & microscopic examination
|
$74.06 |
$74.06 |
$74.06 |
$250.20
|
|
Surgical pathology level 5 gross & microscopic examination
|
$230.92 |
$230.92 |
$230.92 |
$489.00
|
|
Susceptibility agar dilution per agent
|
$8.28 |
$8.28 |
$8.28 |
$42.70
|
|
Susceptibility enzyme detection per enzyme
|
$3.91 |
$3.91 |
$3.91 |
$35.10
|
|
Susceptibility mic per plate
|
$14.95 |
$14.95 |
$14.95 |
$104.00
|
|
Suscept studies macrobroth dilution ea
|
$7.13 |
$7.13 |
$7.13 |
$59.28
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$7.82 |
$7.82 |
$7.82 |
$40.11
|
|
T3 (triiodothyronine) free
|
$29.21 |
$29.21 |
$29.21 |
$99.20
|
|
T3 (triiodothyronine) total
|
$24.38 |
$24.38 |
$24.38 |
$93.52
|
|
T4 (thyroxine) free
|
$15.41 |
$15.41 |
$15.41 |
$85.20
|
|
T4 (thyroxine) total
|
$11.73 |
$11.73 |
$11.73 |
$67.80
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$0.85 |
$0.85 |
$0.85 |
$10.03
|
|
Tacrolimus therapeutic drug level
|
$23.69 |
$23.69 |
$23.69 |
$120.60
|
|
Target gsa panel hmtlmph neop
|
$816.50 |
$816.50 |
$816.50 |
$2,160.00
|
|
Target gsa panel organ/hmtlmph neop
|
$3,676.78 |
$3,676.78 |
$3,676.78 |
$3,678.78
|
|
Tbp gene detc abnor alleles
|
$105.80 |
$105.80 |
$105.80 |
$150.70
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$106.49 |
$106.49 |
$106.49 |
$175.00
|
|
Tc-99m disofenin
|
$35.65 |
$35.65 |
$35.65 |
$131.30
|
|
Tc-99m exame autol wbc diag per dose
|
$1,255.34 |
$1,255.34 |
$1,255.34 |
$2,431.95
|
|
Tc-99m exametazime diag
|
$713.00 |
$713.00 |
$713.00 |
$2,033.20
|
|
Tc-99m labeled rbc
|
$291.87 |
$291.87 |
$291.87 |
$302.40
|
|
Tc-99m maa
|
$48.07 |
$48.07 |
$48.07 |
$283.41
|
|
Tc-99m mebrofenin
|
$51.52 |
$51.52 |
$51.52 |
$160.58
|
|
Tc-99m medronate
|
$26.45 |
$26.45 |
$26.45 |
$109.50
|
|
Tc-99m mertiatide
|
$356.27 |
$356.27 |
$356.27 |
$756.00
|
|
Tc-99m oxidronate
|
$26.45 |
$26.45 |
$26.45 |
$105.30
|
|
Tc-99m pentetate dtpa
|
$63.94 |
$63.94 |
$63.94 |
$222.60
|
|
Tc-99m pertechnetate per mci
|
$5.29 |
$5.29 |
$5.29 |
$27.20
|
|
Tc-99m sestamibi p study dose
|
$65.32 |
$65.32 |
$65.32 |
$293.73
|
|
Tc-99m sulfur colloid
|
$44.85 |
$44.85 |
$44.85 |
$239.40
|
|
Tc-99m tetrofosmin p study dose
|
$214.59 |
$214.59 |
$214.59 |
$188.50
|
|
T cells absolute cd4/cd8 including ratio
|
$80.73 |
$80.73 |
$80.73 |
$175.00
|
|
T cells absolute cd 4 count
|
$46.00 |
$46.00 |
$46.00 |
$110.00
|
|
T cells total count
|
$64.63 |
$64.63 |
$64.63 |
$123.00
|
|
Telehealth original site facility fee
|
$22.54 |
$22.54 |
$22.54 |
$49.80
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$11,418.53 |
$11,418.53 |
$11,418.53 |
$15,600.75
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$67.46 |
$67.46 |
$67.46 |
$39.18
|
|
Test for chlorohydrocarbons
|
$6.44 |
$6.44 |
$6.44 |
$61.60
|
|
Test for urine cystines
|
$8.74 |
$8.74 |
$8.74 |
$27.03
|
|
Test pathogen(s) for platelets reference
|
$32.20 |
$32.20 |
$32.20 |
$66.00
|
|
Test stress cardiovascular tracing only
|
$219.88 |
$219.88 |
$219.88 |
$953.40
|
|
Tetanus immune globulin inj
|
$1,038.78 |
$1,038.78 |
$1,038.78 |
$1,228.80
|
|
Tgsap so/hl 51/< rna alys
|
$947.83 |
$947.83 |
$947.83 |
$3,505.00
|
|
Theophylline therapeutic drug level
|
$24.38 |
$24.38 |
$24.38 |
$108.00
|
|
Therapeutic procd strg endur
|
$77.51 |
$77.51 |
$77.51 |
$83.16
|
|
Ther/proph/diag inj ia
|
$52.67 |
$52.67 |
$52.67 |
$237.75
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$9.33 |
$9.33 |
$9.33 |
$25.54
|
|
Thoracotomy with cardiac massage
|
$1,877.49 |
$1,877.49 |
$1,877.49 |
$1,989.60
|
|
Thrombin time
|
$9.89 |
$9.89 |
$9.89 |
$53.60
|
|
Thromboplastin inhibition
|
$16.56 |
$16.56 |
$16.56 |
$53.30
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$11.04 |
$11.04 |
$11.04 |
$60.39
|
|
Thyroglobulin antibody
|
$27.37 |
$27.37 |
$27.37 |
$81.90
|
|
Thyroid (TSH) Test
|
$28.98 |
$28.98 |
$28.98 |
$112.00
|
|
Thyroid Ultrasound
|
$99.82 |
$99.82 |
$99.82 |
$589.96
|
|
Tigecycline injection
|
$351.31 |
$351.31 |
$351.31 |
$234.00
|
|
Tissue culture skin/biopsy
|
$128.34 |
$128.34 |
$128.34 |
$518.40
|
|
Tissue exam koh skin/hair/nails
|
$6.90 |
$6.90 |
$6.90 |
$47.40
|
|
Tissue transglutaminase iga
|
$72.91 |
$72.91 |
$72.91 |
$46.20
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$12.71 |
$12.71 |
$12.71 |
$152.80
|
|
Tobramycin non-comp unit
|
$49.39 |
$49.39 |
$49.39 |
$105.75
|
|
Tobramycin peak therapeutic drug level
|
$27.60 |
$27.60 |
$27.60 |
$121.55
|
|
Tomosynthesis breast screen bilateral
|
$72.68 |
$72.68 |
$72.68 |
$70.89
|
|
Total tau
|
$50.14 |
$50.14 |
$50.14 |
$297.70
|
|
Toxoplasma antibody igg
|
$24.61 |
$24.61 |
$24.61 |
$89.57
|
|
Toxoplasma antibody igm
|
$24.61 |
$24.61 |
$24.61 |
$87.00
|
|
Tp53 gene full gene sequence
|
$808.22 |
$808.22 |
$808.22 |
$706.04
|
|
Tp53 gene known famil vrnt
|
$388.01 |
$388.01 |
$388.01 |
$395.40
|
|
Tp53 gene trgt sequence alys
|
$414.92 |
$414.92 |
$414.92 |
$823.00
|
|
Tpmt gene com vrnts
|
$220.11 |
$220.11 |
$220.11 |
$373.00
|
|
Tracheobrnchsc thru est trachs incisn
|
$264.50 |
$264.50 |
$264.50 |
$1,371.84
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$20.47 |
$20.47 |
$20.47 |
$101.58
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$19.39 |
$19.39 |
$19.39 |
$55.69
|
|
Transferrin
|
$21.39 |
$21.39 |
$21.39 |
$81.60
|
|
Transfusion blood/blood component(s)
|
$117.07 |
$117.07 |
$117.07 |
$937.30
|
|
Tray bonemarrw oncontrol 102mm
|
$894.50 |
$894.50 |
$894.50 |
$934.07
|
|
Treat elbow dislocation
|
$710.01 |
$710.01 |
$710.01 |
$2,200.00
|
|
Treat elbow fracture
|
$710.01 |
$710.01 |
$710.01 |
$1,919.00
|
|
Treat finger fracture each
|
$62.10 |
$62.10 |
$62.10 |
$1,593.00
|
|
Treat foot dislocation
|
$99.82 |
$99.82 |
$99.82 |
$466.14
|
|
Treat fracture of radius
|
$201.94 |
$201.94 |
$201.94 |
$1,790.00
|
|
Treat fracture of ulna
|
$207.92 |
$207.92 |
$207.92 |
$716.95
|
|
Treat hip dislocation
|
$676.20 |
$676.20 |
$676.20 |
$2,132.50
|
|
Treat humerus fracture
|
$278.76 |
$278.76 |
$278.76 |
$1,790.00
|
|
Treat knee dislocation
|
$646.99 |
$646.99 |
$646.99 |
$2,126.80
|
|
Treat knee fracture 27530
|
$106.95 |
$106.95 |
$106.95 |
$535.60
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$42.55 |
$42.55 |
$42.55 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$38.87 |
$38.87 |
$38.87 |
$141.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$96.60 |
$96.60 |
$96.60 |
$203.35
|
|
Treatment of ankle fracture
|
$3,023.58 |
$3,023.58 |
$3,023.58 |
$8,453.60
|
|
Treatment of fibula fracture 27780
|
$217.35 |
$217.35 |
$217.35 |
$478.40
|
|
Treatment of thigh fracture
|
$617.55 |
$617.55 |
$617.55 |
$1,749.06
|
|
Treat midfoot fracture each
|
$74.52 |
$74.52 |
$74.52 |
$1,824.50
|
|
Treat thigh fx growth plate
|
$94.99 |
$94.99 |
$94.99 |
$466.14
|
|
Treat ulnar fracture
|
$207.92 |
$207.92 |
$207.92 |
$1,672.00
|
|
Treat wrist bone fracture
|
$207.92 |
$207.92 |
$207.92 |
$1,703.20
|
|
Treat wrist dislocation
|
$207.92 |
$207.92 |
$207.92 |
$656.25
|
|
Treponema pallidum antibody
|
$23.00 |
$23.00 |
$23.00 |
$70.85
|
|
Trg gene rearrangement anal
|
$346.38 |
$346.38 |
$346.38 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$35.10 |
$35.10 |
$35.10 |
$43.80
|
