|
Tc-99m pentetate dtpa
|
$175.00 |
$175.00 |
$175.00 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$115.00 |
$115.00 |
$115.00 |
$190.80
|
|
Tc-99m pertechnetate per mci
|
$4.00 |
$4.00 |
$4.00 |
$22.10
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$110.00 |
$110.00 |
$110.00 |
$136.40
|
|
Tc-99m sestamibi p study dose
|
$310.00 |
$310.00 |
$310.00 |
$274.45
|
|
Tc-99m sulfur colloid
|
$250.00 |
$250.00 |
$250.00 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$357.50 |
$357.50 |
$357.50 |
$190.80
|
|
Tc-99m tilmanocept diag
|
$800.00 |
$800.00 |
$800.00 |
$955.60
|
|
T cells absolute cd4/cd8 including ratio
|
$175.00 |
$175.00 |
$175.00 |
$176.40
|
|
T cells absolute cd 4 count
|
$95.00 |
$95.00 |
$95.00 |
$111.20
|
|
T cells total count
|
$135.00 |
$135.00 |
$135.00 |
$126.90
|
|
Team conf without pat by hc pro
|
$87.50 |
$87.50 |
$87.50 |
$112.86
|
|
Team conf w/pat by hc prof
|
$82.50 |
$82.50 |
$82.50 |
$107.10
|
|
Telehealth original site facility fee
|
$27.50 |
$27.50 |
$27.50 |
$51.00
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$380.45 |
$380.45 |
$380.45 |
$15,245.38
|
|
Tert gene targeted seq alys
|
$335.00 |
$335.00 |
$335.00 |
$335.00
|
|
Test pathogen(s) for platelets reference
|
$60.00 |
$60.00 |
$60.00 |
$70.00
|
|
Test stress cardiovascular tracing only
|
$995.00 |
$995.00 |
$995.00 |
$949.70
|
|
Tgsap so/hl 51/< rna alys
|
$3,505.00 |
$3,505.00 |
$3,505.00 |
$4,347.00
|
|
Theophylline therapeutic drug level
|
$92.50 |
$92.50 |
$92.50 |
$108.00
|
|
Therapeutic procd strg endur
|
$65.00 |
$65.00 |
$65.00 |
$85.68
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$57.50 |
$57.50 |
$57.50 |
$57.31
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$50.00 |
$50.00 |
$50.00 |
$50.00
|
|
Ther nma rdctj intus/obstrcj
|
$322.50 |
$322.50 |
$322.50 |
$529.08
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$57.91 |
$57.91 |
$57.91 |
$25.54
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,150.00 |
$1,150.00 |
$1,150.00 |
$1,687.50
|
|
Thrombectomy/inf pq dialysis circuit
|
$3,610.00 |
$3,610.00 |
$3,610.00 |
$8,084.00
|
|
Thrombectomy/inf pq dialysis circuit w/pta
|
$16,070.00 |
$16,070.00 |
$16,070.00 |
$14,277.20
|
|
Thrombin time
|
$50.00 |
$50.00 |
$50.00 |
$53.76
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$50.00 |
$50.00 |
$50.00 |
$61.52
|
|
Thyroglobulin antibody
|
$90.00 |
$90.00 |
$90.00 |
$82.00
|
|
Thyroid met imaging
|
$1,120.00 |
$1,120.00 |
$1,120.00 |
$838.25
|
|
Thyroid mets imag whole body
|
$1,760.00 |
$1,760.00 |
$1,760.00 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$105.00 |
$105.00 |
$105.00 |
$111.00
|
|
Thyroid Ultrasound
|
$645.00 |
$645.00 |
$645.00 |
$588.50
|
|
Thyroxine binding globulin (tbg)
|
$92.50 |
$92.50 |
$92.50 |
$64.35
|
|
Tib/per revasc stent & ather 37231
|
$7,195.00 |
$7,195.00 |
$7,195.00 |
$21,249.26
|
|
Tib/per revasc stnt & ather
|
$7,195.00 |
$7,195.00 |
$7,195.00 |
$11,078.70
|
|
Tib/per revasc w/ather add-on 37233
|
$4,415.00 |
$4,415.00 |
$4,415.00 |
$9,769.65
|
|
Tilt table study
|
$2,070.00 |
$2,070.00 |
$2,070.00 |
$1,507.01
|
|
Tissue amnio epifix inj 100mg
|
$47.50 |
$47.50 |
$47.50 |
$4,834.73
|
|
Tissue culture placenta
|
$370.00 |
$370.00 |
$370.00 |
$457.00
|
|
Tissue culture skin/biopsy
|
$575.00 |
$575.00 |
$575.00 |
$484.00
|
|
Tissue exam koh skin/hair/nails
|
$30.00 |
$30.00 |
$30.00 |
$47.20
|
|
Tissue transglutaminase iga
|
$80.00 |
$80.00 |
$80.00 |
$44.16
|
|
Tl-201 thallium diag per mci
|
$82.50 |
$82.50 |
$82.50 |
$78.40
|
|
Tobramycin peak therapeutic drug level
|
$115.00 |
$115.00 |
$115.00 |
$120.60
|
|
Total tau
|
$312.50 |
$312.50 |
$312.50 |
$312.50
|
|
Toxoplasma antibody igg
|
$62.50 |
$62.50 |
$62.50 |
$89.40
|
|
Toxoplasma antibody igm
|
$62.50 |
$62.50 |
$62.50 |
$87.00
|
|
Tp53 gene trgt sequence alys
|
$1,095.00 |
$1,095.00 |
$1,095.00 |
$790.68
|
|
Tpmt gene com vrnts
|
$202.50 |
$202.50 |
$202.50 |
$371.80
|
|
Transcath biopsy
|
$2,995.00 |
$2,995.00 |
$2,995.00 |
$4,285.93
|
|
Transcatheter bx s&i
|
$1,785.00 |
$1,785.00 |
$1,785.00 |
$1,915.00
|
|
Transcath occlusion cns
|
$2,290.00 |
$2,290.00 |
$2,290.00 |
$7,157.76
|
|
Transcath occlusion non-cns
|
$3,670.00 |
$3,670.00 |
$3,670.00 |
$10,031.28
|
|
Transferrin
|
$92.50 |
$92.50 |
$92.50 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$725.00 |
$725.00 |
$725.00 |
$983.00
|
|
Transparent film >16<=48 in
|
$2.86 |
$2.86 |
$2.86 |
$12.95
|
|
Trauma partial team response w/critical care services level 4
|
$3,185.00 |
$3,185.00 |
$3,185.00 |
$4,523.04
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$180.00 |
$180.00 |
$180.00 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$90.00 |
$90.00 |
$90.00 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$92.50 |
$92.50 |
$92.50 |
$203.35
|
|
Treponema pallidum antibody
|
$52.50 |
$52.50 |
$52.50 |
$70.40
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$17.74 |
$17.74 |
$17.74 |
$43.21
|
|
Trichomonas assay w/optic
|
$52.50 |
$52.50 |
$52.50 |
$55.50
|
|
Triglycerides
|
$65.00 |
$65.00 |
$65.00 |
$58.05
|
|
Trim nail(s)
|
$50.00 |
$50.00 |
$50.00 |
$79.00
|
|
Trim nondyst nails
|
$50.00 |
$50.00 |
$50.00 |
$113.40
|
|
Trnscath plc vas stent w/s&i ini vein
|
$16,005.00 |
$16,005.00 |
$16,005.00 |
$15,330.11
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$2,005.00 |
$2,005.00 |
$2,005.00 |
$5,069.50
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$3,510.00 |
$3,510.00 |
$3,510.00 |
$4,250.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$3,510.00 |
$3,510.00 |
$3,510.00 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$2,005.00 |
$2,005.00 |
$2,005.00 |
$3,866.70
|
|
Troponin quantitative
|
$87.50 |
$87.50 |
$87.50 |
$127.20
|
|
Tube trach disp innr can 5 xlt
|
$150.00 |
$150.00 |
$150.00 |
$445.99
|
|
Tyms gene com variants
|
$140.00 |
$140.00 |
$140.00 |
$192.29
|
|
Ua w/micro/comp poc
|
$15.00 |
$15.00 |
$15.00 |
$23.00
|
|
Ugt1a1 gene analy common variants
|
$235.00 |
$235.00 |
$235.00 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$380.00 |
$380.00 |
$380.00 |
$394.20
|
|
Ultrasound breast complete
|
$1,150.00 |
$1,150.00 |
$1,150.00 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$865.00 |
$865.00 |
$865.00 |
$449.35
|
|
Ultrasound chest
|
$530.00 |
$530.00 |
$530.00 |
$460.85
|
|
Ultrasound elastography ea l target les
|
$180.00 |
$180.00 |
$180.00 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$362.50 |
$362.50 |
$362.50 |
$307.00
|
|
Ultrasound exam k transpl w/doppler
|
$670.00 |
$670.00 |
$670.00 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$490.00 |
$490.00 |
$490.00 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$180.00 |
$180.00 |
$180.00 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$720.00 |
$720.00 |
$720.00 |
$720.15
|
|
Ultrasound guide intraoperative
|
$292.50 |
$292.50 |
$292.50 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$420.00 |
$420.00 |
$420.00 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$370.00 |
$370.00 |
$370.00 |
$403.88
|
|
Ultrasound joint complete left
|
$750.00 |
$750.00 |
$750.00 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$565.00 |
$565.00 |
$565.00 |
$425.45
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$355.00 |
$355.00 |
$355.00 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$330.00 |
$330.00 |
$330.00 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$267.50 |
$267.50 |
$267.50 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$535.00 |
$535.00 |
$535.00 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$387.50 |
$387.50 |
$387.50 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$387.50 |
$387.50 |
$387.50 |
$459.00
|
