|
Target gsa panel organ/hmtlmph neop
|
$1,735.00 |
$1,735.00 |
$1,735.00 |
$3,678.78
|
|
Target gsa panel organ neop
|
$1,525.00 |
$1,525.00 |
$1,525.00 |
$1,643.25
|
|
Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells
|
$212.50 |
$212.50 |
$212.50 |
$194.35
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$175.00 |
$175.00 |
$175.00 |
$175.00
|
|
Tc-99m diag per dose
|
$2,120.00 |
$2,120.00 |
$2,120.00 |
$425.25
|
|
Tc-99m exame autol wbc diag per dose
|
$4,150.00 |
$4,150.00 |
$4,150.00 |
$2,431.95
|
|
Tc-99m exametazime diag
|
$1,515.00 |
$1,515.00 |
$1,515.00 |
$2,033.20
|
|
Tc-99m labeled rbc
|
$232.50 |
$232.50 |
$232.50 |
$302.40
|
|
Tc-99m maa
|
$265.00 |
$265.00 |
$265.00 |
$283.41
|
|
Tc-99m mebrofenin
|
$157.50 |
$157.50 |
$157.50 |
$160.58
|
|
Tc-99m medronate
|
$95.00 |
$95.00 |
$95.00 |
$109.50
|
|
Tc-99m mertiatide
|
$407.50 |
$407.50 |
$407.50 |
$756.00
|
|
Tc-99m non-heu per study dose
|
$5.00 |
$5.00 |
$5.00 |
$6.50
|
|
Tc-99m pentetate dtpa
|
$175.00 |
$175.00 |
$175.00 |
$222.60
|
|
Tc-99m pentetate dtpa aerosol
|
$115.00 |
$115.00 |
$115.00 |
$181.37
|
|
Tc-99m pertechnetate per mci
|
$4.00 |
$4.00 |
$4.00 |
$27.20
|
|
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 |
$293.73
|
|
Tc-99m sulfur colloid
|
$250.00 |
$250.00 |
$250.00 |
$239.40
|
|
Tc-99m tilmanocept diag
|
$800.00 |
$800.00 |
$800.00 |
$930.54
|
|
T cells absolute cd4/cd8 including ratio
|
$175.00 |
$175.00 |
$175.00 |
$175.00
|
|
T cells absolute cd 4 count
|
$95.00 |
$95.00 |
$95.00 |
$110.00
|
|
T cells total count
|
$135.00 |
$135.00 |
$135.00 |
$123.00
|
|
Telehealth original site facility fee
|
$27.50 |
$27.50 |
$27.50 |
$49.80
|
|
Telethx isodose plan cplx
|
$2,915.00 |
$2,915.00 |
$2,915.00 |
$1,488.40
|
|
Telethx isodose plan simple
|
$1,780.00 |
$1,780.00 |
$1,780.00 |
$788.00
|
|
Temozolomide
|
$2.07 |
$2.07 |
$2.07 |
$540.06
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$199.26 |
$199.26 |
$199.26 |
$15,600.75
|
|
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 |
$66.00
|
|
Test stress cardiovascular tracing only
|
$995.00 |
$995.00 |
$995.00 |
$953.40
|
|
Tgsap so/hl 51/< rna alys
|
$3,505.00 |
$3,505.00 |
$3,505.00 |
$3,505.00
|
|
Theophylline therapeutic drug level
|
$92.50 |
$92.50 |
$92.50 |
$108.00
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$57.50 |
$57.50 |
$57.50 |
$57.50
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$50.00 |
$50.00 |
$50.00 |
$50.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$11.15 |
$11.15 |
$11.15 |
$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
|
|
Thrombin time
|
$50.00 |
$50.00 |
$50.00 |
$53.60
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$50.00 |
$50.00 |
$50.00 |
$60.39
|
|
Thyroglobulin antibody
|
$90.00 |
$90.00 |
$90.00 |
$81.90
|
|
Thyroid mets imag whole body
|
$1,760.00 |
$1,760.00 |
$1,760.00 |
$1,544.00
|
|
Thyroid met uptake
|
$495.00 |
$495.00 |
$495.00 |
$398.40
|
|
Thyroid (TSH) Test
|
$105.00 |
$105.00 |
$105.00 |
$112.00
|
|
Thyroid Ultrasound
|
$322.50 |
$322.50 |
$322.50 |
$589.96
|
|
Thyroxine binding globulin (tbg)
|
$92.50 |
$92.50 |
$92.50 |
$64.92
|
|
Tilt table study
|
$930.00 |
$930.00 |
$930.00 |
$1,495.00
|
|
Tissue amnio epifix inj 100mg
|
$47.50 |
$47.50 |
$47.50 |
$4,201.20
|
|
Tissue culture skin/biopsy
|
$575.00 |
$575.00 |
$575.00 |
$518.40
|
|
Tissue exam koh skin/hair/nails
|
$30.00 |
$30.00 |
$30.00 |
$47.40
|
|
Tissue transglutaminase iga
|
$80.00 |
$80.00 |
$80.00 |
$46.20
|
|
Tobramycin peak therapeutic drug level
|
$115.00 |
$115.00 |
$115.00 |
$121.55
|
|
Tomosynthesis breast diagnostic left
|
$62.50 |
$62.50 |
$62.50 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$62.50 |
$62.50 |
$62.50 |
$70.89
|
|
Total tau
|
$312.50 |
$312.50 |
$312.50 |
$297.70
|
|
Toxoplasma antibody igg
|
$62.50 |
$62.50 |
$62.50 |
$89.57
|
|
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 |
$823.00
|
|
Tpmt gene com vrnts
|
$202.50 |
$202.50 |
$202.50 |
$373.00
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$85.00 |
$85.00 |
$85.00 |
$101.58
|
|
Transcrv abltj utrn fibrd rf
|
$6,340.00 |
$6,340.00 |
$6,340.00 |
$8,750.72
|
|
Transferrin
|
$92.50 |
$92.50 |
$92.50 |
$81.60
|
|
Transfusion blood/blood component(s)
|
$725.00 |
$725.00 |
$725.00 |
$937.30
|
|
Trauma partial team response w/critical care services level 4
|
$3,185.00 |
$3,185.00 |
$3,185.00 |
$4,063.80
|
|
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 |
$141.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$85.00 |
$85.00 |
$85.00 |
$203.35
|
|
Treponema pallidum antibody
|
$52.50 |
$52.50 |
$52.50 |
$70.85
|
|
Trg gene rearrangement anal
|
$610.00 |
$610.00 |
$610.00 |
$455.70
|
|
Trichomonas assay w/optic
|
$52.50 |
$52.50 |
$52.50 |
$58.25
|
|
Triglycerides
|
$65.00 |
$65.00 |
$65.00 |
$57.85
|
|
Trimethobenzamide hcl inj
|
$122.74 |
$122.74 |
$122.74 |
$117.49
|
|
Trim nail(s)
|
$50.00 |
$50.00 |
$50.00 |
$77.60
|
|
Trim nondyst nails
|
$50.00 |
$50.00 |
$50.00 |
$115.70
|
|
Trml dstrj ios bvn 1st 2 l/s
|
$10,145.00 |
$10,145.00 |
$10,145.00 |
$15,226.08
|
|
Troponin quantitative
|
$87.50 |
$87.50 |
$87.50 |
$128.80
|
|
Tube trach disp innr can 5 xlt
|
$150.00 |
$150.00 |
$150.00 |
$445.99
|
|
Tube trach disp innr can 6 xlt
|
$10.00 |
$10.00 |
$10.00 |
$16.80
|
|
Tube trach fen sz 6 uncuffed
|
$125.00 |
$125.00 |
$125.00 |
$160.88
|
|
Tyms gene com variants
|
$140.00 |
$140.00 |
$140.00 |
$192.29
|
|
Ugt1a1 gene analy common variants
|
$235.00 |
$235.00 |
$235.00 |
$406.38
|
|
Ultrasound abdomen aorta screening study aaa
|
$380.00 |
$380.00 |
$380.00 |
$394.20
|
|
Ultrasound breast complete
|
$1,100.00 |
$1,100.00 |
$1,100.00 |
$533.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$825.00 |
$825.00 |
$825.00 |
$455.26
|
|
Ultrasound chest
|
$352.50 |
$352.50 |
$352.50 |
$451.52
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$285.00 |
$285.00 |
$285.00 |
$338.00
|
|
Ultrasound elastography ea l target les
|
$180.00 |
$180.00 |
$180.00 |
$177.00
|
|
Ultrasound elastography parenchyma
|
$362.50 |
$362.50 |
$362.50 |
$284.25
|
|
Ultrasound encephalogram
|
$570.00 |
$570.00 |
$570.00 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$670.00 |
$670.00 |
$670.00 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$472.50 |
$472.50 |
$472.50 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$252.50 |
$252.50 |
$252.50 |
$379.36
|
|
Ultrasound guided needle placement supervision & interpretation
|
$720.00 |
$720.00 |
$720.00 |
$720.00
|
|
Ultrasound guide intraoperative
|
$292.50 |
$292.50 |
$292.50 |
$625.15
|
|
Ultrasound infant hips ltd without stress
|
$247.50 |
$247.50 |
$247.50 |
$295.50
|
|
Ultrasound joint complete left
|
$750.00 |
$750.00 |
$750.00 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$565.00 |
$565.00 |
$565.00 |
$418.80
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$355.00 |
$355.00 |
$355.00 |
$280.02
|
|
Ultrasound ob >=14wks ea addl gest
|
$330.00 |
$330.00 |
$330.00 |
$397.15
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$267.50 |
$267.50 |
$267.50 |
$323.40
|
|
Ultrasound pregnant uterus follow up per fetus
|
$387.50 |
$387.50 |
$387.50 |
$420.80
|
