|
Tib/per revasc w/ather add-on 37233
|
$5,357.46 |
$5,357.46 |
$5,357.46 |
$10,165.00
|
|
Tilt table study
|
$807.21 |
$807.21 |
$807.21 |
$1,551.60
|
|
Tissue culture placenta
|
$130.50 |
$130.50 |
$130.50 |
$444.00
|
|
Tissue culture skin/biopsy
|
$122.22 |
$122.22 |
$122.22 |
$484.00
|
|
Tissue culture tumor
|
$127.98 |
$127.98 |
$127.98 |
$483.36
|
|
Tissue exam koh skin/hair/nails
|
$44.50 |
$44.50 |
$44.50 |
$47.40
|
|
Tissue transglutaminase iga
|
$10.03 |
$10.03 |
$10.03 |
$44.80
|
|
Tobramycin peak therapeutic drug level
|
$5.54 |
$5.54 |
$5.54 |
$119.60
|
|
Toe X-ray (both feet)
|
$53.96 |
$53.96 |
$53.96 |
$258.65
|
|
Total tau
|
$50.96 |
$50.96 |
$50.96 |
$312.50
|
|
Toxoplasma antibody igg
|
$10.71 |
$10.71 |
$10.71 |
$91.65
|
|
Toxoplasma antibody igm
|
$10.20 |
$10.20 |
$10.20 |
$87.75
|
|
Tpmt gene com vrnts
|
$133.19 |
$133.19 |
$133.19 |
$371.80
|
|
Transcath biopsy
|
$806.35 |
$806.35 |
$806.35 |
$4,285.93
|
|
Transcatheter bx s&i
|
$405.06 |
$405.06 |
$405.06 |
$1,950.85
|
|
Transcath occlusion non-cns
|
$1,149.00 |
$1,149.00 |
$1,149.00 |
$10,270.00
|
|
Transferrin
|
$16.84 |
$16.84 |
$16.84 |
$82.00
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$186.19 |
$186.19 |
$186.19 |
$561.60
|
|
Transvaginal Pregnancy Ultrasound
|
$156.70 |
$156.70 |
$156.70 |
$499.20
|
|
Trauma partial team response w/critical care services level 4
|
$551.14 |
$551.14 |
$551.14 |
$4,499.40
|
|
Treponema pallidum antibody
|
$12.58 |
$12.58 |
$12.58 |
$72.05
|
|
Trg gene rearrangement anal
|
$153.42 |
$153.42 |
$153.42 |
$455.70
|
|
Trichinella antibody
|
$11.73 |
$11.73 |
$11.73 |
$70.56
|
|
#tricyclicantidprssnt
|
$10.40 |
$10.40 |
$10.40 |
$50.54
|
|
Triglycerides
|
$17.85 |
$17.85 |
$17.85 |
$58.40
|
|
Trim nondyst nails
|
$78.75 |
$78.75 |
$78.75 |
$114.48
|
|
Trnscath plc stent crv crtd w/prtct
|
$3,002.68 |
$3,002.68 |
$3,002.68 |
$9,767.25
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$2,442.86 |
$2,442.86 |
$2,442.86 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$2,035.67 |
$2,035.67 |
$2,035.67 |
$8,776.32
|
|
Trnscath plc vas stent w/s&i ini vein
|
$3,053.65 |
$3,053.65 |
$3,053.65 |
$14,558.70
|
|
Trnscath retrv pq vasc fb w/guide
|
$1,528.49 |
$1,528.49 |
$1,528.49 |
$4,766.40
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$1,896.07 |
$1,896.07 |
$1,896.07 |
$5,139.20
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$745.68 |
$745.68 |
$745.68 |
$4,341.66
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$643.75 |
$643.75 |
$643.75 |
$4,372.08
|
|
Trnscath tx thromblytc vein ini day
|
$1,090.83 |
$1,090.83 |
$1,090.83 |
$3,866.70
|
|
Troponin quantitative
|
$37.40 |
$37.40 |
$37.40 |
$127.20
|
|
Tte w or without fol w/con,stres
|
$431.90 |
$431.90 |
$431.90 |
$1,632.80
|
|
Ugt1a1 gene analy common variants
|
$178.22 |
$178.22 |
$178.22 |
$438.75
|
|
Ultrasound breast complete
|
$171.99 |
$171.99 |
$171.99 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$132.40 |
$132.40 |
$132.40 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$106.47 |
$106.47 |
$106.47 |
$338.00
|
|
Ultrasound encephalogram
|
$202.57 |
$202.57 |
$202.57 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$152.33 |
$152.33 |
$152.33 |
$578.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$173.63 |
$173.63 |
$173.63 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$212.94 |
$212.94 |
$212.94 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$167.08 |
$167.08 |
$167.08 |
$388.08
|
|
Ultrasound guide intraoperative
|
$185.37 |
$185.37 |
$185.37 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$132.68 |
$132.68 |
$132.68 |
$560.00
|
|
Ultrasound hips infant dynamic
|
$153.43 |
$153.43 |
$153.43 |
$403.88
|
|
Ultrasound joint complete left
|
$127.76 |
$127.76 |
$127.76 |
$557.99
|
|
Ultrasound ob >=14wks ea addl gest
|
$144.42 |
$144.42 |
$144.42 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$95.00 |
$95.00 |
$95.00 |
$335.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$238.33 |
$238.33 |
$238.33 |
$698.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$138.68 |
$138.68 |
$138.68 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$147.97 |
$147.97 |
$147.97 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$214.03 |
$214.03 |
$214.03 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$200.11 |
$200.11 |
$200.11 |
$421.00
|
|
Unlisted hematology&coagj px
|
$12.08 |
$12.08 |
$12.08 |
$39.52
|
|
Unlisted transfusion med px
|
$76.92 |
$76.92 |
$76.92 |
$147.50
|
|
Unsched dialysis esrd pt hos
|
$429.66 |
$429.66 |
$429.66 |
$1,296.00
|
|
Upgrade pm system
|
$3,539.78 |
$3,539.78 |
$3,539.78 |
$12,077.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$75.68 |
$75.68 |
$75.68 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$542.69 |
$542.69 |
$542.69 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$434.12 |
$434.12 |
$434.12 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$475.99 |
$475.99 |
$475.99 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$396.66 |
$396.66 |
$396.66 |
$2,384.25
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$317.33 |
$317.33 |
$317.33 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$80.84 |
$80.84 |
$80.84 |
$381.60
|
|
Upper GI Barium X-ray (barium and gas)
|
$132.22 |
$132.22 |
$132.22 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$130.29 |
$130.29 |
$130.29 |
$607.20
|
|
Urea nitrogen
|
$15.26 |
$15.26 |
$15.26 |
$42.25
|
|
Urea nitrogen 24 hour urine
|
$5.88 |
$5.88 |
$5.88 |
$52.00
|
|
Ureteral reflux study
|
$324.85 |
$324.85 |
$324.85 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$228.33 |
$228.33 |
$228.33 |
$584.00
|
|
Urethrocystography void s&i
|
$147.92 |
$147.92 |
$147.92 |
$631.75
|
|
Uric acid blood
|
$15.82 |
$15.82 |
$15.82 |
$49.32
|
|
Uric acid urine
|
$8.14 |
$8.14 |
$8.14 |
$44.80
|
|
Urinalysis microscopic only
|
$2.21 |
$2.21 |
$2.21 |
$26.46
|
|
Urinalysis qual/semiquant excpt ia
|
$1.55 |
$1.55 |
$1.55 |
$25.72
|
|
Urinalysis (with microscopy)
|
$26.74 |
$26.74 |
$26.74 |
$55.20
|
|
Urinalysis (without microscopy)
|
$23.65 |
$23.65 |
$23.65 |
$36.00
|
|
Urinary bldr retent nuc study
|
$112.49 |
$112.49 |
$112.49 |
$350.66
|
|
Urine Culture Test
|
$55.27 |
$55.27 |
$55.27 |
$82.32
|
|
Urine pregnancy test
|
$43.32 |
$43.32 |
$43.32 |
$68.21
|
|
Urography, antegrade
|
$290.90 |
$290.90 |
$290.90 |
$622.35
|
|
Vaccine Administration (one shot)
|
$9.07 |
$9.07 |
$9.07 |
$67.74
|
|
Valproic acid total therapeutic drug level
|
$5.99 |
$5.99 |
$5.99 |
$115.00
|
|
Vancomycin peak therapeutic drug level
|
$22.83 |
$22.83 |
$22.83 |
$136.13
|
|
Varicella zoster antibody igg
|
$9.01 |
$9.01 |
$9.01 |
$86.80
|
|
Vein x-ray adrenal gland
|
$765.40 |
$765.40 |
$765.40 |
$2,833.34
|
|
Vein x-ray adrenal glands
|
$933.74 |
$933.74 |
$933.74 |
$3,480.10
|
|
Vein x-ray kidney
|
$786.90 |
$786.90 |
$786.90 |
$2,870.00
|
|
Vein x-ray liver
|
$1,068.12 |
$1,068.12 |
$1,068.12 |
$3,312.00
|
|
Vein x-ray liver w/hemodynam
|
$1,058.44 |
$1,058.44 |
$1,058.44 |
$3,610.20
|
|
Vein x-ray liver w/hemodynam
|
$1,058.44 |
$1,058.44 |
$1,058.44 |
$3,683.90
|
|
Vein x-ray liver without hemodyn
|
$629.30 |
$629.30 |
$629.30 |
$2,452.80
|
|
Vein x-ray skull epidural
|
$592.54 |
$592.54 |
$592.54 |
$1,596.00
|
|
Vein x-ray spleen/liver
|
$580.07 |
$580.07 |
$580.07 |
$3,434.00
|
|
Venogram ext bil s&i
|
$490.63 |
$490.63 |
$490.63 |
$1,838.28
|
|
Venogram extremity supervision & interpretation unilateral
|
$419.25 |
$419.25 |
$419.25 |
$1,382.58
|
