|
Tb test cell mediated immunity antigen response gamma interferon
|
$48.87 |
$48.87 |
$48.87 |
$166.46
|
|
Tc-99m apcitide diag
|
$11,587.53 |
$11,587.53 |
$11,587.53 |
$1,765.30
|
|
Tc-99m bicisate
|
$3,471.51 |
$3,471.51 |
$3,471.51 |
$1,969.45
|
|
Tc-99m exametazime diag
|
$8,804.57 |
$8,804.57 |
$8,804.57 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$1,382.87 |
$1,382.87 |
$1,382.87 |
$323.01
|
|
Tc-99m maa
|
$964.56 |
$964.56 |
$964.56 |
$312.06
|
|
Tc-99m mebrofenin
|
$1,586.98 |
$1,586.98 |
$1,586.98 |
$169.53
|
|
Tc-99m medronate
|
$964.56 |
$964.56 |
$964.56 |
$122.46
|
|
Tc-99m mertiatide
|
$1,839.97 |
$1,839.97 |
$1,839.97 |
$757.25
|
|
Tc-99m pentetate dtpa
|
$964.56 |
$964.56 |
$964.56 |
$245.85
|
|
Tc-99m pertechnetate per mci
|
$675.62 |
$675.62 |
$675.62 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$964.56 |
$964.56 |
$964.56 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$6,056.09 |
$6,056.09 |
$6,056.09 |
$221.60
|
|
Tc-99m succimer (dmsa)
|
$4,056.57 |
$4,056.57 |
$4,056.57 |
$1,578.33
|
|
Tc-99m sulfur colloid
|
$1,204.60 |
$1,204.60 |
$1,204.60 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$1,632.98 |
$1,632.98 |
$1,632.98 |
$198.05
|
|
T cells absolute cd 4 count
|
$30.75 |
$30.75 |
$30.75 |
$120.25
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$76.25 |
$76.25 |
$76.25 |
$44.49
|
|
Testicular imaging w/vasc flow
|
$5,621.99 |
$5,621.99 |
$5,621.99 |
$780.48
|
|
Tetanus immune globulin inj
|
$3,562.00 |
$3,562.00 |
$3,562.00 |
$1,395.20
|
|
Theophylline therapeutic drug level
|
$1,390.90 |
$1,390.90 |
$1,390.90 |
$108.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$25.10 |
$25.10 |
$25.10 |
$38.64
|
|
Thyroid imaging
|
$4,530.94 |
$4,530.94 |
$4,530.94 |
$670.80
|
|
Thyroid mets imag whole body
|
$8,862.06 |
$8,862.06 |
$8,862.06 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$2,040.95 |
$2,040.95 |
$2,040.95 |
$120.00
|
|
Thyroid Ultrasound
|
$3,693.92 |
$3,693.92 |
$3,693.92 |
$589.96
|
|
Thyroid uptake measurement
|
$2,896.52 |
$2,896.52 |
$2,896.52 |
$653.60
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$13,393.25 |
$13,393.25 |
$13,393.25 |
$4,886.55
|
|
Thyroxine binding globulin (tbg)
|
$9.00 |
$9.00 |
$9.00 |
$63.60
|
|
Tissue culture skin/biopsy
|
$200.00 |
$200.00 |
$200.00 |
$558.87
|
|
Tissue culture tumor
|
$206.00 |
$206.00 |
$206.00 |
$529.23
|
|
Tissue exam koh skin/hair/nails
|
$853.57 |
$853.57 |
$853.57 |
$47.40
|
|
Tissue transglutaminase iga
|
$27.60 |
$27.60 |
$27.60 |
$48.57
|
|
Tl-201 thallium diag per mci
|
$2,463.84 |
$2,463.84 |
$2,463.84 |
$77.22
|
|
Tobramycin non-comp unit
|
$386.32 |
$386.32 |
$386.32 |
$107.07
|
|
Tobramycin peak therapeutic drug level
|
$1,475.82 |
$1,475.82 |
$1,475.82 |
$121.55
|
|
Tomosynthesis breast diagnostic left
|
$57.10 |
$57.10 |
$57.10 |
$63.70
|
|
Tomosynthesis breast screen bilateral
|
$57.10 |
$57.10 |
$57.10 |
$73.45
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$49.61 |
$49.61 |
$49.61 |
$93.75
|
|
Transcatheter bx s&i
|
$9,966.13 |
$9,966.13 |
$9,966.13 |
$1,875.96
|
|
Trastuzumab 150 mg intravenous solution
|
$370.00 |
$370.00 |
$370.00 |
$3,401.26
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$306.00 |
$306.00 |
$306.00 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$156.66 |
$156.66 |
$156.66 |
$149.00
|
|
Treprostinil injection
|
$6,962.00 |
$6,962.00 |
$6,962.00 |
$528.60
|
|
Trichinella antibody
|
$65.32 |
$65.32 |
$65.32 |
$70.65
|
|
Trichomonas assay w/optic
|
$92.51 |
$92.51 |
$92.51 |
$66.00
|
|
Trimethobenzamide hcl inj
|
$42.50 |
$42.50 |
$42.50 |
$154.09
|
|
Troponin quantitative
|
$963.38 |
$963.38 |
$963.38 |
$123.75
|
|
Ultrasound chest
|
$2,953.09 |
$2,953.09 |
$2,953.09 |
$459.55
|
|
Ultrasound encephalogram
|
$3,623.65 |
$3,623.65 |
$3,623.65 |
$481.60
|
|
Ultrasound guide intraoperative
|
$1,979.46 |
$1,979.46 |
$1,979.46 |
$632.90
|
|
Ultrasound ob >=14wks ea addl gest
|
$6,765.61 |
$6,765.61 |
$6,765.61 |
$454.11
|
|
Ultrasound pregnant uterus follow up per fetus
|
$1,696.89 |
$1,696.89 |
$1,696.89 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$2,437.73 |
$2,437.73 |
$2,437.73 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$4,095.09 |
$4,095.09 |
$4,095.09 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$4,572.38 |
$4,572.38 |
$4,572.38 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$5,898.86 |
$5,898.86 |
$5,898.86 |
$498.00
|
|
Ultrasound scrotum and contents
|
$3,913.54 |
$3,913.54 |
$3,913.54 |
$617.28
|
|
Ultrasound transvaginal non obstetric
|
$4,095.09 |
$4,095.09 |
$4,095.09 |
$567.44
|
|
Unlisted ultrasound procedure
|
$1,979.46 |
$1,979.46 |
$1,979.46 |
$321.20
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$8,035.98 |
$8,035.98 |
$8,035.98 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$8,108.82 |
$8,108.82 |
$8,108.82 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$7,409.80 |
$7,409.80 |
$7,409.80 |
$2,013.08
|
|
Urea nitrogen 24 hour urine
|
$655.92 |
$655.92 |
$655.92 |
$50.00
|
|
Urethrcystgrphy rtrgrde s&i
|
$5,440.60 |
$5,440.60 |
$5,440.60 |
$574.40
|
|
Urethrocystography void s&i
|
$4,390.84 |
$4,390.84 |
$4,390.84 |
$634.50
|
|
Uric acid blood
|
$963.38 |
$963.38 |
$963.38 |
$46.64
|
|
Urinalysis microscopic only
|
$500.72 |
$500.72 |
$500.72 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$4.18 |
$4.18 |
$4.18 |
$25.72
|
|
Urine Culture Test
|
$890.18 |
$890.18 |
$890.18 |
$84.81
|
|
Urography inf drip &/or bolus
|
$4,390.84 |
$4,390.84 |
$4,390.84 |
$641.69
|
|
Vaccine dtap < 7 years im
|
$375.00 |
$375.00 |
$375.00 |
$87.80
|
|
Vaccine hepatitis a (hepa) adult im
|
$90.00 |
$90.00 |
$90.00 |
$178.07
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$120.00 |
$120.00 |
$120.00 |
$218.40
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$412.86 |
$412.86 |
$412.86 |
$173.98
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$135.00 |
$135.00 |
$135.00 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$149.90 |
$149.90 |
$149.90 |
$26.40
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$171.00 |
$171.00 |
$171.00 |
$40.01
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$654.00 |
$654.00 |
$654.00 |
$349.15
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$821.25 |
$821.25 |
$821.25 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$95.00 |
$95.00 |
$95.00 |
$224.04
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$800.72 |
$800.72 |
$800.72 |
$385.45
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$112.80 |
$112.80 |
$112.80 |
$715.41
|
|
Vaccine rabies im
|
$1,353.48 |
$1,353.48 |
$1,353.48 |
$945.46
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$5,943.75 |
$5,943.75 |
$5,943.75 |
$108.00
|
|
Vaccine tdap >=7 years im
|
$341.69 |
$341.69 |
$341.69 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$181.20 |
$181.20 |
$181.20 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$95.00 |
$95.00 |
$95.00 |
$447.80
|
|
Valproic acid total therapeutic drug level
|
$963.38 |
$963.38 |
$963.38 |
$115.00
|
|
Vancomycin peak therapeutic drug level
|
$994.13 |
$994.13 |
$994.13 |
$126.79
|
|
Varicella-zoster immue globin im
|
$1,762.50 |
$1,762.50 |
$1,762.50 |
$2,372.84
|
|
Vasopressin 20 unit/ml intravenous solution
|
$378.38 |
$378.38 |
$378.38 |
$394.13
|
|
Vedolizumab 300 mg intravenous solution
|
$35,613.75 |
$35,613.75 |
$35,613.75 |
$23,003.79
|
|
Vein x-ray liver
|
$16,027.51 |
$16,027.51 |
$16,027.51 |
$3,320.80
|
|
Vein x-ray liver w/hemodynam
|
$5,809.55 |
$5,809.55 |
$5,809.55 |
$3,439.84
|
|
Vein x-ray liver without hemodyn
|
$11,723.05 |
$11,723.05 |
$11,723.05 |
$2,489.25
|
|
Vein x-ray skull epidural
|
$1,847.69 |
$1,847.69 |
$1,847.69 |
$1,344.60
|
|
Venous sampling s&i
|
$5,199.02 |
$5,199.02 |
$5,199.02 |
$4,416.78
|
|
Ven thrombosis images bilat
|
$5,558.74 |
$5,558.74 |
$5,558.74 |
$779.56
|
|
Ventilator each subsequent day
|
$7,062.81 |
$7,062.81 |
$7,062.81 |
$1,305.92
|
