|
St treatment speech individual
|
$1,028.00 |
$1,028.00 |
$1,028.00 |
$256.55
|
|
St treatment swallow dysfunction/oral
|
$1,028.00 |
$1,028.00 |
$1,028.00 |
$260.00
|
|
Succinylcholine chloride 20 mg/ml injection solution (wrapper)
|
$11.00 |
$11.00 |
$11.00 |
$49.13
|
|
Sugars single quant
|
$38.00 |
$38.00 |
$38.00 |
$52.47
|
|
Sulfonylurea screen qn-sendout
|
$172.00 |
$172.00 |
$172.00 |
$172.00
|
|
Surgical pathology level 1 gross examination only
|
$368.00 |
$368.00 |
$368.00 |
$92.95
|
|
Surgical pathology level 2 gross & microscopic examination
|
$834.00 |
$834.00 |
$834.00 |
$150.40
|
|
Surgical pathology level 3 gross & microscopic examination
|
$1,161.00 |
$1,161.00 |
$1,161.00 |
$195.06
|
|
Surgical pathology level 4 gross & microscopic examination
|
$1,393.00 |
$1,393.00 |
$1,393.00 |
$254.94
|
|
Surgical pathology level 5 gross & microscopic examination
|
$1,662.00 |
$1,662.00 |
$1,662.00 |
$494.40
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,939.00 |
$1,939.00 |
$1,939.00 |
$791.85
|
|
Tacrolimus therapeutic drug level
|
$278.00 |
$278.00 |
$278.00 |
$122.50
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$220.00 |
$220.00 |
$220.00 |
$166.46
|
|
Tc-99m arcitumomab
|
$16,413.00 |
$16,413.00 |
$16,413.00 |
$2,159.40
|
|
Tc-99m exame autol wbc diag per dose
|
$7,453.00 |
$7,453.00 |
$7,453.00 |
$2,393.40
|
|
Tc-99m exametazime diag
|
$22,424.00 |
$22,424.00 |
$22,424.00 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$1,444.00 |
$1,444.00 |
$1,444.00 |
$323.01
|
|
Tc-99m maa
|
$8,356.00 |
$8,356.00 |
$8,356.00 |
$312.06
|
|
Tc-99m mebrofenin
|
$470.00 |
$470.00 |
$470.00 |
$169.53
|
|
Tc-99m medronate
|
$207.00 |
$207.00 |
$207.00 |
$122.46
|
|
Tc-99m mertiatide
|
$4,683.00 |
$4,683.00 |
$4,683.00 |
$757.25
|
|
Tc-99m pentetate dtpa
|
$578.00 |
$578.00 |
$578.00 |
$240.46
|
|
Tc-99m pentetate dtpa aerosol
|
$544.00 |
$544.00 |
$544.00 |
$244.02
|
|
Tc-99m pertechnetate per mci
|
$81.00 |
$81.00 |
$81.00 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$232.00 |
$232.00 |
$232.00 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$1,367.00 |
$1,367.00 |
$1,367.00 |
$221.60
|
|
Tc-99m sulfur colloid
|
$2,115.00 |
$2,115.00 |
$2,115.00 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$194.00 |
$194.00 |
$194.00 |
$198.05
|
|
T cells absolute cd4/cd8 including ratio
|
$427.00 |
$427.00 |
$427.00 |
$185.28
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$128.00 |
$128.00 |
$128.00 |
$44.76
|
|
Test for chlorohydrocarbons
|
$162.00 |
$162.00 |
$162.00 |
$71.04
|
|
Testicular imaging w/vasc flow
|
$4,660.00 |
$4,660.00 |
$4,660.00 |
$765.60
|
|
Tetanus immune globulin inj
|
$4,718.00 |
$4,718.00 |
$4,718.00 |
$1,395.20
|
|
Theophylline therapeutic drug level
|
$775.00 |
$775.00 |
$775.00 |
$108.00
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$161.00 |
$161.00 |
$161.00 |
$55.00
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$161.00 |
$161.00 |
$161.00 |
$50.40
|
|
Ther/proph/diag inj ia
|
$1,221.00 |
$1,221.00 |
$1,221.00 |
$247.33
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$50.00 |
$50.00 |
$50.00 |
$37.12
|
|
Thyroid imaging
|
$3,454.00 |
$3,454.00 |
$3,454.00 |
$662.20
|
|
Thyroid mets imag whole body
|
$3,923.00 |
$3,923.00 |
$3,923.00 |
$1,524.99
|
|
Thyroid uptake measurement
|
$1,049.00 |
$1,049.00 |
$1,049.00 |
$619.20
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$25,911.00 |
$25,911.00 |
$25,911.00 |
$4,852.41
|
|
Thyroxine binding globulin (tbg)
|
$254.00 |
$254.00 |
$254.00 |
$63.05
|
|
Tissue culture tumor
|
$582.00 |
$582.00 |
$582.00 |
$529.23
|
|
Tl-201 thallium diag per mci
|
$234.00 |
$234.00 |
$234.00 |
$77.22
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$128.00 |
$128.00 |
$128.00 |
$131.70
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$11,291.00 |
$11,291.00 |
$11,291.00 |
$5,790.85
|
|
Tomosynthesis breast diagnostic left
|
$769.00 |
$769.00 |
$769.00 |
$63.00
|
|
Tomosynthesis breast screen bilateral
|
$1,479.00 |
$1,479.00 |
$1,479.00 |
$73.45
|
|
Toxoplasma antibody igg
|
$254.00 |
$254.00 |
$254.00 |
$84.60
|
|
Toxoplasma antibody igm
|
$126.00 |
$126.00 |
$126.00 |
$84.00
|
|
Trabectedin 1 mg intravenous solution
|
$35,935.00 |
$35,935.00 |
$35,935.00 |
$6,133.80
|
|
Transcatheter bx s&i
|
$5,220.00 |
$5,220.00 |
$5,220.00 |
$1,875.96
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$614.00 |
$614.00 |
$614.00 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$310.00 |
$310.00 |
$310.00 |
$150.53
|
|
Trichinella antibody
|
$136.00 |
$136.00 |
$136.00 |
$72.15
|
|
Trimethobenzamide hcl inj
|
$128.00 |
$128.00 |
$128.00 |
$154.09
|
|
Triptorelin pamoate
|
$5,256.00 |
$5,256.00 |
$5,256.00 |
$3,673.28
|
|
Ultrasound encephalogram
|
$1,630.00 |
$1,630.00 |
$1,630.00 |
$479.17
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$667.00 |
$667.00 |
$667.00 |
$477.10
|
|
Ultrasound guide intraoperative
|
$3,391.00 |
$3,391.00 |
$3,391.00 |
$632.90
|
|
Ultrasound infant hips ltd without stress
|
$1,823.00 |
$1,823.00 |
$1,823.00 |
$311.25
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$1,373.00 |
$1,373.00 |
$1,373.00 |
$326.15
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$4,098.00 |
$4,098.00 |
$4,098.00 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$2,534.00 |
$2,534.00 |
$2,534.00 |
$450.75
|
|
Ultrasound pregnant uterus transvaginal
|
$1,823.00 |
$1,823.00 |
$1,823.00 |
$485.16
|
|
Ultrasound spinal canal and contents
|
$2,941.00 |
$2,941.00 |
$2,941.00 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$1,373.00 |
$1,373.00 |
$1,373.00 |
$425.10
|
|
Unlisted CT procedure
|
$5,331.00 |
$5,331.00 |
$5,331.00 |
$1,043.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$12,738.00 |
$12,738.00 |
$12,738.00 |
$2,919.75
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$7,279.00 |
$7,279.00 |
$7,279.00 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$7,279.00 |
$7,279.00 |
$7,279.00 |
$2,013.08
|
|
Urethrocystography void s&i
|
$3,420.00 |
$3,420.00 |
$3,420.00 |
$631.75
|
|
Urinalysis microscopic only
|
$99.00 |
$99.00 |
$99.00 |
$26.46
|
|
Urinary bldr retent nuc study
|
$4,105.00 |
$4,105.00 |
$4,105.00 |
$309.22
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$16,139.00 |
$16,139.00 |
$16,139.00 |
$6,892.54
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$348.00 |
$348.00 |
$348.00 |
$26.40
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$276.00 |
$276.00 |
$276.00 |
$40.01
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$215.00 |
$215.00 |
$215.00 |
$72.00
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$1,637.00 |
$1,637.00 |
$1,637.00 |
$488.44
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$1,638.00 |
$1,638.00 |
$1,638.00 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$806.00 |
$806.00 |
$806.00 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$915.00 |
$915.00 |
$915.00 |
$273.66
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$2,246.00 |
$2,246.00 |
$2,246.00 |
$397.18
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$2,085.00 |
$2,085.00 |
$2,085.00 |
$720.50
|
|
Vaccine rabies im
|
$4,302.00 |
$4,302.00 |
$4,302.00 |
$945.46
|
|
Vaccine td preservative free >= 7 years im
|
$243.00 |
$243.00 |
$243.00 |
$131.77
|
|
Valrubicin injection
|
$14,856.00 |
$14,856.00 |
$14,856.00 |
$2,929.63
|
|
Vasopressin 20 unit/ml intravenous solution
|
$207.00 |
$207.00 |
$207.00 |
$421.05
|
|
Vedolizumab 300 mg intravenous solution
|
$31,145.00 |
$31,145.00 |
$31,145.00 |
$24,950.38
|
|
Vein x-ray adrenal gland
|
$6,484.00 |
$6,484.00 |
$6,484.00 |
$2,489.25
|
|
Vein x-ray adrenal glands
|
$6,552.00 |
$6,552.00 |
$6,552.00 |
$3,999.60
|
|
Vein x-ray liver
|
$9,318.00 |
$9,318.00 |
$9,318.00 |
$3,310.45
|
|
Vein x-ray liver w/hemodynam
|
$5,876.00 |
$5,876.00 |
$5,876.00 |
$3,413.25
|
|
Vein x-ray liver w/hemodynam
|
$8,255.00 |
$8,255.00 |
$8,255.00 |
$3,439.84
|
|
Vein x-ray liver without hemodyn
|
$3,431.00 |
$3,431.00 |
$3,431.00 |
$2,483.00
|
|
Vein x-ray skull
|
$16,916.00 |
$16,916.00 |
$16,916.00 |
$2,284.75
|
|
Venous sampling s&i
|
$4,383.00 |
$4,383.00 |
$4,383.00 |
$4,416.78
|
|
Ven thrombosis images bilat
|
$3,150.00 |
$3,150.00 |
$3,150.00 |
$720.49
|
|
Ventilator each subsequent day
|
$16,856.00 |
$16,856.00 |
$16,856.00 |
$1,305.92
|
