|
Susceptibility agar dilution per agent
|
$13.16 |
$13.16 |
$13.16 |
$40.30
|
|
Svc venogram s&i
|
$8,682.07 |
$8,682.07 |
$8,682.07 |
$1,908.00
|
|
Tc-99m disofenin
|
$661.00 |
$661.00 |
$661.00 |
$151.32
|
|
Tc-99m exame autol wbc diag per dose
|
$5,887.26 |
$5,887.26 |
$5,887.26 |
$2,393.40
|
|
Tc-99m exametazime diag
|
$5,887.26 |
$5,887.26 |
$5,887.26 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$1,407.25 |
$1,407.25 |
$1,407.25 |
$323.01
|
|
Tc-99m maa
|
$546.10 |
$546.10 |
$546.10 |
$312.06
|
|
Tc-99m mebrofenin
|
$661.00 |
$661.00 |
$661.00 |
$169.53
|
|
Tc-99m medronate
|
$289.11 |
$289.11 |
$289.11 |
$122.46
|
|
Tc-99m mertiatide
|
$1,229.34 |
$1,229.34 |
$1,229.34 |
$757.25
|
|
Tc-99m pentetate dtpa
|
$699.30 |
$699.30 |
$699.30 |
$245.85
|
|
Tc-99m pertechnetate per mci
|
$326.17 |
$326.17 |
$326.17 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$370.66 |
$370.66 |
$370.66 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$1,219.46 |
$1,219.46 |
$1,219.46 |
$221.60
|
|
Tc-99m sulfur colloid
|
$880.92 |
$880.92 |
$880.92 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$651.12 |
$651.12 |
$651.12 |
$198.05
|
|
T cells absolute cd 4 count
|
$67.61 |
$67.61 |
$67.61 |
$120.25
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$259.09 |
$259.09 |
$259.09 |
$44.49
|
|
Testicular imaging w/vasc flow
|
$4,224.24 |
$4,224.24 |
$4,224.24 |
$780.48
|
|
Tetanus immune globulin inj
|
$4,038.46 |
$4,038.46 |
$4,038.46 |
$1,395.20
|
|
Theophylline therapeutic drug level
|
$3,460.20 |
$3,460.20 |
$3,460.20 |
$108.00
|
|
Therapeutic procd strg endur
|
$181.10 |
$181.10 |
$181.10 |
$81.36
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$50.72 |
$50.72 |
$50.72 |
$38.64
|
|
Thyroid imaging
|
$3,219.77 |
$3,219.77 |
$3,219.77 |
$670.80
|
|
Thyroid mets imag whole body
|
$7,862.84 |
$7,862.84 |
$7,862.84 |
$1,524.99
|
|
Thyroid met uptake
|
$1,630.88 |
$1,630.88 |
$1,630.88 |
$380.00
|
|
Thyroid Ultrasound
|
$2,724.56 |
$2,724.56 |
$2,724.56 |
$589.96
|
|
Thyroid uptake measurement
|
$1,630.88 |
$1,630.88 |
$1,630.88 |
$653.60
|
|
Tigecycline injection
|
$734.27 |
$734.27 |
$734.27 |
$308.75
|
|
Tilt table study
|
$8,792.62 |
$8,792.62 |
$8,792.62 |
$1,495.00
|
|
Tissue culture skin/biopsy
|
$510.30 |
$510.30 |
$510.30 |
$558.87
|
|
Tissue culture tumor
|
$652.08 |
$652.08 |
$652.08 |
$529.23
|
|
Tl-201 thallium diag per mci
|
$122.32 |
$122.32 |
$122.32 |
$77.22
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$48.51 |
$48.51 |
$48.51 |
$125.87
|
|
Tobramycin non-comp unit
|
$55.82 |
$55.82 |
$55.82 |
$107.07
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$11,975.36 |
$11,975.36 |
$11,975.36 |
$303.88
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$19.50 |
$19.50 |
$19.50 |
$82.60
|
|
Trastuzumab 150 mg intravenous solution
|
$1,015.40 |
$1,015.40 |
$1,015.40 |
$3,401.26
|
|
Treponema pallidum antibody
|
$9.72 |
$9.72 |
$9.72 |
$72.80
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$169.79 |
$169.79 |
$169.79 |
$48.22
|
|
Troponin quantitative
|
$3,696.89 |
$3,696.89 |
$3,696.89 |
$123.75
|
|
Tube drain vert dev st 5-40f
|
$297.64 |
$297.64 |
$297.64 |
$72.21
|
|
Tx atrial fib pulm vein isol
|
$132,343.49 |
$132,343.49 |
$132,343.49 |
$32,426.20
|
|
Tx l/r atrial fib addl
|
$35,503.70 |
$35,503.70 |
$35,503.70 |
$7,717.80
|
|
Ultrasound abdomen aorta screening study aaa
|
$3,775.20 |
$3,775.20 |
$3,775.20 |
$403.26
|
|
Ultrasound breast complete
|
$3,098.49 |
$3,098.49 |
$3,098.49 |
$519.75
|
|
Ultrasound chest
|
$3,159.28 |
$3,159.28 |
$3,159.28 |
$459.55
|
|
Ultrasound guided needle placement supervision & interpretation
|
$5,071.23 |
$5,071.23 |
$5,071.23 |
$701.35
|
|
Ultrasound guide tissue ablation
|
$2,642.64 |
$2,642.64 |
$2,642.64 |
$498.40
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$1,416.45 |
$1,416.45 |
$1,416.45 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$1,701.87 |
$1,701.87 |
$1,701.87 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$1,701.87 |
$1,701.87 |
$1,701.87 |
$545.16
|
|
Ultrasound scrotum and contents
|
$2,682.28 |
$2,682.28 |
$2,682.28 |
$617.28
|
|
Ultrasound transvaginal non obstetric
|
$1,701.87 |
$1,701.87 |
$1,701.87 |
$567.44
|
|
Unlisted dx gi procedure
|
$1,399.74 |
$1,399.74 |
$1,399.74 |
$482.90
|
|
Unlisted mr procedure
|
$6,162.30 |
$6,162.30 |
$6,162.30 |
$1,032.20
|
|
Unlisted ultrasound procedure
|
$1,026.66 |
$1,026.66 |
$1,026.66 |
$321.20
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$11,268.40 |
$11,268.40 |
$11,268.40 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$8,982.81 |
$8,982.81 |
$8,982.81 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$8,195.08 |
$8,195.08 |
$8,195.08 |
$2,013.08
|
|
Urethrocystography void s&i
|
$4,645.32 |
$4,645.32 |
$4,645.32 |
$634.50
|
|
Uric acid blood
|
$2,214.76 |
$2,214.76 |
$2,214.76 |
$46.64
|
|
Urinalysis (without microscopy)
|
$986.23 |
$986.23 |
$986.23 |
$38.99
|
|
Urine Culture Test
|
$424.56 |
$424.56 |
$424.56 |
$84.81
|
|
Urography, antegrade
|
$3,714.78 |
$3,714.78 |
$3,714.78 |
$593.37
|
|
Vaccine dtap < 7 years im
|
$154.55 |
$154.55 |
$154.55 |
$87.80
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$209.34 |
$209.34 |
$209.34 |
$85.00
|
|
Vaccine hepatitis a (hepa) adult im
|
$80.00 |
$80.00 |
$80.00 |
$178.07
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$242.95 |
$242.95 |
$242.95 |
$61.50
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$242.95 |
$242.95 |
$242.95 |
$173.98
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$189.74 |
$189.74 |
$189.74 |
$26.40
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$115.32 |
$115.32 |
$115.32 |
$40.01
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$533.60 |
$533.60 |
$533.60 |
$426.80
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$371.69 |
$371.69 |
$371.69 |
$349.15
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$1,829.05 |
$1,829.05 |
$1,829.05 |
$397.18
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$728.78 |
$728.78 |
$728.78 |
$385.45
|
|
Vaccine polio (ipv) subcutaneous/im
|
$186.77 |
$186.77 |
$186.77 |
$119.17
|
|
Vaccine rabies im
|
$1,797.21 |
$1,797.21 |
$1,797.21 |
$945.46
|
|
Vaccine tdap >=7 years im
|
$525.89 |
$525.89 |
$525.89 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$281.14 |
$281.14 |
$281.14 |
$131.77
|
|
Valproic acid total therapeutic drug level
|
$4,692.49 |
$4,692.49 |
$4,692.49 |
$115.00
|
|
Vasopressin 20 unit/ml intravenous solution
|
$394.13 |
$394.13 |
$394.13 |
$394.13
|
|
Venogram ext bil s&i
|
$13,262.24 |
$13,262.24 |
$13,262.24 |
$1,838.28
|
|
Venous sampling s&i
|
$6,938.21 |
$6,938.21 |
$6,938.21 |
$4,416.78
|
|
Ventilator each subsequent day
|
$9,260.15 |
$9,260.15 |
$9,260.15 |
$1,305.92
|
|
Ventilator initial day
|
$9,260.15 |
$9,260.15 |
$9,260.15 |
$1,540.80
|
|
Vinblastine 1 mg/ml intravenous solution
|
$47.71 |
$47.71 |
$47.71 |
$186.71
|
|
Vincristine 1 mg/ml intravenous solution
|
$136.71 |
$136.71 |
$136.71 |
$104.79
|
|
Vital capacity test
|
$536.03 |
$536.03 |
$536.03 |
$173.33
|
|
Volume measurement urine timed
|
$614.27 |
$614.27 |
$614.27 |
$21.45
|
|
Warde 1003990 aldosterone
|
$4.86 |
$4.86 |
$4.86 |
$145.60
|
|
Warde 1005055 5-hiaa 24 hour urine
|
$10.80 |
$10.80 |
$10.80 |
$72.50
|
|
Warde 1007138 vanillymandelic acid 24 hour urine
|
$7.56 |
$7.56 |
$7.56 |
$69.55
|
|
Warde 3004000 immunoglobulin subclass 1
|
$4.75 |
$4.75 |
$4.75 |
$40.70
|
|
Warde 3400852 arsenic
|
$36.72 |
$36.72 |
$36.72 |
$105.12
|
|
Warde 3708165 mercury urine
|
$36.72 |
$36.72 |
$36.72 |
$72.80
|
|
Warde actin (smooth muscle) antibody each
|
$7.02 |
$7.02 |
$7.02 |
$45.58
|
|
Warde adrenocorticotropic hormone (acth)
|
$6.21 |
$6.21 |
$6.21 |
$129.75
|
|
Warde aldolase
|
$2.16 |
$2.16 |
$2.16 |
$49.20
|
|
Warde amiodarone therapeutic drug level
|
$10.80 |
$10.80 |
$10.80 |
$53.95
|
