|
Surgical pathology level 1 gross examination only
|
$405.96 |
$405.96 |
$405.96 |
$92.59
|
|
Surgical pathology level 2 gross & microscopic examination
|
$1,732.96 |
$1,732.96 |
$1,732.96 |
$149.76
|
|
Surgical pathology level 3 gross & microscopic examination
|
$2,053.73 |
$2,053.73 |
$2,053.73 |
$192.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$67.05 |
$67.05 |
$67.05 |
$253.75
|
|
Surgical pathology level 5 gross & microscopic examination
|
$2,595.45 |
$2,595.45 |
$2,595.45 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$2,881.62 |
$2,881.62 |
$2,881.62 |
$790.00
|
|
Svc venogram s&i
|
$10,389.06 |
$10,389.06 |
$10,389.06 |
$1,908.00
|
|
Syphilis test non-treponemal antibody quantitative rpr
|
$684.13 |
$684.13 |
$684.13 |
$44.85
|
|
T3 (triiodothyronine) free
|
$1,112.72 |
$1,112.72 |
$1,112.72 |
$89.82
|
|
T3 (triiodothyronine) total
|
$451.21 |
$451.21 |
$451.21 |
$94.90
|
|
T4 (thyroxine) free
|
$821.23 |
$821.23 |
$821.23 |
$81.60
|
|
T4 (thyroxine) total
|
$451.21 |
$451.21 |
$451.21 |
$73.64
|
|
Tacrolimus therapeutic drug level
|
$250.11 |
$250.11 |
$250.11 |
$122.40
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$62.70 |
$62.70 |
$62.70 |
$166.46
|
|
Tc-99m arcitumomab
|
$25,420.77 |
$25,420.77 |
$25,420.77 |
$2,159.40
|
|
Tc-99m exame autol wbc diag per dose
|
$26,566.76 |
$26,566.76 |
$26,566.76 |
$2,393.40
|
|
Tc-99m labeled rbc
|
$1,719.65 |
$1,719.65 |
$1,719.65 |
$323.01
|
|
Tc-99m maa
|
$2,823.05 |
$2,823.05 |
$2,823.05 |
$312.06
|
|
Tc-99m mebrofenin
|
$238.25 |
$238.25 |
$238.25 |
$169.53
|
|
Tc-99m medronate
|
$355.38 |
$355.38 |
$355.38 |
$122.46
|
|
Tc-99m pentetate dtpa
|
$613.59 |
$613.59 |
$613.59 |
$245.85
|
|
Tc-99m pentetate dtpa aerosol
|
$613.59 |
$613.59 |
$613.59 |
$244.02
|
|
Tc-99m pertechnetate per mci
|
$130.44 |
$130.44 |
$130.44 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$1,060.81 |
$1,060.81 |
$1,060.81 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$3,669.57 |
$3,669.57 |
$3,669.57 |
$221.60
|
|
Tc-99m succimer (dmsa)
|
$889.11 |
$889.11 |
$889.11 |
$1,578.33
|
|
Tc-99m sulfur colloid
|
$907.74 |
$907.74 |
$907.74 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$758.67 |
$758.67 |
$758.67 |
$198.05
|
|
T cells total count
|
$19.11 |
$19.11 |
$19.11 |
$124.11
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$65.00 |
$65.00 |
$65.00 |
$44.49
|
|
Testicular imaging w/vasc flow
|
$5,656.75 |
$5,656.75 |
$5,656.75 |
$780.48
|
|
Test stress cardiovascular tracing only
|
$3,334.16 |
$3,334.16 |
$3,334.16 |
$1,001.55
|
|
Tetanus immune globulin inj
|
$1,289.00 |
$1,289.00 |
$1,289.00 |
$1,395.20
|
|
Theophylline therapeutic drug level
|
$943.68 |
$943.68 |
$943.68 |
$108.00
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$276.68 |
$276.68 |
$276.68 |
$55.00
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$132.35 |
$132.35 |
$132.35 |
$50.40
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$85.00 |
$85.00 |
$85.00 |
$38.64
|
|
Thrombin time
|
$107.81 |
$107.81 |
$107.81 |
$48.75
|
|
Thyroglobulin antibody
|
$52.61 |
$52.61 |
$52.61 |
$84.00
|
|
Thyroid (TSH) Test
|
$1,747.60 |
$1,747.60 |
$1,747.60 |
$120.00
|
|
Tigecycline injection
|
$1,004.00 |
$1,004.00 |
$1,004.00 |
$308.75
|
|
Tilt table study
|
$4,607.92 |
$4,607.92 |
$4,607.92 |
$1,495.00
|
|
Tl-201 thallium diag per mci
|
$198.32 |
$198.32 |
$198.32 |
$77.22
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$27.00 |
$27.00 |
$27.00 |
$125.87
|
|
Tobramycin non-comp unit
|
$835.00 |
$835.00 |
$835.00 |
$107.07
|
|
Tomosynthesis breast diagnostic left
|
$91.84 |
$91.84 |
$91.84 |
$63.70
|
|
Tomosynthesis breast screen bilateral
|
$91.84 |
$91.84 |
$91.84 |
$73.45
|
|
Toxoplasma antibody igm
|
$7.57 |
$7.57 |
$7.57 |
$83.20
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$330.85 |
$330.85 |
$330.85 |
$93.75
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$1,684.40 |
$1,684.40 |
$1,684.40 |
$82.60
|
|
Transcatheter bx s&i
|
$21,446.36 |
$21,446.36 |
$21,446.36 |
$1,875.96
|
|
Transferrin
|
$83.37 |
$83.37 |
$83.37 |
$87.30
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$1,396.22 |
$1,396.22 |
$1,396.22 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$1,051.49 |
$1,051.49 |
$1,051.49 |
$149.00
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$179.00 |
$179.00 |
$179.00 |
$48.22
|
|
Trichinella antibody
|
$320.65 |
$320.65 |
$320.65 |
$70.65
|
|
Troponin quantitative
|
$1,703.68 |
$1,703.68 |
$1,703.68 |
$123.75
|
|
Tx atrial fib pulm vein isol
|
$134,916.82 |
$134,916.82 |
$134,916.82 |
$32,426.20
|
|
Tx l/r atrial fib addl
|
$33,728.87 |
$33,728.87 |
$33,728.87 |
$7,717.80
|
|
Ua w/micro/comp poc
|
$15.23 |
$15.23 |
$15.23 |
$24.45
|
|
Ultrasound guided needle placement supervision & interpretation
|
$8,116.44 |
$8,116.44 |
$8,116.44 |
$701.35
|
|
Ultrasound guide intraoperative
|
$2,974.79 |
$2,974.79 |
$2,974.79 |
$632.90
|
|
Ultrasound guide tissue ablation
|
$1,634.47 |
$1,634.47 |
$1,634.47 |
$498.40
|
|
Urea nitrogen
|
$995.59 |
$995.59 |
$995.59 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$182.35 |
$182.35 |
$182.35 |
$50.00
|
|
Urethrcystgrphy rtrgrde s&i
|
$7,083.80 |
$7,083.80 |
$7,083.80 |
$574.40
|
|
Urethrocystography void s&i
|
$3,184.70 |
$3,184.70 |
$3,184.70 |
$634.50
|
|
Uric acid blood
|
$1,300.39 |
$1,300.39 |
$1,300.39 |
$46.64
|
|
Urinalysis (with microscopy)
|
$2,145.57 |
$2,145.57 |
$2,145.57 |
$48.14
|
|
Urinalysis (without microscopy)
|
$389.98 |
$389.98 |
$389.98 |
$38.99
|
|
Urine pregnancy test
|
$910.40 |
$910.40 |
$910.40 |
$66.40
|
|
Urography, antegrade
|
$2,684.48 |
$2,684.48 |
$2,684.48 |
$593.37
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$891.00 |
$891.00 |
$891.00 |
$84.38
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$179.00 |
$179.00 |
$179.00 |
$79.04
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$124.45 |
$124.45 |
$124.45 |
$40.01
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$150.00 |
$150.00 |
$150.00 |
$103.88
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$2,009.00 |
$2,009.00 |
$2,009.00 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$289.00 |
$289.00 |
$289.00 |
$224.04
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$1,013.00 |
$1,013.00 |
$1,013.00 |
$397.18
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$526.86 |
$526.86 |
$526.86 |
$385.45
|
|
Vaccine rabies im
|
$2,074.00 |
$2,074.00 |
$2,074.00 |
$945.46
|
|
Vaccine tdap >=7 years im
|
$332.00 |
$332.00 |
$332.00 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$270.00 |
$270.00 |
$270.00 |
$131.77
|
|
Valproic acid total therapeutic drug level
|
$1,196.57 |
$1,196.57 |
$1,196.57 |
$115.00
|
|
Vein x-ray liver w/hemodynam
|
$46,982.93 |
$46,982.93 |
$46,982.93 |
$3,413.25
|
|
Venous sampling s&i
|
$36,588.73 |
$36,588.73 |
$36,588.73 |
$4,416.78
|
|
Vinblastine 1 mg/ml intravenous solution
|
$43.00 |
$43.00 |
$43.00 |
$186.71
|
|
Vital capacity test
|
$255.55 |
$255.55 |
$255.55 |
$173.33
|
|
Vitamin b-12
|
$1,196.57 |
$1,196.57 |
$1,196.57 |
$94.90
|
|
Vitamin D Test
|
$7.95 |
$7.95 |
$7.95 |
$132.00
|
|
Volume measurement urine timed
|
$223.61 |
$223.61 |
$223.61 |
$21.45
|
|
Warde 1005020 citrate 24 hour urine
|
$6.59 |
$6.59 |
$6.59 |
$97.61
|
|
Warde 1005055 5-hiaa 24 hour urine
|
$10.45 |
$10.45 |
$10.45 |
$72.50
|
|
Warde 1007138 vanillymandelic acid 24 hour urine
|
$7.31 |
$7.31 |
$7.31 |
$69.55
|
|
Warde 3008005 oligoclonal bands
|
$404.03 |
$404.03 |
$404.03 |
$102.60
|
|
Warde 3400652 ova & parasites direct smear concentration and id
|
$818.57 |
$818.57 |
$818.57 |
$63.05
|
|
Warde 3708165 mercury urine
|
$19.85 |
$19.85 |
$19.85 |
$72.80
|
|
Warde actin (smooth muscle) antibody each
|
$121.85 |
$121.85 |
$121.85 |
$45.58
|
|
Warde adrenocorticotropic hormone (acth)
|
$13.59 |
$13.59 |
$13.59 |
$129.75
|
|
Warde aldolase
|
$2.35 |
$2.35 |
$2.35 |
$49.20
|
