|
Thyroid (TSH) Test
|
$571.97 |
$571.97 |
$571.97 |
$120.00
|
|
Thyroid Ultrasound
|
$2,536.78 |
$2,536.78 |
$2,536.78 |
$589.96
|
|
Thyroxine binding globulin (tbg)
|
$46.56 |
$46.56 |
$46.56 |
$63.60
|
|
Tib/per revasc w/ather add-on 37233
|
$28,061.22 |
$28,061.22 |
$28,061.22 |
$10,406.14
|
|
Tissue exam koh skin/hair/nails
|
$114.05 |
$114.05 |
$114.05 |
$47.40
|
|
Tissue transglutaminase iga
|
$53.39 |
$53.39 |
$53.39 |
$48.57
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$267.90 |
$267.90 |
$267.90 |
$125.87
|
|
Tobramycin peak therapeutic drug level
|
$317.15 |
$317.15 |
$317.15 |
$121.55
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$19,389.40 |
$19,389.40 |
$19,389.40 |
$5,790.85
|
|
Tomosynthesis breast screen bilateral
|
$316.07 |
$316.07 |
$316.07 |
$73.45
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$343.05 |
$343.05 |
$343.05 |
$303.88
|
|
Toxoplasma antibody igg
|
$49.98 |
$49.98 |
$49.98 |
$84.35
|
|
Toxoplasma antibody igm
|
$50.04 |
$50.04 |
$50.04 |
$83.20
|
|
Tpmt gene com vrnts
|
$1,828.30 |
$1,828.30 |
$1,828.30 |
$381.55
|
|
Transferrin
|
$95.49 |
$95.49 |
$95.49 |
$87.30
|
|
Transfusion blood/blood component(s)
|
$3,375.26 |
$3,375.26 |
$3,375.26 |
$988.24
|
|
Treat finger fracture each
|
$4,940.21 |
$4,940.21 |
$4,940.21 |
$1,815.75
|
|
Treat foot dislocation
|
$731.04 |
$731.04 |
$731.04 |
$527.28
|
|
Treat fracture of radius
|
$4,940.21 |
$4,940.21 |
$4,940.21 |
$2,030.33
|
|
Treat fracture of radius
|
$4,940.21 |
$4,940.21 |
$4,940.21 |
$2,316.75
|
|
Treat fracture of ulna
|
$731.04 |
$731.04 |
$731.04 |
$766.72
|
|
Treat knuckle dislocation
|
$4,940.21 |
$4,940.21 |
$4,940.21 |
$1,893.86
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$904.43 |
$904.43 |
$904.43 |
$241.15
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$919.85 |
$919.85 |
$919.85 |
$210.00
|
|
Treatment of ankle fracture 27786
|
$731.04 |
$731.04 |
$731.04 |
$580.00
|
|
Treatment of heel fracture 28400
|
$731.04 |
$731.04 |
$731.04 |
$494.00
|
|
Treatment radiation delivery level 2
|
$1,143.12 |
$1,143.12 |
$1,143.12 |
$735.00
|
|
Treat toe dislocation
|
$855.66 |
$855.66 |
$855.66 |
$855.66
|
|
Treat vaginal bleeding
|
$578.71 |
$578.71 |
$578.71 |
$400.86
|
|
Treat wrist bone fracture
|
$4,940.21 |
$4,940.21 |
$4,940.21 |
$1,907.64
|
|
Treat wrist dislocation
|
$731.04 |
$731.04 |
$731.04 |
$760.00
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$404,153.26 |
$404,153.26 |
$404,153.26 |
$120,541.18
|
|
Treponema pallidum antibody
|
$153.44 |
$153.44 |
$153.44 |
$72.80
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$634.69 |
$634.69 |
$634.69 |
$48.22
|
|
Triglycerides
|
$429.25 |
$429.25 |
$429.25 |
$54.60
|
|
Trimethobenzamide hcl inj
|
$1,725.10 |
$1,725.10 |
$1,725.10 |
$154.09
|
|
Trim nondyst nails
|
$264.01 |
$264.01 |
$264.01 |
$124.22
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$36,988.75 |
$36,988.75 |
$36,988.75 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$37,815.52 |
$37,815.52 |
$37,815.52 |
$15,408.00
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$12,681.09 |
$12,681.09 |
$12,681.09 |
$6,156.00
|
|
Troponin quantitative
|
$402.26 |
$402.26 |
$402.26 |
$123.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$7,169.61 |
$7,169.61 |
$7,169.61 |
$403.26
|
|
Ultrasound breast complete
|
$1,638.34 |
$1,638.34 |
$1,638.34 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$1,638.34 |
$1,638.34 |
$1,638.34 |
$449.35
|
|
Ultrasound chest
|
$2,318.41 |
$2,318.41 |
$2,318.41 |
$459.55
|
|
Ultrasound encephalogram
|
$2,559.22 |
$2,559.22 |
$2,559.22 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$768.21 |
$768.21 |
$768.21 |
$570.44
|
|
Ultrasound guidance for vascular access
|
$756.61 |
$756.61 |
$756.61 |
$340.22
|
|
Ultrasound joint complete left
|
$2,536.78 |
$2,536.78 |
$2,536.78 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$1,268.36 |
$1,268.36 |
$1,268.36 |
$448.50
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$2,028.11 |
$2,028.11 |
$2,028.11 |
$326.54
|
|
Ultrasound pregnant uterus follow up per fetus
|
$1,587.24 |
$1,587.24 |
$1,587.24 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$2,536.78 |
$2,536.78 |
$2,536.78 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$372.19 |
$372.19 |
$372.19 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$3,511.87 |
$3,511.87 |
$3,511.87 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$2,536.78 |
$2,536.78 |
$2,536.78 |
$498.00
|
|
Ultrasound scrotum and contents
|
$2,733.97 |
$2,733.97 |
$2,733.97 |
$617.28
|
|
Ultrasound transvaginal non obstetric
|
$2,733.97 |
$2,733.97 |
$2,733.97 |
$567.44
|
|
Unlisted transfusion med px
|
$164.36 |
$164.36 |
$164.36 |
$141.35
|
|
Unsched dialysis esrd pt hos
|
$3,365.73 |
$3,365.73 |
$3,365.73 |
$1,505.29
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$18,799.04 |
$18,799.04 |
$18,799.04 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$8,008.68 |
$8,008.68 |
$8,008.68 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$14,823.93 |
$14,823.93 |
$14,823.93 |
$2,013.08
|
|
Urea nitrogen
|
$326.62 |
$326.62 |
$326.62 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$259.08 |
$259.08 |
$259.08 |
$50.00
|
|
Uric acid blood
|
$238.76 |
$238.76 |
$238.76 |
$46.64
|
|
Uric acid urine
|
$16.00 |
$16.00 |
$16.00 |
$46.75
|
|
Urinalysis (with microscopy)
|
$278.50 |
$278.50 |
$278.50 |
$48.14
|
|
Urinalysis (without microscopy)
|
$278.50 |
$278.50 |
$278.50 |
$38.99
|
|
Urine Culture Test
|
$675.31 |
$675.31 |
$675.31 |
$84.81
|
|
Urography, antegrade
|
$1,306.11 |
$1,306.11 |
$1,306.11 |
$593.37
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$192,577.02 |
$192,577.02 |
$192,577.02 |
$6,892.54
|
|
Vaccine hepatitis a (hepa) adult im
|
$1,175.11 |
$1,175.11 |
$1,175.11 |
$178.07
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$3,402.84 |
$3,402.84 |
$3,402.84 |
$218.40
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$1,738.14 |
$1,738.14 |
$1,738.14 |
$173.98
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$6,538.03 |
$6,538.03 |
$6,538.03 |
$686.67
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$2,361.70 |
$2,361.70 |
$2,361.70 |
$157.41
|
|
Vaccine influenza inactivated adjuvant im
|
$1,040.17 |
$1,040.17 |
$1,040.17 |
$110.25
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$681.07 |
$681.07 |
$681.07 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$573.17 |
$573.17 |
$573.17 |
$42.90
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$1,147.67 |
$1,147.67 |
$1,147.67 |
$103.88
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$3,708.74 |
$3,708.74 |
$3,708.74 |
$499.00
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$3,579.16 |
$3,579.16 |
$3,579.16 |
$408.70
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$2,515.85 |
$2,515.85 |
$2,515.85 |
$274.95
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$5,243.81 |
$5,243.81 |
$5,243.81 |
$715.41
|
|
Vaccine tdap >=7 years im
|
$1,634.06 |
$1,634.06 |
$1,634.06 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$1,342.97 |
$1,342.97 |
$1,342.97 |
$131.77
|
|
Valproic acid total therapeutic drug level
|
$292.36 |
$292.36 |
$292.36 |
$115.00
|
|
Vancomycin hcl injection
|
$1,406.17 |
$1,406.17 |
$1,406.17 |
$83.79
|
|
Vancomycin peak therapeutic drug level
|
$968.61 |
$968.61 |
$968.61 |
$126.79
|
|
Varicella zoster antibody igg
|
$40.57 |
$40.57 |
$40.57 |
$82.55
|
|
Vasopressin 20 unit/ml intravenous solution
|
$1,717.95 |
$1,717.95 |
$1,717.95 |
$394.13
|
|
Veeg unmon 12-26 hrs
|
$3,531.51 |
$3,531.51 |
$3,531.51 |
$1,411.20
|
|
Venogram ext bil s&i
|
$6,544.92 |
$6,544.92 |
$6,544.92 |
$1,838.28
|
|
Venogram extremity supervision & interpretation unilateral
|
$4,555.95 |
$4,555.95 |
$4,555.95 |
$1,326.00
|
|
Venous mech thrombectomy
|
$19,794.56 |
$19,794.56 |
$19,794.56 |
$8,869.50
|
|
Ventilator each subsequent day
|
$3,927.41 |
$3,927.41 |
$3,927.41 |
$1,305.92
|
|
Ventilator initial day
|
$3,927.41 |
$3,927.41 |
$3,927.41 |
$1,540.80
|
|
Vinblastine 1 mg/ml intravenous solution
|
$1,350.56 |
$1,350.56 |
$1,350.56 |
$186.71
|
|
Vincristine 1 mg/ml intravenous solution
|
$407.50 |
$407.50 |
$407.50 |
$104.79
|