|
Tb test cell mediated immunity antigen response gamma interferon
|
$40.00 |
$40.00 |
$40.00 |
$166.46
|
|
Tc-99m apcitide diag
|
$12,686.16 |
$12,686.16 |
$12,686.16 |
$1,765.30
|
|
Tc-99m exame autol wbc diag per dose
|
$769.71 |
$769.71 |
$769.71 |
$2,393.40
|
|
Tc-99m exametazime diag
|
$17,798.24 |
$17,798.24 |
$17,798.24 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$2,129.12 |
$2,129.12 |
$2,129.12 |
$323.01
|
|
Tc-99m maa
|
$1,115.87 |
$1,115.87 |
$1,115.87 |
$312.06
|
|
Tc-99m mebrofenin
|
$1,264.74 |
$1,264.74 |
$1,264.74 |
$169.53
|
|
Tc-99m medronate
|
$1,086.12 |
$1,086.12 |
$1,086.12 |
$122.46
|
|
Tc-99m mertiatide
|
$2,061.80 |
$2,061.80 |
$2,061.80 |
$757.25
|
|
Tc-99m oxidronate
|
$2,953.65 |
$2,953.65 |
$2,953.65 |
$124.23
|
|
Tc-99m pentetate dtpa
|
$585.52 |
$585.52 |
$585.52 |
$245.85
|
|
Tc-99m pentetate dtpa aerosol
|
$1,033.20 |
$1,033.20 |
$1,033.20 |
$244.02
|
|
Tc-99m pertechnetate per mci
|
$218.78 |
$218.78 |
$218.78 |
$28.08
|
|
Tc-99m sestamibi p study dose
|
$4,567.85 |
$4,567.85 |
$4,567.85 |
$221.60
|
|
Tc-99m sulfur colloid
|
$670.53 |
$670.53 |
$670.53 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$3,277.80 |
$3,277.80 |
$3,277.80 |
$198.05
|
|
T cells absolute cd 4 count
|
$127.85 |
$127.85 |
$127.85 |
$120.25
|
|
T cells total count
|
$48.71 |
$48.71 |
$48.71 |
$124.11
|
|
Telethx isodose plan cplx
|
$609.49 |
$609.49 |
$609.49 |
$1,617.00
|
|
Telethx isodose plan simple
|
$609.49 |
$609.49 |
$609.49 |
$848.72
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$8,708.23 |
$8,708.23 |
$8,708.23 |
$17,652.73
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$63.35 |
$63.35 |
$63.35 |
$44.49
|
|
Testicular imaging w/vasc flow
|
$5,753.13 |
$5,753.13 |
$5,753.13 |
$780.48
|
|
Tetanus immune globulin inj
|
$1,741.49 |
$1,741.49 |
$1,741.49 |
$1,395.20
|
|
Theophylline therapeutic drug level
|
$925.80 |
$925.80 |
$925.80 |
$108.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$68.92 |
$68.92 |
$68.92 |
$38.64
|
|
Thyroid met imaging
|
$5,740.33 |
$5,740.33 |
$5,740.33 |
$549.70
|
|
Thyroid mets imag whole body
|
$9,169.71 |
$9,169.71 |
$9,169.71 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$1,148.25 |
$1,148.25 |
$1,148.25 |
$120.00
|
|
Thyroid Ultrasound
|
$4,473.26 |
$4,473.26 |
$4,473.26 |
$589.96
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$5,331.72 |
$5,331.72 |
$5,331.72 |
$4,886.55
|
|
Thyroxine binding globulin (tbg)
|
$11.50 |
$11.50 |
$11.50 |
$63.60
|
|
Tigecycline injection
|
$1,906.64 |
$1,906.64 |
$1,906.64 |
$308.75
|
|
Tissue culture placenta
|
$900.00 |
$900.00 |
$900.00 |
$520.91
|
|
Tl-201 thallium diag per mci
|
$818.61 |
$818.61 |
$818.61 |
$77.22
|
|
Tomosynthesis breast diagnostic left
|
$88.22 |
$88.22 |
$88.22 |
$63.70
|
|
Tomosynthesis breast screen bilateral
|
$88.22 |
$88.22 |
$88.22 |
$73.45
|
|
Transcatheter bx s&i
|
$20,078.75 |
$20,078.75 |
$20,078.75 |
$1,875.96
|
|
Transfusion blood/blood component(s)
|
$862.87 |
$862.87 |
$862.87 |
$988.24
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$1,134.23 |
$1,134.23 |
$1,134.23 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$567.11 |
$567.11 |
$567.11 |
$149.00
|
|
Treatment radiation delivery level 2
|
$649.11 |
$649.11 |
$649.11 |
$735.00
|
|
Treponema pallidum antibody
|
$7.33 |
$7.33 |
$7.33 |
$72.80
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$127.73 |
$127.73 |
$127.73 |
$48.22
|
|
Triamcinolone a inj prs-free
|
$1,832.60 |
$1,832.60 |
$1,832.60 |
$225.43
|
|
Trichinella antibody
|
$91.08 |
$91.08 |
$91.08 |
$70.65
|
|
Trichomonas assay w/optic
|
$101.76 |
$101.76 |
$101.76 |
$66.00
|
|
Trimethobenzamide hcl inj
|
$46.46 |
$46.46 |
$46.46 |
$154.09
|
|
Troponin quantitative
|
$1,496.59 |
$1,496.59 |
$1,496.59 |
$123.75
|
|
Tube drain vert dev st 5-40f
|
$62.28 |
$62.28 |
$62.28 |
$72.21
|
|
Tx atrial fib pulm vein isol
|
$205,925.91 |
$205,925.91 |
$205,925.91 |
$32,426.20
|
|
Ultrasound abdomen aorta screening study aaa
|
$5,990.13 |
$5,990.13 |
$5,990.13 |
$403.26
|
|
Ultrasound chest
|
$3,984.42 |
$3,984.42 |
$3,984.42 |
$459.55
|
|
Ultrasound encephalogram
|
$7,431.38 |
$7,431.38 |
$7,431.38 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$2,952.36 |
$2,952.36 |
$2,952.36 |
$570.44
|
|
Ultrasound guide intraoperative
|
$3,536.03 |
$3,536.03 |
$3,536.03 |
$632.90
|
|
Ultrasound guide tissue ablation
|
$9,237.77 |
$9,237.77 |
$9,237.77 |
$498.40
|
|
Ultrasound joint complete left
|
$3,308.99 |
$3,308.99 |
$3,308.99 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$2,206.00 |
$2,206.00 |
$2,206.00 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$7,650.42 |
$7,650.42 |
$7,650.42 |
$454.11
|
|
Ultrasound pregnant uterus follow up per fetus
|
$6,329.27 |
$6,329.27 |
$6,329.27 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$3,797.59 |
$3,797.59 |
$3,797.59 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$4,477.15 |
$4,477.15 |
$4,477.15 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$4,170.87 |
$4,170.87 |
$4,170.87 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$5,899.00 |
$5,899.00 |
$5,899.00 |
$498.00
|
|
Ultrasound scrotum and contents
|
$4,656.10 |
$4,656.10 |
$4,656.10 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$7,431.38 |
$7,431.38 |
$7,431.38 |
$450.60
|
|
Ultrasound transvaginal non obstetric
|
$4,477.15 |
$4,477.15 |
$4,477.15 |
$567.44
|
|
Unlisted chemotherapy px
|
$10,257.62 |
$10,257.62 |
$10,257.62 |
$153.85
|
|
Unlisted CT procedure
|
$3,949.26 |
$3,949.26 |
$3,949.26 |
$1,043.00
|
|
Unlisted misc path test
|
$5.00 |
$5.00 |
$5.00 |
$89.40
|
|
Unlisted ultrasound procedure
|
$4,141.24 |
$4,141.24 |
$4,141.24 |
$321.20
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$27,405.68 |
$27,405.68 |
$27,405.68 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$19,170.42 |
$19,170.42 |
$19,170.42 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$16,674.04 |
$16,674.04 |
$16,674.04 |
$2,013.08
|
|
Urea nitrogen
|
$464.56 |
$464.56 |
$464.56 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$580.55 |
$580.55 |
$580.55 |
$50.00
|
|
Urethrcystgrphy rtrgrde s&i
|
$2,707.87 |
$2,707.87 |
$2,707.87 |
$574.40
|
|
Urethrocystography void s&i
|
$2,707.00 |
$2,707.00 |
$2,707.00 |
$634.50
|
|
Uric acid blood
|
$1,161.64 |
$1,161.64 |
$1,161.64 |
$46.64
|
|
Urine Culture Test
|
$739.06 |
$739.06 |
$739.06 |
$84.81
|
|
Vaccine dtap < 7 years im
|
$178.55 |
$178.55 |
$178.55 |
$87.80
|
|
Vaccine hepatitis a (hepa) adult im
|
$75.00 |
$75.00 |
$75.00 |
$178.07
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$291.99 |
$291.99 |
$291.99 |
$173.98
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$122.18 |
$122.18 |
$122.18 |
$48.29
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$441.57 |
$441.57 |
$441.57 |
$72.00
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$1,643.72 |
$1,643.72 |
$1,643.72 |
$426.80
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$944.63 |
$944.63 |
$944.63 |
$349.15
|
|
Vaccine mmr live subcutaneous
|
$65.00 |
$65.00 |
$65.00 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$337.60 |
$337.60 |
$337.60 |
$274.95
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$769.16 |
$769.16 |
$769.16 |
$385.45
|
|
Vaccine rabies im
|
$1,071.86 |
$1,071.86 |
$1,071.86 |
$945.46
|
|
Vaccine tdap >=7 years im
|
$512.20 |
$512.20 |
$512.20 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$273.21 |
$273.21 |
$273.21 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$306.63 |
$306.63 |
$306.63 |
$447.80
|
|
Vad battery clip set hmii 14-v li-ion
|
$2,805.05 |
$2,805.05 |
$2,805.05 |
$1,683.99
|
|
Vad univ batt charger hm 1440
|
$36,720.60 |
$36,720.60 |
$36,720.60 |
$14,929.92
|
|
Valproic acid total therapeutic drug level
|
$592.97 |
$592.97 |
$592.97 |
$115.00
|
|
Vasopressin 20 unit/ml intravenous solution
|
$421.05 |
$421.05 |
$421.05 |
$394.13
|
|
Vein x-ray liver
|
$7,898.06 |
$7,898.06 |
$7,898.06 |
$3,320.80
|
