|
T3 (triiodothyronine) total
|
$773.00 |
$773.00 |
$773.00 |
$94.90
|
|
T4 (thyroxine) free
|
$247.00 |
$247.00 |
$247.00 |
$81.60
|
|
T4 (thyroxine) total
|
$196.00 |
$196.00 |
$196.00 |
$73.64
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$928.00 |
$928.00 |
$928.00 |
$612.11
|
|
Tacrolimus therapeutic drug level
|
$557.00 |
$557.00 |
$557.00 |
$122.40
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$887.00 |
$887.00 |
$887.00 |
$166.46
|
|
Tc-99m apcitide diag
|
$4,109.00 |
$4,109.00 |
$4,109.00 |
$1,765.30
|
|
Tc-99m disofenin
|
$697.00 |
$697.00 |
$697.00 |
$151.32
|
|
Tc-99m exametazime diag
|
$12,722.00 |
$12,722.00 |
$12,722.00 |
$2,166.26
|
|
Tc-99m labeled rbc
|
$1,197.00 |
$1,197.00 |
$1,197.00 |
$323.01
|
|
Tc-99m maa
|
$4,453.00 |
$4,453.00 |
$4,453.00 |
$312.06
|
|
Tc-99m mebrofenin
|
$697.00 |
$697.00 |
$697.00 |
$169.53
|
|
Tc-99m medronate
|
$697.00 |
$697.00 |
$697.00 |
$122.46
|
|
Tc-99m mertiatide
|
$6,635.00 |
$6,635.00 |
$6,635.00 |
$757.25
|
|
Tc-99m pentetate dtpa
|
$697.00 |
$697.00 |
$697.00 |
$245.85
|
|
Tc-99m pentetate dtpa aerosol
|
$1,852.00 |
$1,852.00 |
$1,852.00 |
$244.02
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$726.00 |
$726.00 |
$726.00 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$1,498.00 |
$1,498.00 |
$1,498.00 |
$221.60
|
|
Tc-99m succimer (dmsa)
|
$5,861.00 |
$5,861.00 |
$5,861.00 |
$1,578.33
|
|
Tc-99m sulfur colloid
|
$697.00 |
$697.00 |
$697.00 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$515.00 |
$515.00 |
$515.00 |
$198.05
|
|
T cells absolute cd4/cd8 including ratio
|
$96.00 |
$96.00 |
$96.00 |
$186.00
|
|
T cells absolute cd 4 count
|
$179.00 |
$179.00 |
$179.00 |
$120.25
|
|
T cells total count
|
$362.00 |
$362.00 |
$362.00 |
$124.11
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$7,543.00 |
$7,543.00 |
$7,543.00 |
$2,791.41
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$18,449.00 |
$18,449.00 |
$18,449.00 |
$17,652.73
|
|
Test stress cardiovascular tracing only
|
$8,324.00 |
$8,324.00 |
$8,324.00 |
$1,001.55
|
|
Tetanus immune globulin inj
|
$2,708.00 |
$2,708.00 |
$2,708.00 |
$1,395.20
|
|
Theophylline therapeutic drug level
|
$1,046.00 |
$1,046.00 |
$1,046.00 |
$108.00
|
|
Therapy nutrition individual initial f2f w/patient each 15 minutes
|
$50.00 |
$50.00 |
$50.00 |
$55.00
|
|
Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes
|
$50.00 |
$50.00 |
$50.00 |
$50.40
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$142.00 |
$142.00 |
$142.00 |
$38.64
|
|
Thrombin time
|
$677.00 |
$677.00 |
$677.00 |
$48.75
|
|
Thyroglobulin antibody
|
$407.00 |
$407.00 |
$407.00 |
$84.00
|
|
Thyroid imaging
|
$2,126.00 |
$2,126.00 |
$2,126.00 |
$670.80
|
|
Thyroid (TSH) Test
|
$1,027.00 |
$1,027.00 |
$1,027.00 |
$120.00
|
|
Thyroid Ultrasound
|
$4,672.00 |
$4,672.00 |
$4,672.00 |
$589.96
|
|
Thyroid uptake measurement
|
$2,077.00 |
$2,077.00 |
$2,077.00 |
$653.60
|
|
Thyroxine binding globulin (tbg)
|
$347.00 |
$347.00 |
$347.00 |
$63.60
|
|
Tigecycline injection
|
$969.00 |
$969.00 |
$969.00 |
$308.75
|
|
Tilt table study
|
$3,095.00 |
$3,095.00 |
$3,095.00 |
$1,495.00
|
|
Tl-201 thallium diag per mci
|
$1,631.00 |
$1,631.00 |
$1,631.00 |
$77.22
|
|
Tomosynthesis breast diagnostic left
|
$334.00 |
$334.00 |
$334.00 |
$63.70
|
|
Tomosynthesis breast screen bilateral
|
$334.00 |
$334.00 |
$334.00 |
$73.45
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$9,834.00 |
$9,834.00 |
$9,834.00 |
$303.88
|
|
Toxoplasma antibody igg
|
$239.00 |
$239.00 |
$239.00 |
$84.35
|
|
Toxoplasma antibody igm
|
$239.00 |
$239.00 |
$239.00 |
$83.20
|
|
Trabectedin 1 mg intravenous solution
|
$18,584.00 |
$18,584.00 |
$18,584.00 |
$6,133.80
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$214.00 |
$214.00 |
$214.00 |
$93.75
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$39.00 |
$39.00 |
$39.00 |
$82.60
|
|
Transcatheter bx s&i
|
$15,215.00 |
$15,215.00 |
$15,215.00 |
$1,875.96
|
|
Transferrin
|
$489.00 |
$489.00 |
$489.00 |
$87.30
|
|
Transfusion blood/blood component(s)
|
$2,090.00 |
$2,090.00 |
$2,090.00 |
$988.24
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$1,100.00 |
$1,100.00 |
$1,100.00 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$1,100.00 |
$1,100.00 |
$1,100.00 |
$149.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$633.00 |
$633.00 |
$633.00 |
$210.00
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$331.00 |
$331.00 |
$331.00 |
$48.22
|
|
Trimethobenzamide hcl inj
|
$180.00 |
$180.00 |
$180.00 |
$154.09
|
|
Troponin quantitative
|
$1,378.00 |
$1,378.00 |
$1,378.00 |
$123.75
|
|
Tube drain vert dev st 5-40f
|
$139.00 |
$139.00 |
$139.00 |
$72.21
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$1,024.00 |
$1,024.00 |
$1,024.00 |
$340.14
|
|
Ultrasound encephalogram
|
$4,268.00 |
$4,268.00 |
$4,268.00 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$4,008.00 |
$4,008.00 |
$4,008.00 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$3,762.00 |
$3,762.00 |
$3,762.00 |
$477.88
|
|
Ultrasound guide intraoperative
|
$3,302.00 |
$3,302.00 |
$3,302.00 |
$632.90
|
|
Ultrasound hips infant dynamic
|
$1,432.00 |
$1,432.00 |
$1,432.00 |
$403.00
|
|
Ultrasound joint complete left
|
$3,307.00 |
$3,307.00 |
$3,307.00 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$1,656.00 |
$1,656.00 |
$1,656.00 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$7,519.00 |
$7,519.00 |
$7,519.00 |
$454.11
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$4,666.00 |
$4,666.00 |
$4,666.00 |
$690.48
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$3,634.00 |
$3,634.00 |
$3,634.00 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$765.00 |
$765.00 |
$765.00 |
$485.48
|
|
Ultrasound retroperitoneal limited
|
$4,306.00 |
$4,306.00 |
$4,306.00 |
$498.00
|
|
Ultrasound scrotum and contents
|
$4,568.00 |
$4,568.00 |
$4,568.00 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$1,605.00 |
$1,605.00 |
$1,605.00 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$6,966.00 |
$6,966.00 |
$6,966.00 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$4,763.00 |
$4,763.00 |
$4,763.00 |
$567.44
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$19,981.00 |
$19,981.00 |
$19,981.00 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$16,617.00 |
$16,617.00 |
$16,617.00 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$15,173.00 |
$15,173.00 |
$15,173.00 |
$2,013.08
|
|
Urea nitrogen 24 hour urine
|
$968.00 |
$968.00 |
$968.00 |
$50.00
|
|
Urethrcystgrphy rtrgrde s&i
|
$2,124.00 |
$2,124.00 |
$2,124.00 |
$574.40
|
|
Urethrocystography void s&i
|
$3,984.00 |
$3,984.00 |
$3,984.00 |
$634.50
|
|
Uric acid blood
|
$1,044.00 |
$1,044.00 |
$1,044.00 |
$46.64
|
|
Uric acid urine
|
$965.00 |
$965.00 |
$965.00 |
$46.75
|
|
Urinalysis (with microscopy)
|
$1,147.00 |
$1,147.00 |
$1,147.00 |
$48.14
|
|
Urinalysis (without microscopy)
|
$512.00 |
$512.00 |
$512.00 |
$38.99
|
|
Urine Culture Test
|
$126.00 |
$126.00 |
$126.00 |
$84.81
|
|
Urine pregnancy test
|
$1,552.00 |
$1,552.00 |
$1,552.00 |
$66.40
|
|
Vaccine dtap < 7 years im
|
$159.00 |
$159.00 |
$159.00 |
$87.80
|
|
Vaccine dtap-ipv/hib im
|
$1,700.00 |
$1,700.00 |
$1,700.00 |
$248.80
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$690.00 |
$690.00 |
$690.00 |
$45.33
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$172.00 |
$172.00 |
$172.00 |
$79.04
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$367.00 |
$367.00 |
$367.00 |
$48.29
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$1,243.15 |
$1,243.15 |
$1,243.15 |
$426.80
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$1,600.00 |
$1,600.00 |
$1,600.00 |
$349.15
|
|
Vaccine mmr live subcutaneous
|
$436.00 |
$436.00 |
$436.00 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$758.00 |
$758.00 |
$758.00 |
$274.95
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$1,335.00 |
$1,335.00 |
$1,335.00 |
$385.45
|
|
Vaccine polio (ipv) subcutaneous/im
|
$375.00 |
$375.00 |
$375.00 |
$119.17
|
