|
Tissue exam koh skin/hair/nails
|
$656.41 |
$656.41 |
$656.41 |
$47.40
|
|
Tl-201 thallium diag per mci
|
$1,390.17 |
$1,390.17 |
$1,390.17 |
$77.22
|
|
Tomosynthesis breast diagnostic left
|
$62.21 |
$62.21 |
$62.21 |
$63.70
|
|
Tomosynthesis breast screen bilateral
|
$62.21 |
$62.21 |
$62.21 |
$73.45
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$13,068.00 |
$13,068.00 |
$13,068.00 |
$303.88
|
|
Transcatheter bx s&i
|
$12,616.11 |
$12,616.11 |
$12,616.11 |
$1,875.96
|
|
Trastuzumab 150 mg intravenous solution
|
$396.00 |
$396.00 |
$396.00 |
$3,401.26
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$862.49 |
$862.49 |
$862.49 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$432.58 |
$432.58 |
$432.58 |
$149.00
|
|
Trg gene rearrangement anal
|
$150.00 |
$150.00 |
$150.00 |
$455.70
|
|
Triamcinolone a inj prs-free
|
$3,224.00 |
$3,224.00 |
$3,224.00 |
$225.43
|
|
Trichinella antibody
|
$21.71 |
$21.71 |
$21.71 |
$70.65
|
|
#tricyclicantidprssnt
|
$15.00 |
$15.00 |
$15.00 |
$57.08
|
|
Trilaciclib 300 mg intravenous solution
|
$5,865.00 |
$5,865.00 |
$5,865.00 |
$5.36
|
|
Trimethobenzamide hcl inj
|
$261.00 |
$261.00 |
$261.00 |
$154.09
|
|
Troponin quantitative
|
$1,118.83 |
$1,118.83 |
$1,118.83 |
$123.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$2,185.50 |
$2,185.50 |
$2,185.50 |
$403.26
|
|
Ultrasound chest
|
$3,481.84 |
$3,481.84 |
$3,481.84 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$2,184.84 |
$2,184.84 |
$2,184.84 |
$340.14
|
|
Ultrasound encephalogram
|
$2,986.42 |
$2,986.42 |
$2,986.42 |
$481.60
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$1,608.94 |
$1,608.94 |
$1,608.94 |
$477.88
|
|
Ultrasound ob >=14wks ea addl gest
|
$4,485.33 |
$4,485.33 |
$4,485.33 |
$454.11
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$4,073.17 |
$4,073.17 |
$4,073.17 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$1,951.97 |
$1,951.97 |
$1,951.97 |
$450.75
|
|
Ultrasound pregnant uterus transvaginal
|
$4,073.17 |
$4,073.17 |
$4,073.17 |
$485.48
|
|
Ultrasound spinal canal and contents
|
$2,834.06 |
$2,834.06 |
$2,834.06 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$1,226.57 |
$1,226.57 |
$1,226.57 |
$425.10
|
|
Unlisted ultrasound procedure
|
$4,331.53 |
$4,331.53 |
$4,331.53 |
$321.20
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$17,738.50 |
$17,738.50 |
$17,738.50 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$5,357.50 |
$5,357.50 |
$5,357.50 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$14,045.63 |
$14,045.63 |
$14,045.63 |
$2,013.08
|
|
Urea nitrogen 24 hour urine
|
$947.76 |
$947.76 |
$947.76 |
$50.00
|
|
Urea nitrogen clearance
|
$734.10 |
$734.10 |
$734.10 |
$33.57
|
|
Urethrcystgrphy rtrgrde s&i
|
$6,869.98 |
$6,869.98 |
$6,869.98 |
$574.40
|
|
Urethrocystography void s&i
|
$6,869.98 |
$6,869.98 |
$6,869.98 |
$634.50
|
|
Uric acid blood
|
$1,332.49 |
$1,332.49 |
$1,332.49 |
$46.64
|
|
Urinalysis qual/semiquant excpt ia
|
$240.57 |
$240.57 |
$240.57 |
$25.72
|
|
Urinary bldr retent nuc study
|
$5,390.03 |
$5,390.03 |
$5,390.03 |
$309.22
|
|
Urine Culture Test
|
$2,619.61 |
$2,619.61 |
$2,619.61 |
$84.81
|
|
Urography inf drip &/or bolus
|
$6,277.48 |
$6,277.48 |
$6,277.48 |
$641.69
|
|
Vaccine dtap < 7 years im
|
$180.00 |
$180.00 |
$180.00 |
$87.80
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$332.24 |
$332.24 |
$332.24 |
$45.33
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$151.00 |
$151.00 |
$151.00 |
$218.40
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$137.76 |
$137.76 |
$137.76 |
$40.01
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$1,743.28 |
$1,743.28 |
$1,743.28 |
$426.80
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$1,128.68 |
$1,128.68 |
$1,128.68 |
$349.15
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$2,485.00 |
$2,485.00 |
$2,485.00 |
$408.70
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$614.00 |
$614.00 |
$614.00 |
$274.95
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$1,058.00 |
$1,058.00 |
$1,058.00 |
$397.18
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$1,560.22 |
$1,560.22 |
$1,560.22 |
$385.45
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$1,354.06 |
$1,354.06 |
$1,354.06 |
$715.41
|
|
Vaccine rabies im
|
$1,857.00 |
$1,857.00 |
$1,857.00 |
$945.46
|
|
Vaccine tdap >=7 years im
|
$468.27 |
$468.27 |
$468.27 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$554.00 |
$554.00 |
$554.00 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$105.00 |
$105.00 |
$105.00 |
$447.80
|
|
Valproic acid total therapeutic drug level
|
$1,345.15 |
$1,345.15 |
$1,345.15 |
$115.00
|
|
Vasopressin 20 unit/ml intravenous solution
|
$315.59 |
$315.59 |
$315.59 |
$394.13
|
|
Vedolizumab 300 mg intravenous solution
|
$22,352.00 |
$22,352.00 |
$22,352.00 |
$23,003.79
|
|
Vein x-ray adrenal glands
|
$6,596.74 |
$6,596.74 |
$6,596.74 |
$3,999.60
|
|
Vein x-ray liver
|
$5,566.70 |
$5,566.70 |
$5,566.70 |
$3,320.80
|
|
Vein x-ray liver w/hemodynam
|
$11,539.18 |
$11,539.18 |
$11,539.18 |
$3,413.25
|
|
Vein x-ray liver w/hemodynam
|
$5,566.70 |
$5,566.70 |
$5,566.70 |
$3,439.84
|
|
Vein x-ray liver without hemodyn
|
$11,539.18 |
$11,539.18 |
$11,539.18 |
$2,489.25
|
|
Ventilator each subsequent day
|
$2,574.15 |
$2,574.15 |
$2,574.15 |
$1,305.92
|
|
Ventilator initial day
|
$3,798.67 |
$3,798.67 |
$3,798.67 |
$1,540.80
|
|
Vincristine 1 mg/ml intravenous solution
|
$543.00 |
$543.00 |
$543.00 |
$104.79
|
|
Vital capacity test
|
$739.65 |
$739.65 |
$739.65 |
$173.33
|
|
Volume measurement urine timed
|
$104.73 |
$104.73 |
$104.73 |
$21.45
|
|
Voriconazole in ns IV syringe 5 mg/ml (pediatric) - cnr
|
$3,458.00 |
$3,458.00 |
$3,458.00 |
$224.40
|
|
Warde amino acids 6 or more quantitative each specimen
|
$330.75 |
$330.75 |
$330.75 |
$176.20
|
|
Warde antiepileptics nos definitive assay 1-3 clobazam w metabolites
|
$50.00 |
$50.00 |
$50.00 |
$142.65
|
|
Warde calcitonin
|
$19.04 |
$19.04 |
$19.04 |
$89.40
|
|
Warde calculus (stone) infrared
|
$10.82 |
$10.82 |
$10.82 |
$61.73
|
|
Warde clozapine therapeutic drug level
|
$264.03 |
$264.03 |
$264.03 |
$63.00
|
|
Warde haloperidol therapeutic drug level
|
$15.26 |
$15.26 |
$15.26 |
$68.16
|
|
Warde hepatitis delta agent antibody
|
$25.00 |
$25.00 |
$25.00 |
$92.30
|
|
Warde islet cell antibody zinc transporter 8
|
$17.92 |
$17.92 |
$17.92 |
$137.55
|
|
Warde lipoprotein-associated phospholipase a2
|
$20.00 |
$20.00 |
$20.00 |
$97.00
|
|
Warde neutralization rabies
|
$8.77 |
$8.77 |
$8.77 |
$106.50
|
|
Warde oxcarbazepine therapeutic drug level
|
$37.97 |
$37.97 |
$37.97 |
$64.50
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$1,606.00 |
$1,606.00 |
$1,606.00 |
$288.91
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$1,606.00 |
$1,606.00 |
$1,606.00 |
$436.15
|
|
Xe133 xenon 10mci
|
$1,330.98 |
$1,330.98 |
$1,330.98 |
$299.00
|
|
X-ray bone age studies
|
$2,662.34 |
$2,662.34 |
$2,662.34 |
$246.75
|
|
X-ray bone length studies
|
$10,546.39 |
$10,546.39 |
$10,546.39 |
$287.25
|
|
X-ray bone survey infant
|
$455.81 |
$455.81 |
$455.81 |
$410.73
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$4,623.73 |
$4,623.73 |
$4,623.73 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$5,857.21 |
$5,857.21 |
$5,857.21 |
$820.15
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$3,801.86 |
$3,801.86 |
$3,801.86 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$3,082.48 |
$3,082.48 |
$3,082.48 |
$486.01
|
|
X-ray exam entire spi 6/> vw
|
$3,593.83 |
$3,593.83 |
$3,593.83 |
$575.76
|
|
X-ray exam of femur 1
|
$2,260.63 |
$2,260.63 |
$2,260.63 |
$232.36
|
|
X-ray exam of middle ear
|
$3,615.26 |
$3,615.26 |
$3,615.26 |
$341.25
|
|
X-ray exam of penis
|
$8,825.76 |
$8,825.76 |
$8,825.76 |
$565.20
|
|
X-ray exam thorac spine4/>vw
|
$3,958.82 |
$3,958.82 |
$3,958.82 |
$395.59
|
|
X-ray femur >=2 views (both sides)
|
$3,185.06 |
$3,185.06 |
$3,185.06 |
$304.15
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$4,110.93 |
$4,110.93 |
$4,110.93 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$4,005.47 |
$4,005.47 |
$4,005.47 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$4,418.56 |
$4,418.56 |
$4,418.56 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$4,929.90 |
$4,929.90 |
$4,929.90 |
$508.00
|
