|
Tissue exam koh skin/hair/nails
|
$293.86 |
$293.86 |
$293.86 |
$47.40
|
|
Tissue transglutaminase iga
|
$278.74 |
$278.74 |
$278.74 |
$48.57
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$205.25 |
$205.25 |
$205.25 |
$125.87
|
|
Tobramycin peak therapeutic drug level
|
$275.50 |
$275.50 |
$275.50 |
$121.55
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$12,002.74 |
$12,002.74 |
$12,002.74 |
$5,790.85
|
|
Tomosynthesis breast screen bilateral
|
$106.00 |
$106.00 |
$106.00 |
$73.45
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$143.57 |
$143.57 |
$143.57 |
$303.88
|
|
Toxoplasma antibody igg
|
$322.10 |
$322.10 |
$322.10 |
$84.35
|
|
Toxoplasma antibody igm
|
$147.03 |
$147.03 |
$147.03 |
$83.20
|
|
Tpmt gene com vrnts
|
$1,962.84 |
$1,962.84 |
$1,962.84 |
$381.55
|
|
Transferrin
|
$71.19 |
$71.19 |
$71.19 |
$87.30
|
|
Transfusion blood/blood component(s)
|
$3,296.42 |
$3,296.42 |
$3,296.42 |
$988.24
|
|
Treat finger fracture each
|
$8,878.56 |
$8,878.56 |
$8,878.56 |
$1,815.75
|
|
Treat foot dislocation
|
$1,371.94 |
$1,371.94 |
$1,371.94 |
$435.60
|
|
Treat fracture of radius
|
$8,962.32 |
$8,962.32 |
$8,962.32 |
$2,030.33
|
|
Treat fracture of ulna
|
$1,371.94 |
$1,371.94 |
$1,371.94 |
$766.72
|
|
Treat hip dislocation
|
$8,878.56 |
$8,878.56 |
$8,878.56 |
$2,561.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$774.92 |
$774.92 |
$774.92 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$497.65 |
$497.65 |
$497.65 |
$149.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$976.18 |
$976.18 |
$976.18 |
$210.00
|
|
Treatment radiation delivery level 2
|
$1,950.25 |
$1,950.25 |
$1,950.25 |
$735.00
|
|
Treat toe dislocation
|
$1,608.74 |
$1,608.74 |
$1,608.74 |
$855.66
|
|
Treat ulnar fracture
|
$8,962.32 |
$8,962.32 |
$8,962.32 |
$1,861.60
|
|
Treat wrist dislocation
|
$1,884.98 |
$1,884.98 |
$1,884.98 |
$760.00
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$127,773.61 |
$127,773.61 |
$127,773.61 |
$120,541.18
|
|
Treponema pallidum antibody
|
$62.94 |
$62.94 |
$62.94 |
$72.80
|
|
Trg gene rearrangement anal
|
$352.59 |
$352.59 |
$352.59 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$462.72 |
$462.72 |
$462.72 |
$48.22
|
|
Triglycerides
|
$177.50 |
$177.50 |
$177.50 |
$54.60
|
|
Trimethobenzamide hcl inj
|
$1,256.80 |
$1,256.80 |
$1,256.80 |
$154.09
|
|
Trim nondyst nails
|
$109.16 |
$109.16 |
$109.16 |
$124.22
|
|
Troponin quantitative
|
$397.48 |
$397.48 |
$397.48 |
$123.75
|
|
Tx closed hip disl traumatic without anes
|
$2,344.36 |
$2,344.36 |
$2,344.36 |
$657.28
|
|
Tx closed tib shaft fx without manip
|
$1,419.51 |
$1,419.51 |
$1,419.51 |
$635.46
|
|
Ugt1a1 gene analy common variants
|
$1,794.44 |
$1,794.44 |
$1,794.44 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$948.77 |
$948.77 |
$948.77 |
$403.26
|
|
Ultrasound breast complete
|
$285.79 |
$285.79 |
$285.79 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$199.23 |
$199.23 |
$199.23 |
$449.35
|
|
Ultrasound chest
|
$387.37 |
$387.37 |
$387.37 |
$459.55
|
|
Ultrasound encephalogram
|
$450.29 |
$450.29 |
$450.29 |
$481.60
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$1,140.60 |
$1,140.60 |
$1,140.60 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$2,025.01 |
$2,025.01 |
$2,025.01 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$689.68 |
$689.68 |
$689.68 |
$701.35
|
|
Ultrasound guide intraoperative
|
$1,741.95 |
$1,741.95 |
$1,741.95 |
$632.90
|
|
Ultrasound joint complete left
|
$583.77 |
$583.77 |
$583.77 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$498.06 |
$498.06 |
$498.06 |
$448.50
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$1,028.89 |
$1,028.89 |
$1,028.89 |
$326.54
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$893.11 |
$893.11 |
$893.11 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$723.21 |
$723.21 |
$723.21 |
$485.48
|
|
Ultrasound retroperitoneal limited
|
$802.22 |
$802.22 |
$802.22 |
$498.00
|
|
Ultrasound scrotum and contents
|
$856.95 |
$856.95 |
$856.95 |
$617.28
|
|
Ultrasound transvaginal non obstetric
|
$857.22 |
$857.22 |
$857.22 |
$567.44
|
|
Unlisted transfusion med px
|
$326.00 |
$326.00 |
$326.00 |
$141.35
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$7,593.18 |
$7,593.18 |
$7,593.18 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$5,573.76 |
$5,573.76 |
$5,573.76 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$5,819.74 |
$5,819.74 |
$5,819.74 |
$2,013.08
|
|
Urea nitrogen
|
$102.81 |
$102.81 |
$102.81 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$116.71 |
$116.71 |
$116.71 |
$50.00
|
|
Urethrcystgrphy rtrgrde s&i
|
$1,903.08 |
$1,903.08 |
$1,903.08 |
$574.40
|
|
Uric acid blood
|
$215.93 |
$215.93 |
$215.93 |
$46.64
|
|
Uric acid urine
|
$208.84 |
$208.84 |
$208.84 |
$46.75
|
|
Urinalysis (with microscopy)
|
$189.11 |
$189.11 |
$189.11 |
$48.14
|
|
Urinalysis (without microscopy)
|
$200.00 |
$200.00 |
$200.00 |
$38.99
|
|
Urine Culture Test
|
$229.08 |
$229.08 |
$229.08 |
$84.81
|
|
Urography, antegrade
|
$2,758.08 |
$2,758.08 |
$2,758.08 |
$593.37
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$119,185.81 |
$119,185.81 |
$119,185.81 |
$6,892.54
|
|
Vaccine hepatitis a (hepa) adult im
|
$856.28 |
$856.28 |
$856.28 |
$178.07
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$2,478.60 |
$2,478.60 |
$2,478.60 |
$218.40
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$1,266.30 |
$1,266.30 |
$1,266.30 |
$173.98
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$4,049.24 |
$4,049.24 |
$4,049.24 |
$686.67
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$1,720.40 |
$1,720.40 |
$1,720.40 |
$157.41
|
|
Vaccine influenza inactivated adjuvant im
|
$758.01 |
$758.01 |
$758.01 |
$110.25
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$496.50 |
$496.50 |
$496.50 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$417.92 |
$417.92 |
$417.92 |
$42.90
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$836.29 |
$836.29 |
$836.29 |
$103.88
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$2,298.23 |
$2,298.23 |
$2,298.23 |
$499.00
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$2,218.04 |
$2,218.04 |
$2,218.04 |
$408.70
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$1,559.97 |
$1,559.97 |
$1,559.97 |
$274.95
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$3,248.26 |
$3,248.26 |
$3,248.26 |
$715.41
|
|
Vaccine tdap >=7 years im
|
$1,190.50 |
$1,190.50 |
$1,190.50 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$978.52 |
$978.52 |
$978.52 |
$131.77
|
|
Valproic acid total therapeutic drug level
|
$223.64 |
$223.64 |
$223.64 |
$115.00
|
|
Vancomycin hcl injection
|
$1,497.78 |
$1,497.78 |
$1,497.78 |
$83.79
|
|
Vancomycin peak therapeutic drug level
|
$373.51 |
$373.51 |
$373.51 |
$126.79
|
|
Varicella zoster antibody igg
|
$275.04 |
$275.04 |
$275.04 |
$82.55
|
|
Vasopressin 20 unit/ml intravenous solution
|
$1,927.57 |
$1,927.57 |
$1,927.57 |
$394.13
|
|
Venogram extremity supervision & interpretation unilateral
|
$8,422.65 |
$8,422.65 |
$8,422.65 |
$1,326.00
|
|
Venous mech thrombectomy
|
$14,630.57 |
$14,630.57 |
$14,630.57 |
$8,869.50
|
|
Ventilator each subsequent day
|
$3,965.61 |
$3,965.61 |
$3,965.61 |
$1,305.92
|
|
Ventilator initial day
|
$4,682.13 |
$4,682.13 |
$4,682.13 |
$1,540.80
|
|
Version cephalic external
|
$1,164.46 |
$1,164.46 |
$1,164.46 |
$2,598.57
|
|
Vinblastine 1 mg/ml intravenous solution
|
$498.75 |
$498.75 |
$498.75 |
$186.71
|
|
Vincristine 1 mg/ml intravenous solution
|
$167.34 |
$167.34 |
$167.34 |
$104.79
|
|
Vinorelbine 10 mg/ml intravenous solution (wrapper)
|
$260.10 |
$260.10 |
$260.10 |
$245.36
|
|
Virus isolation addl studies ea
|
$91.35 |
$91.35 |
$91.35 |
$90.35
|
|
Vital capacity test
|
$288.16 |
$288.16 |
$288.16 |
$173.33
|
|
Vitamin b-12
|
$229.32 |
$229.32 |
$229.32 |
$94.90
|
|
Vitamin D Test
|
$99.88 |
$99.88 |
$99.88 |
$132.00
|
|
Warde 1003990 aldosterone
|
$165.19 |
$165.19 |
$165.19 |
$145.60
|
|
Warde 1005055 5-hiaa 24 hour urine
|
$141.03 |
$141.03 |
$141.03 |
$72.50
|
