|
Tissue exam koh skin/hair/nails
|
$68.00 |
$68.00 |
$68.00 |
$47.40
|
|
Tl-201 thallium diag per mci
|
$78.40 |
$78.40 |
$78.40 |
$80.10
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$61.27 |
$61.27 |
$61.27 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$142.40 |
$142.40 |
$142.40 |
$120.60
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$4,203.08 |
$4,203.08 |
$4,203.08 |
$5,258.52
|
|
Toe X-ray (both feet)
|
$284.00 |
$284.00 |
$284.00 |
$258.65
|
|
Tomosynthesis breast diagnostic left
|
$145.60 |
$145.60 |
$145.60 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$121.60 |
$121.60 |
$121.60 |
$74.10
|
|
Toxoplasma antibody igg
|
$116.80 |
$116.80 |
$116.80 |
$91.65
|
|
Toxoplasma antibody igm
|
$116.80 |
$116.80 |
$116.80 |
$87.75
|
|
Tpmt gene com vrnts
|
$256.00 |
$256.00 |
$256.00 |
$371.80
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$118.40 |
$118.40 |
$118.40 |
$102.27
|
|
Transferrin
|
$103.20 |
$103.20 |
$103.20 |
$82.00
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$809.60 |
$809.60 |
$809.60 |
$561.60
|
|
Transvaginal Pregnancy Ultrasound
|
$699.20 |
$699.20 |
$699.20 |
$499.20
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$4,141.58 |
$4,141.58 |
$4,141.58 |
$7,540.20
|
|
Trauma partial team response w/critical care services level 4
|
$1,792.00 |
$1,792.00 |
$1,792.00 |
$4,523.04
|
|
Treat ankle dislocation
|
$2,052.00 |
$2,052.00 |
$2,052.00 |
$2,360.00
|
|
Treat clavicle dislocation 23545
|
$458.40 |
$458.40 |
$458.40 |
$692.80
|
|
Treat elbow dislocation
|
$1,937.60 |
$1,937.60 |
$1,937.60 |
$2,272.50
|
|
Treat elbow fracture
|
$1,016.00 |
$1,016.00 |
$1,016.00 |
$2,026.50
|
|
Treat finger fracture each
|
$994.40 |
$994.40 |
$994.40 |
$1,592.00
|
|
Treat foot dislocation
|
$338.40 |
$338.40 |
$338.40 |
$405.60
|
|
Treat foot dislocation
|
$338.40 |
$338.40 |
$338.40 |
$534.05
|
|
Treat foot dislocation
|
$374.40 |
$374.40 |
$374.40 |
$445.80
|
|
Treat fracture of radius
|
$1,098.40 |
$1,098.40 |
$1,098.40 |
$1,790.00
|
|
Treat fracture of radius
|
$1,004.80 |
$1,004.80 |
$1,004.80 |
$1,849.00
|
|
Treat fracture of ulna
|
$1,896.80 |
$1,896.80 |
$1,896.80 |
$731.04
|
|
Treat hip dislocation
|
$1,811.20 |
$1,811.20 |
$1,811.20 |
$2,211.05
|
|
Treat humerus fracture
|
$1,240.80 |
$1,240.80 |
$1,240.80 |
$1,790.00
|
|
Treat humerus fracture
|
$1,672.00 |
$1,672.00 |
$1,672.00 |
$1,790.00
|
|
Treat knee fracture 27530
|
$427.20 |
$427.20 |
$427.20 |
$550.73
|
|
Treat knee fracture(s)
|
$576.80 |
$576.80 |
$576.80 |
$643.26
|
|
Treat lower leg dislocation
|
$1,046.40 |
$1,046.40 |
$1,046.40 |
$532.60
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$321.60 |
$321.60 |
$321.60 |
$227.70
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$203.20 |
$203.20 |
$203.20 |
$147.48
|
|
Treatment of ankle fracture 27786
|
$416.00 |
$416.00 |
$416.00 |
$523.20
|
|
Treatment of fibula fracture 27780
|
$358.40 |
$358.40 |
$358.40 |
$501.20
|
|
Treatment of heel fracture 28400
|
$375.20 |
$375.20 |
$375.20 |
$473.00
|
|
Treatment of thigh fracture
|
$521.60 |
$521.60 |
$521.60 |
$477.75
|
|
Treatment of thigh fracture
|
$450.40 |
$450.40 |
$450.40 |
$549.00
|
|
Treatment of thigh fracture
|
$1,135.20 |
$1,135.20 |
$1,135.20 |
$1,790.00
|
|
Treatment of toe fracture 28510
|
$318.40 |
$318.40 |
$318.40 |
$371.40
|
|
Treat midfoot fracture each
|
$2,700.80 |
$2,700.80 |
$2,700.80 |
$1,884.74
|
|
Treat sternum fracture
|
$467.20 |
$467.20 |
$467.20 |
$423.00
|
|
Treat thigh fracture
|
$424.80 |
$424.80 |
$424.80 |
$661.00
|
|
Treat thigh fracture
|
$1,460.00 |
$1,460.00 |
$1,460.00 |
$1,893.86
|
|
Treat thigh fracture
|
$368.80 |
$368.80 |
$368.80 |
$618.80
|
|
Treat thigh fx growth plate
|
$362.40 |
$362.40 |
$362.40 |
$478.40
|
|
Treat ulnar fracture
|
$1,325.60 |
$1,325.60 |
$1,325.60 |
$1,677.20
|
|
Treat vaginal bleeding
|
$409.60 |
$409.60 |
$409.60 |
$379.60
|
|
Treat wrist bone fracture
|
$1,204.80 |
$1,204.80 |
$1,204.80 |
$1,703.20
|
|
Treat wrist dislocation
|
$483.20 |
$483.20 |
$483.20 |
$656.25
|
|
Treponema pallidum antibody
|
$97.60 |
$97.60 |
$97.60 |
$72.05
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$66.77 |
$66.77 |
$66.77 |
$43.09
|
|
Triglycerides
|
$42.40 |
$42.40 |
$42.40 |
$58.50
|
|
Trmt of fracture (femoral shaft) 27500
|
$432.00 |
$432.00 |
$432.00 |
$754.80
|
|
Troponin quantitative
|
$127.20 |
$127.20 |
$127.20 |
$127.60
|
|
Tx closed hip disl traumatic without anes
|
$568.00 |
$568.00 |
$568.00 |
$586.40
|
|
Tx closed tib shaft fx without manip
|
$416.00 |
$416.00 |
$416.00 |
$535.60
|
|
Tx tarsal bone fx without manip 28450
|
$328.80 |
$328.80 |
$328.80 |
$419.04
|
|
Ultrasound breast complete
|
$519.20 |
$519.20 |
$519.20 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$446.40 |
$446.40 |
$446.40 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$448.00 |
$448.00 |
$448.00 |
$338.00
|
|
Ultrasound encephalogram
|
$620.80 |
$620.80 |
$620.80 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$800.00 |
$800.00 |
$800.00 |
$578.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$696.80 |
$696.80 |
$696.80 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$906.40 |
$906.40 |
$906.40 |
$720.15
|
|
Ultrasound guide intraoperative
|
$1,131.20 |
$1,131.20 |
$1,131.20 |
$632.85
|
|
Ultrasound hips infant dynamic
|
$603.20 |
$603.20 |
$603.20 |
$403.88
|
|
Ultrasound ob >=14wks ea addl gest
|
$620.80 |
$620.80 |
$620.80 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$474.40 |
$474.40 |
$474.40 |
$334.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,128.80 |
$1,128.80 |
$1,128.80 |
$698.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$494.40 |
$494.40 |
$494.40 |
$425.60
|
|
Ultrasound spinal canal and contents
|
$642.40 |
$642.40 |
$642.40 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$678.40 |
$678.40 |
$678.40 |
$419.50
|
|
Unlisted procedure rectum
|
$2,164.00 |
$2,164.00 |
$2,164.00 |
$1,223.20
|
|
Unlisted px leg/ankle
|
$3,078.40 |
$3,078.40 |
$3,078.40 |
$882.30
|
|
Unlisted ultrasound procedure
|
$464.80 |
$464.80 |
$464.80 |
$332.16
|
|
Upper Arm (Humerus) X-ray (left side)
|
$324.00 |
$324.00 |
$324.00 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$2,577.60 |
$2,577.60 |
$2,577.60 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$2,491.20 |
$2,491.20 |
$2,491.20 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,425.60 |
$4,425.60 |
$4,425.60 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,452.80 |
$3,452.80 |
$3,452.80 |
$2,369.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,044.80 |
$3,044.80 |
$3,044.80 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$372.00 |
$372.00 |
$372.00 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$446.40 |
$446.40 |
$446.40 |
$381.60
|
|
Upper GI Barium X-ray (barium and gas)
|
$1,021.60 |
$1,021.60 |
$1,021.60 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$946.40 |
$946.40 |
$946.40 |
$607.20
|
|
Urea nitrogen
|
$33.60 |
$33.60 |
$33.60 |
$42.25
|
|
Urea nitrogen 24 hour urine
|
$27.20 |
$27.20 |
$27.20 |
$52.00
|
|
Uric acid blood
|
$34.40 |
$34.40 |
$34.40 |
$49.44
|
|
Uric acid urine
|
$36.80 |
$36.80 |
$36.80 |
$45.36
|
|
Urinalysis microscopic only
|
$25.60 |
$25.60 |
$25.60 |
$26.46
|
|
Urinalysis qual/semiquant excpt ia
|
$15.20 |
$15.20 |
$15.20 |
$25.72
|
|
Urinalysis (with microscopy)
|
$40.00 |
$40.00 |
$40.00 |
$55.20
|
|
Urinalysis (without microscopy)
|
$34.40 |
$34.40 |
$34.40 |
$36.00
|
|
Urine Culture Test
|
$70.40 |
$70.40 |
$70.40 |
$83.00
|
|
Urine pregnancy test
|
$46.40 |
$46.40 |
$46.40 |
$68.78
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$2,745.45 |
$2,745.45 |
$2,745.45 |
$5,205.00
|
