|
Thyroglobulin antibody
|
$496.20 |
$496.20 |
$496.20 |
$82.00
|
|
Thyroid (TSH) Test
|
$159.00 |
$159.00 |
$159.00 |
$111.00
|
|
Thyroid Ultrasound
|
$764.40 |
$764.40 |
$764.40 |
$588.50
|
|
Thyroxine binding globulin (tbg)
|
$204.00 |
$204.00 |
$204.00 |
$64.35
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$152.63 |
$152.63 |
$152.63 |
$1,134.00
|
|
Tissue matrix xcm thk 20x30cm -cost per sq cm
|
$830.41 |
$830.41 |
$830.41 |
$18,999.96
|
|
Tissue transglutaminase iga
|
$21.60 |
$21.60 |
$21.60 |
$44.16
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$12.00 |
$12.00 |
$12.00 |
$152.36
|
|
Tomosynthesis breast diagnostic left
|
$40.20 |
$40.20 |
$40.20 |
$73.00
|
|
Tomosynthesis breast screen bilateral
|
$40.20 |
$40.20 |
$40.20 |
$72.68
|
|
Toxoplasma antibody igg
|
$203.40 |
$203.40 |
$203.40 |
$89.40
|
|
Tp53 gene trgt sequence alys
|
$1,245.60 |
$1,245.60 |
$1,245.60 |
$790.68
|
|
Tpmt gene com vrnts
|
$619.20 |
$619.20 |
$619.20 |
$371.80
|
|
Transferrin
|
$115.20 |
$115.20 |
$115.20 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$511.20 |
$511.20 |
$511.20 |
$983.00
|
|
Trauma partial team response w/critical care services level 4
|
$1,570.20 |
$1,570.20 |
$1,570.20 |
$4,523.04
|
|
Treat ankle dislocation
|
$2,827.20 |
$2,827.20 |
$2,827.20 |
$2,358.40
|
|
Treat elbow dislocation
|
$2,827.20 |
$2,827.20 |
$2,827.20 |
$2,223.20
|
|
Treat foot dislocation
|
$287.40 |
$287.40 |
$287.40 |
$445.80
|
|
Treat fracture of radius
|
$1,000.80 |
$1,000.80 |
$1,000.80 |
$1,790.00
|
|
Treat lower leg dislocation
|
$3,788.40 |
$3,788.40 |
$3,788.40 |
$3,908.80
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$253.20 |
$253.20 |
$253.20 |
$203.35
|
|
Treatment of thigh fracture
|
$1,000.80 |
$1,000.80 |
$1,000.80 |
$1,772.97
|
|
Treatment of tibia fracture
|
$4,828.20 |
$4,828.20 |
$4,828.20 |
$6,183.84
|
|
Treponema pallidum antibody
|
$166.20 |
$166.20 |
$166.20 |
$70.40
|
|
Trg gene rearrangement anal
|
$592.80 |
$592.80 |
$592.80 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$31.80 |
$31.80 |
$31.80 |
$43.21
|
|
Triglycerides
|
$88.80 |
$88.80 |
$88.80 |
$58.05
|
|
Trim nondyst nails
|
$145.20 |
$145.20 |
$145.20 |
$113.40
|
|
Troponin quantitative
|
$147.00 |
$147.00 |
$147.00 |
$127.20
|
|
Tx closed hip disl traumatic without anes
|
$287.40 |
$287.40 |
$287.40 |
$581.07
|
|
Ua w/micro/comp poc
|
$52.80 |
$52.80 |
$52.80 |
$23.00
|
|
Ultrasound abdomen aorta screening study aaa
|
$438.60 |
$438.60 |
$438.60 |
$394.20
|
|
Ultrasound breast complete
|
$853.80 |
$853.80 |
$853.80 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$225.00 |
$225.00 |
$225.00 |
$449.35
|
|
Ultrasound chest
|
$1,012.20 |
$1,012.20 |
$1,012.20 |
$460.85
|
|
Ultrasound elastography parenchyma
|
$127.20 |
$127.20 |
$127.20 |
$307.00
|
|
Ultrasound encephalogram
|
$852.00 |
$852.00 |
$852.00 |
$488.80
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$943.80 |
$943.80 |
$943.80 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$448.80 |
$448.80 |
$448.80 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$1,065.60 |
$1,065.60 |
$1,065.60 |
$720.15
|
|
Ultrasound hips infant dynamic
|
$733.20 |
$733.20 |
$733.20 |
$403.88
|
|
Ultrasound joint complete left
|
$490.80 |
$490.80 |
$490.80 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$252.60 |
$252.60 |
$252.60 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$303.60 |
$303.60 |
$303.60 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$303.60 |
$303.60 |
$303.60 |
$331.50
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$702.00 |
$702.00 |
$702.00 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$879.00 |
$879.00 |
$879.00 |
$497.12
|
|
Ultrasound retroperitoneal limited
|
$151.20 |
$151.20 |
$151.20 |
$486.50
|
|
Ultrasound scrotum and contents
|
$962.40 |
$962.40 |
$962.40 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$436.80 |
$436.80 |
$436.80 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$879.00 |
$879.00 |
$879.00 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$962.40 |
$962.40 |
$962.40 |
$558.35
|
|
Unlisted chemotherapy px
|
$58.20 |
$58.20 |
$58.20 |
$150.00
|
|
Unsched dialysis esrd pt hos
|
$1,500.00 |
$1,500.00 |
$1,500.00 |
$1,268.17
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$5,716.80 |
$5,716.80 |
$5,716.80 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,763.20 |
$3,763.20 |
$3,763.20 |
$2,034.41
|
|
Urea nitrogen
|
$72.00 |
$72.00 |
$72.00 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$83.40 |
$83.40 |
$83.40 |
$51.75
|
|
Urea nitrogen clearance
|
$133.80 |
$133.80 |
$133.80 |
$42.25
|
|
Uric acid blood
|
$69.60 |
$69.60 |
$69.60 |
$48.75
|
|
Uric acid urine
|
$72.00 |
$72.00 |
$72.00 |
$44.33
|
|
Urinalysis microscopic only
|
$54.00 |
$54.00 |
$54.00 |
$26.35
|
|
Urinalysis (with microscopy)
|
$55.80 |
$55.80 |
$55.80 |
$55.00
|
|
Urinalysis (without microscopy)
|
$54.00 |
$54.00 |
$54.00 |
$35.75
|
|
Urine Culture Test
|
$121.20 |
$121.20 |
$121.20 |
$81.50
|
|
Urine pregnancy test
|
$170.40 |
$170.40 |
$170.40 |
$67.20
|
|
Urography inf drip &/or bolus
|
$937.80 |
$937.80 |
$937.80 |
$642.50
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$7,440.00 |
$7,440.00 |
$7,440.00 |
$5,184.34
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$589.50 |
$589.50 |
$589.50 |
$236.50
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$102.00 |
$102.00 |
$102.00 |
$75.39
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$54.90 |
$54.90 |
$54.90 |
$47.88
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$69.00 |
$69.00 |
$69.00 |
$33.60
|
|
Vaccine mmr live subcutaneous
|
$243.60 |
$243.60 |
$243.60 |
$211.68
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$991.20 |
$991.20 |
$991.20 |
$563.36
|
|
Vaccine rabies im
|
$1,461.60 |
$1,461.60 |
$1,461.60 |
$858.95
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$1,990.20 |
$1,990.20 |
$1,990.20 |
$1,104.47
|
|
Vaccine tdap >=7 years im
|
$173.40 |
$173.40 |
$173.40 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$147.00 |
$147.00 |
$147.00 |
$112.10
|
|
Valproic acid total therapeutic drug level
|
$27.60 |
$27.60 |
$27.60 |
$114.72
|
|
Vancomycin 1,000 mg intravenous injection
|
$94.20 |
$94.20 |
$94.20 |
$251.86
|
|
Vancomycin 750 mg intravenous solution
|
$82.20 |
$82.20 |
$82.20 |
$90.33
|
|
Vancomycin peak therapeutic drug level
|
$180.00 |
$180.00 |
$180.00 |
$136.13
|
|
Varicella zoster antibody igg
|
$289.20 |
$289.20 |
$289.20 |
$86.80
|
|
Vasopressin 20 unit/ml intravenous solution
|
$325.80 |
$325.80 |
$325.80 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$20,329.80 |
$20,329.80 |
$20,329.80 |
$18,732.33
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$1,759.20 |
$1,759.20 |
$1,759.20 |
$202.80
|
|
Ventilator each subsequent day
|
$397.20 |
$397.20 |
$397.20 |
$1,204.00
|
|
Ventilator initial day
|
$776.40 |
$776.40 |
$776.40 |
$1,431.43
|
|
Vinblastine 1 mg/ml intravenous solution
|
$144.60 |
$144.60 |
$144.60 |
$165.00
|
|
Vincristine 1 mg/ml intravenous solution
|
$36.00 |
$36.00 |
$36.00 |
$87.15
|
|
Vital capacity test
|
$202.80 |
$202.80 |
$202.80 |
$170.00
|
|
Vitamin b-12
|
$208.80 |
$208.80 |
$208.80 |
$100.00
|
|
Vitamin D Test
|
$219.60 |
$219.60 |
$219.60 |
$132.00
|
|
Voriconazole in ns IV syringe 5 mg/ml (pediatric) - cnr
|
$466.20 |
$466.20 |
$466.20 |
$165.81
|
|
Warde 1003990 aldosterone
|
$87.00 |
$87.00 |
$87.00 |
$144.73
|
|
Warde 1005020 citrate 24 hour urine
|
$340.80 |
$340.80 |
$340.80 |
$97.50
|
|
Warde 1005055 5-hiaa 24 hour urine
|
$50.40 |
$50.40 |
$50.40 |
$63.50
|
|
Warde 1006955 catecholamines fractionated 24 hour urine
|
$93.60 |
$93.60 |
$93.60 |
$113.10
|
|
Warde 1007138 vanillymandelic acid 24 hour urine
|
$204.00 |
$204.00 |
$204.00 |
$70.85
|
