|
Tc-99m mebrofenin
|
$127.20 |
$127.20 |
$127.20 |
$157.65
|
|
Tc-99m medronate
|
$118.80 |
$118.80 |
$118.80 |
$111.01
|
|
Tc-99m mertiatide
|
$460.80 |
$460.80 |
$460.80 |
$756.00
|
|
Tc-99m pentetate dtpa
|
$118.80 |
$118.80 |
$118.80 |
$224.40
|
|
Tc-99m pertechnetate per mci
|
$3.00 |
$3.00 |
$3.00 |
$22.10
|
|
Tc-99m sestamibi p study dose
|
$369.00 |
$369.00 |
$369.00 |
$289.80
|
|
Tc-99m sulfur colloid
|
$135.00 |
$135.00 |
$135.00 |
$240.50
|
|
Tc-99m tilmanocept diag
|
$860.40 |
$860.40 |
$860.40 |
$955.60
|
|
T cells absolute cd4/cd8 including ratio
|
$235.80 |
$235.80 |
$235.80 |
$175.00
|
|
T cells total count
|
$120.00 |
$120.00 |
$120.00 |
$123.00
|
|
Telehealth original site facility fee
|
$30.60 |
$30.60 |
$30.60 |
$51.85
|
|
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial)
|
$21,126.00 |
$21,126.00 |
$21,126.00 |
$15,245.38
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$16.20 |
$16.20 |
$16.20 |
$37.76
|
|
Test stress cardiovascular tracing only
|
$484.20 |
$484.20 |
$484.20 |
$949.92
|
|
Theophylline therapeutic drug level
|
$120.60 |
$120.60 |
$120.60 |
$108.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$17.40 |
$17.40 |
$17.40 |
$25.54
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$1,608.00 |
$1,608.00 |
$1,608.00 |
$1,687.50
|
|
Thrombin time
|
$76.80 |
$76.80 |
$76.80 |
$53.76
|
|
Thromboplastin inhibition
|
$46.80 |
$46.80 |
$46.80 |
$55.20
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$180.00 |
$180.00 |
$180.00 |
$61.50
|
|
Thyroglobulin antibody
|
$477.60 |
$477.60 |
$477.60 |
$81.90
|
|
Thyroid imaging
|
$663.00 |
$663.00 |
$663.00 |
$695.02
|
|
Thyroid (TSH) Test
|
$158.40 |
$158.40 |
$158.40 |
$112.00
|
|
Thyroid Ultrasound
|
$643.20 |
$643.20 |
$643.20 |
$588.50
|
|
Thyroid uptake measurement
|
$297.00 |
$297.00 |
$297.00 |
$590.05
|
|
Thyroxine binding globulin (tbg)
|
$186.60 |
$186.60 |
$186.60 |
$64.35
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$152.63 |
$152.63 |
$152.63 |
$2,516.07
|
|
Tissue matrix xcm thk 20x30cm -cost per sq cm
|
$830.41 |
$830.41 |
$830.41 |
$18,999.96
|
|
Tobramycin peak therapeutic drug level
|
$169.20 |
$169.20 |
$169.20 |
$121.55
|
|
Tomosynthesis breast diagnostic left
|
$42.00 |
$42.00 |
$42.00 |
$71.40
|
|
Tomosynthesis breast screen bilateral
|
$42.00 |
$42.00 |
$42.00 |
$68.43
|
|
Toxoplasma antibody igg
|
$185.40 |
$185.40 |
$185.40 |
$89.24
|
|
Toxoplasma antibody igm
|
$435.60 |
$435.60 |
$435.60 |
$87.00
|
|
Tpmt gene com vrnts
|
$619.20 |
$619.20 |
$619.20 |
$371.80
|
|
Transferrin
|
$102.60 |
$102.60 |
$102.60 |
$81.60
|
|
Transfusion blood/blood component(s)
|
$546.60 |
$546.60 |
$546.60 |
$936.80
|
|
Trastuzumab 150 mg intravenous solution
|
$5,196.60 |
$5,196.60 |
$5,196.60 |
$3,141.85
|
|
Trauma partial team response w/critical care services level 4
|
$1,602.60 |
$1,602.60 |
$1,602.60 |
$4,063.80
|
|
Treat fracture of radius
|
$935.40 |
$935.40 |
$935.40 |
$1,790.00
|
|
Treat hip dislocation
|
$2,643.60 |
$2,643.60 |
$2,643.60 |
$2,612.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$247.20 |
$247.20 |
$247.20 |
$203.49
|
|
Treatment of ankle fracture 27786
|
$240.60 |
$240.60 |
$240.60 |
$520.80
|
|
Treatment of toe fracture 28510
|
$108.00 |
$108.00 |
$108.00 |
$362.00
|
|
Treat metatarsal fracture
|
$4,515.00 |
$4,515.00 |
$4,515.00 |
$3,839.54
|
|
Treponema pallidum antibody
|
$168.00 |
$168.00 |
$168.00 |
$69.60
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$239.40 |
$239.40 |
$239.40 |
$43.05
|
|
Triglycerides
|
$82.80 |
$82.80 |
$82.80 |
$56.94
|
|
Troponin quantitative
|
$149.40 |
$149.40 |
$149.40 |
$125.00
|
|
Tx closed hip disl traumatic without anes
|
$267.60 |
$267.60 |
$267.60 |
$568.80
|
|
Ua w/micro/comp poc
|
$58.20 |
$58.20 |
$58.20 |
$24.45
|
|
Ultrasound abdomen aorta screening study aaa
|
$404.40 |
$404.40 |
$404.40 |
$394.20
|
|
Ultrasound breast complete
|
$718.20 |
$718.20 |
$718.20 |
$530.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$361.20 |
$361.20 |
$361.20 |
$455.20
|
|
Ultrasound chest
|
$857.40 |
$857.40 |
$857.40 |
$458.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$939.00 |
$939.00 |
$939.00 |
$477.10
|
|
Ultrasound guidance for vascular access
|
$97.80 |
$97.80 |
$97.80 |
$384.45
|
|
Ultrasound guided needle placement supervision & interpretation
|
$904.20 |
$904.20 |
$904.20 |
$720.00
|
|
Ultrasound hips infant dynamic
|
$331.80 |
$331.80 |
$331.80 |
$403.88
|
|
Ultrasound joint complete left
|
$461.40 |
$461.40 |
$461.40 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$299.40 |
$299.40 |
$299.40 |
$419.25
|
|
Ultrasound ob >=14wks ea addl gest
|
$279.60 |
$279.60 |
$279.60 |
$393.43
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$279.60 |
$279.60 |
$279.60 |
$331.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,193.40 |
$1,193.40 |
$1,193.40 |
$698.50
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$643.20 |
$643.20 |
$643.20 |
$451.00
|
|
Ultrasound pregnant uterus transvaginal
|
$808.20 |
$808.20 |
$808.20 |
$488.40
|
|
Ultrasound retroperitoneal limited
|
$808.20 |
$808.20 |
$808.20 |
$477.10
|
|
Ultrasound scrotum and contents
|
$808.20 |
$808.20 |
$808.20 |
$612.55
|
|
Ultrasound transabd ea addl gest
|
$808.20 |
$808.20 |
$808.20 |
$423.36
|
|
Ultrasound transvaginal non obstetric
|
$808.20 |
$808.20 |
$808.20 |
$558.35
|
|
Unsched dialysis esrd pt hos
|
$1,500.00 |
$1,500.00 |
$1,500.00 |
$1,266.30
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,588.80 |
$4,588.80 |
$4,588.80 |
$2,984.45
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,851.80 |
$2,851.80 |
$2,851.80 |
$2,034.41
|
|
Urea nitrogen
|
$64.20 |
$64.20 |
$64.20 |
$40.80
|
|
Urethrocystography void s&i
|
$334.80 |
$334.80 |
$334.80 |
$634.50
|
|
Uric acid blood
|
$60.00 |
$60.00 |
$60.00 |
$49.32
|
|
Uric acid urine
|
$64.20 |
$64.20 |
$64.20 |
$44.14
|
|
Urinalysis microscopic only
|
$52.20 |
$52.20 |
$52.20 |
$26.35
|
|
Urinalysis (with microscopy)
|
$57.60 |
$57.60 |
$57.60 |
$55.20
|
|
Urinalysis (without microscopy)
|
$27.00 |
$27.00 |
$27.00 |
$36.00
|
|
Urine Culture Test
|
$108.60 |
$108.60 |
$108.60 |
$80.60
|
|
Urine pregnancy test
|
$122.40 |
$122.40 |
$122.40 |
$66.87
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$7,440.00 |
$7,440.00 |
$7,440.00 |
$5,084.76
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$103,222.80 |
$103,222.80 |
$103,222.80 |
$50,368.90
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$589.50 |
$589.50 |
$589.50 |
$239.85
|
|
Vaccine dtap < 7 years im
|
$109.80 |
$109.80 |
$109.80 |
$69.46
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$189.00 |
$189.00 |
$189.00 |
$150.85
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$102.00 |
$102.00 |
$102.00 |
$72.24
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$61.80 |
$61.80 |
$61.80 |
$35.04
|
|
Vaccine mmr live subcutaneous
|
$243.60 |
$243.60 |
$243.60 |
$213.00
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$991.20 |
$991.20 |
$991.20 |
$561.12
|
|
Vaccine rabies im
|
$1,326.00 |
$1,326.00 |
$1,326.00 |
$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 |
$114.48
|
|
Vancomycin 1,000 mg intravenous injection
|
$94.20 |
$94.20 |
$94.20 |
$246.70
|
|
Vancomycin 750 mg intravenous solution
|
$93.60 |
$93.60 |
$93.60 |
$90.33
|
|
Vancomycin peak therapeutic drug level
|
$168.00 |
$168.00 |
$168.00 |
$131.30
|
|
Varicella zoster antibody igg
|
$287.40 |
$287.40 |
$287.40 |
$86.80
|
|
Vasectomy
|
$1,316.88 |
$1,316.88 |
$1,316.88 |
$2,424.12
|
