|
T3 (triiodothyronine) free
|
$316.80 |
$316.80 |
$316.80 |
$99.20
|
|
T3 (triiodothyronine) total
|
$183.00 |
$183.00 |
$183.00 |
$93.52
|
|
T4 (thyroxine) free
|
$169.20 |
$169.20 |
$169.20 |
$85.20
|
|
T4 (thyroxine) total
|
$189.00 |
$189.00 |
$189.00 |
$69.00
|
|
Tacrolimus 1 mg capsule, immediate-release
|
$3.60 |
$3.60 |
$3.60 |
$9.84
|
|
Tacrolimus therapeutic drug level
|
$120.00 |
$120.00 |
$120.00 |
$122.40
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$132.60 |
$132.60 |
$132.60 |
$177.65
|
|
Tc-99m labeled rbc
|
$213.60 |
$213.60 |
$213.60 |
$302.40
|
|
Tc-99m maa
|
$108.60 |
$108.60 |
$108.60 |
$292.80
|
|
Tc-99m mebrofenin
|
$124.80 |
$124.80 |
$124.80 |
$157.65
|
|
Tc-99m medronate
|
$108.60 |
$108.60 |
$108.60 |
$111.01
|
|
Tc-99m mertiatide
|
$402.00 |
$402.00 |
$402.00 |
$756.00
|
|
Tc-99m pentetate dtpa
|
$108.60 |
$108.60 |
$108.60 |
$222.60
|
|
Tc-99m pertechnetate per mci
|
$4.20 |
$4.20 |
$4.20 |
$22.10
|
|
Tc-99m sestamibi p study dose
|
$352.80 |
$352.80 |
$352.80 |
$274.45
|
|
Tc-99m sulfur colloid
|
$108.60 |
$108.60 |
$108.60 |
$240.50
|
|
Tc-99m tetrofosmin p study dose
|
$301.80 |
$301.80 |
$301.80 |
$190.80
|
|
Tc-99m tilmanocept diag
|
$887.40 |
$887.40 |
$887.40 |
$955.60
|
|
T cells absolute cd4/cd8 including ratio
|
$154.80 |
$154.80 |
$154.80 |
$176.40
|
|
T cells absolute cd 4 count
|
$28.80 |
$28.80 |
$28.80 |
$111.20
|
|
T cells total count
|
$124.80 |
$124.80 |
$124.80 |
$126.90
|
|
Telehealth original site facility fee
|
$32.40 |
$32.40 |
$32.40 |
$51.00
|
|
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 |
$39.33
|
|
Test stress cardiovascular tracing only
|
$470.40 |
$470.40 |
$470.40 |
$949.70
|
|
Theophylline therapeutic drug level
|
$126.00 |
$126.00 |
$126.00 |
$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)
|
$1,224.00 |
$1,224.00 |
$1,224.00 |
$1,687.50
|
|
Thrombin time
|
$76.80 |
$76.80 |
$76.80 |
$53.76
|
|
Thromboplastin inhibition
|
$46.80 |
$46.80 |
$46.80 |
$53.30
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$77.40 |
$77.40 |
$77.40 |
$61.52
|
|
Thyroglobulin antibody
|
$183.00 |
$183.00 |
$183.00 |
$82.00
|
|
Thyroid (TSH) Test
|
$165.60 |
$165.60 |
$165.60 |
$111.00
|
|
Thyroid Ultrasound
|
$720.00 |
$720.00 |
$720.00 |
$588.50
|
|
Thyroid uptake measurement
|
$323.40 |
$323.40 |
$323.40 |
$591.25
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$6,846.00 |
$6,846.00 |
$6,846.00 |
$4,112.43
|
|
Thyroxine binding globulin (tbg)
|
$193.20 |
$193.20 |
$193.20 |
$64.35
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$12.00 |
$12.00 |
$12.00 |
$152.36
|
|
Tocilizumab for covid-19
|
$7,282.20 |
$7,282.20 |
$7,282.20 |
$21.08
|
|
Tomosynthesis breast diagnostic left
|
$40.20 |
$40.20 |
$40.20 |
$73.00
|
|
Tomosynthesis breast screen bilateral
|
$64.80 |
$64.80 |
$64.80 |
$72.68
|
|
Toxoplasma antibody igg
|
$190.20 |
$190.20 |
$190.20 |
$89.40
|
|
Toxoplasma antibody igm
|
$190.20 |
$190.20 |
$190.20 |
$87.00
|
|
Transferrin
|
$105.60 |
$105.60 |
$105.60 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$616.80 |
$616.80 |
$616.80 |
$983.00
|
|
Trauma partial team response w/critical care services level 4
|
$1,512.00 |
$1,512.00 |
$1,512.00 |
$4,523.04
|
|
Treat fracture of radius
|
$899.40 |
$899.40 |
$899.40 |
$1,790.00
|
|
Treat knee fracture(s)
|
$172.80 |
$172.80 |
$172.80 |
$642.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$133.80 |
$133.80 |
$133.80 |
$203.35
|
|
Treat toe dislocation
|
$2,539.20 |
$2,539.20 |
$2,539.20 |
$756.39
|
|
Treponema pallidum antibody
|
$172.20 |
$172.20 |
$172.20 |
$70.40
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$31.80 |
$31.80 |
$31.80 |
$43.21
|
|
Triglycerides
|
$85.20 |
$85.20 |
$85.20 |
$58.05
|
|
Trim nondyst nails
|
$34.20 |
$34.20 |
$34.20 |
$113.40
|
|
Troponin quantitative
|
$153.60 |
$153.60 |
$153.60 |
$127.20
|
|
Ua w/micro/comp poc
|
$58.20 |
$58.20 |
$58.20 |
$23.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$42,093.60 |
$42,093.60 |
$42,093.60 |
$20,945.01
|
|
Ultrasound abdomen aorta screening study aaa
|
$452.40 |
$452.40 |
$452.40 |
$394.20
|
|
Ultrasound breast complete
|
$807.00 |
$807.00 |
$807.00 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$403.80 |
$403.80 |
$403.80 |
$449.35
|
|
Ultrasound chest
|
$958.20 |
$958.20 |
$958.20 |
$460.85
|
|
Ultrasound encephalogram
|
$805.80 |
$805.80 |
$805.80 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$578.40 |
$578.40 |
$578.40 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$153.60 |
$153.60 |
$153.60 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$458.40 |
$458.40 |
$458.40 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$1,010.40 |
$1,010.40 |
$1,010.40 |
$720.15
|
|
Ultrasound guide intraoperative
|
$132.60 |
$132.60 |
$132.60 |
$632.85
|
|
Ultrasound hips infant dynamic
|
$733.20 |
$733.20 |
$733.20 |
$403.88
|
|
Ultrasound joint complete left
|
$255.00 |
$255.00 |
$255.00 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$331.80 |
$331.80 |
$331.80 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$316.20 |
$316.20 |
$316.20 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$316.20 |
$316.20 |
$316.20 |
$331.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$904.80 |
$904.80 |
$904.80 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$720.00 |
$720.00 |
$720.00 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$448.20 |
$448.20 |
$448.20 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$904.80 |
$904.80 |
$904.80 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$452.40 |
$452.40 |
$452.40 |
$486.50
|
|
Ultrasound scrotum and contents
|
$904.80 |
$904.80 |
$904.80 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$432.00 |
$432.00 |
$432.00 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$1,073.40 |
$1,073.40 |
$1,073.40 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$904.80 |
$904.80 |
$904.80 |
$558.35
|
|
Unlisted chemotherapy px
|
$58.20 |
$58.20 |
$58.20 |
$150.00
|
|
Unlisted procedure rectum
|
$982.20 |
$982.20 |
$982.20 |
$1,220.35
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$5,052.00 |
$5,052.00 |
$5,052.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,324.00 |
$3,324.00 |
$3,324.00 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,325.20 |
$3,325.20 |
$3,325.20 |
$2,034.41
|
|
Upper Endoscopy (EGD, diagnostic)
|
$623.40 |
$623.40 |
$623.40 |
$1,751.66
|
|
Upper Endoscopy (EGD, with biopsy)
|
$589.80 |
$589.80 |
$589.80 |
$1,768.00
|
|
Urea nitrogen
|
$71.40 |
$71.40 |
$71.40 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$58.80 |
$58.80 |
$58.80 |
$51.75
|
|
Urea nitrogen clearance
|
$139.20 |
$139.20 |
$139.20 |
$42.25
|
|
Urethrocystography void s&i
|
$334.80 |
$334.80 |
$334.80 |
$622.35
|
|
Uric acid blood
|
$60.00 |
$60.00 |
$60.00 |
$48.75
|
|
Uric acid urine
|
$64.20 |
$64.20 |
$64.20 |
$44.33
|
|
Urinalysis microscopic only
|
$54.00 |
$54.00 |
$54.00 |
$26.35
|
|
Urinalysis (with microscopy)
|
$55.20 |
$55.20 |
$55.20 |
$55.00
|
|
Urinalysis (without microscopy)
|
$31.80 |
$31.80 |
$31.80 |
$35.75
|
|
Urine Culture Test
|
$116.40 |
$116.40 |
$116.40 |
$81.50
|
|
Urine pregnancy test
|
$127.20 |
$127.20 |
$127.20 |
$67.20
|
|
Urography inf drip &/or bolus
|
$739.80 |
$739.80 |
$739.80 |
$642.50
|
