|
Three-Phase Bone Scan (Nuclear Medicine)
|
$2,184.80 |
$2,184.80 |
$2,184.80 |
$1,703.45
|
|
Thrombin time
|
$78.40 |
$78.40 |
$78.40 |
$54.18
|
|
Thromboplastin time partial (ptt) substitution fractions each
|
$88.00 |
$88.00 |
$88.00 |
$62.01
|
|
Thyroglobulin antibody
|
$124.00 |
$124.00 |
$124.00 |
$82.50
|
|
Thyroid imaging
|
$853.60 |
$853.60 |
$853.60 |
$695.60
|
|
Thyroid (TSH) Test
|
$133.60 |
$133.60 |
$133.60 |
$112.70
|
|
Thyroid Ultrasound
|
$772.00 |
$772.00 |
$772.00 |
$588.50
|
|
Tirofiban 12.5 mg/50 ml
|
$346.53 |
$346.53 |
$346.53 |
$458.85
|
|
Tissue exam koh skin/hair/nails
|
$63.20 |
$63.20 |
$63.20 |
$47.40
|
|
Tissue transglutaminase iga
|
$233.60 |
$233.60 |
$233.60 |
$44.80
|
|
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
|
$62.68 |
$62.68 |
$62.68 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$78.40 |
$78.40 |
$78.40 |
$120.60
|
|
Toe X-ray (both feet)
|
$305.60 |
$305.60 |
$305.60 |
$258.65
|
|
Tomosynthesis breast screen bilateral
|
$137.60 |
$137.60 |
$137.60 |
$74.10
|
|
Tp53 gene trgt sequence alys
|
$804.00 |
$804.00 |
$804.00 |
$804.00
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$103.20 |
$103.20 |
$103.20 |
$102.27
|
|
Transferrin
|
$62.40 |
$62.40 |
$62.40 |
$82.00
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$742.40 |
$742.40 |
$742.40 |
$561.60
|
|
Transvaginal Pregnancy Ultrasound
|
$656.80 |
$656.80 |
$656.80 |
$499.20
|
|
Trastuzumab 150 mg intravenous solution
|
$2,480.88 |
$2,480.88 |
$2,480.88 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$4,295.74 |
$4,295.74 |
$4,295.74 |
$7,540.20
|
|
Trauma partial team response w/critical care services level 4
|
$2,500.80 |
$2,500.80 |
$2,500.80 |
$4,523.04
|
|
Treat elbow dislocation
|
$2,594.40 |
$2,594.40 |
$2,594.40 |
$2,272.50
|
|
Treat finger fracture each
|
$1,357.60 |
$1,357.60 |
$1,357.60 |
$1,592.00
|
|
Treat hip dislocation
|
$2,472.00 |
$2,472.00 |
$2,472.00 |
$2,211.05
|
|
Treat humerus fracture
|
$2,016.00 |
$2,016.00 |
$2,016.00 |
$1,790.00
|
|
Treponema pallidum antibody
|
$72.80 |
$72.80 |
$72.80 |
$72.05
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$65.61 |
$65.61 |
$65.61 |
$43.09
|
|
Triglycerides
|
$52.00 |
$52.00 |
$52.00 |
$58.50
|
|
Trim nail(s)
|
$75.20 |
$75.20 |
$75.20 |
$79.00
|
|
Trim nondyst nails
|
$115.20 |
$115.20 |
$115.20 |
$113.88
|
|
Troponin quantitative
|
$194.40 |
$194.40 |
$194.40 |
$127.60
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$428.80 |
$428.80 |
$428.80 |
$338.00
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$677.60 |
$677.60 |
$677.60 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$488.00 |
$488.00 |
$488.00 |
$720.15
|
|
Ultrasound ob >=14wks ea addl gest
|
$473.60 |
$473.60 |
$473.60 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$425.60 |
$425.60 |
$425.60 |
$334.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$594.40 |
$594.40 |
$594.40 |
$425.60
|
|
Unlisted dialysis procedure
|
$1,588.00 |
$1,588.00 |
$1,588.00 |
$1,144.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$338.40 |
$338.40 |
$338.40 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$2,437.60 |
$2,437.60 |
$2,437.60 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,144.00 |
$4,144.00 |
$4,144.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,461.60 |
$3,461.60 |
$3,461.60 |
$2,369.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,237.60 |
$3,237.60 |
$3,237.60 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$382.40 |
$382.40 |
$382.40 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$474.40 |
$474.40 |
$474.40 |
$381.60
|
|
Upper GI Barium X-ray (barium only)
|
$910.40 |
$910.40 |
$910.40 |
$607.20
|
|
Urea nitrogen
|
$52.00 |
$52.00 |
$52.00 |
$42.25
|
|
Urea nitrogen 24 hour urine
|
$16.00 |
$16.00 |
$16.00 |
$52.00
|
|
Ureteral reflux study
|
$1,383.20 |
$1,383.20 |
$1,383.20 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$856.80 |
$856.80 |
$856.80 |
$584.00
|
|
Urethrocystography void s&i
|
$1,009.60 |
$1,009.60 |
$1,009.60 |
$631.40
|
|
Uric acid blood
|
$53.60 |
$53.60 |
$53.60 |
$49.44
|
|
Uric acid urine
|
$13.60 |
$13.60 |
$13.60 |
$45.36
|
|
Urinalysis microscopic only
|
$23.20 |
$23.20 |
$23.20 |
$26.46
|
|
Urinalysis (with microscopy)
|
$56.80 |
$56.80 |
$56.80 |
$55.20
|
|
Urinalysis (without microscopy)
|
$36.80 |
$36.80 |
$36.80 |
$36.00
|
|
Urine Culture Test
|
$88.00 |
$88.00 |
$88.00 |
$83.00
|
|
Urine pregnancy test
|
$68.80 |
$68.80 |
$68.80 |
$68.78
|
|
Urography, antegrade
|
$684.80 |
$684.80 |
$684.80 |
$622.35
|
|
Urography inf drip &/or bolus
|
$1,040.00 |
$1,040.00 |
$1,040.00 |
$642.50
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$3,130.79 |
$3,130.79 |
$3,130.79 |
$5,205.00
|
|
Vaccine Administration (one shot)
|
$73.60 |
$73.60 |
$73.60 |
$67.70
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$232.02 |
$232.02 |
$232.02 |
$236.50
|
|
Vaccine dtap < 7 years im
|
$76.58 |
$76.58 |
$76.58 |
$71.17
|
|
Vaccine hepatitis a (hepa) adult im
|
$101.91 |
$101.91 |
$101.91 |
$166.62
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$218.79 |
$218.79 |
$218.79 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$76.32 |
$76.32 |
$76.32 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$443.59 |
$443.59 |
$443.59 |
$576.48
|
|
Vaccine influenza inactivated adjuvant im
|
$53.76 |
$53.76 |
$53.76 |
$110.25
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$29.07 |
$29.07 |
$29.07 |
$82.71
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$394.26 |
$394.26 |
$394.26 |
$394.26
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$238.10 |
$238.10 |
$238.10 |
$409.35
|
|
Vaccine mmr live subcutaneous
|
$104.84 |
$104.84 |
$104.84 |
$213.00
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$192.88 |
$192.88 |
$192.88 |
$252.87
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$287.84 |
$287.84 |
$287.84 |
$397.11
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$365.22 |
$365.22 |
$365.22 |
$414.46
|
|
Vaccine rabies im
|
$564.92 |
$564.92 |
$564.92 |
$858.95
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$106.63 |
$106.63 |
$106.63 |
$126.14
|
|
Vaccine tdap >=7 years im
|
$89.71 |
$89.71 |
$89.71 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$79.88 |
$79.88 |
$79.88 |
$112.10
|
|
Valproic acid total therapeutic drug level
|
$121.60 |
$121.60 |
$121.60 |
$115.00
|
|
Vancomycin 1,000 mg intravenous injection
|
$74.49 |
$74.49 |
$74.49 |
$259.05
|
|
Vancomycin 750 mg intravenous solution
|
$91.42 |
$91.42 |
$91.42 |
$90.33
|
|
Vancomycin peak therapeutic drug level
|
$132.00 |
$132.00 |
$132.00 |
$136.13
|
|
Varicella zoster antibody igg
|
$60.00 |
$60.00 |
$60.00 |
$86.80
|
|
Vasectomy
|
$3,408.00 |
$3,408.00 |
$3,408.00 |
$2,424.12
|
|
Vasopressin 20 unit/ml intravenous solution
|
$64.40 |
$64.40 |
$64.40 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$9,441.12 |
$9,441.12 |
$9,441.12 |
$18,732.33
|
|
Venogram extremity supervision & interpretation unilateral
|
$2,020.00 |
$2,020.00 |
$2,020.00 |
$1,382.58
|
|
Ventilator each subsequent day
|
$1,309.60 |
$1,309.60 |
$1,309.60 |
$1,184.00
|
|
Ventilator Management (first day)
|
$1,497.60 |
$1,497.60 |
$1,497.60 |
$1,434.60
|
|
Video Swallow Study (Modified Barium Swallow)
|
$698.40 |
$698.40 |
$698.40 |
$524.50
|
|
Vincristine 1 mg/ml intravenous solution
|
$315.68 |
$315.68 |
$315.68 |
$87.15
|
|
Vitamin b-12
|
$140.00 |
$140.00 |
$140.00 |
$100.28
|
|
Vitamin D Test
|
$132.00 |
$132.00 |
$132.00 |
$132.00
|
|
Walking (Gait) Training (each 15 minutes)
|
$124.80 |
$124.80 |
$124.80 |
$87.50
|
|
Warde 1003990 aldosterone
|
$293.60 |
$293.60 |
$293.60 |
$144.73
|
|
Warde 1005020 citrate 24 hour urine
|
$72.80 |
$72.80 |
$72.80 |
$100.10
|
