|
Tlso 3mod sacro-scap pre
|
$1,975.85 |
$1,975.85 |
$1,975.85 |
$2,117.57
|
|
Tlso 3 piece rigid shell
|
$791.34 |
$791.34 |
$791.34 |
$1,051.18
|
|
Tlso corset front
|
$169.12 |
$169.12 |
$169.12 |
$244.50
|
|
Tlso full corset
|
$276.53 |
$276.53 |
$276.53 |
$377.78
|
|
Tlso r fram soft ant pre cst
|
$600.43 |
$600.43 |
$600.43 |
$801.11
|
|
Tlso rig fram pelvic pre cst
|
$752.42 |
$752.42 |
$752.42 |
$999.43
|
|
Tlso rigid frame pre subclav
|
$1,041.15 |
$1,041.15 |
$1,041.15 |
$1,382.98
|
|
Tlso rigid lined custom fab
|
$2,669.86 |
$2,669.86 |
$2,669.86 |
$2,831.21
|
|
Tlso rigid lined pre one pie
|
$1,588.50 |
$1,588.50 |
$1,588.50 |
$2,110.02
|
|
Tlso rigid plastic cust fab
|
$2,883.33 |
$2,883.33 |
$2,883.33 |
$2,347.16
|
|
Tlso rigid plastic custom fa
|
$2,390.14 |
$2,390.14 |
$2,390.14 |
$2,788.42
|
|
Tlso rigid plastic pre one
|
$447.66 |
$447.66 |
$447.66 |
$594.61
|
|
Tlso trnk sj-t9 pre cst
|
$548.80 |
$548.80 |
$548.80 |
$523.94
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$141.25 |
$141.25 |
$141.25 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$81.42 |
$81.42 |
$81.42 |
$120.60
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$7,141.75 |
$7,141.75 |
$7,141.75 |
$5,258.52
|
|
Toe X-ray (both feet)
|
$257.66 |
$257.66 |
$257.66 |
$258.65
|
|
Tomosynthesis breast diagnostic left
|
$25.37 |
$25.37 |
$25.37 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$25.37 |
$25.37 |
$25.37 |
$74.10
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$360.04 |
$360.04 |
$360.04 |
$316.84
|
|
Torsion ank & half solid sti
|
$194.71 |
$194.71 |
$194.71 |
$291.13
|
|
Torsion straight knee joint
|
$204.18 |
$204.18 |
$204.18 |
$247.25
|
|
Total tau
|
$609.62 |
$609.62 |
$609.62 |
$312.50
|
|
Tot contact ak/knee disart s
|
$769.55 |
$769.55 |
$769.55 |
$733.60
|
|
Toxoplasma antibody igg
|
$54.43 |
$54.43 |
$54.43 |
$91.65
|
|
Toxoplasma antibody igm
|
$42.45 |
$42.45 |
$42.45 |
$87.75
|
|
Tp53 gene full gene sequence
|
$358.34 |
$358.34 |
$358.34 |
$706.04
|
|
Tp53 gene trgt sequence alys
|
$1,331.18 |
$1,331.18 |
$1,331.18 |
$804.00
|
|
Tpmt gene com vrnts
|
$265.66 |
$265.66 |
$265.66 |
$371.80
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$27.83 |
$27.83 |
$27.83 |
$56.38
|
|
Transferrin
|
$45.08 |
$45.08 |
$45.08 |
$82.00
|
|
Trans shoe caliper plate new
|
$158.98 |
$158.98 |
$158.98 |
$217.22
|
|
Trans shoe calip plate exist
|
$120.74 |
$120.74 |
$120.74 |
$164.98
|
|
Trans shoe solid stirrup exi
|
$120.74 |
$120.74 |
$120.74 |
$141.41
|
|
Trans shoe solid stirrup new
|
$158.98 |
$158.98 |
$158.98 |
$217.22
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$614.26 |
$614.26 |
$614.26 |
$561.60
|
|
Transvaginal Pregnancy Ultrasound
|
$283.53 |
$283.53 |
$283.53 |
$499.20
|
|
Trapezius sling
|
$177.46 |
$177.46 |
$177.46 |
$265.44
|
|
Trastuzumab 150 mg intravenous solution
|
$2,899.00 |
$2,899.00 |
$2,899.00 |
$3,141.85
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$4,505.69 |
$4,505.69 |
$4,505.69 |
$5,846.40
|
|
Trauma partial team response w/critical care services level 4
|
$336.73 |
$336.73 |
$336.73 |
$4,523.04
|
|
Tray bonemarrw oncontrol 102mm
|
$277.87 |
$277.87 |
$277.87 |
$940.80
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$96.32 |
$96.32 |
$96.32 |
$227.70
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$47.99 |
$47.99 |
$47.99 |
$147.48
|
|
Treponema pallidum antibody
|
$177.07 |
$177.07 |
$177.07 |
$72.05
|
|
Trg gene rearrangement anal
|
$177.35 |
$177.35 |
$177.35 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$44.28 |
$44.28 |
$44.28 |
$43.09
|
|
Triamcinolone a inj prs-free
|
$29.32 |
$29.32 |
$29.32 |
$223.56
|
|
Triglycerides
|
$28.06 |
$28.06 |
$28.06 |
$58.50
|
|
Trml dstrj ios bvn 1st 2 l/s
|
$853.27 |
$853.27 |
$853.27 |
$15,258.00
|
|
Trml dstrj ios bvn ea addl
|
$70.00 |
$70.00 |
$70.00 |
$7,354.00
|
|
Troponin quantitative
|
$87.81 |
$87.81 |
$87.81 |
$127.60
|
|
Truss double with standard pad
|
$235.59 |
$235.59 |
$235.59 |
$201.60
|
|
Tte w or without contr, cont ecg
|
$1,816.64 |
$1,816.64 |
$1,816.64 |
$2,067.00
|
|
Tte w or without fol w/con,stres
|
$1,816.64 |
$1,816.64 |
$1,816.64 |
$1,632.80
|
|
Tte w or without fol w/cont, com
|
$1,579.48 |
$1,579.48 |
$1,579.48 |
$1,220.31
|
|
Tte w or without fol w/cont, f/u
|
$508.14 |
$508.14 |
$508.14 |
$1,178.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$15,853.47 |
$15,853.47 |
$15,853.47 |
$21,992.26
|
|
Ultrasound breast complete
|
$409.36 |
$409.36 |
$409.36 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$322.39 |
$322.39 |
$322.39 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$141.68 |
$141.68 |
$141.68 |
$338.00
|
|
Ultrasound elastography ea l target les
|
$240.24 |
$240.24 |
$240.24 |
$180.00
|
|
Ultrasound elastography parenchyma
|
$283.53 |
$283.53 |
$283.53 |
$313.95
|
|
Ultrasound encephalogram
|
$283.53 |
$283.53 |
$283.53 |
$494.92
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$637.90 |
$637.90 |
$637.90 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$286.61 |
$286.61 |
$286.61 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$822.42 |
$822.42 |
$822.42 |
$388.08
|
|
Ultrasound guide intraoperative
|
$986.38 |
$986.38 |
$986.38 |
$632.85
|
|
Ultrasound infant hips ltd without stress
|
$425.21 |
$425.21 |
$425.21 |
$311.25
|
|
Ultrasound joint complete left
|
$425.21 |
$425.21 |
$425.21 |
$557.99
|
|
Ultrasound ob >=14wks ea addl gest
|
$283.53 |
$283.53 |
$283.53 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$425.26 |
$425.26 |
$425.26 |
$334.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$425.21 |
$425.21 |
$425.21 |
$698.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$637.90 |
$637.90 |
$637.90 |
$425.60
|
|
Ultrasound spinal canal and contents
|
$425.21 |
$425.21 |
$425.21 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$283.53 |
$283.53 |
$283.53 |
$419.50
|
|
Ultrasound trgt dyn mbubb 1st les
|
$310.30 |
$310.30 |
$310.30 |
$568.32
|
|
Ultrasound trgt dyn mbubb ea addl
|
$162.85 |
$162.85 |
$162.85 |
$348.00
|
|
Ultraviolet therapy
|
$65.46 |
$65.46 |
$65.46 |
$39.76
|
|
Unlisted chemotherapy px
|
$163.69 |
$163.69 |
$163.69 |
$149.15
|
|
Unlisted cytogenetic study
|
$234.98 |
$234.98 |
$234.98 |
$160.00
|
|
Unlisted mr procedure
|
$2,422.17 |
$2,422.17 |
$2,422.17 |
$1,165.00
|
|
Unlisted procedure liver
|
$1,087.46 |
$1,087.46 |
$1,087.46 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$3,729.32 |
$3,729.32 |
$3,729.32 |
$530.00
|
|
Unlisted procedure pancreas
|
$801.47 |
$801.47 |
$801.47 |
$4,810.00
|
|
Unlisted px small intestine
|
$700.17 |
$700.17 |
$700.17 |
$2,118.35
|
|
Unlisted px tongue flr mouth
|
$953.40 |
$953.40 |
$953.40 |
$282.50
|
|
Unlisted reprod med lab proc
|
$92.68 |
$92.68 |
$92.68 |
$70.00
|
|
Unlisted transfusion med px
|
$426.72 |
$426.72 |
$426.72 |
$147.50
|
|
Unlisted ultrasound procedure
|
$425.21 |
$425.21 |
$425.21 |
$332.16
|
|
Unlisted urinalysis px
|
$57.62 |
$57.62 |
$57.62 |
$25.72
|
|
Upper Arm (Humerus) X-ray (left side)
|
$257.66 |
$257.66 |
$257.66 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$1,192.13 |
$1,192.13 |
$1,192.13 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$794.70 |
$794.70 |
$794.70 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,018.46 |
$2,018.46 |
$2,018.46 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,614.76 |
$1,614.76 |
$1,614.76 |
$2,369.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,211.06 |
$1,211.06 |
$1,211.06 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$257.66 |
$257.66 |
$257.66 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$171.81 |
$171.81 |
$171.81 |
$381.60
|
|
Upper ext fx orthosis rad/ul
|
$565.66 |
$565.66 |
$565.66 |
$619.49
|
