|
Tissue transglutaminase iga
|
$43.55 |
$43.55 |
$43.55 |
$48.57
|
|
Tlh w/t/o 250 g or less
|
$40,402.32 |
$40,402.32 |
$40,402.32 |
$10,799.26
|
|
Tlh w/t/o uterus over 250 g
|
$63,022.06 |
$63,022.06 |
$63,022.06 |
$10,700.71
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$250.25 |
$250.25 |
$250.25 |
$72.00
|
|
Tobramycin peak therapeutic drug level
|
$222.95 |
$222.95 |
$222.95 |
$117.00
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$4,323.51 |
$4,323.51 |
$4,323.51 |
$2,743.02
|
|
Tomosynthesis breast diagnostic left
|
$163.15 |
$163.15 |
$163.15 |
$53.92
|
|
Tomosynthesis breast screen bilateral
|
$163.15 |
$163.15 |
$163.15 |
$77.46
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$240.84 |
$240.84 |
$240.84 |
$200.93
|
|
Total tau
|
$377.00 |
$377.00 |
$377.00 |
$282.60
|
|
Toxoplasma antibody igg
|
$166.40 |
$166.40 |
$166.40 |
$83.20
|
|
Toxoplasma antibody igm
|
$199.55 |
$199.55 |
$199.55 |
$85.80
|
|
Tp53 gene trgt sequence alys
|
$1,022.45 |
$1,022.45 |
$1,022.45 |
$919.10
|
|
Tpmt gene com vrnts
|
$194.35 |
$194.35 |
$194.35 |
$402.35
|
|
Tprnl plmt biodegrdabl matrl
|
$21,390.64 |
$21,390.64 |
$21,390.64 |
$7,438.40
|
|
Transcath closure of asd
|
$14,353.30 |
$14,353.30 |
$14,353.30 |
$19,715.47
|
|
Transcatheter bx s&i
|
$2,388.75 |
$2,388.75 |
$2,388.75 |
$1,795.70
|
|
Transferrin
|
$149.50 |
$149.50 |
$149.50 |
$83.07
|
|
Transfusion blood/blood component(s)
|
$3,354.65 |
$3,354.65 |
$3,354.65 |
$988.24
|
|
Trastuzumab 150 mg intravenous solution
|
$2,540.23 |
$2,540.23 |
$2,540.23 |
$934.80
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$6,196.09 |
$6,196.09 |
$6,196.09 |
$43.28
|
|
Treatment incomplete abortion completed surgically any trimester
|
$15,166.96 |
$15,166.96 |
$15,166.96 |
$3,916.04
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$72.80 |
$72.80 |
$72.80 |
$224.90
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$224.25 |
$224.25 |
$224.25 |
$197.60
|
|
Treatment missed abortion completed surgically 1st trimester
|
$15,649.06 |
$15,649.06 |
$15,649.06 |
$3,820.53
|
|
Treatment radiation delivery level 2
|
$21,756.15 |
$21,756.15 |
$21,756.15 |
$737.25
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$68,943.21 |
$68,943.21 |
$68,943.21 |
$200.64
|
|
Treponema pallidum antibody
|
$116.35 |
$116.35 |
$116.35 |
$74.40
|
|
Trg gene rearrangement anal
|
$569.40 |
$569.40 |
$569.40 |
$474.50
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$199.26 |
$199.26 |
$199.26 |
$28.90
|
|
Triglycerides
|
$124.80 |
$124.80 |
$124.80 |
$48.75
|
|
Trml dstrj ios bvn 1st 2 l/s
|
$34,200.77 |
$34,200.77 |
$34,200.77 |
$15,111.95
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$101,048.09 |
$101,048.09 |
$101,048.09 |
$9,565.92
|
|
Trnscath plc vas stent w/s&i ini vein
|
$101,048.09 |
$101,048.09 |
$101,048.09 |
$15,873.70
|
|
Trnscath retrv pq vasc fb w/guide
|
$53,213.79 |
$53,213.79 |
$53,213.79 |
$5,555.55
|
|
Troponin quantitative
|
$303.55 |
$303.55 |
$303.55 |
$112.80
|
|
Tte w or without contr, cont ecg
|
$2,067.00 |
$2,067.00 |
$2,067.00 |
$1,613.95
|
|
Tx atrial fib pulm vein isol
|
$17,609.15 |
$17,609.15 |
$17,609.15 |
$32,426.20
|
|
Ua w/micro/comp poc
|
$46.15 |
$46.15 |
$46.15 |
$25.72
|
|
Ugt1a1 gene analy common variants
|
$648.70 |
$648.70 |
$648.70 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$257.40 |
$257.40 |
$257.40 |
$394.20
|
|
Ultrasound breast complete
|
$285.35 |
$285.35 |
$285.35 |
$519.20
|
|
Ultrasound breast unilateral limited (both sides)
|
$285.35 |
$285.35 |
$285.35 |
$427.00
|
|
Ultrasound chest
|
$503.10 |
$503.10 |
$503.10 |
$430.10
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$564.20 |
$564.20 |
$564.20 |
$340.03
|
|
Ultrasound encephalogram
|
$584.35 |
$584.35 |
$584.35 |
$463.50
|
|
Ultrasound exam k transpl w/doppler
|
$716.95 |
$716.95 |
$716.95 |
$494.00
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$652.60 |
$652.60 |
$652.60 |
$428.68
|
|
Ultrasound guided needle placement supervision & interpretation
|
$703.30 |
$703.30 |
$703.30 |
$629.64
|
|
Ultrasound guide intraoperative
|
$546.65 |
$546.65 |
$546.65 |
$628.80
|
|
Ultrasound hips infant dynamic
|
$665.60 |
$665.60 |
$665.60 |
$395.20
|
|
Ultrasound infant hips ltd without stress
|
$377.65 |
$377.65 |
$377.65 |
$311.25
|
|
Ultrasound joint/nonvascular extremity limited left
|
$1,318.85 |
$1,318.85 |
$1,318.85 |
$426.60
|
|
Ultrasound ob >=14wks ea addl gest
|
$342.55 |
$342.55 |
$342.55 |
$431.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$220.35 |
$220.35 |
$220.35 |
$304.80
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,190.15 |
$1,190.15 |
$1,190.15 |
$680.71
|
|
Ultrasound pregnant uterus follow up per fetus
|
$220.35 |
$220.35 |
$220.35 |
$393.32
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$627.25 |
$627.25 |
$627.25 |
$434.20
|
|
Ultrasound pregnant uterus transvaginal
|
$342.55 |
$342.55 |
$342.55 |
$477.10
|
|
Ultrasound prostate/transrectal
|
$366.60 |
$366.60 |
$366.60 |
$515.63
|
|
Ultrasound retroperitoneal limited
|
$873.60 |
$873.60 |
$873.60 |
$469.58
|
|
Ultrasound scrotum and contents
|
$949.00 |
$949.00 |
$949.00 |
$558.03
|
|
Ultrasound spinal canal and contents
|
$382.85 |
$382.85 |
$382.85 |
$415.00
|
|
Ultrasound transabd ea addl gest
|
$342.55 |
$342.55 |
$342.55 |
$424.80
|
|
Ultrasound transvaginal non obstetric
|
$905.45 |
$905.45 |
$905.45 |
$523.20
|
|
Unlisted laparoscopic liver biopy 47379
|
$24,890.05 |
$24,890.05 |
$24,890.05 |
$6,307.38
|
|
Unlisted laparoscopic procedure 49659
|
$26,568.24 |
$26,568.24 |
$26,568.24 |
$6,838.32
|
|
Unlisted mr procedure
|
$2,579.85 |
$2,579.85 |
$2,579.85 |
$1,249.50
|
|
Unlisted neurological dx px
|
$413.40 |
$413.40 |
$413.40 |
$176.93
|
|
Unlisted procedure microbiology
|
$33.80 |
$33.80 |
$33.80 |
$384.15
|
|
Unlisted px arthroscopy
|
$54,739.68 |
$54,739.68 |
$54,739.68 |
$11,433.76
|
|
Unlisted px small intestine
|
$5,335.40 |
$5,335.40 |
$5,335.40 |
$2,493.00
|
|
Unlstd laps px sprmatic cord
|
$29,217.19 |
$29,217.19 |
$29,217.19 |
$4,608.50
|
|
Unsched dialysis esrd pt hos
|
$1,398.80 |
$1,398.80 |
$1,398.80 |
$980.20
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,146.00 |
$3,146.00 |
$3,146.00 |
$2,590.50
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,392.00 |
$2,392.00 |
$2,392.00 |
$2,001.87
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,189.20 |
$2,189.20 |
$2,189.20 |
$1,794.00
|
|
Upper Endoscopy (EGD, diagnostic)
|
$6,098.96 |
$6,098.96 |
$6,098.96 |
$1,760.00
|
|
Upper Endoscopy (EGD, with biopsy)
|
$7,903.79 |
$7,903.79 |
$7,903.79 |
$1,760.00
|
|
Uppr gi scope w/submuc inj
|
$6,924.24 |
$6,924.24 |
$6,924.24 |
$1,247.13
|
|
Urea nitrogen
|
$90.35 |
$90.35 |
$90.35 |
$38.25
|
|
Urea nitrogen 24 hour urine
|
$93.60 |
$93.60 |
$93.60 |
$42.90
|
|
Urethrcystgrphy rtrgrde s&i
|
$496.60 |
$496.60 |
$496.60 |
$554.28
|
|
Urethrocystography void s&i
|
$923.65 |
$923.65 |
$923.65 |
$586.50
|
|
Uric acid blood
|
$111.15 |
$111.15 |
$111.15 |
$44.00
|
|
Uric acid urine
|
$120.25 |
$120.25 |
$120.25 |
$43.20
|
|
Urinalysis microscopic only
|
$35.10 |
$35.10 |
$35.10 |
$25.72
|
|
Urinalysis (with microscopy)
|
$113.75 |
$113.75 |
$113.75 |
$37.39
|
|
Urinalysis (without microscopy)
|
$81.25 |
$81.25 |
$81.25 |
$33.00
|
|
Urine Culture Test
|
$159.90 |
$159.90 |
$159.90 |
$63.84
|
|
Urine pregnancy test
|
$137.80 |
$137.80 |
$137.80 |
$57.00
|
|
Urography, antegrade
|
$707.85 |
$707.85 |
$707.85 |
$593.37
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$7,241.17 |
$7,241.17 |
$7,241.17 |
$8,225.22
|
|
Vaccine dtap < 7 years im
|
$92.42 |
$92.42 |
$92.42 |
$66.69
|
|
Vaccine dtap-hep b-ipv im
|
$349.24 |
$349.24 |
$349.24 |
$169.85
|
|
Vaccine dtap-ipv/hib im
|
$412.03 |
$412.03 |
$412.03 |
$199.37
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$99.85 |
$99.85 |
$99.85 |
$70.53
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$288.66 |
$288.66 |
$288.66 |
$84.38
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$241.64 |
$241.64 |
$241.64 |
$162.07
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$95.41 |
$95.41 |
$95.41 |
$75.39
|