|
Thyroid met uptake
|
$747.20 |
$747.20 |
$747.20 |
$398.40
|
|
Thyroid (TSH) Test
|
$40.00 |
$40.00 |
$40.00 |
$111.00
|
|
Thyroid Ultrasound
|
$1,031.20 |
$1,031.20 |
$1,031.20 |
$588.50
|
|
Thyroid uptake measurement
|
$1,713.60 |
$1,713.60 |
$1,713.60 |
$591.25
|
|
Thyroxine binding globulin (tbg)
|
$61.60 |
$61.60 |
$61.60 |
$64.35
|
|
Tilt table study
|
$2,605.60 |
$2,605.60 |
$2,605.60 |
$1,507.01
|
|
Tissue culture skin/biopsy
|
$591.20 |
$591.20 |
$591.20 |
$484.00
|
|
Tissue exam koh skin/hair/nails
|
$17.60 |
$17.60 |
$17.60 |
$47.20
|
|
Tissue transglutaminase iga
|
$48.00 |
$48.00 |
$48.00 |
$44.16
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$808.80 |
$808.80 |
$808.80 |
$152.36
|
|
Tomosynthesis breast screen bilateral
|
$91.20 |
$91.20 |
$91.20 |
$72.68
|
|
Toxoplasma antibody igg
|
$60.00 |
$60.00 |
$60.00 |
$89.40
|
|
Toxoplasma antibody igm
|
$60.00 |
$60.00 |
$60.00 |
$87.00
|
|
Tpmt gene com vrnts
|
$360.80 |
$360.80 |
$360.80 |
$371.80
|
|
Tracheobrnchsc thru est trachs incisn
|
$1,532.00 |
$1,532.00 |
$1,532.00 |
$1,420.44
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$56.00 |
$56.00 |
$56.00 |
$101.25
|
|
Transferrin
|
$50.00 |
$50.00 |
$50.00 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$1,714.40 |
$1,714.40 |
$1,714.40 |
$983.00
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$549.60 |
$549.60 |
$549.60 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$255.20 |
$255.20 |
$255.20 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$246.40 |
$246.40 |
$246.40 |
$203.35
|
|
Treatment of ankle fracture 27786
|
$1,197.60 |
$1,197.60 |
$1,197.60 |
$520.80
|
|
Treatment of fibula fracture 27780
|
$1,192.80 |
$1,192.80 |
$1,192.80 |
$491.50
|
|
Treponema pallidum antibody
|
$55.20 |
$55.20 |
$55.20 |
$70.40
|
|
Trg gene rearrangement anal
|
$838.40 |
$838.40 |
$838.40 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$30.40 |
$30.40 |
$30.40 |
$43.21
|
|
Triglycerides
|
$24.00 |
$24.00 |
$24.00 |
$58.05
|
|
Trnscath plc vas stent w/s&i ini vein
|
$22,448.00 |
$22,448.00 |
$22,448.00 |
$15,330.11
|
|
Trnscath retrv pq vasc fb w/guide
|
$3,180.80 |
$3,180.80 |
$3,180.80 |
$4,523.96
|
|
Troponin quantitative
|
$62.40 |
$62.40 |
$62.40 |
$127.20
|
|
Tx closed hip disl traumatic without anes
|
$1,468.80 |
$1,468.80 |
$1,468.80 |
$581.07
|
|
Ultrasound abdomen aorta screening study aaa
|
$695.20 |
$695.20 |
$695.20 |
$394.20
|
|
Ultrasound breast complete
|
$540.80 |
$540.80 |
$540.80 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$492.00 |
$492.00 |
$492.00 |
$449.35
|
|
Ultrasound chest
|
$631.20 |
$631.20 |
$631.20 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$672.00 |
$672.00 |
$672.00 |
$338.00
|
|
Ultrasound elastography parenchyma
|
$249.60 |
$249.60 |
$249.60 |
$307.00
|
|
Ultrasound encephalogram
|
$588.80 |
$588.80 |
$588.80 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$544.00 |
$544.00 |
$544.00 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$748.00 |
$748.00 |
$748.00 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$504.00 |
$504.00 |
$504.00 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$1,047.20 |
$1,047.20 |
$1,047.20 |
$720.15
|
|
Ultrasound hips infant dynamic
|
$636.80 |
$636.80 |
$636.80 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$196.80 |
$196.80 |
$196.80 |
$311.25
|
|
Ultrasound joint complete left
|
$575.20 |
$575.20 |
$575.20 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$468.00 |
$468.00 |
$468.00 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$364.00 |
$364.00 |
$364.00 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$336.80 |
$336.80 |
$336.80 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,229.60 |
$1,229.60 |
$1,229.60 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$820.80 |
$820.80 |
$820.80 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$699.20 |
$699.20 |
$699.20 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$696.00 |
$696.00 |
$696.00 |
$497.12
|
|
Ultrasound retroperitoneal limited
|
$900.80 |
$900.80 |
$900.80 |
$486.50
|
|
Ultrasound scrotum and contents
|
$689.60 |
$689.60 |
$689.60 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$320.80 |
$320.80 |
$320.80 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$404.00 |
$404.00 |
$404.00 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$708.80 |
$708.80 |
$708.80 |
$558.35
|
|
Unlisted CT procedure
|
$1,177.60 |
$1,177.60 |
$1,177.60 |
$732.70
|
|
Unlisted mr procedure
|
$400.00 |
$400.00 |
$400.00 |
$1,163.00
|
|
Unsched dialysis esrd pt hos
|
$1,440.00 |
$1,440.00 |
$1,440.00 |
$1,268.17
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$700.50 |
$700.50 |
$700.50 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$633.50 |
$633.50 |
$633.50 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$454.00 |
$454.00 |
$454.00 |
$2,034.41
|
|
Urea nitrogen
|
$16.80 |
$16.80 |
$16.80 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$23.20 |
$23.20 |
$23.20 |
$51.75
|
|
Urethrcystgrphy rtrgrde s&i
|
$672.00 |
$672.00 |
$672.00 |
$579.73
|
|
Urethrocystography void s&i
|
$600.00 |
$600.00 |
$600.00 |
$622.35
|
|
Uric acid blood
|
$15.00 |
$15.00 |
$15.00 |
$48.75
|
|
Uric acid urine
|
$20.80 |
$20.80 |
$20.80 |
$44.33
|
|
Urinalysis microscopic only
|
$12.80 |
$12.80 |
$12.80 |
$26.35
|
|
Urinalysis (with microscopy)
|
$10.00 |
$10.00 |
$10.00 |
$55.00
|
|
Urinalysis (without microscopy)
|
$10.00 |
$10.00 |
$10.00 |
$35.75
|
|
Urine Culture Test
|
$25.00 |
$25.00 |
$25.00 |
$81.50
|
|
Urine pregnancy test
|
$36.00 |
$36.00 |
$36.00 |
$67.20
|
|
Vaccine hepatitis a (hepa) adult im
|
$734.00 |
$734.00 |
$734.00 |
$166.62
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$657.40 |
$657.40 |
$657.40 |
$155.16
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$211.60 |
$211.60 |
$211.60 |
$75.39
|
|
Vaccine influenza inactivated adjuvant im
|
$506.20 |
$506.20 |
$506.20 |
$109.50
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$114.00 |
$114.00 |
$114.00 |
$47.88
|
|
Vaccine mmr live subcutaneous
|
$347.60 |
$347.60 |
$347.60 |
$211.68
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$1,554.00 |
$1,554.00 |
$1,554.00 |
$563.36
|
|
Vaccine rabies im
|
$1,222.20 |
$1,222.20 |
$1,222.20 |
$858.95
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$750.80 |
$750.80 |
$750.80 |
$1,104.47
|
|
Vaccine tdap >=7 years im
|
$367.40 |
$367.40 |
$367.40 |
$131.34
|
|
Valproic acid total therapeutic drug level
|
$56.80 |
$56.80 |
$56.80 |
$114.72
|
|
Vancomycin 1,000 mg intravenous injection
|
$1,245.40 |
$1,245.40 |
$1,245.40 |
$251.86
|
|
Vancomycin peak therapeutic drug level
|
$56.80 |
$56.80 |
$56.80 |
$136.13
|
|
Varicella zoster antibody igg
|
$53.60 |
$53.60 |
$53.60 |
$86.80
|
|
Vasopressin 20 unit/ml intravenous solution
|
$221.00 |
$221.00 |
$221.00 |
$325.80
|
|
Veeg unmon 12-26 hrs
|
$2,904.00 |
$2,904.00 |
$2,904.00 |
$1,671.09
|
|
Ven blood coll snf/hha
|
$27.20 |
$27.20 |
$27.20 |
$15.65
|
|
Venogram ext bil s&i
|
$4,980.00 |
$4,980.00 |
$4,980.00 |
$1,797.50
|
|
Venogram extremity supervision & interpretation unilateral
|
$3,320.00 |
$3,320.00 |
$3,320.00 |
$1,366.20
|
|
Venous mech thrombectomy
|
$10,528.00 |
$10,528.00 |
$10,528.00 |
$7,965.00
|
|
Ventilator each subsequent day
|
$1,669.60 |
$1,669.60 |
$1,669.60 |
$1,204.00
|
|
Ventilator initial day
|
$1,745.60 |
$1,745.60 |
$1,745.60 |
$1,431.43
|
|
Version cephalic external
|
$935.20 |
$935.20 |
$935.20 |
$2,361.75
|
|
Very long chain fatty acids
|
$82.40 |
$82.40 |
$82.40 |
$139.88
|
|
Vital capacity test
|
$360.00 |
$360.00 |
$360.00 |
$170.00
|
|
Vitamin b-12
|
$40.00 |
$40.00 |
$40.00 |
$100.00
|
