|
Thyroid (TSH) Test
|
$54.08 |
$54.08 |
$54.08 |
$111.00
|
|
Thyroid Ultrasound
|
$147.20 |
$147.20 |
$147.20 |
$588.50
|
|
Thyroid uptake measurement
|
$196.16 |
$196.16 |
$196.16 |
$591.25
|
|
Thyroxine binding globulin (tbg)
|
$21.76 |
$21.76 |
$21.76 |
$64.35
|
|
Tigecycline injection
|
$170.13 |
$170.13 |
$170.13 |
$234.00
|
|
Tirofiban 12.5 mg/50 ml
|
$535.97 |
$535.97 |
$535.97 |
$458.85
|
|
Tisotumab vedotin-tftv 40 mg intravenous solution
|
$7,768.06 |
$7,768.06 |
$7,768.06 |
$13,339.20
|
|
Tissue culture skin/biopsy
|
$123.52 |
$123.52 |
$123.52 |
$484.00
|
|
Tissue transglutaminase iga
|
$10.24 |
$10.24 |
$10.24 |
$44.16
|
|
Tl-201 thallium diag per mci
|
$22.23 |
$22.23 |
$22.23 |
$78.40
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$91.20 |
$91.20 |
$91.20 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$51.84 |
$51.84 |
$51.84 |
$120.60
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$2,896.33 |
$2,896.33 |
$2,896.33 |
$5,258.52
|
|
Tomosynthesis breast diagnostic left
|
$11.20 |
$11.20 |
$11.20 |
$73.00
|
|
Tomosynthesis breast screen bilateral
|
$11.20 |
$11.20 |
$11.20 |
$72.68
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$325.58 |
$325.58 |
$325.58 |
$325.00
|
|
Toxoplasma antibody igg
|
$13.12 |
$13.12 |
$13.12 |
$89.40
|
|
Toxoplasma antibody igm
|
$13.12 |
$13.12 |
$13.12 |
$87.00
|
|
Trabectedin 1 mg intravenous solution
|
$3,760.38 |
$3,760.38 |
$3,760.38 |
$6,827.00
|
|
Transcath biopsy
|
$1,571.20 |
$1,571.20 |
$1,571.20 |
$4,285.93
|
|
Transcatheter bx s&i
|
$415.36 |
$415.36 |
$415.36 |
$1,915.00
|
|
Transferrin
|
$40.64 |
$40.64 |
$40.64 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$114.88 |
$114.88 |
$114.88 |
$983.00
|
|
Trastuzumab 150 mg intravenous solution
|
$1,699.55 |
$1,699.55 |
$1,699.55 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$4,153.05 |
$4,153.05 |
$4,153.05 |
$7,540.20
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$3,698.18 |
$3,698.18 |
$3,698.18 |
$5,835.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$65.28 |
$65.28 |
$65.28 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$20.16 |
$20.16 |
$20.16 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$107.52 |
$107.52 |
$107.52 |
$203.35
|
|
Treatment radiation delivery level 2
|
$604.80 |
$604.80 |
$604.80 |
$767.65
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$45,135.13 |
$45,135.13 |
$45,135.13 |
$73,346.25
|
|
Treponema pallidum antibody
|
$40.32 |
$40.32 |
$40.32 |
$70.40
|
|
Treprostinil injection
|
$2,248.21 |
$2,248.21 |
$2,248.21 |
$19,071.84
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$159.13 |
$159.13 |
$159.13 |
$43.21
|
|
Triglycerides
|
$18.56 |
$18.56 |
$18.56 |
$58.05
|
|
Trimethobenzamide hcl inj
|
$112.68 |
$112.68 |
$112.68 |
$117.49
|
|
Trim nondyst nails
|
$28.80 |
$28.80 |
$28.80 |
$113.40
|
|
Trnscath plc stent crv crtd without prtct
|
$243.84 |
$243.84 |
$243.84 |
$7,795.71
|
|
Trnscath plc stent crv crtd w/prtct
|
$2,762.24 |
$2,762.24 |
$2,762.24 |
$9,767.25
|
|
Trnscath plc stnt ante carotid art
|
$362.24 |
$362.24 |
$362.24 |
$6,069.00
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$1,793.92 |
$1,793.92 |
$1,793.92 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$1,793.92 |
$1,793.92 |
$1,793.92 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$3,709.44 |
$3,709.44 |
$3,709.44 |
$15,330.11
|
|
Trnscath retrv pq vasc fb w/guide
|
$1,009.60 |
$1,009.60 |
$1,009.60 |
$4,523.96
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$3,142.40 |
$3,142.40 |
$3,142.40 |
$5,069.50
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$1,589.76 |
$1,589.76 |
$1,589.76 |
$4,250.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$1,589.76 |
$1,589.76 |
$1,589.76 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$945.28 |
$945.28 |
$945.28 |
$3,866.70
|
|
Troponin quantitative
|
$31.68 |
$31.68 |
$31.68 |
$127.20
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$12,116.12 |
$12,116.12 |
$12,116.12 |
$20,945.01
|
|
Ultrasound abdomen aorta screening study aaa
|
$53.44 |
$53.44 |
$53.44 |
$394.20
|
|
Ultrasound breast complete
|
$303.36 |
$303.36 |
$303.36 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$202.24 |
$202.24 |
$202.24 |
$449.35
|
|
Ultrasound chest
|
$128.00 |
$128.00 |
$128.00 |
$460.85
|
|
Ultrasound exam k transpl w/doppler
|
$173.44 |
$173.44 |
$173.44 |
$573.54
|
|
Ultrasound guidance for vascular access
|
$96.32 |
$96.32 |
$96.32 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$134.40 |
$134.40 |
$134.40 |
$720.15
|
|
Ultrasound guide intraoperative
|
$191.36 |
$191.36 |
$191.36 |
$632.85
|
|
Ultrasound hips infant dynamic
|
$113.92 |
$113.92 |
$113.92 |
$403.88
|
|
Ultrasound joint/nonvascular extremity limited left
|
$164.48 |
$164.48 |
$164.48 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$260.16 |
$260.16 |
$260.16 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$211.84 |
$211.84 |
$211.84 |
$331.50
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$84.80 |
$84.80 |
$84.80 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$203.84 |
$203.84 |
$203.84 |
$497.12
|
|
Ultrasound retroperitoneal limited
|
$71.04 |
$71.04 |
$71.04 |
$486.50
|
|
Ultrasound scrotum and contents
|
$110.40 |
$110.40 |
$110.40 |
$608.90
|
|
Ultrasound transvaginal non obstetric
|
$89.28 |
$89.28 |
$89.28 |
$558.35
|
|
Unlisted mr procedure
|
$539.84 |
$539.84 |
$539.84 |
$1,163.00
|
|
Unlisted procedure liver
|
$1,197.44 |
$1,197.44 |
$1,197.44 |
$2,287.20
|
|
Unlisted px med radj physics
|
$275.84 |
$275.84 |
$275.84 |
$462.35
|
|
Unsched dialysis esrd pt hos
|
$634.88 |
$634.88 |
$634.88 |
$1,268.17
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$924.80 |
$924.80 |
$924.80 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$752.00 |
$752.00 |
$752.00 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$752.00 |
$752.00 |
$752.00 |
$2,034.41
|
|
Urea nitrogen
|
$12.80 |
$12.80 |
$12.80 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$13.76 |
$13.76 |
$13.76 |
$51.75
|
|
Urethrcystgrphy rtrgrde s&i
|
$138.24 |
$138.24 |
$138.24 |
$579.73
|
|
Urethrocystography void s&i
|
$152.32 |
$152.32 |
$152.32 |
$622.35
|
|
Uric acid blood
|
$14.40 |
$14.40 |
$14.40 |
$48.75
|
|
Uric acid urine
|
$42.88 |
$42.88 |
$42.88 |
$44.33
|
|
Urinalysis (with microscopy)
|
$10.24 |
$10.24 |
$10.24 |
$55.00
|
|
Urinalysis (without microscopy)
|
$7.36 |
$7.36 |
$7.36 |
$35.75
|
|
Urine Culture Test
|
$25.92 |
$25.92 |
$25.92 |
$81.50
|
|
Urine pregnancy test
|
$20.48 |
$20.48 |
$20.48 |
$67.20
|
|
Urography, antegrade
|
$180.48 |
$180.48 |
$180.48 |
$622.35
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$3,939.52 |
$3,939.52 |
$3,939.52 |
$5,184.34
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$161.07 |
$161.07 |
$161.07 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$91.20 |
$91.20 |
$91.20 |
$123.20
|
|
Vaccine dtap-ipv 4-6 years im
|
$91.20 |
$91.20 |
$91.20 |
$105.95
|
|
Vaccine dtap-ipv-hib-hepb im
|
$159.05 |
$159.05 |
$159.05 |
$174.72
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$56.60 |
$56.60 |
$56.60 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$24.47 |
$24.47 |
$24.47 |
$43.12
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$134.26 |
$134.26 |
$134.26 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$169.86 |
$169.86 |
$169.86 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$54.16 |
$54.16 |
$54.16 |
$75.39
|
|
Vaccine influenza inactivated adjuvant im
|
$93.90 |
$93.90 |
$93.90 |
$109.50
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$41.45 |
$41.45 |
$41.45 |
$47.88
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$91.20 |
$91.20 |
$91.20 |
$76.50
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$258.60 |
$258.60 |
$258.60 |
$400.03
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$187.41 |
$187.41 |
$187.41 |
$310.93
|
