|
Svc venogram s&i
|
$3,317.44 |
$3,317.44 |
$3,317.44 |
$1,934.62
|
|
T3 (triiodothyronine) free
|
$309.30 |
$309.30 |
$309.30 |
$99.20
|
|
T3 (triiodothyronine) total
|
$766.23 |
$766.23 |
$766.23 |
$93.52
|
|
T4 (thyroxine) free
|
$505.12 |
$505.12 |
$505.12 |
$85.20
|
|
T4 (thyroxine) total
|
$577.46 |
$577.46 |
$577.46 |
$67.80
|
|
Tacrolimus therapeutic drug level
|
$608.03 |
$608.03 |
$608.03 |
$120.60
|
|
Tamoxifen 10 mg tabs 60 each bottle
|
$37.00 |
$37.00 |
$37.00 |
$14.62
|
|
Target gsa panel organ/hmtlmph neop
|
$19,821.97 |
$19,821.97 |
$19,821.97 |
$3,678.78
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$648.62 |
$648.62 |
$648.62 |
$175.00
|
|
Tc-99m exametazime diag
|
$230.43 |
$230.43 |
$230.43 |
$2,033.20
|
|
Tc-99m maa
|
$576.08 |
$576.08 |
$576.08 |
$283.41
|
|
Tc-99m mebrofenin
|
$1,152.22 |
$1,152.22 |
$1,152.22 |
$160.58
|
|
Tc-99m medronate
|
$576.08 |
$576.08 |
$576.08 |
$109.50
|
|
Tc-99m mertiatide
|
$5,677.72 |
$5,677.72 |
$5,677.72 |
$756.00
|
|
Tc-99m oxidronate
|
$1,667.43 |
$1,667.43 |
$1,667.43 |
$105.30
|
|
Tc-99m pentetate dtpa
|
$576.08 |
$576.08 |
$576.08 |
$222.60
|
|
Tc-99m pertechnetate per mci
|
$14.97 |
$14.97 |
$14.97 |
$27.20
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$1,152.22 |
$1,152.22 |
$1,152.22 |
$136.40
|
|
Tc-99m sestamibi p study dose
|
$3,572.81 |
$3,572.81 |
$3,572.81 |
$293.73
|
|
Tc-99m tetrofosmin p study dose
|
$3,572.81 |
$3,572.81 |
$3,572.81 |
$188.50
|
|
Tc-99m tilmanocept diag
|
$741.00 |
$741.00 |
$741.00 |
$930.54
|
|
T cells absolute cd4/cd8 including ratio
|
$1,462.49 |
$1,462.49 |
$1,462.49 |
$175.00
|
|
T cells total count
|
$548.36 |
$548.36 |
$548.36 |
$123.00
|
|
Telethx isodose plan cplx
|
$9,410.49 |
$9,410.49 |
$9,410.49 |
$1,488.40
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$112.31 |
$112.31 |
$112.31 |
$39.18
|
|
Test pathogen(s) for platelets reference
|
$2,354.00 |
$2,354.00 |
$2,354.00 |
$66.00
|
|
Tetanus immune globulin inj
|
$7,307.63 |
$7,307.63 |
$7,307.63 |
$1,228.80
|
|
Theophylline therapeutic drug level
|
$837.39 |
$837.39 |
$837.39 |
$108.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$139.86 |
$139.86 |
$139.86 |
$25.54
|
|
Thrombin time
|
$288.46 |
$288.46 |
$288.46 |
$53.60
|
|
Thyroid imaging
|
$4,003.26 |
$4,003.26 |
$4,003.26 |
$673.01
|
|
Thyroid mets imag whole body
|
$7,125.97 |
$7,125.97 |
$7,125.97 |
$1,544.00
|
|
Thyroid Ultrasound
|
$1,044.51 |
$1,044.51 |
$1,044.51 |
$589.96
|
|
Thyroid uptake measurement
|
$4,040.72 |
$4,040.72 |
$4,040.72 |
$580.20
|
|
Thyroxine binding globulin (tbg)
|
$1,403.68 |
$1,403.68 |
$1,403.68 |
$64.92
|
|
Tilt table study
|
$3,670.61 |
$3,670.61 |
$3,670.61 |
$1,495.00
|
|
Tissue culture skin/biopsy
|
$580.19 |
$580.19 |
$580.19 |
$518.40
|
|
Tissue exam koh skin/hair/nails
|
$277.57 |
$277.57 |
$277.57 |
$47.40
|
|
Toxoplasma antibody igg
|
$853.88 |
$853.88 |
$853.88 |
$89.57
|
|
Toxoplasma antibody igm
|
$452.16 |
$452.16 |
$452.16 |
$87.00
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$30.75 |
$30.75 |
$30.75 |
$55.69
|
|
Transcatheter bx s&i
|
$5,502.57 |
$5,502.57 |
$5,502.57 |
$1,973.01
|
|
Transferrin
|
$357.53 |
$357.53 |
$357.53 |
$81.60
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$963.45 |
$963.45 |
$963.45 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$963.45 |
$963.45 |
$963.45 |
$141.00
|
|
Treatment radiation delivery level 2
|
$4,998.22 |
$4,998.22 |
$4,998.22 |
$737.25
|
|
Treponema pallidum antibody
|
$678.02 |
$678.02 |
$678.02 |
$70.85
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$200.72 |
$200.72 |
$200.72 |
$43.80
|
|
Troponin quantitative
|
$934.41 |
$934.41 |
$934.41 |
$128.80
|
|
Ultrasound abdomen aorta screening study aaa
|
$1,443.29 |
$1,443.29 |
$1,443.29 |
$394.20
|
|
Ultrasound encephalogram
|
$1,008.21 |
$1,008.21 |
$1,008.21 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$1,375.32 |
$1,375.32 |
$1,375.32 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$916.52 |
$916.52 |
$916.52 |
$469.50
|
|
Ultrasound guide intraoperative
|
$1,191.58 |
$1,191.58 |
$1,191.58 |
$625.15
|
|
Ultrasound infant hips ltd without stress
|
$847.37 |
$847.37 |
$847.37 |
$295.50
|
|
Ultrasound joint/nonvascular extremity limited left
|
$611.99 |
$611.99 |
$611.99 |
$418.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$927.31 |
$927.31 |
$927.31 |
$397.15
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$916.52 |
$916.52 |
$916.52 |
$323.40
|
|
Ultrasound pregnant uterus follow up per fetus
|
$825.19 |
$825.19 |
$825.19 |
$420.80
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$825.19 |
$825.19 |
$825.19 |
$442.80
|
|
Ultrasound pregnant uterus transvaginal
|
$1,293.69 |
$1,293.69 |
$1,293.69 |
$484.52
|
|
Ultrasound retroperitoneal limited
|
$1,375.32 |
$1,375.32 |
$1,375.32 |
$477.10
|
|
Ultrasound scrotum and contents
|
$1,191.58 |
$1,191.58 |
$1,191.58 |
$606.60
|
|
Ultrasound spinal canal and contents
|
$1,191.58 |
$1,191.58 |
$1,191.58 |
$459.00
|
|
Ultrasound transvaginal non obstetric
|
$953.57 |
$953.57 |
$953.57 |
$549.75
|
|
Unlisted ultrasound procedure
|
$825.19 |
$825.19 |
$825.19 |
$321.20
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$6,224.13 |
$6,224.13 |
$6,224.13 |
$3,039.60
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$5,106.42 |
$5,106.42 |
$5,106.42 |
$2,412.60
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,742.33 |
$3,742.33 |
$3,742.33 |
$2,034.41
|
|
Urea nitrogen
|
$422.21 |
$422.21 |
$422.21 |
$39.90
|
|
Urea nitrogen 24 hour urine
|
$268.72 |
$268.72 |
$268.72 |
$52.00
|
|
Urethrcystgrphy rtrgrde s&i
|
$1,251.91 |
$1,251.91 |
$1,251.91 |
$584.00
|
|
Urethrocystography void s&i
|
$1,157.38 |
$1,157.38 |
$1,157.38 |
$622.35
|
|
Uric acid blood
|
$528.09 |
$528.09 |
$528.09 |
$49.32
|
|
Urinalysis (with microscopy)
|
$318.72 |
$318.72 |
$318.72 |
$55.00
|
|
Urine Culture Test
|
$898.53 |
$898.53 |
$898.53 |
$84.00
|
|
Urine pregnancy test
|
$968.52 |
$968.52 |
$968.52 |
$69.48
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$120.14 |
$120.14 |
$120.14 |
$42.90
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$635.50 |
$635.50 |
$635.50 |
$143.20
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$166.75 |
$166.75 |
$166.75 |
$47.88
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$1,880.81 |
$1,880.81 |
$1,880.81 |
$409.35
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$1,564.73 |
$1,564.73 |
$1,564.73 |
$310.93
|
|
Vaccine mmr live subcutaneous
|
$1,183.84 |
$1,183.84 |
$1,183.84 |
$213.00
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$1,289.14 |
$1,289.14 |
$1,289.14 |
$252.90
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$1,933.75 |
$1,933.75 |
$1,933.75 |
$385.45
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$2,520.69 |
$2,520.69 |
$2,520.69 |
$563.36
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$1,212.57 |
$1,212.57 |
$1,212.57 |
$1,105.21
|
|
Vaccine tdap >=7 years im
|
$444.98 |
$444.98 |
$444.98 |
$136.80
|
|
Vaccine td preservative free >= 7 years im
|
$345.55 |
$345.55 |
$345.55 |
$112.10
|
|
Valproate in ns IV syringe 10 mg/ml (pediatric) - cnr
|
$399.60 |
$399.60 |
$399.60 |
$24.12
|
|
Valproic acid total therapeutic drug level
|
$968.52 |
$968.52 |
$968.52 |
$115.00
|
|
Vasopressin 20 unit/ml intravenous solution
|
$820.39 |
$820.39 |
$820.39 |
$342.98
|
|
Veeg unmon 2-12 hrs
|
$2,391.62 |
$2,391.62 |
$2,391.62 |
$813.95
|
|
Vein x-ray liver w/hemodynam
|
$14,647.03 |
$14,647.03 |
$14,647.03 |
$3,413.25
|
|
Venogram ext bil s&i
|
$2,103.11 |
$2,103.11 |
$2,103.11 |
$1,794.54
|
|
Ventilator each subsequent day
|
$6,045.92 |
$6,045.92 |
$6,045.92 |
$1,148.00
|
|
Ventilator initial day
|
$7,069.38 |
$7,069.38 |
$7,069.38 |
$1,433.60
|
|
Virus isolation addl studies ea
|
$182.49 |
$182.49 |
$182.49 |
$79.34
|
|
Vital capacity test
|
$633.81 |
$633.81 |
$633.81 |
$170.99
|
|
Vitamin b-12
|
$417.52 |
$417.52 |
$417.52 |
$100.00
|