|
Thyroid imaging
|
$552.60 |
$552.60 |
$552.60 |
$670.80
|
|
Thyroid mets imag whole body
|
$376.20 |
$376.20 |
$376.20 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$62.10 |
$62.10 |
$62.10 |
$120.00
|
|
Thyroid Ultrasound
|
$395.01 |
$395.01 |
$395.01 |
$589.96
|
|
Thyroid uptake measurement
|
$552.60 |
$552.60 |
$552.60 |
$653.60
|
|
Thyroxine binding globulin (tbg)
|
$76.77 |
$76.77 |
$76.77 |
$63.60
|
|
Tigecycline injection
|
$34.60 |
$34.60 |
$34.60 |
$308.75
|
|
Tirofiban 12.5 mg/50 ml
|
$10.89 |
$10.89 |
$10.89 |
$360.60
|
|
Tissue culture placenta
|
$1,098.27 |
$1,098.27 |
$1,098.27 |
$520.91
|
|
Tissue culture skin/biopsy
|
$283.50 |
$283.50 |
$283.50 |
$558.87
|
|
Tissue culture tumor
|
$465.39 |
$465.39 |
$465.39 |
$529.23
|
|
Tissue exam koh skin/hair/nails
|
$115.92 |
$115.92 |
$115.92 |
$47.40
|
|
Tissue transglutaminase iga
|
$19.44 |
$19.44 |
$19.44 |
$48.57
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$246.11 |
$246.11 |
$246.11 |
$125.87
|
|
Tobramycin peak therapeutic drug level
|
$48.33 |
$48.33 |
$48.33 |
$121.55
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$3,017.34 |
$3,017.34 |
$3,017.34 |
$5,790.85
|
|
Tomosynthesis breast diagnostic left
|
$49.95 |
$49.95 |
$49.95 |
$63.70
|
|
Tomosynthesis breast screen bilateral
|
$56.88 |
$56.88 |
$56.88 |
$73.45
|
|
Toxoplasma antibody igg
|
$168.39 |
$168.39 |
$168.39 |
$84.35
|
|
Toxoplasma antibody igm
|
$151.65 |
$151.65 |
$151.65 |
$83.20
|
|
Tpmt gene com vrnts
|
$207.45 |
$207.45 |
$207.45 |
$381.55
|
|
Trabectedin 1 mg intravenous solution
|
$1,364.85 |
$1,364.85 |
$1,364.85 |
$6,133.80
|
|
Transferrin
|
$76.77 |
$76.77 |
$76.77 |
$87.30
|
|
Transfusion blood/blood component(s)
|
$736.56 |
$736.56 |
$736.56 |
$988.24
|
|
Trastuzumab 150 mg intravenous solution
|
$1,664.46 |
$1,664.46 |
$1,664.46 |
$3,401.26
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$1,465.02 |
$1,465.02 |
$1,465.02 |
$3,600.00
|
|
Trauma partial team response w/critical care services level 4
|
$4,523.04 |
$4,523.04 |
$4,523.04 |
$5,941.07
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$91.17 |
$91.17 |
$91.17 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$91.17 |
$91.17 |
$91.17 |
$149.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$61.65 |
$61.65 |
$61.65 |
$210.00
|
|
Treponema pallidum antibody
|
$43.65 |
$43.65 |
$43.65 |
$72.80
|
|
Trg gene rearrangement anal
|
$344.16 |
$344.16 |
$344.16 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$14.49 |
$14.49 |
$14.49 |
$48.22
|
|
Trichinella antibody
|
$53.10 |
$53.10 |
$53.10 |
$70.65
|
|
Triglycerides
|
$65.70 |
$65.70 |
$65.70 |
$54.60
|
|
Troponin quantitative
|
$102.78 |
$102.78 |
$102.78 |
$123.75
|
|
Tte w or without fol w/con,stres
|
$564.39 |
$564.39 |
$564.39 |
$1,446.48
|
|
Tube trach disp innr can 5 xlt
|
$160.92 |
$160.92 |
$160.92 |
$460.58
|
|
Ultrasound abdomen aorta screening study aaa
|
$266.67 |
$266.67 |
$266.67 |
$403.26
|
|
Ultrasound breast complete
|
$160.74 |
$160.74 |
$160.74 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$163.35 |
$163.35 |
$163.35 |
$449.35
|
|
Ultrasound chest
|
$213.12 |
$213.12 |
$213.12 |
$459.55
|
|
Ultrasound dx ophth b-scan
|
$169.47 |
$169.47 |
$169.47 |
$330.40
|
|
Ultrasound elastography parenchyma
|
$189.72 |
$189.72 |
$189.72 |
$284.25
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$147.15 |
$147.15 |
$147.15 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$172.62 |
$172.62 |
$172.62 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$399.33 |
$399.33 |
$399.33 |
$701.35
|
|
Ultrasound guide intraoperative
|
$312.75 |
$312.75 |
$312.75 |
$632.90
|
|
Ultrasound infant hips ltd without stress
|
$610.56 |
$610.56 |
$610.56 |
$321.35
|
|
Ultrasound joint complete left
|
$348.66 |
$348.66 |
$348.66 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$263.16 |
$263.16 |
$263.16 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$269.91 |
$269.91 |
$269.91 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$153.63 |
$153.63 |
$153.63 |
$326.54
|
|
Ultrasound pregnant uterus follow up per fetus
|
$157.95 |
$157.95 |
$157.95 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$232.20 |
$232.20 |
$232.20 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$314.82 |
$314.82 |
$314.82 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$336.33 |
$336.33 |
$336.33 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$300.78 |
$300.78 |
$300.78 |
$498.00
|
|
Ultrasound scrotum and contents
|
$611.91 |
$611.91 |
$611.91 |
$617.28
|
|
Ultrasound transvaginal non obstetric
|
$405.72 |
$405.72 |
$405.72 |
$567.44
|
|
Unlisted cytopathology px
|
$78.30 |
$78.30 |
$78.30 |
$71.65
|
|
Unlisted mr procedure
|
$1,007.10 |
$1,007.10 |
$1,007.10 |
$1,032.20
|
|
Unlisted procedure microbiology
|
$305.64 |
$305.64 |
$305.64 |
$487.50
|
|
Unlisted surgical path px
|
$97.92 |
$97.92 |
$97.92 |
$71.65
|
|
Unlisted transfusion med px
|
$225.72 |
$225.72 |
$225.72 |
$141.35
|
|
Unlisted ultrasound procedure
|
$178.38 |
$178.38 |
$178.38 |
$321.20
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,669.13 |
$2,669.13 |
$2,669.13 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,561.41 |
$1,561.41 |
$1,561.41 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,306.89 |
$1,306.89 |
$1,306.89 |
$2,013.08
|
|
Urea nitrogen
|
$47.61 |
$47.61 |
$47.61 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$87.48 |
$87.48 |
$87.48 |
$50.00
|
|
Urethrcystgrphy rtrgrde s&i
|
$475.92 |
$475.92 |
$475.92 |
$574.40
|
|
Urethrocystography void s&i
|
$482.22 |
$482.22 |
$482.22 |
$634.50
|
|
Uric acid blood
|
$55.44 |
$55.44 |
$55.44 |
$46.64
|
|
Uric acid urine
|
$30.69 |
$30.69 |
$30.69 |
$46.75
|
|
Urinalysis microscopic only
|
$11.34 |
$11.34 |
$11.34 |
$26.35
|
|
Urinalysis (with microscopy)
|
$134.01 |
$134.01 |
$134.01 |
$48.14
|
|
Urinalysis (without microscopy)
|
$76.14 |
$76.14 |
$76.14 |
$38.99
|
|
Urine Culture Test
|
$64.53 |
$64.53 |
$64.53 |
$84.81
|
|
Urine pregnancy test
|
$56.16 |
$56.16 |
$56.16 |
$66.40
|
|
Urography, antegrade
|
$255.15 |
$255.15 |
$255.15 |
$593.37
|
|
Use 1st target lesion
|
$189.72 |
$189.72 |
$189.72 |
$245.30
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$32,974.29 |
$32,974.29 |
$32,974.29 |
$6,892.54
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$52.11 |
$52.11 |
$52.11 |
$306.24
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$84.51 |
$84.51 |
$84.51 |
$79.04
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$31.68 |
$31.68 |
$31.68 |
$157.41
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$81.24 |
$81.24 |
$81.24 |
$40.01
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$110.97 |
$110.97 |
$110.97 |
$715.41
|
|
Vaccine rabies im
|
$802.93 |
$802.93 |
$802.93 |
$945.46
|
|
Vaccine tdap >=7 years im
|
$203.42 |
$203.42 |
$203.42 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$195.07 |
$195.07 |
$195.07 |
$131.77
|
|
Valproic acid total therapeutic drug level
|
$84.51 |
$84.51 |
$84.51 |
$115.00
|
|
Vancomycin peak therapeutic drug level
|
$159.03 |
$159.03 |
$159.03 |
$126.79
|
|
Varicella zoster antibody igg
|
$68.31 |
$68.31 |
$68.31 |
$82.55
|
|
Vasopressin 20 unit/ml intravenous solution
|
$85.32 |
$85.32 |
$85.32 |
$394.13
|
|
Vedolizumab 300 mg intravenous solution
|
$8,141.85 |
$8,141.85 |
$8,141.85 |
$23,003.79
|
|
Venogram ext bil s&i
|
$345.51 |
$345.51 |
$345.51 |
$1,838.28
|
|
Venogram extremity supervision & interpretation unilateral
|
$242.46 |
$242.46 |
$242.46 |
$1,326.00
|
|
Ventilator each subsequent day
|
$1,165.59 |
$1,165.59 |
$1,165.59 |
$1,305.92
|
|
Ventilator initial day
|
$1,416.96 |
$1,416.96 |
$1,416.96 |
$1,540.80
|
