|
Thyroid mets imag whole body
|
$1,957.18 |
$1,957.18 |
$1,957.18 |
$1,524.99
|
|
Thyroid (TSH) Test
|
$303.60 |
$303.60 |
$303.60 |
$120.00
|
|
Thyroid Ultrasound
|
$1,093.37 |
$1,093.37 |
$1,093.37 |
$589.96
|
|
Thyroxine binding globulin (tbg)
|
$228.92 |
$228.92 |
$228.92 |
$63.60
|
|
Tissue exam koh skin/hair/nails
|
$84.95 |
$84.95 |
$84.95 |
$47.40
|
|
Tissue transglutaminase iga
|
$357.34 |
$357.34 |
$357.34 |
$48.57
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$69.87 |
$69.87 |
$69.87 |
$125.87
|
|
Tobramycin peak therapeutic drug level
|
$294.55 |
$294.55 |
$294.55 |
$121.55
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$4,711.84 |
$4,711.84 |
$4,711.84 |
$5,790.85
|
|
Tomosynthesis breast screen bilateral
|
$318.28 |
$318.28 |
$318.28 |
$73.45
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$66.58 |
$66.58 |
$66.58 |
$303.88
|
|
Toxoplasma antibody igg
|
$409.16 |
$409.16 |
$409.16 |
$84.35
|
|
Toxoplasma antibody igm
|
$341.36 |
$341.36 |
$341.36 |
$83.20
|
|
Tpmt gene com vrnts
|
$1,925.98 |
$1,925.98 |
$1,925.98 |
$381.55
|
|
Transcath biopsy
|
$4,907.06 |
$4,907.06 |
$4,907.06 |
$4,298.05
|
|
Transcatheter bx s&i
|
$4,062.06 |
$4,062.06 |
$4,062.06 |
$1,875.96
|
|
Transferrin
|
$177.60 |
$177.60 |
$177.60 |
$87.30
|
|
Transfusion blood/blood component(s)
|
$3,775.85 |
$3,775.85 |
$3,775.85 |
$988.24
|
|
Trauma partial team response w/critical care services level 4
|
$3,917.99 |
$3,917.99 |
$3,917.99 |
$5,941.07
|
|
Treat finger fracture each
|
$8,711.83 |
$8,711.83 |
$8,711.83 |
$1,815.75
|
|
Treat foot dislocation
|
$1,859.34 |
$1,859.34 |
$1,859.34 |
$527.28
|
|
Treat foot dislocation
|
$1,859.34 |
$1,859.34 |
$1,859.34 |
$478.40
|
|
Treat fracture of radius
|
$8,794.01 |
$8,794.01 |
$8,794.01 |
$2,030.33
|
|
Treat kneecap dislocation
|
$1,849.58 |
$1,849.58 |
$1,849.58 |
$1,351.35
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$327.58 |
$327.58 |
$327.58 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$188.51 |
$188.51 |
$188.51 |
$149.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$957.84 |
$957.84 |
$957.84 |
$210.00
|
|
Treatment of ankle fracture 27786
|
$1,346.17 |
$1,346.17 |
$1,346.17 |
$580.00
|
|
Treatment of fibula fracture 27780
|
$1,346.17 |
$1,346.17 |
$1,346.17 |
$558.75
|
|
Treat toe dislocation
|
$1,578.53 |
$1,578.53 |
$1,578.53 |
$855.66
|
|
Treat wrist dislocation
|
$1,849.58 |
$1,849.58 |
$1,849.58 |
$760.00
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$43,414.48 |
$43,414.48 |
$43,414.48 |
$120,541.18
|
|
Treponema pallidum antibody
|
$304.99 |
$304.99 |
$304.99 |
$72.80
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$159.84 |
$159.84 |
$159.84 |
$48.22
|
|
Trichinella antibody
|
$176.82 |
$176.82 |
$176.82 |
$70.65
|
|
#tricyclicantidprssnt
|
$128.74 |
$128.74 |
$128.74 |
$57.08
|
|
Triglycerides
|
$181.39 |
$181.39 |
$181.39 |
$54.60
|
|
Trimethobenzamide hcl inj
|
$416.80 |
$416.80 |
$416.80 |
$154.09
|
|
Trim nondyst nails
|
$429.38 |
$429.38 |
$429.38 |
$124.22
|
|
Trnscath plc vas stent w/s&i ini vein
|
$29,332.33 |
$29,332.33 |
$29,332.33 |
$15,408.00
|
|
Troponin quantitative
|
$402.87 |
$402.87 |
$402.87 |
$123.75
|
|
Tx closed tib shaft fx without manip
|
$1,392.86 |
$1,392.86 |
$1,392.86 |
$635.46
|
|
Tx l/r atrial fib addl
|
$32,528.78 |
$32,528.78 |
$32,528.78 |
$7,717.80
|
|
Tx open dstl phlngl fx f/t internal fixation ea
|
$20,547.23 |
$20,547.23 |
$20,547.23 |
$4,499.12
|
|
Ultrasound abdomen aorta screening study aaa
|
$950.10 |
$950.10 |
$950.10 |
$403.26
|
|
Ultrasound breast complete
|
$688.16 |
$688.16 |
$688.16 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$688.16 |
$688.16 |
$688.16 |
$449.35
|
|
Ultrasound chest
|
$956.71 |
$956.71 |
$956.71 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$446.00 |
$446.00 |
$446.00 |
$340.14
|
|
Ultrasound dx ophth b-scan
|
$870.69 |
$870.69 |
$870.69 |
$330.40
|
|
Ultrasound encephalogram
|
$873.85 |
$873.85 |
$873.85 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$2,288.27 |
$2,288.27 |
$2,288.27 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$1,153.45 |
$1,153.45 |
$1,153.45 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$1,631.77 |
$1,631.77 |
$1,631.77 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$1,996.93 |
$1,996.93 |
$1,996.93 |
$701.35
|
|
Ultrasound hips infant dynamic
|
$1,128.57 |
$1,128.57 |
$1,128.57 |
$403.00
|
|
Ultrasound joint complete left
|
$1,399.39 |
$1,399.39 |
$1,399.39 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$932.95 |
$932.95 |
$932.95 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$1,354.29 |
$1,354.29 |
$1,354.29 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$952.55 |
$952.55 |
$952.55 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,702.20 |
$1,702.20 |
$1,702.20 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$743.40 |
$743.40 |
$743.40 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$915.27 |
$915.27 |
$915.27 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$954.63 |
$954.63 |
$954.63 |
$485.48
|
|
Ultrasound retroperitoneal limited
|
$1,068.52 |
$1,068.52 |
$1,068.52 |
$498.00
|
|
Ultrasound scrotum and contents
|
$1,180.35 |
$1,180.35 |
$1,180.35 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$1,068.52 |
$1,068.52 |
$1,068.52 |
$450.60
|
|
Ultrasound transvaginal non obstetric
|
$1,130.64 |
$1,130.64 |
$1,130.64 |
$567.44
|
|
Unlistd noninvas vasc dx std
|
$219.59 |
$219.59 |
$219.59 |
$819.65
|
|
Unlisted transfusion med px
|
$319.88 |
$319.88 |
$319.88 |
$141.35
|
|
Unsched dialysis esrd pt hos
|
$2,655.58 |
$2,655.58 |
$2,655.58 |
$1,505.29
|
|
Upgrade pm system
|
$27,436.98 |
$27,436.98 |
$27,436.98 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,609.30 |
$4,609.30 |
$4,609.30 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$4,162.33 |
$4,162.33 |
$4,162.33 |
$2,013.08
|
|
Urea nitrogen
|
$100.88 |
$100.88 |
$100.88 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$126.02 |
$126.02 |
$126.02 |
$50.00
|
|
Urethrcystgrphy rtrgrde s&i
|
$1,307.02 |
$1,307.02 |
$1,307.02 |
$574.40
|
|
Uric acid blood
|
$160.38 |
$160.38 |
$160.38 |
$46.64
|
|
Uric acid urine
|
$178.67 |
$178.67 |
$178.67 |
$46.75
|
|
Urinalysis (with microscopy)
|
$132.23 |
$132.23 |
$132.23 |
$48.14
|
|
Urinalysis (without microscopy)
|
$67.11 |
$67.11 |
$67.11 |
$38.99
|
|
Urine Culture Test
|
$203.12 |
$203.12 |
$203.12 |
$84.81
|
|
Urine pregnancy test
|
$246.12 |
$246.12 |
$246.12 |
$66.40
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$46,707.98 |
$46,707.98 |
$46,707.98 |
$6,892.54
|
|
Vaccine hepatitis a (hepa) adult im
|
$287.19 |
$287.19 |
$287.19 |
$178.07
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$812.17 |
$812.17 |
$812.17 |
$218.40
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$419.87 |
$419.87 |
$419.87 |
$173.98
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$1,595.52 |
$1,595.52 |
$1,595.52 |
$686.67
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$566.82 |
$566.82 |
$566.82 |
$157.41
|
|
Vaccine influenza inactivated adjuvant im
|
$255.39 |
$255.39 |
$255.39 |
$110.25
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$170.77 |
$170.77 |
$170.77 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$145.34 |
$145.34 |
$145.34 |
$42.90
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$280.72 |
$280.72 |
$280.72 |
$103.88
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$909.45 |
$909.45 |
$909.45 |
$499.00
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$878.03 |
$878.03 |
$878.03 |
$408.70
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$620.18 |
$620.18 |
$620.18 |
$274.95
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$1,281.69 |
$1,281.69 |
$1,281.69 |
$715.41
|
|
Vaccine tdap >=7 years im
|
$395.35 |
$395.35 |
$395.35 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$326.75 |
$326.75 |
$326.75 |
$131.77
|
|
Valproic acid total therapeutic drug level
|
$219.44 |
$219.44 |
$219.44 |
$115.00
|
