|
Tc-99m pertechnetate per mci
|
$403.14 |
$403.14 |
$403.14 |
$27.20
|
|
Tc-99m sestamibi p study dose
|
$2,011.67 |
$2,011.67 |
$2,011.67 |
$293.73
|
|
Tc-99m sulfur colloid
|
$1,751.51 |
$1,751.51 |
$1,751.51 |
$239.40
|
|
T cells absolute cd4/cd8 including ratio
|
$1,409.51 |
$1,409.51 |
$1,409.51 |
$175.00
|
|
T cells absolute cd 4 count
|
$663.59 |
$663.59 |
$663.59 |
$110.00
|
|
T cells total count
|
$1,409.51 |
$1,409.51 |
$1,409.51 |
$123.00
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$123.41 |
$123.41 |
$123.41 |
$39.18
|
|
Test for chlorohydrocarbons
|
$1,409.51 |
$1,409.51 |
$1,409.51 |
$61.60
|
|
Test pathogen(s) for platelets reference
|
$395.35 |
$395.35 |
$395.35 |
$66.00
|
|
Test stress cardiovascular tracing only
|
$6,953.14 |
$6,953.14 |
$6,953.14 |
$953.40
|
|
Test urine for porphyrins
|
$324.08 |
$324.08 |
$324.08 |
$50.50
|
|
Tetanus immune globulin inj
|
$6,748.95 |
$6,748.95 |
$6,748.95 |
$1,228.80
|
|
Ther nma rdctj intus/obstrcj
|
$2,640.13 |
$2,640.13 |
$2,640.13 |
$538.88
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$121.27 |
$121.27 |
$121.27 |
$25.54
|
|
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides)
|
$6,613.90 |
$6,613.90 |
$6,613.90 |
$1,687.50
|
|
Thromboplastin inhibition
|
$1,075.13 |
$1,075.13 |
$1,075.13 |
$53.30
|
|
Thyroxine binding globulin (tbg)
|
$1,200.31 |
$1,200.31 |
$1,200.31 |
$64.92
|
|
Tigecycline injection
|
$1,210.64 |
$1,210.64 |
$1,210.64 |
$234.00
|
|
Tilt table study
|
$17,793.27 |
$17,793.27 |
$17,793.27 |
$1,495.00
|
|
Tissue culture placenta
|
$3,112.23 |
$3,112.23 |
$3,112.23 |
$462.80
|
|
Tissue culture skin/biopsy
|
$2,685.27 |
$2,685.27 |
$2,685.27 |
$518.40
|
|
Tissue culture tumor
|
$2,405.77 |
$2,405.77 |
$2,405.77 |
$513.00
|
|
Tissue transglutaminase iga
|
$1,001.40 |
$1,001.40 |
$1,001.40 |
$46.20
|
|
Tl-201 thallium diag per mci
|
$1,695.68 |
$1,695.68 |
$1,695.68 |
$80.10
|
|
Tlso 2 shl symphys-stern cst
|
$1,955.36 |
$1,955.36 |
$1,955.36 |
$1,702.48
|
|
Tlso 3mod sacro-scap pre
|
$6,949.00 |
$6,949.00 |
$6,949.00 |
$1,986.72
|
|
Tlso rigid lined custom fab
|
$8,026.00 |
$8,026.00 |
$8,026.00 |
$2,831.21
|
|
Tomosynthesis breast diagnostic left
|
$251.97 |
$251.97 |
$251.97 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$251.97 |
$251.97 |
$251.97 |
$70.89
|
|
Toxoplasma antibody igg
|
$953.39 |
$953.39 |
$953.39 |
$89.57
|
|
Toxoplasma antibody igm
|
$953.39 |
$953.39 |
$953.39 |
$87.00
|
|
Transcatheter bx s&i
|
$3,287.11 |
$3,287.11 |
$3,287.11 |
$1,973.01
|
|
Transcath rmvl perm ldss pmkr rv
|
$12,117.88 |
$12,117.88 |
$12,117.88 |
$4,775.16
|
|
Transferrin
|
$483.56 |
$483.56 |
$483.56 |
$81.60
|
|
Trapezius sling
|
$1,308.00 |
$1,308.00 |
$1,308.00 |
$265.44
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$788.07 |
$788.07 |
$788.07 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$571.22 |
$571.22 |
$571.22 |
$141.00
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$273.63 |
$273.63 |
$273.63 |
$43.80
|
|
Trichinella antibody
|
$1,299.40 |
$1,299.40 |
$1,299.40 |
$70.65
|
|
Tx atrial fib pulm vein isol
|
$54,227.89 |
$54,227.89 |
$54,227.89 |
$29,030.54
|
|
Tx l/r atrial fib addl
|
$17,841.00 |
$17,841.00 |
$17,841.00 |
$7,005.00
|
|
Ultrasound exam k transpl w/doppler
|
$2,911.93 |
$2,911.93 |
$2,911.93 |
$573.54
|
|
Ultrasound guide intraoperative
|
$3,261.97 |
$3,261.97 |
$3,261.97 |
$625.15
|
|
Ultrasound hips infant dynamic
|
$1,936.75 |
$1,936.75 |
$1,936.75 |
$403.00
|
|
Ultrasound infant hips ltd without stress
|
$1,379.69 |
$1,379.69 |
$1,379.69 |
$295.50
|
|
Ultrasound prostate/transrectal
|
$2,255.45 |
$2,255.45 |
$2,255.45 |
$545.16
|
|
Ultrasound spinal canal and contents
|
$2,499.26 |
$2,499.26 |
$2,499.26 |
$459.00
|
|
Unlistd noninvas vasc dx std
|
$4,146.50 |
$4,146.50 |
$4,146.50 |
$564.60
|
|
Unlisted ultrasound procedure
|
$415.41 |
$415.41 |
$415.41 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$6,113.12 |
$6,113.12 |
$6,113.12 |
$1,248.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$13,418.33 |
$13,418.33 |
$13,418.33 |
$3,039.60
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$9,427.70 |
$9,427.70 |
$9,427.70 |
$2,412.60
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$9,762.75 |
$9,762.75 |
$9,762.75 |
$2,034.41
|
|
Urea nitrogen 24 hour urine
|
$397.81 |
$397.81 |
$397.81 |
$52.00
|
|
Urea nitrogen clearance
|
$535.00 |
$535.00 |
$535.00 |
$47.73
|
|
Urethrcystgrphy rtrgrde s&i
|
$1,721.74 |
$1,721.74 |
$1,721.74 |
$584.00
|
|
Urethrocystography void s&i
|
$1,638.18 |
$1,638.18 |
$1,638.18 |
$622.35
|
|
Urinalysis qual/semiquant excpt ia
|
$294.94 |
$294.94 |
$294.94 |
$25.72
|
|
Urography inf drip &/or bolus
|
$3,534.41 |
$3,534.41 |
$3,534.41 |
$690.85
|
|
Vaccine dtap < 7 years im
|
$276.48 |
$276.48 |
$276.48 |
$73.01
|
|
Vaccine dtap-hep b-ipv im
|
$1,145.08 |
$1,145.08 |
$1,145.08 |
$165.26
|
|
Vaccine dtap-ipv/hib im
|
$832.45 |
$832.45 |
$832.45 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$329.02 |
$329.02 |
$329.02 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$277.89 |
$277.89 |
$277.89 |
$42.90
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$158.62 |
$158.62 |
$158.62 |
$31.91
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$1,223.45 |
$1,223.45 |
$1,223.45 |
$409.35
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$982.66 |
$982.66 |
$982.66 |
$310.93
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$1,094.03 |
$1,094.03 |
$1,094.03 |
$381.89
|
|
Vaccine mmr live subcutaneous
|
$1,020.51 |
$1,020.51 |
$1,020.51 |
$213.00
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$618.43 |
$618.43 |
$618.43 |
$252.90
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$2,084.77 |
$2,084.77 |
$2,084.77 |
$397.11
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$1,314.41 |
$1,314.41 |
$1,314.41 |
$385.45
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$2,802.32 |
$2,802.32 |
$2,802.32 |
$1,105.21
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$2,802.32 |
$2,802.32 |
$2,802.32 |
$997.44
|
|
Vaccine tdap >=7 years im
|
$792.36 |
$792.36 |
$792.36 |
$136.80
|
|
Vaccine td preservative free >= 7 years im
|
$361.35 |
$361.35 |
$361.35 |
$112.10
|
|
Veeg ea 12-26hr cont mntr
|
$7,971.48 |
$7,971.48 |
$7,971.48 |
$2,810.56
|
|
Vein x-ray liver
|
$7,650.32 |
$7,650.32 |
$7,650.32 |
$3,158.72
|
|
Vein x-ray liver w/hemodynam
|
$6,149.14 |
$6,149.14 |
$6,149.14 |
$3,421.50
|
|
Venous sampling s&i
|
$12,679.25 |
$12,679.25 |
$12,679.25 |
$4,414.56
|
|
Ventilator each subsequent day
|
$9,243.42 |
$9,243.42 |
$9,243.42 |
$1,148.00
|
|
Ventilator initial day
|
$11,364.29 |
$11,364.29 |
$11,364.29 |
$1,433.60
|
|
Viper venom prothrombin time
|
$1,045.98 |
$1,045.98 |
$1,045.98 |
$85.80
|
|
Virus isolation addl studies ea
|
$70.70 |
$70.70 |
$70.70 |
$79.34
|
|
Vital capacity test
|
$1,061.68 |
$1,061.68 |
$1,061.68 |
$170.99
|
|
Vitamin b-12
|
$538.43 |
$538.43 |
$538.43 |
$100.00
|
|
Vkorc1 gene
|
$564.14 |
$564.14 |
$564.14 |
$176.80
|
|
Volume measurement urine timed
|
$114.88 |
$114.88 |
$114.88 |
$21.00
|
|
Voriconazole in ns IV syringe 5 mg/ml (pediatric) - cnr
|
$2,169.57 |
$2,169.57 |
$2,169.57 |
$165.81
|
|
Warde 1005020 citrate 24 hour urine
|
$1,279.19 |
$1,279.19 |
$1,279.19 |
$94.90
|
|
Warde 1005055 5-hiaa 24 hour urine
|
$631.02 |
$631.02 |
$631.02 |
$68.25
|
|
Warde 1007138 vanillymandelic acid 24 hour urine
|
$675.60 |
$675.60 |
$675.60 |
$78.60
|
|
Warde 3004000 immunoglobulin subclass 1
|
$805.92 |
$805.92 |
$805.92 |
$39.60
|
|
Warde 3008005 oligoclonal bands
|
$937.96 |
$937.96 |
$937.96 |
$103.95
|
|
Warde 3400652 smear complex special stain ova/parasites
|
$62.93 |
$62.93 |
$62.93 |
$70.20
|
|
Warde adrenocorticotropic hormone (acth)
|
$1,191.73 |
$1,191.73 |
$1,191.73 |
$150.60
|
|
Warde aldolase
|
$636.17 |
$636.17 |
$636.17 |
$54.50
|
|
Warde amino acids 6 or more quantitative each specimen
|
$3,616.36 |
$3,616.36 |
$3,616.36 |
$196.50
|
|
Warde amiodarone therapeutic drug level
|
$615.58 |
$615.58 |
$615.58 |
$53.25
|
|
Warde analysis gene hfe common variants
|
$1,543.26 |
$1,543.26 |
$1,543.26 |
$267.28
|
