|
Surgical pathology level 3 gross & microscopic examination
|
$549.00 |
$549.00 |
$549.00 |
$192.00
|
|
Surgical pathology level 4 gross & microscopic examination
|
$783.00 |
$783.00 |
$783.00 |
$253.75
|
|
Surgical pathology level 5 gross & microscopic examination
|
$1,247.00 |
$1,247.00 |
$1,247.00 |
$494.00
|
|
Surgical pathology level 6 gross & microscopic examination
|
$1,727.00 |
$1,727.00 |
$1,727.00 |
$790.00
|
|
Susceptibility enzyme detection per enzyme
|
$241.00 |
$241.00 |
$241.00 |
$34.48
|
|
Suscept studies macrobroth dilution ea
|
$277.00 |
$277.00 |
$277.00 |
$48.30
|
|
T3 (triiodothyronine) free
|
$794.00 |
$794.00 |
$794.00 |
$89.82
|
|
T3 (triiodothyronine) total
|
$603.00 |
$603.00 |
$603.00 |
$94.90
|
|
T4 (thyroxine) free
|
$454.00 |
$454.00 |
$454.00 |
$81.60
|
|
T4 (thyroxine) total
|
$273.00 |
$273.00 |
$273.00 |
$73.64
|
|
Tacrol astagraf ex rel oral
|
$42.00 |
$42.00 |
$42.00 |
$9.01
|
|
Tacrolimus 5 mg/ml intravenous solution
|
$3,263.00 |
$3,263.00 |
$3,263.00 |
$612.11
|
|
Tacrolimus therapeutic drug level
|
$901.00 |
$901.00 |
$901.00 |
$122.40
|
|
Target gsa panel hmtlmph neop
|
$5,807.00 |
$5,807.00 |
$5,807.00 |
$1,928.40
|
|
Tb test cell mediated immunity antigen response gamma interferon
|
$710.00 |
$710.00 |
$710.00 |
$166.46
|
|
Tc-99m arcitumomab
|
$9,753.00 |
$9,753.00 |
$9,753.00 |
$2,159.40
|
|
Tc-99m bicisate
|
$3,233.00 |
$3,233.00 |
$3,233.00 |
$1,969.45
|
|
Tc-99m disofenin
|
$1,152.00 |
$1,152.00 |
$1,152.00 |
$151.32
|
|
Tc-99m exame autol wbc diag per dose
|
$4,997.00 |
$4,997.00 |
$4,997.00 |
$2,393.40
|
|
Tc-99m labeled rbc
|
$1,603.00 |
$1,603.00 |
$1,603.00 |
$323.01
|
|
Tc-99m maa
|
$1,106.00 |
$1,106.00 |
$1,106.00 |
$312.06
|
|
Tc-99m mebrofenin
|
$1,106.00 |
$1,106.00 |
$1,106.00 |
$169.53
|
|
Tc-99m medronate
|
$1,103.00 |
$1,103.00 |
$1,103.00 |
$122.46
|
|
Tc-99m mertiatide
|
$1,730.00 |
$1,730.00 |
$1,730.00 |
$757.25
|
|
Tc-99m oxidronate
|
$659.00 |
$659.00 |
$659.00 |
$124.23
|
|
Tc-99m pentetate dtpa
|
$1,144.00 |
$1,144.00 |
$1,144.00 |
$245.85
|
|
Tc-99m pentetate dtpa aerosol
|
$1,144.00 |
$1,144.00 |
$1,144.00 |
$244.02
|
|
Tc-99m pertechnetate per mci
|
$123.00 |
$123.00 |
$123.00 |
$28.08
|
|
Tc-99m pyroph diag per dose up to 25 mci
|
$1,204.00 |
$1,204.00 |
$1,204.00 |
$147.24
|
|
Tc-99m sestamibi p study dose
|
$1,094.00 |
$1,094.00 |
$1,094.00 |
$221.60
|
|
Tc-99m succimer (dmsa)
|
$1,532.00 |
$1,532.00 |
$1,532.00 |
$1,578.33
|
|
Tc-99m sulfur colloid
|
$1,231.00 |
$1,231.00 |
$1,231.00 |
$245.70
|
|
Tc-99m tetrofosmin p study dose
|
$790.00 |
$790.00 |
$790.00 |
$198.05
|
|
Tc-99m tilmanocept diag
|
$1,523.00 |
$1,523.00 |
$1,523.00 |
$930.54
|
|
T cells absolute cd4/cd8 including ratio
|
$1,191.00 |
$1,191.00 |
$1,191.00 |
$186.00
|
|
T cells absolute cd 4 count
|
$989.00 |
$989.00 |
$989.00 |
$120.25
|
|
T cells total count
|
$790.00 |
$790.00 |
$790.00 |
$124.11
|
|
Temozolomide 100 mg intravenous solution
|
$8,327.00 |
$8,327.00 |
$8,327.00 |
$3,129.70
|
|
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln
|
$18,996.00 |
$18,996.00 |
$18,996.00 |
$3,957.79
|
|
Test pathogen(s) for platelets reference
|
$184.00 |
$184.00 |
$184.00 |
$73.45
|
|
Tetanus immune globulin inj
|
$3,031.00 |
$3,031.00 |
$3,031.00 |
$1,204.50
|
|
Theophylline therapeutic drug level
|
$574.00 |
$574.00 |
$574.00 |
$108.00
|
|
Ther nma rdctj intus/obstrcj
|
$1,803.00 |
$1,803.00 |
$1,803.00 |
$534.32
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$281.00 |
$281.00 |
$281.00 |
$35.72
|
|
Thrombin time
|
$288.00 |
$288.00 |
$288.00 |
$48.75
|
|
Thromboplastin inhibition
|
$457.00 |
$457.00 |
$457.00 |
$52.00
|
|
Thyroglobulin antibody
|
$516.00 |
$516.00 |
$516.00 |
$84.00
|
|
Thyroid mets imag whole body
|
$3,594.00 |
$3,594.00 |
$3,594.00 |
$1,524.99
|
|
Thyroid uptake measurement
|
$3,884.00 |
$3,884.00 |
$3,884.00 |
$653.60
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$12,462.00 |
$12,462.00 |
$12,462.00 |
$4,319.71
|
|
Thyroxine binding globulin (tbg)
|
$421.00 |
$421.00 |
$421.00 |
$63.60
|
|
Tigecycline injection
|
$1,672.00 |
$1,672.00 |
$1,672.00 |
$277.31
|
|
Tisotumab vedotin-tftv 40 mg intravenous solution
|
$39,176.00 |
$39,176.00 |
$39,176.00 |
$14,271.00
|
|
Tl-201 thallium diag per mci
|
$829.00 |
$829.00 |
$829.00 |
$77.22
|
|
Tobramycin non-comp unit
|
$681.15 |
$681.15 |
$681.15 |
$143.38
|
|
Tomosynthesis breast diagnostic left
|
$43.00 |
$43.00 |
$43.00 |
$78.80
|
|
Tomosynthesis breast screen bilateral
|
$43.00 |
$43.00 |
$43.00 |
$73.45
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$7,256.00 |
$7,256.00 |
$7,256.00 |
$404.20
|
|
Total tau
|
$317.00 |
$317.00 |
$317.00 |
$293.00
|
|
Toxoplasma antibody igg
|
$457.00 |
$457.00 |
$457.00 |
$84.35
|
|
Toxoplasma antibody igm
|
$562.00 |
$562.00 |
$562.00 |
$83.20
|
|
Trabectedin 1 mg intravenous solution
|
$23,827.00 |
$23,827.00 |
$23,827.00 |
$7,403.70
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$1,112.00 |
$1,112.00 |
$1,112.00 |
$104.50
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$1,594.00 |
$1,594.00 |
$1,594.00 |
$77.65
|
|
Transcatheter bx s&i
|
$9,193.00 |
$9,193.00 |
$9,193.00 |
$1,875.96
|
|
Transferrin
|
$528.00 |
$528.00 |
$528.00 |
$87.30
|
|
Trastuzumab 150 mg intravenous solution
|
$13,086.00 |
$13,086.00 |
$13,086.00 |
$3,900.04
|
|
Treponema pallidum antibody
|
$409.00 |
$409.00 |
$409.00 |
$72.80
|
|
Trimethobenzamide hcl inj
|
$528.00 |
$528.00 |
$528.00 |
$128.00
|
|
Ultrasound abdomen aorta screening study aaa
|
$968.00 |
$968.00 |
$968.00 |
$403.26
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$2,386.00 |
$2,386.00 |
$2,386.00 |
$340.14
|
|
Ultrasound elastography parenchyma
|
$1,011.00 |
$1,011.00 |
$1,011.00 |
$284.25
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$1,608.00 |
$1,608.00 |
$1,608.00 |
$477.88
|
|
Ultrasound guide tissue ablation
|
$1,816.00 |
$1,816.00 |
$1,816.00 |
$498.40
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$2,414.00 |
$2,414.00 |
$2,414.00 |
$690.48
|
|
Ultrasound transabd ea addl gest
|
$2,414.00 |
$2,414.00 |
$2,414.00 |
$425.10
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$8,058.00 |
$8,058.00 |
$8,058.00 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$7,811.00 |
$7,811.00 |
$7,811.00 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$7,811.00 |
$7,811.00 |
$7,811.00 |
$2,013.08
|
|
Urea nitrogen
|
$220.00 |
$220.00 |
$220.00 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$243.00 |
$243.00 |
$243.00 |
$50.00
|
|
Urethrcystgrphy rtrgrde s&i
|
$3,289.00 |
$3,289.00 |
$3,289.00 |
$574.40
|
|
Urethrocystography void s&i
|
$3,473.00 |
$3,473.00 |
$3,473.00 |
$634.50
|
|
Uric acid blood
|
$313.00 |
$313.00 |
$313.00 |
$46.64
|
|
Urinary pouch w/barrier
|
$46.00 |
$46.00 |
$46.00 |
$11.83
|
|
Urine Culture Test
|
$597.00 |
$597.00 |
$597.00 |
$84.81
|
|
Urine ost pouch w faucet/tap
|
$70.00 |
$70.00 |
$70.00 |
$12.82
|
|
Use 1st target lesion
|
$1,011.00 |
$1,011.00 |
$1,011.00 |
$245.30
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$9,178.00 |
$9,178.00 |
$9,178.00 |
$5,521.54
|
|
Vaccine dtap < 7 years im
|
$170.00 |
$170.00 |
$170.00 |
$87.80
|
|
Vaccine dtap-ipv/hib im
|
$444.00 |
$444.00 |
$444.00 |
$248.80
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$1,773.00 |
$1,773.00 |
$1,773.00 |
$45.33
|
|
Vaccine hepatitis a (hepa) adult im
|
$2,425.00 |
$2,425.00 |
$2,425.00 |
$178.07
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$210.00 |
$210.00 |
$210.00 |
$84.38
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$605.00 |
$605.00 |
$605.00 |
$173.98
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$301.00 |
$301.00 |
$301.00 |
$79.04
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$217.60 |
$217.60 |
$217.60 |
$157.41
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$60.75 |
$60.75 |
$60.75 |
$48.29
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$1,588.00 |
$1,588.00 |
$1,588.00 |
$426.80
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$5,647.00 |
$5,647.00 |
$5,647.00 |
$349.15
|
