|
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 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
|
|
Terbutaline 1 mg/ml subcutaneous solution
|
$561.00 |
$561.00 |
$561.00 |
$46.10
|
|
Test pathogen(s) for platelets reference
|
$184.00 |
$184.00 |
$184.00 |
$73.45
|
|
Tetanus immune globulin inj
|
$2,129.00 |
$2,129.00 |
$2,129.00 |
$1,204.50
|
|
Theophylline therapeutic drug level
|
$574.00 |
$574.00 |
$574.00 |
$108.00
|
|
Thiamine hcl (vitamin b1) 100 mg/ml injection solution
|
$157.00 |
$157.00 |
$157.00 |
$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 (TSH) Test
|
$632.00 |
$632.00 |
$632.00 |
$120.00
|
|
Thyroid uptake measurement
|
$3,884.00 |
$3,884.00 |
$3,884.00 |
$653.60
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$11,331.00 |
$11,331.00 |
$11,331.00 |
$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
|
|
Tl-201 thallium diag per mci
|
$829.00 |
$829.00 |
$829.00 |
$77.22
|
|
Tomosynthesis breast diagnostic left
|
$43.00 |
$43.00 |
$43.00 |
$78.80
|
|
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
|
|
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
|
$1,641.00 |
$1,641.00 |
$1,641.00 |
$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
|
|
Treponema pallidum antibody
|
$409.00 |
$409.00 |
$409.00 |
$72.80
|
|
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 encephalogram
|
$1,189.00 |
$1,189.00 |
$1,189.00 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$764.00 |
$764.00 |
$764.00 |
$570.44
|
|
Ultrasound guide tissue ablation
|
$1,816.00 |
$1,816.00 |
$1,816.00 |
$498.40
|
|
Ultrasound hips infant dynamic
|
$1,183.00 |
$1,183.00 |
$1,183.00 |
$403.00
|
|
Ultrasound infant hips ltd without stress
|
$1,183.00 |
$1,183.00 |
$1,183.00 |
$321.35
|
|
Ultrasound joint complete left
|
$1,377.00 |
$1,377.00 |
$1,377.00 |
$556.14
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$2,414.00 |
$2,414.00 |
$2,414.00 |
$690.48
|
|
Ultrasound spinal canal and contents
|
$1,442.00 |
$1,442.00 |
$1,442.00 |
$450.60
|
|
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)
|
$7,981.00 |
$7,981.00 |
$7,981.00 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$7,737.00 |
$7,737.00 |
$7,737.00 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$7,737.00 |
$7,737.00 |
$7,737.00 |
$2,013.08
|
|
Urea nitrogen
|
$313.00 |
$313.00 |
$313.00 |
$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
|
|
Urinalysis (with microscopy)
|
$277.00 |
$277.00 |
$277.00 |
$48.14
|
|
Urinary pouch w/barrier
|
$82.00 |
$82.00 |
$82.00 |
$11.83
|
|
Urine Culture Test
|
$597.00 |
$597.00 |
$597.00 |
$84.81
|
|
Urine ost pouch w faucet/tap
|
$759.00 |
$759.00 |
$759.00 |
$12.82
|
|
Urine pregnancy test
|
$336.00 |
$336.00 |
$336.00 |
$66.40
|
|
Use 1st target lesion
|
$1,011.00 |
$1,011.00 |
$1,011.00 |
$245.30
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$4,472.00 |
$4,472.00 |
$4,472.00 |
$5,521.54
|
|
Vaccine dtap-ipv/hib im
|
$178.00 |
$178.00 |
$178.00 |
$248.80
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$722.00 |
$722.00 |
$722.00 |
$85.00
|
|
Vaccine hepatitis a (hepa) adult im
|
$2,425.00 |
$2,425.00 |
$2,425.00 |
$178.07
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$2,048.00 |
$2,048.00 |
$2,048.00 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$377.00 |
$377.00 |
$377.00 |
$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
|
$217.61 |
$217.61 |
$217.61 |
$157.41
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$60.75 |
$60.75 |
$60.75 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$99.00 |
$99.00 |
$99.00 |
$40.01
|
|
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
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$692.00 |
$692.00 |
$692.00 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$2,075.00 |
$2,075.00 |
$2,075.00 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$525.00 |
$525.00 |
$525.00 |
$274.95
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$1,714.00 |
$1,714.00 |
$1,714.00 |
$385.45
|
|
Vaccine polio (ipv) subcutaneous/im
|
$1,207.00 |
$1,207.00 |
$1,207.00 |
$119.17
|
|
Vaccine rabies im
|
$6,590.00 |
$6,590.00 |
$6,590.00 |
$945.46
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$3,499.00 |
$3,499.00 |
$3,499.00 |
$1,196.00
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$3,499.00 |
$3,499.00 |
$3,499.00 |
$1,159.00
|
|
Vaccine td preservative free >= 7 years im
|
$434.00 |
$434.00 |
$434.00 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$1,862.00 |
$1,862.00 |
$1,862.00 |
$447.80
|
|
Valproic acid total therapeutic drug level
|
$597.00 |
$597.00 |
$597.00 |
$115.00
|
|
Vancomycin 750 mg intravenous solution
|
$260.00 |
$260.00 |
$260.00 |
$100.15
|
|
Varicella-zoster immue globin im
|
$13,228.00 |
$13,228.00 |
$13,228.00 |
$2,372.84
|
|
Vasopressin 20 unit/ml intravenous solution
|
$706.00 |
$706.00 |
$706.00 |
$362.93
|
|
Vedolizumab 300 mg intravenous solution
|
$53,289.00 |
$53,289.00 |
$53,289.00 |
$20,730.98
|
