|
Tissue transglutaminase iga
|
$80.00 |
$80.00 |
$80.00 |
$44.16
|
|
Tl-201 thallium diag per mci
|
$82.50 |
$82.50 |
$82.50 |
$78.40
|
|
Tobramycin peak therapeutic drug level
|
$115.00 |
$115.00 |
$115.00 |
$120.60
|
|
Tomosynthesis breast diagnostic left
|
$62.50 |
$62.50 |
$62.50 |
$73.00
|
|
Tomosynthesis breast screen bilateral
|
$62.50 |
$62.50 |
$62.50 |
$72.68
|
|
Total tau
|
$312.50 |
$312.50 |
$312.50 |
$312.50
|
|
Toxoplasma antibody igg
|
$62.50 |
$62.50 |
$62.50 |
$89.40
|
|
Toxoplasma antibody igm
|
$62.50 |
$62.50 |
$62.50 |
$87.00
|
|
Tp53 gene trgt sequence alys
|
$1,095.00 |
$1,095.00 |
$1,095.00 |
$790.68
|
|
Tpmt gene com vrnts
|
$202.50 |
$202.50 |
$202.50 |
$371.80
|
|
Transcath biopsy
|
$5,275.00 |
$5,275.00 |
$5,275.00 |
$4,285.93
|
|
Transcatheter bx s&i
|
$1,785.00 |
$1,785.00 |
$1,785.00 |
$1,915.00
|
|
Transcath occlusion cns
|
$2,290.00 |
$2,290.00 |
$2,290.00 |
$7,157.76
|
|
Transcath occlusion non-cns
|
$15,145.00 |
$15,145.00 |
$15,145.00 |
$10,031.28
|
|
Transferrin
|
$92.50 |
$92.50 |
$92.50 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$725.00 |
$725.00 |
$725.00 |
$983.00
|
|
Transparent film >16<=48 in
|
$2.02 |
$2.02 |
$2.02 |
$12.95
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$256.11 |
$256.11 |
$256.11 |
$7,540.20
|
|
Trauma partial team response w/critical care services level 4
|
$3,185.00 |
$3,185.00 |
$3,185.00 |
$4,523.04
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$180.00 |
$180.00 |
$180.00 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$90.00 |
$90.00 |
$90.00 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$127.50 |
$127.50 |
$127.50 |
$203.35
|
|
Treatment radiation delivery level 2
|
$880.00 |
$880.00 |
$880.00 |
$767.65
|
|
Treponema pallidum antibody
|
$52.50 |
$52.50 |
$52.50 |
$70.40
|
|
Trg gene rearrangement anal
|
$610.00 |
$610.00 |
$610.00 |
$455.70
|
|
Trichinella antibody
|
$92.50 |
$92.50 |
$92.50 |
$70.20
|
|
Trichomonas assay w/optic
|
$52.50 |
$52.50 |
$52.50 |
$55.50
|
|
Triglycerides
|
$65.00 |
$65.00 |
$65.00 |
$58.05
|
|
Trilaciclib 300 mg intravenous solution
|
$14.46 |
$14.46 |
$14.46 |
$4,043.12
|
|
Trim nail(s)
|
$50.00 |
$50.00 |
$50.00 |
$79.00
|
|
Trim nondyst nails
|
$50.00 |
$50.00 |
$50.00 |
$113.40
|
|
Trnscath plc stent crv crtd w/prtct
|
$6,570.00 |
$6,570.00 |
$6,570.00 |
$9,767.25
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$10,405.00 |
$10,405.00 |
$10,405.00 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$10,405.00 |
$10,405.00 |
$10,405.00 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$16,005.00 |
$16,005.00 |
$16,005.00 |
$15,330.11
|
|
Trnscath retrv pq vasc fb w/guide
|
$2,965.00 |
$2,965.00 |
$2,965.00 |
$4,523.96
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$2,005.00 |
$2,005.00 |
$2,005.00 |
$5,069.50
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$3,510.00 |
$3,510.00 |
$3,510.00 |
$4,250.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$3,510.00 |
$3,510.00 |
$3,510.00 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$2,005.00 |
$2,005.00 |
$2,005.00 |
$3,866.70
|
|
Troponin quantitative
|
$87.50 |
$87.50 |
$87.50 |
$127.20
|
|
Tube trach disp innr can 5 xlt
|
$150.00 |
$150.00 |
$150.00 |
$445.99
|
|
Tube trach fen sz 6 uncuffed
|
$125.00 |
$125.00 |
$125.00 |
$155.98
|
|
Tyms gene com variants
|
$140.00 |
$140.00 |
$140.00 |
$192.29
|
|
Ua w/micro/comp poc
|
$15.00 |
$15.00 |
$15.00 |
$23.00
|
|
Ugt1a1 gene analy common variants
|
$235.00 |
$235.00 |
$235.00 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$380.00 |
$380.00 |
$380.00 |
$394.20
|
|
Ultrasound breast complete
|
$905.00 |
$905.00 |
$905.00 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$680.00 |
$680.00 |
$680.00 |
$449.35
|
|
Ultrasound chest
|
$505.00 |
$505.00 |
$505.00 |
$460.85
|
|
Ultrasound elastography parenchyma
|
$362.50 |
$362.50 |
$362.50 |
$307.00
|
|
Ultrasound encephalogram
|
$570.00 |
$570.00 |
$570.00 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$670.00 |
$670.00 |
$670.00 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$467.50 |
$467.50 |
$467.50 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$422.50 |
$422.50 |
$422.50 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$720.00 |
$720.00 |
$720.00 |
$720.15
|
|
Ultrasound guide intraoperative
|
$292.50 |
$292.50 |
$292.50 |
$632.85
|
|
Ultrasound hips infant dynamic
|
$370.00 |
$370.00 |
$370.00 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$247.50 |
$247.50 |
$247.50 |
$311.25
|
|
Ultrasound joint complete left
|
$750.00 |
$750.00 |
$750.00 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$565.00 |
$565.00 |
$565.00 |
$425.45
|
|
Ultrasound nrv&acc strux 1xtr compre
|
$355.00 |
$355.00 |
$355.00 |
$277.80
|
|
Ultrasound ob >=14wks ea addl gest
|
$330.00 |
$330.00 |
$330.00 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$267.50 |
$267.50 |
$267.50 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$535.00 |
$535.00 |
$535.00 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$387.50 |
$387.50 |
$387.50 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$387.50 |
$387.50 |
$387.50 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$452.50 |
$452.50 |
$452.50 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$790.00 |
$790.00 |
$790.00 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$735.00 |
$735.00 |
$735.00 |
$486.50
|
|
Ultrasound scrotum and contents
|
$595.00 |
$595.00 |
$595.00 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$405.00 |
$405.00 |
$405.00 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$267.50 |
$267.50 |
$267.50 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$670.00 |
$670.00 |
$670.00 |
$558.35
|
|
Unlisted chemotherapy px
|
$127.50 |
$127.50 |
$127.50 |
$150.00
|
|
Unlisted neurological dx px
|
$242.50 |
$242.50 |
$242.50 |
$242.50
|
|
Unlisted procedure microbiology
|
$530.00 |
$530.00 |
$530.00 |
$523.50
|
|
Unlisted px casting/strpg
|
$110.00 |
$110.00 |
$110.00 |
$219.70
|
|
Unlisted px med radj physics
|
$495.00 |
$495.00 |
$495.00 |
$462.35
|
|
Unlisted reprod med lab proc
|
$65.00 |
$65.00 |
$65.00 |
$70.00
|
|
Unsched dialysis esrd pt hos
|
$1,240.00 |
$1,240.00 |
$1,240.00 |
$1,268.17
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$3,265.00 |
$3,265.00 |
$3,265.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,210.00 |
$2,210.00 |
$2,210.00 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,110.00 |
$2,110.00 |
$2,110.00 |
$2,034.41
|
|
Urea nitrogen
|
$27.50 |
$27.50 |
$27.50 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$57.50 |
$57.50 |
$57.50 |
$51.75
|
|
Ureteral reflux study
|
$1,035.00 |
$1,035.00 |
$1,035.00 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$515.00 |
$515.00 |
$515.00 |
$579.73
|
|
Urethrocystography void s&i
|
$690.00 |
$690.00 |
$690.00 |
$622.35
|
|
Uric acid blood
|
$57.50 |
$57.50 |
$57.50 |
$48.75
|
|
Uric acid urine
|
$52.50 |
$52.50 |
$52.50 |
$44.33
|
|
Urinalysis microscopic only
|
$20.00 |
$20.00 |
$20.00 |
$26.35
|
|
Urinalysis (with microscopy)
|
$57.50 |
$57.50 |
$57.50 |
$55.00
|
|
Urinalysis (without microscopy)
|
$25.00 |
$25.00 |
$25.00 |
$35.75
|
|
Urine Culture Test
|
$80.00 |
$80.00 |
$80.00 |
$81.50
|
|
Urine pregnancy test
|
$77.50 |
$77.50 |
$77.50 |
$67.20
|
|
Urography, antegrade
|
$560.00 |
$560.00 |
$560.00 |
$622.35
|
|
Urography inf drip &/or bolus
|
$650.00 |
$650.00 |
$650.00 |
$642.50
|
|
Vaccine tdap >=7 years im
|
$124.91 |
$124.91 |
$124.91 |
$131.34
|
|
Vacuum drain bottle/tube kit
|
$1,245.00 |
$1,245.00 |
$1,245.00 |
$325.20
|
