|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$3.43 |
$3.43 |
$12.26 |
$303.88
|
|
Toxoplasma antibody igg
|
$21.30 |
$21.30 |
$21.30 |
$84.35
|
|
Tpmt gene com vrnts
|
$74.00 |
$74.00 |
$74.00 |
$381.55
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$303.00 |
$303.00 |
$303.00 |
$82.60
|
|
Transcatheter bx s&i
|
$5,664.00 |
$5,664.00 |
$5,664.00 |
$1,875.96
|
|
Transferrin
|
$36.17 |
$36.17 |
$260.00 |
$87.30
|
|
Trastuzumab 150 mg intravenous solution
|
$112.33 |
$112.33 |
$123.56 |
$3,401.26
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$44.76 |
$44.76 |
$918.89 |
$7,620.16
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$108.27 |
$108.27 |
$108.27 |
$3,600.00
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$117.01 |
$117.01 |
$1,075.00 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$80.57 |
$80.57 |
$1,075.00 |
$149.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$61.05 |
$61.05 |
$61.05 |
$210.00
|
|
Treponema pallidum antibody
|
$23.50 |
$23.50 |
$23.50 |
$72.80
|
|
Treprostinil injection
|
$180.64 |
$180.64 |
$180.64 |
$528.60
|
|
Trg gene rearrangement anal
|
$120.25 |
$120.25 |
$122.00 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$48.22 |
$48.22 |
$48.22 |
$48.22
|
|
Trichinella antibody
|
$76.00 |
$76.00 |
$76.00 |
$70.65
|
|
Trichomonas assay w/optic
|
$58.00 |
$58.00 |
$58.00 |
$66.00
|
|
#tricyclicantidprssnt
|
$12.00 |
$12.00 |
$12.00 |
$57.08
|
|
Triglycerides
|
$68.08 |
$68.08 |
$582.00 |
$54.60
|
|
Trimethobenzamide hcl inj
|
$56.24 |
$56.24 |
$132.00 |
$154.09
|
|
Troponin quantitative
|
$55.96 |
$55.96 |
$55.96 |
$123.75
|
|
Tube trach disp innr can 5 xlt
|
$476.75 |
$476.75 |
$476.75 |
$460.58
|
|
Tube trach fen sz 6 uncuffed
|
$138.84 |
$138.84 |
$138.84 |
$132.40
|
|
Tx atrial fib pulm vein isol
|
$120,110.00 |
$120,110.00 |
$120,110.00 |
$32,426.20
|
|
Tx l/r atrial fib addl
|
$10,786.00 |
$10,786.00 |
$10,786.00 |
$7,717.80
|
|
Ua w/micro/comp poc
|
$12.03 |
$12.03 |
$12.03 |
$24.45
|
|
Ultrasound abdomen aorta screening study aaa
|
$263.63 |
$263.63 |
$263.63 |
$403.26
|
|
Ultrasound breast complete
|
$754.80 |
$754.80 |
$754.80 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$666.00 |
$666.00 |
$666.00 |
$449.35
|
|
Ultrasound chest
|
$444.56 |
$444.56 |
$444.56 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$452.33 |
$452.33 |
$624.28 |
$340.14
|
|
Ultrasound encephalogram
|
$659.80 |
$659.80 |
$659.80 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$513.93 |
$513.93 |
$513.93 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$640.38 |
$640.38 |
$883.65 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$340.22 |
$340.22 |
$340.22 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$946.92 |
$946.92 |
$946.92 |
$701.35
|
|
Ultrasound joint complete left
|
$693.29 |
$693.29 |
$693.29 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$684.22 |
$684.22 |
$684.22 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$159.75 |
$159.75 |
$159.75 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$154.66 |
$154.66 |
$154.66 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$617.90 |
$617.90 |
$617.90 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$247.07 |
$247.07 |
$340.96 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$340.96 |
$340.96 |
$340.96 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$549.27 |
$549.27 |
$549.27 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$750.36 |
$750.36 |
$750.36 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$444.56 |
$444.56 |
$444.56 |
$498.00
|
|
Ultrasound scrotum and contents
|
$632.61 |
$632.61 |
$632.61 |
$617.28
|
|
Ultrasound transabd ea addl gest
|
$199.25 |
$199.25 |
$199.25 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$710.31 |
$710.31 |
$710.31 |
$567.44
|
|
Unlisted gu px dx nuc med
|
$3,183.00 |
$3,183.00 |
$3,183.00 |
$475.51
|
|
Unlisted mr procedure
|
$590.15 |
$590.15 |
$590.15 |
$1,032.20
|
|
Unlisted procedure microbiology
|
$10.92 |
$10.92 |
$10.92 |
$487.50
|
|
Unlisted resp px dx nuc med
|
$2,448.00 |
$2,448.00 |
$2,448.00 |
$545.61
|
|
Unlisted transfusion med px
|
$12.86 |
$12.86 |
$12.86 |
$141.35
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$622.25 |
$622.25 |
$622.25 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$590.15 |
$590.15 |
$590.15 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$558.05 |
$558.05 |
$558.05 |
$2,013.08
|
|
Urea nitrogen
|
$10.55 |
$10.55 |
$762.00 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$42.00 |
$42.00 |
$762.00 |
$50.00
|
|
Urea nitrogen clearance
|
$13.97 |
$13.97 |
$13.97 |
$33.57
|
|
Urethrocystography void s&i
|
$432.81 |
$432.81 |
$432.81 |
$634.50
|
|
Uric acid blood
|
$50.14 |
$50.14 |
$989.00 |
$46.64
|
|
Uric acid urine
|
$27.20 |
$27.20 |
$551.00 |
$46.75
|
|
Urinalysis microscopic only
|
$6.57 |
$6.57 |
$728.00 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$5.00 |
$5.00 |
$5.00 |
$25.72
|
|
Urinalysis (with microscopy)
|
$22.20 |
$22.20 |
$616.00 |
$48.14
|
|
Urinalysis (without microscopy)
|
$10.45 |
$10.45 |
$10.45 |
$38.99
|
|
Urine Culture Test
|
$80.01 |
$80.01 |
$1,576.00 |
$84.81
|
|
Urine pregnancy test
|
$75.94 |
$75.94 |
$75.94 |
$66.40
|
|
Urography, antegrade
|
$588.49 |
$588.49 |
$735.65 |
$593.37
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$1,005.47 |
$3,222.53 |
$6,174.00 |
$6,892.54
|
|
Vaccine dtap < 7 years im
|
$45.31 |
$48.14 |
$146.00 |
$87.80
|
|
Vaccine dtap-ipv 4-6 years im
|
$100.18 |
$100.18 |
$100.18 |
$126.84
|
|
Vaccine dtap-ipv/hib im
|
$187.87 |
$187.87 |
$463.00 |
$248.80
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$48.14 |
$48.14 |
$48.14 |
$85.00
|
|
Vaccine hepatitis a (hepa) adult im
|
$92.87 |
$92.87 |
$247.00 |
$178.07
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$108.78 |
$108.78 |
$108.78 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$80.75 |
$80.75 |
$80.75 |
$84.38
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 3 dose im
|
$49.21 |
$49.21 |
$49.21 |
$48.10
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$48.03 |
$48.03 |
$48.14 |
$61.50
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$67.71 |
$67.71 |
$307.00 |
$173.98
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$67.34 |
$67.34 |
$67.34 |
$79.04
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$655.27 |
$655.27 |
$655.27 |
$686.67
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$156.05 |
$156.05 |
$156.05 |
$157.41
|
|
Vaccine influenza nos 0.5ml dose im
|
$48.29 |
$48.29 |
$48.34 |
$36.80
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$48.29 |
$48.29 |
$48.29 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$67.00 |
$158.27 |
$158.27 |
$42.90
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$108.41 |
$108.41 |
$108.41 |
$26.40
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$67.00 |
$79.37 |
$79.37 |
$40.01
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$137.00 |
$137.00 |
$137.00 |
$72.00
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$45.79 |
$45.79 |
$45.79 |
$103.88
|
|
Vaccine influenza trivalent (iiv3) 0.25ml dose im
|
$9.25 |
$9.25 |
$9.25 |
$32.50
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$163.54 |
$163.54 |
$163.54 |
$499.00
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$354.55 |
$354.55 |
$787.00 |
$426.80
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$372.00 |
$372.00 |
$372.00 |
$349.15
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$247.62 |
$247.62 |
$486.00 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$52.17 |
$52.17 |
$226.00 |
$224.04
|
|
Vaccine mmrv live subcutaneous
|
$202.11 |
$202.11 |
$202.11 |
$474.24
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$150.13 |
$150.13 |
$278.00 |
$274.95
|
