|
Tomosynthesis breast screen bilateral
|
$68.43 |
$68.43 |
$68.43 |
$73.45
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$13,068.00 |
$13,068.00 |
$13,068.00 |
$303.88
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$82.60 |
$82.60 |
$82.60 |
$82.60
|
|
Transcatheter bx s&i
|
$13,877.72 |
$13,877.72 |
$13,877.72 |
$1,875.96
|
|
Trastuzumab 150 mg intravenous solution
|
$396.00 |
$396.00 |
$396.00 |
$3,401.26
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$948.74 |
$948.74 |
$948.74 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$475.84 |
$475.84 |
$475.84 |
$149.00
|
|
Trg gene rearrangement anal
|
$150.00 |
$150.00 |
$150.00 |
$455.70
|
|
Triamcinolone a inj prs-free
|
$3,224.00 |
$3,224.00 |
$3,224.00 |
$225.43
|
|
Trichinella antibody
|
$21.71 |
$21.71 |
$21.71 |
$70.65
|
|
#tricyclicantidprssnt
|
$15.00 |
$15.00 |
$15.00 |
$57.08
|
|
Trilaciclib 300 mg intravenous solution
|
$5,865.00 |
$5,865.00 |
$5,865.00 |
$5.36
|
|
Trimethobenzamide hcl inj
|
$261.00 |
$261.00 |
$261.00 |
$154.09
|
|
Troponin quantitative
|
$1,230.71 |
$1,230.71 |
$1,230.71 |
$123.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$2,404.05 |
$2,404.05 |
$2,404.05 |
$403.26
|
|
Ultrasound chest
|
$3,830.02 |
$3,830.02 |
$3,830.02 |
$459.55
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$2,403.32 |
$2,403.32 |
$2,403.32 |
$340.14
|
|
Ultrasound encephalogram
|
$3,285.06 |
$3,285.06 |
$3,285.06 |
$481.60
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$1,769.83 |
$1,769.83 |
$1,769.83 |
$477.88
|
|
Ultrasound ob >=14wks ea addl gest
|
$4,933.86 |
$4,933.86 |
$4,933.86 |
$454.11
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$4,480.49 |
$4,480.49 |
$4,480.49 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$2,147.17 |
$2,147.17 |
$2,147.17 |
$450.75
|
|
Ultrasound pregnant uterus transvaginal
|
$4,480.49 |
$4,480.49 |
$4,480.49 |
$485.48
|
|
Ultrasound spinal canal and contents
|
$3,117.47 |
$3,117.47 |
$3,117.47 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$1,349.23 |
$1,349.23 |
$1,349.23 |
$425.10
|
|
Unlisted ultrasound procedure
|
$4,764.68 |
$4,764.68 |
$4,764.68 |
$321.20
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$19,512.35 |
$19,512.35 |
$19,512.35 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$5,893.25 |
$5,893.25 |
$5,893.25 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$15,450.19 |
$15,450.19 |
$15,450.19 |
$2,013.08
|
|
Urea nitrogen 24 hour urine
|
$1,042.54 |
$1,042.54 |
$1,042.54 |
$50.00
|
|
Urea nitrogen clearance
|
$807.51 |
$807.51 |
$807.51 |
$33.57
|
|
Urethrcystgrphy rtrgrde s&i
|
$7,556.98 |
$7,556.98 |
$7,556.98 |
$574.40
|
|
Urethrocystography void s&i
|
$7,556.98 |
$7,556.98 |
$7,556.98 |
$634.50
|
|
Uric acid blood
|
$1,465.74 |
$1,465.74 |
$1,465.74 |
$46.64
|
|
Urinalysis qual/semiquant excpt ia
|
$264.63 |
$264.63 |
$264.63 |
$25.72
|
|
Urinary bldr retent nuc study
|
$5,929.03 |
$5,929.03 |
$5,929.03 |
$309.22
|
|
Urine Culture Test
|
$2,881.57 |
$2,881.57 |
$2,881.57 |
$84.81
|
|
Urography inf drip &/or bolus
|
$6,905.23 |
$6,905.23 |
$6,905.23 |
$641.69
|
|
Vaccine dtap < 7 years im
|
$180.00 |
$180.00 |
$180.00 |
$87.80
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$332.24 |
$332.24 |
$332.24 |
$45.33
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$151.00 |
$151.00 |
$151.00 |
$218.40
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$137.76 |
$137.76 |
$137.76 |
$40.01
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$1,743.28 |
$1,743.28 |
$1,743.28 |
$426.80
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$1,128.68 |
$1,128.68 |
$1,128.68 |
$349.15
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$2,485.00 |
$2,485.00 |
$2,485.00 |
$408.70
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$614.00 |
$614.00 |
$614.00 |
$274.95
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$1,058.00 |
$1,058.00 |
$1,058.00 |
$397.18
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$1,560.22 |
$1,560.22 |
$1,560.22 |
$385.45
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$1,354.06 |
$1,354.06 |
$1,354.06 |
$715.41
|
|
Vaccine rabies im
|
$1,857.00 |
$1,857.00 |
$1,857.00 |
$945.46
|
|
Vaccine tdap >=7 years im
|
$468.27 |
$468.27 |
$468.27 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$554.00 |
$554.00 |
$554.00 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$105.00 |
$105.00 |
$105.00 |
$447.80
|
|
Valproic acid total therapeutic drug level
|
$1,479.67 |
$1,479.67 |
$1,479.67 |
$115.00
|
|
Vasopressin 20 unit/ml intravenous solution
|
$315.59 |
$315.59 |
$315.59 |
$394.13
|
|
Vedolizumab 300 mg intravenous solution
|
$22,352.00 |
$22,352.00 |
$22,352.00 |
$23,003.79
|
|
Vein x-ray adrenal glands
|
$7,256.41 |
$7,256.41 |
$7,256.41 |
$3,999.60
|
|
Vein x-ray liver
|
$6,123.37 |
$6,123.37 |
$6,123.37 |
$3,320.80
|
|
Vein x-ray liver w/hemodynam
|
$12,693.10 |
$12,693.10 |
$12,693.10 |
$3,413.25
|
|
Vein x-ray liver w/hemodynam
|
$6,123.37 |
$6,123.37 |
$6,123.37 |
$3,439.84
|
|
Vein x-ray liver without hemodyn
|
$12,693.10 |
$12,693.10 |
$12,693.10 |
$2,489.25
|
|
Ventilator each subsequent day
|
$2,831.57 |
$2,831.57 |
$2,831.57 |
$1,305.92
|
|
Ventilator initial day
|
$4,178.54 |
$4,178.54 |
$4,178.54 |
$1,540.80
|
|
Vincristine 1 mg/ml intravenous solution
|
$543.00 |
$543.00 |
$543.00 |
$104.79
|
|
Vital capacity test
|
$813.62 |
$813.62 |
$813.62 |
$173.33
|
|
Volume measurement urine timed
|
$115.20 |
$115.20 |
$115.20 |
$21.45
|
|
Voriconazole in ns IV syringe 5 mg/ml (pediatric) - cnr
|
$3,458.00 |
$3,458.00 |
$3,458.00 |
$224.40
|
|
Warde acetylcholine receptor blocking antibody
|
$30.00 |
$30.00 |
$30.00 |
$68.90
|
|
Warde amino acids 6 or more quantitative each specimen
|
$330.75 |
$330.75 |
$330.75 |
$176.20
|
|
Warde antiepileptics nos definitive assay 1-3 clobazam w metabolites
|
$50.00 |
$50.00 |
$50.00 |
$142.65
|
|
Warde calcitonin
|
$19.04 |
$19.04 |
$19.04 |
$89.40
|
|
Warde calculus (stone) infrared
|
$10.82 |
$10.82 |
$10.82 |
$61.73
|
|
Warde clozapine therapeutic drug level
|
$290.43 |
$290.43 |
$290.43 |
$63.00
|
|
Warde haloperidol therapeutic drug level
|
$15.26 |
$15.26 |
$15.26 |
$68.16
|
|
Warde hepatitis delta agent antibody
|
$25.00 |
$25.00 |
$25.00 |
$92.30
|
|
Warde islet cell antibody zinc transporter 8
|
$17.92 |
$17.92 |
$17.92 |
$137.55
|
|
Warde lipoprotein-associated phospholipase a2
|
$20.00 |
$20.00 |
$20.00 |
$97.00
|
|
Warde neutralization rabies
|
$8.77 |
$8.77 |
$8.77 |
$106.50
|
|
Warde oxcarbazepine therapeutic drug level
|
$41.77 |
$41.77 |
$41.77 |
$64.50
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$1,606.00 |
$1,606.00 |
$1,606.00 |
$288.91
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$1,606.00 |
$1,606.00 |
$1,606.00 |
$436.15
|
|
Xe133 xenon 10mci
|
$1,464.08 |
$1,464.08 |
$1,464.08 |
$299.00
|
|
X-ray bone age studies
|
$2,928.57 |
$2,928.57 |
$2,928.57 |
$246.75
|
|
X-ray bone length studies
|
$11,601.03 |
$11,601.03 |
$11,601.03 |
$287.25
|
|
X-ray bone survey infant
|
$501.39 |
$501.39 |
$501.39 |
$410.73
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$5,086.10 |
$5,086.10 |
$5,086.10 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$6,442.93 |
$6,442.93 |
$6,442.93 |
$820.15
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$4,182.05 |
$4,182.05 |
$4,182.05 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$3,390.73 |
$3,390.73 |
$3,390.73 |
$486.01
|
|
X-ray exam entire spi 6/> vw
|
$3,953.21 |
$3,953.21 |
$3,953.21 |
$575.76
|
|
X-ray exam of femur 1
|
$2,486.69 |
$2,486.69 |
$2,486.69 |
$232.36
|
|
X-ray exam of middle ear
|
$3,976.79 |
$3,976.79 |
$3,976.79 |
$341.25
|
|
X-ray exam of penis
|
$9,708.34 |
$9,708.34 |
$9,708.34 |
$565.20
|
|
X-ray exam thorac spine4/>vw
|
$4,354.70 |
$4,354.70 |
$4,354.70 |
$395.59
|
|
X-ray femur >=2 views (both sides)
|
$3,503.57 |
$3,503.57 |
$3,503.57 |
$304.15
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$4,522.02 |
$4,522.02 |
$4,522.02 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$4,406.02 |
$4,406.02 |
$4,406.02 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$4,860.42 |
$4,860.42 |
$4,860.42 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$5,422.89 |
$5,422.89 |
$5,422.89 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$2,486.69 |
$2,486.69 |
$2,486.69 |
$207.35
|
