|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$54.00 |
$54.00 |
$54.00 |
$147.48
|
|
Treatment of foot infection
|
$2,928.60 |
$2,928.60 |
$2,928.60 |
$2,928.60
|
|
Treatment radiation delivery level 2
|
$602.40 |
$602.40 |
$602.40 |
$830.70
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$200.64 |
$200.64 |
$200.64 |
$73,346.25
|
|
Treponema pallidum antibody
|
$109.20 |
$109.20 |
$109.20 |
$72.05
|
|
Treprostinil injection
|
$2,174.58 |
$2,174.58 |
$2,174.58 |
$19,071.84
|
|
Trg gene rearrangement anal
|
$181.20 |
$181.20 |
$181.20 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$177.22 |
$177.22 |
$177.22 |
$43.00
|
|
Triamcinolone a inj prs-free
|
$1,309.80 |
$1,309.80 |
$1,309.80 |
$223.56
|
|
Triamcinolone hexacetonl inj
|
$122.74 |
$122.74 |
$122.74 |
$21.36
|
|
Trichinella antibody
|
$120.60 |
$120.60 |
$120.60 |
$70.65
|
|
Trichomonas assay w/optic
|
$72.60 |
$72.60 |
$72.60 |
$57.40
|
|
Triglycerides
|
$36.60 |
$36.60 |
$36.60 |
$58.05
|
|
Trimethobenzamide hcl inj
|
$120.73 |
$120.73 |
$120.73 |
$117.49
|
|
Trim nondyst nails
|
$90.60 |
$90.60 |
$90.60 |
$114.48
|
|
Triptorelin pamoate
|
$4,619.39 |
$4,619.39 |
$4,619.39 |
$4,619.39
|
|
Trml dstrj ios bvn 1st 2 l/s
|
$24,720.00 |
$24,720.00 |
$24,720.00 |
$15,258.00
|
|
Trml dstrj ios bvn ea addl
|
$29,955.00 |
$29,955.00 |
$29,955.00 |
$7,354.00
|
|
Trnscath plc stent crv crtd w/prtct
|
$10,242.60 |
$10,242.60 |
$10,242.60 |
$9,767.25
|
|
Trnscath plc stnt ante carotid art
|
$3,165.00 |
$3,165.00 |
$3,165.00 |
$6,046.25
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$13,998.60 |
$13,998.60 |
$13,998.60 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$9,292.80 |
$9,292.80 |
$9,292.80 |
$8,790.54
|
|
Trnscath plc vas stent w/s&i ini vein
|
$19,338.60 |
$19,338.60 |
$19,338.60 |
$14,558.70
|
|
Trnscath retrv pq vasc fb w/guide
|
$6,043.20 |
$6,043.20 |
$6,043.20 |
$4,766.40
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$9,660.60 |
$9,660.60 |
$9,660.60 |
$5,139.20
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$5,603.40 |
$5,603.40 |
$5,603.40 |
$4,350.00
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$5,603.40 |
$5,603.40 |
$5,603.40 |
$4,379.34
|
|
Trnscath tx thromblytc vein ini day
|
$4,557.00 |
$4,557.00 |
$4,557.00 |
$3,866.70
|
|
Troponin quantitative
|
$70.20 |
$70.20 |
$70.20 |
$127.20
|
|
Tube trach disp innr can 5 xlt
|
$45.00 |
$45.00 |
$45.00 |
$445.99
|
|
Tx atrial fib pulm vein isol
|
$53,967.00 |
$53,967.00 |
$53,967.00 |
$29,030.54
|
|
Tx l/r atrial fib addl
|
$7,395.60 |
$7,395.60 |
$7,395.60 |
$6,986.85
|
|
Typhoid vaccine oral
|
$48.88 |
$48.88 |
$48.88 |
$63.28
|
|
Ua w/micro/comp poc
|
$43.80 |
$43.80 |
$43.80 |
$23.00
|
|
Ultrasound breast complete
|
$588.00 |
$588.00 |
$588.00 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$523.80 |
$523.80 |
$523.80 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$544.20 |
$544.20 |
$544.20 |
$338.00
|
|
Ultrasound dx ophth b-scan
|
$343.80 |
$343.80 |
$343.80 |
$296.80
|
|
Ultrasound elastography parenchyma
|
$523.80 |
$523.80 |
$523.80 |
$313.95
|
|
Ultrasound encephalogram
|
$544.20 |
$544.20 |
$544.20 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$544.20 |
$544.20 |
$544.20 |
$575.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$523.80 |
$523.80 |
$523.80 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$523.80 |
$523.80 |
$523.80 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$539.40 |
$539.40 |
$539.40 |
$388.08
|
|
Ultrasound guide intraoperative
|
$523.80 |
$523.80 |
$523.80 |
$632.85
|
|
Ultrasound hips infant dynamic
|
$523.80 |
$523.80 |
$523.80 |
$403.88
|
|
Ultrasound joint complete left
|
$523.80 |
$523.80 |
$523.80 |
$557.99
|
|
Ultrasound ob >=14wks ea addl gest
|
$523.80 |
$523.80 |
$523.80 |
$409.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$544.20 |
$544.20 |
$544.20 |
$335.00
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$544.20 |
$544.20 |
$544.20 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$544.20 |
$544.20 |
$544.20 |
$425.60
|
|
Ultrasound prostate/transrectal
|
$529.20 |
$529.20 |
$529.20 |
$557.40
|
|
Ultrasound spinal canal and contents
|
$523.80 |
$523.80 |
$523.80 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$544.20 |
$544.20 |
$544.20 |
$421.00
|
|
Unlisted dx gi procedure
|
$1,422.00 |
$1,422.00 |
$1,422.00 |
$649.22
|
|
Unlisted fetal invas px w/us
|
$507.00 |
$507.00 |
$507.00 |
$498.40
|
|
Unlisted hematology&coagj px
|
$63.60 |
$63.60 |
$63.60 |
$39.52
|
|
Unlisted procedure liver
|
$997.20 |
$997.20 |
$997.20 |
$2,287.20
|
|
Unlisted px casting/strpg
|
$133.80 |
$133.80 |
$133.80 |
$222.00
|
|
Unlisted urinalysis px
|
$38.40 |
$38.40 |
$38.40 |
$25.72
|
|
Upgrade pm system
|
$9,148.80 |
$9,148.80 |
$9,148.80 |
$12,077.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$281.40 |
$281.40 |
$281.40 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$1,680.60 |
$1,680.60 |
$1,680.60 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$885.00 |
$885.00 |
$885.00 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,176.20 |
$2,176.20 |
$2,176.20 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,176.20 |
$2,176.20 |
$2,176.20 |
$2,392.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,270.20 |
$1,270.20 |
$1,270.20 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$281.40 |
$281.40 |
$281.40 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$310.80 |
$310.80 |
$310.80 |
$381.60
|
|
Upper GI Barium X-ray (barium and gas)
|
$694.20 |
$694.20 |
$694.20 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$650.40 |
$650.40 |
$650.40 |
$607.20
|
|
Urea nitrogen
|
$52.20 |
$52.20 |
$52.20 |
$42.01
|
|
Urea nitrogen 24 hour urine
|
$46.80 |
$46.80 |
$46.80 |
$51.84
|
|
Urethrcystgrphy rtrgrde s&i
|
$678.00 |
$678.00 |
$678.00 |
$584.00
|
|
Urethrocystography void s&i
|
$966.60 |
$966.60 |
$966.60 |
$634.50
|
|
Uric acid blood
|
$24.60 |
$24.60 |
$24.60 |
$49.32
|
|
Uric acid urine
|
$43.80 |
$43.80 |
$43.80 |
$44.52
|
|
Urinalysis microscopic only
|
$38.40 |
$38.40 |
$38.40 |
$26.35
|
|
Urinalysis (with microscopy)
|
$40.20 |
$40.20 |
$40.20 |
$55.20
|
|
Urinalysis (without microscopy)
|
$24.00 |
$24.00 |
$24.00 |
$35.91
|
|
Urine Culture Test
|
$78.00 |
$78.00 |
$78.00 |
$82.32
|
|
Urine pregnancy test
|
$87.00 |
$87.00 |
$87.00 |
$68.21
|
|
Urography, antegrade
|
$635.40 |
$635.40 |
$635.40 |
$622.35
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$3,183.44 |
$3,183.44 |
$3,183.44 |
$5,205.00
|
|
Vaccine Administration (one shot)
|
$87.00 |
$87.00 |
$87.00 |
$67.74
|
|
Vaccine dtap < 7 years im
|
$49.35 |
$49.35 |
$49.35 |
$71.17
|
|
Vaccine dtap-hep b-ipv im
|
$180.74 |
$180.74 |
$180.74 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$131.65 |
$131.65 |
$131.65 |
$105.95
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$52.77 |
$52.77 |
$52.77 |
$70.53
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$48.82 |
$48.82 |
$48.82 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$135.49 |
$135.49 |
$135.49 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$201.80 |
$201.80 |
$201.80 |
$231.56
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$120.25 |
$120.25 |
$120.25 |
$78.25
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$175.91 |
$175.91 |
$175.91 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$446.88 |
$446.88 |
$446.88 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$45.91 |
$45.91 |
$45.91 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$441.38 |
$441.38 |
$441.38 |
$576.48
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$418.42 |
$418.42 |
$418.42 |
$282.50
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$179.55 |
$179.55 |
$179.55 |
$149.21
|
|
Vaccine influenza inactivated adjuvant im
|
$34.61 |
$34.61 |
$34.61 |
$110.25
|