|
Tpmt gene com vrnts
|
$232.00 |
$232.00 |
$232.00 |
$371.80
|
|
Trabectedin 1 mg intravenous solution
|
$8,645.95 |
$8,645.95 |
$8,645.95 |
$6,827.00
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$74.00 |
$74.00 |
$74.00 |
$101.25
|
|
Transferrin
|
$65.38 |
$65.38 |
$65.38 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$650.38 |
$650.38 |
$650.38 |
$983.00
|
|
Trastuzumab 150 mg intravenous solution
|
$3,921.88 |
$3,921.88 |
$3,921.88 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$9,169.45 |
$9,169.45 |
$9,169.45 |
$7,540.20
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$5,316.26 |
$5,316.26 |
$5,316.26 |
$5,835.15
|
|
Tray bonemarrw oncontrol 102mm
|
$1,799.44 |
$1,799.44 |
$1,799.44 |
$940.80
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$269.82 |
$269.82 |
$269.82 |
$203.35
|
|
Treatment radiation delivery level 2
|
$373.00 |
$373.00 |
$373.00 |
$767.65
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$99,476.00 |
$99,476.00 |
$99,476.00 |
$73,346.25
|
|
Treponema pallidum antibody
|
$94.50 |
$94.50 |
$94.50 |
$70.40
|
|
Treprostinil injection
|
$10,371.45 |
$10,371.45 |
$10,371.45 |
$19,071.84
|
|
Treprostinil, non-comp unit
|
$7,365.50 |
$7,365.50 |
$7,365.50 |
$3,894.40
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$82.74 |
$82.74 |
$82.74 |
$43.21
|
|
Triamcinolone a inj prs-free
|
$3,116.36 |
$3,116.36 |
$3,116.36 |
$223.56
|
|
Triglycerides
|
$27.62 |
$27.62 |
$27.62 |
$58.05
|
|
Trilaciclib 300 mg intravenous solution
|
$3,903.74 |
$3,903.74 |
$3,903.74 |
$4,043.12
|
|
Trimethobenzamide hcl inj
|
$262.24 |
$262.24 |
$262.24 |
$117.49
|
|
Trim nondyst nails
|
$103.00 |
$103.00 |
$103.00 |
$113.40
|
|
Triptorelin pamoate
|
$10,504.62 |
$10,504.62 |
$10,504.62 |
$4,619.39
|
|
Troponin quantitative
|
$90.25 |
$90.25 |
$90.25 |
$127.20
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$26,207.26 |
$26,207.26 |
$26,207.26 |
$20,945.01
|
|
Ultrasound abdomen aorta screening study aaa
|
$145.25 |
$145.25 |
$145.25 |
$394.20
|
|
Ultrasound breast complete
|
$383.12 |
$383.12 |
$383.12 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$352.62 |
$352.62 |
$352.62 |
$449.35
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$129.35 |
$129.35 |
$129.35 |
$338.00
|
|
Ultrasound encephalogram
|
$288.38 |
$288.38 |
$288.38 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$501.00 |
$501.00 |
$501.00 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$233.88 |
$233.88 |
$233.88 |
$469.50
|
|
Ultrasound guided needle placement supervision & interpretation
|
$396.50 |
$396.50 |
$396.50 |
$720.15
|
|
Ultrasound guide intraoperative
|
$313.88 |
$313.88 |
$313.88 |
$632.85
|
|
Ultrasound joint/nonvascular extremity limited left
|
$142.62 |
$142.62 |
$142.62 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$347.50 |
$347.50 |
$347.50 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$334.50 |
$334.50 |
$334.50 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$390.98 |
$390.98 |
$390.98 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$259.50 |
$259.50 |
$259.50 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$349.12 |
$349.12 |
$349.12 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$234.50 |
$234.50 |
$234.50 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$576.50 |
$576.50 |
$576.50 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$340.75 |
$340.75 |
$340.75 |
$486.50
|
|
Ultrasound scrotum and contents
|
$406.00 |
$406.00 |
$406.00 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$217.88 |
$217.88 |
$217.88 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$164.12 |
$164.12 |
$164.12 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$300.00 |
$300.00 |
$300.00 |
$558.35
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$804.12 |
$804.12 |
$804.12 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$742.75 |
$742.75 |
$742.75 |
$2,034.41
|
|
Urea nitrogen
|
$23.50 |
$23.50 |
$23.50 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$33.50 |
$33.50 |
$33.50 |
$51.75
|
|
Uric acid blood
|
$29.25 |
$29.25 |
$29.25 |
$48.75
|
|
Uric acid urine
|
$32.00 |
$32.00 |
$32.00 |
$44.33
|
|
Urinalysis microscopic only
|
$14.00 |
$14.00 |
$14.00 |
$26.35
|
|
Urinalysis (with microscopy)
|
$18.38 |
$18.38 |
$18.38 |
$55.00
|
|
Urinalysis (without microscopy)
|
$12.12 |
$12.12 |
$12.12 |
$35.75
|
|
Urine Culture Test
|
$16.38 |
$16.38 |
$16.38 |
$81.50
|
|
Urine pregnancy test
|
$23.00 |
$23.00 |
$23.00 |
$67.20
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$5,084.76 |
$5,084.76 |
$5,084.76 |
$5,184.34
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$37,645.70 |
$37,645.70 |
$37,645.70 |
$51,633.07
|
|
Vaccine dtap < 7 years im
|
$99.83 |
$99.83 |
$99.83 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$165.26 |
$165.26 |
$165.26 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$150.98 |
$150.98 |
$150.98 |
$105.95
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$61.05 |
$61.05 |
$61.05 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$170.44 |
$170.44 |
$170.44 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$238.59 |
$238.59 |
$238.59 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$127.36 |
$127.36 |
$127.36 |
$79.15
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$249.58 |
$249.58 |
$249.58 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$296.22 |
$296.22 |
$296.22 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$95.62 |
$95.62 |
$95.62 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$1,062.82 |
$1,062.82 |
$1,062.82 |
$576.48
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$66.09 |
$66.09 |
$66.09 |
$143.20
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$29.05 |
$29.05 |
$29.05 |
$47.88
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$387.95 |
$387.95 |
$387.95 |
$400.03
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$544.94 |
$544.94 |
$544.94 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$213.00 |
$213.00 |
$213.00 |
$211.68
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$268.66 |
$268.66 |
$268.66 |
$251.64
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$466.48 |
$466.48 |
$466.48 |
$397.11
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$532.20 |
$532.20 |
$532.20 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$907.72 |
$907.72 |
$907.72 |
$90.70
|
|
Vaccine rabies im
|
$1,780.26 |
$1,780.26 |
$1,780.26 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$588.40 |
$588.40 |
$588.40 |
$538.84
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$1,135.24 |
$1,135.24 |
$1,135.24 |
$1,104.47
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$1,135.24 |
$1,135.24 |
$1,135.24 |
$997.44
|
|
Vaccine tdap >=7 years im
|
$160.60 |
$160.60 |
$160.60 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$159.04 |
$159.04 |
$159.04 |
$112.10
|
|
Vaccine typhoid vicps im
|
$325.62 |
$325.62 |
$325.62 |
$264.78
|
|
Vaccine varicella live subcutaneous
|
$409.26 |
$409.26 |
$409.26 |
$365.17
|
|
Valproic acid total therapeutic drug level
|
$99.25 |
$99.25 |
$99.25 |
$114.72
|
|
Vancomycin hcl injection
|
$154.40 |
$154.40 |
$154.40 |
$154.40
|
|
Vancomycin peak therapeutic drug level
|
$87.00 |
$87.00 |
$87.00 |
$136.13
|
|
Vantas implant
|
$12,207.65 |
$12,207.65 |
$12,207.65 |
$12,207.65
|
|
Varicella zoster antibody igg
|
$87.62 |
$87.62 |
$87.62 |
$86.80
|
|
Varicella-zoster immue globin im
|
$4,062.76 |
$4,062.76 |
$4,062.76 |
$3,816.19
|
|
Vasopressin 20 unit/ml intravenous solution
|
$80.23 |
$80.23 |
$80.23 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$21,692.45 |
$21,692.45 |
$21,692.45 |
$18,732.33
|
|
Velaglucerase alfa 400 unit intravenous solution
|
$3,678.15 |
$3,678.15 |
$3,678.15 |
$2,632.35
|
|
Ventilator each subsequent day
|
$443.00 |
$443.00 |
$443.00 |
$1,204.00
|
|
Ventilator initial day
|
$472.50 |
$472.50 |
$472.50 |
$1,431.43
|
|
Vinblastine 1 mg/ml intravenous solution
|
$298.22 |
$298.22 |
$298.22 |
$165.00
|
|
Vincristine 1 mg/ml intravenous solution
|
$81.36 |
$81.36 |
$81.36 |
$87.15
|
