|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$188.75 |
$188.75 |
$188.75 |
$316.84
|
|
Toripalimab-tpzi 240 mg/6 ml (40 mg/ml) intravenous solution
|
$48,786.25 |
$48,786.25 |
$48,786.25 |
$15,383.12
|
|
Toxoplasma antibody igg
|
$79.30 |
$79.30 |
$79.30 |
$91.65
|
|
Toxoplasma antibody igm
|
$62.40 |
$62.40 |
$62.40 |
$87.75
|
|
Trabectedin 1 mg intravenous solution
|
$11,842.80 |
$11,842.80 |
$11,842.80 |
$6,684.23
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$10.60 |
$10.60 |
$10.60 |
$56.38
|
|
Transferrin
|
$109.85 |
$109.85 |
$109.85 |
$82.00
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$558.35 |
$558.35 |
$558.35 |
$561.60
|
|
Trastuzumab 150 mg intravenous solution
|
$4,708.00 |
$4,708.00 |
$4,708.00 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$10,508.35 |
$10,508.35 |
$10,508.35 |
$7,540.20
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$9,357.40 |
$9,357.40 |
$9,357.40 |
$5,846.40
|
|
Trauma partial team response w/critical care services level 4
|
$2,798.25 |
$2,798.25 |
$2,798.25 |
$4,523.04
|
|
Tray bonemarrw oncontrol 102mm
|
$699.55 |
$699.55 |
$699.55 |
$940.80
|
|
Tray trach basic clean/care ster
|
$0.57 |
$0.57 |
$0.57 |
$0.57
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$127,265.40 |
$127,265.40 |
$127,265.40 |
$73,346.25
|
|
Treponema pallidum antibody
|
$130.00 |
$130.00 |
$130.00 |
$72.05
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$43.05 |
$43.05 |
$43.05 |
$43.09
|
|
Triglycerides
|
$50.05 |
$50.05 |
$50.05 |
$58.50
|
|
Trilaciclib 300 mg intravenous solution
|
$8,065.15 |
$8,065.15 |
$8,065.15 |
$4,043.12
|
|
Trim nail(s)
|
$70.00 |
$70.00 |
$70.00 |
$79.00
|
|
Troponin quantitative
|
$970.00 |
$970.00 |
$970.00 |
$127.60
|
|
Tube drain vert dev st 5-40f
|
$17.68 |
$17.68 |
$17.68 |
$27.60
|
|
Tube trach disp innr can 5 xlt
|
$416.99 |
$416.99 |
$416.99 |
$445.99
|
|
Tube trach disp innr can 6 xlt
|
$2.78 |
$2.78 |
$2.78 |
$16.80
|
|
Tube trach fen sz 6 uncuffed
|
$128.15 |
$128.15 |
$128.15 |
$160.88
|
|
Ua w/micro/comp poc
|
$11.04 |
$11.04 |
$11.04 |
$23.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$35,496.45 |
$35,496.45 |
$35,496.45 |
$21,992.26
|
|
Ultrasound breast complete
|
$799.50 |
$799.50 |
$799.50 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$729.30 |
$729.30 |
$729.30 |
$452.40
|
|
Ultrasound joint complete left
|
$642.85 |
$642.85 |
$642.85 |
$557.99
|
|
Unit mobile power mpu
|
$11,821.68 |
$11,821.68 |
$11,821.68 |
$14,359.52
|
|
Unlisted procedure microbiology
|
$2,388.75 |
$2,388.75 |
$2,388.75 |
$530.00
|
|
Upper Arm (Humerus) X-ray (left side)
|
$201.50 |
$201.50 |
$201.50 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$1,330.55 |
$1,330.55 |
$1,330.55 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,551.90 |
$2,551.90 |
$2,551.90 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$261.30 |
$261.30 |
$261.30 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$333.45 |
$333.45 |
$333.45 |
$381.60
|
|
Upper Endoscopy (EGD, with biopsy)
|
$14,658.80 |
$14,658.80 |
$14,658.80 |
$1,768.00
|
|
Urea nitrogen
|
$42.25 |
$42.25 |
$42.25 |
$42.25
|
|
Urea nitrogen 24 hour urine
|
$54.60 |
$54.60 |
$54.60 |
$52.00
|
|
Uric acid blood
|
$57.85 |
$57.85 |
$57.85 |
$49.44
|
|
Uric acid urine
|
$66.30 |
$66.30 |
$66.30 |
$45.36
|
|
Urinalysis microscopic only
|
$31.85 |
$31.85 |
$31.85 |
$26.46
|
|
Urinalysis (with microscopy)
|
$509.00 |
$509.00 |
$509.00 |
$55.20
|
|
Urinalysis (without microscopy)
|
$387.00 |
$387.00 |
$387.00 |
$36.00
|
|
Urine Culture Test
|
$58.50 |
$58.50 |
$58.50 |
$83.00
|
|
Urine pregnancy test
|
$42.25 |
$42.25 |
$42.25 |
$68.78
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$6,677.00 |
$6,677.00 |
$6,677.00 |
$5,205.00
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$45,913.60 |
$45,913.60 |
$45,913.60 |
$51,633.07
|
|
Vaccine Administration (one shot)
|
$95.55 |
$95.55 |
$95.55 |
$67.70
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$273.00 |
$273.00 |
$273.00 |
$224.25
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$533.00 |
$533.00 |
$533.00 |
$209.40
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$98.15 |
$98.15 |
$98.15 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$65.65 |
$65.65 |
$65.65 |
$123.20
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$49.40 |
$49.40 |
$49.40 |
$80.15
|
|
Vaccine dtap < 7 years im
|
$142.05 |
$142.05 |
$142.05 |
$71.17
|
|
Vaccine dtap-hep b-ipv im
|
$513.00 |
$513.00 |
$513.00 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$301.15 |
$301.15 |
$301.15 |
$105.95
|
|
Vaccine dtap-ipv-hib-hepb im
|
$128.70 |
$128.70 |
$128.70 |
$174.72
|
|
Vaccine dtap-ipv/hib im
|
$98.15 |
$98.15 |
$98.15 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$37.05 |
$37.05 |
$37.05 |
$70.53
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$35.10 |
$35.10 |
$35.10 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$135.85 |
$135.85 |
$135.85 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$118.95 |
$118.95 |
$118.95 |
$231.56
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$185.55 |
$185.55 |
$185.55 |
$78.25
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 3 dose im
|
$45.50 |
$45.50 |
$45.50 |
$57.20
|
|
Vaccine hepatitis b (hepb) adolescent 2 dose im
|
$54.60 |
$54.60 |
$54.60 |
$90.35
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$345.70 |
$345.70 |
$345.70 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$310.70 |
$310.70 |
$310.70 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$138.80 |
$138.80 |
$138.80 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$1,547.80 |
$1,547.80 |
$1,547.80 |
$576.48
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$215.15 |
$215.15 |
$215.15 |
$282.50
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$197.00 |
$197.00 |
$197.00 |
$149.21
|
|
Vaccine influenza inactivated adjuvant im
|
$197.00 |
$197.00 |
$197.00 |
$110.25
|
|
Vaccine influenza nos 0.5ml dose im
|
$20.15 |
$20.15 |
$20.15 |
$24.20
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$71.00 |
$71.00 |
$71.00 |
$48.59
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$40.95 |
$40.95 |
$40.95 |
$35.88
|
|
Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im
|
$150.15 |
$150.15 |
$150.15 |
$72.80
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$19.50 |
$19.50 |
$19.50 |
$28.77
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$43.55 |
$43.55 |
$43.55 |
$33.60
|
|
Vaccine influenza quadrivalent (iiv4) split virus 0.25 ml im
|
$20.80 |
$20.80 |
$20.80 |
$20.80
|
|
Vaccine influenza quadrivalent live (laiv4) intranasal
|
$53.95 |
$53.95 |
$53.95 |
$37.05
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$142.35 |
$142.35 |
$142.35 |
$72.00
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$499.85 |
$499.85 |
$499.85 |
$82.71
|
|
Vaccine influenza trivalent (iiv3) 0.25ml dose im
|
$31.20 |
$31.20 |
$31.20 |
$27.45
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$1,156.10 |
$1,156.10 |
$1,156.10 |
$394.26
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$161.20 |
$161.20 |
$161.20 |
$409.35
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$142.35 |
$142.35 |
$142.35 |
$310.93
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$813.00 |
$813.00 |
$813.00 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$466.05 |
$466.05 |
$466.05 |
$213.00
|
|
Vaccine mmrv live subcutaneous
|
$621.00 |
$621.00 |
$621.00 |
$424.32
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$556.15 |
$556.15 |
$556.15 |
$252.87
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$499.85 |
$499.85 |
$499.85 |
$397.11
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$477.10 |
$477.10 |
$477.10 |
$414.46
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$1,376.55 |
$1,376.55 |
$1,376.55 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$36.40 |
$36.40 |
$36.40 |
$90.70
|
|
Vaccine rabies im
|
$1,998.80 |
$1,998.80 |
$1,998.80 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$251.55 |
$251.55 |
$251.55 |
$538.84
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$421.85 |
$421.85 |
$421.85 |
$1,105.21
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$421.85 |
$421.85 |
$421.85 |
$1,031.86
|
