|
Tissue amnio epifix inj 100mg
|
$2,555.89 |
$2,555.89 |
$2,555.89 |
$4,201.20
|
|
Tissue dermagraft 2x3in 37.5sqcm-cost per sq cm
|
$67.73 |
$67.73 |
$67.73 |
$67.73
|
|
Tissue exam koh skin/hair/nails
|
$28.60 |
$28.60 |
$28.60 |
$47.40
|
|
Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm
|
$271.69 |
$271.69 |
$271.69 |
$537.50
|
|
Tissue matrix xcm thk 20x30cm -cost per sq cm
|
$49.04 |
$49.04 |
$49.04 |
$830.41
|
|
Tissue surgimend prs meshed 20 cm x 10 cm - cost per 0.5cm
|
$38.88 |
$38.88 |
$38.88 |
$1,403.42
|
|
Tissue transglutaminase iga
|
$176.80 |
$176.80 |
$176.80 |
$44.80
|
|
Tl-201 thallium diag per mci
|
$80.10 |
$80.10 |
$80.10 |
$80.10
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$3.65 |
$3.65 |
$3.65 |
$152.36
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$12,214.20 |
$12,214.20 |
$12,214.20 |
$5,258.52
|
|
Toe X-ray (both feet)
|
$270.40 |
$270.40 |
$270.40 |
$258.65
|
|
Tomosynthesis breast diagnostic left
|
$221.65 |
$221.65 |
$221.65 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$78.00 |
$78.00 |
$78.00 |
$74.10
|
|
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
|
|
Trabectedin 1 mg intravenous solution
|
$11,842.80 |
$11,842.80 |
$11,842.80 |
$6,684.23
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$157.30 |
$157.30 |
$157.30 |
$102.27
|
|
Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution
|
$41.50 |
$41.50 |
$41.50 |
$56.38
|
|
Transferrin
|
$109.85 |
$109.85 |
$109.85 |
$82.00
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$558.35 |
$558.35 |
$558.35 |
$561.60
|
|
Transvaginal Pregnancy Ultrasound
|
$589.55 |
$589.55 |
$589.55 |
$499.20
|
|
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
|
$0.51 |
$0.51 |
$0.51 |
$0.57
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$158.60 |
$158.60 |
$158.60 |
$147.48
|
|
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
|
$39.10 |
$39.10 |
$39.10 |
$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
|
|
Troponin quantitative
|
$812.00 |
$812.00 |
$812.00 |
$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
|
$128.12 |
$128.12 |
$128.12 |
$160.88
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$35,496.45 |
$35,496.45 |
$35,496.45 |
$21,992.26
|
|
Ultrasound breast unilateral limited (both sides)
|
$729.30 |
$729.30 |
$729.30 |
$452.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$534.95 |
$534.95 |
$534.95 |
$476.94
|
|
Ultrasound pregnant uterus follow up per fetus
|
$446.55 |
$446.55 |
$446.55 |
$425.60
|
|
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 (with and without contrast)
|
$4,634.50 |
$4,634.50 |
$4,634.50 |
$2,998.00
|
|
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
|
|
Urea nitrogen
|
$242.00 |
$242.00 |
$242.00 |
$42.25
|
|
Uric acid blood
|
$57.85 |
$57.85 |
$57.85 |
$49.44
|
|
Uric acid urine
|
$66.30 |
$66.30 |
$66.30 |
$45.36
|
|
Urinalysis (with microscopy)
|
$392.00 |
$392.00 |
$392.00 |
$55.20
|
|
Urinalysis (without microscopy)
|
$385.00 |
$385.00 |
$385.00 |
$36.00
|
|
Urine Culture Test
|
$392.00 |
$392.00 |
$392.00 |
$83.00
|
|
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
|
$33.15 |
$33.15 |
$33.15 |
$71.17
|
|
Vaccine dtap-hep b-ipv im
|
$95.55 |
$95.55 |
$95.55 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$54.60 |
$54.60 |
$54.60 |
$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
|
$43.55 |
$43.55 |
$43.55 |
$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
|
$245.05 |
$245.05 |
$245.05 |
$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
|
$142.35 |
$142.35 |
$142.35 |
$149.21
|
|
Vaccine influenza inactivated adjuvant im
|
$303.40 |
$303.40 |
$303.40 |
$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
|
$102.45 |
$102.45 |
$102.45 |
$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
|
$180.70 |
$180.70 |
$180.70 |
$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
|
$382.20 |
$382.20 |
$382.20 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$79.30 |
$79.30 |
$79.30 |
$213.00
|
|
Vaccine mmrv live subcutaneous
|
$403.65 |
$403.65 |
$403.65 |
$424.32
|