|
Thyroid Ultrasound
|
$700.80 |
$700.80 |
$700.80 |
$588.50
|
|
Thyroid uptake measurement
|
$801.60 |
$801.60 |
$801.60 |
$591.25
|
|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$3,223.59 |
$3,223.59 |
$3,223.59 |
$4,152.21
|
|
Tirofiban 12.5 mg/50 ml
|
$219.63 |
$219.63 |
$219.63 |
$458.85
|
|
Tl-201 thallium diag per mci
|
$78.40 |
$78.40 |
$78.40 |
$80.10
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$101.61 |
$101.61 |
$101.61 |
$152.36
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$4,203.04 |
$4,203.04 |
$4,203.04 |
$5,258.52
|
|
Toe X-ray (both feet)
|
$270.40 |
$270.40 |
$270.40 |
$258.65
|
|
Tomosynthesis breast diagnostic left
|
$110.40 |
$110.40 |
$110.40 |
$74.10
|
|
Tomosynthesis breast screen bilateral
|
$110.40 |
$110.40 |
$110.40 |
$74.10
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$89.60 |
$89.60 |
$89.60 |
$102.27
|
|
Transvaginal Pelvic Ultrasound (not pregnancy)
|
$718.40 |
$718.40 |
$718.40 |
$561.60
|
|
Transvaginal Pregnancy Ultrasound
|
$763.20 |
$763.20 |
$763.20 |
$499.20
|
|
Trastuzumab 150 mg intravenous solution
|
$3,900.04 |
$3,900.04 |
$3,900.04 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$5,907.62 |
$5,907.62 |
$5,907.62 |
$7,540.20
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$5,957.01 |
$5,957.01 |
$5,957.01 |
$5,846.40
|
|
Trauma partial team response w/critical care services level 4
|
$1,567.20 |
$1,567.20 |
$1,567.20 |
$4,523.04
|
|
Treat elbow dislocation
|
$1,782.40 |
$1,782.40 |
$1,782.40 |
$2,272.50
|
|
Treat elbow fracture
|
$991.20 |
$991.20 |
$991.20 |
$2,026.50
|
|
Treat finger fracture each
|
$914.40 |
$914.40 |
$914.40 |
$1,592.00
|
|
Treat fracture of radius
|
$1,010.40 |
$1,010.40 |
$1,010.40 |
$1,790.00
|
|
Treat humerus fracture
|
$1,062.40 |
$1,062.40 |
$1,062.40 |
$1,790.00
|
|
Treat kneecap dislocation
|
$398.40 |
$398.40 |
$398.40 |
$1,068.06
|
|
Treatment incomplete abortion completed surgically any trimester
|
$3,806.40 |
$3,806.40 |
$3,806.40 |
$3,928.20
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$300.00 |
$300.00 |
$300.00 |
$227.70
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$198.40 |
$198.40 |
$198.40 |
$147.48
|
|
Treatment of ankle fracture 27786
|
$442.40 |
$442.40 |
$442.40 |
$523.20
|
|
Treatment radiation delivery level 2
|
$2,852.80 |
$2,852.80 |
$2,852.80 |
$830.70
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$39,737.05 |
$39,737.05 |
$39,737.05 |
$73,346.25
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$68.99 |
$68.99 |
$68.99 |
$43.09
|
|
Tx closed tib fx proximal w/w/o manip w/skel trac
|
$856.00 |
$856.00 |
$856.00 |
$3,977.49
|
|
Ultrasound breast complete
|
$704.80 |
$704.80 |
$704.80 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$516.00 |
$516.00 |
$516.00 |
$452.40
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$516.00 |
$516.00 |
$516.00 |
$338.00
|
|
Ultrasound encephalogram
|
$533.60 |
$533.60 |
$533.60 |
$494.92
|
|
Ultrasound exam k transpl w/doppler
|
$746.40 |
$746.40 |
$746.40 |
$578.40
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$676.24 |
$676.24 |
$676.24 |
$476.94
|
|
Ultrasound Guidance for a Needle Procedure
|
$824.80 |
$824.80 |
$824.80 |
$720.15
|
|
Ultrasound guidance for vascular access
|
$519.20 |
$519.20 |
$519.20 |
$388.08
|
|
Ultrasound guide intraoperative
|
$814.40 |
$814.40 |
$814.40 |
$632.85
|
|
Ultrasound joint complete left
|
$662.40 |
$662.40 |
$662.40 |
$557.99
|
|
Ultrasound ob >=14wks ea addl gest
|
$636.80 |
$636.80 |
$636.80 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$319.20 |
$319.20 |
$319.20 |
$334.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$916.00 |
$916.00 |
$916.00 |
$698.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$500.00 |
$500.00 |
$500.00 |
$425.60
|
|
Ultrasound spinal canal and contents
|
$604.00 |
$604.00 |
$604.00 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$597.60 |
$597.60 |
$597.60 |
$419.50
|
|
Unlisted chemotherapy px
|
$197.60 |
$197.60 |
$197.60 |
$149.15
|
|
Unlisted CT procedure
|
$147.20 |
$147.20 |
$147.20 |
$732.70
|
|
Unlisted dialysis procedure
|
$1,588.00 |
$1,588.00 |
$1,588.00 |
$1,144.00
|
|
Unlisted px med radj physics
|
$640.80 |
$640.80 |
$640.80 |
$462.35
|
|
Unlisted ultrasound procedure
|
$326.40 |
$326.40 |
$326.40 |
$332.16
|
|
Upper Arm (Humerus) X-ray (left side)
|
$272.00 |
$272.00 |
$272.00 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$2,464.80 |
$2,464.80 |
$2,464.80 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$2,296.80 |
$2,296.80 |
$2,296.80 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,724.80 |
$4,724.80 |
$4,724.80 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,636.80 |
$3,636.80 |
$3,636.80 |
$2,369.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,441.60 |
$3,441.60 |
$3,441.60 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$349.60 |
$349.60 |
$349.60 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$266.40 |
$266.40 |
$266.40 |
$381.60
|
|
Upper GI Barium X-ray (barium and gas)
|
$899.20 |
$899.20 |
$899.20 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$924.00 |
$924.00 |
$924.00 |
$607.20
|
|
Urethrcystgrphy rtrgrde s&i
|
$832.00 |
$832.00 |
$832.00 |
$584.00
|
|
Urethrocystography void s&i
|
$908.00 |
$908.00 |
$908.00 |
$631.40
|
|
Urography, antegrade
|
$804.00 |
$804.00 |
$804.00 |
$622.35
|
|
Urography inf drip &/or bolus
|
$863.20 |
$863.20 |
$863.20 |
$642.50
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$3,281.09 |
$3,281.09 |
$3,281.09 |
$5,205.00
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$31,052.44 |
$31,052.44 |
$31,052.44 |
$51,633.07
|
|
Vaccine Administration (one shot)
|
$94.40 |
$94.40 |
$94.40 |
$67.70
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$256.68 |
$256.68 |
$256.68 |
$224.25
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$238.92 |
$238.92 |
$238.92 |
$209.40
|
|
Vaccine dtap < 7 years im
|
$78.13 |
$78.13 |
$78.13 |
$71.17
|
|
Vaccine dtap-ipv-hib-hepb im
|
$214.68 |
$214.68 |
$214.68 |
$174.72
|
|
Vaccine dtap-ipv/hib im
|
$108.20 |
$108.20 |
$108.20 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$78.60 |
$78.60 |
$78.60 |
$70.53
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$68.21 |
$68.21 |
$68.21 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$111.10 |
$111.10 |
$111.10 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$245.62 |
$245.62 |
$245.62 |
$231.56
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$80.92 |
$80.92 |
$80.92 |
$78.25
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$111.11 |
$111.11 |
$111.11 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$254.02 |
$254.02 |
$254.02 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$75.87 |
$75.87 |
$75.87 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$469.81 |
$469.81 |
$469.81 |
$576.48
|
|
Vaccine influenza inactivated adjuvant im
|
$51.71 |
$51.71 |
$51.71 |
$110.25
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$29.17 |
$29.17 |
$29.17 |
$82.71
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$375.62 |
$375.62 |
$375.62 |
$394.26
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$289.03 |
$289.03 |
$289.03 |
$409.35
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$220.52 |
$220.52 |
$220.52 |
$310.93
|
|
Vaccine mmr live subcutaneous
|
$190.84 |
$190.84 |
$190.84 |
$213.00
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$216.40 |
$216.40 |
$216.40 |
$252.87
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$367.34 |
$367.34 |
$367.34 |
$414.46
|
|
Vaccine polio (ipv) subcutaneous/im
|
$79.53 |
$79.53 |
$79.53 |
$90.70
|
|
Vaccine rabies im
|
$663.38 |
$663.38 |
$663.38 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$449.67 |
$449.67 |
$449.67 |
$538.84
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$794.82 |
$794.82 |
$794.82 |
$1,105.21
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$794.82 |
$794.82 |
$794.82 |
$1,031.86
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$111.48 |
$111.48 |
$111.48 |
$126.14
|
|
Vaccine tdap >=7 years im
|
$89.67 |
$89.67 |
$89.67 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$79.88 |
$79.88 |
$79.88 |
$112.10
|
|
Vaccine varicella live subcutaneous
|
$324.87 |
$324.87 |
$324.87 |
$365.17
|