|
Thyrotropin alfa 0.9 mg intramuscular solution
|
$2,698.93 |
$2,698.93 |
$2,698.93 |
$4,112.43
|
|
Thyroxine binding globulin (tbg)
|
$59.50 |
$59.50 |
$59.50 |
$64.51
|
|
Tigecycline injection
|
$64.07 |
$64.07 |
$64.07 |
$234.00
|
|
Tilt table study
|
$1,040.00 |
$1,040.00 |
$1,040.00 |
$1,551.60
|
|
Tirofiban 12.5 mg/50 ml
|
$212.19 |
$212.19 |
$212.19 |
$458.51
|
|
Tisotumab vedotin-tftv 40 mg intravenous solution
|
$8,912.80 |
$8,912.80 |
$8,912.80 |
$12,955.88
|
|
Tissue transglutaminase iga
|
$48.50 |
$48.50 |
$48.50 |
$44.80
|
|
Tl-201 thallium diag per mci
|
$304.20 |
$304.20 |
$304.20 |
$78.40
|
|
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr
|
$379.36 |
$379.36 |
$379.36 |
$152.36
|
|
Tobramycin peak therapeutic drug level
|
$51.00 |
$51.00 |
$51.00 |
$121.55
|
|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$3,331.74 |
$3,331.74 |
$3,331.74 |
$5,258.52
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$69.36 |
$69.36 |
$69.36 |
$312.65
|
|
Toripalimab-tpzi 240 mg/6 ml (40 mg/ml) intravenous solution
|
$11,790.84 |
$11,790.84 |
$11,790.84 |
$15,383.12
|
|
Toxoplasma antibody igm
|
$66.00 |
$66.00 |
$66.00 |
$87.00
|
|
Tp53 gene trgt sequence alys
|
$860.00 |
$860.00 |
$860.00 |
$823.00
|
|
Trabectedin 1 mg intravenous solution
|
$4,482.38 |
$4,482.38 |
$4,482.38 |
$6,684.23
|
|
Training self management diabetes individual outpatient department per 30 minutes
|
$90.00 |
$90.00 |
$90.00 |
$101.25
|
|
Transferrin
|
$59.50 |
$59.50 |
$59.50 |
$81.60
|
|
Transfusion blood/blood component(s)
|
$794.50 |
$794.50 |
$794.50 |
$936.80
|
|
Trastuzumab 150 mg intravenous solution
|
$2,025.86 |
$2,025.86 |
$2,025.86 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$4,754.60 |
$4,754.60 |
$4,754.60 |
$7,540.20
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$2,750.94 |
$2,750.94 |
$2,750.94 |
$5,525.09
|
|
Tray bonemarrw oncontrol 102mm
|
$1,799.44 |
$1,799.44 |
$1,799.44 |
$940.80
|
|
Treat fracture of radius
|
$529.00 |
$529.00 |
$529.00 |
$1,790.00
|
|
Treat fracture of ulna
|
$930.00 |
$930.00 |
$930.00 |
$731.04
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$241.50 |
$241.50 |
$241.50 |
$203.49
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$51,714.00 |
$51,714.00 |
$51,714.00 |
$69,118.20
|
|
Treponema pallidum antibody
|
$66.00 |
$66.00 |
$66.00 |
$70.40
|
|
Treprostinil injection
|
$5,381.20 |
$5,381.20 |
$5,381.20 |
$19,071.84
|
|
Trg gene rearrangement anal
|
$435.00 |
$435.00 |
$435.00 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$22.54 |
$22.54 |
$22.54 |
$43.09
|
|
Triamcinolone a inj prs-free
|
$1,275.32 |
$1,275.32 |
$1,275.32 |
$239.62
|
|
Triglycerides
|
$34.00 |
$34.00 |
$34.00 |
$57.85
|
|
Trilaciclib 300 mg intravenous solution
|
$2,016.42 |
$2,016.42 |
$2,016.42 |
$3,903.74
|
|
Trimethobenzamide hcl inj
|
$88.02 |
$88.02 |
$88.02 |
$117.49
|
|
Trim nail(s)
|
$79.00 |
$79.00 |
$79.00 |
$78.50
|
|
Trim nondyst nails
|
$79.00 |
$79.00 |
$79.00 |
$115.70
|
|
Triptorelin pamoate
|
$5,450.44 |
$5,450.44 |
$5,450.44 |
$4,619.39
|
|
Troponin quantitative
|
$51.50 |
$51.50 |
$51.50 |
$127.20
|
|
Tx closed hip disl traumatic without anes
|
$632.50 |
$632.50 |
$632.50 |
$581.07
|
|
Ua w/micro/comp poc
|
$51.00 |
$51.00 |
$51.00 |
$24.45
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$13,614.26 |
$13,614.26 |
$13,614.26 |
$17,921.01
|
|
Ugt1a1 gene analy common variants
|
$560.00 |
$560.00 |
$560.00 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$504.00 |
$504.00 |
$504.00 |
$394.20
|
|
Ultrasound breast complete
|
$757.00 |
$757.00 |
$757.00 |
$532.00
|
|
Ultrasound breast unilateral limited (both sides)
|
$549.50 |
$549.50 |
$549.50 |
$452.00
|
|
Ultrasound chest
|
$486.50 |
$486.50 |
$486.50 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$300.00 |
$300.00 |
$300.00 |
$338.00
|
|
Ultrasound exam k transpl w/doppler
|
$504.00 |
$504.00 |
$504.00 |
$585.15
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$495.50 |
$495.50 |
$495.50 |
$477.10
|
|
Ultrasound guidance for vascular access
|
$297.50 |
$297.50 |
$297.50 |
$388.08
|
|
Ultrasound guided needle placement supervision & interpretation
|
$288.00 |
$288.00 |
$288.00 |
$720.15
|
|
Ultrasound hips infant dynamic
|
$388.00 |
$388.00 |
$388.00 |
$403.88
|
|
Ultrasound joint/nonvascular extremity limited left
|
$730.00 |
$730.00 |
$730.00 |
$424.00
|
|
Ultrasound ob >=14wks ea addl gest
|
$432.50 |
$432.50 |
$432.50 |
$393.86
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$342.50 |
$342.50 |
$342.50 |
$331.50
|
|
Ultrasound pregnant uterus follow up per fetus
|
$504.00 |
$504.00 |
$504.00 |
$428.25
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$495.50 |
$495.50 |
$495.50 |
$452.10
|
|
Ultrasound pregnant uterus transvaginal
|
$504.00 |
$504.00 |
$504.00 |
$490.00
|
|
Ultrasound prostate/transrectal
|
$432.50 |
$432.50 |
$432.50 |
$549.95
|
|
Ultrasound retroperitoneal limited
|
$486.50 |
$486.50 |
$486.50 |
$479.60
|
|
Ultrasound scrotum and contents
|
$504.00 |
$504.00 |
$504.00 |
$612.55
|
|
Ultrasound spinal canal and contents
|
$523.00 |
$523.00 |
$523.00 |
$459.00
|
|
Ultrasound transvaginal non obstetric
|
$513.00 |
$513.00 |
$513.00 |
$558.35
|
|
Unlistd noninvas vasc dx std
|
$42.50 |
$42.50 |
$42.50 |
$564.60
|
|
Unlisted orl service/px
|
$145.50 |
$145.50 |
$145.50 |
$121.50
|
|
Unlisted procedure microbiology
|
$209.50 |
$209.50 |
$209.50 |
$490.70
|
|
Unlisted px ther rad tx plng
|
$916.50 |
$916.50 |
$916.50 |
$182.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,445.50 |
$2,445.50 |
$2,445.50 |
$2,984.45
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,369.00 |
$2,369.00 |
$2,369.00 |
$2,369.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,497.50 |
$1,497.50 |
$1,497.50 |
$2,034.41
|
|
Urea nitrogen
|
$25.00 |
$25.00 |
$25.00 |
$40.95
|
|
Urea nitrogen 24 hour urine
|
$34.00 |
$34.00 |
$34.00 |
$52.00
|
|
Urethrocystography void s&i
|
$605.00 |
$605.00 |
$605.00 |
$648.05
|
|
Uric acid blood
|
$25.00 |
$25.00 |
$25.00 |
$49.44
|
|
Uric acid urine
|
$34.00 |
$34.00 |
$34.00 |
$44.22
|
|
Urinalysis qual/semiquant excpt ia
|
$20.00 |
$20.00 |
$20.00 |
$25.72
|
|
Urinalysis (with microscopy)
|
$29.50 |
$29.50 |
$29.50 |
$55.44
|
|
Urinalysis (without microscopy)
|
$20.00 |
$20.00 |
$20.00 |
$36.00
|
|
Urine Culture Test
|
$68.50 |
$68.50 |
$68.50 |
$81.27
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$2,630.56 |
$2,630.56 |
$2,630.56 |
$5,084.76
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$34,928.87 |
$34,928.87 |
$34,928.87 |
$50,368.90
|
|
Vaccine dtap < 7 years im
|
$41.78 |
$41.78 |
$41.78 |
$71.17
|
|
Vaccine dtap-hep b-ipv im
|
$117.44 |
$117.44 |
$117.44 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$105.90 |
$105.90 |
$105.90 |
$105.95
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$23.74 |
$23.74 |
$23.74 |
$42.90
|
|
Vaccine hepatitis a (hepa) adult im
|
$0.01 |
$0.01 |
$0.01 |
$168.95
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$176.73 |
$176.73 |
$176.73 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$53.22 |
$53.22 |
$53.22 |
$80.75
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$83.36 |
$83.36 |
$83.36 |
$154.78
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$213.14 |
$213.14 |
$213.14 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$0.01 |
$0.01 |
$0.01 |
$74.42
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$422.39 |
$422.39 |
$422.39 |
$576.48
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$98.36 |
$98.36 |
$98.36 |
$143.20
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$28.55 |
$28.55 |
$28.55 |
$47.88
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$274.00 |
$274.00 |
$274.00 |
$395.24
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$187.11 |
$187.11 |
$187.11 |
$337.91
|
|
Vaccine mmr live subcutaneous
|
$156.04 |
$156.04 |
$156.04 |
$213.00
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$185.18 |
$185.18 |
$185.18 |
$252.87
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$332.48 |
$332.48 |
$332.48 |
$397.11
|
