|
Tomosynthesis breast screen bilateral
|
$10.50 |
$10.50 |
$10.50 |
$72.68
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$305.23 |
$305.23 |
$305.23 |
$325.00
|
|
Toxoplasma antibody igg
|
$12.60 |
$12.60 |
$12.60 |
$89.40
|
|
Toxoplasma antibody igm
|
$12.30 |
$12.30 |
$12.30 |
$87.00
|
|
Trabectedin 1 mg intravenous solution
|
$3,525.35 |
$3,525.35 |
$3,525.35 |
$6,827.00
|
|
Transferrin
|
$38.10 |
$38.10 |
$38.10 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$107.70 |
$107.70 |
$107.70 |
$983.00
|
|
Trastuzumab 150 mg intravenous solution
|
$1,593.33 |
$1,593.33 |
$1,593.33 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$3,893.49 |
$3,893.49 |
$3,893.49 |
$7,540.20
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$3,467.04 |
$3,467.04 |
$3,467.04 |
$5,835.15
|
|
Tray bonemarrw oncontrol 102mm
|
$391.87 |
$391.87 |
$391.87 |
$940.80
|
|
Treat chest lining
|
$1,190.10 |
$1,190.10 |
$1,190.10 |
$3,888.00
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$61.20 |
$61.20 |
$61.20 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$18.90 |
$18.90 |
$18.90 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$100.80 |
$100.80 |
$100.80 |
$203.35
|
|
Treatment radiation delivery level 2
|
$567.00 |
$567.00 |
$567.00 |
$767.65
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$42,314.18 |
$42,314.18 |
$42,314.18 |
$73,346.25
|
|
Treponema pallidum antibody
|
$37.80 |
$37.80 |
$37.80 |
$70.40
|
|
Treprostinil injection
|
$2,107.70 |
$2,107.70 |
$2,107.70 |
$19,071.84
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$149.18 |
$149.18 |
$149.18 |
$43.21
|
|
Triglycerides
|
$77.70 |
$77.70 |
$77.70 |
$58.05
|
|
Trimethobenzamide hcl inj
|
$105.63 |
$105.63 |
$105.63 |
$117.49
|
|
Trim nondyst nails
|
$27.00 |
$27.00 |
$27.00 |
$113.40
|
|
Trnscath plc stent crv crtd w/prtct
|
$2,589.60 |
$2,589.60 |
$2,589.60 |
$9,767.25
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$1,681.80 |
$1,681.80 |
$1,681.80 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ini vein
|
$3,477.60 |
$3,477.60 |
$3,477.60 |
$15,330.11
|
|
Trnscath retrv pq vasc fb w/guide
|
$946.50 |
$946.50 |
$946.50 |
$4,523.96
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$1,473.00 |
$1,473.00 |
$1,473.00 |
$5,069.50
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$745.20 |
$745.20 |
$745.20 |
$4,250.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$745.20 |
$745.20 |
$745.20 |
$4,250.25
|
|
Troponin quantitative
|
$29.70 |
$29.70 |
$29.70 |
$127.20
|
|
Tte w or without contr, cont ecg
|
$403.50 |
$403.50 |
$403.50 |
$2,012.40
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$11,358.86 |
$11,358.86 |
$11,358.86 |
$20,945.01
|
|
Ultrasound abdomen aorta screening study aaa
|
$50.10 |
$50.10 |
$50.10 |
$394.20
|
|
Ultrasound breast complete
|
$284.40 |
$284.40 |
$284.40 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$189.60 |
$189.60 |
$189.60 |
$449.35
|
|
Ultrasound chest
|
$120.00 |
$120.00 |
$120.00 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$50.10 |
$50.10 |
$50.10 |
$338.00
|
|
Ultrasound elastography parenchyma
|
$111.30 |
$111.30 |
$111.30 |
$307.00
|
|
Ultrasound encephalogram
|
$131.40 |
$131.40 |
$131.40 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$162.60 |
$162.60 |
$162.60 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$50.10 |
$50.10 |
$50.10 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$90.30 |
$90.30 |
$90.30 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$126.00 |
$126.00 |
$126.00 |
$720.15
|
|
Ultrasound guide intraoperative
|
$179.40 |
$179.40 |
$179.40 |
$632.85
|
|
Ultrasound hips infant dynamic
|
$106.80 |
$106.80 |
$106.80 |
$403.88
|
|
Ultrasound infant hips ltd without stress
|
$54.90 |
$54.90 |
$54.90 |
$311.25
|
|
Ultrasound joint/nonvascular extremity limited left
|
$154.20 |
$154.20 |
$154.20 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$243.90 |
$243.90 |
$243.90 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$198.60 |
$198.60 |
$198.60 |
$331.50
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$79.50 |
$79.50 |
$79.50 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$191.10 |
$191.10 |
$191.10 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$191.10 |
$191.10 |
$191.10 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$66.60 |
$66.60 |
$66.60 |
$486.50
|
|
Ultrasound scrotum and contents
|
$103.50 |
$103.50 |
$103.50 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$54.90 |
$54.90 |
$54.90 |
$463.00
|
|
Ultrasound transvaginal non obstetric
|
$83.70 |
$83.70 |
$83.70 |
$558.35
|
|
Unlisted maaa
|
$295.20 |
$295.20 |
$295.20 |
$235.20
|
|
Unlisted procedure microbiology
|
$108.00 |
$108.00 |
$108.00 |
$523.50
|
|
Unlisted px med radj physics
|
$258.60 |
$258.60 |
$258.60 |
$462.35
|
|
Unlisted ultrasound procedure
|
$144.30 |
$144.30 |
$144.30 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$595.20 |
$595.20 |
$595.20 |
$1,268.17
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$867.00 |
$867.00 |
$867.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$705.00 |
$705.00 |
$705.00 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$705.00 |
$705.00 |
$705.00 |
$2,034.41
|
|
Urea nitrogen
|
$12.00 |
$12.00 |
$12.00 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$12.90 |
$12.90 |
$12.90 |
$51.75
|
|
Ureteral reflux study
|
$183.90 |
$183.90 |
$183.90 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$129.60 |
$129.60 |
$129.60 |
$579.73
|
|
Urethrocystography void s&i
|
$142.80 |
$142.80 |
$142.80 |
$622.35
|
|
Uric acid blood
|
$13.50 |
$13.50 |
$13.50 |
$48.75
|
|
Uric acid urine
|
$40.20 |
$40.20 |
$40.20 |
$44.33
|
|
Urinalysis (with microscopy)
|
$9.60 |
$9.60 |
$9.60 |
$55.00
|
|
Urinalysis (without microscopy)
|
$6.90 |
$6.90 |
$6.90 |
$35.75
|
|
Urine Culture Test
|
$24.30 |
$24.30 |
$24.30 |
$81.50
|
|
Urine pregnancy test
|
$19.20 |
$19.20 |
$19.20 |
$67.20
|
|
Urography, antegrade
|
$169.20 |
$169.20 |
$169.20 |
$622.35
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$3,693.30 |
$3,693.30 |
$3,693.30 |
$5,184.34
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$151.00 |
$151.00 |
$151.00 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$85.50 |
$85.50 |
$85.50 |
$123.20
|
|
Vaccine dtap-ipv 4-6 years im
|
$85.50 |
$85.50 |
$85.50 |
$105.95
|
|
Vaccine dtap-ipv-hib-hepb im
|
$149.11 |
$149.11 |
$149.11 |
$174.72
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$53.06 |
$53.06 |
$53.06 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$22.94 |
$22.94 |
$22.94 |
$43.12
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$125.87 |
$125.87 |
$125.87 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$159.24 |
$159.24 |
$159.24 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$50.78 |
$50.78 |
$50.78 |
$75.39
|
|
Vaccine influenza inactivated adjuvant im
|
$88.04 |
$88.04 |
$88.04 |
$109.50
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$38.86 |
$38.86 |
$38.86 |
$47.88
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$85.50 |
$85.50 |
$85.50 |
$76.50
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$242.44 |
$242.44 |
$242.44 |
$400.03
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$175.70 |
$175.70 |
$175.70 |
$310.93
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$170.48 |
$170.48 |
$170.48 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$99.80 |
$99.80 |
$99.80 |
$211.68
|
|
Vaccine mmrv live subcutaneous
|
$283.88 |
$283.88 |
$283.88 |
$424.32
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$119.70 |
$119.70 |
$119.70 |
$251.64
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$231.38 |
$231.38 |
$231.38 |
$397.11
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$234.21 |
$234.21 |
$234.21 |
$414.46
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$280.62 |
$280.62 |
$280.62 |
$563.36
|
|
Vaccine rabies im
|
$461.27 |
$461.27 |
$461.27 |
$858.95
|
