|
Trastuzumab 150 mg intravenous solution
|
$1,752.66 |
$1,752.66 |
$1,752.66 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$4,282.84 |
$4,282.84 |
$4,282.84 |
$7,540.20
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$3,813.75 |
$3,813.75 |
$3,813.75 |
$5,835.15
|
|
Tray bonemarrw oncontrol 102mm
|
$754.88 |
$754.88 |
$754.88 |
$940.80
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$67.32 |
$67.32 |
$67.32 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$20.79 |
$20.79 |
$20.79 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$110.88 |
$110.88 |
$110.88 |
$203.35
|
|
Treatment radiation delivery level 2
|
$623.70 |
$623.70 |
$623.70 |
$767.65
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$46,545.60 |
$46,545.60 |
$46,545.60 |
$73,346.25
|
|
Treponema pallidum antibody
|
$41.58 |
$41.58 |
$41.58 |
$70.40
|
|
Treprostinil injection
|
$2,318.46 |
$2,318.46 |
$2,318.46 |
$19,071.84
|
|
Trg gene rearrangement anal
|
$154.11 |
$154.11 |
$154.11 |
$455.70
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$164.10 |
$164.10 |
$164.10 |
$43.21
|
|
Triglycerides
|
$19.14 |
$19.14 |
$19.14 |
$58.05
|
|
Trimethobenzamide hcl inj
|
$116.20 |
$116.20 |
$116.20 |
$117.49
|
|
Trim nondyst nails
|
$29.70 |
$29.70 |
$29.70 |
$113.40
|
|
Trnscath plc stent crv crtd without prtct
|
$251.46 |
$251.46 |
$251.46 |
$7,795.71
|
|
Trnscath plc stent crv crtd w/prtct
|
$2,848.56 |
$2,848.56 |
$2,848.56 |
$9,767.25
|
|
Trnscath plc stnt ante carotid art
|
$373.56 |
$373.56 |
$373.56 |
$6,069.00
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$1,849.98 |
$1,849.98 |
$1,849.98 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$1,849.98 |
$1,849.98 |
$1,849.98 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$3,825.36 |
$3,825.36 |
$3,825.36 |
$15,330.11
|
|
Trnscath retrv pq vasc fb w/guide
|
$1,041.15 |
$1,041.15 |
$1,041.15 |
$4,523.96
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$3,240.60 |
$3,240.60 |
$3,240.60 |
$5,069.50
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$1,639.44 |
$1,639.44 |
$1,639.44 |
$4,250.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$1,639.44 |
$1,639.44 |
$1,639.44 |
$4,250.25
|
|
Trnscath tx thromblytc vein ini day
|
$974.82 |
$974.82 |
$974.82 |
$3,866.70
|
|
Troponin quantitative
|
$32.67 |
$32.67 |
$32.67 |
$127.20
|
|
Tte w or without contr, cont ecg
|
$443.85 |
$443.85 |
$443.85 |
$2,012.40
|
|
Tx atrial fib pulm vein isol
|
$5,207.73 |
$5,207.73 |
$5,207.73 |
$29,030.54
|
|
Tx l/r atrial fib addl
|
$1,973.40 |
$1,973.40 |
$1,973.40 |
$6,769.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$12,494.75 |
$12,494.75 |
$12,494.75 |
$20,945.01
|
|
Ugt1a1 gene analy common variants
|
$297.00 |
$297.00 |
$297.00 |
$438.75
|
|
Ultrasound abdomen aorta screening study aaa
|
$55.11 |
$55.11 |
$55.11 |
$394.20
|
|
Ultrasound breast complete
|
$312.84 |
$312.84 |
$312.84 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$208.56 |
$208.56 |
$208.56 |
$449.35
|
|
Ultrasound chest
|
$132.00 |
$132.00 |
$132.00 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$55.11 |
$55.11 |
$55.11 |
$338.00
|
|
Ultrasound elastography parenchyma
|
$122.43 |
$122.43 |
$122.43 |
$307.00
|
|
Ultrasound encephalogram
|
$144.54 |
$144.54 |
$144.54 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$178.86 |
$178.86 |
$178.86 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$55.11 |
$55.11 |
$55.11 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$99.33 |
$99.33 |
$99.33 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$138.60 |
$138.60 |
$138.60 |
$720.15
|
|
Ultrasound guide intraoperative
|
$197.34 |
$197.34 |
$197.34 |
$632.85
|
|
Ultrasound guide tissue ablation
|
$37.62 |
$37.62 |
$37.62 |
$560.00
|
|
Ultrasound joint/nonvascular extremity limited left
|
$169.62 |
$169.62 |
$169.62 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$268.29 |
$268.29 |
$268.29 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$218.46 |
$218.46 |
$218.46 |
$331.50
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$87.45 |
$87.45 |
$87.45 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$210.21 |
$210.21 |
$210.21 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$210.21 |
$210.21 |
$210.21 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$73.26 |
$73.26 |
$73.26 |
$486.50
|
|
Ultrasound scrotum and contents
|
$113.85 |
$113.85 |
$113.85 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$60.39 |
$60.39 |
$60.39 |
$463.00
|
|
Ultrasound transvaginal non obstetric
|
$92.07 |
$92.07 |
$92.07 |
$558.35
|
|
Unlisted procedure liver
|
$1,234.86 |
$1,234.86 |
$1,234.86 |
$2,287.20
|
|
Unlisted procedure microbiology
|
$118.80 |
$118.80 |
$118.80 |
$523.50
|
|
Unlisted px med radj physics
|
$284.46 |
$284.46 |
$284.46 |
$462.35
|
|
Unlisted ultrasound procedure
|
$158.73 |
$158.73 |
$158.73 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$654.72 |
$654.72 |
$654.72 |
$1,268.17
|
|
Upgrade pm system
|
$3,887.07 |
$3,887.07 |
$3,887.07 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$953.70 |
$953.70 |
$953.70 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$775.50 |
$775.50 |
$775.50 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$775.50 |
$775.50 |
$775.50 |
$2,034.41
|
|
Urea nitrogen
|
$13.20 |
$13.20 |
$13.20 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$14.19 |
$14.19 |
$14.19 |
$51.75
|
|
Urea nitrogen clearance
|
$17.16 |
$17.16 |
$17.16 |
$42.25
|
|
Ureteral reflux study
|
$202.29 |
$202.29 |
$202.29 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$142.56 |
$142.56 |
$142.56 |
$579.73
|
|
Urethrocystography void s&i
|
$157.08 |
$157.08 |
$157.08 |
$622.35
|
|
Uric acid blood
|
$14.85 |
$14.85 |
$14.85 |
$48.75
|
|
Uric acid urine
|
$15.84 |
$15.84 |
$15.84 |
$44.33
|
|
Urinalysis (with microscopy)
|
$10.56 |
$10.56 |
$10.56 |
$55.00
|
|
Urinalysis (without microscopy)
|
$7.59 |
$7.59 |
$7.59 |
$35.75
|
|
Urine Culture Test
|
$26.73 |
$26.73 |
$26.73 |
$81.50
|
|
Urine pregnancy test
|
$21.12 |
$21.12 |
$21.12 |
$67.20
|
|
Urography, antegrade
|
$186.12 |
$186.12 |
$186.12 |
$622.35
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$4,062.63 |
$4,062.63 |
$4,062.63 |
$5,184.34
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$166.10 |
$166.10 |
$166.10 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$94.05 |
$94.05 |
$94.05 |
$123.20
|
|
Vaccine dtap-ipv 4-6 years im
|
$94.05 |
$94.05 |
$94.05 |
$105.95
|
|
Vaccine dtap-ipv-hib-hepb im
|
$164.02 |
$164.02 |
$164.02 |
$174.72
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$58.37 |
$58.37 |
$58.37 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$25.23 |
$25.23 |
$25.23 |
$43.12
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$138.46 |
$138.46 |
$138.46 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$175.16 |
$175.16 |
$175.16 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$55.85 |
$55.85 |
$55.85 |
$75.39
|
|
Vaccine influenza inactivated adjuvant im
|
$96.84 |
$96.84 |
$96.84 |
$109.50
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$42.75 |
$42.75 |
$42.75 |
$47.88
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$94.05 |
$94.05 |
$94.05 |
$76.50
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$266.68 |
$266.68 |
$266.68 |
$400.03
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$193.26 |
$193.26 |
$193.26 |
$310.93
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$187.53 |
$187.53 |
$187.53 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$109.78 |
$109.78 |
$109.78 |
$211.68
|
|
Vaccine mmrv live subcutaneous
|
$312.27 |
$312.27 |
$312.27 |
$424.32
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$131.67 |
$131.67 |
$131.67 |
$251.64
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$254.51 |
$254.51 |
$254.51 |
$397.11
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$257.63 |
$257.63 |
$257.63 |
$414.46
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$308.69 |
$308.69 |
$308.69 |
$563.36
|
