|
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector
|
$2,624.80 |
$2,624.80 |
$2,624.80 |
$5,258.52
|
|
Tomosynthesis breast diagnostic left
|
$10.15 |
$10.15 |
$10.15 |
$73.00
|
|
Tomosynthesis breast screen bilateral
|
$10.15 |
$10.15 |
$10.15 |
$72.68
|
|
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution
|
$295.05 |
$295.05 |
$295.05 |
$325.00
|
|
Toxoplasma antibody igg
|
$12.18 |
$12.18 |
$12.18 |
$89.40
|
|
Trabectedin 1 mg intravenous solution
|
$3,407.84 |
$3,407.84 |
$3,407.84 |
$6,827.00
|
|
Transcatheter bx s&i
|
$376.42 |
$376.42 |
$376.42 |
$1,915.00
|
|
Transferrin
|
$36.83 |
$36.83 |
$36.83 |
$82.00
|
|
Transfusion blood/blood component(s)
|
$104.11 |
$104.11 |
$104.11 |
$983.00
|
|
Trastuzumab 150 mg intravenous solution
|
$1,540.22 |
$1,540.22 |
$1,540.22 |
$3,141.85
|
|
Trastuzumab-anns 150 mg intravenous solution
|
$3,763.70 |
$3,763.70 |
$3,763.70 |
$7,540.20
|
|
Trastuzumab-qyyp 150 mg intravenous solution
|
$3,351.47 |
$3,351.47 |
$3,351.47 |
$5,835.15
|
|
Tray bonemarrw oncontrol 102mm
|
$663.38 |
$663.38 |
$663.38 |
$940.80
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$59.16 |
$59.16 |
$59.16 |
$224.90
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$18.27 |
$18.27 |
$18.27 |
$145.51
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$97.44 |
$97.44 |
$97.44 |
$203.35
|
|
Treatment radiation delivery level 2
|
$548.10 |
$548.10 |
$548.10 |
$767.65
|
|
Tremelimumab-actl 20 mg/ml intravenous solution
|
$40,903.71 |
$40,903.71 |
$40,903.71 |
$73,346.25
|
|
Treponema pallidum antibody
|
$36.54 |
$36.54 |
$36.54 |
$70.40
|
|
Treprostinil injection
|
$2,037.44 |
$2,037.44 |
$2,037.44 |
$19,071.84
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$144.21 |
$144.21 |
$144.21 |
$43.21
|
|
Triglycerides
|
$75.11 |
$75.11 |
$75.11 |
$58.05
|
|
Trimethobenzamide hcl inj
|
$102.11 |
$102.11 |
$102.11 |
$117.49
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$1,625.74 |
$1,625.74 |
$1,625.74 |
$8,372.00
|
|
Trnscath plc vas stent w/s&i ini vein
|
$3,361.68 |
$3,361.68 |
$3,361.68 |
$15,330.11
|
|
Trnscath retrv pq vasc fb w/guide
|
$914.95 |
$914.95 |
$914.95 |
$4,523.96
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$1,423.90 |
$1,423.90 |
$1,423.90 |
$5,069.50
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$720.36 |
$720.36 |
$720.36 |
$4,250.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$720.36 |
$720.36 |
$720.36 |
$4,250.25
|
|
Troponin quantitative
|
$28.71 |
$28.71 |
$28.71 |
$127.20
|
|
Tte w or without contr, cont ecg
|
$390.05 |
$390.05 |
$390.05 |
$2,012.40
|
|
Tx atrial fib pulm vein isol
|
$4,576.49 |
$4,576.49 |
$4,576.49 |
$29,030.54
|
|
Tx l/r atrial fib addl
|
$1,734.20 |
$1,734.20 |
$1,734.20 |
$6,769.00
|
|
Ublituximab-xiiy 25 mg/ml intravenous solution
|
$10,980.24 |
$10,980.24 |
$10,980.24 |
$20,945.01
|
|
Ultrasound abdomen aorta screening study aaa
|
$48.43 |
$48.43 |
$48.43 |
$394.20
|
|
Ultrasound breast complete
|
$274.92 |
$274.92 |
$274.92 |
$528.41
|
|
Ultrasound breast unilateral limited (both sides)
|
$183.28 |
$183.28 |
$183.28 |
$449.35
|
|
Ultrasound chest
|
$116.00 |
$116.00 |
$116.00 |
$460.85
|
|
Ultrasound doppler velocimetry fetal umbilical artery
|
$48.43 |
$48.43 |
$48.43 |
$338.00
|
|
Ultrasound elastography parenchyma
|
$107.59 |
$107.59 |
$107.59 |
$307.00
|
|
Ultrasound encephalogram
|
$127.02 |
$127.02 |
$127.02 |
$488.80
|
|
Ultrasound exam k transpl w/doppler
|
$157.18 |
$157.18 |
$157.18 |
$573.54
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$48.43 |
$48.43 |
$48.43 |
$469.50
|
|
Ultrasound guidance for vascular access
|
$87.29 |
$87.29 |
$87.29 |
$400.20
|
|
Ultrasound guided needle placement supervision & interpretation
|
$121.80 |
$121.80 |
$121.80 |
$720.15
|
|
Ultrasound guide intraoperative
|
$173.42 |
$173.42 |
$173.42 |
$632.85
|
|
Ultrasound joint/nonvascular extremity limited left
|
$149.06 |
$149.06 |
$149.06 |
$425.45
|
|
Ultrasound ob >=14wks ea addl gest
|
$235.77 |
$235.77 |
$235.77 |
$407.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$191.98 |
$191.98 |
$191.98 |
$331.50
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$76.85 |
$76.85 |
$76.85 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$184.73 |
$184.73 |
$184.73 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$184.73 |
$184.73 |
$184.73 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$64.38 |
$64.38 |
$64.38 |
$486.50
|
|
Ultrasound scrotum and contents
|
$100.05 |
$100.05 |
$100.05 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$53.07 |
$53.07 |
$53.07 |
$463.00
|
|
Ultrasound transvaginal non obstetric
|
$80.91 |
$80.91 |
$80.91 |
$558.35
|
|
Unlisted maaa
|
$200.10 |
$200.10 |
$200.10 |
$235.20
|
|
Unlisted neurological dx px
|
$253.75 |
$253.75 |
$253.75 |
$242.50
|
|
Unlisted procedure microbiology
|
$104.40 |
$104.40 |
$104.40 |
$523.50
|
|
Unlisted px med radj physics
|
$249.98 |
$249.98 |
$249.98 |
$462.35
|
|
Unlisted ultrasound procedure
|
$139.49 |
$139.49 |
$139.49 |
$321.20
|
|
Unsched dialysis esrd pt hos
|
$575.36 |
$575.36 |
$575.36 |
$1,268.17
|
|
Upgrade pm system
|
$3,415.91 |
$3,415.91 |
$3,415.91 |
$12,077.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$838.10 |
$838.10 |
$838.10 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$681.50 |
$681.50 |
$681.50 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$681.50 |
$681.50 |
$681.50 |
$2,034.41
|
|
Urea nitrogen
|
$11.60 |
$11.60 |
$11.60 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$12.47 |
$12.47 |
$12.47 |
$51.75
|
|
Urethrcystgrphy rtrgrde s&i
|
$125.28 |
$125.28 |
$125.28 |
$579.73
|
|
Urethrocystography void s&i
|
$138.04 |
$138.04 |
$138.04 |
$622.35
|
|
Uric acid blood
|
$13.05 |
$13.05 |
$13.05 |
$48.75
|
|
Uric acid urine
|
$13.92 |
$13.92 |
$13.92 |
$44.33
|
|
Urinalysis (with microscopy)
|
$9.28 |
$9.28 |
$9.28 |
$55.00
|
|
Urinalysis (without microscopy)
|
$6.67 |
$6.67 |
$6.67 |
$35.75
|
|
Urine Culture Test
|
$23.49 |
$23.49 |
$23.49 |
$81.50
|
|
Urine pregnancy test
|
$18.56 |
$18.56 |
$18.56 |
$67.20
|
|
Urography, antegrade
|
$163.56 |
$163.56 |
$163.56 |
$622.35
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$3,570.19 |
$3,570.19 |
$3,570.19 |
$5,184.34
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$145.97 |
$145.97 |
$145.97 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$82.65 |
$82.65 |
$82.65 |
$123.20
|
|
Vaccine dtap-ipv 4-6 years im
|
$82.65 |
$82.65 |
$82.65 |
$105.95
|
|
Vaccine dtap-ipv-hib-hepb im
|
$144.14 |
$144.14 |
$144.14 |
$174.72
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$51.29 |
$51.29 |
$51.29 |
$70.26
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$22.17 |
$22.17 |
$22.17 |
$43.12
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$121.68 |
$121.68 |
$121.68 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$153.93 |
$153.93 |
$153.93 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$49.08 |
$49.08 |
$49.08 |
$75.39
|
|
Vaccine influenza inactivated adjuvant im
|
$85.10 |
$85.10 |
$85.10 |
$109.50
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$37.57 |
$37.57 |
$37.57 |
$47.88
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$82.65 |
$82.65 |
$82.65 |
$76.50
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$234.36 |
$234.36 |
$234.36 |
$400.03
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$169.84 |
$169.84 |
$169.84 |
$310.93
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$164.80 |
$164.80 |
$164.80 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$96.47 |
$96.47 |
$96.47 |
$211.68
|
|
Vaccine mmrv live subcutaneous
|
$274.42 |
$274.42 |
$274.42 |
$424.32
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$115.71 |
$115.71 |
$115.71 |
$251.64
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$223.66 |
$223.66 |
$223.66 |
$397.11
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$226.40 |
$226.40 |
$226.40 |
$414.46
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$271.27 |
$271.27 |
$271.27 |
$563.36
|
|
Vaccine rabies im
|
$445.89 |
$445.89 |
$445.89 |
$858.95
|
