|
Trastuzumab-anns 150 mg intravenous solution
|
$161.63 |
$161.63 |
$161.63 |
$7,620.16
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour
|
$228.00 |
$228.00 |
$228.00 |
$241.15
|
|
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour
|
$114.00 |
$114.00 |
$114.00 |
$149.00
|
|
Treatment inhalation pressurized/nonpressurized acute airway obstruction
|
$165.30 |
$165.30 |
$165.30 |
$210.00
|
|
Treatment missed abortion completed surgically 1st trimester
|
$1,026.00 |
$1,026.00 |
$1,026.00 |
$3,820.53
|
|
Treatment of miscarriage
|
$1,026.00 |
$1,026.00 |
$1,026.00 |
$4,146.69
|
|
Treponema pallidum antibody
|
$22.80 |
$22.80 |
$22.80 |
$72.80
|
|
Triamcinolone acetonide 40 mg/ml suspension for injection
|
$5.33 |
$5.33 |
$5.33 |
$48.22
|
|
#tricyclicantidprssnt
|
$165.30 |
$165.30 |
$165.30 |
$57.08
|
|
Triglycerides
|
$14.82 |
$14.82 |
$14.82 |
$54.60
|
|
Trim nail(s)
|
$91.77 |
$91.77 |
$91.77 |
$70.56
|
|
Trim nondyst nails
|
$153.90 |
$153.90 |
$153.90 |
$124.22
|
|
Trnscath plc stent crv crtd without prtct
|
$15,607.74 |
$15,607.74 |
$15,607.74 |
$7,944.75
|
|
Trnscath plc stent crv crtd w/prtct
|
$20,196.24 |
$20,196.24 |
$20,196.24 |
$11,099.98
|
|
Trnscath plc stnt ante carotid art
|
$22,143.36 |
$22,143.36 |
$22,143.36 |
$9,114.56
|
|
Trnscath plc vas stent w/s&i ea addl artery
|
$13,970.70 |
$13,970.70 |
$13,970.70 |
$8,244.55
|
|
Trnscath plc vas stent w/s&i ea addl vein
|
$13,970.70 |
$13,970.70 |
$13,970.70 |
$8,990.80
|
|
Trnscath plc vas stent w/s&i ini vein
|
$28,889.88 |
$28,889.88 |
$28,889.88 |
$15,408.00
|
|
Trnscath retrv pq vasc fb w/guide
|
$6,084.18 |
$6,084.18 |
$6,084.18 |
$4,969.90
|
|
Trnscath tx thromblytc artery non-intracrn ini day
|
$4,626.12 |
$4,626.12 |
$4,626.12 |
$6,156.00
|
|
Trnscath tx thromblytc art/ven sbsq day
|
$4,412.37 |
$4,412.37 |
$4,412.37 |
$4,505.25
|
|
Trnscath tx thromblytc cath rmv sbsq day
|
$4,793.13 |
$4,793.13 |
$4,793.13 |
$4,793.13
|
|
Trnscath tx thromblytc vein ini day
|
$2,151.18 |
$2,151.18 |
$2,151.18 |
$4,329.36
|
|
Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm
|
$2,415.09 |
$2,415.09 |
$2,415.09 |
$4,805.85
|
|
Trnsfr/rearrngmnt adjcnt tiss defec ea addl 30sqcm/<
|
$788.88 |
$788.88 |
$788.88 |
$2,343.60
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm
|
$2,202.48 |
$2,202.48 |
$2,202.48 |
$2,328.30
|
|
Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/<
|
$1,706.58 |
$1,706.58 |
$1,706.58 |
$2,190.24
|
|
Troponin quantitative
|
$59.28 |
$59.28 |
$59.28 |
$123.75
|
|
Tr retinal les preterm inf
|
$958.17 |
$958.17 |
$958.17 |
$1,736.63
|
|
Tx atrial fib pulm vein isol
|
$39,318.03 |
$39,318.03 |
$39,318.03 |
$32,426.20
|
|
Tx l/r atrial fib addl
|
$19,659.30 |
$19,659.30 |
$19,659.30 |
$7,717.80
|
|
Ultrasound abdomen aorta screening study aaa
|
$117.99 |
$117.99 |
$117.99 |
$403.26
|
|
Ultrasound breast complete
|
$493.05 |
$493.05 |
$493.05 |
$519.75
|
|
Ultrasound breast unilateral limited (both sides)
|
$410.97 |
$410.97 |
$410.97 |
$449.35
|
|
Ultrasound chest
|
$131.10 |
$131.10 |
$131.10 |
$459.55
|
|
Ultrasound encephalogram
|
$160.74 |
$160.74 |
$160.74 |
$481.60
|
|
Ultrasound exam k transpl w/doppler
|
$205.20 |
$205.20 |
$205.20 |
$570.44
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$98.61 |
$98.61 |
$98.61 |
$477.88
|
|
Ultrasound guidance for vascular access
|
$134.52 |
$134.52 |
$134.52 |
$340.22
|
|
Ultrasound guided needle placement supervision & interpretation
|
$389.31 |
$389.31 |
$389.31 |
$701.35
|
|
Ultrasound guide intraoperative
|
$390.45 |
$390.45 |
$390.45 |
$632.90
|
|
Ultrasound guide tissue ablation
|
$287.85 |
$287.85 |
$287.85 |
$498.40
|
|
Ultrasound hips infant dynamic
|
$194.94 |
$194.94 |
$194.94 |
$403.00
|
|
Ultrasound infant hips ltd without stress
|
$150.48 |
$150.48 |
$150.48 |
$321.35
|
|
Ultrasound joint complete left
|
$156.18 |
$156.18 |
$156.18 |
$556.14
|
|
Ultrasound joint/nonvascular extremity limited left
|
$83.22 |
$83.22 |
$83.22 |
$448.50
|
|
Ultrasound ob >=14wks ea addl gest
|
$90.63 |
$90.63 |
$90.63 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$73.53 |
$73.53 |
$73.53 |
$326.54
|
|
Ultrasound pregnant uterus follow up per fetus
|
$135.66 |
$135.66 |
$135.66 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$144.21 |
$144.21 |
$144.21 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$120.27 |
$120.27 |
$120.27 |
$485.48
|
|
Ultrasound retroperitoneal limited
|
$225.72 |
$225.72 |
$225.72 |
$498.00
|
|
Ultrasound scrotum and contents
|
$232.56 |
$232.56 |
$232.56 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$141.93 |
$141.93 |
$141.93 |
$450.60
|
|
Ultrasound transvaginal non obstetric
|
$164.73 |
$164.73 |
$164.73 |
$567.44
|
|
Ultraviolet therapy
|
$52.44 |
$52.44 |
$52.44 |
$42.60
|
|
Umbilical artery cath newborn 36660
|
$535.23 |
$535.23 |
$535.23 |
$265.85
|
|
Unlisted mr procedure
|
$1,165.08 |
$1,165.08 |
$1,165.08 |
$1,032.20
|
|
Upgrade pm system
|
$30,827.88 |
$30,827.88 |
$30,827.88 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,111.50 |
$1,111.50 |
$1,111.50 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$877.23 |
$877.23 |
$877.23 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$808.26 |
$808.26 |
$808.26 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$1,588.59 |
$1,588.59 |
$1,588.59 |
$1,588.59
|
|
Urea nitrogen
|
$10.83 |
$10.83 |
$10.83 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$12.54 |
$12.54 |
$12.54 |
$50.00
|
|
Urethrcystgrphy rtrgrde s&i
|
$238.83 |
$238.83 |
$238.83 |
$574.40
|
|
Urethrocystography void s&i
|
$257.07 |
$257.07 |
$257.07 |
$634.50
|
|
Uric acid blood
|
$17.10 |
$17.10 |
$17.10 |
$46.64
|
|
Uric acid urine
|
$15.39 |
$15.39 |
$15.39 |
$46.75
|
|
Urinalysis microscopic only
|
$3.99 |
$3.99 |
$3.99 |
$26.35
|
|
Urinalysis (with microscopy)
|
$18.24 |
$18.24 |
$18.24 |
$48.14
|
|
Urinalysis (without microscopy)
|
$13.68 |
$13.68 |
$13.68 |
$38.99
|
|
Urine Culture Test
|
$43.32 |
$43.32 |
$43.32 |
$84.81
|
|
Urine pregnancy test
|
$16.53 |
$16.53 |
$16.53 |
$66.40
|
|
Urography, antegrade
|
$257.07 |
$257.07 |
$257.07 |
$593.37
|
|
Vaccine dtap < 7 years im
|
$42.39 |
$42.39 |
$42.39 |
$87.80
|
|
Vaccine dtap-hep b-ipv im
|
$170.19 |
$170.19 |
$170.19 |
$193.83
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$70.51 |
$70.51 |
$70.51 |
$85.00
|
|
Vaccine hepatitis a (hepa) adult im
|
$149.77 |
$149.77 |
$149.77 |
$178.07
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$125.34 |
$125.34 |
$125.34 |
$173.98
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$53.96 |
$53.96 |
$53.96 |
$79.04
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$143.20 |
$143.20 |
$143.20 |
$157.41
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$49.98 |
$49.98 |
$49.98 |
$48.29
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$404.35 |
$404.35 |
$404.35 |
$499.00
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$318.37 |
$318.37 |
$318.37 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$172.80 |
$172.80 |
$172.80 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$195.69 |
$195.69 |
$195.69 |
$274.95
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$445.09 |
$445.09 |
$445.09 |
$397.18
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$358.95 |
$358.95 |
$358.95 |
$715.41
|
|
Vaccine rabies im
|
$770.67 |
$770.67 |
$770.67 |
$945.46
|
|
Vaccine tdap >=7 years im
|
$106.72 |
$106.72 |
$106.72 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$91.34 |
$91.34 |
$91.34 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$314.05 |
$314.05 |
$314.05 |
$447.80
|
|
Valproic acid total therapeutic drug level
|
$51.87 |
$51.87 |
$51.87 |
$115.00
|
|
Valvuloplasty aortic
|
$7,730.34 |
$7,730.34 |
$7,730.34 |
$7,324.85
|
|
Vancomycin hcl injection
|
$200.25 |
$200.25 |
$200.25 |
$83.79
|
|
Vancomycin peak therapeutic drug level
|
$56.43 |
$56.43 |
$56.43 |
$126.79
|
|
Varicella zoster antibody igg
|
$22.80 |
$22.80 |
$22.80 |
$82.55
|
|
Vasopressin 20 unit/ml intravenous solution
|
$165.56 |
$165.56 |
$165.56 |
$394.13
|
|
Veeg intrmnt 2-12 hrs
|
$505.59 |
$505.59 |
$505.59 |
$904.90
|
