|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$403.92 |
$403.92 |
$403.92 |
$349.15
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$1,502.16 |
$1,502.16 |
$1,502.16 |
$408.70
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$553.85 |
$553.85 |
$553.85 |
$274.95
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$804.22 |
$804.22 |
$804.22 |
$397.18
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$784.26 |
$784.26 |
$784.26 |
$385.45
|
|
Vaccine rabies im
|
$1,513.42 |
$1,513.42 |
$1,513.42 |
$945.46
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$1,534.28 |
$1,534.28 |
$1,534.28 |
$1,196.00
|
|
Vaccine tdap >=7 years im
|
$431.64 |
$431.64 |
$431.64 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$269.10 |
$269.10 |
$269.10 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$64.75 |
$64.75 |
$64.75 |
$447.80
|
|
Valproic acid total therapeutic drug level
|
$1,146.90 |
$1,146.90 |
$1,146.90 |
$115.00
|
|
Vedolizumab 300 mg intravenous solution
|
$27,287.36 |
$27,287.36 |
$27,287.36 |
$23,003.79
|
|
Venogram ext bil s&i
|
$7,535.88 |
$7,535.88 |
$7,535.88 |
$1,838.28
|
|
Venous sampling s&i
|
$8,996.35 |
$8,996.35 |
$8,996.35 |
$4,416.78
|
|
Ven thrombosis images bilat
|
$15,985.31 |
$15,985.31 |
$15,985.31 |
$779.56
|
|
Ventilator each subsequent day
|
$7,676.24 |
$7,676.24 |
$7,676.24 |
$1,305.92
|
|
Ventilator initial day
|
$10,040.58 |
$10,040.58 |
$10,040.58 |
$1,540.80
|
|
Vinblastine 1 mg/ml intravenous solution
|
$32.05 |
$32.05 |
$32.05 |
$186.71
|
|
Vincristine 1 mg/ml intravenous solution
|
$225.05 |
$225.05 |
$225.05 |
$104.79
|
|
Vital capacity test
|
$352.11 |
$352.11 |
$352.11 |
$173.33
|
|
Volume measurement urine timed
|
$239.87 |
$239.87 |
$239.87 |
$21.45
|
|
Warde 1005055 5-hiaa 24 hour urine
|
$8.15 |
$8.15 |
$8.15 |
$72.50
|
|
Warde 1007138 vanillymandelic acid 24 hour urine
|
$5.70 |
$5.70 |
$5.70 |
$69.55
|
|
Warde 3004000 immunoglobulin subclass 1
|
$22.56 |
$22.56 |
$22.56 |
$40.70
|
|
Warde 3016300 saccharomyces cerevisiae iga antibody
|
$50.00 |
$50.00 |
$50.00 |
$55.25
|
|
Warde acetylcholine receptor blocking antibody
|
$40.73 |
$40.73 |
$40.73 |
$68.90
|
|
Warde adrenocorticotropic hormone (acth)
|
$5.75 |
$5.75 |
$5.75 |
$129.75
|
|
Warde aldolase
|
$2.00 |
$2.00 |
$2.00 |
$49.20
|
|
Warde amiodarone therapeutic drug level
|
$8.15 |
$8.15 |
$8.15 |
$53.95
|
|
Warde analysis translocation bcr/abl1 major breakpoint qualitative/quantitative
|
$162.90 |
$162.90 |
$162.90 |
$381.50
|
|
Warde bile acids
|
$4.00 |
$4.00 |
$4.00 |
$64.28
|
|
Warde cadmium blood
|
$70.00 |
$70.00 |
$70.00 |
$77.00
|
|
Warde calcitonin
|
$8.00 |
$8.00 |
$8.00 |
$89.40
|
|
Warde calculus (stone) infrared
|
$18.01 |
$18.01 |
$18.01 |
$61.73
|
|
Warde complement total hemolytic
|
$43.08 |
$43.08 |
$43.08 |
$105.00
|
|
Warde g6pd (glucose 6 phosphate dehydrogenase) quantitative
|
$7.33 |
$7.33 |
$7.33 |
$43.55
|
|
Warde gastrin
|
$4.72 |
$4.72 |
$4.72 |
$75.25
|
|
Warde haloperidol therapeutic drug level
|
$13.03 |
$13.03 |
$13.03 |
$68.16
|
|
Warde helminth antibody strongyloides igg
|
$149.00 |
$149.00 |
$149.00 |
$96.80
|
|
Warde hepatitis delta agent antibody
|
$247.50 |
$247.50 |
$247.50 |
$92.30
|
|
Warde infectious agent nucleic acid genotype hepatitis c
|
$79.00 |
$79.00 |
$79.00 |
$636.09
|
|
Warde islet cell antibody zinc transporter 8
|
$17.92 |
$17.92 |
$17.92 |
$137.55
|
|
Warde lipoprotein-associated phospholipase a2
|
$61.09 |
$61.09 |
$61.09 |
$97.00
|
|
Warde oxcarbazepine therapeutic drug level
|
$8.00 |
$8.00 |
$8.00 |
$64.50
|
|
Warde t3 (triiodothyronine) reverse
|
$5.70 |
$5.70 |
$5.70 |
$70.85
|
|
Warde thyroid stimulating immunoglobulins
|
$24.44 |
$24.44 |
$24.44 |
$173.50
|
|
Warde topiramate therapeutic drug level
|
$9.77 |
$9.77 |
$9.77 |
$71.19
|
|
Warde vitamin a
|
$9.50 |
$9.50 |
$9.50 |
$59.66
|
|
Warde vitamin b-1 (thiamine)
|
$12.14 |
$12.14 |
$12.14 |
$78.65
|
|
Warde vitamin b6 (pyridoxine)
|
$7.25 |
$7.25 |
$7.25 |
$116.00
|
|
Warde vitamin c (ascorbic acid)
|
$11.24 |
$11.24 |
$11.24 |
$45.60
|
|
Warde vitamin d (1 25 dihydroxy)
|
$9.77 |
$9.77 |
$9.77 |
$138.50
|
|
Warde vitamin e (alpha-tocopherol)
|
$8.65 |
$8.65 |
$8.65 |
$55.00
|
|
Warde zinc
|
$4.28 |
$4.28 |
$4.28 |
$62.50
|
|
Wbc automated
|
$365.52 |
$365.52 |
$365.52 |
$32.80
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$1,699.16 |
$1,699.16 |
$1,699.16 |
$558.97
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$1,699.16 |
$1,699.16 |
$1,699.16 |
$611.25
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$1,016.40 |
$1,016.40 |
$1,016.40 |
$288.91
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$1,956.90 |
$1,956.90 |
$1,956.90 |
$436.15
|
|
Xe133 xenon 10mci
|
$938.96 |
$938.96 |
$938.96 |
$299.00
|
|
X-ray abdomen 1 view
|
$2,485.34 |
$2,485.34 |
$2,485.34 |
$255.00
|
|
X-ray abdomen 2 views
|
$2,958.45 |
$2,958.45 |
$2,958.45 |
$312.36
|
|
X-ray abdomen >=3 views
|
$4,070.44 |
$4,070.44 |
$4,070.44 |
$332.15
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$4,070.44 |
$4,070.44 |
$4,070.44 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$4,005.10 |
$4,005.10 |
$4,005.10 |
$271.44
|
|
X-ray bone age studies
|
$3,061.30 |
$3,061.30 |
$3,061.30 |
$246.75
|
|
X-ray bone survey complete
|
$6,922.41 |
$6,922.41 |
$6,922.41 |
$666.60
|
|
X-ray cervical spine 2-3 views
|
$2,756.38 |
$2,756.38 |
$2,756.38 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$3,844.17 |
$3,844.17 |
$3,844.17 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$4,624.62 |
$4,624.62 |
$4,624.62 |
$515.35
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$5,843.09 |
$5,843.09 |
$5,843.09 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$7,769.41 |
$7,769.41 |
$7,769.41 |
$820.15
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$3,096.39 |
$3,096.39 |
$3,096.39 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$3,146.00 |
$3,146.00 |
$3,146.00 |
$486.01
|
|
X-ray exam entire spi 6/> vw
|
$3,844.17 |
$3,844.17 |
$3,844.17 |
$575.76
|
|
X-ray exam of eye sockets
|
$3,751.00 |
$3,751.00 |
$3,751.00 |
$349.05
|
|
X-ray exam of femur 1
|
$1,247.51 |
$1,247.51 |
$1,247.51 |
$232.36
|
|
X-ray exam of middle ear
|
$3,713.49 |
$3,713.49 |
$3,713.49 |
$341.25
|
|
X-ray exam of sinuses
|
$1,085.37 |
$1,085.37 |
$1,085.37 |
$211.00
|
|
X-ray exam thorac spine4/>vw
|
$2,859.23 |
$2,859.23 |
$2,859.23 |
$395.59
|
|
X-ray facial bones complete > 3 views
|
$3,702.60 |
$3,702.60 |
$3,702.60 |
$366.60
|
|
X-ray femur >=2 views (both sides)
|
$2,756.38 |
$2,756.38 |
$2,756.38 |
$304.15
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$2,733.39 |
$2,733.39 |
$2,733.39 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$2,733.39 |
$2,733.39 |
$2,733.39 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$2,733.39 |
$2,733.39 |
$2,733.39 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$2,969.34 |
$2,969.34 |
$2,969.34 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$2,184.05 |
$2,184.05 |
$2,184.05 |
$207.35
|
|
X-ray lumbosacral spine >= 4 views
|
$4,564.12 |
$4,564.12 |
$4,564.12 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$3,697.76 |
$3,697.76 |
$3,697.76 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$3,455.76 |
$3,455.76 |
$3,455.76 |
$352.83
|
|
X-ray nasal bones complete > 3 views
|
$2,756.38 |
$2,756.38 |
$2,756.38 |
$277.70
|
|
X-ray neck soft tissue
|
$2,436.94 |
$2,436.94 |
$2,436.94 |
$237.43
|
|
X-ray nose to rectum for foreign body child
|
$2,404.27 |
$2,404.27 |
$2,404.27 |
$225.96
|
|
X-ray pelvis 1-2 views
|
$2,534.95 |
$2,534.95 |
$2,534.95 |
$270.84
|
|
X-ray pelvis complete > 3 views
|
$2,733.39 |
$2,733.39 |
$2,733.39 |
$342.30
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$5,585.36 |
$5,585.36 |
$5,585.36 |
$742.00
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$3,729.22 |
$3,729.22 |
$3,729.22 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$2,945.14 |
$2,945.14 |
$2,945.14 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$4,282.19 |
$4,282.19 |
$4,282.19 |
$285.60
|
|
X-ray sella turcica
|
$2,960.87 |
$2,960.87 |
$2,960.87 |
$162.50
|
