|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$156.80 |
$156.80 |
$156.80 |
$326.54
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$441.20 |
$441.20 |
$441.20 |
$690.48
|
|
Ultrasound pregnant uterus follow up per fetus
|
$102.40 |
$102.40 |
$102.40 |
$450.75
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$158.80 |
$158.80 |
$158.80 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$144.40 |
$144.40 |
$144.40 |
$485.48
|
|
Ultrasound prostate/transrectal
|
$346.00 |
$346.00 |
$346.00 |
$545.16
|
|
Ultrasound retroperitoneal limited
|
$428.00 |
$428.00 |
$428.00 |
$498.00
|
|
Ultrasound scrotum and contents
|
$570.00 |
$570.00 |
$570.00 |
$617.28
|
|
Ultrasound spinal canal and contents
|
$451.20 |
$451.20 |
$451.20 |
$450.60
|
|
Ultrasound transabd ea addl gest
|
$295.60 |
$295.60 |
$295.60 |
$425.10
|
|
Ultrasound transvaginal non obstetric
|
$393.20 |
$393.20 |
$393.20 |
$567.44
|
|
Ultrasound trgt dyn mbubb 1st les
|
$345.60 |
$345.60 |
$345.60 |
$479.72
|
|
Unlisted fluoroscopic px
|
$95.80 |
$95.80 |
$95.80 |
$324.85
|
|
Unlisted transfusion med px
|
$54.80 |
$54.80 |
$54.80 |
$141.35
|
|
Unlisted ultrasound procedure
|
$195.60 |
$195.60 |
$195.60 |
$321.20
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,009.60 |
$1,009.60 |
$1,009.60 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,262.80 |
$1,262.80 |
$1,262.80 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,009.60 |
$1,009.60 |
$1,009.60 |
$2,013.08
|
|
Urea nitrogen
|
$43.60 |
$43.60 |
$43.60 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$43.14 |
$43.14 |
$43.14 |
$50.00
|
|
Urea nitrogen clearance
|
$7.14 |
$7.14 |
$7.14 |
$33.57
|
|
Ureteral reflux study
|
$845.20 |
$845.20 |
$845.20 |
$961.20
|
|
Urethrcystgrphy rtrgrde s&i
|
$429.20 |
$429.20 |
$429.20 |
$574.40
|
|
Urethrocystography void s&i
|
$285.20 |
$285.20 |
$285.20 |
$634.50
|
|
Uric acid blood
|
$40.08 |
$40.08 |
$40.08 |
$46.64
|
|
Uric acid urine
|
$37.01 |
$37.01 |
$37.01 |
$46.75
|
|
Urinalysis microscopic only
|
$13.50 |
$13.50 |
$13.50 |
$26.35
|
|
Urinalysis qual/semiquant excpt ia
|
$4.96 |
$4.96 |
$4.96 |
$25.72
|
|
Urinalysis (with microscopy)
|
$59.48 |
$59.48 |
$59.48 |
$48.14
|
|
Urinalysis (without microscopy)
|
$45.98 |
$45.98 |
$45.98 |
$38.99
|
|
Urine Culture Test
|
$60.17 |
$60.17 |
$60.17 |
$84.81
|
|
Urine pregnancy test
|
$9.06 |
$9.06 |
$9.06 |
$66.40
|
|
Urography, antegrade
|
$371.20 |
$371.20 |
$371.20 |
$593.37
|
|
Use 1st target lesion
|
$410.00 |
$410.00 |
$410.00 |
$245.30
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$179.92 |
$179.92 |
$179.92 |
$223.08
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$177.84 |
$177.84 |
$177.84 |
$218.88
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$173.64 |
$173.64 |
$173.64 |
$239.85
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$111.44 |
$111.44 |
$111.44 |
$131.67
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$249.64 |
$249.64 |
$249.64 |
$91.00
|
|
Vaccine dtap < 7 years im
|
$43.62 |
$43.62 |
$43.62 |
$87.80
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$63.88 |
$63.88 |
$63.88 |
$45.33
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$174.18 |
$174.18 |
$174.18 |
$306.24
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$21.34 |
$21.34 |
$21.34 |
$79.04
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$70.98 |
$70.98 |
$70.98 |
$226.20
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$24.56 |
$24.56 |
$24.56 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$11.88 |
$11.88 |
$11.88 |
$42.90
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$39.60 |
$39.60 |
$39.60 |
$26.40
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$29.60 |
$29.60 |
$29.60 |
$40.01
|
|
Vaccine influenza quadrivalent live (laiv4) intranasal
|
$22.00 |
$22.00 |
$22.00 |
$37.05
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$46.00 |
$46.00 |
$46.00 |
$72.00
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$231.24 |
$231.24 |
$231.24 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$76.20 |
$76.20 |
$76.20 |
$224.04
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$281.60 |
$281.60 |
$281.60 |
$397.18
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$359.73 |
$359.73 |
$359.73 |
$715.41
|
|
Vaccine polio (ipv) subcutaneous/im
|
$85.88 |
$85.88 |
$85.88 |
$119.17
|
|
Vaccine rabies im
|
$428.31 |
$428.31 |
$428.31 |
$945.46
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$715.19 |
$715.19 |
$715.19 |
$1,196.00
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$924.26 |
$924.26 |
$924.26 |
$1,159.00
|
|
Vaccine tdap >=7 years im
|
$55.08 |
$55.08 |
$55.08 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$65.64 |
$65.64 |
$65.64 |
$131.77
|
|
Valproic acid total therapeutic drug level
|
$121.44 |
$121.44 |
$121.44 |
$115.00
|
|
Vancomycin peak therapeutic drug level
|
$91.11 |
$91.11 |
$91.11 |
$126.79
|
|
Varicella zoster antibody igg
|
$42.21 |
$42.21 |
$42.21 |
$82.55
|
|
Vasopressin 20 unit/ml intravenous solution
|
$1.23 |
$1.23 |
$1.23 |
$394.13
|
|
Venogram ext bil s&i
|
$1,800.00 |
$1,800.00 |
$1,800.00 |
$1,838.28
|
|
Venogram extremity supervision & interpretation unilateral
|
$1,439.60 |
$1,439.60 |
$1,439.60 |
$1,326.00
|
|
Very long chain fatty acids
|
$22.59 |
$22.59 |
$22.59 |
$140.40
|
|
Vincristine 1 mg/ml intravenous solution
|
$51.86 |
$51.86 |
$51.86 |
$104.79
|
|
Vitamin b-12
|
$116.82 |
$116.82 |
$116.82 |
$94.90
|
|
Vitamin D Test
|
$72.11 |
$72.11 |
$72.11 |
$132.00
|
|
Volume measurement urine timed
|
$21.72 |
$21.72 |
$21.72 |
$21.45
|
|
Voriconazole in ns IV syringe 5 mg/ml (pediatric) - cnr
|
$12.19 |
$12.19 |
$12.19 |
$224.40
|
|
Warde 1003990 aldosterone
|
$75.37 |
$75.37 |
$75.37 |
$145.60
|
|
Warde 1005055 5-hiaa 24 hour urine
|
$21.51 |
$21.51 |
$21.51 |
$72.50
|
|
Warde 1006955 catecholamines fractionated 24 hour urine
|
$39.06 |
$39.06 |
$39.06 |
$113.10
|
|
Warde 1007138 vanillymandelic acid 24 hour urine
|
$29.82 |
$29.82 |
$29.82 |
$69.55
|
|
Warde 1015200 kappa light chain free
|
$28.80 |
$28.80 |
$28.80 |
$64.28
|
|
Warde 3004000 immunoglobulin subclass 1
|
$4.80 |
$4.80 |
$4.80 |
$40.70
|
|
Warde 3008005 oligoclonal bands
|
$45.60 |
$45.60 |
$45.60 |
$102.60
|
|
Warde 3016000 west nile virus antibody
|
$6.82 |
$6.82 |
$6.82 |
$68.80
|
|
Warde 3016000 west nile virus antibody igg
|
$6.82 |
$6.82 |
$6.82 |
$69.00
|
|
Warde 3016300 saccharomyces cerevisiae iga antibody
|
$86.56 |
$86.56 |
$86.56 |
$55.25
|
|
Warde 3400652 ova & parasites direct smear concentration and id
|
$30.75 |
$30.75 |
$30.75 |
$63.05
|
|
Warde 3400652 smear complex special stain ova/parasites
|
$20.85 |
$20.85 |
$20.85 |
$78.57
|
|
Warde 3400852 arsenic
|
$102.00 |
$102.00 |
$102.00 |
$105.12
|
|
Warde actin (smooth muscle) antibody each
|
$20.07 |
$20.07 |
$20.07 |
$45.58
|
|
Warde adenosine deaminase pleural fluid
|
$132.58 |
$132.58 |
$132.58 |
$91.76
|
|
Warde adrenocorticotropic hormone (acth)
|
$87.78 |
$87.78 |
$87.78 |
$129.75
|
|
Warde aldolase
|
$21.42 |
$21.42 |
$21.42 |
$49.20
|
|
Warde amino acids 6 or more quantitative each specimen
|
$37.20 |
$37.20 |
$37.20 |
$176.20
|
|
Warde analysis translocation bcr/abl1 major breakpoint qualitative/quantitative
|
$76.00 |
$76.00 |
$76.00 |
$381.50
|
|
Warde antiepileptics nos definitive assay 1-3 clobazam w metabolites
|
$50.40 |
$50.40 |
$50.40 |
$142.65
|
|
Warde cobalt heavy metal quantitative each nes
|
$31.60 |
$31.60 |
$31.60 |
$122.50
|
|
Warde collagen cross links c-telopeptide
|
$28.11 |
$28.11 |
$28.11 |
$90.40
|
|
Warde complement total hemolytic
|
$38.22 |
$38.22 |
$38.22 |
$105.00
|
|
Warde cryoglobulin
|
$72.03 |
$72.03 |
$72.03 |
$43.45
|
|
Warde erythropoietin
|
$51.44 |
$51.44 |
$51.44 |
$90.35
|
|
Warde folic acid rbc
|
$30.24 |
$30.24 |
$30.24 |
$81.60
|
|
Warde g6pd (glucose 6 phosphate dehydrogenase) quantitative
|
$43.91 |
$43.91 |
$43.91 |
$43.55
|
|
Warde gastrin
|
$32.76 |
$32.76 |
$32.76 |
$75.25
|
