|
Vaccine dtap < 7 years im
|
$137.20 |
$137.20 |
$137.20 |
$87.80
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$113.00 |
$113.00 |
$113.00 |
$45.33
|
|
Vaccine hepatitis a (hepa) adult im
|
$172.00 |
$172.00 |
$172.00 |
$178.07
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$172.00 |
$172.00 |
$172.00 |
$84.38
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$81.00 |
$81.00 |
$81.00 |
$173.98
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$91.00 |
$91.00 |
$91.00 |
$40.01
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$1,350.00 |
$1,350.00 |
$1,350.00 |
$499.00
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$499.00 |
$499.00 |
$499.00 |
$349.15
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$499.00 |
$499.00 |
$499.00 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$395.00 |
$395.00 |
$395.00 |
$224.04
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$285.00 |
$285.00 |
$285.00 |
$274.95
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$610.00 |
$610.00 |
$610.00 |
$397.18
|
|
Vaccine td preservative free >= 7 years im
|
$108.00 |
$108.00 |
$108.00 |
$131.77
|
|
Vedolizumab 300 mg intravenous solution
|
$12,194.00 |
$12,194.00 |
$12,194.00 |
$23,003.79
|
|
Venogram ext bil s&i
|
$3,040.25 |
$3,040.25 |
$3,040.25 |
$1,838.28
|
|
Ventilator each subsequent day
|
$2,568.50 |
$2,568.50 |
$2,568.50 |
$1,305.92
|
|
Ventilator initial day
|
$2,805.50 |
$2,805.50 |
$2,805.50 |
$1,540.80
|
|
Very long chain fatty acids
|
$525.25 |
$525.25 |
$525.25 |
$140.40
|
|
Viper venom prothrombin time
|
$289.25 |
$289.25 |
$289.25 |
$35.20
|
|
Vital capacity test
|
$164.00 |
$164.00 |
$164.00 |
$173.33
|
|
Vitamin b-12
|
$183.25 |
$183.25 |
$183.25 |
$94.90
|
|
Volume measurement urine timed
|
$104.50 |
$104.50 |
$104.50 |
$21.45
|
|
Voriconazole in ns IV syringe 5 mg/ml (pediatric) - cnr
|
$130.00 |
$130.00 |
$130.00 |
$224.40
|
|
Warde 3400652 ova & parasites direct smear concentration and id
|
$108.25 |
$108.25 |
$108.25 |
$63.05
|
|
Warde 3400652 smear complex special stain ova/parasites
|
$513.00 |
$513.00 |
$513.00 |
$78.57
|
|
Warde acetylcholine receptor blocking antibody
|
$85.00 |
$85.00 |
$85.00 |
$68.90
|
|
Warde amiodarone therapeutic drug level
|
$122.50 |
$122.50 |
$122.50 |
$53.95
|
|
Warde analysis gene hfe common variants
|
$83.00 |
$83.00 |
$83.00 |
$260.94
|
|
Warde analysis translocation bcr/abl1 major breakpoint qualitative/quantitative
|
$773.75 |
$773.75 |
$773.75 |
$381.50
|
|
Warde antiepileptics nos definitive assay 1-3 clobazam w metabolites
|
$115.25 |
$115.25 |
$115.25 |
$142.65
|
|
Warde cadmium blood
|
$289.25 |
$289.25 |
$289.25 |
$77.00
|
|
Warde calculus (stone) infrared
|
$59.50 |
$59.50 |
$59.50 |
$61.73
|
|
Warde clozapine therapeutic drug level
|
$411.75 |
$411.75 |
$411.75 |
$63.00
|
|
Warde estrogen fractionated
|
$662.50 |
$662.50 |
$662.50 |
$112.18
|
|
Warde folic acid rbc
|
$51.25 |
$51.25 |
$51.25 |
$81.60
|
|
Warde haloperidol therapeutic drug level
|
$445.00 |
$445.00 |
$445.00 |
$68.16
|
|
Warde neutralization rabies
|
$513.00 |
$513.00 |
$513.00 |
$106.50
|
|
Warde sugars single qualitative each specimen stool
|
$51.50 |
$51.50 |
$51.50 |
$35.75
|
|
Warde vitamin d (1 25 dihydroxy)
|
$1,145.00 |
$1,145.00 |
$1,145.00 |
$138.50
|
|
Warde vitamin e (alpha-tocopherol)
|
$423.00 |
$423.00 |
$423.00 |
$55.00
|
|
Western blot test
|
$513.00 |
$513.00 |
$513.00 |
$153.18
|
|
Wet mounts/ w preparations
|
$64.00 |
$64.00 |
$64.00 |
$19.54
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$257.50 |
$257.50 |
$257.50 |
$288.91
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$257.50 |
$257.50 |
$257.50 |
$436.15
|
|
X-ray abdomen 1 view
|
$354.00 |
$354.00 |
$354.00 |
$255.00
|
|
X-ray abdomen 2 views
|
$677.25 |
$677.25 |
$677.25 |
$312.36
|
|
X-ray abdomen >=3 views
|
$677.25 |
$677.25 |
$677.25 |
$332.15
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$3,367.75 |
$3,367.75 |
$3,367.75 |
$768.30
|
|
X-ray bone age studies
|
$738.25 |
$738.25 |
$738.25 |
$246.75
|
|
X-ray bone length studies
|
$2,085.50 |
$2,085.50 |
$2,085.50 |
$287.25
|
|
X-ray bone survey complete
|
$2,126.75 |
$2,126.75 |
$2,126.75 |
$666.60
|
|
X-ray bone survey infant
|
$1,494.00 |
$1,494.00 |
$1,494.00 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$1,583.00 |
$1,583.00 |
$1,583.00 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$3,164.25 |
$3,164.25 |
$3,164.25 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$3,188.75 |
$3,188.75 |
$3,188.75 |
$515.35
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$4,829.00 |
$4,829.00 |
$4,829.00 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$4,773.50 |
$4,773.50 |
$4,773.50 |
$820.15
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$3,124.50 |
$3,124.50 |
$3,124.50 |
$486.24
|
|
X-ray exam entire spi 6/> vw
|
$2,625.50 |
$2,625.50 |
$2,625.50 |
$575.76
|
|
X-ray exam of eye sockets
|
$2,688.75 |
$2,688.75 |
$2,688.75 |
$349.05
|
|
X-ray exam of sinuses
|
$1,717.75 |
$1,717.75 |
$1,717.75 |
$211.00
|
|
X-ray facial bones complete > 3 views
|
$2,540.50 |
$2,540.50 |
$2,540.50 |
$366.60
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$6,452.00 |
$6,452.00 |
$6,452.00 |
$350.35
|
|
X-ray knee ap standing bilateral
|
$1,821.25 |
$1,821.25 |
$1,821.25 |
$276.25
|
|
X-ray lumbosacral spine >= 4 views
|
$4,161.25 |
$4,161.25 |
$4,161.25 |
$505.83
|
|
X-ray lumbosacral spine complete including bending views >= 6 views
|
$4,086.75 |
$4,086.75 |
$4,086.75 |
$559.65
|
|
X-ray mandible complete > 4 views
|
$2,862.00 |
$2,862.00 |
$2,862.00 |
$352.83
|
|
X-ray mandible ltd <4 views
|
$1,432.50 |
$1,432.50 |
$1,432.50 |
$238.00
|
|
X-ray nasal bones complete > 3 views
|
$2,306.25 |
$2,306.25 |
$2,306.25 |
$277.70
|
|
X-ray neck soft tissue
|
$1,954.00 |
$1,954.00 |
$1,954.00 |
$237.43
|
|
X-ray pelvis 1-2 views
|
$2,064.50 |
$2,064.50 |
$2,064.50 |
$270.84
|
|
X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation
|
$4,402.50 |
$4,402.50 |
$4,402.50 |
$742.00
|
|
X-ray ribs 3 views bilateral
|
$1,642.25 |
$1,642.25 |
$1,642.25 |
$394.34
|
|
X-ray ribs w/posterior anterior chest > 4 views bilateral
|
$4,838.50 |
$4,838.50 |
$4,838.50 |
$497.00
|
|
X-ray sacroiliac joints >= 3 views
|
$2,361.50 |
$2,361.50 |
$2,361.50 |
$313.95
|
|
X-ray sacrum/coccyx >= 2 views
|
$1,956.25 |
$1,956.25 |
$1,956.25 |
$285.60
|
|
X-ray sinuses paranasal complete > 3 views
|
$2,890.00 |
$2,890.00 |
$2,890.00 |
$339.00
|
|
X-ray skull < 4 views
|
$1,717.75 |
$1,717.75 |
$1,717.75 |
$291.78
|
|
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study
|
$3,495.25 |
$3,495.25 |
$3,495.25 |
$557.70
|
|
X-ray small intestine follow-through study
|
$364.25 |
$364.25 |
$364.25 |
$504.14
|
|
X-ray sternoclavicular joint(s) > 3 views
|
$2,361.50 |
$2,361.50 |
$2,361.50 |
$263.49
|
|
X-ray sternum > 2 views
|
$2,176.75 |
$2,176.75 |
$2,176.75 |
$269.75
|
|
X-ray surgical specimen
|
$1,298.25 |
$1,298.25 |
$1,298.25 |
$482.24
|
|
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study
|
$3,124.50 |
$3,124.50 |
$3,124.50 |
$514.00
|
|
X-ray temporomandibular joint open/closed mouth bilateral
|
$2,519.25 |
$2,519.25 |
$2,519.25 |
$317.70
|
|
X-ray thoracic spine 3 views
|
$2,289.00 |
$2,289.00 |
$2,289.00 |
$387.60
|
|
X-ray thoracolumbar spine >=2 views
|
$961.00 |
$961.00 |
$961.00 |
$294.00
|
|
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views
|
$2,625.50 |
$2,625.50 |
$2,625.50 |
$385.80
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast
|
$4,614.50 |
$4,614.50 |
$4,614.50 |
$657.77
|
|
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study
|
$5,305.00 |
$5,305.00 |
$5,305.00 |
$555.04
|
|
Xylose absorption test blood &/or urine
|
$362.25 |
$362.25 |
$362.25 |
$64.28
|
|
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr
|
$131.00 |
$131.00 |
$131.00 |
$106.94
|
|
Ziprasidone 20 mg/ml (final concentration) intramuscular solution
|
$955.00 |
$955.00 |
$955.00 |
$128.10
|
|
Zoledronic acid 4 mg/5 ml intravenous solution
|
$279.00 |
$279.00 |
$279.00 |
$346.14
|
