|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$293.40 |
$293.40 |
$293.40 |
$434.20
|
|
Ultrasound pregnant uterus transvaginal
|
$330.60 |
$330.60 |
$330.60 |
$477.10
|
|
Ultrasound prostate/transrectal
|
$462.60 |
$462.60 |
$462.60 |
$515.63
|
|
Ultrasound retroperitoneal limited
|
$239.40 |
$239.40 |
$239.40 |
$469.58
|
|
Ultrasound scrotum and contents
|
$382.20 |
$382.20 |
$382.20 |
$558.03
|
|
Ultrasound spinal canal and contents
|
$324.60 |
$324.60 |
$324.60 |
$415.00
|
|
Ultrasound transvaginal non obstetric
|
$330.60 |
$330.60 |
$330.60 |
$523.20
|
|
Ultraviolet therapy
|
$42.60 |
$42.60 |
$42.60 |
$42.60
|
|
Unlisted CT procedure
|
$542.40 |
$542.40 |
$542.40 |
$1,268.98
|
|
Unlisted mr procedure
|
$582.60 |
$582.60 |
$582.60 |
$1,249.50
|
|
Unlisted orl service/px
|
$153.60 |
$153.60 |
$153.60 |
$153.60
|
|
Unlisted px casting/strpg
|
$159.00 |
$159.00 |
$159.00 |
$223.45
|
|
Unlisted ultrasound procedure
|
$164.40 |
$164.40 |
$164.40 |
$335.00
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$582.60 |
$582.60 |
$582.60 |
$2,590.50
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$582.60 |
$582.60 |
$582.60 |
$2,001.87
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$582.60 |
$582.60 |
$582.60 |
$1,794.00
|
|
Urea nitrogen
|
$90.60 |
$90.60 |
$90.60 |
$38.25
|
|
Urea nitrogen 24 hour urine
|
$105.60 |
$105.60 |
$105.60 |
$42.90
|
|
Ureteral reflux study
|
$961.20 |
$961.20 |
$961.20 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$258.00 |
$258.00 |
$258.00 |
$554.28
|
|
Urethrocystography void s&i
|
$258.00 |
$258.00 |
$258.00 |
$586.50
|
|
Uric acid blood
|
$100.80 |
$100.80 |
$100.80 |
$44.00
|
|
Uric acid urine
|
$131.40 |
$131.40 |
$131.40 |
$43.20
|
|
Urinalysis microscopic only
|
$54.00 |
$54.00 |
$54.00 |
$25.72
|
|
Urinalysis (with microscopy)
|
$135.00 |
$135.00 |
$135.00 |
$37.39
|
|
Urinalysis (without microscopy)
|
$101.40 |
$101.40 |
$101.40 |
$33.00
|
|
Urine Culture Test
|
$223.80 |
$223.80 |
$223.80 |
$63.84
|
|
Urine pregnancy test
|
$159.60 |
$159.60 |
$159.60 |
$57.00
|
|
Urography, antegrade
|
$351.00 |
$351.00 |
$351.00 |
$593.37
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$3,183.44 |
$3,183.44 |
$3,183.44 |
$8,225.22
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$42,196.74 |
$42,196.74 |
$42,196.74 |
$89,537.92
|
|
Vaccine dtap < 7 years im
|
$49.35 |
$49.35 |
$49.35 |
$66.69
|
|
Vaccine dtap-hep b-ipv im
|
$180.74 |
$180.74 |
$180.74 |
$169.85
|
|
Vaccine dtap-ipv 4-6 years im
|
$131.65 |
$131.65 |
$131.65 |
$129.00
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$52.77 |
$52.77 |
$52.77 |
$70.53
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$48.82 |
$48.82 |
$48.82 |
$39.78
|
|
Vaccine hepatitis a (hepa) adult im
|
$178.07 |
$178.07 |
$178.07 |
$163.15
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$201.80 |
$201.80 |
$201.80 |
$201.80
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$120.25 |
$120.25 |
$120.25 |
$84.38
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$175.91 |
$175.91 |
$175.91 |
$162.07
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$446.88 |
$446.88 |
$446.88 |
$310.70
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$45.91 |
$45.91 |
$45.91 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$441.38 |
$441.38 |
$441.38 |
$521.70
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$179.55 |
$179.55 |
$179.55 |
$130.67
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$47.88 |
$47.88 |
$47.88 |
$47.38
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$47.65 |
$47.65 |
$47.65 |
$26.40
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$49.02 |
$49.02 |
$49.02 |
$29.60
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$53.06 |
$53.06 |
$53.06 |
$72.00
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$322.90 |
$322.90 |
$322.90 |
$400.03
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$329.24 |
$329.24 |
$329.24 |
$321.80
|
|
Vaccine mmr live subcutaneous
|
$417.25 |
$417.25 |
$417.25 |
$222.36
|
|
Vaccine mmrv live subcutaneous
|
$424.32 |
$424.32 |
$424.32 |
$604.50
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$166.40 |
$166.40 |
$166.40 |
$195.69
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$429.30 |
$429.30 |
$429.30 |
$393.25
|
|
Vaccine polio (ipv) subcutaneous/im
|
$119.17 |
$119.17 |
$119.17 |
$100.00
|
|
Vaccine rabies im
|
$659.39 |
$659.39 |
$659.39 |
$800.00
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$659.71 |
$659.71 |
$659.71 |
$534.92
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$1,105.21 |
$1,105.21 |
$1,105.21 |
$1,159.00
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$1,105.21 |
$1,105.21 |
$1,105.21 |
$997.44
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$191.74 |
$191.74 |
$191.74 |
$108.00
|
|
Vaccine tdap >=7 years im
|
$131.34 |
$131.34 |
$131.34 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$120.13 |
$120.13 |
$120.13 |
$112.10
|
|
Vaccine varicella live subcutaneous
|
$313.70 |
$313.70 |
$313.70 |
$434.73
|
|
Valproic acid total therapeutic drug level
|
$291.00 |
$291.00 |
$291.00 |
$100.80
|
|
Valrubicin injection
|
$2,929.63 |
$2,929.63 |
$2,929.63 |
$2,929.63
|
|
Vancomycin peak therapeutic drug level
|
$316.80 |
$316.80 |
$316.80 |
$116.00
|
|
Varicella zoster antibody igg
|
$280.80 |
$280.80 |
$280.80 |
$90.35
|
|
Vasopressin 20 unit/ml intravenous solution
|
$543.52 |
$543.52 |
$543.52 |
$330.41
|
|
Vedolizumab 300 mg intravenous solution
|
$46.29 |
$46.29 |
$46.29 |
$22,019.50
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$280.80 |
$280.80 |
$280.80 |
$123.00
|
|
Ventilator each subsequent day
|
$1,290.00 |
$1,290.00 |
$1,290.00 |
$1,138.50
|
|
Ventilator initial day
|
$1,434.60 |
$1,434.60 |
$1,434.60 |
$1,331.00
|
|
Version cephalic external
|
$1,186.20 |
$1,186.20 |
$1,186.20 |
$2,361.75
|
|
Verteporfin injection
|
$2,439.18 |
$2,439.18 |
$2,439.18 |
$11.55
|
|
Very long chain fatty acids
|
$505.20 |
$505.20 |
$505.20 |
$157.30
|
|
Vinblastine 1 mg/ml intravenous solution
|
$202.14 |
$202.14 |
$202.14 |
$159.60
|
|
Vincristine 1 mg/ml intravenous solution
|
$191.12 |
$191.12 |
$191.12 |
$52.02
|
|
Vinorelbine 10 mg/ml intravenous solution (wrapper)
|
$200.42 |
$200.42 |
$200.42 |
$177.04
|
|
Virus isolation addl studies ea
|
$98.40 |
$98.40 |
$98.40 |
$90.35
|
|
Visual audiometry (vra)
|
$193.80 |
$193.80 |
$193.80 |
$202.50
|
|
Vitamin b-12
|
$252.00 |
$252.00 |
$252.00 |
$89.70
|
|
Vitamin D Test
|
$408.00 |
$408.00 |
$408.00 |
$132.60
|
|
Volume measurement urine timed
|
$16.20 |
$16.20 |
$16.20 |
$17.40
|
|
Voriconazole in ns IV syringe 5 mg/ml (pediatric) - cnr
|
$317.31 |
$317.31 |
$317.31 |
$59.11
|
|
Vutrisiran 25 mg/0.5 ml subcutaneous syringe
|
$179,026.50 |
$179,026.50 |
$179,026.50 |
$4,983.86
|
|
Warde 1003990 aldosterone
|
$654.00 |
$654.00 |
$654.00 |
$182.65
|
|
Warde 1005020 citrate 24 hour urine
|
$105.00 |
$105.00 |
$105.00 |
$113.75
|
|
Warde 1005055 5-hiaa 24 hour urine
|
$48.00 |
$48.00 |
$48.00 |
$72.50
|
|
Warde 1006955 catecholamines fractionated 24 hour urine
|
$525.60 |
$525.60 |
$525.60 |
$128.05
|
|
Warde 1007138 vanillymandelic acid 24 hour urine
|
$320.40 |
$320.40 |
$320.40 |
$83.06
|
|
Warde 3004000 immunoglobulin subclass 1
|
$17.40 |
$17.40 |
$17.40 |
$51.20
|
|
Warde 3008005 oligoclonal bands
|
$608.40 |
$608.40 |
$608.40 |
$117.13
|
|
Warde 3016000 west nile virus antibody
|
$49.20 |
$49.20 |
$49.20 |
$78.65
|
|
Warde 3016000 west nile virus antibody igg
|
$69.00 |
$69.00 |
$69.00 |
$78.00
|
|
Warde 3016300 saccharomyces cerevisiae iga antibody
|
$141.00 |
$141.00 |
$141.00 |
$70.85
|
|
Warde 3400652 ova & parasites direct smear concentration and id
|
$226.20 |
$226.20 |
$226.20 |
$60.00
|
|
Warde 3400652 smear complex special stain ova/parasites
|
$174.60 |
$174.60 |
$174.60 |
$79.30
|
|
Warde 3400683 amplification rna markers infectious disease bacterial vaginosis
|
$256.80 |
$256.80 |
$256.80 |
$250.90
|
|
Warde 3400852 arsenic
|
$141.60 |
$141.60 |
$141.60 |
$107.38
|
|
Warde 3708165 mercury urine
|
$128.40 |
$128.40 |
$128.40 |
$82.20
|
