|
Treatment of ankle fracture 27786
|
$68.00 |
$68.00 |
$68.00 |
$575.25
|
|
Treatment of toe fracture 28510
|
$63.20 |
$63.20 |
$63.20 |
$362.00
|
|
Treatment radiation delivery level 2
|
$148.00 |
$148.00 |
$148.00 |
$737.25
|
|
Treponema pallidum antibody
|
$75.20 |
$75.20 |
$75.20 |
$74.40
|
|
Triglycerides
|
$32.40 |
$32.40 |
$32.40 |
$48.75
|
|
Troponin quantitative
|
$53.20 |
$53.20 |
$53.20 |
$112.80
|
|
Ultrasound abdomen aorta screening study aaa
|
$485.20 |
$485.20 |
$485.20 |
$394.20
|
|
Ultrasound breast unilateral limited (both sides)
|
$376.40 |
$376.40 |
$376.40 |
$427.00
|
|
Ultrasound chest
|
$242.40 |
$242.40 |
$242.40 |
$430.10
|
|
Ultrasound encephalogram
|
$353.60 |
$353.60 |
$353.60 |
$463.50
|
|
Ultrasound exam k transpl w/doppler
|
$325.60 |
$325.60 |
$325.60 |
$494.00
|
|
Ultrasound fetal biophysical profile without non-stress testing
|
$502.40 |
$502.40 |
$502.40 |
$428.68
|
|
Ultrasound guidance for vascular access
|
$418.80 |
$418.80 |
$418.80 |
$300.00
|
|
Ultrasound guided needle placement supervision & interpretation
|
$475.60 |
$475.60 |
$475.60 |
$629.64
|
|
Ultrasound guide intraoperative
|
$461.20 |
$461.20 |
$461.20 |
$628.80
|
|
Ultrasound hips infant dynamic
|
$776.80 |
$776.80 |
$776.80 |
$395.20
|
|
Ultrasound infant hips ltd without stress
|
$420.40 |
$420.40 |
$420.40 |
$311.25
|
|
Ultrasound joint complete left
|
$484.80 |
$484.80 |
$484.80 |
$534.00
|
|
Ultrasound joint/nonvascular extremity limited left
|
$239.20 |
$239.20 |
$239.20 |
$426.60
|
|
Ultrasound ob >=14wks ea addl gest
|
$450.80 |
$450.80 |
$450.80 |
$431.20
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$319.20 |
$319.20 |
$319.20 |
$304.80
|
|
Ultrasound pregnant uterus follow up per fetus
|
$414.40 |
$414.40 |
$414.40 |
$393.32
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$286.00 |
$286.00 |
$286.00 |
$434.20
|
|
Ultrasound pregnant uterus transvaginal
|
$345.60 |
$345.60 |
$345.60 |
$477.10
|
|
Ultrasound retroperitoneal limited
|
$236.00 |
$236.00 |
$236.00 |
$469.58
|
|
Ultrasound scrotum and contents
|
$533.20 |
$533.20 |
$533.20 |
$558.03
|
|
Ultrasound spinal canal and contents
|
$136.80 |
$136.80 |
$136.80 |
$415.00
|
|
Ultrasound transvaginal non obstetric
|
$404.40 |
$404.40 |
$404.40 |
$523.20
|
|
Unlisted fluoroscopic px
|
$414.00 |
$414.00 |
$414.00 |
$256.00
|
|
Unlisted misc path test
|
$30.80 |
$30.80 |
$30.80 |
$89.40
|
|
Unlisted transfusion med px
|
$86.80 |
$86.80 |
$86.80 |
$113.36
|
|
Unlisted ultrasound procedure
|
$307.60 |
$307.60 |
$307.60 |
$335.00
|
|
Upgrade pm system
|
$9,650.40 |
$9,650.40 |
$9,650.40 |
$12,324.60
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,688.40 |
$1,688.40 |
$1,688.40 |
$2,590.50
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,500.80 |
$1,500.80 |
$1,500.80 |
$2,001.87
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,343.20 |
$1,343.20 |
$1,343.20 |
$1,794.00
|
|
Urea nitrogen
|
$29.20 |
$29.20 |
$29.20 |
$38.25
|
|
Urea nitrogen 24 hour urine
|
$52.00 |
$52.00 |
$52.00 |
$42.90
|
|
Urethrcystgrphy rtrgrde s&i
|
$422.00 |
$422.00 |
$422.00 |
$554.28
|
|
Urethrocystography void s&i
|
$526.00 |
$526.00 |
$526.00 |
$586.50
|
|
Uric acid blood
|
$40.80 |
$40.80 |
$40.80 |
$44.00
|
|
Uric acid urine
|
$34.00 |
$34.00 |
$34.00 |
$43.20
|
|
Urinalysis microscopic only
|
$26.80 |
$26.80 |
$26.80 |
$25.72
|
|
Urinalysis (with microscopy)
|
$56.80 |
$56.80 |
$56.80 |
$37.39
|
|
Urinalysis (without microscopy)
|
$22.80 |
$22.80 |
$22.80 |
$33.00
|
|
Urine pregnancy test
|
$59.60 |
$59.60 |
$59.60 |
$57.00
|
|
Urography, antegrade
|
$422.00 |
$422.00 |
$422.00 |
$593.37
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$73.10 |
$73.10 |
$73.10 |
$130.67
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$18.96 |
$18.96 |
$18.96 |
$47.38
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$20.28 |
$20.28 |
$20.28 |
$29.60
|
|
Vaccine mmr live subcutaneous
|
$92.56 |
$92.56 |
$92.56 |
$222.36
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$99.77 |
$99.77 |
$99.77 |
$195.69
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$254.98 |
$254.98 |
$254.98 |
$579.50
|
|
Vaccine polio (ipv) subcutaneous/im
|
$36.00 |
$36.00 |
$36.00 |
$100.00
|
|
Vaccine rabies im
|
$378.00 |
$378.00 |
$378.00 |
$800.00
|
|
Vaccine tdap >=7 years im
|
$39.43 |
$39.43 |
$39.43 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$36.69 |
$36.69 |
$36.69 |
$112.10
|
|
Vaccine varicella live subcutaneous
|
$88.00 |
$88.00 |
$88.00 |
$434.73
|
|
Valproic acid total therapeutic drug level
|
$64.00 |
$64.00 |
$64.00 |
$100.80
|
|
Vancomycin peak therapeutic drug level
|
$64.80 |
$64.80 |
$64.80 |
$116.00
|
|
Varicella zoster antibody igg
|
$52.80 |
$52.80 |
$52.80 |
$90.35
|
|
Venogram ext bil s&i
|
$926.40 |
$926.40 |
$926.40 |
$1,697.72
|
|
Venogram extremity supervision & interpretation unilateral
|
$822.80 |
$822.80 |
$822.80 |
$1,270.23
|
|
Ventilator each subsequent day
|
$602.00 |
$602.00 |
$602.00 |
$1,138.50
|
|
Ventilator initial day
|
$936.40 |
$936.40 |
$936.40 |
$1,331.00
|
|
Vital capacity test
|
$78.40 |
$78.40 |
$78.40 |
$170.00
|
|
Vitamin b-12
|
$33.60 |
$33.60 |
$33.60 |
$89.70
|
|
Vitamin D Test
|
$140.40 |
$140.40 |
$140.40 |
$132.60
|
|
Volume measurement urine timed
|
$9.20 |
$9.20 |
$9.20 |
$17.40
|
|
Warde 1003990 aldosterone
|
$97.60 |
$97.60 |
$97.60 |
$182.65
|
|
Warde 1005020 citrate 24 hour urine
|
$79.60 |
$79.60 |
$79.60 |
$113.75
|
|
Warde 1005055 5-hiaa 24 hour urine
|
$36.00 |
$36.00 |
$36.00 |
$72.50
|
|
Warde 1006955 catecholamines fractionated 24 hour urine
|
$118.40 |
$118.40 |
$118.40 |
$128.05
|
|
Warde 1007138 vanillymandelic acid 24 hour urine
|
$42.80 |
$42.80 |
$42.80 |
$83.06
|
|
Warde 3004000 immunoglobulin subclass 1
|
$63.20 |
$63.20 |
$63.20 |
$51.20
|
|
Warde 3008005 oligoclonal bands
|
$163.20 |
$163.20 |
$163.20 |
$117.13
|
|
Warde 3016000 west nile virus antibody
|
$36.00 |
$36.00 |
$36.00 |
$78.65
|
|
Warde 3016000 west nile virus antibody igg
|
$48.80 |
$48.80 |
$48.80 |
$78.00
|
|
Warde 3400652 ova & parasites direct smear concentration and id
|
$28.80 |
$28.80 |
$28.80 |
$60.00
|
|
Warde 3400652 smear complex special stain ova/parasites
|
$18.40 |
$18.40 |
$18.40 |
$79.30
|
|
Warde 3400852 arsenic
|
$53.20 |
$53.20 |
$53.20 |
$107.38
|
|
Warde 3708165 mercury urine
|
$40.40 |
$40.40 |
$40.40 |
$82.20
|
|
Warde adenosine deaminase pleural fluid
|
$109.60 |
$109.60 |
$109.60 |
$96.03
|
|
Warde adrenocorticotropic hormone (acth)
|
$76.00 |
$76.00 |
$76.00 |
$147.55
|
|
Warde aldolase
|
$27.20 |
$27.20 |
$27.20 |
$60.00
|
|
Warde amino acids 6 or more quantitative each specimen
|
$418.80 |
$418.80 |
$418.80 |
$177.60
|
|
Warde analysis gene hfe common variants
|
$181.60 |
$181.60 |
$181.60 |
$284.70
|
|
Warde analysis translocation bcr/abl1 major breakpoint qualitative/quantitative
|
$108.40 |
$108.40 |
$108.40 |
$403.20
|
|
Warde apolipoprotein b
|
$51.20 |
$51.20 |
$51.20 |
$80.60
|
|
Warde cadmium blood
|
$44.40 |
$44.40 |
$44.40 |
$79.20
|
|
Warde calcitonin
|
$70.00 |
$70.00 |
$70.00 |
$120.25
|
|
Warde clozapine therapeutic drug level
|
$40.40 |
$40.40 |
$40.40 |
$71.20
|
|
Warde cobalt heavy metal quantitative each nes
|
$86.40 |
$86.40 |
$86.40 |
$126.08
|
|
Warde collagen cross links c-telopeptide
|
$89.20 |
$89.20 |
$89.20 |
$94.80
|
|
Warde complement total hemolytic
|
$70.40 |
$70.40 |
$70.40 |
$108.55
|
|
Warde copper
|
$31.60 |
$31.60 |
$31.60 |
$88.20
|
|
Warde erythropoietin
|
$65.60 |
$65.60 |
$65.60 |
$92.50
|
|
Warde folic acid rbc
|
$59.60 |
$59.60 |
$59.60 |
$91.85
|
|
Warde g6pd (glucose 6 phosphate dehydrogenase) quantitative
|
$68.40 |
$68.40 |
$68.40 |
$65.00
|
|
Warde gastrin
|
$68.80 |
$68.80 |
$68.80 |
$94.68
|
