|
Unlisted transfusion med px
|
$86.80 |
$86.80 |
$86.80 |
|
|
Unlisted ultrasound procedure
|
$307.60 |
$307.60 |
$307.60 |
|
|
Upgrade pm system
|
$9,650.40 |
$9,650.40 |
$9,650.40 |
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$1,688.40 |
$1,688.40 |
$3,177.20 |
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$1,500.80 |
$1,722.80 |
$2,905.50 |
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,343.20 |
$1,402.00 |
$2,811.25 |
|
|
Upper Endoscopy (EGD, diagnostic)
|
$3,806.18 |
$3,806.18 |
$3,806.18 |
|
|
Upper Endoscopy (EGD, with biopsy)
|
$7,692.01 |
$7,692.01 |
$7,692.01 |
|
|
Urea nitrogen
|
$29.20 |
$36.40 |
$40.00 |
|
|
Urea nitrogen 24 hour urine
|
$13.65 |
$52.00 |
$66.00 |
|
|
Urethrcystgrphy rtrgrde s&i
|
$422.00 |
$422.00 |
$907.40 |
|
|
Urethrocystography void s&i
|
$526.00 |
$526.00 |
$715.00 |
|
|
Uric acid blood
|
$40.80 |
$44.00 |
$48.75 |
|
|
Uric acid urine
|
$34.00 |
$47.20 |
$74.10 |
|
|
Urinalysis microscopic only
|
$26.00 |
$26.80 |
$36.40 |
|
|
Urinalysis (with microscopy)
|
$36.00 |
$56.80 |
$83.85 |
|
|
Urinalysis (without microscopy)
|
$22.80 |
$27.60 |
$55.25 |
|
|
Urine Culture Test
|
$42.80 |
$42.80 |
$128.70 |
|
|
Urine pregnancy test
|
$57.20 |
$59.60 |
$111.80 |
|
|
Urography, antegrade
|
$422.00 |
$422.00 |
$422.00 |
|
|
Urography inf drip &/or bolus
|
$715.00 |
$715.00 |
$715.00 |
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$7,964.51 |
$7,964.51 |
$7,964.51 |
|
|
Vaccine dtap < 7 years im
|
$25.32 |
$25.32 |
$120.14 |
|
|
Vaccine dtap-hep b-ipv im
|
$454.02 |
$454.02 |
$454.02 |
|
|
Vaccine dtap-ipv 4-6 years im
|
$262.86 |
$262.86 |
$262.86 |
|
|
Vaccine dtap-ipv/hib im
|
$535.65 |
$535.65 |
$535.65 |
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$129.80 |
$129.80 |
$129.80 |
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$167.01 |
$167.01 |
$167.01 |
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$314.13 |
$314.13 |
$314.13 |
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$697.53 |
$697.53 |
$697.53 |
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$124.04 |
$124.04 |
$124.04 |
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$1,387.24 |
$1,387.24 |
$1,387.24 |
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$73.10 |
$73.10 |
$361.15 |
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$18.96 |
$18.96 |
$83.40 |
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$20.28 |
$20.28 |
$20.28 |
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$1,058.62 |
$1,058.62 |
$1,058.62 |
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$745.11 |
$745.11 |
$745.11 |
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$743.42 |
$743.42 |
$743.42 |
|
|
Vaccine mmr live subcutaneous
|
$92.56 |
$92.56 |
$404.50 |
|
|
Vaccine mmrv live subcutaneous
|
$1,209.06 |
$1,209.06 |
$1,209.06 |
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$99.77 |
$99.77 |
$494.67 |
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$254.98 |
$254.98 |
$1,261.16 |
|
|
Vaccine polio (ipv) subcutaneous/im
|
$36.00 |
$36.00 |
$198.83 |
|
|
Vaccine rabies im
|
$238.80 |
$378.00 |
$986.92 |
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$2,514.14 |
$2,514.14 |
$2,514.14 |
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$2,514.14 |
$2,514.14 |
$2,514.14 |
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$430.92 |
$430.92 |
$430.92 |
|
|
Vaccine tdap >=7 years im
|
$39.43 |
$40.13 |
$202.34 |
|
|
Vaccine td preservative free >= 7 years im
|
$36.69 |
$36.69 |
$187.65 |
|
|
Vaccine varicella live subcutaneous
|
$88.00 |
$88.00 |
$808.52 |
|
|
Valproate in ns IV syringe 10 mg/ml (pediatric) - cnr
|
$28.31 |
$28.31 |
$28.31 |
|
|
Valproic acid total therapeutic drug level
|
$64.00 |
$66.80 |
$82.55 |
|
|
Vancomycin 1,000 mg intravenous injection
|
$67.77 |
$67.77 |
$67.77 |
|
|
Vancomycin 750 mg intravenous solution
|
$180.84 |
$180.84 |
$180.84 |
|
|
Vancomycin peak therapeutic drug level
|
$64.80 |
$93.20 |
$222.95 |
|
|
Varicella zoster antibody igg
|
$52.80 |
$52.80 |
$87.60 |
|
|
Vasopressin 20 unit/ml intravenous solution
|
$144.07 |
$144.07 |
$144.07 |
|
|
Vedolizumab 300 mg intravenous solution
|
$18,077.10 |
$18,077.10 |
$18,077.10 |
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$2,540.20 |
$2,540.20 |
$2,540.20 |
|
|
Venogram ext bil s&i
|
$926.40 |
$926.40 |
$926.40 |
|
|
Venogram extremity supervision & interpretation unilateral
|
$822.80 |
$822.80 |
$1,389.05 |
|
|
Ventilator each subsequent day
|
$602.00 |
$602.00 |
$1,283.10 |
|
|
Ventilator initial day
|
$936.40 |
$936.40 |
$1,575.60 |
|
|
Version cephalic external
|
$3,008.88 |
$3,008.88 |
$3,008.88 |
|
|
Very long chain fatty acids
|
$323.05 |
$323.05 |
$323.05 |
|
|
Vincristine 1 mg/ml intravenous solution
|
$74.44 |
$74.44 |
$74.44 |
|
|
Vinorelbine 10 mg/ml intravenous solution (wrapper)
|
$168.67 |
$168.67 |
$168.67 |
|
|
Virus isolation addl studies ea
|
$43.60 |
$43.60 |
$43.60 |
|
|
Vital capacity test
|
$78.40 |
$78.40 |
$119.60 |
|
|
Vitamin b-12
|
$33.60 |
$33.60 |
$107.90 |
|
|
Vitamin D Test
|
$114.40 |
$140.40 |
$295.10 |
|
|
Voiding pressure study/intra-abd 51797
|
$533.65 |
$533.65 |
$533.65 |
|
|
Volume measurement urine timed
|
$9.20 |
$9.20 |
$28.60 |
|
|
Voriconazole in ns IV syringe 5 mg/ml (pediatric) - cnr
|
$309.44 |
$309.44 |
$309.44 |
|
|
Vulvectomy simple partial
|
$11,208.68 |
$11,208.68 |
$11,208.68 |
|
|
Warde 1003990 aldosterone
|
$96.80 |
$97.60 |
$244.40 |
|
|
Warde 1005020 citrate 24 hour urine
|
$79.60 |
$79.60 |
$84.00 |
|
|
Warde 1005055 5-hiaa 24 hour urine
|
$36.00 |
$105.60 |
$139.75 |
|
|
Warde 1006955 catecholamines fractionated 24 hour urine
|
$118.40 |
$118.40 |
$146.40 |
|
|
Warde 1007138 vanillymandelic acid 24 hour urine
|
$42.80 |
$42.80 |
$42.80 |
|
|
Warde 1015200 kappa light chain free
|
$68.40 |
$68.40 |
$114.40 |
|
|
Warde 3004000 immunoglobulin subclass 1
|
$63.20 |
$94.90 |
$176.40 |
|
|
Warde 3008005 oligoclonal bands
|
$125.45 |
$125.45 |
$163.20 |
|
|
Warde 3016000 west nile virus antibody
|
$36.00 |
$36.00 |
$82.80 |
|
|
Warde 3016000 west nile virus antibody igg
|
$48.80 |
$48.80 |
$82.80 |
|
|
Warde 3016300 saccharomyces cerevisiae iga antibody
|
$38.40 |
$38.40 |
$38.40 |
|
|
Warde 3400652 ova & parasites direct smear concentration and id
|
$28.80 |
$46.15 |
$89.60 |
|
|
Warde 3400652 smear complex special stain ova/parasites
|
$18.40 |
$33.60 |
$96.85 |
|
|
Warde 3400852 arsenic
|
$53.20 |
$70.40 |
$124.80 |
|
|
Warde 3708165 mercury urine
|
$40.40 |
$68.40 |
$109.85 |
|
|
Warde acetylcholine receptor blocking antibody
|
$70.40 |
$70.40 |
$191.10 |
|
|
Warde adenosine deaminase pleural fluid
|
$95.20 |
$95.20 |
$109.60 |
|
|
Warde adrenocorticotropic hormone (acth)
|
$76.00 |
$109.20 |
$336.05 |
|
|
Warde aldolase
|
$27.20 |
$27.20 |
$113.60 |
|
|
Warde amino acids 6 or more quantitative each specimen
|
$394.00 |
$394.00 |
$418.80 |
|
|
Warde amiodarone therapeutic drug level
|
$124.40 |
$124.40 |
$165.10 |
|
|
Warde analysis gene hfe common variants
|
$181.60 |
$181.60 |
$637.65 |
|
|
Warde analysis translocation bcr/abl1 major breakpoint qualitative/quantitative
|
$108.40 |
$256.00 |
$432.25 |
|
|
Warde anti-mullerian hormone
|
$150.15 |
$150.15 |
$150.15 |
|
|
Warde apolipoprotein b
|
$51.20 |
$51.20 |
$186.55 |
|
