|
Unlisted cranfcl&maxlfcl px
|
$114.60 |
$114.60 |
$114.60 |
$571.20
|
|
Unlisted CT procedure
|
$758.40 |
$758.40 |
$758.40 |
$732.70
|
|
Unlisted cv px dx nuc med
|
$1,864.20 |
$1,864.20 |
$1,864.20 |
$1,747.20
|
|
Unlisted gi px dx nuc med
|
$780.60 |
$780.60 |
$780.60 |
$995.00
|
|
Unlisted muscskel px dx nuc
|
$545.40 |
$545.40 |
$545.40 |
$1,279.98
|
|
Unlisted procedure microbiology
|
$368.40 |
$368.40 |
$368.40 |
$530.00
|
|
Unlisted px hands/fingers
|
$5,383.80 |
$5,383.80 |
$5,383.80 |
$354.20
|
|
Unlstd hematop ret/endo lymp
|
$607.20 |
$607.20 |
$607.20 |
$473.22
|
|
Upper Arm (Humerus) X-ray (left side)
|
$567.00 |
$567.00 |
$567.00 |
$309.31
|
|
Upper Back (Thoracic Spine) CT Scan (with contrast)
|
$2,555.40 |
$2,555.40 |
$2,555.40 |
$1,669.00
|
|
Upper Back (Thoracic Spine) CT Scan (without contrast)
|
$2,074.20 |
$2,074.20 |
$2,074.20 |
$1,425.85
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,010.40 |
$4,010.40 |
$4,010.40 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,051.00 |
$3,051.00 |
$3,051.00 |
$2,369.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,514.00 |
$2,514.00 |
$2,514.00 |
$2,034.41
|
|
Upper Back (Thoracic Spine) X-ray (2 views)
|
$642.00 |
$642.00 |
$642.00 |
$321.95
|
|
Upper Back (Thoracic Spine) X-ray (3 views)
|
$551.40 |
$551.40 |
$551.40 |
$381.60
|
|
Upper Endoscopy (EGD, diagnostic)
|
$3,526.20 |
$3,526.20 |
$3,526.20 |
$1,824.75
|
|
Upper Endoscopy (EGD, with biopsy)
|
$3,526.20 |
$3,526.20 |
$3,526.20 |
$1,768.00
|
|
Upper GI Barium X-ray (barium and gas)
|
$580.20 |
$580.20 |
$580.20 |
$660.40
|
|
Upper GI Barium X-ray (barium only)
|
$580.20 |
$580.20 |
$580.20 |
$607.20
|
|
Urea nitrogen
|
$39.60 |
$39.60 |
$39.60 |
$42.25
|
|
Urea nitrogen 24 hour urine
|
$63.60 |
$63.60 |
$63.60 |
$52.00
|
|
Ureteral reflux study
|
$1,861.80 |
$1,861.80 |
$1,861.80 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$642.60 |
$642.60 |
$642.60 |
$584.00
|
|
Urethrocystography void s&i
|
$1,272.60 |
$1,272.60 |
$1,272.60 |
$631.40
|
|
Uric acid blood
|
$48.60 |
$48.60 |
$48.60 |
$49.44
|
|
Uric acid urine
|
$52.20 |
$52.20 |
$52.20 |
$45.36
|
|
Urinalysis qual/semiquant excpt ia
|
$51.00 |
$51.00 |
$51.00 |
$25.72
|
|
Urinalysis (with microscopy)
|
$70.20 |
$70.20 |
$70.20 |
$55.20
|
|
Urinalysis (without microscopy)
|
$37.80 |
$37.80 |
$37.80 |
$36.00
|
|
Urinary bldr retent nuc study
|
$1,489.80 |
$1,489.80 |
$1,489.80 |
$350.66
|
|
Urinary pouch on barr w/flng
|
$201.60 |
$201.60 |
$201.60 |
$9.89
|
|
Urine Culture Test
|
$218.40 |
$218.40 |
$218.40 |
$83.00
|
|
Urine pregnancy test
|
$112.80 |
$112.80 |
$112.80 |
$68.78
|
|
Urography, antegrade
|
$1,132.80 |
$1,132.80 |
$1,132.80 |
$622.35
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$7,410.00 |
$7,410.00 |
$7,410.00 |
$5,205.00
|
|
Vaccine Administration (one shot)
|
$12.60 |
$12.60 |
$12.60 |
$67.70
|
|
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml
|
$340.00 |
$340.00 |
$340.00 |
$224.25
|
|
Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml
|
$209.40 |
$209.40 |
$209.40 |
$209.40
|
|
Vaccine hepatitis a (hepa) adult im
|
$108.00 |
$108.00 |
$108.00 |
$166.62
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$653.40 |
$653.40 |
$653.40 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$168.80 |
$168.80 |
$168.80 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$63.20 |
$63.20 |
$63.20 |
$75.39
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$12.60 |
$12.60 |
$12.60 |
$28.77
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$12.00 |
$12.00 |
$12.00 |
$33.60
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$54.00 |
$54.00 |
$54.00 |
$72.00
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$24.00 |
$24.00 |
$24.00 |
$82.71
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$109.60 |
$109.60 |
$109.60 |
$394.26
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$108.80 |
$108.80 |
$108.80 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$64.80 |
$64.80 |
$64.80 |
$213.00
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$75.00 |
$75.00 |
$75.00 |
$252.87
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$144.00 |
$144.00 |
$144.00 |
$397.11
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$192.00 |
$192.00 |
$192.00 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$38.40 |
$38.40 |
$38.40 |
$90.70
|
|
Vaccine rabies im
|
$800.00 |
$800.00 |
$800.00 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$672.00 |
$672.00 |
$672.00 |
$538.84
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$1,184.80 |
$1,184.80 |
$1,184.80 |
$1,105.21
|
|
Vaccine tdap >=7 years im
|
$42.40 |
$42.40 |
$42.40 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$74.40 |
$74.40 |
$74.40 |
$112.10
|
|
Vaccine typhoid vicps im
|
$39.00 |
$39.00 |
$39.00 |
$264.78
|
|
Vaccine varicella live subcutaneous
|
$748.80 |
$748.80 |
$748.80 |
$365.17
|
|
Vacuum drain bottle/tube kit
|
$122.40 |
$122.40 |
$122.40 |
$325.20
|
|
Vaginal bx
|
$120.00 |
$120.00 |
$120.00 |
$455.94
|
|
Valproic acid total therapeutic drug level
|
$181.20 |
$181.20 |
$181.20 |
$115.00
|
|
Vancomycin 1,000 mg intravenous injection
|
$0.60 |
$0.60 |
$0.60 |
$259.05
|
|
Vancomycin hcl injection
|
$74.40 |
$74.40 |
$74.40 |
$149.49
|
|
Vancomycin peak therapeutic drug level
|
$213.00 |
$213.00 |
$213.00 |
$136.13
|
|
Varicella zoster antibody igg
|
$146.40 |
$146.40 |
$146.40 |
$86.80
|
|
Vasopressin 20 unit/ml intravenous solution
|
$42.00 |
$42.00 |
$42.00 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$27,154.80 |
$27,154.80 |
$27,154.80 |
$18,732.33
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$511.20 |
$511.20 |
$511.20 |
$188.83
|
|
Venogram ext bil s&i
|
$3,953.40 |
$3,953.40 |
$3,953.40 |
$1,829.42
|
|
Venogram extremity supervision & interpretation unilateral
|
$3,302.40 |
$3,302.40 |
$3,302.40 |
$1,382.58
|
|
Venous thrombosis imaging
|
$1,172.40 |
$1,172.40 |
$1,172.40 |
$697.20
|
|
Ven thrombosis images bilat
|
$1,989.60 |
$1,989.60 |
$1,989.60 |
$796.50
|
|
Ventilator each subsequent day
|
$1,718.40 |
$1,718.40 |
$1,718.40 |
$1,184.00
|
|
Ventilator Management (first day)
|
$1,735.20 |
$1,735.20 |
$1,735.20 |
$1,434.60
|
|
Video Swallow Study (Modified Barium Swallow)
|
$828.00 |
$828.00 |
$828.00 |
$524.50
|
|
Vinblastine 1 mg/ml intravenous solution
|
$199.20 |
$199.20 |
$199.20 |
$165.00
|
|
Vincristine 1 mg/ml intravenous solution
|
$48.60 |
$48.60 |
$48.60 |
$87.15
|
|
Vinorelbine 10 mg/ml intravenous solution (wrapper)
|
$417.00 |
$417.00 |
$417.00 |
$223.55
|
|
Vitamin b-12
|
$133.80 |
$133.80 |
$133.80 |
$100.28
|
|
Vitamin D Test
|
$226.80 |
$226.80 |
$226.80 |
$132.00
|
|
Voriconazole in ns IV syringe 5 mg/ml (pediatric) - cnr
|
$690.60 |
$690.60 |
$690.60 |
$165.81
|
|
Walking (Gait) Training (each 15 minutes)
|
$130.20 |
$130.20 |
$130.20 |
$87.50
|
|
Warde 1003990 aldosterone
|
$569.40 |
$569.40 |
$569.40 |
$144.73
|
|
Warde 1005020 citrate 24 hour urine
|
$243.00 |
$243.00 |
$243.00 |
$100.10
|
|
Warde 1005055 5-hiaa 24 hour urine
|
$373.20 |
$373.20 |
$373.20 |
$64.08
|
|
Warde 1006955 catecholamines fractionated 24 hour urine
|
$417.60 |
$417.60 |
$417.60 |
$113.10
|
|
Warde 1007138 vanillymandelic acid 24 hour urine
|
$209.40 |
$209.40 |
$209.40 |
$70.85
|
|
Warde 1015200 kappa light chain free
|
$130.80 |
$130.80 |
$130.80 |
$65.20
|
|
Warde 3004000 immunoglobulin subclass 1
|
$45.60 |
$45.60 |
$45.60 |
$39.36
|
|
Warde 3008005 oligoclonal bands
|
$237.60 |
$237.60 |
$237.60 |
$108.50
|
|
Warde 3016000 west nile virus antibody
|
$91.80 |
$91.80 |
$91.80 |
$71.60
|
|
Warde 3016000 west nile virus antibody igg
|
$91.80 |
$91.80 |
$91.80 |
$70.74
|
|
Warde 3016300 saccharomyces cerevisiae iga antibody
|
$100.80 |
$100.80 |
$100.80 |
$60.50
|
|
Warde 3400652 ova & parasites direct smear concentration and id
|
$41.40 |
$41.40 |
$41.40 |
$62.50
|
|
Warde 3400652 smear complex special stain ova/parasites
|
$88.80 |
$88.80 |
$88.80 |
$73.60
|
|
Warde 3400683 amplification rna markers infectious disease bacterial vaginosis
|
$538.20 |
$538.20 |
$538.20 |
$219.13
|
|
Warde 3400852 arsenic
|
$334.80 |
$334.80 |
$334.80 |
$101.00
|
