|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$531.50 |
$531.50 |
$531.50 |
$331.50
|
|
Ultrasound pregnant uterus detailed fetal exam single/1st gestation
|
$1,023.00 |
$1,023.00 |
$1,023.00 |
$707.20
|
|
Ultrasound pregnant uterus follow up per fetus
|
$363.00 |
$363.00 |
$363.00 |
$425.60
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$478.50 |
$478.50 |
$478.50 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$414.50 |
$414.50 |
$414.50 |
$497.12
|
|
Ultrasound prostate/transrectal
|
$661.50 |
$661.50 |
$661.50 |
$557.40
|
|
Ultrasound retroperitoneal limited
|
$549.50 |
$549.50 |
$549.50 |
$486.50
|
|
Ultrasound scrotum and contents
|
$573.50 |
$573.50 |
$573.50 |
$608.90
|
|
Ultrasound spinal canal and contents
|
$463.00 |
$463.00 |
$463.00 |
$463.00
|
|
Ultrasound transabd ea addl gest
|
$612.00 |
$612.00 |
$612.00 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$661.50 |
$661.50 |
$661.50 |
$558.35
|
|
Unlisted misc path test
|
$69.00 |
$69.00 |
$69.00 |
$89.40
|
|
Unlisted procedure microbiology
|
$1,485.00 |
$1,485.00 |
$1,485.00 |
$523.50
|
|
Unlisted surgical path px
|
$360.00 |
$360.00 |
$360.00 |
$217.75
|
|
Unsched dialysis esrd pt hos
|
$3,632.50 |
$3,632.50 |
$3,632.50 |
$1,268.17
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,998.00 |
$2,998.00 |
$2,998.00 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$2,652.50 |
$2,652.50 |
$2,652.50 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$2,307.00 |
$2,307.00 |
$2,307.00 |
$2,034.41
|
|
Urea nitrogen
|
$117.00 |
$117.00 |
$117.00 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$101.00 |
$101.00 |
$101.00 |
$51.75
|
|
Ureteral reflux study
|
$475.50 |
$475.50 |
$475.50 |
$952.50
|
|
Urethrcystgrphy rtrgrde s&i
|
$442.50 |
$442.50 |
$442.50 |
$579.73
|
|
Urethrocystography void s&i
|
$547.50 |
$547.50 |
$547.50 |
$622.35
|
|
Uric acid blood
|
$108.00 |
$108.00 |
$108.00 |
$48.75
|
|
Uric acid urine
|
$61.00 |
$61.00 |
$61.00 |
$44.33
|
|
Urinalysis microscopic only
|
$70.00 |
$70.00 |
$70.00 |
$26.35
|
|
Urinalysis (with microscopy)
|
$117.00 |
$117.00 |
$117.00 |
$55.00
|
|
Urinalysis (without microscopy)
|
$47.00 |
$47.00 |
$47.00 |
$35.75
|
|
Urine Culture Test
|
$201.00 |
$201.00 |
$201.00 |
$81.50
|
|
Urine pregnancy test
|
$55.50 |
$55.50 |
$55.50 |
$67.20
|
|
Urography, antegrade
|
$505.00 |
$505.00 |
$505.00 |
$622.35
|
|
Vaccine dtap < 7 years im
|
$55.75 |
$55.75 |
$55.75 |
$68.19
|
|
Vaccine dtap-hep b-ipv im
|
$175.25 |
$175.25 |
$175.25 |
$164.63
|
|
Vaccine dtap-ipv/hib im
|
$206.12 |
$206.12 |
$206.12 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$62.75 |
$62.75 |
$62.75 |
$70.26
|
|
Vaccine hepatitis a (hepa) adult im
|
$165.25 |
$165.25 |
$165.25 |
$166.62
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$78.25 |
$78.25 |
$78.25 |
$79.15
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$138.37 |
$138.37 |
$138.37 |
$155.16
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$61.75 |
$61.75 |
$61.75 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$570.87 |
$570.87 |
$570.87 |
$576.48
|
|
Vaccine influenza inactivated adjuvant im
|
$159.00 |
$159.00 |
$159.00 |
$109.50
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$45.62 |
$45.62 |
$45.62 |
$47.88
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$87.50 |
$87.50 |
$87.50 |
$76.50
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$291.37 |
$291.37 |
$291.37 |
$329.24
|
|
Vaccine mmr live subcutaneous
|
$178.12 |
$178.12 |
$178.12 |
$211.68
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$217.87 |
$217.87 |
$217.87 |
$251.64
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$572.75 |
$572.75 |
$572.75 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$87.50 |
$87.50 |
$87.50 |
$90.70
|
|
Vaccine rabies im
|
$775.00 |
$775.00 |
$775.00 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$184.08 |
$184.08 |
$184.08 |
$538.84
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$182.50 |
$182.50 |
$182.50 |
$126.14
|
|
Vaccine tdap >=7 years im
|
$89.12 |
$89.12 |
$89.12 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$58.87 |
$58.87 |
$58.87 |
$112.10
|
|
Vaccine varicella live subcutaneous
|
$356.00 |
$356.00 |
$356.00 |
$365.17
|
|
Valproic acid total therapeutic drug level
|
$146.00 |
$146.00 |
$146.00 |
$114.72
|
|
Valvuloplasty aortic
|
$9,161.00 |
$9,161.00 |
$9,161.00 |
$7,830.80
|
|
Vancomycin 1,000 mg intravenous injection
|
$395.25 |
$395.25 |
$395.25 |
$251.86
|
|
Vancomycin 750 mg intravenous solution
|
$87.50 |
$87.50 |
$87.50 |
$90.33
|
|
Vancomycin peak therapeutic drug level
|
$176.00 |
$176.00 |
$176.00 |
$136.13
|
|
Varicella zoster antibody igg
|
$68.00 |
$68.00 |
$68.00 |
$86.80
|
|
Veeg cont 2-12 hrs
|
$553.50 |
$553.50 |
$553.50 |
$1,540.00
|
|
Veeg ea 12-26hr cont mntr
|
$963.00 |
$963.00 |
$963.00 |
$3,225.60
|
|
Veeg intrmnt 2-12 hrs
|
$300.50 |
$300.50 |
$300.50 |
$961.00
|
|
Veeg unmon 12-26 hrs
|
$553.50 |
$553.50 |
$553.50 |
$1,671.09
|
|
Veeg unmon 2-12 hrs
|
$300.50 |
$300.50 |
$300.50 |
$826.15
|
|
Vein x-ray adrenal gland
|
$1,749.50 |
$1,749.50 |
$1,749.50 |
$2,845.80
|
|
Vein x-ray eye socket
|
$629.50 |
$629.50 |
$629.50 |
$1,438.32
|
|
Vein x-ray kidney
|
$2,583.50 |
$2,583.50 |
$2,583.50 |
$2,766.73
|
|
Vein x-ray liver
|
$3,083.00 |
$3,083.00 |
$3,083.00 |
$3,305.50
|
|
Vein x-ray liver w/hemodynam
|
$1,895.00 |
$1,895.00 |
$1,895.00 |
$3,486.86
|
|
Vein x-ray liver w/hemodynam
|
$3,468.50 |
$3,468.50 |
$3,468.50 |
$3,483.84
|
|
Vein x-ray liver without hemodyn
|
$1,895.00 |
$1,895.00 |
$1,895.00 |
$2,452.80
|
|
Vein x-ray skull
|
$1,749.50 |
$1,749.50 |
$1,749.50 |
$2,141.00
|
|
Vein x-ray skull epidural
|
$1,746.50 |
$1,746.50 |
$1,746.50 |
$1,746.50
|
|
Vein x-ray spleen/liver
|
$1,749.50 |
$1,749.50 |
$1,749.50 |
$3,427.50
|
|
Venogram ext bil s&i
|
$1,441.50 |
$1,441.50 |
$1,441.50 |
$1,797.50
|
|
Venogram extremity supervision & interpretation unilateral
|
$1,163.00 |
$1,163.00 |
$1,163.00 |
$1,366.20
|
|
Venous sampling s&i
|
$3,738.50 |
$3,738.50 |
$3,738.50 |
$4,193.20
|
|
Ventilator each subsequent day
|
$1,581.50 |
$1,581.50 |
$1,581.50 |
$1,204.00
|
|
Ventilator initial day
|
$1,885.00 |
$1,885.00 |
$1,885.00 |
$1,431.43
|
|
Very long chain fatty acids
|
$97.00 |
$97.00 |
$97.00 |
$139.88
|
|
Virus isolation addl studies ea
|
$77.50 |
$77.50 |
$77.50 |
$77.50
|
|
Vital capacity test
|
$176.00 |
$176.00 |
$176.00 |
$170.00
|
|
Vitamin b-12
|
$179.00 |
$179.00 |
$179.00 |
$100.00
|
|
Vitamin D Test
|
$146.00 |
$146.00 |
$146.00 |
$132.00
|
|
Vkorc1 gene
|
$60.00 |
$60.00 |
$60.00 |
$176.80
|
|
Voiding pressure study/intra-abd 51797
|
$587.00 |
$587.00 |
$587.00 |
$433.20
|
|
Vol reduction of blood/prod
|
$47.50 |
$47.50 |
$47.50 |
$172.78
|
|
Volume measurement urine timed
|
$19.00 |
$19.00 |
$19.00 |
$21.45
|
|
Warde 1003990 aldosterone
|
$103.00 |
$103.00 |
$103.00 |
$144.73
|
|
Warde 1005020 citrate 24 hour urine
|
$20.50 |
$20.50 |
$20.50 |
$97.50
|
|
Warde 1005055 5-hiaa 24 hour urine
|
$12.50 |
$12.50 |
$12.50 |
$63.50
|
|
Warde 1006955 catecholamines fractionated 24 hour urine
|
$24.00 |
$24.00 |
$24.00 |
$113.10
|
|
Warde 1007138 vanillymandelic acid 24 hour urine
|
$10.50 |
$10.50 |
$10.50 |
$70.85
|
|
Warde 1015200 kappa light chain free
|
$16.00 |
$16.00 |
$16.00 |
$65.20
|
|
Warde 3004000 immunoglobulin subclass 1
|
$7.50 |
$7.50 |
$7.50 |
$39.00
|
|
Warde 3008005 oligoclonal bands
|
$44.00 |
$44.00 |
$44.00 |
$107.97
|
|
Warde 3016000 west nile virus antibody
|
$12.50 |
$12.50 |
$12.50 |
$69.60
|
|
Warde 3016000 west nile virus antibody igg
|
$12.50 |
$12.50 |
$12.50 |
$69.12
|
|
Warde 3016300 saccharomyces cerevisiae iga antibody
|
$38.50 |
$38.50 |
$38.50 |
$60.50
|
