|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$702.00 |
$702.00 |
$702.00 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$883.80 |
$883.80 |
$883.80 |
$497.12
|
|
Ultrasound retroperitoneal limited
|
$440.40 |
$440.40 |
$440.40 |
$486.50
|
|
Ultrasound scrotum and contents
|
$883.80 |
$883.80 |
$883.80 |
$608.90
|
|
Ultrasound transabd ea addl gest
|
$883.80 |
$883.80 |
$883.80 |
$421.00
|
|
Ultrasound transvaginal non obstetric
|
$883.80 |
$883.80 |
$883.80 |
$558.35
|
|
Unlisted chemotherapy px
|
$60.00 |
$60.00 |
$60.00 |
$150.00
|
|
Unlisted fluoroscopic px
|
$331.20 |
$331.20 |
$331.20 |
$305.76
|
|
Unlisted spec derm svc/px
|
$227.40 |
$227.40 |
$227.40 |
$223.08
|
|
Unsched dialysis esrd pt hos
|
$1,500.00 |
$1,500.00 |
$1,500.00 |
$1,268.17
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$4,926.60 |
$4,926.60 |
$4,926.60 |
$2,998.00
|
|
Upper Back (Thoracic Spine) MRI (with contrast)
|
$3,242.40 |
$3,242.40 |
$3,242.40 |
$2,364.35
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$3,243.60 |
$3,243.60 |
$3,243.60 |
$2,034.41
|
|
Urea nitrogen
|
$73.20 |
$73.20 |
$73.20 |
$41.46
|
|
Urea nitrogen 24 hour urine
|
$86.40 |
$86.40 |
$86.40 |
$51.75
|
|
Uric acid blood
|
$66.00 |
$66.00 |
$66.00 |
$48.75
|
|
Urinalysis microscopic only
|
$57.60 |
$57.60 |
$57.60 |
$26.35
|
|
Urinalysis (with microscopy)
|
$60.00 |
$60.00 |
$60.00 |
$55.00
|
|
Urinalysis (without microscopy)
|
$36.00 |
$36.00 |
$36.00 |
$35.75
|
|
Urine Culture Test
|
$127.20 |
$127.20 |
$127.20 |
$81.50
|
|
Urine pregnancy test
|
$139.80 |
$139.80 |
$139.80 |
$67.20
|
|
Urography inf drip &/or bolus
|
$753.60 |
$753.60 |
$753.60 |
$642.50
|
|
Ustekinumab 130 mg/26 ml intravenous solution
|
$7,440.00 |
$7,440.00 |
$7,440.00 |
$5,184.34
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$589.50 |
$589.50 |
$589.50 |
$236.50
|
|
Vaccine hepatitis a (hepa) adult im
|
$97.80 |
$97.80 |
$97.80 |
$166.62
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$263.40 |
$263.40 |
$263.40 |
$155.16
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$478.80 |
$478.80 |
$478.80 |
$576.48
|
|
Vaccine influenza inactivated adjuvant im
|
$250.80 |
$250.80 |
$250.80 |
$109.50
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$54.90 |
$54.90 |
$54.90 |
$47.88
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$69.00 |
$69.00 |
$69.00 |
$33.60
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$451.80 |
$451.80 |
$451.80 |
$251.64
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$598.80 |
$598.80 |
$598.80 |
$397.11
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$991.20 |
$991.20 |
$991.20 |
$563.36
|
|
Vaccine rabies im
|
$1,326.00 |
$1,326.00 |
$1,326.00 |
$858.95
|
|
Vaccine tdap >=7 years im
|
$205.20 |
$205.20 |
$205.20 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$147.00 |
$147.00 |
$147.00 |
$112.10
|
|
Vaginal hysterectomy
|
$2,017.80 |
$2,017.80 |
$2,017.80 |
$5,766.00
|
|
Valproic acid total therapeutic drug level
|
$27.60 |
$27.60 |
$27.60 |
$114.72
|
|
Vancomycin 1,000 mg intravenous injection
|
$94.20 |
$94.20 |
$94.20 |
$251.86
|
|
Vancomycin 750 mg intravenous solution
|
$82.20 |
$82.20 |
$82.20 |
$90.33
|
|
Vancomycin peak therapeutic drug level
|
$188.40 |
$188.40 |
$188.40 |
$136.13
|
|
Varicella zoster antibody igg
|
$297.00 |
$297.00 |
$297.00 |
$86.80
|
|
Vasopressin 20 unit/ml intravenous solution
|
$325.80 |
$325.80 |
$325.80 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$20,329.80 |
$20,329.80 |
$20,329.80 |
$18,732.33
|
|
Vein byp fem-tibial peroneal 35585
|
$2,902.80 |
$2,902.80 |
$2,902.80 |
$2,931.20
|
|
Vein byp pop-tibl peroneal
|
$1,753.20 |
$1,753.20 |
$1,753.20 |
$6,646.40
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$1,759.20 |
$1,759.20 |
$1,759.20 |
$202.80
|
|
Venogram ext bil s&i
|
$3,990.00 |
$3,990.00 |
$3,990.00 |
$1,797.50
|
|
Venogram extremity supervision & interpretation unilateral
|
$1,575.60 |
$1,575.60 |
$1,575.60 |
$1,366.20
|
|
Venous mech thrombectomy
|
$7,528.80 |
$7,528.80 |
$7,528.80 |
$7,965.00
|
|
Venous m-thrombectomy add-on
|
$7,528.80 |
$7,528.80 |
$7,528.80 |
$5,094.75
|
|
Venous thrombosis imaging
|
$24.00 |
$24.00 |
$24.00 |
$697.20
|
|
Ventilator each subsequent day
|
$379.20 |
$379.20 |
$379.20 |
$1,204.00
|
|
Ventilator initial day
|
$739.80 |
$739.80 |
$739.80 |
$1,431.43
|
|
Vinblastine 1 mg/ml intravenous solution
|
$144.60 |
$144.60 |
$144.60 |
$165.00
|
|
Vincristine 1 mg/ml intravenous solution
|
$36.00 |
$36.00 |
$36.00 |
$87.15
|
|
Vital capacity test
|
$180.00 |
$180.00 |
$180.00 |
$170.00
|
|
Vitamin b-12
|
$219.00 |
$219.00 |
$219.00 |
$100.00
|
|
Vitamin D Test
|
$250.80 |
$250.80 |
$250.80 |
$132.00
|
|
Warde 1003990 aldosterone
|
$87.00 |
$87.00 |
$87.00 |
$144.73
|
|
Warde 1005055 5-hiaa 24 hour urine
|
$52.80 |
$52.80 |
$52.80 |
$63.50
|
|
Warde 1006955 catecholamines fractionated 24 hour urine
|
$106.20 |
$106.20 |
$106.20 |
$113.10
|
|
Warde 1007138 vanillymandelic acid 24 hour urine
|
$214.20 |
$214.20 |
$214.20 |
$70.85
|
|
Warde 1015200 kappa light chain free
|
$289.20 |
$289.20 |
$289.20 |
$65.20
|
|
Warde 3004000 immunoglobulin subclass 1
|
$36.00 |
$36.00 |
$36.00 |
$39.00
|
|
Warde 3008005 oligoclonal bands
|
$369.60 |
$369.60 |
$369.60 |
$107.97
|
|
Warde 3016000 west nile virus antibody
|
$93.00 |
$93.00 |
$93.00 |
$69.60
|
|
Warde 3016000 west nile virus antibody igg
|
$93.00 |
$93.00 |
$93.00 |
$69.12
|
|
Warde 3016300 saccharomyces cerevisiae iga antibody
|
$78.00 |
$78.00 |
$78.00 |
$60.50
|
|
Warde 3400652 ova & parasites direct smear concentration and id
|
$163.80 |
$163.80 |
$163.80 |
$62.50
|
|
Warde 3400652 smear complex special stain ova/parasites
|
$83.40 |
$83.40 |
$83.40 |
$72.50
|
|
Warde 3400852 arsenic
|
$255.00 |
$255.00 |
$255.00 |
$100.88
|
|
Warde 3708165 mercury urine
|
$170.40 |
$170.40 |
$170.40 |
$71.50
|
|
Warde actin (smooth muscle) antibody each
|
$15.00 |
$15.00 |
$15.00 |
$40.20
|
|
Warde adenosine deaminase pleural fluid
|
$387.60 |
$387.60 |
$387.60 |
$90.00
|
|
Warde adrenocorticotropic hormone (acth)
|
$592.20 |
$592.20 |
$592.20 |
$151.20
|
|
Warde aldolase
|
$127.20 |
$127.20 |
$127.20 |
$53.30
|
|
Warde amiodarone therapeutic drug level
|
$1,105.20 |
$1,105.20 |
$1,105.20 |
$53.95
|
|
Warde analysis gene hfe common variants
|
$432.00 |
$432.00 |
$432.00 |
$267.28
|
|
Warde antiepileptics nos definitive assay 1-3 clobazam w metabolites
|
$100.80 |
$100.80 |
$100.80 |
$126.43
|
|
Warde anti-mullerian hormone
|
$73.20 |
$73.20 |
$73.20 |
$80.08
|
|
Warde apolipoprotein b
|
$163.80 |
$163.80 |
$163.80 |
$61.75
|
|
Warde cadmium blood
|
$313.20 |
$313.20 |
$313.20 |
$76.50
|
|
Warde calcitonin
|
$356.40 |
$356.40 |
$356.40 |
$96.97
|
|
Warde clozapine therapeutic drug level
|
$57.00 |
$57.00 |
$57.00 |
$66.43
|
|
Warde cobalt heavy metal quantitative each nes
|
$388.20 |
$388.20 |
$388.20 |
$113.09
|
|
Warde complement total hemolytic
|
$424.80 |
$424.80 |
$424.80 |
$104.82
|
|
Warde copper
|
$30.00 |
$30.00 |
$30.00 |
$80.00
|
|
Warde cryoglobulin
|
$18.00 |
$18.00 |
$18.00 |
$50.35
|
|
Warde erythropoietin
|
$102.00 |
$102.00 |
$102.00 |
$90.36
|
|
Warde fluorescent antibody screen endomysial iga
|
$27.00 |
$27.00 |
$27.00 |
$43.20
|
|
Warde g6pd (glucose 6 phosphate dehydrogenase) quantitative
|
$163.20 |
$163.20 |
$163.20 |
$43.55
|
|
Warde gastrin
|
$293.40 |
$293.40 |
$293.40 |
$73.60
|
|
Warde growth hormone (hgh)
|
$66.00 |
$66.00 |
$66.00 |
$77.55
|
|
Warde helminth antibody strongyloides igg
|
$438.60 |
$438.60 |
$438.60 |
$100.92
|
|
Warde hepatitis a antibody
|
$147.00 |
$147.00 |
$147.00 |
$83.40
|
|
Warde hepatitis be antibody
|
$147.00 |
$147.00 |
$147.00 |
$52.20
|
|
Warde immunofixation electrophoresis urine
|
$223.20 |
$223.20 |
$223.20 |
$161.28
|
|
Warde infectious agent antigen immunoassay ql/sq multi step hepatitis be agn
|
$147.60 |
$147.60 |
$147.60 |
$57.50
|
|
Warde infectious agent nucleic acid genotype hepatitis c
|
$993.60 |
$993.60 |
$993.60 |
$636.09
|
