|
Ultrasound ob >=14wks ea addl gest
|
$216.03 |
$216.03 |
$216.03 |
$454.11
|
|
Ultrasound pregnant uterus < 14 weeks each additional gestation
|
$73.53 |
$73.53 |
$73.53 |
$326.54
|
|
Ultrasound pregnant uterus limited >= 1 fetuses
|
$343.71 |
$343.71 |
$343.71 |
$459.00
|
|
Ultrasound pregnant uterus transvaginal
|
$285.57 |
$285.57 |
$285.57 |
$485.48
|
|
Ultrasound retroperitoneal limited
|
$540.93 |
$540.93 |
$540.93 |
$498.00
|
|
Ultrasound scrotum and contents
|
$558.03 |
$558.03 |
$558.03 |
$617.28
|
|
Ultrasound transvaginal non obstetric
|
$522.69 |
$522.69 |
$522.69 |
$567.44
|
|
Ultraviolet therapy
|
$54.15 |
$54.15 |
$54.15 |
$42.60
|
|
Unlisted mr procedure
|
$1,457.49 |
$1,457.49 |
$1,457.49 |
$1,032.20
|
|
Upper Back (Thoracic Spine) MRI (with and without contrast)
|
$2,474.94 |
$2,474.94 |
$2,474.94 |
$2,916.00
|
|
Upper Back (Thoracic Spine) MRI (without contrast)
|
$1,866.75 |
$1,866.75 |
$1,866.75 |
$2,013.08
|
|
Upper Endoscopy (EGD, diagnostic)
|
$234.27 |
$234.27 |
$234.27 |
$1,588.59
|
|
Upper Endoscopy (EGD, with biopsy)
|
$241.68 |
$241.68 |
$241.68 |
$1,656.60
|
|
Uppr gi scope w/submuc inj
|
$242.25 |
$242.25 |
$242.25 |
$1,773.85
|
|
Urea nitrogen
|
$15.96 |
$15.96 |
$15.96 |
$45.10
|
|
Urea nitrogen 24 hour urine
|
$18.24 |
$18.24 |
$18.24 |
$50.00
|
|
Uric acid blood
|
$25.08 |
$25.08 |
$25.08 |
$46.64
|
|
Uric acid urine
|
$22.80 |
$22.80 |
$22.80 |
$46.75
|
|
Urinalysis microscopic only
|
$5.70 |
$5.70 |
$5.70 |
$26.35
|
|
Urinalysis (with microscopy)
|
$26.79 |
$26.79 |
$26.79 |
$48.14
|
|
Urinalysis (without microscopy)
|
$19.95 |
$19.95 |
$19.95 |
$38.99
|
|
Urine Culture Test
|
$63.84 |
$63.84 |
$63.84 |
$84.81
|
|
Urine pregnancy test
|
$24.51 |
$24.51 |
$24.51 |
$66.40
|
|
Vaccine dtap < 7 years im
|
$28.50 |
$28.50 |
$28.50 |
$87.80
|
|
Vaccine dtap-hep b-ipv im
|
$170.19 |
$170.19 |
$170.19 |
$193.83
|
|
Vaccine dtap-ipv 4-6 years im
|
$57.57 |
$57.57 |
$57.57 |
$126.84
|
|
Vaccine dtap-ipv/hib im
|
$125.97 |
$125.97 |
$125.97 |
$248.80
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$70.51 |
$70.51 |
$70.51 |
$85.00
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$41.04 |
$41.04 |
$41.04 |
$45.33
|
|
Vaccine hepatitis a (hepa) adult im
|
$166.44 |
$166.44 |
$166.44 |
$178.07
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$119.70 |
$119.70 |
$119.70 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$34.20 |
$34.20 |
$34.20 |
$84.38
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$59.28 |
$59.28 |
$59.28 |
$173.98
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$196.65 |
$196.65 |
$196.65 |
$306.24
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$30.78 |
$30.78 |
$30.78 |
$79.04
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$312.93 |
$312.93 |
$312.93 |
$686.67
|
|
Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im
|
$220.02 |
$220.02 |
$220.02 |
$226.20
|
|
Vaccine influenza (iiv) preservative free antigen content im
|
$111.67 |
$111.67 |
$111.67 |
$157.41
|
|
Vaccine influenza inactivated adjuvant im
|
$88.35 |
$88.35 |
$88.35 |
$110.25
|
|
Vaccine influenza nos 0.5ml dose im
|
$22.23 |
$22.23 |
$22.23 |
$36.80
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$23.37 |
$23.37 |
$23.37 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) 0.5ml dose im
|
$19.95 |
$19.95 |
$19.95 |
$42.90
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$27.36 |
$27.36 |
$27.36 |
$26.40
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$23.94 |
$23.94 |
$23.94 |
$40.01
|
|
Vaccine influenza quadrivalent (iiv4) split virus 0.25 ml im
|
$17.10 |
$17.10 |
$17.10 |
$20.80
|
|
Vaccine influenza quadrivalent live (laiv4) intranasal
|
$41.61 |
$41.61 |
$41.61 |
$37.05
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$54.15 |
$54.15 |
$54.15 |
$72.00
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$39.33 |
$39.33 |
$39.33 |
$103.88
|
|
Vaccine influenza trivalent (iiv3) 0.25ml dose im
|
$11.40 |
$11.40 |
$11.40 |
$32.50
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$196.65 |
$196.65 |
$196.65 |
$499.00
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$133.38 |
$133.38 |
$133.38 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$108.87 |
$108.87 |
$108.87 |
$224.04
|
|
Vaccine mmrv live subcutaneous
|
$331.74 |
$331.74 |
$331.74 |
$474.24
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$137.94 |
$137.94 |
$137.94 |
$274.95
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$258.21 |
$258.21 |
$258.21 |
$397.18
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$370.50 |
$370.50 |
$370.50 |
$715.41
|
|
Vaccine polio (ipv) subcutaneous/im
|
$45.60 |
$45.60 |
$45.60 |
$119.17
|
|
Vaccine rabies im
|
$799.08 |
$799.08 |
$799.08 |
$945.46
|
|
Vaccine rotavirus attenuated (rv1) live 2 dose oral
|
$170.43 |
$170.43 |
$170.43 |
$200.70
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$117.42 |
$117.42 |
$117.42 |
$108.00
|
|
Vaccine tdap >=7 years im
|
$106.75 |
$106.75 |
$106.75 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$91.34 |
$91.34 |
$91.34 |
$131.77
|
|
Vaccine typhoid vicps im
|
$137.94 |
$137.94 |
$137.94 |
$205.22
|
|
Vaccine varicella live subcutaneous
|
$200.64 |
$200.64 |
$200.64 |
$447.80
|
|
Vaccine yellow fever live subcutaneous
|
$478.80 |
$478.80 |
$478.80 |
$421.20
|
|
Valproic acid total therapeutic drug level
|
$76.95 |
$76.95 |
$76.95 |
$115.00
|
|
Valrubicin injection
|
$1,908.36 |
$1,908.36 |
$1,908.36 |
$2,813.49
|
|
Vancomycin hcl injection
|
$25.58 |
$25.58 |
$25.58 |
$186.80
|
|
Vancomycin peak therapeutic drug level
|
$83.22 |
$83.22 |
$83.22 |
$126.79
|
|
Varicella zoster antibody igg
|
$33.63 |
$33.63 |
$33.63 |
$82.55
|
|
Vasopressin 20 unit/ml intravenous solution
|
$160.65 |
$160.65 |
$160.65 |
$362.93
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$59.28 |
$59.28 |
$59.28 |
$188.65
|
|
Ventilator each subsequent day
|
$868.68 |
$868.68 |
$868.68 |
$1,305.92
|
|
Ventilator initial day
|
$868.68 |
$868.68 |
$868.68 |
$1,540.80
|
|
Visual audiometry (vra)
|
$41.61 |
$41.61 |
$41.61 |
$202.50
|
|
Vital capacity test
|
$232.56 |
$232.56 |
$232.56 |
$173.33
|
|
Vitamin b-12
|
$61.56 |
$61.56 |
$61.56 |
$94.90
|
|
Vitamin D Test
|
$127.11 |
$127.11 |
$127.11 |
$132.00
|
|
Voiding pressure study/intra-abd 51797
|
$438.90 |
$438.90 |
$438.90 |
$463.40
|
|
Volume measurement urine timed
|
$11.97 |
$11.97 |
$11.97 |
$21.45
|
|
Vulvectomy simple partial
|
$1,586.31 |
$1,586.31 |
$1,586.31 |
$3,762.53
|
|
Warde 1003990 aldosterone
|
$143.07 |
$143.07 |
$143.07 |
$145.60
|
|
Warde 1005020 citrate 24 hour urine
|
$127.11 |
$127.11 |
$127.11 |
$97.61
|
|
Warde 1005055 5-hiaa 24 hour urine
|
$46.74 |
$46.74 |
$46.74 |
$72.50
|
|
Warde 1006955 catecholamines fractionated 24 hour urine
|
$90.06 |
$90.06 |
$90.06 |
$113.10
|
|
Warde 1007138 vanillymandelic acid 24 hour urine
|
$55.86 |
$55.86 |
$55.86 |
$69.55
|
|
Warde 1015200 kappa light chain free
|
$102.60 |
$102.60 |
$102.60 |
$64.28
|
|
Warde 3004000 immunoglobulin subclass 1
|
$57.00 |
$57.00 |
$57.00 |
$40.70
|
|
Warde 3016000 west nile virus antibody
|
$37.62 |
$37.62 |
$37.62 |
$68.80
|
|
Warde 3016000 west nile virus antibody igg
|
$45.03 |
$45.03 |
$45.03 |
$69.00
|
|
Warde 3016300 saccharomyces cerevisiae iga antibody
|
$19.38 |
$19.38 |
$19.38 |
$55.25
|
|
Warde 3400652 ova & parasites direct smear concentration and id
|
$33.06 |
$33.06 |
$33.06 |
$63.05
|
|
Warde 3400652 smear complex special stain ova/parasites
|
$63.84 |
$63.84 |
$63.84 |
$78.57
|
|
Warde 3400852 arsenic
|
$57.00 |
$57.00 |
$57.00 |
$105.12
|
|
Warde 3708165 mercury urine
|
$48.45 |
$48.45 |
$48.45 |
$72.80
|
|
Warde actin (smooth muscle) antibody each
|
$43.32 |
$43.32 |
$43.32 |
$45.58
|
|
Warde adenosine deaminase pleural fluid
|
$27.36 |
$27.36 |
$27.36 |
$91.76
|
|
Warde adrenocorticotropic hormone (acth)
|
$135.66 |
$135.66 |
$135.66 |
$129.75
|
|
Warde aldolase
|
$35.34 |
$35.34 |
$35.34 |
$49.20
|
|
Warde amino acids 6 or more quantitative each specimen
|
$79.80 |
$79.80 |
$79.80 |
$176.20
|
