|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$266.68 |
$266.68 |
$266.68 |
$236.50
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$105.60 |
$105.60 |
$105.60 |
$123.20
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$78.40 |
$78.40 |
$78.40 |
$80.15
|
|
Vaccine dtap < 7 years im
|
$39.76 |
$39.76 |
$39.76 |
$71.17
|
|
Vaccine dtap-ipv 4-6 years im
|
$90.70 |
$90.70 |
$90.70 |
$105.95
|
|
Vaccine dtap-ipv-hib-hepb im
|
$173.35 |
$173.35 |
$173.35 |
$174.72
|
|
Vaccine dtap-ipv/hib im
|
$123.43 |
$123.43 |
$123.43 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$56.28 |
$56.28 |
$56.28 |
$70.53
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$31.15 |
$31.15 |
$31.15 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$101.10 |
$101.10 |
$101.10 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$173.97 |
$173.97 |
$173.97 |
$231.56
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$59.24 |
$59.24 |
$59.24 |
$78.25
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$97.64 |
$97.64 |
$97.64 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$275.42 |
$275.42 |
$275.42 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$35.20 |
$35.20 |
$35.20 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$386.21 |
$386.21 |
$386.21 |
$576.48
|
|
Vaccine influenza inactivated adjuvant im
|
$45.84 |
$45.84 |
$45.84 |
$110.25
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$23.31 |
$23.31 |
$23.31 |
$82.71
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$287.21 |
$287.21 |
$287.21 |
$394.26
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$271.32 |
$271.32 |
$271.32 |
$409.35
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$260.33 |
$260.33 |
$260.33 |
$310.93
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$181.64 |
$181.64 |
$181.64 |
$327.37
|
|
Vaccine mmr live subcutaneous
|
$100.84 |
$100.84 |
$100.84 |
$213.00
|
|
Vaccine mmrv live subcutaneous
|
$384.39 |
$384.39 |
$384.39 |
$424.32
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$174.22 |
$174.22 |
$174.22 |
$252.87
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$366.13 |
$366.13 |
$366.13 |
$393.25
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$350.76 |
$350.76 |
$350.76 |
$414.46
|
|
Vaccine polio (ipv) subcutaneous/im
|
$38.76 |
$38.76 |
$38.76 |
$90.70
|
|
Vaccine rabies im
|
$700.61 |
$700.61 |
$700.61 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$403.55 |
$403.55 |
$403.55 |
$538.84
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$579.20 |
$579.20 |
$579.20 |
$1,105.21
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$579.20 |
$579.20 |
$579.20 |
$997.44
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$104.63 |
$104.63 |
$104.63 |
$126.14
|
|
Vaccine tdap >=7 years im
|
$68.67 |
$68.67 |
$68.67 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$39.97 |
$39.97 |
$39.97 |
$112.10
|
|
Vaccine typhoid vicps im
|
$135.72 |
$135.72 |
$135.72 |
$264.78
|
|
Vaccine varicella live subcutaneous
|
$167.58 |
$167.58 |
$167.58 |
$365.17
|
|
Vaginal bx
|
$3,948.80 |
$3,948.80 |
$3,948.80 |
$459.42
|
|
Valrubicin injection
|
$6,277.95 |
$6,277.95 |
$6,277.95 |
$2,813.49
|
|
Valvuloplasty aortic
|
$10,592.80 |
$10,592.80 |
$10,592.80 |
$7,944.16
|
|
Valvuloplasty mitral
|
$19,281.60 |
$19,281.60 |
$19,281.60 |
$10,845.00
|
|
Valvuloplasty pulmonary
|
$18,084.80 |
$18,084.80 |
$18,084.80 |
$11,945.20
|
|
Vancomycin 1,000 mg intravenous injection
|
$320.88 |
$320.88 |
$320.88 |
$251.86
|
|
Vancomycin 750 mg intravenous solution
|
$58.02 |
$58.02 |
$58.02 |
$90.33
|
|
Varicella-zoster immue globin im
|
$3,128.01 |
$3,128.01 |
$3,128.01 |
$3,816.19
|
|
Vasopressin 20 unit/ml intravenous solution
|
$342.98 |
$342.98 |
$342.98 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$8,276.51 |
$8,276.51 |
$8,276.51 |
$18,732.33
|
|
Veeg ea 12-26hr cont mntr
|
$4,029.60 |
$4,029.60 |
$4,029.60 |
$3,225.60
|
|
Veeg unmon 12-26 hrs
|
$3,384.00 |
$3,384.00 |
$3,384.00 |
$1,737.12
|
|
Veeg unmon 2-12 hrs
|
$3,028.00 |
$3,028.00 |
$3,028.00 |
$826.15
|
|
Vein x-ray adrenal gland
|
$4,324.80 |
$4,324.80 |
$4,324.80 |
$2,833.34
|
|
Vein x-ray kidney
|
$4,469.60 |
$4,469.60 |
$4,469.60 |
$2,870.00
|
|
Vein x-ray liver
|
$3,320.80 |
$3,320.80 |
$3,320.80 |
$3,312.00
|
|
Vein x-ray liver w/hemodynam
|
$3,320.80 |
$3,320.80 |
$3,320.80 |
$3,619.84
|
|
Vein x-ray liver w/hemodynam
|
$759.20 |
$759.20 |
$759.20 |
$3,683.90
|
|
Vein x-ray liver without hemodyn
|
$1,030.40 |
$1,030.40 |
$1,030.40 |
$2,452.80
|
|
Vein x-ray skull
|
$506.40 |
$506.40 |
$506.40 |
$2,236.50
|
|
Vein x-ray spleen/liver
|
$2,490.40 |
$2,490.40 |
$2,490.40 |
$3,434.00
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$64.80 |
$64.80 |
$64.80 |
$197.04
|
|
Venipuncture <3 yrs other vein
|
$128.00 |
$128.00 |
$128.00 |
$62.40
|
|
Venogram ext bil s&i
|
$2,173.60 |
$2,173.60 |
$2,173.60 |
$1,838.28
|
|
Venogram extremity supervision & interpretation unilateral
|
$1,798.40 |
$1,798.40 |
$1,798.40 |
$1,382.58
|
|
Venous mech thrombectomy
|
$9,405.60 |
$9,405.60 |
$9,405.60 |
$8,184.00
|
|
Venous m-thrombectomy add-on
|
$4,940.80 |
$4,940.80 |
$4,940.80 |
$5,110.00
|
|
Venous sampling s&i
|
$4,756.00 |
$4,756.00 |
$4,756.00 |
$4,200.00
|
|
Ventilator each subsequent day
|
$1,164.00 |
$1,164.00 |
$1,164.00 |
$1,178.74
|
|
Ventilator Management (first day)
|
$1,366.40 |
$1,366.40 |
$1,366.40 |
$1,434.60
|
|
Version cephalic external
|
$3,372.00 |
$3,372.00 |
$3,372.00 |
$2,361.75
|
|
Video Swallow Study (Modified Barium Swallow)
|
$502.40 |
$502.40 |
$502.40 |
$524.50
|
|
Vinblastine 1 mg/ml intravenous solution
|
$177.85 |
$177.85 |
$177.85 |
$163.80
|
|
Vincristine 1 mg/ml intravenous solution
|
$171.35 |
$171.35 |
$171.35 |
$87.15
|
|
Vinorelbine 10 mg/ml intravenous solution (wrapper)
|
$188.44 |
$188.44 |
$188.44 |
$223.55
|
|
Visc & infraren abd 1 prosth
|
$12,215.20 |
$12,215.20 |
$12,215.20 |
$7,571.20
|
|
Visc & infraren abd 2 prosth
|
$14,013.60 |
$14,013.60 |
$14,013.60 |
$8,957.30
|
|
Visc & infraren abd 3 prosth
|
$15,920.80 |
$15,920.80 |
$15,920.80 |
$9,670.00
|
|
Visc & infraren abd 4+ prost
|
$17,936.80 |
$17,936.80 |
$17,936.80 |
$10,660.00
|
|
Vital capacity test
|
$142.40 |
$142.40 |
$142.40 |
$173.18
|
|
Vngrph chd anom/persist svc
|
$11,257.60 |
$11,257.60 |
$11,257.60 |
$1,492.75
|
|
Vngrph chd azygs/hemiazygs
|
$11,257.60 |
$11,257.60 |
$11,257.60 |
$201.50
|
|
Vngrph chd coronary sinus
|
$11,257.60 |
$11,257.60 |
$11,257.60 |
$161.60
|
|
Vngrph chd vnvn cltrl at/abv
|
$11,257.60 |
$11,257.60 |
$11,257.60 |
$1,118.00
|
|
Vngrph chd vnvn cltrl below
|
$11,257.60 |
$11,257.60 |
$11,257.60 |
$1,118.00
|
|
Voriconazole in ns IV syringe 5 mg/ml (pediatric) - cnr
|
$261.05 |
$261.05 |
$261.05 |
$165.81
|
|
Walking (Gait) Training (each 15 minutes)
|
$104.00 |
$104.00 |
$104.00 |
$87.50
|
|
Whfo electric custom fitted
|
$4,842.40 |
$4,842.40 |
$4,842.40 |
$5,209.82
|
|
Whfo nontorsion joint prefab
|
$240.00 |
$240.00 |
$240.00 |
$224.01
|
|
Whfo w/joint(s) custom fab
|
$586.40 |
$586.40 |
$586.40 |
$452.38
|
|
Whole blood for transfusion
|
$769.80 |
$769.80 |
$769.80 |
$504.00
|
|
Whole-Body Bone Scan (Nuclear Medicine)
|
$1,142.40 |
$1,142.40 |
$1,142.40 |
$1,570.65
|
|
Whole Skeleton X-ray Survey
|
$388.80 |
$388.80 |
$388.80 |
$636.46
|
|
Who nontorsion jnts pre cst
|
$664.00 |
$664.00 |
$664.00 |
$706.80
|
|
Who nontorsion jnts pre ots
|
$664.00 |
$664.00 |
$664.00 |
$1,144.66
|
|
Wound Cleaning and Dead Tissue Removal (up to 20 sq cm)
|
$351.20 |
$351.20 |
$351.20 |
$353.40
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$180.80 |
$180.80 |
$180.80 |
$574.40
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$316.80 |
$316.80 |
$316.80 |
$284.70
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$588.80 |
$588.80 |
$588.80 |
$442.22
|
|
Wrist X-ray
|
$193.60 |
$193.60 |
$193.60 |
$350.40
|
|
Wrist X-ray (2 views, both wrists)
|
$160.80 |
$160.80 |
$160.80 |
$291.20
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$3,687.20 |
$3,687.20 |
$3,687.20 |
$2,707.20
|
|
Xpos opn fmrl eprst aor uni add-on
|
$7,224.80 |
$7,224.80 |
$7,224.80 |
$1,859.09
|
