|
Ustekinumab 130 mg/26 ml intravenous solution
|
$5,184.34 |
$5,184.34 |
$5,184.34 |
$5,205.00
|
|
Ustekinumab 45 mg/0.5 ml subcutaneous solution
|
$49,434.96 |
$49,434.96 |
$49,434.96 |
$51,633.07
|
|
Vaccine Administration (one shot)
|
$128.00 |
$128.00 |
$128.00 |
$67.74
|
|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$396.10 |
$396.10 |
$396.10 |
$236.50
|
|
Vaccine dtap < 7 years im
|
$325.92 |
$325.92 |
$325.92 |
$71.17
|
|
Vaccine dtap-hep b-ipv im
|
$378.20 |
$378.20 |
$378.20 |
$164.63
|
|
Vaccine dtap-ipv 4-6 years im
|
$345.46 |
$345.46 |
$345.46 |
$105.95
|
|
Vaccine dtap-ipv-hib-hepb im
|
$403.48 |
$403.48 |
$403.48 |
$174.72
|
|
Vaccine dtap-ipv/hib im
|
$362.63 |
$362.63 |
$362.63 |
$221.24
|
|
Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im
|
$328.33 |
$328.33 |
$328.33 |
$70.53
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$324.44 |
$324.44 |
$324.44 |
$43.12
|
|
Vaccine hepatitis a (hepa) adult im
|
$357.70 |
$357.70 |
$357.70 |
$166.62
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$382.20 |
$382.20 |
$382.20 |
$231.56
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$330.35 |
$330.35 |
$330.35 |
$78.25
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$352.79 |
$352.79 |
$352.79 |
$155.16
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$387.48 |
$387.48 |
$387.48 |
$274.93
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$25.93 |
$25.93 |
$25.93 |
$75.39
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$451.55 |
$451.55 |
$451.55 |
$576.48
|
|
Vaccine influenza inactivated adjuvant im
|
$56.05 |
$56.05 |
$56.05 |
$110.25
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$26.40 |
$26.40 |
$26.40 |
$48.59
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im
|
$25.60 |
$25.60 |
$25.60 |
$28.77
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$26.40 |
$26.40 |
$26.40 |
$33.60
|
|
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im
|
$86.40 |
$86.40 |
$86.40 |
$72.00
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$41.60 |
$41.60 |
$41.60 |
$82.71
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$413.10 |
$413.10 |
$413.10 |
$394.26
|
|
Vaccine mengingoccocal serogroup b 2 or 3 dose im
|
$406.05 |
$406.05 |
$406.05 |
$409.35
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$396.21 |
$396.21 |
$396.21 |
$310.93
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$396.86 |
$396.86 |
$396.86 |
$327.37
|
|
Vaccine mmr live subcutaneous
|
$359.08 |
$359.08 |
$359.08 |
$213.00
|
|
Vaccine mmrv live subcutaneous
|
$456.57 |
$456.57 |
$456.57 |
$424.32
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$234.59 |
$234.59 |
$234.59 |
$252.87
|
|
Vaccine pneumonococcal conjugate 15 valent (pcv15) im
|
$456.14 |
$456.14 |
$456.14 |
$414.46
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$527.52 |
$527.52 |
$527.52 |
$563.36
|
|
Vaccine polio (ipv) subcutaneous/im
|
$329.83 |
$329.83 |
$329.83 |
$90.70
|
|
Vaccine rabies im
|
$540.48 |
$540.48 |
$540.48 |
$858.95
|
|
Vaccine respiratory syncytial virus bivalent subunit/preservative free im
|
$370.40 |
$370.40 |
$370.40 |
$538.84
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$627.11 |
$627.11 |
$627.11 |
$1,105.21
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$1,225.67 |
$1,225.67 |
$1,225.67 |
$997.44
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$58.76 |
$58.76 |
$58.76 |
$126.14
|
|
Vaccine tdap >=7 years im
|
$337.72 |
$337.72 |
$337.72 |
$131.34
|
|
Vaccine td preservative free >= 7 years im
|
$334.00 |
$334.00 |
$334.00 |
$112.10
|
|
Vaccine varicella live subcutaneous
|
$386.44 |
$386.44 |
$386.44 |
$365.17
|
|
Vaginal bx
|
$306.40 |
$306.40 |
$306.40 |
$459.42
|
|
Valvuloplasty aortic
|
$14,605.60 |
$14,605.60 |
$14,605.60 |
$7,944.16
|
|
Valvuloplasty mitral
|
$16,506.40 |
$16,506.40 |
$16,506.40 |
$10,845.00
|
|
Valvuloplasty pulmonary
|
$16,489.60 |
$16,489.60 |
$16,489.60 |
$11,945.20
|
|
Vancomycin 1,000 mg intravenous injection
|
$366.34 |
$366.34 |
$366.34 |
$251.86
|
|
Vancomycin 750 mg intravenous solution
|
$329.24 |
$329.24 |
$329.24 |
$90.33
|
|
Vasopressin 20 unit/ml intravenous solution
|
$49.84 |
$49.84 |
$49.84 |
$325.80
|
|
Vedolizumab 300 mg intravenous solution
|
$24,267.48 |
$24,267.48 |
$24,267.48 |
$18,732.33
|
|
Veeg cont 2-12 hrs
|
$5,027.20 |
$5,027.20 |
$5,027.20 |
$1,540.00
|
|
Veeg ea 12-26hr cont mntr
|
$6,340.00 |
$6,340.00 |
$6,340.00 |
$3,225.60
|
|
Veeg intrmnt 2-12 hrs
|
$4,493.60 |
$4,493.60 |
$4,493.60 |
$994.91
|
|
Veeg unmon 12-26 hrs
|
$5,104.80 |
$5,104.80 |
$5,104.80 |
$1,737.12
|
|
Veeg unmon 2-12 hrs
|
$3,897.60 |
$3,897.60 |
$3,897.60 |
$826.15
|
|
Vein gft fem a/p tib/pero/dis art 35566
|
$10,245.60 |
$10,245.60 |
$10,245.60 |
$8,152.00
|
|
Vein x-ray adrenal gland
|
$4,469.60 |
$4,469.60 |
$4,469.60 |
$2,833.34
|
|
Vein x-ray kidney
|
$5,091.20 |
$5,091.20 |
$5,091.20 |
$2,870.00
|
|
Vein x-ray liver
|
$4,417.60 |
$4,417.60 |
$4,417.60 |
$3,312.00
|
|
Vein x-ray liver w/hemodynam
|
$4,051.20 |
$4,051.20 |
$4,051.20 |
$3,619.84
|
|
Vein x-ray liver w/hemodynam
|
$5,239.20 |
$5,239.20 |
$5,239.20 |
$3,683.90
|
|
Vein x-ray liver without hemodyn
|
$3,250.40 |
$3,250.40 |
$3,250.40 |
$2,452.80
|
|
Vein x-ray skull
|
$2,976.00 |
$2,976.00 |
$2,976.00 |
$2,236.50
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$143.20 |
$143.20 |
$143.20 |
$197.04
|
|
Venogram ext bil s&i
|
$2,691.20 |
$2,691.20 |
$2,691.20 |
$1,838.28
|
|
Venogram extremity supervision & interpretation unilateral
|
$2,198.40 |
$2,198.40 |
$2,198.40 |
$1,382.58
|
|
Venous mech thrombectomy
|
$7,113.60 |
$7,113.60 |
$7,113.60 |
$8,184.00
|
|
Venous m-thrombectomy add-on
|
$6,823.20 |
$6,823.20 |
$6,823.20 |
$5,110.00
|
|
Venous sampling s&i
|
$5,493.60 |
$5,493.60 |
$5,493.60 |
$4,200.00
|
|
Ven thrombosis images bilat
|
$2,106.40 |
$2,106.40 |
$2,106.40 |
$796.50
|
|
Ventilator each subsequent day
|
$1,676.00 |
$1,676.00 |
$1,676.00 |
$1,178.74
|
|
Ventilator Management (first day)
|
$1,748.00 |
$1,748.00 |
$1,748.00 |
$1,434.60
|
|
Version cephalic external
|
$3,618.40 |
$3,618.40 |
$3,618.40 |
$2,361.75
|
|
Video Swallow Study (Modified Barium Swallow)
|
$757.60 |
$757.60 |
$757.60 |
$524.50
|
|
Vinblastine 1 mg/ml intravenous solution
|
$285.91 |
$285.91 |
$285.91 |
$163.80
|
|
Vincristine 1 mg/ml intravenous solution
|
$239.19 |
$239.19 |
$239.19 |
$87.15
|
|
Vinorelbine 10 mg/ml intravenous solution (wrapper)
|
$351.91 |
$351.91 |
$351.91 |
$223.55
|
|
Visc & infraren abd 2 prosth
|
$10,212.80 |
$10,212.80 |
$10,212.80 |
$8,957.30
|
|
Visc & infraren abd 3 prosth
|
$10,212.80 |
$10,212.80 |
$10,212.80 |
$9,670.00
|
|
Visc & infraren abd 4+ prost
|
$10,212.80 |
$10,212.80 |
$10,212.80 |
$10,660.00
|
|
Visit established high 40-54 minutes/level 5
|
$206.40 |
$206.40 |
$206.40 |
$240.50
|
|
Visual audiometry (vra)
|
$214.40 |
$214.40 |
$214.40 |
$220.60
|
|
Vngrph chd anom/persist svc
|
$5,316.80 |
$5,316.80 |
$5,316.80 |
$1,492.75
|
|
Vngrph chd azygs/hemiazygs
|
$4,262.40 |
$4,262.40 |
$4,262.40 |
$201.50
|
|
Vngrph chd vnvn cltrl at/abv
|
$4,262.40 |
$4,262.40 |
$4,262.40 |
$1,118.00
|
|
Vngrph chd vnvn cltrl below
|
$3,595.20 |
$3,595.20 |
$3,595.20 |
$1,118.00
|
|
Voiding pressure study/intra-abd 51797
|
$420.00 |
$420.00 |
$420.00 |
$429.48
|
|
Voriconazole in ns IV syringe 5 mg/ml (pediatric) - cnr
|
$329.53 |
$329.53 |
$329.53 |
$165.81
|
|
Walking (Gait) Training (each 15 minutes)
|
$120.00 |
$120.00 |
$120.00 |
$87.50
|
|
Whfo electric custom fitted
|
$4,700.80 |
$4,700.80 |
$4,700.80 |
$5,209.82
|
|
Whfo nontorsion joint prefab
|
$167.20 |
$167.20 |
$167.20 |
$224.01
|
|
Whfo w/joint(s) custom fab
|
$627.20 |
$627.20 |
$627.20 |
$452.38
|
|
Whole blood for transfusion
|
$567.20 |
$567.20 |
$567.20 |
$504.00
|
|
Whole-Body Bone Scan (Nuclear Medicine)
|
$2,167.20 |
$2,167.20 |
$2,167.20 |
$1,570.65
|
|
Whole Skeleton X-ray Survey
|
$1,091.20 |
$1,091.20 |
$1,091.20 |
$636.46
|
|
Who nontorsion jnts pre cst
|
$476.00 |
$476.00 |
$476.00 |
$706.80
|
|
Who nontorsion jnts pre ots
|
$644.00 |
$644.00 |
$644.00 |
$1,144.66
|
|
Wound Cleaning and Dead Tissue Removal (up to 20 sq cm)
|
$488.00 |
$488.00 |
$488.00 |
$353.40
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$719.20 |
$719.20 |
$719.20 |
$574.40
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$568.00 |
$568.00 |
$568.00 |
$594.00
|