|
Vaccine covid-19 pfizer tris-sucrose >=12yrs 30mcg/0.3ml im
|
$110.12 |
$110.12 |
$110.12 |
$239.85
|
|
Vaccine covid-19 pfizer tris-sucrose 5yrs-11yrs 10mcg/0.3ml im
|
$73.74 |
$73.74 |
$73.74 |
$131.67
|
|
Vaccine covid-19 pfizer tris-sucrose 6mos-4yrs 3mcg/0.3ml im
|
$54.90 |
$54.90 |
$54.90 |
$91.00
|
|
Vaccine dtap < 7 years im
|
$191.07 |
$191.07 |
$191.07 |
$87.80
|
|
Vaccine dtap-hep b-ipv im
|
$505.49 |
$505.49 |
$505.49 |
$193.83
|
|
Vaccine dtap-ipv 4-6 years im
|
$351.30 |
$351.30 |
$351.30 |
$126.84
|
|
Vaccine dtap-ipv-hib-hepb im
|
$155.82 |
$155.82 |
$155.82 |
$158.30
|
|
Vaccine dtap-ipv/hib im
|
$578.25 |
$578.25 |
$578.25 |
$248.80
|
|
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im
|
$106.75 |
$106.75 |
$106.75 |
$45.33
|
|
Vaccine hepatitis a (hepa) adult im
|
$529.40 |
$529.40 |
$529.40 |
$178.07
|
|
Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im
|
$776.33 |
$776.33 |
$776.33 |
$218.40
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im
|
$29.40 |
$29.40 |
$29.40 |
$84.38
|
|
Vaccine hepatitis a (hepa) pediatric/adolescent 3 dose im
|
$251.29 |
$251.29 |
$251.29 |
$48.10
|
|
Vaccine hepatitis b (hepb) adult 3 dose im
|
$353.44 |
$353.44 |
$353.44 |
$173.98
|
|
Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im
|
$106.26 |
$106.26 |
$106.26 |
$306.24
|
|
Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im
|
$151.91 |
$151.91 |
$151.91 |
$79.04
|
|
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im
|
$170.10 |
$170.10 |
$170.10 |
$686.67
|
|
Vaccine influenza inactivated adjuvant im
|
$508.57 |
$508.57 |
$508.57 |
$110.25
|
|
Vaccine influenza nos 0.5ml dose im
|
$8.40 |
$8.40 |
$8.40 |
$36.80
|
|
Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im
|
$18.48 |
$18.48 |
$18.48 |
$48.29
|
|
Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im
|
$28.56 |
$28.56 |
$28.56 |
$40.01
|
|
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im
|
$203.70 |
$203.70 |
$203.70 |
$103.88
|
|
Vaccine mengingoccocal serogroup b 2 dose im
|
$232.26 |
$232.26 |
$232.26 |
$499.00
|
|
Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im
|
$126.00 |
$126.00 |
$126.00 |
$349.15
|
|
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im
|
$840.31 |
$840.31 |
$840.31 |
$408.70
|
|
Vaccine mmr live subcutaneous
|
$685.24 |
$685.24 |
$685.24 |
$224.04
|
|
Vaccine mmrv live subcutaneous
|
$100.80 |
$100.80 |
$100.80 |
$474.24
|
|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$773.03 |
$773.03 |
$773.03 |
$274.95
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$176.40 |
$176.40 |
$176.40 |
$397.18
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$1,703.58 |
$1,703.58 |
$1,703.58 |
$715.41
|
|
Vaccine polio (ipv) subcutaneous/im
|
$327.41 |
$327.41 |
$327.41 |
$119.17
|
|
Vaccine rabies im
|
$196.56 |
$196.56 |
$196.56 |
$945.46
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$286.86 |
$286.86 |
$286.86 |
$1,196.00
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im
|
$246.54 |
$246.54 |
$246.54 |
$1,159.00
|
|
Vaccine rotavirus attenuated (rv1) live 2 dose oral
|
$69.72 |
$69.72 |
$69.72 |
$200.70
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$63.84 |
$63.84 |
$63.84 |
$108.00
|
|
Vaccine tdap >=7 years im
|
$321.30 |
$321.30 |
$321.30 |
$150.76
|
|
Vaccine varicella live subcutaneous
|
$1,083.24 |
$1,083.24 |
$1,083.24 |
$447.80
|
|
Vad battery clip set hmii 14-v li-ion
|
$1,683.99 |
$1,683.99 |
$1,683.99 |
$1,683.99
|
|
Vad univ batt charger hm 1440
|
$14,827.28 |
$14,827.28 |
$14,827.28 |
$14,893.34
|
|
Vaginal bx
|
$3,900.54 |
$3,900.54 |
$3,900.54 |
$441.75
|
|
Vaginal delivery after cesarean delivery 59612
|
$3,760.68 |
$3,760.68 |
$3,760.68 |
$4,109.28
|
|
Valproic acid total therapeutic drug level
|
$24.36 |
$24.36 |
$24.36 |
$115.00
|
|
Vancomycin 1,000 mg intravenous injection
|
$650.56 |
$650.56 |
$650.56 |
$246.70
|
|
Vancomycin 750 mg intravenous solution
|
$129.78 |
$129.78 |
$129.78 |
$100.15
|
|
Vancomycin peak therapeutic drug level
|
$24.36 |
$24.36 |
$24.36 |
$126.79
|
|
Vasectomy
|
$1,131.48 |
$1,131.48 |
$1,131.48 |
$2,424.12
|
|
Vasopressin 20 unit/ml intravenous solution
|
$147.84 |
$147.84 |
$147.84 |
$362.93
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$587.16 |
$587.16 |
$587.16 |
$188.65
|
|
Venipuncture <3 yrs other vein
|
$120.96 |
$120.96 |
$120.96 |
$82.11
|
|
Venogram ext bil s&i
|
$1,260.00 |
$1,260.00 |
$1,260.00 |
$1,838.28
|
|
Venogram extremity supervision & interpretation unilateral
|
$1,107.96 |
$1,107.96 |
$1,107.96 |
$1,326.00
|
|
Ventilator each subsequent day
|
$777.00 |
$777.00 |
$777.00 |
$1,305.92
|
|
Ventilator initial day
|
$861.42 |
$861.42 |
$861.42 |
$1,540.80
|
|
Ventricular puncture prev burr hole without inj 61020
|
$1,012.62 |
$1,012.62 |
$1,012.62 |
$1,081.00
|
|
Version cephalic external
|
$3,766.14 |
$3,766.14 |
$3,766.14 |
$2,598.57
|
|
Vest large holster
|
$1,390.37 |
$1,390.37 |
$1,390.37 |
$1,012.50
|
|
Visit established high 40-54 minutes/level 5
|
$252.84 |
$252.84 |
$252.84 |
$287.73
|
|
Vital capacity test
|
$173.46 |
$173.46 |
$173.46 |
$173.33
|
|
Vitamin b-12
|
$81.06 |
$81.06 |
$81.06 |
$94.90
|
|
Vitamin D Test
|
$159.18 |
$159.18 |
$159.18 |
$132.00
|
|
Volume measurement urine timed
|
$44.10 |
$44.10 |
$44.10 |
$21.45
|
|
Vulvectomy simple partial
|
$168.00 |
$168.00 |
$168.00 |
$3,762.53
|
|
Warde apolipoprotein b
|
$26.46 |
$26.46 |
$26.46 |
$64.28
|
|
Warde hepatitis a antibody
|
$94.92 |
$94.92 |
$94.92 |
$83.70
|
|
Wbc automated
|
$15.54 |
$15.54 |
$15.54 |
$32.80
|
|
Wedging of cast
|
$319.20 |
$319.20 |
$319.20 |
$309.54
|
|
Whole blood for transfusion
|
$252.00 |
$252.00 |
$252.00 |
$479.50
|
|
Wnd prep f/n/hf/g addl cm
|
$386.40 |
$386.40 |
$386.40 |
$865.80
|
|
Wound closure by adhesive
|
$120.96 |
$120.96 |
$120.96 |
$149.25
|
|
Wound therapy negative pressure per session <= 50 sq cm
|
$443.10 |
$443.10 |
$443.10 |
$558.97
|
|
Wound therapy negative pressure per session > 50 sq cm
|
$465.78 |
$465.78 |
$465.78 |
$611.25
|
|
Wound therapy negative pressure per session <= 50 sq cm dme
|
$240.24 |
$240.24 |
$240.24 |
$288.91
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$465.78 |
$465.78 |
$465.78 |
$436.15
|
|
Wrist X-ray
|
$147.00 |
$147.00 |
$147.00 |
$343.70
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$2,295.30 |
$2,295.30 |
$2,295.30 |
$2,830.00
|
|
Xfer tis s/a/l 10 sq cm/<
|
$2,295.30 |
$2,295.30 |
$2,295.30 |
$2,623.24
|
|
X-ray abdomen 1 view
|
$141.12 |
$141.12 |
$141.12 |
$255.00
|
|
X-ray abdomen 2 views
|
$189.84 |
$189.84 |
$189.84 |
$312.36
|
|
X-ray abdomen >=3 views
|
$189.84 |
$189.84 |
$189.84 |
$332.15
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$189.84 |
$189.84 |
$189.84 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$147.00 |
$147.00 |
$147.00 |
$271.44
|
|
X-ray ankle 2 views (both sides)
|
$147.00 |
$147.00 |
$147.00 |
$283.00
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$431.34 |
$431.34 |
$431.34 |
$768.30
|
|
X-ray bone age studies
|
$197.82 |
$197.82 |
$197.82 |
$246.75
|
|
X-ray bone length studies
|
$197.82 |
$197.82 |
$197.82 |
$287.25
|
|
X-ray bone survey complete
|
$197.82 |
$197.82 |
$197.82 |
$666.60
|
|
X-ray bone survey infant
|
$197.82 |
$197.82 |
$197.82 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$147.00 |
$147.00 |
$147.00 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$197.82 |
$197.82 |
$197.82 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$197.82 |
$197.82 |
$197.82 |
$515.35
|
|
X-ray clavicle complete (both sides)
|
$147.00 |
$147.00 |
$147.00 |
$299.65
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$311.22 |
$311.22 |
$311.22 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$311.22 |
$311.22 |
$311.22 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$147.00 |
$147.00 |
$147.00 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$147.00 |
$147.00 |
$147.00 |
$342.00
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$311.22 |
$311.22 |
$311.22 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$197.82 |
$197.82 |
$197.82 |
$486.01
|
|
X-ray exam entire spi 6/> vw
|
$197.82 |
$197.82 |
$197.82 |
$575.76
|
|
X-ray exam of arm infant
|
$197.82 |
$197.82 |
$197.82 |
$248.82
|
