|
Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im
|
$125.16 |
$125.16 |
$125.16 |
$274.95
|
|
Vaccine pneumococcal conjugate 13 valent (pcv13) im
|
$84.00 |
$84.00 |
$84.00 |
$397.18
|
|
Vaccine pneumonococcal conjugate 20 valent (pcv20) im
|
$245.28 |
$245.28 |
$245.28 |
$715.41
|
|
Vaccine polio (ipv) subcutaneous/im
|
$8.40 |
$8.40 |
$8.40 |
$119.17
|
|
Vaccine rabies im
|
$2,153.16 |
$2,153.16 |
$2,153.16 |
$945.46
|
|
Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im
|
$3,686.45 |
$3,686.45 |
$3,686.45 |
$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
|
$10.50 |
$10.50 |
$10.50 |
$200.70
|
|
Vaccine rotavirus pentavalent (rv5) live 3 dose oral
|
$10.50 |
$10.50 |
$10.50 |
$108.00
|
|
Vaccine tdap >=7 years im
|
$345.82 |
$345.82 |
$345.82 |
$150.76
|
|
Vaccine td preservative free >= 7 years im
|
$28.35 |
$28.35 |
$28.35 |
$131.77
|
|
Vaccine varicella live subcutaneous
|
$14.70 |
$14.70 |
$14.70 |
$447.80
|
|
Vad battery clip set hmii 14-v li-ion
|
$1,683.99 |
$1,683.99 |
$1,683.99 |
$1,455.30
|
|
Vad univ batt charger hm 1440
|
$14,827.28 |
$14,827.28 |
$14,827.28 |
$14,556.67
|
|
Vaginal bx
|
$4,002.18 |
$4,002.18 |
$4,002.18 |
$441.75
|
|
Vaginal delivery after cesarean delivery 59612
|
$4,109.28 |
$4,109.28 |
$4,109.28 |
$4,109.28
|
|
Valproic acid total therapeutic drug level
|
$30.66 |
$30.66 |
$30.66 |
$115.00
|
|
Vancomycin 1,000 mg intravenous injection
|
$77.39 |
$77.39 |
$77.39 |
$170.87
|
|
Vancomycin 750 mg intravenous solution
|
$310.75 |
$310.75 |
$310.75 |
$117.58
|
|
Vancomycin peak therapeutic drug level
|
$30.66 |
$30.66 |
$30.66 |
$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 |
$378.38
|
|
Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture)
|
$15.96 |
$15.96 |
$15.96 |
$188.65
|
|
Venipuncture <3 yrs other vein
|
$120.96 |
$120.96 |
$120.96 |
$82.11
|
|
Venogram ext bil s&i
|
$3,296.58 |
$3,296.58 |
$3,296.58 |
$1,838.28
|
|
Venogram extremity supervision & interpretation unilateral
|
$3,296.58 |
$3,296.58 |
$3,296.58 |
$1,326.00
|
|
Venous sampling s&i
|
$11,183.34 |
$11,183.34 |
$11,183.34 |
$4,416.78
|
|
Ventilator each subsequent day
|
$1,267.98 |
$1,267.98 |
$1,267.98 |
$1,305.92
|
|
Ventilator initial day
|
$1,658.16 |
$1,658.16 |
$1,658.16 |
$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
|
$4,109.28 |
$4,109.28 |
$4,109.28 |
$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
|
$447.30 |
$447.30 |
$447.30 |
$279.44
|
|
Vital capacity test
|
$122.22 |
$122.22 |
$122.22 |
$173.33
|
|
Vitamin b-12
|
$89.04 |
$89.04 |
$89.04 |
$94.90
|
|
Vitamin D Test
|
$174.72 |
$174.72 |
$174.72 |
$132.00
|
|
Volume measurement urine timed
|
$53.34 |
$53.34 |
$53.34 |
$21.45
|
|
Vulvectomy simple partial
|
$168.00 |
$168.00 |
$168.00 |
$3,762.53
|
|
Warde apolipoprotein b
|
$28.14 |
$28.14 |
$28.14 |
$64.28
|
|
Warde hepatitis a antibody
|
$106.26 |
$106.26 |
$106.26 |
$83.70
|
|
Warde sex hormone binding globulin
|
$28.56 |
$28.56 |
$28.56 |
$86.59
|
|
Warde vitamin d (1 25 dihydroxy)
|
$49.98 |
$49.98 |
$49.98 |
$138.50
|
|
Wbc automated
|
$24.36 |
$24.36 |
$24.36 |
$32.80
|
|
Wedging of cast
|
$320.04 |
$320.04 |
$320.04 |
$309.54
|
|
Whole blood for transfusion
|
$252.00 |
$252.00 |
$252.00 |
$460.36
|
|
Wnd prep f/n/hf/g addl cm
|
$422.52 |
$422.52 |
$422.52 |
$865.80
|
|
Wound closure by adhesive
|
$120.96 |
$120.96 |
$120.96 |
$153.40
|
|
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
|
$117.18 |
$117.18 |
$117.18 |
$288.91
|
|
Wound therapy negative pressure per session > 50 sq cm dme
|
$465.78 |
$465.78 |
$465.78 |
$436.15
|
|
Wrist X-ray
|
$179.76 |
$179.76 |
$179.76 |
$343.70
|
|
Xcapsl ctrc rmvl cplx wo ecp
|
$755.16 |
$755.16 |
$755.16 |
$3,724.80
|
|
Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/<
|
$2,508.24 |
$2,508.24 |
$2,508.24 |
$2,830.00
|
|
Xfer tis s/a/l 10 sq cm/<
|
$2,301.18 |
$2,301.18 |
$2,301.18 |
$2,623.24
|
|
X-ray abdomen 1 view
|
$172.62 |
$172.62 |
$172.62 |
$255.00
|
|
X-ray abdomen 2 views
|
$232.68 |
$232.68 |
$232.68 |
$312.36
|
|
X-ray abdomen >=3 views
|
$232.68 |
$232.68 |
$232.68 |
$332.15
|
|
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest
|
$232.68 |
$232.68 |
$232.68 |
$418.63
|
|
X-ray acromioclavicular joints without or w/weighted distraction bilateral
|
$179.76 |
$179.76 |
$179.76 |
$271.44
|
|
X-ray ankle 2 views (both sides)
|
$179.76 |
$179.76 |
$179.76 |
$283.00
|
|
X-ray arthrogram shoulder supervision & interpretation (both sides)
|
$863.10 |
$863.10 |
$863.10 |
$768.30
|
|
X-ray bone age studies
|
$241.92 |
$241.92 |
$241.92 |
$246.75
|
|
X-ray bone length studies
|
$241.92 |
$241.92 |
$241.92 |
$287.25
|
|
X-ray bone survey complete
|
$241.92 |
$241.92 |
$241.92 |
$666.60
|
|
X-ray bone survey infant
|
$241.92 |
$241.92 |
$241.92 |
$410.73
|
|
X-ray cervical spine 2-3 views
|
$179.76 |
$179.76 |
$179.76 |
$326.04
|
|
X-ray cervical spine 4-5 views
|
$241.92 |
$241.92 |
$241.92 |
$455.65
|
|
X-ray cervical spine >= 6 views
|
$241.92 |
$241.92 |
$241.92 |
$515.35
|
|
X-ray clavicle complete (both sides)
|
$179.76 |
$179.76 |
$179.76 |
$299.65
|
|
X-ray colon abdominal radiograph(s) & delayed images single contrast study
|
$380.94 |
$380.94 |
$380.94 |
$647.40
|
|
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study
|
$380.94 |
$380.94 |
$380.94 |
$820.15
|
|
X-ray elbow 2 views (both sides)
|
$179.76 |
$179.76 |
$179.76 |
$291.94
|
|
X-ray elbow >= 3 views (both sides)
|
$179.76 |
$179.76 |
$179.76 |
$342.00
|
|
X-ray esophogram chest radiograph(s) & delayed images single contrast study
|
$380.94 |
$380.94 |
$380.94 |
$486.24
|
|
X-ray exam entire spi 4/5 vw
|
$241.92 |
$241.92 |
$241.92 |
$486.01
|
|
X-ray exam entire spi 6/> vw
|
$241.92 |
$241.92 |
$241.92 |
$575.76
|
|
X-ray exam of arm infant
|
$241.92 |
$241.92 |
$241.92 |
$248.82
|
|
X-ray exam of eye sockets
|
$241.92 |
$241.92 |
$241.92 |
$349.05
|
|
X-ray exam of femur 1
|
$179.76 |
$179.76 |
$179.76 |
$232.36
|
|
X-ray exam of jaw joint
|
$81.48 |
$81.48 |
$81.48 |
$192.39
|
|
X-ray exam of sinuses
|
$179.76 |
$179.76 |
$179.76 |
$211.00
|
|
X-ray exam si joints
|
$241.92 |
$241.92 |
$241.92 |
$246.16
|
|
X-ray exam thorac spine4/>vw
|
$241.92 |
$241.92 |
$241.92 |
$395.59
|
|
X-ray eye detection foreign body (both sides)
|
$122.64 |
$122.64 |
$122.64 |
$235.00
|
|
X-ray facial bones complete > 3 views
|
$241.92 |
$241.92 |
$241.92 |
$366.60
|
|
X-ray femur >=2 views (both sides)
|
$179.76 |
$179.76 |
$179.76 |
$304.15
|
|
X-ray finger(s) >= 2 views (both sides)
|
$179.76 |
$179.76 |
$179.76 |
$262.40
|
|
X-ray foot 2 views (both sides)
|
$179.76 |
$179.76 |
$179.76 |
$288.40
|
|
X-ray forearm 2 views (both sides)
|
$179.76 |
$179.76 |
$179.76 |
$319.00
|
|
X-ray hand 2 views (both sides)
|
$99.54 |
$99.54 |
$99.54 |
$316.50
|
|
X-ray heel/calcaneus > 2 views (both sides)
|
$179.76 |
$179.76 |
$179.76 |
$270.00
|
|
X-ray hip uni w/wo pelvis min 4 views
|
$241.92 |
$241.92 |
$241.92 |
$370.80
|
|
X-ray hip with pelvis when performed bilateral 2 views
|
$241.92 |
$241.92 |
$241.92 |
$350.35
|
|
X-ray hip with pelvis when performed bilateral 3-4 views
|
$241.92 |
$241.92 |
$241.92 |
$409.24
|
|
X-ray hip with pelvis when performed bilateral >= 5 views
|
$241.92 |
$241.92 |
$241.92 |
$508.00
|
|
X-ray hip with pelvis when performed unilateral 1 view left
|
$179.76 |
$179.76 |
$179.76 |
$207.35
|
|
X-ray humerus >= 2 views left
|
$179.76 |
$179.76 |
$179.76 |
$304.15
|
|
X-ray joint survey 1 view
|
$154.56 |
$154.56 |
$154.56 |
$211.00
|
|
X-ray knee 1-2 views (both sides)
|
$179.76 |
$179.76 |
$179.76 |
$283.50
|