West Valley Medical Center

Typical

—

$2 – $10

"""""""POUCH OSTOMY 12"""""""" DRAINABLE 18006"""""""

A5063

Cash price

$59

$3 – $14

"""""""POUCH OSTOMY 12"""""""" DRAINABLE 18193"""""""

A4425

Cash price

$19

$4 – $19

"""""""UNNA BOOT W/CALAZIME 4"""""""" X 10 Y"""""""

A6456

Typical

—

$1 – $6.63

1 pc ost pou w built-in conv

A5057

Typical

—

$11 – $51

1 pc ost pouch w filter

A5056

Typical

—

$5 – $25

1/MLT NJXS SCLRSG SLNS SPIDER VEINS LIMB/TRNK

36468

Typical

—

$300 – $9,193

1150

Typical

—

$20 – $21

12-24hr sealed lead acid

K0733

Typical

—

$3.34 – $132

1274

Typical

—

$6,086 – $6,117

1440

Typical

—

$5.42 – $5.45

1486

Typical

—

$3.59 – $3.61

1500

Typical

—

$44 – $44

1502

Typical

—

$72 – $73

1656

Typical

—

$2.34 – $2.36

1670

Typical

—

$582 – $585

1829

Typical

—

$24 – $24

1844

Typical

—

$2.1 – $2.11

1850

Typical

—

$50 – $50

1852

Typical

—

$1,911 – $1,920

1ST PLMT DRUG ELUT OC INS

0444T

Typical

—

$9,193 – $9,193

1pc ost pch drain hgh output

A4435

Typical

—

$7 – $30

2 pc drainable ost pouch

A4413

Typical

—

$6 – $29

2.5MM THREAD GUIDE WIRE

705

DRG

Typical

—

$110 – $110

2019-NCOV CORONAVIRUS, SARS-COV-2/2019-NCOV (COVID-19), ANY TECHNIQUE, MULTIPLE TYPES OR SUBTYPES (INCLUDES ALL TARGETS), NON-CDC

U0002

Cash price

$47

$46 – $103

22nf nonsealed leadacid

E2360

Typical

—

$14 – $594

22nf sealed leadacid battery

E2361

Typical

—

$16 – $625

29125 APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STA

29125

Typical

—

$55 – $9,193

29130 ed proc application of finger splint static

29130

Typical

—

$34 – $9,193

29131 ed proc application finger splint dynamic

29131

Typical

—

$44 – $9,193

3-DIMENSIONAL RADIOTHERAPY PLAN, INCLUDING DOSE-VOLUME HISTOGRAMS

77295

Typical

—

$188 – $2,681

3.2MM DRILL BIT 195MM

706

DRG

Typical

—

$68 – $68

36000 ed proc introduction of needle or intracathe

36000

Typical

—

$21 – $9,193

37799 ed proc vascular surgery unlisted proc

37799

Typical

—

$542 – $4,441

3D RENDERING WITH INTERPRETATION AND REPORTING OF COMPUTED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING, ULTRASOUND, OR OTHER TOMOGRAPHIC MODALITY WITH IMAGE POSTPROCESSING UNDER CONCURRENT SUPERVISION; NOT REQUIRING IMAGE POSTPROCESSING ON AN INDEPENDENT WORKSTATION

76376

Typical

—

$7 – $12

3D RENDERING WITH INTERPRETATION AND REPORTING OF COMPUTED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING, ULTRASOUND, OR OTHER TOMOGRAPHIC MODALITY WITH IMAGE POSTPROCESSING UNDER CONCURRENT SUPERVISION; REQUIRING IMAGE POSTPROCESSING ON AN INDEPENDENT WORKSTATION

76377

Cash price

$1,143

$31 – $32

4-bar link above knee w/swng

L5614

Typical

—

$1,747 – $7,524

43258 OPERATIVE UPPER GI ENDOSCOPY

43258

Typical

—

$413 – $413

45345 SIGMOIDOSCOPY W/STENT

45345

Typical

—

$413 – $413

45355 surgical colonoscopy

45355

Typical

—

$551 – $551

45383 lesion removal colonoscopy

45383

Typical

—

$551 – $551

5% DEXTROSE IN LACTATED RINGERS INFUSION, UP TO 1000 CC

J7121

Cash price

$216

$9.82 – $9.82

58160-0890-52 - influenza virus vaccine, inactivated preservative-free quadrivalent Sus [MEMO]

90675

Cash price

$1,313

$292 – $831

67938 ed proc remove fb eyelid- hospital

67938

Typical

—

$218 – $9,193

92506 auditory function test

92506

Cash price

$679

ABDOMINAL LYMPHADENECTOMY, REGIONAL, INCLUDING CELIAC, GASTRIC, PORTAL, PERIPANCREATIC, WITH OR WITHOUT PARA-AORTIC AND VENA CAVAL NODES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

38747

Typical

—

$209 – $15,298

2514

Typical

—

$14,826 – $17,297

2513

Typical

—

$9,530 – $11,118

2512

Typical

—

$7,210 – $8,411

2511

Typical

—

$5,619 – $6,555