|
Part hymenectomy/revi hymenal ring 56700
|
$2,150.40 |
$2,150.40 |
$2,150.40 |
$3,762.53
|
|
Partial exc bone humerus
|
$7,968.80 |
$7,968.80 |
$7,968.80 |
$3,839.54
|
|
Partial excision bone tars/metatars exc talus/calcaneus (both sides) (rest meth ii cah)
|
$8,915.20 |
$8,915.20 |
$8,915.20 |
$4,914.00
|
|
Partial excision of lip
|
$8,008.00 |
$8,008.00 |
$8,008.00 |
$3,837.72
|
|
Partial hip replacement
|
$649.05 |
$649.05 |
$649.05 |
$3,874.00
|
|
Partial removal finger bone
|
$296.55 |
$296.55 |
$6,137.60 |
$2,021.04
|
|
Partial removal finger bone
|
$1,276.80 |
$1,276.80 |
$1,276.80 |
$2,049.27
|
|
Partial removal foot fascia
|
$8,618.40 |
$8,618.40 |
$8,618.40 |
$3,762.00
|
|
Partial removal leg bone(s)
|
$9,564.80 |
$9,564.80 |
$9,564.80 |
$4,315.20
|
|
Partial removal of bladder
|
$537.15 |
$537.15 |
$537.15 |
$1,465.20
|
|
Partial removal of eye fluid
|
$6,529.60 |
$6,529.60 |
$6,529.60 |
$2,698.92
|
|
Partial removal of eye fluid
|
$4,172.00 |
$4,172.00 |
$4,172.00 |
$2,698.92
|
|
Partial removal of fibula
|
$9,564.80 |
$9,564.80 |
$9,564.80 |
$3,786.00
|
|
Partial removal of foot bone
|
$261.30 |
$261.30 |
$4,894.40 |
$3,839.54
|
|
Partial removal of hand bone
|
$8,741.60 |
$8,741.60 |
$8,741.60 |
$3,839.54
|
|
Partial removal of lip
|
$3,276.00 |
$3,276.00 |
$3,276.00 |
$3,544.29
|
|
Partial removal of nose
|
$14,319.20 |
$14,319.20 |
$14,319.20 |
$6,603.11
|
|
Partial removal of penis
|
$11,508.00 |
$11,508.00 |
$11,508.00 |
$4,081.37
|
|
Partial removal of pharynx 42890
|
$14,319.20 |
$14,319.20 |
$14,319.20 |
$6,465.11
|
|
Partial removal of radius
|
$7,968.80 |
$7,968.80 |
$7,968.80 |
$3,839.54
|
|
Partial removal of radius
|
$3,472.00 |
$3,472.00 |
$3,472.00 |
$3,472.00
|
|
Partial removal of rib
|
$5,376.00 |
$5,376.00 |
$5,376.00 |
$5,376.00
|
|
Partial removal of thyroid
|
$399.60 |
$399.60 |
$28,800.80 |
$6,457.82
|
|
Partial removal of thyroid
|
$529.65 |
$529.65 |
$14,336.00 |
$5,855.00
|
|
Partial removal of tibia
|
$9,564.80 |
$9,564.80 |
$9,564.80 |
$4,108.80
|
|
Partial removal of toe
|
$9,788.80 |
$9,788.80 |
$9,788.80 |
$3,674.58
|
|
Partial removal of tongue
|
$9,828.00 |
$9,828.00 |
$9,828.00 |
$5,978.70
|
|
Partial removal of ulna
|
$7,968.80 |
$7,968.80 |
$7,968.80 |
$3,839.54
|
|
Partial removal of ulna
|
$3,186.40 |
$3,186.40 |
$3,186.40 |
$3,594.44
|
|
Partial removal of ulna
|
$261.30 |
$261.30 |
$9,564.80 |
$3,839.54
|
|
Partial removal of vaginal wall 57106
|
$312.45 |
$312.45 |
$8,573.60 |
$3,762.53
|
|
Partial removal tear gland
|
$8,562.40 |
$8,562.40 |
$8,562.40 |
$5,006.40
|
|
Partial thyroid excision
|
$399.00 |
$399.00 |
$16,576.00 |
$6,457.82
|
|
Partial thyroid lobect w/contratlat stot lobec 60212
|
$14,509.60 |
$14,509.60 |
$14,509.60 |
$6,376.26
|
|
Particle matristem matrix 1000mg micron-q4118-cost per mg
|
$5,040.00 |
$5,040.00 |
$5,040.00 |
$4,921.76
|
|
Part removal of metatarsal
|
$9,788.80 |
$9,788.80 |
$9,788.80 |
$3,795.71
|
|
Part removal of metatarsal
|
$4,894.40 |
$4,894.40 |
$4,894.40 |
$3,134.00
|
|
Part removal of metatarsal 28112
|
$4,911.20 |
$4,911.20 |
$4,911.20 |
$3,839.54
|
|
Passy muir valve metal trach
|
$446.07 |
$446.07 |
$446.07 |
$275.75
|
|
Path clin consltj high 41-60
|
$414.40 |
$414.40 |
$414.40 |
$201.80
|
|
Path clin consltj mod 21-40
|
$414.40 |
$414.40 |
$414.40 |
$202.78
|
|
Path clin consltj prolng svc
|
$22.96 |
$22.96 |
$22.96 |
$97.14
|
|
Path clin consltj sf 5-20
|
$20.85 |
$20.85 |
$139.44 |
$97.14
|
|
Patient recorded spirometry
|
$604.80 |
$604.80 |
$604.80 |
$456.56
|
|
Patient recorded spirometry
|
$217.28 |
$217.28 |
$217.28 |
$338.52
|
|
Patten bottom
|
$361.20 |
$361.20 |
$361.20 |
$672.73
|
|
Pca3/klk3 antigen
|
$582.40 |
$582.40 |
$582.40 |
$510.40
|
|
Pdgfra gene
|
$756.00 |
$756.00 |
$756.00 |
$717.23
|
|
Pd hl 3.5in 4d med rbr mld 6432
|
$28.00 |
$28.00 |
$28.00 |
$49.45
|
|
Pdt dstr prmlg les phys/qhp
|
$705.60 |
$705.60 |
$705.60 |
$294.77
|
|
Pedcle fh/ch/ch/m/n/ax/g/h/f
|
$5,504.80 |
$5,504.80 |
$5,504.80 |
$2,837.09
|
|
Ped home apnea mntr att only
|
$537.60 |
$537.60 |
$537.60 |
$185.15
|
|
Ped home apnea mntr dl&alys
|
$515.20 |
$515.20 |
$515.20 |
$296.92
|
|
Pediatric electric hand
|
$6,504.40 |
$6,504.40 |
$6,504.40 |
$6,504.40
|
|
Pediatric electric hook
|
$1,817.20 |
$1,817.20 |
$1,817.20 |
$1,817.20
|
|
Pedicle enel/ntroral 15576
|
$5,415.20 |
$5,415.20 |
$5,415.20 |
$2,501.10
|
|
Ped term dev, hand, vol clos
|
$1,575.28 |
$1,575.28 |
$1,575.28 |
$1,575.28
|
|
Ped term dev, hand, vol open
|
$1,859.76 |
$1,859.76 |
$1,859.76 |
$1,859.76
|
|
Ped term dev, hook, vol clos
|
$1,473.36 |
$1,473.36 |
$1,473.36 |
$1,473.36
|
|
Ped term dev, hook, vol open
|
$800.24 |
$800.24 |
$800.24 |
$800.24
|
|
Pegaspargase injection
|
$44,353.86 |
$44,353.86 |
$44,353.86 |
$39,780.27
|
|
Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector
|
$5,198.57 |
$5,198.57 |
$11,216.31 |
$11,216.31
|
|
Pegfilgrastim-apgf 6 mg/0.6 ml subcutaneous syringe
|
$6,860.56 |
$6,860.56 |
$6,860.56 |
$6,370.52
|
|
Pegfilgrastim-cbqv 6 mg/0.6 ml subcutaneous syringe
|
$3,381.75 |
$3,381.75 |
$7,297.36 |
$7,297.36
|
|
Pegfilgrastim-jmdb 6 mg/0.6 ml subcutaneous syringe
|
$1,690.88 |
$1,690.88 |
$3,650.08 |
$4,133.25
|
|
Pegloticase 8 mg/ml intravenous solution
|
$49,585.09 |
$49,585.09 |
$49,585.09 |
$49,135.11
|
|
Pegunigalsidase alfa-iwxj
|
$7,740.62 |
$7,740.62 |
$7,740.62 |
$2,146.13
|
|
Pelv band/spread bar thigh c
|
$487.20 |
$487.20 |
$487.20 |
$802.87
|
|
Pelvic band & belt thigh fla
|
$504.00 |
$504.00 |
$504.00 |
$504.00
|
|
Pelvic control band & belt b
|
$473.20 |
$473.20 |
$473.20 |
$566.16
|
|
Pelvic control band & belt u
|
$350.00 |
$350.00 |
$350.00 |
$500.58
|
|
Pelvic control hip heavy dut
|
$378.00 |
$378.00 |
$378.00 |
$591.53
|
|
Pelvic control pelvic sling
|
$655.20 |
$655.20 |
$655.20 |
$912.18
|
|
Pelvic CT scan (with and without contrast)
|
$1,767.30 |
$1,767.30 |
$5,023.20 |
$1,890.36
|
|
Pelvic CT scan (with contrast)
|
$1,436.25 |
$1,436.25 |
$4,760.00 |
$1,608.98
|
|
Pelvic CT scan (without contrast)
|
$1,348.35 |
$1,348.35 |
$3,589.60 |
$1,363.11
|
|
Pelvic & hip control thigh c
|
$1,716.40 |
$1,716.40 |
$1,716.40 |
$2,512.27
|
|
Pelvic MRI (with and without contrast)
|
$2,441.55 |
$2,441.55 |
$6,714.40 |
$2,860.00
|
|
Pelvic MRI (with contrast)
|
$1,674.45 |
$1,674.45 |
$4,995.20 |
$2,210.00
|
|
Pelvic MRI (without contrast)
|
$1,529.10 |
$1,529.10 |
$3,612.00 |
$1,902.00
|
|
Pelvic ring fracture uni/bil
|
$5,112.80 |
$5,112.80 |
$5,112.80 |
$4,599.00
|
|
Pelvic Ultrasound (complete)
|
$393.30 |
$393.30 |
$940.80 |
$643.80
|
|
Pelvic Ultrasound (limited)
|
$268.65 |
$268.65 |
$616.00 |
$430.00
|
|
Pelv & thor control gluteal
|
$142.80 |
$142.80 |
$142.80 |
$299.21
|
|
Pembrolizumab 25 mg/ml intravenous solution
|
$2,412.45 |
$2,412.45 |
$10,535.80 |
$12,385.22
|
|
Pemetrexed disodium 100 mg intravenous powder for solution
|
$7,089.13 |
$7,089.13 |
$7,089.13 |
$7,089.13
|
|
Pemivibart infusion
|
$233.85 |
$233.85 |
$233.85 |
$533.10
|
|
Peng benzathine/procaine inj
|
$427.58 |
$427.58 |
$427.58 |
$375.32
|
|
Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe
|
$864.35 |
$864.35 |
$1,324.06 |
$826.47
|
|
Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr
|
$105.38 |
$105.38 |
$105.38 |
$101.34
|
|
Penicillin g procaine inj
|
$158.53 |
$158.53 |
$158.53 |
$147.96
|
|
Penile injection
|
$840.00 |
$840.00 |
$840.00 |
$418.00
|
|
Penile rear tip xtnd 0.5cm
|
$10,580.22 |
$10,580.22 |
$10,580.22 |
$18,764.94
|
|
Penile vascular study
|
$761.60 |
$761.60 |
$761.60 |
$576.40
|
|
Penile vascular study
|
$1,041.60 |
$1,041.60 |
$1,041.60 |
$574.60
|
|
Penile venous occlusion
|
$8,215.20 |
$8,215.20 |
$8,215.20 |
$4,081.37
|
|
Penis plastic surgery
|
$10,057.60 |
$10,057.60 |
$10,057.60 |
$4,081.37
|
|
Penis study
|
$868.00 |
$868.00 |
$868.00 |
$368.50
|
|
Pentamidine non-comp unit
|
$294.39 |
$294.39 |
$294.39 |
$294.39
|
|
Pentobarbital sodium inj
|
$2,205.38 |
$2,205.38 |
$2,205.38 |
$2,205.38
|
