|
Off/op cnsltj new/est low 30
|
$228.60 |
$228.60 |
$228.60 |
$180.00
|
|
Off/op cnsltj new/est mod 40
|
$339.00 |
$339.00 |
$339.00 |
$269.60
|
|
Off/op consltj new/est hi 55
|
$415.20 |
$415.20 |
$415.20 |
$339.30
|
|
Off/op consltj new/est sf 20
|
$171.00 |
$171.00 |
$171.00 |
$133.80
|
|
Ortho elbow without jnt cstm w/fit&adj
|
$158.40 |
$158.40 |
$158.40 |
$279.81
|
|
Ortho elbow w/lock w/ft&adj
|
$265.20 |
$265.20 |
$265.20 |
$536.90
|
|
Ortho ewh rgd without jnt cstm w/fit&adj
|
$396.60 |
$396.60 |
$396.60 |
$708.88
|
|
Ortho hnd/fngr without jnt cstm w/fit&adj
|
$152.40 |
$152.40 |
$152.40 |
$238.34
|
|
Ortho hnd/fngr w/jnt cstm w/fit&adj
|
$176.40 |
$176.40 |
$176.40 |
$310.00
|
|
Ortho hnd metcrpl fx prefb w/fit&adj
|
$585.60 |
$585.60 |
$585.60 |
$174.40
|
|
Ortho hnd without jnt w/fit&adj
|
$148.20 |
$148.20 |
$148.20 |
$231.00
|
|
Orthopantogram
|
$195.00 |
$195.00 |
$195.00 |
$241.50
|
|
Ortho whf rigd without jnt cstm w/fit&adj
|
$200.40 |
$200.40 |
$200.40 |
$420.76
|
|
Ortho wrst/hnd w/jnt cstm w/fit&adj
|
$538.80 |
$538.80 |
$538.80 |
$718.40
|
|
Oscillation chest wall mechanical per session
|
$113.40 |
$113.40 |
$113.40 |
$195.00
|
|
Osmolality blood
|
$130.20 |
$130.20 |
$130.20 |
$67.60
|
|
Osmolality urine
|
$139.20 |
$139.20 |
$139.20 |
$65.00
|
|
Ot evaluation high complexity patient/family
|
$278.40 |
$278.40 |
$278.40 |
$297.00
|
|
Ot evaluation low complexity patient/family
|
$231.60 |
$231.60 |
$231.60 |
$231.60
|
|
Ot evaluation moderate complexity patient/family
|
$247.20 |
$247.20 |
$247.20 |
$263.50
|
|
Oth resp proc, group
|
$102.60 |
$102.60 |
$102.60 |
$123.05
|
|
Oth resp proc, indiv
|
$114.60 |
$114.60 |
$114.60 |
$82.50
|
|
Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes
|
$108.00 |
$108.00 |
$108.00 |
$98.40
|
|
Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes
|
$105.00 |
$105.00 |
$105.00 |
$105.00
|
|
Ot manual therpy techniques >=1 region each 15 minutes
|
$105.00 |
$105.00 |
$105.00 |
$105.00
|
|
Ot re-evaluation patient/family
|
$160.80 |
$160.80 |
$160.80 |
$160.80
|
|
Ot therapeutic activities direct patient contact each 15 minutes
|
$105.00 |
$105.00 |
$105.00 |
$101.38
|
|
Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes
|
$108.00 |
$108.00 |
$108.00 |
$87.00
|
|
Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes
|
$148.20 |
$148.20 |
$148.20 |
$91.80
|
|
Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes
|
$105.00 |
$105.00 |
$105.00 |
$98.15
|
|
Ot therapeutic procedure neuromuscular reeducate each 15 minutes
|
$108.00 |
$108.00 |
$108.00 |
$101.23
|
|
Ot training self care/home management direct contact each 15 minutes
|
$105.00 |
$105.00 |
$105.00 |
$94.25
|
|
Ovulation tests
|
$280.80 |
$280.80 |
$280.80 |
$29.60
|
|
Parathormone (pth) intact
|
$389.40 |
$389.40 |
$389.40 |
$204.87
|
|
Parathyrd planar w/spect&ct
|
$1,593.60 |
$1,593.60 |
$1,593.60 |
$1,574.40
|
|
Parathyroid planar imaging
|
$1,102.20 |
$1,102.20 |
$1,102.20 |
$1,129.91
|
|
Parathyroid planar img w/tomo spect
|
$1,488.00 |
$1,488.00 |
$1,488.00 |
$1,350.60
|
|
Paring/cutting benign hyperkeratotic lesion single
|
$274.80 |
$274.80 |
$274.80 |
$245.00
|
|
Ped crit care transport
|
$448.80 |
$448.80 |
$448.80 |
$434.40
|
|
Ped crit care transport addl
|
$224.40 |
$224.40 |
$224.40 |
$217.60
|
|
Ped critical care initial
|
$1,507.80 |
$1,507.80 |
$1,507.80 |
$1,446.40
|
|
Ped critical care subsq
|
$753.60 |
$753.60 |
$753.60 |
$724.00
|
|
Pelvic CT scan (with and without contrast)
|
$2,296.80 |
$2,296.80 |
$2,296.80 |
$1,890.36
|
|
Pelvic CT scan (with contrast)
|
$2,061.00 |
$2,061.00 |
$2,061.00 |
$1,608.98
|
|
Pelvic CT scan (without contrast)
|
$1,694.40 |
$1,694.40 |
$1,694.40 |
$1,363.11
|
|
Pelvic MRI (with and without contrast)
|
$2,908.20 |
$2,908.20 |
$2,908.20 |
$2,860.00
|
|
Pelvic MRI (with contrast)
|
$2,889.60 |
$2,889.60 |
$2,889.60 |
$2,210.00
|
|
Pelvic MRI (without contrast)
|
$2,458.20 |
$2,458.20 |
$2,458.20 |
$1,902.00
|
|
Pelvic Ultrasound (complete)
|
$720.60 |
$720.60 |
$720.60 |
$643.80
|
|
Pelvic Ultrasound (limited)
|
$547.80 |
$547.80 |
$547.80 |
$430.00
|
|
Perc rf ablate renal tumor
|
$8,046.00 |
$8,046.00 |
$8,046.00 |
$7,243.60
|
|
Pericardiocentesis wwo imaging
|
$3,064.20 |
$3,064.20 |
$3,064.20 |
$2,251.20
|
|
Peripheral vascular rehab
|
$145.20 |
$145.20 |
$145.20 |
$132.50
|
|
Peri-proc device eval pm
|
$115.20 |
$115.20 |
$115.20 |
$159.90
|
|
Perq art m-thrombect &/nfs
|
$14,581.20 |
$14,581.20 |
$14,581.20 |
$7,559.55
|
|
Perq clsr tcat l atr apndge
|
$28,329.60 |
$28,329.60 |
$28,329.60 |
$9,509.53
|
|
Perq dev breast 1st strtctc
|
$1,799.40 |
$1,799.40 |
$1,799.40 |
$1,456.00
|
|
Perq rplcmt g-tube req revsn gstrst trk
|
$448.80 |
$448.80 |
$448.80 |
$625.93
|
|
Pet CT skull-mid thgh initial
|
$7,687.20 |
$7,687.20 |
$7,687.20 |
$4,707.00
|
|
Pet CT whole body initial
|
$7,687.20 |
$7,687.20 |
$7,687.20 |
$4,850.00
|
|
Pet fdg brain metoblic eval sb
|
$8,767.20 |
$8,767.20 |
$8,767.20 |
$4,060.00
|
|
Pet image w/ct lmtd
|
$6,989.40 |
$6,989.40 |
$6,989.40 |
$4,305.60
|
|
Ph1 assmt&mgmt nqhp 11-20
|
$95.40 |
$95.40 |
$95.40 |
$60.80
|
|
Ph1 assmt&mgmt nqhp 21-30
|
$141.00 |
$141.00 |
$141.00 |
$91.50
|
|
Ph1 assmt&mgmt nqhp 5-10
|
$49.20 |
$49.20 |
$49.20 |
$33.30
|
|
Ph body fluid
|
$94.80 |
$94.80 |
$94.80 |
$41.28
|
|
Phencyclidine (pcp)
|
$437.40 |
$437.40 |
$437.40 |
$96.00
|
|
Phenobarbital therapeutic drug level
|
$195.00 |
$195.00 |
$195.00 |
$104.50
|
|
Phenytoin total therapeutic drug level
|
$243.60 |
$243.60 |
$243.60 |
$110.88
|
|
Phlebotomy therapeutic
|
$195.00 |
$195.00 |
$195.00 |
$231.66
|
|
Phleb veins 1 extrm 10-20 stab
|
$6,231.60 |
$6,231.60 |
$6,231.60 |
$4,599.65
|
|
Phleb veins 1 extrm >20 stab
|
$6,936.00 |
$6,936.00 |
$6,936.00 |
$4,453.46
|
|
Phosphorus
|
$117.60 |
$117.60 |
$117.60 |
$48.80
|
|
Phosphorus 24 hour urine
|
$243.60 |
$243.60 |
$243.60 |
$41.51
|
|
Pillow shldr abduc inflat univ
|
$307.80 |
$307.80 |
$307.80 |
$614.36
|
|
Pin service 60m per month
|
$161.40 |
$161.40 |
$161.40 |
$114.00
|
|
Pinworm exam
|
$79.20 |
$79.20 |
$79.20 |
$39.75
|
|
Place cath intracranial art
|
$7,195.80 |
$7,195.80 |
$7,195.80 |
$3,775.95
|
|
Place cath xtrnl carotid
|
$9,230.40 |
$9,230.40 |
$9,230.40 |
$4,202.90
|
|
Place cecostomy tube perc
|
$2,082.60 |
$2,082.60 |
$2,082.60 |
$2,580.90
|
|
Place device/marker, non pro
|
$1,170.00 |
$1,170.00 |
$1,170.00 |
$1,969.20
|
|
Place duod/jej tube perc
|
$2,964.00 |
$2,964.00 |
$2,964.00 |
$2,473.10
|
|
Place gastrostomy tube perc
|
$3,169.80 |
$3,169.80 |
$3,169.80 |
$2,289.60
|
|
Placement localization device(s) breast percutaneous mammographic guidance 1st lesion (both sides)
|
$1,032.00 |
$1,032.00 |
$1,032.00 |
$1,517.21
|
|
Placement localization device(s) breast percutaneous mammographic guide ea addl lesion left
|
$1,125.00 |
$1,125.00 |
$1,125.00 |
$795.00
|
|
Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides)
|
$1,396.80 |
$1,396.80 |
$1,396.80 |
$1,332.43
|
|
Placement nephrostomy catheter (both sides)
|
$3,327.00 |
$3,327.00 |
$3,327.00 |
$3,873.65
|
|
Placement occlusive device venous/arterial access site post procedure
|
$712.80 |
$712.80 |
$712.80 |
$571.45
|
|
Placement of seton
|
$2,253.00 |
$2,253.00 |
$2,253.00 |
$3,845.10
|
|
Placement stent(s) intravascular transcatheter artery initial
|
$12,533.40 |
$12,533.40 |
$12,533.40 |
$13,964.50
|
|
Place ndl musc/tis for right
|
$609.60 |
$609.60 |
$609.60 |
$3,591.33
|
|
Place needles h&n for right
|
$1,098.00 |
$1,098.00 |
$1,098.00 |
$7,000.36
|
|
Place needles pelvic for right
|
$951.00 |
$951.00 |
$951.00 |
$6,624.80
|
|
Place non-slctv cath thoracic arta
|
$5,809.80 |
$5,809.80 |
$5,809.80 |
$5,053.33
|
|
Place right device/marker pros
|
$912.00 |
$912.00 |
$912.00 |
$2,195.93
|
|
Place slctv cath carotd art uni
|
$14,313.00 |
$14,313.00 |
$14,313.00 |
$10,014.40
|
|
Place slctv cath carotid/inom art excrn uni
|
$8,366.40 |
$8,366.40 |
$8,366.40 |
$6,498.00
|
|
Place slctv cath carotid/inom art intcrn uni
|
$14,313.00 |
$14,313.00 |
$14,313.00 |
$8,538.00
|
|
Place slctv cath subclavian art
|
$14,313.00 |
$14,313.00 |
$14,313.00 |
$6,325.00
|
|
Place slctv cath vertebral art uni
|
$14,313.00 |
$14,313.00 |
$14,313.00 |
$8,971.00
|
