|
Pelvic CT scan (with and without contrast)
|
$1,285.00 |
$1,285.00 |
$1,285.00 |
$1,890.36
|
|
Pelvic CT scan (with contrast)
|
$890.00 |
$890.00 |
$890.00 |
$1,608.98
|
|
Pelvic CT scan (without contrast)
|
$785.00 |
$785.00 |
$785.00 |
$1,335.34
|
|
Pelvic MRI (with and without contrast)
|
$2,360.00 |
$2,360.00 |
$2,360.00 |
$2,860.00
|
|
Pelvic MRI (with contrast)
|
$1,605.00 |
$1,605.00 |
$1,605.00 |
$2,210.00
|
|
Pelvic MRI (without contrast)
|
$1,505.00 |
$1,505.00 |
$1,505.00 |
$1,916.50
|
|
Pelvic Ultrasound (complete)
|
$880.00 |
$880.00 |
$880.00 |
$643.80
|
|
Pelvic Ultrasound (limited)
|
$660.00 |
$660.00 |
$660.00 |
$430.80
|
|
Pelvis X-ray (1 to 2 views)
|
$412.50 |
$412.50 |
$412.50 |
$281.82
|
|
Pelvis X-ray (complete, 4 or more views)
|
$515.00 |
$515.00 |
$515.00 |
$351.75
|
|
Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe
|
$75.22 |
$75.22 |
$75.22 |
$824.70
|
|
Penile vascular study
|
$590.00 |
$590.00 |
$590.00 |
$561.00
|
|
Perc cryo ablate renal tum
|
$7,650.00 |
$7,650.00 |
$7,650.00 |
$11,523.76
|
|
Perc rf ablate renal tumor
|
$6,380.00 |
$6,380.00 |
$6,380.00 |
$7,243.60
|
|
Percut ablate liver rf
|
$7,440.00 |
$7,440.00 |
$7,440.00 |
$6,904.15
|
|
Perflutren lipid microspheres 1.1 mg/ml intravenous suspension
|
$198.32 |
$198.32 |
$198.32 |
$332.84
|
|
Pericardiocentesis wwo imaging
|
$1,980.00 |
$1,980.00 |
$1,980.00 |
$2,375.00
|
|
Peripheral vascular rehab
|
$67.50 |
$67.50 |
$67.50 |
$132.50
|
|
Peri-proc device eval icd
|
$135.00 |
$135.00 |
$135.00 |
$192.40
|
|
Peri-proc device eval pm
|
$102.50 |
$102.50 |
$102.50 |
$156.00
|
|
Peritoneogram rs&i
|
$640.00 |
$640.00 |
$640.00 |
$698.50
|
|
Perq art m-thrombect &/nfs
|
$7,365.00 |
$7,365.00 |
$7,365.00 |
$7,559.55
|
|
Perq clsr tcat l atr apndge
|
$10,785.00 |
$10,785.00 |
$10,785.00 |
$9,309.08
|
|
Perq dev breast 1st mr guide
|
$955.00 |
$955.00 |
$955.00 |
$1,768.20
|
|
Perq nl/pl lithotrp smpl<2cm
|
$6,530.00 |
$6,530.00 |
$6,530.00 |
$9,442.38
|
|
Perq p-art revsc 1 abnor bi
|
$24,880.00 |
$24,880.00 |
$24,880.00 |
$17,321.20
|
|
Perq p-art revsc 1 abnor uni
|
$19,905.00 |
$19,905.00 |
$19,905.00 |
$22,559.00
|
|
Perq p-art revsc 1 nm nt bi
|
$15,400.00 |
$15,400.00 |
$15,400.00 |
$15,916.29
|
|
Perq p-art revsc 1 nm nt uni
|
$12,320.00 |
$12,320.00 |
$12,320.00 |
$17,321.20
|
|
Perq p-art revsc each addl
|
$6,160.00 |
$6,160.00 |
$6,160.00 |
$8,824.30
|
|
Perq plmt bile duct stent
|
$4,255.00 |
$4,255.00 |
$4,255.00 |
$6,904.15
|
|
Perq plmt bile duct stent
|
$4,255.00 |
$4,255.00 |
$4,255.00 |
$6,810.50
|
|
Perq plmt bile duct stent
|
$6,705.00 |
$6,705.00 |
$6,705.00 |
$7,020.00
|
|
Perq rplcmt g-tube req revsn gstrst trk
|
$675.00 |
$675.00 |
$675.00 |
$625.93
|
|
Perq transcath closure pda
|
$17,610.00 |
$17,610.00 |
$17,610.00 |
$18,408.00
|
|
Perq transcath cls aortic
|
$18,420.00 |
$18,420.00 |
$18,420.00 |
$22,633.26
|
|
Perq transcath cls mitral
|
$18,420.00 |
$18,420.00 |
$18,420.00 |
$23,617.60
|
|
Perq transcath septal reduxn
|
$11,810.00 |
$11,810.00 |
$11,810.00 |
$8,999.20
|
|
Pet CT skull-mid thgh initial
|
$4,850.00 |
$4,850.00 |
$4,850.00 |
$4,707.00
|
|
Pet CT whole body initial
|
$4,850.00 |
$4,850.00 |
$4,850.00 |
$4,850.00
|
|
Pet fdg brain metoblic eval sb
|
$4,850.00 |
$4,850.00 |
$4,850.00 |
$4,060.00
|
|
Pet image w/ct lmtd
|
$4,850.00 |
$4,850.00 |
$4,850.00 |
$4,349.76
|
|
Pfc sigma fem post aug sz3 8mm
|
$18,827.50 |
$18,827.50 |
$18,827.50 |
$39,920.50
|
|
Ph1 assmt&mgmt nqhp 11-20
|
$82.50 |
$82.50 |
$82.50 |
$60.80
|
|
Ph1 assmt&mgmt nqhp 21-30
|
$110.00 |
$110.00 |
$110.00 |
$91.50
|
|
Ph1 assmt&mgmt nqhp 5-10
|
$50.00 |
$50.00 |
$50.00 |
$31.20
|
|
Ph body fluid
|
$27.50 |
$27.50 |
$27.50 |
$42.00
|
|
Phencyclidine (pcp)
|
$212.50 |
$212.50 |
$212.50 |
$96.39
|
|
Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr
|
$72.45 |
$72.45 |
$72.45 |
$114.56
|
|
Phenobarbital therapeutic drug level
|
$77.50 |
$77.50 |
$77.50 |
$105.00
|
|
Phenylephrine 10 mg/ml injection solution
|
$9.37 |
$9.37 |
$9.37 |
$62.98
|
|
Phenytoin total therapeutic drug level
|
$100.00 |
$100.00 |
$100.00 |
$111.27
|
|
Phlebotomy therapeutic
|
$207.50 |
$207.50 |
$207.50 |
$231.40
|
|
Phleb veins 1 extrm 10-20 stab
|
$3,785.00 |
$3,785.00 |
$3,785.00 |
$4,810.00
|
|
Phleb veins 1 extrm >20 stab
|
$4,355.00 |
$4,355.00 |
$4,355.00 |
$4,621.21
|
|
Phosphorus
|
$35.00 |
$35.00 |
$35.00 |
$49.20
|
|
Phosphorus 24 hour urine
|
$57.50 |
$57.50 |
$57.50 |
$42.25
|
|
Phys blood bank serv reactj
|
$285.00 |
$285.00 |
$285.00 |
$207.50
|
|
Physical Therapy Evaluation (high complexity)
|
$212.50 |
$212.50 |
$212.50 |
$294.00
|
|
Physical Therapy Evaluation (low complexity)
|
$207.50 |
$207.50 |
$207.50 |
$223.92
|
|
Physical Therapy Evaluation (moderate complexity)
|
$210.00 |
$210.00 |
$210.00 |
$256.20
|
|
Physical Therapy Re-Evaluation
|
$120.00 |
$120.00 |
$120.00 |
$154.80
|
|
Phytonadione (vitamin k1) 10 mg/ml injection solution
|
$124.48 |
$124.48 |
$124.48 |
$90.25
|
|
Piflu f-18, dia 1 millicurie
|
$574.45 |
$574.45 |
$574.45 |
$1,038.40
|
|
Pinworm exam
|
$22.50 |
$22.50 |
$22.50 |
$39.62
|
|
Piperacillin-tazobactam 3.375 gram intravenous solution
|
$23.66 |
$23.66 |
$23.66 |
$81.36
|
|
Place cath intracranial art
|
$2,380.00 |
$2,380.00 |
$2,380.00 |
$3,775.95
|
|
Place cath xtrnl carotid
|
$2,765.00 |
$2,765.00 |
$2,765.00 |
$4,202.90
|
|
Place device/marker, non pro
|
$1,870.00 |
$1,870.00 |
$1,870.00 |
$1,969.20
|
|
Place duod/jej tube perc
|
$2,130.00 |
$2,130.00 |
$2,130.00 |
$2,562.75
|
|
Place gastrostomy tube perc
|
$2,685.00 |
$2,685.00 |
$2,685.00 |
$2,289.60
|
|
Placement bile duct support
|
$2,030.00 |
$2,030.00 |
$2,030.00 |
$2,732.00
|
|
Placement localization device(s) breast percutaneous mammographic guidance 1st lesion (both sides)
|
$1,070.00 |
$1,070.00 |
$1,070.00 |
$1,485.90
|
|
Placement localization device(s) breast percutaneous mammographic guide ea addl lesion left
|
$800.00 |
$800.00 |
$800.00 |
$795.00
|
|
Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides)
|
$1,250.00 |
$1,250.00 |
$1,250.00 |
$1,332.43
|
|
Placement nephrostomy catheter (both sides)
|
$3,850.00 |
$3,850.00 |
$3,850.00 |
$3,933.00
|
|
Placement occlusive device venous/arterial access site post procedure
|
$625.00 |
$625.00 |
$625.00 |
$572.00
|
|
Placement stent(s) intravascular transcatheter artery initial
|
$11,270.00 |
$11,270.00 |
$11,270.00 |
$13,879.25
|
|
Place non-slctv cath thoracic arta
|
$3,770.00 |
$3,770.00 |
$3,770.00 |
$5,271.46
|
|
Placental lactogen
|
$125.00 |
$125.00 |
$125.00 |
$163.28
|
|
Place po breast cath for rad
|
$11,285.00 |
$11,285.00 |
$11,285.00 |
$10,741.80
|
|
Place right device/marker pros
|
$1,895.00 |
$1,895.00 |
$1,895.00 |
$2,402.50
|
|
Place slctv cath carotd art uni
|
$7,900.00 |
$7,900.00 |
$7,900.00 |
$10,150.40
|
|
Place slctv cath carotid/inom art excrn uni
|
$5,910.00 |
$5,910.00 |
$5,910.00 |
$6,498.00
|
|
Place slctv cath carotid/inom art intcrn uni
|
$7,900.00 |
$7,900.00 |
$7,900.00 |
$9,074.00
|
|
Place slctv cath subclavian art
|
$5,840.00 |
$5,840.00 |
$5,840.00 |
$6,325.00
|
|
Place slctv cath vertebral art uni
|
$7,900.00 |
$7,900.00 |
$7,900.00 |
$9,090.00
|
|
Plasma cryoprecipitate reduced each unit
|
$185.00 |
$185.00 |
$185.00 |
$163.04
|
|
Platelet aggregation each agent teg
|
$120.00 |
$120.00 |
$120.00 |
$148.98
|
|
Platelet automated
|
$32.50 |
$32.50 |
$32.50 |
$46.00
|
|
Platelet pheresis each unit
|
$1,270.00 |
$1,270.00 |
$1,270.00 |
$1,012.80
|
|
Platelet pheresis irr ea
|
$1,025.00 |
$1,025.00 |
$1,025.00 |
$1,108.52
|
|
Platelets each unit
|
$252.50 |
$252.50 |
$252.50 |
$169.29
|
|
Platelets hla matched leukocytes reduced apheresis/pheresis each unit
|
$1,275.00 |
$1,275.00 |
$1,275.00 |
$1,532.70
|
|
Platelets irradiated ea unit
|
$365.00 |
$365.00 |
$365.00 |
$259.70
|
|
Platelets leukocytes reduced each unit
|
$322.50 |
$322.50 |
$322.50 |
$315.25
|
|
Platelets leukocytes reduced irradiated each unit
|
$545.00 |
$545.00 |
$545.00 |
$411.20
|
|
Platelets leukoreduced cmv negative apheresis/phresis each unit
|
$895.00 |
$895.00 |
$895.00 |
$1,094.60
|
|
Platelets pheresis leukocytes reduced cmv negative irradiated each unit
|
$1,220.00 |
$1,220.00 |
$1,220.00 |
$1,170.65
|
|
Platelets pheresis leukocytes reduced each unit
|
$1,300.00 |
$1,300.00 |
$1,300.00 |
$1,162.50
|
