|
New Patient Office Visit (level 5)
|
$427.20 |
$427.20 |
$427.20 |
$349.70
|
|
Nfct ds bv&vaginitis dna alg
|
$490.20 |
$490.20 |
$490.20 |
$400.00
|
|
Nm imaging bone/joint 3 phase study
|
$2,011.20 |
$2,011.20 |
$2,011.20 |
$1,676.35
|
|
Nm imaging bone/joint whole body
|
$1,755.00 |
$1,755.00 |
$1,755.00 |
$1,570.65
|
|
Nm imaging gastrointestinal acute blood loss
|
$1,871.40 |
$1,871.40 |
$1,871.40 |
$1,200.00
|
|
Nm imaging hepatobiliary system w/pharmacologic intervention
|
$1,955.40 |
$1,955.40 |
$1,955.40 |
$1,612.00
|
|
Nm imaging kidney morphology vascular flow/function single study w/pharmacological intervention
|
$1,808.40 |
$1,808.40 |
$1,808.40 |
$1,517.10
|
|
Nm imaging pulmonary ventilation/perfusion
|
$2,278.20 |
$2,278.20 |
$2,278.20 |
$1,590.00
|
|
Nm imaging thyroid single/multiple uptake(s) quantitative measurement(s)
|
$1,368.00 |
$1,368.00 |
$1,368.00 |
$1,079.00
|
|
Noonan spectrum disorders
|
$3,862.20 |
$3,862.20 |
$3,862.20 |
$2,582.40
|
|
Npm1 gene
|
$1,042.80 |
$1,042.80 |
$1,042.80 |
$457.50
|
|
Nras gene variants exon 2&3
|
$587.40 |
$587.40 |
$587.40 |
$592.00
|
|
Nr lnr acclrtr tx max 5 sessions
|
$11,970.00 |
$11,970.00 |
$11,970.00 |
$6,737.40
|
|
Nuclear rx IV admin
|
$642.00 |
$642.00 |
$642.00 |
$864.50
|
|
Nuclear Stress Test (Heart)
|
$4,045.20 |
$4,045.20 |
$4,045.20 |
$3,804.45
|
|
Nushield 1 square cm
|
$1,177.20 |
$1,177.20 |
$1,177.20 |
$937.50
|
|
Observation direct referral from physician office for admission
|
$369.00 |
$369.00 |
$369.00 |
$384.00
|
|
Observation per hour
|
$604.80 |
$604.80 |
$604.80 |
$81.22
|
|
Obstetrics panel
|
$904.80 |
$904.80 |
$904.80 |
$214.50
|
|
Ortho hnd metcrpl fx prefb w/fit&adj
|
$585.60 |
$585.60 |
$585.60 |
$174.40
|
|
Orthopantogram
|
$2,548.20 |
$2,548.20 |
$2,548.20 |
$241.50
|
|
Ortho whf rigd without jnt cstm w/fit&adj
|
$85.20 |
$85.20 |
$85.20 |
$420.76
|
|
Oscillation chest wall mechanical per session
|
$115.20 |
$115.20 |
$115.20 |
$195.00
|
|
Osmolality blood
|
$130.80 |
$130.80 |
$130.80 |
$67.60
|
|
Osmolality urine
|
$111.00 |
$111.00 |
$111.00 |
$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
|
$55.20 |
$55.20 |
$55.20 |
$123.05
|
|
Oth resp proc, indiv
|
$93.00 |
$93.00 |
$93.00 |
$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
|
$108.00 |
$108.00 |
$108.00 |
$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
|
$217.20 |
$217.20 |
$217.20 |
$29.60
|
|
Parathormone (pth) intact
|
$310.80 |
$310.80 |
$310.80 |
$204.87
|
|
Parathyroid planar imaging
|
$1,396.20 |
$1,396.20 |
$1,396.20 |
$1,129.91
|
|
Ped home apnea mntr dl&alys
|
$319.20 |
$319.20 |
$319.20 |
$296.92
|
|
Pelvic CT scan (with and without contrast)
|
$2,546.40 |
$2,546.40 |
$2,546.40 |
$1,890.36
|
|
Pelvic CT scan (with contrast)
|
$2,447.40 |
$2,447.40 |
$2,447.40 |
$1,608.98
|
|
Pelvic CT scan (without contrast)
|
$2,446.80 |
$2,446.80 |
$2,446.80 |
$1,363.11
|
|
Pelvic MRI (with and without contrast)
|
$4,119.60 |
$4,119.60 |
$4,119.60 |
$2,860.00
|
|
Pelvic MRI (without contrast)
|
$4,119.60 |
$4,119.60 |
$4,119.60 |
$1,902.00
|
|
Pelvic Ultrasound (complete)
|
$742.80 |
$742.80 |
$742.80 |
$643.80
|
|
Pelvic Ultrasound (limited)
|
$543.60 |
$543.60 |
$543.60 |
$430.00
|
|
Penile vascular study
|
$939.60 |
$939.60 |
$939.60 |
$574.60
|
|
Pericardiocentesis wwo imaging
|
$2,079.60 |
$2,079.60 |
$2,079.60 |
$2,251.20
|
|
Peripheral vascular rehab
|
$135.60 |
$135.60 |
$135.60 |
$132.50
|
|
Perq rplcmt g-tube req revsn gstrst trk
|
$925.80 |
$925.80 |
$925.80 |
$625.93
|
|
Pet CT skull-mid thgh initial
|
$8,884.20 |
$8,884.20 |
$8,884.20 |
$4,707.00
|
|
Pet CT whole body initial
|
$9,827.40 |
$9,827.40 |
$9,827.40 |
$4,850.00
|
|
Pet fdg brain metoblic eval sb
|
$7,297.20 |
$7,297.20 |
$7,297.20 |
$4,060.00
|
|
Pet image w/ct lmtd
|
$12,204.60 |
$12,204.60 |
$12,204.60 |
$4,305.60
|
|
Ph1 assmt&mgmt nqhp 11-20
|
$95.40 |
$95.40 |
$95.40 |
$60.80
|
|
Ph1 assmt&mgmt nqhp 21-30
|
$141.60 |
$141.60 |
$141.60 |
$91.50
|
|
Ph1 assmt&mgmt nqhp 5-10
|
$49.20 |
$49.20 |
$49.20 |
$33.30
|
|
Ph body fluid
|
$79.80 |
$79.80 |
$79.80 |
$41.28
|
|
Phencyclidine (pcp)
|
$352.20 |
$352.20 |
$352.20 |
$96.00
|
|
Phenobarbital therapeutic drug level
|
$174.00 |
$174.00 |
$174.00 |
$104.50
|
|
Phenytoin total therapeutic drug level
|
$214.80 |
$214.80 |
$214.80 |
$110.88
|
|
Phlebotomy therapeutic
|
$385.80 |
$385.80 |
$385.80 |
$231.66
|
|
Phosphorus
|
$81.00 |
$81.00 |
$81.00 |
$48.80
|
|
Phosphorus 24 hour urine
|
$180.00 |
$180.00 |
$180.00 |
$41.51
|
|
Pillow shldr abduc inflat univ
|
$307.80 |
$307.80 |
$307.80 |
$614.36
|
|
Pin service 60m per month
|
$159.60 |
$159.60 |
$159.60 |
$114.00
|
|
Pinworm exam
|
$106.80 |
$106.80 |
$106.80 |
$39.75
|
|
Place breast cath for rad
|
$7,254.60 |
$7,254.60 |
$7,254.60 |
$3,332.00
|
|
Place breast rad tube/caths
|
$10,333.80 |
$10,333.80 |
$10,333.80 |
$7,680.06
|
|
Place cecostomy tube perc
|
$9,226.20 |
$9,226.20 |
$9,226.20 |
$2,580.90
|
|
Place duod/jej tube perc
|
$4,647.60 |
$4,647.60 |
$4,647.60 |
$2,473.10
|
|
Placement localization device(s) breast percutaneous mammographic guidance 1st lesion (both sides)
|
$4,234.20 |
$4,234.20 |
$4,234.20 |
$1,517.21
|
|
Placement localization device(s) breast percutaneous mammographic guide ea addl lesion left
|
$2,436.60 |
$2,436.60 |
$2,436.60 |
$795.00
|
|
Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides)
|
$2,544.60 |
$2,544.60 |
$2,544.60 |
$1,332.43
|
|
Placement occlusive device venous/arterial access site post procedure
|
$793.80 |
$793.80 |
$793.80 |
$571.45
|
|
Placement stent(s) intravascular transcatheter artery initial
|
$7,551.00 |
$7,551.00 |
$7,551.00 |
$13,964.50
|
|
Place po breast cath for rad
|
$15,310.80 |
$15,310.80 |
$15,310.80 |
$11,066.55
|
|
Plasma cryoprecipitate reduced each unit
|
$356.40 |
$356.40 |
$356.40 |
$157.95
|
|
Platelet aggregation each agent teg
|
$594.60 |
$594.60 |
$594.60 |
$148.80
|
|
Platelet automated
|
$99.60 |
$99.60 |
$99.60 |
$45.60
|
|
Platelet pheresis each unit
|
$2,590.80 |
$2,590.80 |
$2,590.80 |
$961.70
|
|
Platelets hla matched leukocytes reduced apheresis/pheresis each unit
|
$3,133.20 |
$3,133.20 |
$3,133.20 |
$1,504.10
|
|
Platelets leukocytes reduced each unit
|
$1,451.40 |
$1,451.40 |
$1,451.40 |
$302.25
|
|
Platelets leukocytes reduced irradiated each unit
|
$3,264.60 |
$3,264.60 |
$3,264.60 |
$411.20
|
|
Platelets leukoreduced cmv negative apheresis/phresis each unit
|
$3,351.60 |
$3,351.60 |
$3,351.60 |
$1,094.60
|
|
Platelets pheresis leukocytes reduced each unit
|
$3,001.80 |
$3,001.80 |
$3,001.80 |
$1,139.20
|
|
Platelets pheresis leukocytes reduced irradiated each unit
|
$3,133.20 |
$3,133.20 |
$3,133.20 |
$1,278.55
|
|
Platelets pheresis pathogen-reduced each unit
|
$3,001.80 |
$3,001.80 |
$3,001.80 |
$1,004.00
|
|
Plcmt dlyd xtn pros 1st vsl
|
$11,743.80 |
$11,743.80 |
$11,743.80 |
$3,793.50
|
|
Plcmt sft tiss loc pq w/img 1st lsn
|
$1,015.80 |
$1,015.80 |
$1,015.80 |
$1,230.00
|
|
Plcmt xtn pros evasc rpr per vsl
|
$16,911.00 |
$16,911.00 |
$16,911.00 |
$3,579.75
|
|
Plc pq device breast ea addl lesion Ultrasound guide
|
$2,544.60 |
$2,544.60 |
$2,544.60 |
$758.52
|
|
Plethysmography lung volumes/airway resistance
|
$271.20 |
$271.20 |
$271.20 |
$405.00
|
|
Plmt nephroureteral catheter
|
$2,280.60 |
$2,280.60 |
$2,280.60 |
$4,081.37
|
|
Pmp22 gene dup/delet
|
$2,004.00 |
$2,004.00 |
$2,004.00 |
$1,029.75
|
