|
Observation per hour
|
$622.80 |
$622.80 |
$622.80 |
$81.22
|
|
Obstetric panel inc HIV tstg
|
$1,074.00 |
$1,074.00 |
$1,074.00 |
$262.01
|
|
Off/op cnsltj new/est low 30
|
$454.20 |
$454.20 |
$454.20 |
$180.00
|
|
Off/op cnsltj new/est mod 40
|
$643.80 |
$643.80 |
$643.80 |
$269.60
|
|
Off/op consltj new/est hi 55
|
$859.80 |
$859.80 |
$859.80 |
$339.30
|
|
Off/op consltj new/est sf 20
|
$360.00 |
$360.00 |
$360.00 |
$133.80
|
|
Ortho hnd metcrpl fx prefb w/fit&adj
|
$585.60 |
$585.60 |
$585.60 |
$174.40
|
|
Ortho whf rigd without jnt cstm w/fit&adj
|
$85.20 |
$85.20 |
$85.20 |
$420.76
|
|
Oscillation chest wall mechanical per session
|
$151.20 |
$151.20 |
$151.20 |
$195.00
|
|
Osmolality blood
|
$147.00 |
$147.00 |
$147.00 |
$67.60
|
|
Osmolality urine
|
$126.00 |
$126.00 |
$126.00 |
$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
|
$69.60 |
$69.60 |
$69.60 |
$123.05
|
|
Oth resp proc, indiv
|
$69.60 |
$69.60 |
$69.60 |
$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
|
$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
|
$206.40 |
$206.40 |
$206.40 |
$29.60
|
|
Parathormone (pth) intact
|
$96.60 |
$96.60 |
$96.60 |
$201.50
|
|
Parathyrd planar w/spect&ct
|
$2,200.80 |
$2,200.80 |
$2,200.80 |
$1,574.40
|
|
Parathyroid planar imaging
|
$1,677.00 |
$1,677.00 |
$1,677.00 |
$1,126.25
|
|
Parathyroid planar img w/tomo spect
|
$1,765.20 |
$1,765.20 |
$1,765.20 |
$1,350.00
|
|
Paring/cutting benign hyperkeratotic lesion single
|
$179.40 |
$179.40 |
$179.40 |
$245.00
|
|
Pelvic CT scan (with and without contrast)
|
$2,910.60 |
$2,910.60 |
$2,910.60 |
$1,887.84
|
|
Pelvic CT scan (with contrast)
|
$2,324.40 |
$2,324.40 |
$2,324.40 |
$1,608.98
|
|
Pelvic CT scan (without contrast)
|
$1,881.00 |
$1,881.00 |
$1,881.00 |
$1,362.00
|
|
Pelvic MRI (with and without contrast)
|
$4,281.00 |
$4,281.00 |
$4,281.00 |
$2,860.00
|
|
Pelvic MRI (with contrast)
|
$2,931.60 |
$2,931.60 |
$2,931.60 |
$2,210.00
|
|
Pelvic MRI (without contrast)
|
$2,685.60 |
$2,685.60 |
$2,685.60 |
$1,902.00
|
|
Pelvic Ultrasound (complete)
|
$967.80 |
$967.80 |
$967.80 |
$643.80
|
|
Pelvic Ultrasound (limited)
|
$669.00 |
$669.00 |
$669.00 |
$430.00
|
|
Pericardiocentesis wwo imaging
|
$1,993.80 |
$1,993.80 |
$1,993.80 |
$2,251.20
|
|
Peripheral vascular rehab
|
$134.40 |
$134.40 |
$134.40 |
$132.50
|
|
Perq dev breast 1st mr guide
|
$1,238.40 |
$1,238.40 |
$1,238.40 |
$1,837.20
|
|
Perq dev breast 1st strtctc
|
$1,238.40 |
$1,238.40 |
$1,238.40 |
$1,456.00
|
|
Perq rplcmt g-tube req revsn gstrst trk
|
$186.00 |
$186.00 |
$186.00 |
$625.93
|
|
Pet CT skull-mid thgh initial
|
$6,394.80 |
$6,394.80 |
$6,394.80 |
$4,645.20
|
|
Pet CT whole body initial
|
$6,991.80 |
$6,991.80 |
$6,991.80 |
$4,850.00
|
|
Pet fdg brain metoblic eval sb
|
$7,095.00 |
$7,095.00 |
$7,095.00 |
$4,060.00
|
|
Pet image w/ct lmtd
|
$5,480.40 |
$5,480.40 |
$5,480.40 |
$4,305.60
|
|
Ph1 assmt&mgmt nqhp 11-20
|
$88.80 |
$88.80 |
$88.80 |
$60.80
|
|
Ph1 assmt&mgmt nqhp 21-30
|
$132.00 |
$132.00 |
$132.00 |
$91.50
|
|
Ph1 assmt&mgmt nqhp 5-10
|
$46.20 |
$46.20 |
$46.20 |
$33.30
|
|
Ph body fluid
|
$75.60 |
$75.60 |
$75.60 |
$41.28
|
|
Phencyclidine (pcp)
|
$331.80 |
$331.80 |
$331.80 |
$95.55
|
|
Phenobarbital therapeutic drug level
|
$178.80 |
$178.80 |
$178.80 |
$104.25
|
|
Phenytoin total therapeutic drug level
|
$274.80 |
$274.80 |
$274.80 |
$110.88
|
|
Phlebotomy therapeutic
|
$573.60 |
$573.60 |
$573.60 |
$231.66
|
|
Phosphorus
|
$110.40 |
$110.40 |
$110.40 |
$47.81
|
|
Phosphorus 24 hour urine
|
$120.00 |
$120.00 |
$120.00 |
$40.95
|
|
Pillow shldr abduc inflat univ
|
$307.80 |
$307.80 |
$307.80 |
$543.52
|
|
Pin service 60m per month
|
$158.40 |
$158.40 |
$158.40 |
$114.00
|
|
Pinworm exam
|
$28.80 |
$28.80 |
$28.80 |
$39.67
|
|
Place breast cath for rad
|
$17,440.80 |
$17,440.80 |
$17,440.80 |
$3,332.00
|
|
Place breast rad tube/caths
|
$19,261.20 |
$19,261.20 |
$19,261.20 |
$7,680.06
|
|
Place gastrostomy tube perc
|
$2,391.60 |
$2,391.60 |
$2,391.60 |
$2,289.60
|
|
Placement localization device(s) breast percutaneous mammographic guidance 1st lesion (both sides)
|
$1,201.20 |
$1,201.20 |
$1,201.20 |
$1,517.21
|
|
Placement localization device(s) breast percutaneous mammographic guide ea addl lesion left
|
$1,238.40 |
$1,238.40 |
$1,238.40 |
$795.00
|
|
Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides)
|
$1,238.40 |
$1,238.40 |
$1,238.40 |
$1,332.43
|
|
Placement nephrostomy catheter (both sides)
|
$2,063.40 |
$2,063.40 |
$2,063.40 |
$3,873.65
|
|
Placement stent(s) intravascular transcatheter artery initial
|
$6,720.00 |
$6,720.00 |
$6,720.00 |
$13,964.50
|
|
Place needles h&n for right
|
$1,191.00 |
$1,191.00 |
$1,191.00 |
$7,000.36
|
|
Place needles pelvic for right
|
$1,137.60 |
$1,137.60 |
$1,137.60 |
$6,624.80
|
|
Place po breast cath for rad
|
$21,847.80 |
$21,847.80 |
$21,847.80 |
$11,066.55
|
|
Place right device/marker pros
|
$841.20 |
$841.20 |
$841.20 |
$2,195.93
|
|
Plasma cryoprecipitate reduced each unit
|
$139.20 |
$139.20 |
$139.20 |
$157.30
|
|
Platelet aggregation each agent teg
|
$565.20 |
$565.20 |
$565.20 |
$148.80
|
|
Platelet automated
|
$83.40 |
$83.40 |
$83.40 |
$45.60
|
|
Platelet pheresis each unit
|
$1,582.20 |
$1,582.20 |
$1,582.20 |
$947.00
|
|
Platelets leukocytes reduced each unit
|
$1,439.40 |
$1,439.40 |
$1,439.40 |
$302.25
|
|
Platelets leukoreduced cmv negative apheresis/phresis each unit
|
$1,437.60 |
$1,437.60 |
$1,437.60 |
$1,094.60
|
|
Platelets pheresis leukocytes reduced cmv negative irradiated each unit
|
$1,242.60 |
$1,242.60 |
$1,242.60 |
$1,170.65
|
|
Platelets pheresis leukocytes reduced each unit
|
$1,198.80 |
$1,198.80 |
$1,198.80 |
$1,139.20
|
|
Platelets pheresis leukocytes reduced irradiated each unit
|
$1,259.40 |
$1,259.40 |
$1,259.40 |
$1,259.94
|
|
Platelets pheresis pathogen-reduced each unit
|
$1,582.20 |
$1,582.20 |
$1,582.20 |
$1,004.00
|
|
Plc pq device breast ea addl lesion MRI guide
|
$1,238.40 |
$1,238.40 |
$1,238.40 |
$1,482.50
|
|
Plc pq device breast ea addl lesion stereo guide
|
$1,238.40 |
$1,238.40 |
$1,238.40 |
$691.20
|
|
Plc pq device breast ea addl lesion Ultrasound guide
|
$1,238.40 |
$1,238.40 |
$1,238.40 |
$758.52
|
|
Plethysmography lung volumes/airway resistance
|
$1,185.00 |
$1,185.00 |
$1,185.00 |
$403.80
|
|
Plmt nephroureteral catheter
|
$2,685.00 |
$2,685.00 |
$2,685.00 |
$4,081.37
|
|
Pmp22 gene dup/delet
|
$2,166.00 |
$2,166.00 |
$2,166.00 |
$1,029.75
|
|
Pmp22 gene full sequence
|
$2,166.00 |
$2,166.00 |
$2,166.00 |
$986.40
|
|
Pms2 gene dup/delet variants
|
$555.00 |
$555.00 |
$555.00 |
$407.20
|
|
Pms2 gene full seq analysis
|
$1,122.00 |
$1,122.00 |
$1,122.00 |
$1,002.60
|
|
Poct blood gases ph pco2 po2 arterial calculated o2
|
$304.80 |
$304.80 |
$304.80 |
$187.32
|
|
Polysomnography sleep staging >=4 parameters age >=6 years w/cpap bipap
|
$3,804.00 |
$3,804.00 |
$3,804.00 |
$3,751.48
|
|
Potassium 24 hour urine
|
$125.40 |
$125.40 |
$125.40 |
$50.40
|
|
Potassium serum/plasma/whole blood
|
$120.00 |
$120.00 |
$120.00 |
$46.40
|
|
Pq dr cath chg w cont s&i
|
$922.80 |
$922.80 |
$922.80 |
$720.00
|
|
Pq kyphplsty 1 bdy lumb w/img
|
$11,121.60 |
$11,121.60 |
$11,121.60 |
$9,977.57
|
|
Pq thr inj ext pse
|
$367.80 |
$367.80 |
$367.80 |
$775.00
|
