|
Neck (Cervical Spine) CT scan (with and without contrast)
|
$4,934.40 |
$4,934.40 |
$4,934.40 |
$2,032.20
|
|
Neck (Cervical Spine) CT scan (with contrast)
|
$2,993.60 |
$2,993.60 |
$2,993.60 |
$1,708.20
|
|
Neck (Cervical Spine) CT scan (without contrast)
|
$2,656.00 |
$2,656.00 |
$2,656.00 |
$1,506.05
|
|
Neck (Cervical Spine) MRI (with and without contrast)
|
$5,178.40 |
$5,178.40 |
$5,178.40 |
$2,854.80
|
|
Neck (Cervical Spine) MRI (with contrast)
|
$4,444.00 |
$4,444.00 |
$4,444.00 |
$2,301.53
|
|
Neck (Cervical Spine) MRI (without contrast)
|
$3,684.00 |
$3,684.00 |
$3,684.00 |
$2,001.81
|
|
Neck MRA (blood vessel MRI, with and without contrast)
|
$4,490.40 |
$4,490.40 |
$4,490.40 |
$2,712.45
|
|
Neck MRA (blood vessel MRI, with contrast)
|
$3,495.20 |
$3,495.20 |
$3,495.20 |
$2,055.60
|
|
Neck MRA (blood vessel MRI, without contrast)
|
$3,226.40 |
$3,226.40 |
$3,226.40 |
$1,806.75
|
|
Neurolysis celiac plexus
|
$3,051.20 |
$3,051.20 |
$3,051.20 |
$1,754.00
|
|
Neurolysis trigeminal nerve
|
$5,818.40 |
$5,818.40 |
$5,818.40 |
$2,054.00
|
|
New Patient Office Visit (level 2)
|
$192.80 |
$192.80 |
$192.80 |
$151.50
|
|
New Patient Office Visit (level 3)
|
$273.60 |
$273.60 |
$273.60 |
$207.90
|
|
New Patient Office Visit (level 4)
|
$435.20 |
$435.20 |
$435.20 |
$289.60
|
|
New Patient Office Visit (level 5)
|
$569.60 |
$569.60 |
$569.60 |
$347.82
|
|
Nfct ds bv&vaginitis dna alg
|
$649.60 |
$649.60 |
$649.60 |
$400.00
|
|
Njx aa&/strd nrv nrvtg si jt
|
$3,499.20 |
$3,499.20 |
$3,499.20 |
$1,159.00
|
|
Njx interlaminar crv/thrc
|
$3,051.20 |
$3,051.20 |
$3,051.20 |
$1,586.71
|
|
Njx interlaminar crv/thrc
|
$4,503.20 |
$4,503.20 |
$4,503.20 |
$1,776.00
|
|
Njx interlaminar lmbr/sac
|
$3,051.20 |
$3,051.20 |
$3,051.20 |
$1,493.92
|
|
Njx interlaminar lmbr/sac
|
$4,503.20 |
$4,503.20 |
$4,503.20 |
$1,927.39
|
|
Nm imaging bone/joint 3 phase study
|
$2,161.60 |
$2,161.60 |
$2,161.60 |
$1,710.00
|
|
Nm imaging bone/joint whole body
|
$2,480.00 |
$2,480.00 |
$2,480.00 |
$1,570.65
|
|
Nm imaging cardiac blood pooling planar single study at rest or stress
|
$2,627.20 |
$2,627.20 |
$2,627.20 |
$1,401.00
|
|
Nm imaging gastric emptying study
|
$1,870.40 |
$1,870.40 |
$1,870.40 |
$1,357.00
|
|
Nm imaging gastrointestinal acute blood loss
|
$1,441.60 |
$1,441.60 |
$1,441.60 |
$1,211.60
|
|
Nm imaging hepatobiliary system w/pharmacologic intervention
|
$2,090.40 |
$2,090.40 |
$2,090.40 |
$1,612.00
|
|
Nm imaging kidney morphology vascular flow/function single study w/pharmacological intervention
|
$1,369.60 |
$1,369.60 |
$1,369.60 |
$1,550.95
|
|
Nm imaging pulmonary ventilation/perfusion
|
$2,627.20 |
$2,627.20 |
$2,627.20 |
$1,590.00
|
|
Nm imaging thyroid single/multiple uptake(s) quantitative measurement(s)
|
$1,608.00 |
$1,608.00 |
$1,608.00 |
$1,091.00
|
|
Noonan spectrum disorders
|
$5,060.00 |
$5,060.00 |
$5,060.00 |
$2,452.80
|
|
Npm1 gene
|
$1,528.00 |
$1,528.00 |
$1,528.00 |
$453.20
|
|
Nras gene variants exon 2&3
|
$860.00 |
$860.00 |
$860.00 |
$621.00
|
|
Nuclear Stress Test (Heart)
|
$6,121.60 |
$6,121.60 |
$6,121.60 |
$3,809.00
|
|
Nushield 1 square cm
|
$1,569.60 |
$1,569.60 |
$1,569.60 |
$937.50
|
|
Observation direct referral from physician office for admission
|
$515.20 |
$515.20 |
$515.20 |
$387.00
|
|
Observation per hour
|
$261.60 |
$261.60 |
$261.60 |
$80.73
|
|
Obstetric panel inc HIV tstg
|
$1,644.80 |
$1,644.80 |
$1,644.80 |
$288.01
|
|
Obstetrics panel
|
$1,247.20 |
$1,247.20 |
$1,247.20 |
$214.50
|
|
Ortho hnd metcrpl fx prefb w/fit&adj
|
$780.80 |
$780.80 |
$780.80 |
$174.40
|
|
Ortho whf rigd without jnt cstm w/fit&adj
|
$113.60 |
$113.60 |
$113.60 |
$461.28
|
|
Oscillation chest wall mechanical per session
|
$124.80 |
$124.80 |
$124.80 |
$195.00
|
|
Osmolality blood
|
$300.80 |
$300.80 |
$300.80 |
$69.55
|
|
Osmolality urine
|
$300.80 |
$300.80 |
$300.80 |
$66.13
|
|
Ot evaluation high complexity patient/family
|
$371.20 |
$371.20 |
$371.20 |
$292.00
|
|
Ot evaluation low complexity patient/family
|
$308.80 |
$308.80 |
$308.80 |
$229.45
|
|
Ot evaluation moderate complexity patient/family
|
$329.60 |
$329.60 |
$329.60 |
$263.50
|
|
Oth resp proc, group
|
$103.20 |
$103.20 |
$103.20 |
$123.05
|
|
Oth resp proc, indiv
|
$142.40 |
$142.40 |
$142.40 |
$81.60
|
|
Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes
|
$144.00 |
$144.00 |
$144.00 |
$98.40
|
|
Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes
|
$140.00 |
$140.00 |
$140.00 |
$104.50
|
|
Ot manual therpy techniques >=1 region each 15 minutes
|
$140.00 |
$140.00 |
$140.00 |
$105.00
|
|
Ot re-evaluation patient/family
|
$214.40 |
$214.40 |
$214.40 |
$158.40
|
|
Ot therapeutic activities direct patient contact each 15 minutes
|
$170.40 |
$170.40 |
$170.40 |
$99.00
|
|
Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes
|
$144.00 |
$144.00 |
$144.00 |
$86.65
|
|
Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes
|
$144.00 |
$144.00 |
$144.00 |
$91.30
|
|
Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes
|
$140.00 |
$140.00 |
$140.00 |
$97.80
|
|
Ot therapeutic procedure neuromuscular reeducate each 15 minutes
|
$144.00 |
$144.00 |
$144.00 |
$100.65
|
|
Ot training self care/home management direct contact each 15 minutes
|
$140.00 |
$140.00 |
$140.00 |
$93.60
|
|
Ovulation tests
|
$323.20 |
$323.20 |
$323.20 |
$29.60
|
|
Parathormone (pth) intact
|
$494.40 |
$494.40 |
$494.40 |
$204.00
|
|
Parathyroid planar imaging
|
$1,532.80 |
$1,532.80 |
$1,532.80 |
$1,132.80
|
|
Parathyroid planar img w/tomo spect
|
$2,014.40 |
$2,014.40 |
$2,014.40 |
$1,350.00
|
|
Paring/cutting benign hyperkeratotic lesion single
|
$251.20 |
$251.20 |
$251.20 |
$245.67
|
|
Pelvic CT scan (with and without contrast)
|
$3,340.80 |
$3,340.80 |
$3,340.80 |
$1,890.36
|
|
Pelvic CT scan (with contrast)
|
$2,953.60 |
$2,953.60 |
$2,953.60 |
$1,608.98
|
|
Pelvic CT scan (without contrast)
|
$2,306.40 |
$2,306.40 |
$2,306.40 |
$1,357.52
|
|
Pelvic MRI (with and without contrast)
|
$4,833.60 |
$4,833.60 |
$4,833.60 |
$2,860.00
|
|
Pelvic MRI (with contrast)
|
$4,444.00 |
$4,444.00 |
$4,444.00 |
$2,210.00
|
|
Pelvic MRI (without contrast)
|
$3,495.20 |
$3,495.20 |
$3,495.20 |
$1,916.50
|
|
Pelvic Ultrasound (complete)
|
$1,284.00 |
$1,284.00 |
$1,284.00 |
$652.50
|
|
Pelvic Ultrasound (limited)
|
$835.20 |
$835.20 |
$835.20 |
$435.09
|
|
Pericardiocentesis wwo imaging
|
$5,796.00 |
$5,796.00 |
$5,796.00 |
$2,276.64
|
|
Peripheral vascular rehab
|
$179.20 |
$179.20 |
$179.20 |
$132.50
|
|
Perq dev breast 1st mr guide
|
$2,432.00 |
$2,432.00 |
$2,432.00 |
$1,768.20
|
|
Perq dev breast 1st strtctc
|
$2,432.00 |
$2,432.00 |
$2,432.00 |
$1,456.00
|
|
Perq rplcmt g-tube req revsn gstrst trk
|
$464.80 |
$464.80 |
$464.80 |
$625.93
|
|
Pet CT skull-mid thgh initial
|
$9,546.40 |
$9,546.40 |
$9,546.40 |
$4,707.00
|
|
Pet CT whole body initial
|
$9,546.40 |
$9,546.40 |
$9,546.40 |
$4,850.00
|
|
Pet fdg brain metoblic eval sb
|
$10,888.80 |
$10,888.80 |
$10,888.80 |
$3,926.00
|
|
Pet image w/ct lmtd
|
$8,679.20 |
$8,679.20 |
$8,679.20 |
$4,409.00
|
|
Ph body fluid
|
$133.60 |
$133.60 |
$133.60 |
$40.04
|
|
Phencyclidine (pcp)
|
$479.20 |
$479.20 |
$479.20 |
$90.00
|
|
Phenobarbital therapeutic drug level
|
$456.00 |
$456.00 |
$456.00 |
$104.50
|
|
Phenytoin total therapeutic drug level
|
$287.20 |
$287.20 |
$287.20 |
$112.50
|
|
Phlebotomy therapeutic
|
$581.60 |
$581.60 |
$581.60 |
$238.04
|
|
Phosphorus
|
$129.60 |
$129.60 |
$129.60 |
$49.60
|
|
Phosphorus 24 hour urine
|
$265.60 |
$265.60 |
$265.60 |
$41.58
|
|
Pillow shldr abduc inflat univ
|
$410.40 |
$410.40 |
$410.40 |
$537.66
|
|
Pin service 60m per month
|
$212.00 |
$212.00 |
$212.00 |
$114.00
|
|
Pinworm exam
|
$171.20 |
$171.20 |
$171.20 |
$40.00
|
|
Placement localization device(s) breast percutaneous mammographic guidance 1st lesion (both sides)
|
$2,432.00 |
$2,432.00 |
$2,432.00 |
$1,519.00
|
|
Placement localization device(s) breast percutaneous mammographic guide ea addl lesion left
|
$2,432.00 |
$2,432.00 |
$2,432.00 |
$795.00
|
|
Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides)
|
$2,432.00 |
$2,432.00 |
$2,432.00 |
$1,332.43
|
|
Placement stent(s) intravascular transcatheter artery initial
|
$9,350.40 |
$9,350.40 |
$9,350.40 |
$13,879.25
|
|
Plasma cryoprecipitate reduced each unit
|
$183.20 |
$183.20 |
$183.20 |
$162.21
|
|
Platelet aggregation each agent teg
|
$772.80 |
$772.80 |
$772.80 |
$146.25
|
|
Platelet automated
|
$101.60 |
$101.60 |
$101.60 |
$45.60
|
|
Platelet pheresis each unit
|
$2,092.00 |
$2,092.00 |
$2,092.00 |
$947.00
|
|
Platelets hla matched leukocytes reduced apheresis/pheresis each unit
|
$2,300.00 |
$2,300.00 |
$2,300.00 |
$1,523.42
|