|
MRI chest w IV cont
|
$3,204.80 |
$3,204.80 |
$3,204.80 |
$2,210.00
|
|
MRI loex nonjt w IV cont
|
$5,237.60 |
$5,237.60 |
$5,237.60 |
$2,116.20
|
|
MRI lower extremity other than joint without contrast (both sides)
|
$4,994.40 |
$4,994.40 |
$4,994.40 |
$2,110.00
|
|
MRI lower extremity other than joint without & w/contrast (both sides)
|
$5,428.00 |
$5,428.00 |
$5,428.00 |
$2,855.40
|
|
MRI orbit/face/neck without contrast
|
$2,988.80 |
$2,988.80 |
$2,988.80 |
$1,902.00
|
|
MRI orbit/face/neck without & w/contrast
|
$4,291.20 |
$4,291.20 |
$4,291.20 |
$2,854.80
|
|
MRI orbit fac&nck w IV cont
|
$3,344.80 |
$3,344.80 |
$3,344.80 |
$2,176.20
|
|
MRI upper extremity other than joint without contrast (both sides)
|
$4,235.20 |
$4,235.20 |
$4,235.20 |
$2,020.80
|
|
MRI upper extremity other than joint without & w/contrast (both sides)
|
$5,642.40 |
$5,642.40 |
$5,642.40 |
$2,713.80
|
|
MRI upper extremity w/dye
|
$4,652.80 |
$4,652.80 |
$4,652.80 |
$2,024.40
|
|
Mr safety determination physician/other qhp
|
$152.00 |
$152.00 |
$152.00 |
$161.40
|
|
Mr safety implant elec prepj
|
$159.20 |
$159.20 |
$159.20 |
$168.60
|
|
Mr safety implant&/fb assmt clin staff ea add 30
|
$85.60 |
$85.60 |
$85.60 |
$58.08
|
|
Mr safety implt pos&/immoblj
|
$102.40 |
$102.40 |
$102.40 |
$120.80
|
|
Mr sfty implt&/fb asmt stf 1
|
$43.20 |
$43.20 |
$43.20 |
$45.56
|
|
Mr sfty med physics xm cstmz
|
$419.20 |
$419.20 |
$419.20 |
$444.00
|
|
Mthfr gene analy common variants
|
$429.60 |
$429.60 |
$429.60 |
$180.48
|
|
Mucopolysaccharides
|
$148.00 |
$148.00 |
$148.00 |
$178.36
|
|
Mumps antibody igg
|
$66.40 |
$66.40 |
$66.40 |
$78.00
|
|
Mycoplasma antibody igm
|
$66.40 |
$66.40 |
$66.40 |
$78.40
|
|
Myeloperoxidase ab multi step qualitative/semiquantitative
|
$854.40 |
$854.40 |
$854.40 |
$131.07
|
|
Nasal endoscopy dx uni/bi separate proc
|
$272.00 |
$272.00 |
$272.00 |
$363.48
|
|
Natriuretic peptide
|
$240.80 |
$240.80 |
$240.80 |
$176.15
|
|
Natural killer cells total count
|
$126.40 |
$126.40 |
$126.40 |
$132.60
|
|
Ndl insj without njx 1 or 2 musc
|
$40.00 |
$40.00 |
$40.00 |
$39.20
|
|
Ndl insj without njx 3+ musc
|
$40.00 |
$40.00 |
$40.00 |
$45.00
|
|
Neck (Cervical Spine) CT scan (with and without contrast)
|
$3,460.00 |
$3,460.00 |
$3,460.00 |
$2,055.15
|
|
Neck (Cervical Spine) CT scan (without contrast)
|
$2,412.00 |
$2,412.00 |
$2,412.00 |
$1,513.95
|
|
Neck (Cervical Spine) MRI (with and without contrast)
|
$4,408.80 |
$4,408.80 |
$4,408.80 |
$2,881.80
|
|
Neck (Cervical Spine) MRI (with contrast)
|
$3,704.00 |
$3,704.00 |
$3,704.00 |
$2,305.71
|
|
Neck (Cervical Spine) MRI (without contrast)
|
$3,224.80 |
$3,224.80 |
$3,224.80 |
$2,054.72
|
|
Neck MRA (blood vessel MRI, with and without contrast)
|
$3,555.20 |
$3,555.20 |
$3,555.20 |
$2,743.78
|
|
Neck MRA (blood vessel MRI, with contrast)
|
$3,380.00 |
$3,380.00 |
$3,380.00 |
$2,127.68
|
|
Neck MRA (blood vessel MRI, without contrast)
|
$3,274.40 |
$3,274.40 |
$3,274.40 |
$1,824.90
|
|
Nfct ds bv&vaginitis dna alg
|
$648.00 |
$648.00 |
$648.00 |
$435.00
|
|
Nm imaging bone/joint 3 phase study
|
$1,763.20 |
$1,763.20 |
$1,763.20 |
$1,708.85
|
|
Nm imaging bone/joint whole body
|
$1,748.80 |
$1,748.80 |
$1,748.80 |
$1,570.65
|
|
Nm imaging cardiac blood pooling planar single study at rest or stress
|
$1,688.80 |
$1,688.80 |
$1,688.80 |
$1,397.69
|
|
Nm imaging gastric emptying study
|
$1,499.20 |
$1,499.20 |
$1,499.20 |
$1,340.40
|
|
Nm imaging gastrointestinal acute blood loss
|
$1,499.20 |
$1,499.20 |
$1,499.20 |
$1,197.47
|
|
Nm imaging hepatobiliary system w/pharmacologic intervention
|
$1,912.80 |
$1,912.80 |
$1,912.80 |
$1,612.00
|
|
Nm imaging kidney morphology vascular flow/function single study w/pharmacological intervention
|
$1,592.80 |
$1,592.80 |
$1,592.80 |
$1,530.60
|
|
Nm imaging pulmonary ventilation/perfusion
|
$1,277.60 |
$1,277.60 |
$1,277.60 |
$1,590.00
|
|
Nm imaging thyroid single/multiple uptake(s) quantitative measurement(s)
|
$342.40 |
$342.40 |
$342.40 |
$1,091.00
|
|
Non-card vasc flow imaging
|
$676.00 |
$676.00 |
$676.00 |
$608.56
|
|
Noonan spectrum disorders
|
$4,772.80 |
$4,772.80 |
$4,772.80 |
$2,412.00
|
|
Nuclear Stress Test (Heart)
|
$3,117.60 |
$3,117.60 |
$3,117.60 |
$3,804.45
|
|
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 |
$392.45
|
|
Observation per hour
|
$785.60 |
$785.60 |
$785.60 |
$79.95
|
|
Obstetrics panel
|
$432.00 |
$432.00 |
$432.00 |
$214.50
|
|
Organic acids total quant ea spec
|
$303.20 |
$303.20 |
$303.20 |
$151.36
|
|
Ortho elbow without jnt cstm w/fit&adj
|
$218.40 |
$218.40 |
$218.40 |
$279.81
|
|
Ortho elbow w/lock w/ft&adj
|
$353.60 |
$353.60 |
$353.60 |
$504.00
|
|
Ortho ewh rgd without jnt cstm w/fit&adj
|
$528.80 |
$528.80 |
$528.80 |
$714.59
|
|
Ortho hnd/fngr without jnt cstm w/fit&adj
|
$210.40 |
$210.40 |
$210.40 |
$213.39
|
|
Ortho hnd/fngr w/jnt cstm w/fit&adj
|
$235.20 |
$235.20 |
$235.20 |
$310.00
|
|
Ortho hnd without jnt w/fit&adj
|
$197.60 |
$197.60 |
$197.60 |
$225.00
|
|
Ortho whf rigd without jnt cstm w/fit&adj
|
$272.80 |
$272.80 |
$272.80 |
$420.76
|
|
Ortho wrst/hnd w/jnt cstm w/fit&adj
|
$718.40 |
$718.40 |
$718.40 |
$645.00
|
|
Osmolality blood
|
$98.40 |
$98.40 |
$98.40 |
$69.55
|
|
Osmolality urine
|
$99.20 |
$99.20 |
$99.20 |
$65.65
|
|
Ot evaluation high complexity patient/family
|
$371.20 |
$371.20 |
$371.20 |
$292.80
|
|
Ot evaluation low complexity patient/family
|
$308.80 |
$308.80 |
$308.80 |
$226.80
|
|
Ot evaluation moderate complexity patient/family
|
$329.60 |
$329.60 |
$329.60 |
$263.50
|
|
Oth resp proc, group
|
$47.20 |
$47.20 |
$47.20 |
$127.40
|
|
Oth resp proc, indiv
|
$61.60 |
$61.60 |
$61.60 |
$83.50
|
|
Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes
|
$144.00 |
$144.00 |
$144.00 |
$98.62
|
|
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 |
$160.80
|
|
Ot therapeutic activities direct patient contact each 15 minutes
|
$140.00 |
$140.00 |
$140.00 |
$98.90
|
|
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
|
$334.40 |
$334.40 |
$334.40 |
$91.20
|
|
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
|
|
Parathormone (pth) intact
|
$220.00 |
$220.00 |
$220.00 |
$201.50
|
|
Paring/cutting benign hyperkeratotic lesion single
|
$260.80 |
$260.80 |
$260.80 |
$242.88
|
|
Pelvic CT scan (with and without contrast)
|
$2,916.00 |
$2,916.00 |
$2,916.00 |
$1,899.75
|
|
Pelvic CT scan (with contrast)
|
$2,350.40 |
$2,350.40 |
$2,350.40 |
$1,635.62
|
|
Pelvic CT scan (without contrast)
|
$2,052.80 |
$2,052.80 |
$2,052.80 |
$1,366.50
|
|
Pelvic MRI (with and without contrast)
|
$4,120.00 |
$4,120.00 |
$4,120.00 |
$2,870.36
|
|
Pelvic MRI (with contrast)
|
$3,547.20 |
$3,547.20 |
$3,547.20 |
$2,210.00
|
|
Pelvic MRI (without contrast)
|
$3,557.60 |
$3,557.60 |
$3,557.60 |
$1,929.85
|
|
Pelvic Ultrasound (complete)
|
$1,060.80 |
$1,060.80 |
$1,060.80 |
$650.40
|
|
Pelvic Ultrasound (limited)
|
$584.80 |
$584.80 |
$584.80 |
$430.00
|
|
Pericardiocentesis wwo imaging
|
$2,168.80 |
$2,168.80 |
$2,168.80 |
$2,341.50
|
|
Pet CT skull-mid thgh initial
|
$5,988.80 |
$5,988.80 |
$5,988.80 |
$4,711.20
|
|
Pet CT whole body initial
|
$6,069.60 |
$6,069.60 |
$6,069.60 |
$4,850.00
|
|
Pet fdg brain metoblic eval sb
|
$5,382.40 |
$5,382.40 |
$5,382.40 |
$3,789.00
|
|
Pet image w/ct lmtd
|
$5,676.00 |
$5,676.00 |
$5,676.00 |
$4,366.50
|
|
Ph body fluid
|
$25.60 |
$25.60 |
$25.60 |
$40.04
|
|
Phenobarbital therapeutic drug level
|
$172.00 |
$172.00 |
$172.00 |
$104.50
|
|
Phenytoin total therapeutic drug level
|
$147.20 |
$147.20 |
$147.20 |
$112.50
|
|
Phlebotomy therapeutic
|
$188.80 |
$188.80 |
$188.80 |
$231.66
|
|
Phosphorus
|
$81.60 |
$81.60 |
$81.60 |
$49.60
|
|
Phosphorus 24 hour urine
|
$27.20 |
$27.20 |
$27.20 |
$41.58
|
|
Pin service 60m per month
|
$179.20 |
$179.20 |
$179.20 |
$114.00
|
|
Pinworm exam
|
$73.60 |
$73.60 |
$73.60 |
$40.00
|