|
Ob Ultrasound nuchal meas add-on
|
$544.20 |
$544.20 |
$544.20 |
$249.60
|
|
Occupational Therapy Evaluation (high complexity)
|
$285.00 |
$285.00 |
$285.00 |
$297.00
|
|
Occupational Therapy Evaluation (low complexity)
|
$187.20 |
$187.20 |
$187.20 |
$232.40
|
|
Occupational Therapy Evaluation (moderate complexity)
|
$249.60 |
$249.60 |
$249.60 |
$264.55
|
|
Ocrelizumab 30 mg/ml intravenous solution
|
$30,620.87 |
$30,620.87 |
$30,620.87 |
$41,294.43
|
|
Octreotide acetate 100 mcg/ml injection (wrapper)
|
$97.11 |
$97.11 |
$97.11 |
$90.00
|
|
Octreotide,microspheres ER 20 mg intramuscular susp, extended release
|
$9,617.10 |
$9,617.10 |
$9,617.10 |
$12,080.43
|
|
Olanzapine 10 mg intramuscular solution
|
$120.17 |
$120.17 |
$120.17 |
$109.62
|
|
Omalizumab 150 mg/ml subcutaneous syringe (wrapper)
|
$21.51 |
$21.51 |
$21.51 |
$4,595.01
|
|
Oncoprotein dcp
|
$245.40 |
$245.40 |
$245.40 |
$171.25
|
|
Ondansetron 8 mg disintegrating tablet
|
$1.90 |
$1.90 |
$1.90 |
$9.93
|
|
Ondansetron hcl (pf) 2 mg/ml injection (wrapper)
|
$45.34 |
$45.34 |
$45.34 |
$22.62
|
|
Oral busulfan
|
$18.96 |
$18.96 |
$18.96 |
$176.80
|
|
Organic acids total quant ea spec
|
$106.20 |
$106.20 |
$106.20 |
$152.50
|
|
Orphenadrine citrate 30 mg/ml injection solution
|
$40.92 |
$40.92 |
$40.92 |
$50.63
|
|
Ortho dvc repair per 15 min
|
$62.40 |
$62.40 |
$62.40 |
$53.43
|
|
Ortho elbow without jnt cstm w/fit&adj
|
$487.20 |
$487.20 |
$487.20 |
$279.81
|
|
Ortho ewhf rigd without jnt cstm w
|
$1,008.60 |
$1,008.60 |
$1,008.60 |
$1,288.00
|
|
Ortho ewh rgd without jnt cstm w/fit&adj
|
$663.60 |
$663.60 |
$663.60 |
$702.80
|
|
Ortho hnd/fngr without jnt cstm w/fit&adj
|
$231.00 |
$231.00 |
$231.00 |
$231.66
|
|
Ortho hnd without jnt w/fit&adj
|
$238.20 |
$238.20 |
$238.20 |
$229.45
|
|
Orthopantogram
|
$281.40 |
$281.40 |
$281.40 |
$241.50
|
|
Ortho whf rigd without jnt cstm w/fit&adj
|
$487.80 |
$487.80 |
$487.80 |
$421.00
|
|
Osmolality blood
|
$71.40 |
$71.40 |
$71.40 |
$69.55
|
|
Osmolality urine
|
$79.80 |
$79.80 |
$79.80 |
$65.50
|
|
Oth resp proc, group
|
$97.20 |
$97.20 |
$97.20 |
$126.00
|
|
Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes
|
$79.20 |
$79.20 |
$79.20 |
$98.40
|
|
Ot re-evaluation patient/family
|
$117.00 |
$117.00 |
$117.00 |
$160.80
|
|
Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes
|
$88.80 |
$88.80 |
$88.80 |
$88.54
|
|
Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes
|
$97.80 |
$97.80 |
$97.80 |
$94.81
|
|
Oxaliplatin 5 mg/ml desensitization
|
$3.82 |
$3.82 |
$3.82 |
$348.69
|
|
Oxytocin 10 unit/ml injection solution
|
$64.52 |
$64.52 |
$64.52 |
$50.40
|
|
Paclitaxel 6 mg/ml concentrate,intravenous
|
$1.85 |
$1.85 |
$1.85 |
$216.00
|
|
Paclitaxel protein-bound 100 mg intravenous suspension
|
$29.18 |
$29.18 |
$29.18 |
$3,435.42
|
|
Paliperidone 117 mg/0.75 ml inj
|
$4,898.66 |
$4,898.66 |
$4,898.66 |
$6,238.82
|
|
Palivizumab 50 mg/0.5 ml inj
|
$5,156.88 |
$5,156.88 |
$5,156.88 |
$5,569.20
|
|
Palonosetron hcl
|
$1,272.57 |
$1,272.57 |
$1,272.57 |
$162.89
|
|
Pamidronate 30 mg/10 ml (3 mg/ml) intravenous solution
|
$129.80 |
$129.80 |
$129.80 |
$122.00
|
|
Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr
|
$65.80 |
$65.80 |
$65.80 |
$28.90
|
|
Papaverin hcl injection
|
$121.02 |
$121.02 |
$121.02 |
$78.75
|
|
Parathormone (pth) intact
|
$265.20 |
$265.20 |
$265.20 |
$206.18
|
|
Parathyrd planar w/spect&ct
|
$1,729.80 |
$1,729.80 |
$1,729.80 |
$1,574.40
|
|
Parathyroid planar imaging
|
$1,170.60 |
$1,170.60 |
$1,170.60 |
$1,125.60
|
|
Parathyroid planar img w/tomo spect
|
$1,542.00 |
$1,542.00 |
$1,542.00 |
$1,350.60
|
|
Paricalcitol
|
$47.38 |
$47.38 |
$47.38 |
$47.15
|
|
Paring/cutting benign hyperkeratotic lesion single
|
$192.60 |
$192.60 |
$192.60 |
$245.67
|
|
Particle matristem matrix 1000mg micron-q4118-cost per mg
|
$4,564.80 |
$4,564.80 |
$4,564.80 |
$4,921.76
|
|
Passy muir valve metal trach
|
$12,104.40 |
$12,104.40 |
$12,104.40 |
$275.75
|
|
Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector
|
$9,121.58 |
$9,121.58 |
$9,121.58 |
$11,216.31
|
|
Pegfilgrastim-apgf 6 mg/0.6 ml subcutaneous syringe
|
$5,688.56 |
$5,688.56 |
$5,688.56 |
$6,370.52
|
|
Pegfilgrastim-cbqv 6 mg/0.6 ml subcutaneous syringe
|
$5,159.82 |
$5,159.82 |
$5,159.82 |
$7,297.36
|
|
Pegfilgrastim-jmdb 6 mg/0.6 ml subcutaneous syringe
|
$5,961.60 |
$5,961.60 |
$5,961.60 |
$4,133.25
|
|
Pegloticase 8 mg/ml intravenous solution
|
$41,940.84 |
$41,940.84 |
$41,940.84 |
$49,135.11
|
|
Pelvic CT scan (with and without contrast)
|
$1,707.60 |
$1,707.60 |
$1,707.60 |
$1,890.36
|
|
Pelvic CT scan (with contrast)
|
$1,680.60 |
$1,680.60 |
$1,680.60 |
$1,608.98
|
|
Pelvic CT scan (without contrast)
|
$885.00 |
$885.00 |
$885.00 |
$1,333.20
|
|
Pelvic MRI (with and without contrast)
|
$2,176.20 |
$2,176.20 |
$2,176.20 |
$2,860.00
|
|
Pelvic MRI (with contrast)
|
$2,176.20 |
$2,176.20 |
$2,176.20 |
$2,210.00
|
|
Pelvic MRI (without contrast)
|
$1,270.20 |
$1,270.20 |
$1,270.20 |
$1,916.50
|
|
Pelvic Ultrasound (complete)
|
$544.20 |
$544.20 |
$544.20 |
$643.80
|
|
Pelvic Ultrasound (limited)
|
$544.20 |
$544.20 |
$544.20 |
$432.50
|
|
Pelvis X-ray (1 to 2 views)
|
$281.40 |
$281.40 |
$281.40 |
$282.00
|
|
Pelvis X-ray (complete, 4 or more views)
|
$281.40 |
$281.40 |
$281.40 |
$355.50
|
|
Pembrolizumab 25 mg/ml intravenous solution
|
$85.04 |
$85.04 |
$85.04 |
$12,385.22
|
|
Pemetrexed disodium 100 mg intravenous powder for solution
|
$16.16 |
$16.16 |
$16.16 |
$7,089.13
|
|
Peng benzathine/procaine inj
|
$338.23 |
$338.23 |
$338.23 |
$375.32
|
|
Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe
|
$48.74 |
$48.74 |
$48.74 |
$824.70
|
|
Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr
|
$66.34 |
$66.34 |
$66.34 |
$97.85
|
|
Penicillin g procaine inj
|
$107.18 |
$107.18 |
$107.18 |
$149.20
|
|
Pentamidine non-comp unit
|
$279.76 |
$279.76 |
$279.76 |
$294.39
|
|
Pentobarbital sodium inj
|
$4,918.36 |
$4,918.36 |
$4,918.36 |
$2,205.38
|
|
Perc cryo ablate renal tum
|
$7,600.20 |
$7,600.20 |
$7,600.20 |
$11,523.76
|
|
Perc d-e cor revasc chro add
|
$29,520.00 |
$29,520.00 |
$29,520.00 |
$13,103.00
|
|
Perc d-e cor revasc chro sin
|
$45,602.40 |
$45,602.40 |
$45,602.40 |
$18,435.36
|
|
Perc d-e cor revasc t cabg b
|
$29,520.00 |
$29,520.00 |
$29,520.00 |
$11,976.00
|
|
Perc d-e cor revasc t cabg s
|
$45,602.40 |
$45,602.40 |
$45,602.40 |
$16,047.20
|
|
Perc d-e cor stent ather br
|
$29,520.00 |
$29,520.00 |
$29,520.00 |
$12,449.00
|
|
Perc d-e cor stent ather s
|
$45,602.40 |
$45,602.40 |
$45,602.40 |
$18,545.83
|
|
Perc drug-el cor stent bran
|
$29,520.00 |
$29,520.00 |
$29,520.00 |
$11,667.75
|
|
Perc drug-el cor stent sing
|
$45,602.40 |
$45,602.40 |
$45,602.40 |
$16,258.50
|
|
Perc rf ablate renal tumor
|
$8,358.60 |
$8,358.60 |
$8,358.60 |
$7,243.60
|
|
Percut ablate liver rf
|
$4,189.80 |
$4,189.80 |
$4,189.80 |
$6,904.15
|
|
Perflutren lipid microspheres 1.1 mg/ml intravenous suspension
|
$70.20 |
$70.20 |
$70.20 |
$332.84
|
|
Pericardiocentesis wwo imaging
|
$2,815.20 |
$2,815.20 |
$2,815.20 |
$2,418.99
|
|
Peripheral vascular rehab
|
$240.60 |
$240.60 |
$240.60 |
$132.50
|
|
Perit-vens shunt pat tst
|
$1,183.80 |
$1,183.80 |
$1,183.80 |
$752.49
|
|
Perq art m-thrombect &/nfs
|
$19,830.00 |
$19,830.00 |
$19,830.00 |
$7,559.55
|
|
Perq clsr tcat l atr apndge
|
$16,297.80 |
$16,297.80 |
$16,297.80 |
$9,286.40
|
|
Perq nl/pl lithotrp cplx>2cm
|
$7,866.60 |
$7,866.60 |
$7,866.60 |
$10,114.58
|
|
Perq nl/pl lithotrp smpl<2cm
|
$5,813.40 |
$5,813.40 |
$5,813.40 |
$9,442.38
|
|
Perq plmt bile duct stent
|
$10,143.00 |
$10,143.00 |
$10,143.00 |
$6,904.15
|
|
Perq plmt bile duct stent
|
$10,143.00 |
$10,143.00 |
$10,143.00 |
$7,082.99
|
|
Perq rplcmt g-tube req revsn gstrst trk
|
$643.20 |
$643.20 |
$643.20 |
$625.93
|
|
Perq trluml angp nt/recr coa
|
$12,378.00 |
$12,378.00 |
$12,378.00 |
$6,658.00
|
|
Pertussis ag if
|
$92.40 |
$92.40 |
$92.40 |
$65.00
|
|
Pertuzumab 30 mg/ml desensitization
|
$10,118.19 |
$10,118.19 |
$10,118.19 |
$14,272.91
|
|
Pet CT skull-mid thgh initial
|
$5,433.00 |
$5,433.00 |
$5,433.00 |
$4,707.00
|
|
Pet CT whole body initial
|
$5,860.20 |
$5,860.20 |
$5,860.20 |
$4,850.00
|
|
Pet fdg brain metoblic eval sb
|
$3,789.00 |
$3,789.00 |
$3,789.00 |
$4,060.00
|
|
Pet image w/ct lmtd
|
$5,160.60 |
$5,160.60 |
$5,160.60 |
$4,349.76
|