|
MRI loex nonjt w IV cont
|
$1,438.40 |
$1,438.40 |
$1,438.40 |
$1,953.60
|
|
MRI lower extremity other than joint without contrast (both sides)
|
$1,404.00 |
$1,404.00 |
$1,404.00 |
$2,051.28
|
|
MRI lower extremity other than joint without & w/contrast (both sides)
|
$1,615.20 |
$1,615.20 |
$1,615.20 |
$2,614.43
|
|
MRI orbit/face/neck without contrast
|
$1,033.20 |
$1,033.20 |
$1,033.20 |
$1,782.69
|
|
MRI orbit/face/neck without & w/contrast
|
$1,570.80 |
$1,570.80 |
$1,570.80 |
$2,552.60
|
|
MRI orbit fac&nck w IV cont
|
$1,250.80 |
$1,250.80 |
$1,250.80 |
$2,002.00
|
|
MRI tmj
|
$1,214.00 |
$1,214.00 |
$1,214.00 |
$1,658.77
|
|
MRI upper extremity other than joint without contrast (both sides)
|
$1,414.40 |
$1,414.40 |
$1,414.40 |
$1,902.00
|
|
MRI upper extremity other than joint without & w/contrast (both sides)
|
$1,615.20 |
$1,615.20 |
$1,615.20 |
$2,628.75
|
|
MRI upper extremity w/dye
|
$1,396.00 |
$1,396.00 |
$1,396.00 |
$1,854.07
|
|
Mthfr gene analy common variants
|
$222.80 |
$222.80 |
$222.80 |
$248.82
|
|
Multiple sleep latency test
|
$824.00 |
$824.00 |
$824.00 |
$2,672.68
|
|
Mumps antibody igg
|
$64.00 |
$64.00 |
$64.00 |
$81.45
|
|
Mycoplasma antibody igm
|
$52.40 |
$52.40 |
$52.40 |
$87.50
|
|
Myelography via inj w/s&i 2+ regions
|
$1,784.80 |
$1,784.80 |
$1,784.80 |
$2,178.36
|
|
Myelography via inj w/s&i cervical
|
$1,784.80 |
$1,784.80 |
$1,784.80 |
$1,784.80
|
|
Myelography via inj w/s&i lumbosacral
|
$1,892.80 |
$1,892.80 |
$1,892.80 |
$1,923.03
|
|
Myelography via inj w/s&i thoracic
|
$1,784.80 |
$1,784.80 |
$1,784.80 |
$2,042.95
|
|
Myeloperoxidase ab multi step qualitative/semiquantitative
|
$216.80 |
$216.80 |
$216.80 |
$115.05
|
|
Natriuretic peptide
|
$86.40 |
$86.40 |
$86.40 |
$161.60
|
|
Natural killer cells total count
|
$41.20 |
$41.20 |
$41.20 |
$121.70
|
|
N block inj hypogas plxs
|
$1,054.40 |
$1,054.40 |
$1,054.40 |
$2,031.75
|
|
Neck (Cervical Spine) CT scan (with contrast)
|
$887.20 |
$887.20 |
$887.20 |
$1,685.58
|
|
Neck (Cervical Spine) CT scan (without contrast)
|
$887.20 |
$887.20 |
$887.20 |
$1,435.80
|
|
Neck (Cervical Spine) MRI (with and without contrast)
|
$1,688.40 |
$1,688.40 |
$1,688.40 |
$2,562.00
|
|
Neck (Cervical Spine) MRI (with contrast)
|
$1,606.00 |
$1,606.00 |
$1,606.00 |
$2,164.88
|
|
Neck (Cervical Spine) MRI (without contrast)
|
$1,466.00 |
$1,466.00 |
$1,466.00 |
$1,830.00
|
|
Neck MRA (blood vessel MRI, with and without contrast)
|
$1,702.80 |
$1,702.80 |
$1,702.80 |
$2,547.30
|
|
Neck MRA (blood vessel MRI, with contrast)
|
$1,063.20 |
$1,063.20 |
$1,063.20 |
$1,890.00
|
|
Neck MRA (blood vessel MRI, without contrast)
|
$1,033.20 |
$1,033.20 |
$1,033.20 |
$1,741.80
|
|
Neurolysis trigeminal nerve
|
$856.80 |
$856.80 |
$856.80 |
$2,420.73
|
|
New Patient Office Visit (level 2)
|
$175.60 |
$175.60 |
$175.60 |
$151.45
|
|
New Patient Office Visit (level 3)
|
$276.40 |
$276.40 |
$276.40 |
$205.40
|
|
New Patient Office Visit (level 4)
|
$322.40 |
$322.40 |
$322.40 |
$289.60
|
|
New Patient Office Visit (level 5)
|
$432.00 |
$432.00 |
$432.00 |
$367.20
|
|
Njx aa&/strd lmbr plex nfs
|
$574.00 |
$574.00 |
$574.00 |
$1,555.85
|
|
Nm imaging bone/joint 3 phase study
|
$985.60 |
$985.60 |
$985.60 |
$1,572.00
|
|
Nm imaging bone/joint whole body
|
$971.20 |
$971.20 |
$971.20 |
$1,538.86
|
|
Nm imaging cardiac blood pooling planar single study at rest or stress
|
$1,037.20 |
$1,037.20 |
$1,037.20 |
$1,347.83
|
|
Nm imaging gastric emptying study
|
$1,112.80 |
$1,112.80 |
$1,112.80 |
$1,331.43
|
|
Nm imaging gastrointestinal acute blood loss
|
$642.00 |
$642.00 |
$642.00 |
$1,125.00
|
|
Nm imaging hepatobiliary system w/pharmacologic intervention
|
$1,196.40 |
$1,196.40 |
$1,196.40 |
$1,586.00
|
|
Nm imaging kidney morphology vascular flow/function single study w/pharmacological intervention
|
$1,122.40 |
$1,122.40 |
$1,122.40 |
$1,574.40
|
|
Nm imaging pulmonary ventilation/perfusion
|
$1,044.40 |
$1,044.40 |
$1,044.40 |
$1,566.00
|
|
Nm imaging thyroid single/multiple uptake(s) quantitative measurement(s)
|
$587.60 |
$587.60 |
$587.60 |
$1,075.00
|
|
Nm radiopharmaceutical therapy oral administration
|
$548.80 |
$548.80 |
$548.80 |
$1,004.90
|
|
Nuclear Stress Test (Heart)
|
$2,024.00 |
$2,024.00 |
$2,024.00 |
$3,739.20
|
|
Osmolality blood
|
$32.40 |
$32.40 |
$32.40 |
$57.00
|
|
Osmolality urine
|
$40.00 |
$40.00 |
$40.00 |
$57.85
|
|
Ot evaluation high complexity patient/family
|
$134.40 |
$134.40 |
$134.40 |
$265.50
|
|
Ot evaluation low complexity patient/family
|
$70.40 |
$70.40 |
$70.40 |
$222.50
|
|
Ot evaluation moderate complexity patient/family
|
$112.40 |
$112.40 |
$112.40 |
$249.60
|
|
Other immunoelectrophoresis
|
$119.60 |
$119.60 |
$119.60 |
$92.70
|
|
Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes
|
$62.80 |
$62.80 |
$62.80 |
$94.40
|
|
Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes
|
$62.80 |
$62.80 |
$62.80 |
$102.60
|
|
Ot manual therpy techniques >=1 region each 15 minutes
|
$62.40 |
$62.40 |
$62.40 |
$105.50
|
|
Ot re-evaluation patient/family
|
$47.60 |
$47.60 |
$47.60 |
$146.90
|
|
Ot therapeutic activities direct patient contact each 15 minutes
|
$41.20 |
$41.20 |
$41.20 |
$96.11
|
|
Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes
|
$82.40 |
$82.40 |
$82.40 |
$86.65
|
|
Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes
|
$36.40 |
$36.40 |
$36.40 |
$90.00
|
|
Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes
|
$56.00 |
$56.00 |
$56.00 |
$95.65
|
|
Ot therapeutic procedure neuromuscular reeducate each 15 minutes
|
$50.40 |
$50.40 |
$50.40 |
$94.25
|
|
Ot training self care/home management direct contact each 15 minutes
|
$45.20 |
$45.20 |
$45.20 |
$93.60
|
|
Parathormone (pth) intact
|
$122.00 |
$122.00 |
$122.00 |
$204.00
|
|
Parathyroid planar imaging
|
$626.80 |
$626.80 |
$626.80 |
$1,041.95
|
|
Parathyroid planar img w/tomo spect
|
$713.20 |
$713.20 |
$713.20 |
$1,317.94
|
|
Partial removal of eye fluid
|
$1,764.80 |
$1,764.80 |
$1,764.80 |
$2,524.45
|
|
Pelvic CT scan (with and without contrast)
|
$1,107.20 |
$1,107.20 |
$1,107.20 |
$1,872.00
|
|
Pelvic CT scan (with contrast)
|
$1,253.20 |
$1,253.20 |
$1,253.20 |
$1,602.75
|
|
Pelvic CT scan (without contrast)
|
$1,058.00 |
$1,058.00 |
$1,058.00 |
$1,290.90
|
|
Pelvic MRI (with and without contrast)
|
$1,624.80 |
$1,624.80 |
$1,624.80 |
$2,603.25
|
|
Pelvic MRI (with contrast)
|
$1,338.00 |
$1,338.00 |
$1,338.00 |
$1,854.06
|
|
Pelvic MRI (without contrast)
|
$1,033.20 |
$1,033.20 |
$1,033.20 |
$1,702.00
|
|
Pelvic Ultrasound (complete)
|
$807.60 |
$807.60 |
$807.60 |
$614.64
|
|
Pelvic Ultrasound (limited)
|
$444.00 |
$444.00 |
$444.00 |
$429.66
|
|
Pericardiocentesis wwo imaging
|
$784.80 |
$784.80 |
$784.80 |
$2,554.80
|
|
Peripheral vascular rehab
|
$31.20 |
$31.20 |
$31.20 |
$142.11
|
|
Pet CT skull-mid thgh initial
|
$1,981.60 |
$1,981.60 |
$1,981.60 |
$4,850.00
|
|
Pet CT whole body initial
|
$1,981.60 |
$1,981.60 |
$1,981.60 |
$4,915.50
|
|
Pet fdg brain metoblic eval sb
|
$1,717.20 |
$1,717.20 |
$1,717.20 |
$3,274.20
|
|
Pet image w/ct lmtd
|
$1,832.80 |
$1,832.80 |
$1,832.80 |
$4,422.60
|
|
Ph body fluid
|
$43.60 |
$43.60 |
$43.60 |
$35.75
|
|
Phenobarbital therapeutic drug level
|
$36.40 |
$36.40 |
$36.40 |
$97.50
|
|
Phenytoin total therapeutic drug level
|
$68.40 |
$68.40 |
$68.40 |
$100.75
|
|
Phlebotomy therapeutic
|
$65.20 |
$65.20 |
$65.20 |
$240.24
|
|
Phleb veins 1 extrm 10-20 stab
|
$2,732.00 |
$2,732.00 |
$2,732.00 |
$3,785.00
|
|
Phleb veins 1 extrm >20 stab
|
$3,599.20 |
$3,599.20 |
$3,599.20 |
$4,022.46
|
|
Phosphorus
|
$24.80 |
$24.80 |
$24.80 |
$42.37
|
|
Phosphorus 24 hour urine
|
$22.80 |
$22.80 |
$22.80 |
$41.51
|
|
Phys blood bank serv reactj
|
$81.60 |
$81.60 |
$81.60 |
$219.94
|
|
Placement localization device(s) breast percutaneous mammographic guide ea addl lesion left
|
$200.00 |
$200.00 |
$200.00 |
$1,094.83
|
|
Placement nephrostomy catheter (both sides)
|
$1,006.40 |
$1,006.40 |
$1,006.40 |
$4,653.60
|
|
Platelet automated
|
$33.60 |
$33.60 |
$33.60 |
$33.60
|
|
Plc pq device breast ea addl lesion Ultrasound guide
|
$374.80 |
$374.80 |
$374.80 |
$969.00
|
|
Plethysmography lung volumes/airway resistance
|
$327.60 |
$327.60 |
$327.60 |
$411.51
|
|
Pmp22 gene dup/delet
|
$579.60 |
$579.60 |
$579.60 |
$1,029.75
|
|
Poct blood gases ph pco2 po2 arterial calculated o2
|
$104.80 |
$104.80 |
$104.80 |
$146.15
|
|
Polysomnography sleep staging >=4 parameters age >=6 years w/cpap bipap
|
$1,277.20 |
$1,277.20 |
$1,277.20 |
$4,313.58
|
|
Potassium 24 hour urine
|
$22.80 |
$22.80 |
$22.80 |
$45.00
|
|
Potassium serum/plasma/whole blood
|
$22.40 |
$22.40 |
$22.40 |
$40.00
|