|
Off/op cnsltj new/est low 30
|
$154.80 |
$154.80 |
$154.80 |
$180.00
|
|
Off/op cnsltj new/est mod 40
|
$221.40 |
$221.40 |
$221.40 |
$269.60
|
|
Off/op consltj new/est hi 55
|
$120.00 |
$120.00 |
$120.00 |
$339.30
|
|
Off/op consltj new/est sf 20
|
$60.00 |
$60.00 |
$60.00 |
$133.80
|
|
Olanzapine 10 mg intramuscular solution
|
$121.20 |
$121.20 |
$121.20 |
$109.62
|
|
Omalizumab 150 mg/ml subcutaneous syringe (wrapper)
|
$11,052.00 |
$11,052.00 |
$11,052.00 |
$4,595.01
|
|
Onco (ovar) two proteins
|
$442.20 |
$442.20 |
$442.20 |
$312.18
|
|
Ondansetron hcl (pf) 2 mg/ml injection (wrapper)
|
$17.40 |
$17.40 |
$17.40 |
$22.78
|
|
Opn fem art expos cndt crtj 34714
|
$4,184.40 |
$4,184.40 |
$4,184.40 |
$2,041.65
|
|
Oral aprepitant
|
$694.80 |
$694.80 |
$694.80 |
$410.20
|
|
Oritavancin 1,200 mg intravenous solution
|
$17,931.60 |
$17,931.60 |
$17,931.60 |
$11,017.26
|
|
Orphenadrine citrate 30 mg/ml injection solution
|
$53.40 |
$53.40 |
$53.40 |
$50.63
|
|
Orthosis lso rigd frm hyperex
|
$573.74 |
$573.74 |
$573.74 |
$837.25
|
|
Oscillation chest wall mechanical per session
|
$133.80 |
$133.80 |
$133.80 |
$196.70
|
|
Osmolality blood
|
$163.20 |
$163.20 |
$163.20 |
$68.40
|
|
Osmolality urine
|
$114.00 |
$114.00 |
$114.00 |
$65.52
|
|
Ot evaluation high complexity patient/family
|
$337.80 |
$337.80 |
$337.80 |
$292.00
|
|
Ot evaluation low complexity patient/family
|
$337.80 |
$337.80 |
$337.80 |
$228.58
|
|
Ot evaluation moderate complexity patient/family
|
$337.80 |
$337.80 |
$337.80 |
$257.74
|
|
Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes
|
$179.40 |
$179.40 |
$179.40 |
$98.40
|
|
Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes
|
$100.80 |
$100.80 |
$100.80 |
$104.50
|
|
Ot manual therpy techniques >=1 region each 15 minutes
|
$147.00 |
$147.00 |
$147.00 |
$104.97
|
|
Ot re-evaluation patient/family
|
$249.00 |
$249.00 |
$249.00 |
$158.40
|
|
Ot therapeutic activities direct patient contact each 15 minutes
|
$207.00 |
$207.00 |
$207.00 |
$99.00
|
|
Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes
|
$234.60 |
$234.60 |
$234.60 |
$97.44
|
|
Ot therapeutic procedure neuromuscular reeducate each 15 minutes
|
$186.00 |
$186.00 |
$186.00 |
$100.65
|
|
Ot training self care/home management direct contact each 15 minutes
|
$202.80 |
$202.80 |
$202.80 |
$93.60
|
|
Oxaliplatin 5 mg/ml desensitization
|
$667.20 |
$667.20 |
$667.20 |
$347.26
|
|
Oxytocin 10 unit/ml injection solution
|
$3.60 |
$3.60 |
$3.60 |
$50.04
|
|
Paclitaxel 6 mg/ml concentrate,intravenous
|
$334.20 |
$334.20 |
$334.20 |
$216.00
|
|
Paclitaxel protein-bound 100 mg intravenous suspension
|
$5,716.20 |
$5,716.20 |
$5,716.20 |
$3,420.45
|
|
Paliperidone 117 mg/0.75 ml inj
|
$8,341.20 |
$8,341.20 |
$8,341.20 |
$6,238.82
|
|
Palonosetron hcl
|
$1,510.80 |
$1,510.80 |
$1,510.80 |
$162.89
|
|
Pamidronate 30 mg/10 ml (3 mg/ml) intravenous solution
|
$120.60 |
$120.60 |
$120.60 |
$129.02
|
|
Panitumumab 20 mg/ml intravenous solution (wrapper)
|
$15,835.80 |
$15,835.80 |
$15,835.80 |
$13,051.61
|
|
Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr
|
$11.40 |
$11.40 |
$11.40 |
$29.31
|
|
Parathormone (pth) intact
|
$583.20 |
$583.20 |
$583.20 |
$200.85
|
|
Parathyroid planar imaging
|
$791.40 |
$791.40 |
$791.40 |
$1,129.91
|
|
Paring/cutting benign hyperkeratotic lesion single
|
$265.80 |
$265.80 |
$265.80 |
$249.00
|
|
Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector
|
$25,983.00 |
$25,983.00 |
$25,983.00 |
$11,216.31
|
|
Pegfilgrastim-cbqv 6 mg/0.6 ml subcutaneous syringe
|
$13,920.00 |
$13,920.00 |
$13,920.00 |
$7,265.37
|
|
Pegfilgrastim-jmdb 6 mg/0.6 ml subcutaneous syringe
|
$16,902.60 |
$16,902.60 |
$16,902.60 |
$4,133.25
|
|
Pegfilgrastim-pbbk 6 mg/0.6 ml subcutaneous syringe
|
$9,975.00 |
$9,975.00 |
$9,975.00 |
$4,028.25
|
|
Pegloticase 8 mg/ml intravenous solution
|
$68,089.80 |
$68,089.80 |
$68,089.80 |
$49,585.09
|
|
Pelvic CT scan (with and without contrast)
|
$2,918.40 |
$2,918.40 |
$2,918.40 |
$1,881.00
|
|
Pelvic CT scan (with contrast)
|
$2,554.20 |
$2,554.20 |
$2,554.20 |
$1,608.98
|
|
Pelvic CT scan (without contrast)
|
$1,841.40 |
$1,841.40 |
$1,841.40 |
$1,350.25
|
|
Pelvic MRI (with and without contrast)
|
$3,243.60 |
$3,243.60 |
$3,243.60 |
$2,860.00
|
|
Pelvic MRI (with contrast)
|
$3,243.60 |
$3,243.60 |
$3,243.60 |
$2,210.00
|
|
Pelvic MRI (without contrast)
|
$3,060.60 |
$3,060.60 |
$3,060.60 |
$1,902.00
|
|
Pelvic Ultrasound (complete)
|
$778.80 |
$778.80 |
$778.80 |
$649.35
|
|
Pelvic Ultrasound (limited)
|
$194.40 |
$194.40 |
$194.40 |
$435.00
|
|
Pembrolizumab 25 mg/ml intravenous solution
|
$15,735.00 |
$15,735.00 |
$15,735.00 |
$11,589.18
|
|
Pemetrexed disodium 100 mg intravenous powder for solution
|
$11,278.20 |
$11,278.20 |
$11,278.20 |
$6,582.76
|
|
Peng benzathine/procaine inj
|
$37.20 |
$37.20 |
$37.20 |
$375.32
|
|
Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe
|
$1,013.40 |
$1,013.40 |
$1,013.40 |
$826.47
|
|
Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr
|
$169.80 |
$169.80 |
$169.80 |
$97.85
|
|
Perc d-e cor revasc t cabg b
|
$18,577.20 |
$18,577.20 |
$18,577.20 |
$11,995.20
|
|
Perc d-e cor revasc t cabg s
|
$18,577.20 |
$18,577.20 |
$18,577.20 |
$16,047.20
|
|
Perc d-e cor stent ather s
|
$18,577.20 |
$18,577.20 |
$18,577.20 |
$18,808.65
|
|
Perc drug-el cor stent bran
|
$18,577.20 |
$18,577.20 |
$18,577.20 |
$11,974.50
|
|
Perc drug-el cor stent sing
|
$18,577.20 |
$18,577.20 |
$18,577.20 |
$16,270.00
|
|
Pericardiocentesis wwo imaging
|
$2,496.60 |
$2,496.60 |
$2,496.60 |
$2,276.64
|
|
Pertuzumab 30 mg/ml desensitization
|
$16,712.40 |
$16,712.40 |
$16,712.40 |
$13,666.00
|
|
Pertuzu, trastuzu, 10 mg
|
$46,652.40 |
$46,652.40 |
$46,652.40 |
$25,200.44
|
|
Pet CT skull-mid thgh initial
|
$5,751.00 |
$5,751.00 |
$5,751.00 |
$4,707.00
|
|
Pet CT whole body initial
|
$5,751.00 |
$5,751.00 |
$5,751.00 |
$4,850.00
|
|
Pfc sigma fem post aug sz3 8mm
|
$44,100.00 |
$44,100.00 |
$44,100.00 |
$38,291.09
|
|
Ph body fluid
|
$155.40 |
$155.40 |
$155.40 |
$40.04
|
|
Phencyclidine (pcp)
|
$36.00 |
$36.00 |
$36.00 |
$90.00
|
|
Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr
|
$70.20 |
$70.20 |
$70.20 |
$112.72
|
|
Phenobarbital therapeutic drug level
|
$199.80 |
$199.80 |
$199.80 |
$104.25
|
|
Phentolaine mesylate inj
|
$1,675.20 |
$1,675.20 |
$1,675.20 |
$1,021.73
|
|
Phenylephrine 10 mg/ml injection solution
|
$80.40 |
$80.40 |
$80.40 |
$64.20
|
|
Phenytoin in ns IV syringe 5 mg/ml (neo/ped) - cnr
|
$6.60 |
$6.60 |
$6.60 |
$10.80
|
|
Phenytoin total therapeutic drug level
|
$195.60 |
$195.60 |
$195.60 |
$111.27
|
|
Phlebotomy therapeutic
|
$159.00 |
$159.00 |
$159.00 |
$238.04
|
|
Phosphorus
|
$73.20 |
$73.20 |
$73.20 |
$48.96
|
|
Phosphorus 24 hour urine
|
$71.40 |
$71.40 |
$71.40 |
$41.51
|
|
Phytonadione (vitamin k1) 10 mg/ml injection solution
|
$99.60 |
$99.60 |
$99.60 |
$85.79
|
|
Pin finger dislocation
|
$4,821.60 |
$4,821.60 |
$4,821.60 |
$3,839.54
|
|
Pin finger fracture each
|
$4,821.60 |
$4,821.60 |
$4,821.60 |
$4,035.50
|
|
Piperacillin-tazobactam 3.375 gram intravenous solution
|
$31.20 |
$31.20 |
$31.20 |
$83.41
|
|
Place gastrostomy tube perc
|
$2,061.00 |
$2,061.00 |
$2,061.00 |
$2,286.40
|
|
Placement localization device(s) breast percutaneous mammographic guidance 1st lesion (both sides)
|
$1,099.80 |
$1,099.80 |
$1,099.80 |
$1,537.43
|
|
Placement localization device(s) breast percutaneous mammographic guide ea addl lesion left
|
$430.80 |
$430.80 |
$430.80 |
$795.00
|
|
Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides)
|
$1,776.00 |
$1,776.00 |
$1,776.00 |
$1,332.43
|
|
Placement nephrostomy catheter (both sides)
|
$3,028.80 |
$3,028.80 |
$3,028.80 |
$3,933.00
|
|
Placement occlusive device venous/arterial access site post procedure
|
$402.00 |
$402.00 |
$402.00 |
$591.00
|
|
Placement stent(s) intravascular transcatheter artery initial
|
$18,447.60 |
$18,447.60 |
$18,447.60 |
$13,964.50
|
|
Place non-slctv cath thoracic arta
|
$5,324.40 |
$5,324.40 |
$5,324.40 |
$5,271.46
|
|
Place slctv cath carotid/inom art excrn uni
|
$10,649.40 |
$10,649.40 |
$10,649.40 |
$6,498.00
|
|
Place slctv cath carotid/inom art intcrn uni
|
$5,324.40 |
$5,324.40 |
$5,324.40 |
$9,074.00
|
|
Place slctv cath subclavian art
|
$10,649.40 |
$10,649.40 |
$10,649.40 |
$6,325.00
|
|
Place slctv cath vertebral art uni
|
$17,472.00 |
$17,472.00 |
$17,472.00 |
$9,040.80
|
|
Platelet automated
|
$60.00 |
$60.00 |
$60.00 |
$45.00
|
|
Platelets leukocytes reduced irradiated each unit
|
$90.60 |
$90.60 |
$90.60 |
$427.50
|
|
Platelets pheresis leukocytes reduced each unit
|
$504.00 |
$504.00 |
$504.00 |
$1,140.80
|
|
Plcmt xtn pros evasc rpr per vsl
|
$4,345.20 |
$4,345.20 |
$4,345.20 |
$3,681.01
|
|
Plc pq device breast ea addl lesion Ultrasound guide
|
$889.80 |
$889.80 |
$889.80 |
$758.52
|
