|
Nushield 1 square cm
|
$1,250.00 |
$1,250.00 |
$1,250.00 |
$931.43
|
|
Observation direct referral from physician office for admission
|
$1,602.45 |
$1,602.45 |
$1,602.45 |
$384.00
|
|
Observation/inpatient hospital care hi severity 99236
|
$569.30 |
$569.30 |
$569.30 |
$390.40
|
|
Observation/inpatient hospital care low severity 99234
|
$346.60 |
$346.60 |
$346.60 |
$239.20
|
|
Observation/inpatient hospital care mod severity 99235
|
$441.30 |
$441.30 |
$441.30 |
$303.20
|
|
Observation per hour
|
$255.50 |
$255.50 |
$255.50 |
$82.50
|
|
Ob Ultrasound nuchal meas add-on
|
$438.90 |
$438.90 |
$438.90 |
$249.60
|
|
Occupational Therapy Evaluation (high complexity)
|
$254.30 |
$254.30 |
$254.30 |
$297.00
|
|
Occupational Therapy Evaluation (low complexity)
|
$254.30 |
$254.30 |
$254.30 |
$232.40
|
|
Occupational Therapy Evaluation (moderate complexity)
|
$254.30 |
$254.30 |
$254.30 |
$263.90
|
|
Octreotide acetate 100 mcg/ml injection (wrapper)
|
$25.03 |
$25.03 |
$25.03 |
$90.00
|
|
Off/op cnsltj new/est low 30
|
$248.20 |
$248.20 |
$248.20 |
$183.00
|
|
Off/op cnsltj new/est mod 40
|
$399.15 |
$399.15 |
$399.15 |
$273.60
|
|
Off/op consltj new/est hi 55
|
$495.10 |
$495.10 |
$495.10 |
$352.50
|
|
Off/op consltj new/est sf 20
|
$177.90 |
$177.90 |
$177.90 |
$137.80
|
|
Olanzapine 10 mg intramuscular solution
|
$141.40 |
$141.40 |
$141.40 |
$109.62
|
|
Ondansetron 8 mg disintegrating tablet
|
$3.08 |
$3.08 |
$3.08 |
$9.93
|
|
Ondansetron hcl (pf) 2 mg/ml injection (wrapper)
|
$3.02 |
$3.02 |
$3.02 |
$22.62
|
|
Oral aprepitant
|
$300.92 |
$300.92 |
$300.92 |
$410.20
|
|
Ortho elbow without jnt cstm w/fit&adj
|
$758.35 |
$758.35 |
$758.35 |
$279.81
|
|
Ortho ewhf rigd without jnt cstm w
|
$3,362.00 |
$3,362.00 |
$3,362.00 |
$1,288.00
|
|
Ortho ewh rgd without jnt cstm w/fit&adj
|
$3,362.00 |
$3,362.00 |
$3,362.00 |
$702.80
|
|
Ortho hnd/fngr without jnt cstm w/fit&adj
|
$758.35 |
$758.35 |
$758.35 |
$231.66
|
|
Ortho whf rigd without jnt cstm w/fit&adj
|
$784.95 |
$784.95 |
$784.95 |
$421.00
|
|
Ortho wrst/hnd w/jnt cstm w/fit&adj
|
$2,604.40 |
$2,604.40 |
$2,604.40 |
$686.79
|
|
Oscillation chest wall mechanical per session
|
$570.40 |
$570.40 |
$570.40 |
$196.30
|
|
Osmolality blood
|
$109.35 |
$109.35 |
$109.35 |
$70.85
|
|
Osmolality urine
|
$112.25 |
$112.25 |
$112.25 |
$65.52
|
|
Oth resp proc, group
|
$140.00 |
$140.00 |
$140.00 |
$126.00
|
|
Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes
|
$179.35 |
$179.35 |
$179.35 |
$97.80
|
|
Ot re-evaluation patient/family
|
$168.05 |
$168.05 |
$168.05 |
$160.80
|
|
Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes
|
$60.15 |
$60.15 |
$60.15 |
$88.54
|
|
Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes
|
$62.75 |
$62.75 |
$62.75 |
$93.12
|
|
Oxytocin 10 unit/ml injection solution
|
$7.56 |
$7.56 |
$7.56 |
$50.40
|
|
Paliperidone 117 mg/0.75 ml inj
|
$5,427.25 |
$5,427.25 |
$5,427.25 |
$6,238.82
|
|
Palonosetron hcl
|
$75.56 |
$75.56 |
$75.56 |
$163.00
|
|
Pamidronate 30 mg/10 ml (3 mg/ml) intravenous solution
|
$136.01 |
$136.01 |
$136.01 |
$123.55
|
|
Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr
|
$14.11 |
$14.11 |
$14.11 |
$28.90
|
|
Parathormone (pth) intact
|
$522.65 |
$522.65 |
$522.65 |
$206.18
|
|
Parathyrd planar w/spect&ct
|
$1,454.10 |
$1,454.10 |
$1,454.10 |
$1,574.40
|
|
Parathyroid planar imaging
|
$2,193.65 |
$2,193.65 |
$2,193.65 |
$1,126.00
|
|
Parathyroid planar img w/tomo spect
|
$2,347.00 |
$2,347.00 |
$2,347.00 |
$1,374.75
|
|
Passy muir valve metal trach
|
$90.87 |
$90.87 |
$90.87 |
$275.75
|
|
Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector
|
$9,149.49 |
$9,149.49 |
$9,149.49 |
$11,216.31
|
|
Pelvic CT scan (with and without contrast)
|
$1,495.15 |
$1,495.15 |
$1,495.15 |
$1,890.36
|
|
Pelvic CT scan (with contrast)
|
$1,297.60 |
$1,297.60 |
$1,297.60 |
$1,608.98
|
|
Pelvic CT scan (without contrast)
|
$839.25 |
$839.25 |
$839.25 |
$1,335.34
|
|
Pelvic MRI (with and without contrast)
|
$2,451.45 |
$2,451.45 |
$2,451.45 |
$2,860.00
|
|
Pelvic MRI (without contrast)
|
$1,822.25 |
$1,822.25 |
$1,822.25 |
$1,916.50
|
|
Pelvic Ultrasound (complete)
|
$924.60 |
$924.60 |
$924.60 |
$643.80
|
|
Pelvic Ultrasound (limited)
|
$568.40 |
$568.40 |
$568.40 |
$430.80
|
|
Pelvis X-ray (1 to 2 views)
|
$190.05 |
$190.05 |
$190.05 |
$281.82
|
|
Pelvis X-ray (complete, 4 or more views)
|
$391.10 |
$391.10 |
$391.10 |
$351.75
|
|
Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe
|
$1,147.88 |
$1,147.88 |
$1,147.88 |
$824.70
|
|
Penile rear tip xtnd 0.5cm
|
$11,495.00 |
$11,495.00 |
$11,495.00 |
$18,764.94
|
|
Pentamidine non-comp unit
|
$494.41 |
$494.41 |
$494.41 |
$294.39
|
|
Perflutren lipid microspheres 1.1 mg/ml intravenous suspension
|
$760.72 |
$760.72 |
$760.72 |
$332.84
|
|
Perq nl/pl lithotrp smpl<2cm
|
$10,794.10 |
$10,794.10 |
$10,794.10 |
$9,442.38
|
|
Pessary 3.5 in 7 vag sil rng fold
|
$58.00 |
$58.00 |
$58.00 |
$141.60
|
|
Pessary reusable rub anytype
|
$56.00 |
$56.00 |
$56.00 |
$57.60
|
|
Pet CT skull-mid thgh initial
|
$4,398.30 |
$4,398.30 |
$4,398.30 |
$4,707.00
|
|
Pet CT whole body initial
|
$4,398.30 |
$4,398.30 |
$4,398.30 |
$4,850.00
|
|
Pet fdg brain metoblic eval sb
|
$4,543.25 |
$4,543.25 |
$4,543.25 |
$4,060.00
|
|
Pet image w/ct lmtd
|
$4,398.30 |
$4,398.30 |
$4,398.30 |
$4,349.76
|
|
Pfc sigma fem post aug sz3 8mm
|
$12,797.00 |
$12,797.00 |
$12,797.00 |
$39,920.50
|
|
Ph1 assmt&mgmt nqhp 11-20
|
$71.60 |
$71.60 |
$71.60 |
$60.80
|
|
Ph1 assmt&mgmt nqhp 21-30
|
$105.00 |
$105.00 |
$105.00 |
$91.50
|
|
Ph1 assmt&mgmt nqhp 5-10
|
$37.15 |
$37.15 |
$37.15 |
$31.20
|
|
Ph body fluid
|
$19.70 |
$19.70 |
$19.70 |
$42.00
|
|
Phencyclidine (pcp)
|
$73.50 |
$73.50 |
$73.50 |
$96.39
|
|
Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr
|
$181.34 |
$181.34 |
$181.34 |
$114.56
|
|
Phenobarbital therapeutic drug level
|
$32.10 |
$32.10 |
$32.10 |
$105.00
|
|
Phentolaine mesylate inj
|
$1,676.41 |
$1,676.41 |
$1,676.41 |
$1,028.40
|
|
Phenylephrine 10 mg/ml injection solution
|
$201.49 |
$201.49 |
$201.49 |
$62.98
|
|
Phenylep ketorolac opth soln
|
$1,614.95 |
$1,614.95 |
$1,614.95 |
$934.56
|
|
Phenytoin total therapeutic drug level
|
$261.20 |
$261.20 |
$261.20 |
$111.27
|
|
Phlebotomy therapeutic
|
$314.70 |
$314.70 |
$314.70 |
$231.40
|
|
Phosphorus
|
$159.00 |
$159.00 |
$159.00 |
$49.20
|
|
Phosphorus 24 hour urine
|
$213.15 |
$213.15 |
$213.15 |
$42.25
|
|
Physical Therapy Evaluation (high complexity)
|
$262.15 |
$262.15 |
$262.15 |
$294.00
|
|
Physical Therapy Evaluation (low complexity)
|
$262.15 |
$262.15 |
$262.15 |
$223.92
|
|
Physical Therapy Evaluation (moderate complexity)
|
$262.15 |
$262.15 |
$262.15 |
$256.20
|
|
Physical Therapy Re-Evaluation
|
$179.10 |
$179.10 |
$179.10 |
$154.80
|
|
Phytonadione (vitamin k1) 10 mg/ml injection solution
|
$124.57 |
$124.57 |
$124.57 |
$90.25
|
|
Pinworm exam
|
$79.80 |
$79.80 |
$79.80 |
$39.62
|
|
Piperacillin-tazobactam 3.375 gram intravenous solution
|
$235.06 |
$235.06 |
$235.06 |
$81.36
|
|
Placement localization device(s) breast percutaneous mammographic guidance 1st lesion (both sides)
|
$2,152.25 |
$2,152.25 |
$2,152.25 |
$1,485.90
|
|
Placement localization device(s) breast percutaneous mammographic guide ea addl lesion left
|
$2,152.25 |
$2,152.25 |
$2,152.25 |
$795.00
|
|
Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides)
|
$1,587.90 |
$1,587.90 |
$1,587.90 |
$1,332.43
|
|
Placement nephrostomy catheter (both sides)
|
$5,658.75 |
$5,658.75 |
$5,658.75 |
$3,933.00
|
|
Placement stent(s) intravascular transcatheter artery initial
|
$30,622.00 |
$30,622.00 |
$30,622.00 |
$13,879.25
|
|
Platelet aggregation each agent teg
|
$12.25 |
$12.25 |
$12.25 |
$148.98
|
|
Platelet automated
|
$79.55 |
$79.55 |
$79.55 |
$46.00
|
|
Platelets pheresis leukocytes reduced cmv negative irradiated each unit
|
$1,602.45 |
$1,602.45 |
$1,602.45 |
$1,170.65
|
|
Platelets pheresis leukocytes reduced each unit
|
$1,442.90 |
$1,442.90 |
$1,442.90 |
$1,162.50
|
|
Platelets pheresis leukocytes reduced irradiated each unit
|
$1,439.15 |
$1,439.15 |
$1,439.15 |
$1,284.80
|
|
Platelets pheresis pathogen-reduced each unit
|
$1,627.40 |
$1,627.40 |
$1,627.40 |
$1,005.65
|
|
Plcmnt ureteral stent pq w/img exstng trct
|
$7,385.25 |
$7,385.25 |
$7,385.25 |
$5,087.15
|
|
Plcmnt ureteral stent pq w/img new w/cath
|
$7,385.25 |
$7,385.25 |
$7,385.25 |
$5,589.75
|
|
Plcmt sft tiss loc pq w/img 1st lsn
|
$1,911.75 |
$1,911.75 |
$1,911.75 |
$1,230.00
|