|
Adapt behavior tx phys/qhp
|
$54.15 |
$54.15 |
$54.15 |
$244.07
|
|
Adaptive behavior tx by tech
|
$18.45 |
$18.45 |
$18.45 |
$139.68
|
|
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution
|
$512.14 |
$512.14 |
$512.14 |
$193.40
|
|
Administration vaccine influenza virus
|
$56.95 |
$56.95 |
$56.95 |
$51.07
|
|
Administration vaccine rsv monoclonal ab seasonal dose im
|
$56.95 |
$56.95 |
$56.95 |
$41.45
|
|
Adrenalin epinephrine inject
|
$1,108.47 |
$1,108.47 |
$1,108.47 |
$231.47
|
|
Allograft dermis 20x25x1mm decell w/matracell arthroflex
|
$3,986.00 |
$3,986.00 |
$3,986.00 |
$6,285.56
|
|
Antibody screen rbc
|
$23.05 |
$23.05 |
$23.05 |
$108.55
|
|
Aquatic exercise - group charge
|
$232.50 |
$232.50 |
$232.50 |
$87.45
|
|
Balance and Coordination Retraining (each 15 minutes)
|
$102.10 |
$102.10 |
$102.10 |
$102.20
|
|
Benztropine 1 mg/ml injection solution
|
$90.63 |
$90.63 |
$90.63 |
$108.90
|
|
Bhv id assmt by phys/qhp
|
$43.05 |
$43.05 |
$43.05 |
$121.50
|
|
Bhv id suprt assmt by 1 tech
|
$47.95 |
$47.95 |
$47.95 |
$132.72
|
|
Bln 30frx10mmx12cm renal nephromax
|
$3,400.00 |
$3,400.00 |
$3,400.00 |
$5,330.60
|
|
Blood Clotting (PT/INR) Test
|
$52.00 |
$52.00 |
$52.00 |
$53.30
|
|
Blood typing abo
|
$8.65 |
$8.65 |
$8.65 |
$86.45
|
|
Blood typing rh (d)
|
$36.30 |
$36.30 |
$36.30 |
$57.60
|
|
Brace or Splint Fitting and Training (each 15 minutes)
|
$70.70 |
$70.70 |
$70.70 |
$105.30
|
|
Brief comunicaj tech-bsd svc
|
$35.00 |
$35.00 |
$35.00 |
$30.40
|
|
Cannula ercp contour 5-4-3 tip
|
$478.40 |
$478.40 |
$478.40 |
$44,000.00
|
|
Cap nerve 2x15mm
|
$2,250.00 |
$2,250.00 |
$2,250.00 |
$18,466.88
|
|
Cath groshong MRI 8fr plstc port
|
$195.00 |
$195.00 |
$195.00 |
$1,690.71
|
|
Cath malecot 28fr 4-wing ltx
|
$26.22 |
$26.22 |
$26.22 |
$2,549.50
|
|
Cath uret open tp 6fx70cm
|
$36.45 |
$36.45 |
$36.45 |
$573.88
|
|
Ceftriaxone 1 gram solution for injection
|
$11.72 |
$11.72 |
$11.72 |
$83.39
|
|
Chlorpromazine 0.125 mg/ml IV syringe - cnr
|
$255.30 |
$255.30 |
$255.30 |
$79.74
|
|
Ciprofloxacin otic susp 6 mg
|
$71.64 |
$71.64 |
$71.64 |
$63.31
|
|
Coombs direct
|
$13.35 |
$13.35 |
$13.35 |
$76.80
|
|
Co-treatment - group 15 mins, st
|
$37.25 |
$37.25 |
$37.25 |
$112.00
|
|
Counseling smoke cess interm >10mins
|
$49.20 |
$49.20 |
$49.20 |
$54.60
|
|
Covid-19 administration immunization im inj 1st/only component
|
$50.00 |
$50.00 |
$50.00 |
$49.13
|
|
Crisis psychotherapy 90839
|
$427.25 |
$427.25 |
$427.25 |
$313.30
|
|
Crisis psychotherapy additional 30 mins 90840
|
$140.45 |
$140.45 |
$140.45 |
$149.52
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$53.30 |
$53.30 |
$53.30 |
$25.32
|
|
Developmental screen/score/document 96110
|
$79.90 |
$79.90 |
$79.90 |
$142.38
|
|
Devel tst phys/qhp 1st hr
|
$307.55 |
$307.55 |
$307.55 |
$350.40
|
|
Device ablt adv novasure
|
$205.20 |
$205.20 |
$205.20 |
$6,237.48
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$1,200.00 |
$1,200.00 |
$1,200.00 |
$4,200.00
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$307.55 |
$307.55 |
$307.55 |
$199.50
|
|
Dexamethasone 4 mg tablet
|
$7.74 |
$7.74 |
$7.74 |
$5.85
|
|
Diphenhydramine 12.5 mg/5 ml oral elixir
|
$4.05 |
$4.05 |
$4.05 |
$1.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$9.03 |
$9.03 |
$9.03 |
$18.32
|
|
Droperidol 2.5 mg/ml injection solution
|
$81.99 |
$81.99 |
$81.99 |
$31.25
|
|
Drsg interceed 3x4in adh wnd barr absorb
|
$299.36 |
$299.36 |
$299.36 |
$1,818.32
|
|
EKG (Electrocardiogram)
|
$180.25 |
$180.25 |
$180.25 |
$89.60
|
|
EKG (Tracing Only)
|
$71.35 |
$71.35 |
$71.35 |
$226.50
|
|
Established Patient Office Visit (level 1)
|
$53.20 |
$53.20 |
$53.20 |
$122.20
|
|
Established Patient Office Visit (level 2)
|
$99.65 |
$99.65 |
$99.65 |
$139.20
|
|
Established Patient Office Visit (level 3)
|
$164.85 |
$164.85 |
$164.85 |
$186.94
|
|
Established Patient Office Visit (level 4)
|
$243.55 |
$243.55 |
$243.55 |
$239.25
|
|
Established Patient Office Visit (level 5)
|
$328.45 |
$328.45 |
$328.45 |
$290.68
|
|
Eval/fit voice prosthesis iii, st
|
$166.05 |
$166.05 |
$166.05 |
$359.50
|
|
Evaluation of speech fluency 92521
|
$183.25 |
$183.25 |
$183.25 |
$302.50
|
|
Evaluation psychiatric diagnostic
|
$527.40 |
$527.40 |
$527.40 |
$318.24
|
|
Fam adapt bhv tx gdn phy/qhp
|
$66.40 |
$66.40 |
$66.40 |
$66.40
|
|
Family therapy without pt 50min 90846
|
$261.65 |
$261.65 |
$261.65 |
$244.07
|
|
Family therapy with patient 50 min 90847
|
$283.50 |
$283.50 |
$283.50 |
$236.70
|
|
Fluphenazine decanoate 25 mg/ml injection solution
|
$92.56 |
$92.56 |
$92.56 |
$72.52
|
|
Ghs community re-entry 15 minutes
|
$94.45 |
$94.45 |
$94.45 |
$89.28
|
|
Ghs ot prosthetic training/15 min
|
$154.65 |
$154.65 |
$154.65 |
$93.00
|
|
Ghs ot sensory integrative tech/15min
|
$93.20 |
$93.20 |
$93.20 |
$96.20
|
|
Ghs ppd (tb intradermal)
|
$81.46 |
$81.46 |
$81.46 |
$37.44
|
|
Ghs speech-gen aug dev eval iii, st
|
$49.20 |
$49.20 |
$49.20 |
$157.50
|
|
Ghs sp train/fitting sp device - kx
|
$173.15 |
$173.15 |
$173.15 |
$252.75
|
|
Graft nerve adv 3-4x70mm
|
$4,153.00 |
$4,153.00 |
$4,153.00 |
$20,782.10
|
|
Graft patch felt ptfe 2x2
|
$285.00 |
$285.00 |
$285.00 |
$29,293.39
|
|
Graft xenmtrx sft rect 15x20cm
|
$2,130.00 |
$2,130.00 |
$2,130.00 |
$29,676.26
|
|
Grp adapt bhv tx by phy/qhp
|
$215.35 |
$215.35 |
$215.35 |
$51.52
|
|
Grp adapt bhv tx by tech
|
$18.45 |
$18.45 |
$18.45 |
$61.71
|
|
Guide wire threaded 1.4x150mm
|
$70.35 |
$70.35 |
$70.35 |
$3,284.36
|
|
Guide worley csg 9fx50cm std
|
$79.57 |
$79.57 |
$79.57 |
$1,117.40
|
|
Gw stiffened micro access kit
|
$99.58 |
$99.58 |
$99.58 |
$6,893.38
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$99.85 |
$99.85 |
$99.85 |
$91.09
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$6.79 |
$6.79 |
$6.79 |
$24.30
|
|
Hands-On Manual Therapy (each 15 minutes)
|
$44.95 |
$44.95 |
$44.95 |
$105.30
|
|
Impl ahmed 6x25x9.6mm glaucoma vlv w/sil ped ster
|
$1,045.00 |
$1,045.00 |
$1,045.00 |
$2,946.00
|
|
Infectious agent antigen immunoassay direct optical observation sars-cov-2
|
$51.55 |
$51.55 |
$51.55 |
$53.00
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b
|
$331.10 |
$331.10 |
$331.10 |
$206.00
|
|
Initial care training 30 m
|
$84.05 |
$84.05 |
$84.05 |
$49.89
|
|
Initial observation care
|
$250.65 |
$250.65 |
$250.65 |
$156.00
|
|
Initial observation care
|
$341.75 |
$341.75 |
$341.75 |
$268.20
|
|
Initial observation care
|
$467.80 |
$467.80 |
$467.80 |
$369.00
|
|
Inj, abilify maintena, 1 mg
|
$12,593.07 |
$12,593.07 |
$12,593.07 |
$5,355.30
|
|
Inj fluphenazine hcl 1.25 mg
|
$1,481.44 |
$1,481.44 |
$1,481.44 |
$40.33
|
|
Inj naloxone hydrochloride
|
$77.13 |
$77.13 |
$77.13 |
$83.16
|
|
Inj testosterone cypionate
|
$40.49 |
$40.49 |
$40.49 |
$64.96
|
|
Insulin for insulin pump use
|
$658.77 |
$658.77 |
$658.77 |
$67.93
|
|
Ip/obs cnsltj new/est low 45
|
$223.50 |
$223.50 |
$223.50 |
$174.20
|
|
Ip/obs consltj new/est sf 35
|
$221.60 |
$221.60 |
$221.60 |
$134.46
|
|
Lens iol ant bicnvx 24.0 multi
|
$595.00 |
$595.00 |
$595.00 |
$1,065.00
|
|
Lens iol ant chamb 10.5
|
$150.00 |
$150.00 |
$150.00 |
$377.71
|
|
Lidocaine (pf) 10 mg/ml (1 %) injection solution
|
$30.31 |
$30.31 |
$30.31 |
$46.02
|
|
Lorazepam 2 mg/ml injection (wrapper)
|
$10.97 |
$10.97 |
$10.97 |
$37.20
|
|
Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback
|
$17.51 |
$17.51 |
$17.51 |
$58.70
|
|
Medroxyprogesterone 150 mg/ml im injection (wrapper)
|
$192.83 |
$192.83 |
$192.83 |
$190.81
|
|
Mult fam adapt bhv tx gdn
|
$215.35 |
$215.35 |
$215.35 |
$83.14
|
|
Multi family grp psychotherapy
|
$122.40 |
$122.40 |
$122.40 |
$250.25
|
|
Nebulizer Breathing Treatment
|
$108.40 |
$108.40 |
$108.40 |
$203.49
|
|
Nerobehav stas exam by psy/md f2f 1st hr
|
$606.90 |
$606.90 |
$606.90 |
$429.80
|
|
Nerobehav stas exam phys/qhp f2f ea l hr
|
$314.90 |
$314.90 |
$314.90 |
$339.50
|
