|
Nm imaging kidney morphology vascular flow/function single study w/pharmacological intervention
|
$1,971.20 |
$1,971.20 |
$1,971.20 |
$1,541.32
|
|
Nm imaging pulmonary ventilation/perfusion
|
$2,065.60 |
$2,065.60 |
$2,065.60 |
$1,590.00
|
|
Nm imaging thyroid single/multiple uptake(s) quantitative measurement(s)
|
$1,316.80 |
$1,316.80 |
$1,316.80 |
$1,091.00
|
|
Nm radiopharmaceutical therapy oral administration
|
$1,599.20 |
$1,599.20 |
$1,599.20 |
$1,024.56
|
|
No pt prsnt train add 15
|
$70.40 |
$70.40 |
$70.40 |
$47.60
|
|
No pt prsnt train initial 30
|
$140.80 |
$140.80 |
$140.80 |
$61.33
|
|
Nose (Nasal Bone) X-ray (complete)
|
$404.80 |
$404.80 |
$404.80 |
$274.65
|
|
Nr lnr acclrtr tx max 5 sessions
|
$6,920.00 |
$6,920.00 |
$6,920.00 |
$6,930.00
|
|
Nuclear rx IV admin
|
$1,130.40 |
$1,130.40 |
$1,130.40 |
$864.50
|
|
Nuclear Stress Test (Heart)
|
$3,842.40 |
$3,842.40 |
$3,842.40 |
$3,859.98
|
|
Observation direct referral from physician office for admission
|
$200.00 |
$200.00 |
$200.00 |
$384.00
|
|
Observation per hour
|
$168.00 |
$168.00 |
$168.00 |
$82.50
|
|
Ob Ultrasound nuchal meas 1 gest
|
$509.60 |
$509.60 |
$509.60 |
$357.00
|
|
Ob Ultrasound nuchal meas add-on
|
$450.40 |
$450.40 |
$450.40 |
$249.60
|
|
Occupational Therapy Evaluation (high complexity)
|
$303.20 |
$303.20 |
$303.20 |
$297.00
|
|
Occupational Therapy Evaluation (low complexity)
|
$268.80 |
$268.80 |
$268.80 |
$232.40
|
|
Occupational Therapy Evaluation (moderate complexity)
|
$289.60 |
$289.60 |
$289.60 |
$263.90
|
|
Octreotide acetate 100 mcg/ml injection (wrapper)
|
$52.27 |
$52.27 |
$52.27 |
$90.00
|
|
Octreotide,microspheres ER 20 mg intramuscular susp, extended release
|
$5,952.15 |
$5,952.15 |
$5,952.15 |
$12,080.43
|
|
Off/op cnsltj new/est low 30
|
$213.60 |
$213.60 |
$213.60 |
$183.00
|
|
Off/op cnsltj new/est mod 40
|
$244.00 |
$244.00 |
$244.00 |
$273.60
|
|
Off/op consltj new/est hi 55
|
$320.80 |
$320.80 |
$320.80 |
$352.50
|
|
Off/op consltj new/est sf 20
|
$194.40 |
$194.40 |
$194.40 |
$137.80
|
|
Oil silicone ophth 8.5ml silikon 1000
|
$1,535.79 |
$1,535.79 |
$1,535.79 |
$1,220.80
|
|
Olanzapine 10 mg intramuscular solution
|
$88.04 |
$88.04 |
$88.04 |
$109.62
|
|
Omalizumab 150 mg/ml subcutaneous syringe (wrapper)
|
$1,164.65 |
$1,164.65 |
$1,164.65 |
$4,595.01
|
|
Ondansetron 4 mg s0119
|
$5.37 |
$5.37 |
$5.37 |
$2.52
|
|
Ondansetron 8 mg disintegrating tablet
|
$7.92 |
$7.92 |
$7.92 |
$9.93
|
|
Ondansetron hcl (pf) 2 mg/ml injection (wrapper)
|
$48.68 |
$48.68 |
$48.68 |
$22.62
|
|
Oph Ultrasound dx ant sgm Ultrasound uni/bi
|
$499.20 |
$499.20 |
$499.20 |
$215.90
|
|
Oph Ultrasound dx quan a-scan only
|
$415.20 |
$415.20 |
$415.20 |
$298.98
|
|
Oritavancin 400 mg intravenous solution
|
$1,039.68 |
$1,039.68 |
$1,039.68 |
$3,311.06
|
|
Orphenadrine citrate 30 mg/ml injection solution
|
$57.44 |
$57.44 |
$57.44 |
$50.63
|
|
Ortho elbow without jnt cstm w/fit&adj
|
$310.73 |
$310.73 |
$310.73 |
$279.81
|
|
Ortho elbow w/lock w/ft&adj
|
$786.56 |
$786.56 |
$786.56 |
$536.90
|
|
Ortho ewhf rigd without jnt cstm w
|
$1,332.88 |
$1,332.88 |
$1,332.88 |
$1,288.00
|
|
Ortho ewh rgd without jnt cstm w/fit&adj
|
$708.88 |
$708.88 |
$708.88 |
$702.80
|
|
Ortho hnd/fngr without jnt cstm w/fit&adj
|
$526.45 |
$526.45 |
$526.45 |
$231.66
|
|
Ortho hnd/fngr w/jnt cstm w/fit&adj
|
$345.53 |
$345.53 |
$345.53 |
$310.00
|
|
Ortho hnd metcrpl fx prefb w/fit&adj
|
$167.30 |
$167.30 |
$167.30 |
$174.40
|
|
Ortho hnd without jnt w/fit&adj
|
$423.72 |
$423.72 |
$423.72 |
$229.45
|
|
Orthosis lso rigd frm hyperex
|
$433.89 |
$433.89 |
$433.89 |
$813.61
|
|
Ortho whf rigd without jnt cstm w/fit&adj
|
$534.64 |
$534.64 |
$534.64 |
$421.00
|
|
Ortho wrst/hnd w/jnt cstm w/fit&adj
|
$1,211.11 |
$1,211.11 |
$1,211.11 |
$686.79
|
|
Oth resp proc, group
|
$136.80 |
$136.80 |
$136.80 |
$126.00
|
|
Oth resp proc, indiv
|
$121.60 |
$121.60 |
$121.60 |
$83.50
|
|
Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes
|
$134.40 |
$134.40 |
$134.40 |
$97.80
|
|
Ot re-evaluation patient/family
|
$154.40 |
$154.40 |
$154.40 |
$160.80
|
|
Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes
|
$124.00 |
$124.00 |
$124.00 |
$88.54
|
|
Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes
|
$138.40 |
$138.40 |
$138.40 |
$93.12
|
|
Oxytocin 10 unit/ml injection solution
|
$48.82 |
$48.82 |
$48.82 |
$50.40
|
|
Paliperidone 117 mg/0.75 ml inj
|
$2,374.14 |
$2,374.14 |
$2,374.14 |
$6,238.82
|
|
Palivizumab 50 mg/0.5 ml inj
|
$1,481.67 |
$1,481.67 |
$1,481.67 |
$5,580.28
|
|
Palonosetron hcl
|
$104.77 |
$104.77 |
$104.77 |
$163.00
|
|
Pamidronate 30 mg/10 ml (3 mg/ml) intravenous solution
|
$54.46 |
$54.46 |
$54.46 |
$123.55
|
|
Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr
|
$50.08 |
$50.08 |
$50.08 |
$28.90
|
|
Parathyrd planar w/spect&ct
|
$2,148.80 |
$2,148.80 |
$2,148.80 |
$1,574.40
|
|
Parathyroid planar imaging
|
$1,509.60 |
$1,509.60 |
$1,509.60 |
$1,126.00
|
|
Parathyroid planar img w/tomo spect
|
$1,752.80 |
$1,752.80 |
$1,752.80 |
$1,374.75
|
|
Paring/cutting benign hyperkeratotic lesion single
|
$275.20 |
$275.20 |
$275.20 |
$245.67
|
|
Partial excision bone tars/metatars exc talus/calcaneus (both sides) (rest meth ii cah)
|
$5,355.20 |
$5,355.20 |
$5,355.20 |
$4,914.00
|
|
Partial excision of lip
|
$4,968.80 |
$4,968.80 |
$4,968.80 |
$4,133.59
|
|
Partial removal finger bone
|
$4,820.80 |
$4,820.80 |
$4,820.80 |
$2,134.33
|
|
Particle matristem matrix 1000mg micron-q4118-cost per mg
|
$35.43 |
$35.43 |
$35.43 |
$4,921.76
|
|
Pcv21 vaccine im
|
$268.32 |
$268.32 |
$268.32 |
$410.26
|
|
Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector
|
$5,000.86 |
$5,000.86 |
$5,000.86 |
$11,216.31
|
|
Pegfilgrastim-apgf 6 mg/0.6 ml subcutaneous syringe
|
$1,745.35 |
$1,745.35 |
$1,745.35 |
$6,370.52
|
|
Pegfilgrastim-cbqv 6 mg/0.6 ml subcutaneous syringe
|
$3,943.76 |
$3,943.76 |
$3,943.76 |
$7,297.36
|
|
Pegfilgrastim-fpgk 6 mg/0.6 ml subcutaneous syringe
|
$4,177.60 |
$4,177.60 |
$4,177.60 |
$4,300.20
|
|
Pegfilgrastim-jmdb 6 mg/0.6 ml subcutaneous syringe
|
$1,339.85 |
$1,339.85 |
$1,339.85 |
$4,133.25
|
|
Peg interferon alfa-2a/180
|
$1,075.96 |
$1,075.96 |
$1,075.96 |
$2,672.20
|
|
Pelvic CT scan (with and without contrast)
|
$2,484.00 |
$2,484.00 |
$2,484.00 |
$1,890.36
|
|
Pelvic CT scan (with contrast)
|
$2,002.40 |
$2,002.40 |
$2,002.40 |
$1,608.98
|
|
Pelvic CT scan (without contrast)
|
$1,715.20 |
$1,715.20 |
$1,715.20 |
$1,335.34
|
|
Pelvic MRI (with and without contrast)
|
$3,837.60 |
$3,837.60 |
$3,837.60 |
$2,860.00
|
|
Pelvic MRI (with contrast)
|
$3,341.60 |
$3,341.60 |
$3,341.60 |
$2,210.00
|
|
Pelvic MRI (without contrast)
|
$2,744.00 |
$2,744.00 |
$2,744.00 |
$1,916.50
|
|
Pelvic Ultrasound (complete)
|
$772.00 |
$772.00 |
$772.00 |
$643.80
|
|
Pelvic Ultrasound (limited)
|
$410.40 |
$410.40 |
$410.40 |
$430.80
|
|
Pelvis X-ray (1 to 2 views)
|
$351.20 |
$351.20 |
$351.20 |
$281.82
|
|
Pelvis X-ray (complete, 4 or more views)
|
$456.80 |
$456.80 |
$456.80 |
$351.75
|
|
Pemivibart infusion
|
$798.40 |
$798.40 |
$798.40 |
$533.10
|
|
Peng benzathine/procaine inj
|
$155.22 |
$155.22 |
$155.22 |
$375.32
|
|
Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe
|
$354.99 |
$354.99 |
$354.99 |
$824.70
|
|
Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr
|
$76.63 |
$76.63 |
$76.63 |
$97.85
|
|
Penile injection
|
$510.40 |
$510.40 |
$510.40 |
$424.60
|
|
Penile rear tip xtnd 0.5cm
|
$22,508.72 |
$22,508.72 |
$22,508.72 |
$18,764.94
|
|
Pentamidine non-comp unit
|
$132.05 |
$132.05 |
$132.05 |
$294.39
|
|
Perc cryo ablate renal tum
|
$12,917.60 |
$12,917.60 |
$12,917.60 |
$11,523.76
|
|
Perc d-e cor revasc chro sin
|
$27,648.00 |
$27,648.00 |
$27,648.00 |
$18,435.36
|
|
Perc d-e cor revasc t cabg b
|
$18,468.00 |
$18,468.00 |
$18,468.00 |
$11,976.00
|
|
Perc d-e cor revasc t cabg s
|
$20,732.80 |
$20,732.80 |
$20,732.80 |
$16,047.20
|
|
Perc d-e cor stent ather br
|
$17,742.40 |
$17,742.40 |
$17,742.40 |
$12,449.00
|
|
Perc d-e cor stent ather s
|
$26,204.00 |
$26,204.00 |
$26,204.00 |
$18,545.83
|
|
Perc drug-el cor stent bran
|
$16,140.00 |
$16,140.00 |
$16,140.00 |
$11,667.75
|
|
Perc drug-el cor stent sing
|
$21,376.00 |
$21,376.00 |
$21,376.00 |
$16,258.50
|
|
Perflutren lipid microspheres 1.1 mg/ml intravenous suspension
|
$177.36 |
$177.36 |
$177.36 |
$332.84
|
|
Pericardiocentesis wwo imaging
|
$2,573.60 |
$2,573.60 |
$2,573.60 |
$2,375.00
|
|
Peripheral vascular rehab
|
$143.20 |
$143.20 |
$143.20 |
$132.50
|
|
Peri-proc device eval icd
|
$233.60 |
$233.60 |
$233.60 |
$192.40
|