|
Osteochondral talus autogrft
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$6,731.17
|
|
Osteoplasty humerus
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$6,311.00
|
|
Osteot humerus w/wo int fixj
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$5,886.74
|
|
Osteotomy/graft tarsal/calcaneus/talus 28305
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$5,855.00
|
|
Other immunoelectrophoresis
|
$25.44 |
$25.44 |
$25.44 |
$46.40
|
|
Oth resp proc, group
|
$90.26 |
$90.26 |
$90.26 |
$137.05
|
|
Oth resp proc, indiv
|
$47.46 |
$47.46 |
$47.46 |
$89.70
|
|
Otoplasty 69300
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,589.62
|
|
Ovarian cystectomy 58925
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$5,813.46
|
|
Palb2 gene full gene seq
|
$744.15 |
$744.15 |
$744.15 |
$649.44
|
|
Palb2 gene known famil vrnt
|
$331.49 |
$331.49 |
$331.49 |
$398.20
|
|
Parathormone (pth) intact
|
$45.41 |
$45.41 |
$45.41 |
$200.23
|
|
Parathyrd planar w/spect&ct
|
$556.23 |
$556.23 |
$556.23 |
$1,574.40
|
|
Parathyroid planar imaging
|
$451.77 |
$451.77 |
$451.77 |
$1,166.00
|
|
Parathyroid planar img w/tomo spect
|
$522.12 |
$522.12 |
$522.12 |
$1,398.75
|
|
Paravaginal defect repair 57284
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$5,468.70
|
|
Parial mast w/lymph removal 19302
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$5,428.78
|
|
Paring/cutting benign hyperkeratotic lesion single
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$270.00
|
|
Parotid duct diversion
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$5,339.00
|
|
Parotid duct diversion
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$6,465.11
|
|
Parotid duct diversion
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,837.72
|
|
Part exc/post vert comp/sng/thorac 22101
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$7,553.59
|
|
Part hymenectomy/revi hymenal ring 56700
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,762.53
|
|
Partial exc bone humerus
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,839.54
|
|
Partial excision bone tars/metatars exc talus/calcaneus (both sides) (rest meth ii cah)
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,881.50
|
|
Partial excision of lip
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,837.72
|
|
Partial removal finger bone
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,021.04
|
|
Partial removal finger bone
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,211.05
|
|
Partial removal foot fascia
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,839.54
|
|
Partial removal leg bone(s)
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$4,315.20
|
|
Partial removal of eye fluid
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,698.92
|
|
Partial removal of eye fluid
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,698.92
|
|
Partial removal of fibula
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,714.10
|
|
Partial removal of foot bone
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,839.54
|
|
Partial removal of hand bone
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,668.02
|
|
Partial removal of lip
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,837.72
|
|
Partial removal of nose
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$6,547.81
|
|
Partial removal of penis
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$4,081.37
|
|
Partial removal of pharynx 42890
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$5,416.89
|
|
Partial removal of radius
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,839.54
|
|
Partial removal of radius
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,594.44
|
|
Partial removal of rib
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$5,855.00
|
|
Partial removal of thyroid
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$6,311.00
|
|
Partial removal of thyroid
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$5,741.00
|
|
Partial removal of tibia
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$4,108.80
|
|
Partial removal of toe
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,821.05
|
|
Partial removal of tongue
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$5,978.70
|
|
Partial removal of ulna
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,839.54
|
|
Partial removal of ulna
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,803.90
|
|
Partial removal of ulna
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,839.54
|
|
Partial removal of vaginal wall 57106
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,744.41
|
|
Partial removal tear gland
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$4,627.00
|
|
Partial thyroid excision
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$6,038.00
|
|
Partial thyroid lobect w/contratlat stot lobec 60212
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$5,855.00
|
|
Particle matristem matrix 1000mg micron-q4118-cost per mg
|
$690.97 |
$690.97 |
$690.97 |
$4,418.35
|
|
Part removal of metatarsal
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,795.71
|
|
Part removal of metatarsal
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,942.23
|
|
Part removal of metatarsal 28112
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,591.33
|
|
Passy muir valve metal trach
|
$34.19 |
$34.19 |
$34.19 |
$242.47
|
|
Path clin consltj high 41-60
|
$107.22 |
$107.22 |
$107.22 |
$187.28
|
|
Path clin consltj mod 21-40
|
$57.42 |
$57.42 |
$57.42 |
$192.11
|
|
Path clin consltj sf 5-20
|
$19.28 |
$19.28 |
$19.28 |
$82.15
|
|
Pdgfra gene
|
$362.46 |
$362.46 |
$362.46 |
$659.20
|
|
Pedcle fh/ch/ch/m/n/ax/g/h/f
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,216.80
|
|
Pedicle enel/ntroral 15576
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,436.20
|
|
Pelvic CT scan (with and without contrast)
|
$600.94 |
$600.94 |
$600.94 |
$1,918.15
|
|
Pelvic CT scan (with contrast)
|
$543.09 |
$543.09 |
$543.09 |
$1,669.00
|
|
Pelvic CT scan (without contrast)
|
$428.03 |
$428.03 |
$428.03 |
$1,332.80
|
|
Pelvic MRI (with and without contrast)
|
$1,095.73 |
$1,095.73 |
$1,095.73 |
$2,744.64
|
|
Pelvic MRI (with contrast)
|
$1,054.20 |
$1,054.20 |
$1,054.20 |
$2,087.21
|
|
Pelvic MRI (without contrast)
|
$699.90 |
$699.90 |
$699.90 |
$1,879.15
|
|
Pelvic Ultrasound (complete)
|
$237.53 |
$237.53 |
$237.53 |
$643.80
|
|
Pelvic Ultrasound (limited)
|
$86.03 |
$86.03 |
$86.03 |
$445.00
|
|
Pemivibart infusion
|
$190.71 |
$190.71 |
$190.71 |
$603.65
|
|
Penile injection
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$418.00
|
|
Penile vascular study
|
$196.43 |
$196.43 |
$196.43 |
$561.00
|
|
Penile venous occlusion
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$4,081.37
|
|
Penis plastic surgery
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$4,081.37
|
|
Penis study
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$308.10
|
|
Perc cryo ablate renal tum
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$12,320.22
|
|
Perc rf ablate renal tumor
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$6,949.48
|
|
Percut ablate liver rf
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$7,024.12
|
|
Pericardiocentesis wwo imaging
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,573.60
|
|
Peri-implt capslc brst compl
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$4,184.94
|
|
Perineoplasty rpr per nonob
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$3,474.84
|
|
Peripheral vascular rehab
|
$49.79 |
$49.79 |
$49.79 |
$128.69
|
|
Peri-proc device eval icd
|
$55.30 |
$55.30 |
$55.30 |
$220.35
|
|
Peritoneal cath sub q resv per
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$5,625.74
|
|
Perq dev breast 1st mr guide
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$2,032.24
|
|
Perq dev breast 1st strtctc
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$1,548.60
|
|
Perq nl/pl lithotrp cplx>2cm
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$10,114.58
|
|
Perq nl/pl lithotrp smpl<2cm
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$8,748.48
|
|
Perq p-art revsc 1 abnor bi
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$15,916.29
|
|
Perq p-art revsc 1 abnor uni
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$20,544.05
|
|
Perq p-art revsc 1 nm nt bi
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$15,217.89
|
|
Perq p-art revsc 1 nm nt uni
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$15,145.00
|
|
Perq plmt bile duct stent
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$6,904.15
|
|
Perq plmt bile duct stent
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$6,457.82
|
|
Perq plmt bile duct stent
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$7,082.99
|
|
Perq rplcmt g-tube req revsn gstrst trk
|
$6,839.00 |
$6,839.00 |
$6,839.00 |
$625.93
|
