|
Optx rdl shft fx&dstl rad/ul
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$7,807.24
|
|
Optx rdl&uln shft fx rds&uln
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$6,839.00
|
|
Optx rdl&uln shft fx rds/uln
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$6,665.84
|
|
Optx scapular fx w/int fixj
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$7,807.24
|
|
Optx sho dislc fx
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$7,807.24
|
|
Optx sho dislc neck fx fixj
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$10,629.07
|
|
Optx strclv dslc aq/chrn grf
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$5,886.74
|
|
Optx strnclav dislc aqt/chrn
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$6,072.59
|
|
Optx tmprmand dislocation
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,986.00
|
|
Optx trns-scphprlnr fx dislc
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$4,627.00
|
|
Optx ulnar shft fx int fixj
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$7,913.97
|
|
Optx ulnar styloid fracture
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$5,886.74
|
|
Orchiectomy partial
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$4,081.37
|
|
Orchiopexy (fowler-stephens)
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,906.18
|
|
Orchiopexy ingun/scrot appr
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$4,176.15
|
|
Organic acids total quant ea spec
|
$25.96 |
$25.96 |
$25.96 |
$151.36
|
|
Oropharyngeal biopsy 42800
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$1,855.10
|
|
Ortho ewh rgd without jnt cstm w/fit&adj
|
$699.42 |
$699.42 |
$699.42 |
$772.99
|
|
Ortho hnd/fngr without jnt cstm w/fit&adj
|
$94.72 |
$94.72 |
$94.72 |
$231.00
|
|
Ortho hnd/fngr w/jnt cstm w/fit&adj
|
$112.82 |
$112.82 |
$112.82 |
$306.00
|
|
Ortho hnd without jnt w/fit&adj
|
$217.14 |
$217.14 |
$217.14 |
$225.00
|
|
Orthosis lso rigd frm hyperex
|
$182.30 |
$182.30 |
$182.30 |
$813.61
|
|
Ortho whf rigd without jnt cstm w/fit&adj
|
$87.03 |
$87.03 |
$87.03 |
$420.76
|
|
Ortho wrst/hnd w/jnt cstm w/fit&adj
|
$258.83 |
$258.83 |
$258.83 |
$410.92
|
|
Oscillation chest wall mechanical per session
|
$72.79 |
$72.79 |
$72.79 |
$221.34
|
|
Osmolality blood
|
$7.27 |
$7.27 |
$7.27 |
$67.60
|
|
Osmolality urine
|
$7.50 |
$7.50 |
$7.50 |
$65.65
|
|
Ostectomy complete 1st metatarsal head 28111
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,821.05
|
|
Ostectomy scapula partial
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,594.44
|
|
Osteochondral knee allograft
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$7,862.94
|
|
Osteochondral knee autograft
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$7,907.11
|
|
Osteochondral talus autogrft
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$6,731.17
|
|
Osteoplasty humerus
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$6,311.00
|
|
Osteot humerus w/wo int fixj
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$5,886.74
|
|
Osteotomy/graft tarsal/calcaneus/talus 28305
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$5,855.00
|
|
Other immunoelectrophoresis
|
$25.44 |
$25.44 |
$25.44 |
$46.40
|
|
Oth resp proc, group
|
$63.87 |
$63.87 |
$63.87 |
$137.05
|
|
Otoplasty 69300
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,589.62
|
|
Ot therapeutic activities direct patient contact each 15 minutes
|
$76.26 |
$76.26 |
$76.26 |
$100.20
|
|
Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes
|
$76.26 |
$76.26 |
$76.26 |
$97.80
|
|
Ovarian cystectomy 58925
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$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
|
|
Parathyroid planar imaging
|
$503.56 |
$503.56 |
$503.56 |
$1,166.00
|
|
Parathyroid planar img w/tomo spect
|
$575.12 |
$575.12 |
$575.12 |
$1,398.75
|
|
Paravaginal defect repair 57284
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$5,468.70
|
|
Parial mast w/lymph removal 19302
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$5,428.78
|
|
Paring/cutting benign hyperkeratotic lesion single
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$270.00
|
|
Parotid duct diversion
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$5,339.00
|
|
Parotid duct diversion
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$6,465.11
|
|
Parotid duct diversion
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,837.72
|
|
Part exc/post vert comp/sng/thorac 22101
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$7,553.59
|
|
Part hymenectomy/revi hymenal ring 56700
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,762.53
|
|
Partial exc bone humerus
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,839.54
|
|
Partial excision bone tars/metatars exc talus/calcaneus (both sides) (rest meth ii cah)
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,881.50
|
|
Partial excision of lip
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,837.72
|
|
Partial removal finger bone
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$2,021.04
|
|
Partial removal finger bone
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$2,211.05
|
|
Partial removal foot fascia
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,839.54
|
|
Partial removal leg bone(s)
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$4,315.20
|
|
Partial removal of eye fluid
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$2,698.92
|
|
Partial removal of eye fluid
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$2,698.92
|
|
Partial removal of fibula
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,714.10
|
|
Partial removal of foot bone
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,839.54
|
|
Partial removal of hand bone
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,668.02
|
|
Partial removal of lip
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,837.72
|
|
Partial removal of nose
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$6,547.81
|
|
Partial removal of penis
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$4,081.37
|
|
Partial removal of pharynx 42890
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$5,416.89
|
|
Partial removal of radius
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,839.54
|
|
Partial removal of radius
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,594.44
|
|
Partial removal of rib
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$5,855.00
|
|
Partial removal of thyroid
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$6,311.00
|
|
Partial removal of thyroid
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$5,741.00
|
|
Partial removal of tibia
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$4,108.80
|
|
Partial removal of toe
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,821.05
|
|
Partial removal of tongue
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$5,978.70
|
|
Partial removal of ulna
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,839.54
|
|
Partial removal of ulna
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,803.90
|
|
Partial removal of ulna
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,839.54
|
|
Partial removal of vaginal wall 57106
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,744.41
|
|
Partial removal tear gland
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$4,627.00
|
|
Partial thyroid excision
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$6,038.00
|
|
Partial thyroid lobect w/contratlat stot lobec 60212
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$5,855.00
|
|
Particle matristem matrix 1000mg micron-q4118-cost per mg
|
$676.29 |
$676.29 |
$676.29 |
$4,418.35
|
|
Part removal of metatarsal
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,795.71
|
|
Part removal of metatarsal
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$2,942.23
|
|
Part removal of metatarsal 28112
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$3,591.33
|
|
Passy muir valve metal trach
|
$33.47 |
$33.47 |
$33.47 |
$242.47
|
|
Pdgfra gene
|
$362.46 |
$362.46 |
$362.46 |
$659.20
|
|
Pedcle fh/ch/ch/m/n/ax/g/h/f
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$2,216.80
|
|
Pedicle enel/ntroral 15576
|
$3,786.00 |
$3,786.00 |
$3,786.00 |
$2,436.20
|
|
Pelvic CT scan (with and without contrast)
|
$588.18 |
$588.18 |
$588.18 |
$1,918.15
|
|
Pelvic CT scan (with contrast)
|
$531.56 |
$531.56 |
$531.56 |
$1,669.00
|
|
Pelvic CT scan (without contrast)
|
$418.94 |
$418.94 |
$418.94 |
$1,332.80
|
|
Pelvic MRI (with and without contrast)
|
$1,054.21 |
$1,054.21 |
$1,054.21 |
$2,744.64
|
|
Pelvic MRI (with contrast)
|
$1,031.81 |
$1,031.81 |
$1,031.81 |
$2,087.21
|
|
Pelvic MRI (without contrast)
|
$662.22 |
$662.22 |
$662.22 |
$1,879.15
|
|
Pelvic Ultrasound (complete)
|
$236.02 |
$236.02 |
$236.02 |
$643.80
|
