|
Nuclear rx intra-arterial
|
$512.00 |
$512.00 |
$998.40 |
|
|
Nuclear rx intra-articular
|
$244.00 |
$244.00 |
$536.80 |
|
|
Nuclear rx intracav admin
|
$625.60 |
$625.60 |
$625.60 |
|
|
Nuclear rx IV admin
|
$609.60 |
$609.60 |
$1,322.40 |
|
|
Nuclear Stress Test (Heart)
|
$3,233.60 |
$3,233.60 |
$3,676.80 |
|
|
Nusinersen (pf) 12 mg/5 ml intrathecal solution
|
$41,666.68 |
$41,666.68 |
$41,666.68 |
|
|
Obinutuzumab 1,000 mg/40 ml intravenous solution
|
$7,205.96 |
$7,205.96 |
$13,778.64 |
|
|
Observation direct referral from physician office for admission
|
$114.40 |
$210.40 |
$846.40 |
|
|
Observation per hour
|
$47.20 |
$47.20 |
$123.20 |
|
|
Obstetrics panel
|
$303.20 |
$303.20 |
$303.20 |
|
|
Ob Ultrasound nuchal meas 1 gest
|
$285.60 |
$285.60 |
$404.00 |
|
|
Ob Ultrasound nuchal meas add-on
|
$153.60 |
$153.60 |
$153.60 |
|
|
Occupational Therapy Evaluation (high complexity)
|
$292.00 |
$308.80 |
$312.00 |
|
|
Occupational Therapy Evaluation (low complexity)
|
$252.80 |
$257.60 |
$262.40 |
|
|
Occupational Therapy Evaluation (moderate complexity)
|
$272.00 |
$280.00 |
$294.40 |
|
|
Ocrelizumab 30 mg/ml intravenous solution
|
$17,250.11 |
$17,286.00 |
$26,130.16 |
|
|
Octreotide acetate 100 mcg/ml injection (wrapper)
|
$3.06 |
$16.80 |
$28.67 |
|
|
Octreotide,microspheres ER 20 mg intramuscular susp, extended release
|
$6,719.41 |
$6,719.41 |
$6,719.41 |
|
|
Ofatumumab 20 mg/ml intravenous solution (wrapper)
|
$5,204.71 |
$5,204.71 |
$5,204.71 |
|
|
Off/op cnsltj new/est low 30
|
$219.20 |
$219.20 |
$219.20 |
|
|
Off/op cnsltj new/est mod 40
|
$269.60 |
$269.60 |
$269.60 |
|
|
Off/op consltj new/est hi 55
|
$324.00 |
$324.00 |
$324.00 |
|
|
Off/op consltj new/est sf 20
|
$196.00 |
$196.00 |
$196.00 |
|
|
Oil silicone ophth 8.5ml silikon 1000
|
$1,407.80 |
$1,407.80 |
$1,842.95 |
|
|
Olanzapine 10 mg intramuscular solution
|
$40.34 |
$69.23 |
$162.45 |
|
|
Olanzapine long-acting inj
|
$1,937.24 |
$1,937.24 |
$2,493.51 |
|
|
Omalizumab 150 mg/ml subcutaneous syringe (wrapper)
|
$1,516.53 |
$1,545.31 |
$3,210.60 |
|
|
Oncoprotein dcp
|
$156.80 |
$156.80 |
$156.80 |
|
|
Ondansetron 4 mg s0119
|
$2.40 |
$4.04 |
$6.13 |
|
|
Ondansetron 8 mg disintegrating tablet
|
$21.49 |
$21.49 |
$22.04 |
|
|
Ondansetron hcl (pf) 2 mg/ml injection (wrapper)
|
$16.80 |
$25.68 |
$27.39 |
|
|
Oocyte identification
|
$680.00 |
$680.00 |
$680.00 |
|
|
Open aortoiliac prosth repr 34831
|
$4,552.00 |
$4,552.00 |
$10,286.40 |
|
|
Opn ax/subcla art expos
|
$7,224.80 |
$7,224.80 |
$7,224.80 |
|
|
Opn fem art expos cndt crtj 34714
|
$7,947.20 |
$7,947.20 |
$7,947.20 |
|
|
Opps service,sched team conf
|
$684.00 |
$684.00 |
$684.00 |
|
|
Oral aprepitant
|
$389.06 |
$389.06 |
$514.91 |
|
|
Oral everolimus
|
$969.31 |
$969.31 |
$969.31 |
|
|
Oritavancin 400 mg intravenous solution
|
$1,522.61 |
$1,522.61 |
$1,522.61 |
|
|
Oropharyngeal biopsy 42800
|
$3,052.80 |
$3,052.80 |
$3,052.80 |
|
|
Orphenadrine citrate 30 mg/ml injection solution
|
$35.02 |
$35.02 |
$35.02 |
|
|
Ortho dvc repair per 15 min
|
$44.80 |
$44.80 |
$44.80 |
|
|
Ortho elbow without jnt cstm w/fit&adj
|
$316.73 |
$316.73 |
$373.60 |
|
|
Ortho elbow w/lock w/ft&adj
|
$688.24 |
$688.24 |
$1,336.21 |
|
|
Ortho ewh rgd without jnt cstm w/fit&adj
|
$866.40 |
$866.40 |
$866.40 |
|
|
Ortho hnd/fngr without jnt cstm w/fit&adj
|
$302.51 |
$302.51 |
$349.60 |
|
|
Ortho hnd/fngr w/jnt cstm w/fit&adj
|
$415.20 |
$415.20 |
$415.20 |
|
|
Ortho hnd metcrpl fx prefb w/fit&adj
|
$136.80 |
$136.80 |
$224.00 |
|
|
Ortho hnd without jnt w/fit&adj
|
$349.60 |
$349.60 |
$349.60 |
|
|
Orthopantogram
|
$156.00 |
$156.00 |
$388.80 |
|
|
Orthosis lso rigd frm hyperex
|
$406.77 |
$406.77 |
$734.33 |
|
|
Ortho whf rigd without jnt cstm w/fit&adj
|
$469.60 |
$469.60 |
$1,597.92 |
|
|
Ortho wrst/hnd w/jnt cstm w/fit&adj
|
$856.08 |
$856.08 |
$1,279.20 |
|
|
Oscillation chest wall mechanical per session
|
$175.20 |
$175.20 |
$189.60 |
|
|
Osmolality blood
|
$35.20 |
$35.20 |
$35.20 |
|
|
Osmolality urine
|
$38.40 |
$38.40 |
$38.40 |
|
|
Oth resp proc, group
|
$90.40 |
$153.60 |
$174.40 |
|
|
Oth resp proc, indiv
|
$100.00 |
$116.80 |
$118.40 |
|
|
Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes
|
$128.00 |
$130.40 |
$152.80 |
|
|
Ot re-evaluation patient/family
|
$184.00 |
$192.00 |
$194.40 |
|
|
Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes
|
$95.20 |
$96.80 |
$181.60 |
|
|
Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes
|
$97.60 |
$122.40 |
$216.00 |
|
|
Oxacillin in ns IV syringe 40 mg/ml (neo/ped) - cnr
|
$100.90 |
$100.90 |
$100.90 |
|
|
Oxaliplatin 5 mg/ml desensitization
|
$302.24 |
$302.24 |
$389.76 |
|
|
Oxytocin 10 unit/ml injection solution
|
$26.65 |
$26.67 |
$102.14 |
|
|
Paclitaxel 6 mg/ml concentrate,intravenous
|
$137.60 |
$137.60 |
$328.36 |
|
|
Paclitaxel protein-bound 100 mg intravenous suspension
|
$1,521.41 |
$1,521.41 |
$3,361.23 |
|
|
Paliperidone 117 mg/0.75 ml inj
|
$1,669.36 |
$3,434.31 |
$5,213.83 |
|
|
Palivizumab 50 mg/0.5 ml inj
|
$4,074.65 |
$4,074.65 |
$4,776.86 |
|
|
Palonosetron hcl
|
$33.35 |
$136.00 |
$422.89 |
|
|
Pamidronate 30 mg/10 ml (3 mg/ml) intravenous solution
|
$65.92 |
$65.92 |
$128.07 |
|
|
Panitumumab 20 mg/ml intravenous solution (wrapper)
|
$4,925.31 |
$4,925.31 |
$6,368.65 |
|
|
Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr
|
$16.80 |
$27.71 |
$28.54 |
|
|
Papaverin hcl injection
|
$68.88 |
$68.88 |
$108.62 |
|
|
Parathormone (pth) intact
|
$212.00 |
$212.00 |
$212.00 |
|
|
Parathyrd planar w/spect&ct
|
$2,074.40 |
$2,074.40 |
$2,074.40 |
|
|
Parathyroid planar imaging
|
$1,356.00 |
$1,356.00 |
$1,422.40 |
|
|
Parathyroid planar img w/tomo spect
|
$1,558.40 |
$1,558.40 |
$1,643.20 |
|
|
Paricalcitol
|
$50.59 |
$50.59 |
$50.59 |
|
|
Paring/cutting benign hyperkeratotic lesion single
|
$324.80 |
$324.80 |
$391.20 |
|
|
Partial removal finger bone
|
$1,591.20 |
$1,591.20 |
$2,958.40 |
|
|
Partial removal of eye fluid
|
$2,403.20 |
$2,403.20 |
$2,403.20 |
|
|
Particle matristem matrix 1000mg micron-q4118-cost per mg
|
$32.48 |
$32.48 |
$42.52 |
|
|
Passy muir valve metal trach
|
$323.52 |
$323.52 |
$388.23 |
|
|
Pca3/klk3 antigen
|
$664.00 |
$664.00 |
$664.00 |
|
|
Pcv21 vaccine im
|
$384.24 |
$384.24 |
$663.72 |
|
|
Pegaspargase injection
|
$19,601.39 |
$19,601.39 |
$41,065.49 |
|
|
Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector
|
$4,800.69 |
$5,920.86 |
$7,055.11 |
|
|
Pegfilgrastim-apgf 6 mg/0.6 ml subcutaneous syringe
|
$2,635.41 |
$2,635.41 |
$2,635.41 |
|
|
Pegfilgrastim-cbqv 6 mg/0.6 ml subcutaneous syringe
|
$2,502.00 |
$2,665.27 |
$4,412.03 |
|
|
Pegfilgrastim-fpgk 6 mg/0.6 ml subcutaneous syringe
|
$4,175.20 |
$4,175.20 |
$5,097.60 |
|
|
Pegfilgrastim-jmdb 6 mg/0.6 ml subcutaneous syringe
|
$1,655.88 |
$1,655.88 |
$2,732.51 |
|
|
Peg interferon alfa-2a/180
|
$4,983.81 |
$4,983.81 |
$4,983.81 |
|
|
Pegloticase 8 mg/ml intravenous solution
|
$29,491.21 |
$29,491.21 |
$29,491.21 |
|
|
Pelvic CT scan (with and without contrast)
|
$2,065.60 |
$2,460.00 |
$2,576.80 |
|
|
Pelvic CT scan (with contrast)
|
$1,599.20 |
$2,152.80 |
$2,252.80 |
|
|
Pelvic CT scan (without contrast)
|
$1,287.20 |
$1,480.00 |
$2,039.20 |
|
|
Pelvic MRI (with and without contrast)
|
$3,496.00 |
$3,784.00 |
$4,402.40 |
|
|
Pelvic MRI (with contrast)
|
$2,519.20 |
$2,519.20 |
$3,724.80 |
|
|
Pelvic MRI (without contrast)
|
$2,403.20 |
$2,567.20 |
$3,293.60 |
|
