|
Osteotomy/graft tarsal/calcaneus/talus 28305
|
$87,481.60 |
$87,481.60 |
$87,481.60 |
$7,907.11
|
|
Ot evaluation high complexity patient/family
|
$213.00 |
$213.00 |
$213.00 |
$293.70
|
|
Ot evaluation low complexity patient/family
|
$191.40 |
$191.40 |
$191.40 |
$231.60
|
|
Ot evaluation moderate complexity patient/family
|
$180.60 |
$180.60 |
$180.60 |
$263.50
|
|
Other immunoelectrophoresis
|
$42.60 |
$42.60 |
$42.60 |
$107.52
|
|
Oth resp proc, group
|
$274.80 |
$274.80 |
$274.80 |
$126.00
|
|
Oth resp proc, indiv
|
$109.20 |
$109.20 |
$109.20 |
$81.79
|
|
Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes
|
$85.20 |
$85.20 |
$85.20 |
$98.80
|
|
Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes
|
$71.40 |
$71.40 |
$71.40 |
$105.00
|
|
Ot manual therpy techniques >=1 region each 15 minutes
|
$66.60 |
$66.60 |
$66.60 |
$105.00
|
|
Ot re-evaluation patient/family
|
$88.80 |
$88.80 |
$88.80 |
$159.84
|
|
Ot therapeutic activities direct patient contact each 15 minutes
|
$55.80 |
$55.80 |
$55.80 |
$100.75
|
|
Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes
|
$113.40 |
$113.40 |
$113.40 |
$87.00
|
|
Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes
|
$113.40 |
$113.40 |
$113.40 |
$91.80
|
|
Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes
|
$63.60 |
$63.60 |
$63.60 |
$98.15
|
|
Ot therapeutic procedure neuromuscular reeducate each 15 minutes
|
$66.00 |
$66.00 |
$66.00 |
$100.65
|
|
Ot training self care/home management direct contact each 15 minutes
|
$84.60 |
$84.60 |
$84.60 |
$93.60
|
|
Outrigger
|
$123.81 |
$123.81 |
$123.81 |
$123.81
|
|
Outrigger bil with vert extens
|
$414.44 |
$414.44 |
$414.44 |
$378.67
|
|
Oxytocin 10 unit/ml injection solution
|
$51.90 |
$51.90 |
$51.90 |
$50.40
|
|
Pacemaker leadless 19.5f 32.2mm ra
|
$65,474.29 |
$65,474.29 |
$65,474.29 |
$47,880.00
|
|
Paclitaxel 6 mg/ml concentrate,intravenous
|
$510.00 |
$510.00 |
$510.00 |
$216.00
|
|
Paclitaxel protein-bound 100 mg intravenous suspension
|
$8,058.36 |
$8,058.36 |
$8,058.36 |
$3,420.45
|
|
Palb2 gene full gene seq
|
$1,065.60 |
$1,065.60 |
$1,065.60 |
$672.50
|
|
Palingen or palingen xplus
|
$15,246.72 |
$15,246.72 |
$15,246.72 |
$656.01
|
|
Palonosetron hcl
|
$90.00 |
$90.00 |
$90.00 |
$162.89
|
|
Pamidronate 30 mg/10 ml (3 mg/ml) intravenous solution
|
$169.14 |
$169.14 |
$169.14 |
$129.80
|
|
Panitumumab 20 mg/ml intravenous solution (wrapper)
|
$36,957.66 |
$36,957.66 |
$36,957.66 |
$13,051.61
|
|
Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr
|
$27.12 |
$27.12 |
$27.12 |
$27.72
|
|
Papaverin hcl injection
|
$93.48 |
$93.48 |
$93.48 |
$76.40
|
|
Parathormone (pth) intact
|
$130.80 |
$130.80 |
$130.80 |
$206.18
|
|
Parathyrd planar w/spect&ct
|
$962.40 |
$962.40 |
$962.40 |
$1,641.50
|
|
Parathyroid planar imaging
|
$496.20 |
$496.20 |
$496.20 |
$1,132.80
|
|
Parathyroid planar img w/tomo spect
|
$962.40 |
$962.40 |
$962.40 |
$1,350.60
|
|
Paricalcitol
|
$27.36 |
$27.36 |
$27.36 |
$47.15
|
|
Paring/cutting benign hyperkeratotic lesion single
|
$285.60 |
$285.60 |
$285.60 |
$245.89
|
|
Partial excision bone tars/metatars exc talus/calcaneus (both sides) (rest meth ii cah)
|
$87,481.60 |
$87,481.60 |
$87,481.60 |
$4,810.50
|
|
Partial removal finger bone
|
$3,034.80 |
$3,034.80 |
$3,034.80 |
$2,018.00
|
|
Partial removal of hand bone
|
$12,548.46 |
$12,548.46 |
$12,548.46 |
$3,839.54
|
|
Partial removal of thyroid
|
$44,182.31 |
$44,182.31 |
$44,182.31 |
$6,376.26
|
|
Particle matristem matrix 1000mg micron-q4118-cost per mg
|
$11,494.09 |
$11,494.09 |
$11,494.09 |
$4,906.77
|
|
Part removal of metatarsal
|
$16,336.24 |
$16,336.24 |
$16,336.24 |
$3,134.00
|
|
Passy muir valve metal trach
|
$1,053.60 |
$1,053.60 |
$1,053.60 |
$275.75
|
|
Path clin consltj sf 5-20
|
$133.80 |
$133.80 |
$133.80 |
$82.15
|
|
Patten bottom
|
$757.24 |
$757.24 |
$757.24 |
$672.73
|
|
Pd hl 3.5in 4d med rbr mld 6432
|
$54.11 |
$54.11 |
$54.11 |
$54.11
|
|
Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector
|
$27,725.76 |
$27,725.76 |
$27,725.76 |
$11,216.31
|
|
Pegfilgrastim-jmdb 6 mg/0.6 ml subcutaneous syringe
|
$9,018.06 |
$9,018.06 |
$9,018.06 |
$4,133.25
|
|
Pelv band/spread bar thigh c
|
$1,120.07 |
$1,120.07 |
$1,120.07 |
$852.86
|
|
Pelvic control band & belt b
|
$743.50 |
$743.50 |
$743.50 |
$660.52
|
|
Pelvic control band & belt u
|
$547.83 |
$547.83 |
$547.83 |
$547.83
|
|
Pelvic control hip heavy dut
|
$591.53 |
$591.53 |
$591.53 |
$591.53
|
|
Pelvic control pelvic sling
|
$1,026.80 |
$1,026.80 |
$1,026.80 |
$912.18
|
|
Pelvic CT scan (with and without contrast)
|
$1,740.00 |
$1,740.00 |
$1,740.00 |
$1,890.36
|
|
Pelvic CT scan (with contrast)
|
$1,265.40 |
$1,265.40 |
$1,265.40 |
$1,608.98
|
|
Pelvic CT scan (without contrast)
|
$1,068.00 |
$1,068.00 |
$1,068.00 |
$1,363.11
|
|
Pelvic & hip control thigh c
|
$2,512.27 |
$2,512.27 |
$2,512.27 |
$2,512.27
|
|
Pelvic Ultrasound (complete)
|
$732.60 |
$732.60 |
$732.60 |
$662.40
|
|
Pelvic Ultrasound (limited)
|
$256.80 |
$256.80 |
$256.80 |
$435.13
|
|
Pelv & thor control gluteal
|
$327.43 |
$327.43 |
$327.43 |
$299.21
|
|
Pembrolizumab 25 mg/ml intravenous solution
|
$30,679.98 |
$30,679.98 |
$30,679.98 |
$11,589.18
|
|
Pemetrexed disodium 100 mg intravenous powder for solution
|
$20,619.30 |
$20,619.30 |
$20,619.30 |
$6,582.76
|
|
Peng benzathine/procaine inj
|
$1,050.30 |
$1,050.30 |
$1,050.30 |
$397.04
|
|
Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe
|
$1,594.26 |
$1,594.26 |
$1,594.26 |
$826.47
|
|
Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr
|
$135.36 |
$135.36 |
$135.36 |
$100.50
|
|
Penile rear tip xtnd 0.5cm
|
$31,123.99 |
$31,123.99 |
$31,123.99 |
$18,349.50
|
|
Pentamidine 300 mg solution for injection
|
$753.06 |
$753.06 |
$753.06 |
$453.61
|
|
Perc cryo ablate renal tum
|
$8,894.40 |
$8,894.40 |
$8,894.40 |
$11,458.04
|
|
Perc rf ablate renal tumor
|
$15,211.80 |
$15,211.80 |
$15,211.80 |
$7,243.60
|
|
Percut ablate liver rf
|
$5,652.60 |
$5,652.60 |
$5,652.60 |
$6,904.15
|
|
Perflutren lipid microspheres 1.1 mg/ml intravenous suspension
|
$284.40 |
$284.40 |
$284.40 |
$332.84
|
|
Pericardiocentesis wwo imaging
|
$1,213.80 |
$1,213.80 |
$1,213.80 |
$2,305.44
|
|
Pericardiotomy/clot/for bod remove 33020
|
$2,065.80 |
$2,065.80 |
$2,065.80 |
$1,696.80
|
|
Peritoneogram rs&i
|
$995.40 |
$995.40 |
$995.40 |
$698.50
|
|
Perit-vens shunt pat tst
|
$618.60 |
$618.60 |
$618.60 |
$851.40
|
|
Permanent tear duct plug
|
$301.79 |
$301.79 |
$301.79 |
$291.00
|
|
Peroneal straps pair pre ots
|
$40.44 |
$40.44 |
$40.44 |
$36.90
|
|
Perq dev breast 1st mr guide
|
$2,730.60 |
$2,730.60 |
$2,730.60 |
$1,882.56
|
|
Perq dev breast 1st strtctc
|
$3,929.40 |
$3,929.40 |
$3,929.40 |
$1,456.00
|
|
Perq plmt bile duct stent
|
$12,962.40 |
$12,962.40 |
$12,962.40 |
$6,904.15
|
|
Perq plmt bile duct stent
|
$10,801.20 |
$10,801.20 |
$10,801.20 |
$6,857.50
|
|
Perq plmt bile duct stent
|
$10,801.20 |
$10,801.20 |
$10,801.20 |
$7,082.99
|
|
Pertuzumab 30 mg/ml desensitization
|
$34,784.52 |
$34,784.52 |
$34,784.52 |
$13,666.00
|
|
Pessary 3.5 in 7 vag sil rng fold
|
$389.93 |
$389.93 |
$389.93 |
$141.60
|
|
Pet CT skull-mid thgh initial
|
$4,060.20 |
$4,060.20 |
$4,060.20 |
$4,707.00
|
|
Pet CT whole body initial
|
$4,060.20 |
$4,060.20 |
$4,060.20 |
$4,850.00
|
|
Pet fdg brain metoblic eval sb
|
$3,832.80 |
$3,832.80 |
$3,832.80 |
$3,832.80
|
|
Pet image w/ct lmtd
|
$3,867.00 |
$3,867.00 |
$3,867.00 |
$4,409.00
|
|
Pet scan brain perf study
|
$3,832.80 |
$3,832.80 |
$3,832.80 |
$3,832.80
|
|
Pfc sigma fem post aug sz3 8mm
|
$112,395.34 |
$112,395.34 |
$112,395.34 |
$35,919.52
|
|
Ph1 assmt&mgmt nqhp 11-20
|
$36.00 |
$36.00 |
$36.00 |
$60.80
|
|
Ph1 assmt&mgmt nqhp 21-30
|
$52.20 |
$52.20 |
$52.20 |
$91.50
|
|
Ph1 assmt&mgmt nqhp 5-10
|
$18.00 |
$18.00 |
$18.00 |
$31.20
|
|
Ph body fluid
|
$30.00 |
$30.00 |
$30.00 |
$40.04
|
|
Phencyclidine (pcp)
|
$49.20 |
$49.20 |
$49.20 |
$90.00
|
|
Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr
|
$154.32 |
$154.32 |
$154.32 |
$114.56
|
|
Phenobarbital therapeutic drug level
|
$55.80 |
$55.80 |
$55.80 |
$104.80
|
|
Phentolaine mesylate inj
|
$2,210.76 |
$2,210.76 |
$2,210.76 |
$1,028.40
|
|
Phenylephrine 10 mg/ml injection solution
|
$6.00 |
$6.00 |
$6.00 |
$67.92
|
|
Phenytoin in ns IV syringe 5 mg/ml (neo/ped) - cnr
|
$6.30 |
$6.30 |
$6.30 |
$10.80
|
