|
Ot evaluation low complexity patient/family
|
$439.80 |
$439.80 |
$439.80 |
$226.80
|
|
Ot evaluation moderate complexity patient/family
|
$465.00 |
$465.00 |
$465.00 |
$263.50
|
|
Other immunoelectrophoresis
|
$519.00 |
$519.00 |
$519.00 |
$107.52
|
|
Oth resp proc, group
|
$640.80 |
$640.80 |
$640.80 |
$127.40
|
|
Oth resp proc, indiv
|
$454.80 |
$454.80 |
$454.80 |
$83.50
|
|
Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes
|
$123.00 |
$123.00 |
$123.00 |
$98.62
|
|
Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes
|
$219.00 |
$219.00 |
$219.00 |
$104.50
|
|
Ot manual therpy techniques >=1 region each 15 minutes
|
$162.60 |
$162.60 |
$162.60 |
$105.00
|
|
Ot re-evaluation patient/family
|
$254.40 |
$254.40 |
$254.40 |
$160.80
|
|
Ot therapeutic activities direct patient contact each 15 minutes
|
$146.40 |
$146.40 |
$146.40 |
$98.90
|
|
Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes
|
$40.80 |
$40.80 |
$40.80 |
$86.65
|
|
Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes
|
$40.80 |
$40.80 |
$40.80 |
$91.20
|
|
Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes
|
$174.00 |
$174.00 |
$174.00 |
$97.80
|
|
Ot therapeutic procedure neuromuscular reeducate each 15 minutes
|
$162.60 |
$162.60 |
$162.60 |
$100.65
|
|
Ot training self care/home management direct contact each 15 minutes
|
$162.60 |
$162.60 |
$162.60 |
$93.60
|
|
Outrigger
|
$123.81 |
$123.81 |
$123.81 |
$123.81
|
|
Outrigger bil with vert extens
|
$414.44 |
$414.44 |
$414.44 |
$414.44
|
|
Oxaliplatin 5 mg/ml desensitization
|
$157.68 |
$157.68 |
$157.68 |
$370.75
|
|
Oxytocin 10 unit/ml injection solution
|
$209.82 |
$209.82 |
$209.82 |
$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
|
$131.40 |
$131.40 |
$131.40 |
$216.00
|
|
Paclitaxel protein-bound 100 mg intravenous suspension
|
$6,228.60 |
$6,228.60 |
$6,228.60 |
$3,420.45
|
|
Palingen or palingen xplus
|
$15,246.72 |
$15,246.72 |
$15,246.72 |
$656.01
|
|
Paliperidone 117 mg/0.75 ml inj
|
$0.06 |
$0.06 |
$0.06 |
$6,272.41
|
|
Palonosetron hcl
|
$192.00 |
$192.00 |
$192.00 |
$154.78
|
|
Pamidronate 30 mg/10 ml (3 mg/ml) intravenous solution
|
$153.00 |
$153.00 |
$153.00 |
$129.80
|
|
Panitumumab 20 mg/ml intravenous solution (wrapper)
|
$28,566.12 |
$28,566.12 |
$28,566.12 |
$13,318.60
|
|
Papaverin hcl injection
|
$88.92 |
$88.92 |
$88.92 |
$76.40
|
|
Parathormone (pth) intact
|
$282.60 |
$282.60 |
$282.60 |
$201.50
|
|
Parathyrd planar w/spect&ct
|
$1,024.20 |
$1,024.20 |
$1,024.20 |
$1,555.00
|
|
Parathyroid planar imaging
|
$689.40 |
$689.40 |
$689.40 |
$1,073.82
|
|
Parathyroid planar img w/tomo spect
|
$883.80 |
$883.80 |
$883.80 |
$1,345.00
|
|
Paring/cutting benign hyperkeratotic lesion single
|
$500.40 |
$500.40 |
$500.40 |
$242.88
|
|
Partial removal of rib
|
$59,437.54 |
$59,437.54 |
$59,437.54 |
$5,376.00
|
|
Particle matristem matrix 1000mg micron-q4118-cost per mg
|
$11,494.09 |
$11,494.09 |
$11,494.09 |
$4,706.31
|
|
Passy muir valve metal trach
|
$1,053.60 |
$1,053.60 |
$1,053.60 |
$275.75
|
|
Patten bottom
|
$757.24 |
$757.24 |
$757.24 |
$757.24
|
|
Pca3/klk3 antigen
|
$873.00 |
$873.00 |
$873.00 |
$510.40
|
|
Pdgfra gene
|
$873.00 |
$873.00 |
$873.00 |
$717.23
|
|
Pd hl 3.5in 4d med rbr mld 6432
|
$54.11 |
$54.11 |
$54.11 |
$44.97
|
|
Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector
|
$24,645.12 |
$24,645.12 |
$24,645.12 |
$11,216.31
|
|
Pegfilgrastim-cbqv 6 mg/0.6 ml subcutaneous syringe
|
$16,032.00 |
$16,032.00 |
$16,032.00 |
$7,297.36
|
|
Pegfilgrastim-jmdb 6 mg/0.6 ml subcutaneous syringe
|
$8,016.06 |
$8,016.06 |
$8,016.06 |
$4,133.25
|
|
Pegfilgrastim-pbbk 6 mg/0.6 ml subcutaneous syringe
|
$9,600.06 |
$9,600.06 |
$9,600.06 |
$4,067.80
|
|
Pelv band/spread bar thigh c
|
$1,120.07 |
$1,120.07 |
$1,120.07 |
$802.87
|
|
Pelvic control band & belt b
|
$743.50 |
$743.50 |
$743.50 |
$743.50
|
|
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 |
$1,026.80
|
|
Pelvic CT scan (with and without contrast)
|
$1,926.60 |
$1,926.60 |
$1,926.60 |
$1,899.75
|
|
Pelvic CT scan (with contrast)
|
$1,777.80 |
$1,777.80 |
$1,777.80 |
$1,635.62
|
|
Pelvic CT scan (without contrast)
|
$1,579.80 |
$1,579.80 |
$1,579.80 |
$1,366.50
|
|
Pelvic & hip control thigh c
|
$2,512.27 |
$2,512.27 |
$2,512.27 |
$2,512.27
|
|
Pelvic Ultrasound (complete)
|
$1,073.40 |
$1,073.40 |
$1,073.40 |
$650.40
|
|
Pelvic Ultrasound (limited)
|
$435.60 |
$435.60 |
$435.60 |
$430.00
|
|
Pelv & thor control gluteal
|
$327.43 |
$327.43 |
$327.43 |
$327.43
|
|
Pembrolizumab 25 mg/ml intravenous solution
|
$23,713.86 |
$23,713.86 |
$23,713.86 |
$12,385.22
|
|
Pemetrexed disodium 100 mg intravenous powder for solution
|
$253.92 |
$253.92 |
$253.92 |
$6,202.54
|
|
Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe
|
$2,903.88 |
$2,903.88 |
$2,903.88 |
$826.47
|
|
Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr
|
$60.30 |
$60.30 |
$60.30 |
$97.85
|
|
Penile rear tip xtnd 0.5cm
|
$31,123.99 |
$31,123.99 |
$31,123.99 |
$18,349.50
|
|
Pentamidine 300 mg solution for injection
|
$791.10 |
$791.10 |
$791.10 |
$453.61
|
|
Pentamidine non-comp unit
|
$791.10 |
$791.10 |
$791.10 |
$279.76
|
|
Pentostatin 10 mg intravenous solution
|
$11,634.00 |
$11,634.00 |
$11,634.00 |
$5,181.67
|
|
Perc cryo ablate renal tum
|
$10,371.00 |
$10,371.00 |
$10,371.00 |
$11,458.04
|
|
Perc rf ablate renal tumor
|
$6,384.60 |
$6,384.60 |
$6,384.60 |
$6,949.48
|
|
Percut ablate liver rf
|
$4,662.60 |
$4,662.60 |
$4,662.60 |
$6,904.15
|
|
Pericardial drain w/cath pq w/ct guid
|
$1,525.20 |
$1,525.20 |
$1,525.20 |
$2,405.67
|
|
Pericardiocentesis wwo imaging
|
$2,887.80 |
$2,887.80 |
$2,887.80 |
$2,341.50
|
|
Peritoneogram rs&i
|
$790.20 |
$790.20 |
$790.20 |
$689.15
|
|
Perit-vens shunt pat tst
|
$921.00 |
$921.00 |
$921.00 |
$724.75
|
|
Permanent tear duct plug
|
$301.79 |
$301.79 |
$301.79 |
$262.41
|
|
Peroneal straps pair pre ots
|
$40.44 |
$40.44 |
$40.44 |
$40.44
|
|
Perq art m-thrombect &/nfs
|
$6,524.40 |
$6,524.40 |
$6,524.40 |
$7,559.55
|
|
Perq dev breast 1st strtctc
|
$2,505.00 |
$2,505.00 |
$2,505.00 |
$1,456.00
|
|
Pertussis ag if
|
$135.00 |
$135.00 |
$135.00 |
$65.00
|
|
Pertuzumab 30 mg/ml desensitization
|
$26,886.42 |
$26,886.42 |
$26,886.42 |
$14,272.91
|
|
Pessary 3.5 in 7 vag sil rng fold
|
$252.05 |
$252.05 |
$252.05 |
$141.60
|
|
Pet CT skull-mid thgh initial
|
$7,822.20 |
$7,822.20 |
$7,822.20 |
$4,711.20
|
|
Pet CT whole body initial
|
$7,760.40 |
$7,760.40 |
$7,760.40 |
$4,850.00
|
|
Pet fdg brain metoblic eval sb
|
$5,263.80 |
$5,263.80 |
$5,263.80 |
$3,789.00
|
|
Pet image full body
|
$4,570.20 |
$4,570.20 |
$4,570.20 |
$5,070.50
|
|
Pet image w/ct lmtd
|
$8,151.60 |
$8,151.60 |
$8,151.60 |
$4,366.50
|
|
Pfc sigma fem post aug sz3 8mm
|
$112,395.34 |
$112,395.34 |
$112,395.34 |
$34,920.00
|
|
Ph1 assmt&mgmt nqhp 11-20
|
$52.80 |
$52.80 |
$52.80 |
$60.80
|
|
Ph1 assmt&mgmt nqhp 21-30
|
$78.00 |
$78.00 |
$78.00 |
$91.50
|
|
Ph1 assmt&mgmt nqhp 5-10
|
$27.00 |
$27.00 |
$27.00 |
$31.20
|
|
Ph body fluid
|
$86.40 |
$86.40 |
$86.40 |
$40.04
|
|
Phencyclidine (pcp)
|
$70.80 |
$70.80 |
$70.80 |
$90.00
|
|
Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr
|
$162.12 |
$162.12 |
$162.12 |
$114.60
|
|
Phenobarbital therapeutic drug level
|
$126.00 |
$126.00 |
$126.00 |
$104.50
|
|
Phenylephrine 10 mg/ml injection solution
|
$94.80 |
$94.80 |
$94.80 |
$62.98
|
|
Phenytoin total therapeutic drug level
|
$97.80 |
$97.80 |
$97.80 |
$112.50
|
|
Phosphorus
|
$52.20 |
$52.20 |
$52.20 |
$49.60
|
|
Phosphorus 24 hour urine
|
$68.40 |
$68.40 |
$68.40 |
$41.58
|
|
Phys blood bank serv reactj
|
$135.60 |
$135.60 |
$135.60 |
$207.50
|
|
Phytonadione (vitamin k1) 10 mg/ml injection solution
|
$46.44 |
$46.44 |
$46.44 |
$85.79
|
|
Piflu f-18, dia 1 millicurie
|
$747.30 |
$747.30 |
$747.30 |
$880.00
|
|
Pik3ca gene trgt seq alys
|
$463.20 |
$463.20 |
$463.20 |
$453.18
|
|
Pillow shldr abduc inflat univ
|
$1,717.48 |
$1,717.48 |
$1,717.48 |
$446.60
|
