|
One-way allow prorated trip
|
$8.40 |
$8.40 |
$8.40 |
$18.57
|
|
Open bx/exc inguinofem nodes
|
$29,819.66 |
$29,819.66 |
$29,819.66 |
$4,992.00
|
|
Open periprosthetic breast capsule 19370
|
$73,184.41 |
$73,184.41 |
$73,184.41 |
$4,520.16
|
|
Open tenotomy tendon flexor foot single or multiple 28230
|
$35,443.63 |
$35,443.63 |
$35,443.63 |
$2,180.80
|
|
Open thrombectomy of av fistula without revision 36831
|
$52,677.42 |
$52,677.42 |
$52,677.42 |
$6,366.08
|
|
Opn ax/subcla art expos
|
$718.20 |
$718.20 |
$718.20 |
$1,269.60
|
|
Opn impltj crnl nrv nea&pg
|
$174,703.22 |
$174,703.22 |
$174,703.22 |
$35,498.40
|
|
Opn impltj nea sacral nerve
|
$77,613.16 |
$77,613.16 |
$77,613.16 |
$7,766.27
|
|
Opn tx complx malar fx
|
$49,156.93 |
$49,156.93 |
$49,156.93 |
$6,605.19
|
|
Opn tx nasomax fx w/fixj
|
$51,769.65 |
$51,769.65 |
$51,769.65 |
$6,547.81
|
|
Opn tx orbit fx w/implant
|
$25,937.38 |
$25,937.38 |
$25,937.38 |
$6,553.49
|
|
Opn tx orbit periorbtl implt
|
$36,654.30 |
$36,654.30 |
$36,654.30 |
$6,547.81
|
|
Optx carpl scphd fx int fixj
|
$44,491.97 |
$44,491.97 |
$44,491.97 |
$7,807.24
|
|
Optx clavicular fx w/int fix
|
$56,008.38 |
$56,008.38 |
$56,008.38 |
$9,013.88
|
|
Optx gr hmrl tbrs fx int fix
|
$40,852.60 |
$40,852.60 |
$40,852.60 |
$7,157.53
|
|
Optx medial ankle fx
|
$93,700.18 |
$93,700.18 |
$93,700.18 |
$7,807.24
|
|
Optx palatal/max fracture
|
$51,769.65 |
$51,769.65 |
$51,769.65 |
$6,311.00
|
|
Optx prox humrl fx w/int fix
|
$99,870.65 |
$99,870.65 |
$99,870.65 |
$13,938.00
|
|
Optx radial shaft fracture
|
$29,629.64 |
$29,629.64 |
$29,629.64 |
$5,301.66
|
|
Optx rdl&uln shft fx rds&uln
|
$31,269.10 |
$31,269.10 |
$31,269.10 |
$6,915.75
|
|
Optx ulnar shft fx int fixj
|
$76,470.75 |
$76,470.75 |
$76,470.75 |
$8,453.60
|
|
Oral aprepitant
|
$1,230.60 |
$1,230.60 |
$1,230.60 |
$410.20
|
|
Oral everolimus
|
$157.92 |
$157.92 |
$157.92 |
$33.34
|
|
Orchiopexy ingun/scrot appr
|
$26,378.10 |
$26,378.10 |
$26,378.10 |
$4,176.15
|
|
Organic acids total quant ea spec
|
$155.40 |
$155.40 |
$155.40 |
$151.36
|
|
Oritavancin 400 mg intravenous solution
|
$10,238.40 |
$10,238.40 |
$10,238.40 |
$3,082.73
|
|
Orphenadrine citrate 30 mg/ml injection solution
|
$283.62 |
$283.62 |
$283.62 |
$50.63
|
|
Ortho dvc repair per 15 min
|
$679.44 |
$679.44 |
$679.44 |
$53.43
|
|
Ortho elbow without jnt cstm w/fit&adj
|
$715.53 |
$715.53 |
$715.53 |
$279.81
|
|
Ortho elbow w/lock w/ft&adj
|
$1,688.03 |
$1,688.03 |
$1,688.03 |
$536.90
|
|
Ortho ewhf rigd without jnt cstm w
|
$3,177.31 |
$3,177.31 |
$3,177.31 |
$1,288.00
|
|
Ortho hnd/fngr without jnt cstm w/fit&adj
|
$671.08 |
$671.08 |
$671.08 |
$238.34
|
|
Ortho hnd/fngr w/jnt cstm w/fit&adj
|
$795.94 |
$795.94 |
$795.94 |
$310.00
|
|
Ortho hnd metcrpl fx prefb w/fit&adj
|
$261.66 |
$261.66 |
$261.66 |
$174.40
|
|
Ortho hnd without jnt w/fit&adj
|
$671.08 |
$671.08 |
$671.08 |
$231.00
|
|
Orthopantogram
|
$574.80 |
$574.80 |
$574.80 |
$241.50
|
|
Orthopedic shoe add rub insl
|
$79.60 |
$79.60 |
$79.60 |
$70.40
|
|
Ortho shoe add leather insol
|
$79.60 |
$79.60 |
$79.60 |
$63.22
|
|
Ortho shoe add march bar
|
$114.20 |
$114.20 |
$114.20 |
$90.66
|
|
Orthosis lso rigd frm hyperex
|
$1,503.83 |
$1,503.83 |
$1,503.83 |
$816.00
|
|
Ortho whf rigd without jnt cstm w/fit&adj
|
$882.67 |
$882.67 |
$882.67 |
$420.76
|
|
Ortho wrst/hnd w/jnt cstm w/fit&adj
|
$2,457.28 |
$2,457.28 |
$2,457.28 |
$718.40
|
|
Oscillation chest wall mechanical per session
|
$209.40 |
$209.40 |
$209.40 |
$195.00
|
|
O shoe add horseshoe toe tap
|
$62.27 |
$62.27 |
$62.27 |
$49.45
|
|
O shoe add instep extension
|
$232.07 |
$232.07 |
$232.07 |
$201.67
|
|
O shoe add instep velcro clo
|
$176.59 |
$176.59 |
$176.59 |
$140.22
|
|
O shoe add standard toe tap
|
$24.34 |
$24.34 |
$24.34 |
$19.38
|
|
O shoe convert to sof counte
|
$145.46 |
$145.46 |
$145.46 |
$115.53
|
|
Osmolality blood
|
$176.40 |
$176.40 |
$176.40 |
$67.60
|
|
Osmolality urine
|
$192.60 |
$192.60 |
$192.60 |
$65.00
|
|
Osteopath manip tx/5-6 body region 98927
|
$49.80 |
$49.80 |
$49.80 |
$68.25
|
|
Osteopath manip tx/7-8 body region 98928
|
$16.80 |
$16.80 |
$16.80 |
$84.22
|
|
Ot evaluation high complexity patient/family
|
$498.00 |
$498.00 |
$498.00 |
$297.00
|
|
Ot evaluation low complexity patient/family
|
$367.20 |
$367.20 |
$367.20 |
$231.60
|
|
Ot evaluation moderate complexity patient/family
|
$432.60 |
$432.60 |
$432.60 |
$263.50
|
|
Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes
|
$159.00 |
$159.00 |
$159.00 |
$98.40
|
|
Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes
|
$183.00 |
$183.00 |
$183.00 |
$105.00
|
|
Ot manual therpy techniques >=1 region each 15 minutes
|
$150.00 |
$150.00 |
$150.00 |
$105.00
|
|
Ot re-evaluation patient/family
|
$229.20 |
$229.20 |
$229.20 |
$160.80
|
|
Ot therapeutic activities direct patient contact each 15 minutes
|
$174.00 |
$174.00 |
$174.00 |
$101.38
|
|
Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes
|
$193.80 |
$193.80 |
$193.80 |
$87.00
|
|
Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes
|
$193.80 |
$193.80 |
$193.80 |
$91.80
|
|
Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes
|
$227.40 |
$227.40 |
$227.40 |
$98.15
|
|
Ot therapeutic procedure neuromuscular reeducate each 15 minutes
|
$170.40 |
$170.40 |
$170.40 |
$101.23
|
|
Ot training self care/home management direct contact each 15 minutes
|
$115.80 |
$115.80 |
$115.80 |
$94.25
|
|
Outrigger
|
$142.47 |
$142.47 |
$142.47 |
$123.81
|
|
Outrigger bil with vert extens
|
$476.91 |
$476.91 |
$476.91 |
$378.67
|
|
Ovarian cystectomy 58925
|
$41,793.15 |
$41,793.15 |
$41,793.15 |
$5,841.60
|
|
Oxacillin in ns IV syringe 40 mg/ml (neo/ped) - cnr
|
$455.64 |
$455.64 |
$455.64 |
$83.08
|
|
Oxytocin 10 unit/ml injection solution
|
$232.32 |
$232.32 |
$232.32 |
$50.40
|
|
Pabpn1 gene detc abnor allel
|
$417.60 |
$417.60 |
$417.60 |
$225.42
|
|
Pacemaker leadless 19.5f 32.2mm ra
|
$75,342.52 |
$75,342.52 |
$75,342.52 |
$47,880.00
|
|
Paclitaxel 6 mg/ml concentrate,intravenous
|
$852.00 |
$852.00 |
$852.00 |
$216.00
|
|
Paclitaxel protein-bound 100 mg intravenous suspension
|
$13,462.14 |
$13,462.14 |
$13,462.14 |
$3,435.42
|
|
Palb2 gene full gene seq
|
$895.20 |
$895.20 |
$895.20 |
$672.50
|
|
Palingen or palingen xplus
|
$17,544.69 |
$17,544.69 |
$17,544.69 |
$656.01
|
|
Paliperidone 117 mg/0.75 ml inj
|
$57,391.98 |
$57,391.98 |
$57,391.98 |
$6,238.82
|
|
Palonosetron hcl
|
$198.48 |
$198.48 |
$198.48 |
$170.48
|
|
Pamidronate 30 mg/10 ml (3 mg/ml) intravenous solution
|
$490.86 |
$490.86 |
$490.86 |
$128.07
|
|
Panitumumab 20 mg/ml intravenous solution (wrapper)
|
$61,741.08 |
$61,741.08 |
$61,741.08 |
$13,051.61
|
|
Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr
|
$109.08 |
$109.08 |
$109.08 |
$29.31
|
|
Papaverin hcl injection
|
$295.44 |
$295.44 |
$295.44 |
$77.05
|
|
Parathormone (pth) intact
|
$239.40 |
$239.40 |
$239.40 |
$204.87
|
|
Parathyrd planar w/spect&ct
|
$2,481.60 |
$2,481.60 |
$2,481.60 |
$1,574.40
|
|
Parathyroid planar imaging
|
$2,143.20 |
$2,143.20 |
$2,143.20 |
$1,129.91
|
|
Parathyroid planar img w/tomo spect
|
$1,917.00 |
$1,917.00 |
$1,917.00 |
$1,350.60
|
|
Paricalcitol
|
$275.46 |
$275.46 |
$275.46 |
$47.15
|
|
Paring/cutting benign hyperkeratotic lesion single
|
$227.40 |
$227.40 |
$227.40 |
$245.00
|
|
Part hymenectomy/revi hymenal ring 56700
|
$9,232.02 |
$9,232.02 |
$9,232.02 |
$3,762.53
|
|
Partial excision bone tars/metatars exc talus/calcaneus (both sides) (rest meth ii cah)
|
$48,450.76 |
$48,450.76 |
$48,450.76 |
$4,914.00
|
|
Partial removal finger bone
|
$3,310.20 |
$3,310.20 |
$3,310.20 |
$2,049.27
|
|
Partial removal foot fascia
|
$35,746.97 |
$35,746.97 |
$35,746.97 |
$3,762.00
|
|
Partial removal leg bone(s)
|
$76,190.47 |
$76,190.47 |
$76,190.47 |
$4,315.20
|
|
Partial removal of fibula
|
$52,849.76 |
$52,849.76 |
$52,849.76 |
$3,786.00
|
|
Partial removal of foot bone
|
$22,553.62 |
$22,553.62 |
$22,553.62 |
$3,839.54
|
|
Partial removal of thyroid
|
$47,251.43 |
$47,251.43 |
$47,251.43 |
$6,457.82
|
|
Partial removal of tibia
|
$52,849.76 |
$52,849.76 |
$52,849.76 |
$4,108.80
|
|
Partial removal of toe
|
$29,219.19 |
$29,219.19 |
$29,219.19 |
$3,674.58
|
|
Partial removal of ulna
|
$22,106.58 |
$22,106.58 |
$22,106.58 |
$3,839.54
|
|
Particle matristem matrix 1000mg micron-q4118-cost per mg
|
$13,226.46 |
$13,226.46 |
$13,226.46 |
$4,921.76
|
