|
Occupational Therapy Evaluation (high complexity)
|
$272.40 |
$272.40 |
$272.40 |
$297.00
|
|
Occupational Therapy Evaluation (low complexity)
|
$272.40 |
$272.40 |
$272.40 |
$232.40
|
|
Occupational Therapy Evaluation (moderate complexity)
|
$272.40 |
$272.40 |
$272.40 |
$263.90
|
|
Ocrelizumab 30 mg/ml intravenous solution
|
$208.80 |
$208.80 |
$208.80 |
$41,294.43
|
|
Octreotide acetate 100 mcg/ml injection (wrapper)
|
$540.60 |
$540.60 |
$540.60 |
$90.00
|
|
Octreotide,microspheres ER 20 mg intramuscular susp, extended release
|
$571.20 |
$571.20 |
$571.20 |
$12,080.43
|
|
Olanzapine 10 mg intramuscular solution
|
$6.40 |
$6.40 |
$6.40 |
$109.62
|
|
Omalizumab 150 mg/ml subcutaneous syringe (wrapper)
|
$175.20 |
$175.20 |
$175.20 |
$4,595.01
|
|
Onco (ovar) two proteins
|
$150.60 |
$150.60 |
$150.60 |
$359.49
|
|
Ondansetron 4 mg s0119
|
$228.80 |
$228.80 |
$228.80 |
$2.52
|
|
Ondansetron 8 mg disintegrating tablet
|
$52.20 |
$52.20 |
$52.20 |
$9.93
|
|
Ondansetron hcl (pf) 2 mg/ml injection (wrapper)
|
$45.40 |
$45.40 |
$45.40 |
$22.62
|
|
Ophthalmic mitomycin
|
$1,516.80 |
$1,516.80 |
$1,516.80 |
$775.44
|
|
Oral aprepitant
|
$260.40 |
$260.40 |
$260.40 |
$410.20
|
|
Oral everolimus
|
$1,208.40 |
$1,208.40 |
$1,208.40 |
$30.30
|
|
Organic acids total quant ea spec
|
$145.20 |
$145.20 |
$145.20 |
$152.50
|
|
Oscillation chest wall mechanical per session
|
$96.00 |
$96.00 |
$96.00 |
$196.30
|
|
Osmolality blood
|
$42.00 |
$42.00 |
$42.00 |
$70.85
|
|
Osmolality urine
|
$42.00 |
$42.00 |
$42.00 |
$65.52
|
|
Ost pch drain for barrier fl
|
$7.80 |
$7.80 |
$7.80 |
$11.45
|
|
Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes
|
$144.60 |
$144.60 |
$144.60 |
$97.80
|
|
Ot re-evaluation patient/family
|
$105.00 |
$105.00 |
$105.00 |
$160.80
|
|
Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes
|
$274.80 |
$274.80 |
$274.80 |
$88.54
|
|
Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes
|
$274.80 |
$274.80 |
$274.80 |
$93.12
|
|
Oxacillin in ns IV syringe 40 mg/ml (neo/ped) - cnr
|
$125.40 |
$125.40 |
$125.40 |
$76.52
|
|
Oxaliplatin 5 mg/ml desensitization
|
$40.80 |
$40.80 |
$40.80 |
$348.69
|
|
Oxytocin 10 unit/ml injection solution
|
$60.60 |
$60.60 |
$60.60 |
$50.40
|
|
Paclitaxel 6 mg/ml concentrate,intravenous
|
$47.20 |
$47.20 |
$47.20 |
$216.00
|
|
Paclitaxel protein-bound 100 mg intravenous suspension
|
$51.00 |
$51.00 |
$51.00 |
$3,435.42
|
|
Paliperidone 117 mg/0.75 ml inj
|
$99.20 |
$99.20 |
$99.20 |
$6,238.82
|
|
Palonosetron hcl
|
$159.20 |
$159.20 |
$159.20 |
$163.00
|
|
Pamidronate 30 mg/10 ml (3 mg/ml) intravenous solution
|
$1,189.20 |
$1,189.20 |
$1,189.20 |
$123.55
|
|
Panitumumab 20 mg/ml intravenous solution (wrapper)
|
$283.20 |
$283.20 |
$283.20 |
$13,051.61
|
|
Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr
|
$63.40 |
$63.40 |
$63.40 |
$28.90
|
|
Papaverin hcl injection
|
$64.00 |
$64.00 |
$64.00 |
$78.75
|
|
Parathormone (pth) intact
|
$204.00 |
$204.00 |
$204.00 |
$206.18
|
|
Parathyroid planar imaging
|
$944.40 |
$944.40 |
$944.40 |
$1,126.00
|
|
Parenteral 50% dextrose solu
|
$211.20 |
$211.20 |
$211.20 |
$145.60
|
|
Paricalcitol
|
$37.20 |
$37.20 |
$37.20 |
$47.15
|
|
Paring/cutting benign hyperkeratotic lesion single
|
$453.00 |
$453.00 |
$453.00 |
$245.67
|
|
Particle matristem matrix 1000mg micron-q4118-cost per mg
|
$1,099.20 |
$1,099.20 |
$1,099.20 |
$4,921.76
|
|
Passy muir valve metal trach
|
$346.20 |
$346.20 |
$346.20 |
$275.75
|
|
Path clin consltj mod 21-40
|
$447.60 |
$447.60 |
$447.60 |
$202.78
|
|
Path clin consltj sf 5-20
|
$198.60 |
$198.60 |
$198.60 |
$97.14
|
|
Pcv21 vaccine im
|
$252.80 |
$252.80 |
$252.80 |
$410.26
|
|
Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector
|
$1,355.20 |
$1,355.20 |
$1,355.20 |
$11,216.31
|
|
Pegfilgrastim-apgf 6 mg/0.6 ml subcutaneous syringe
|
$1,333.80 |
$1,333.80 |
$1,333.80 |
$6,370.52
|
|
Pegfilgrastim-cbqv 6 mg/0.6 ml subcutaneous syringe
|
$10,699.80 |
$10,699.80 |
$10,699.80 |
$7,297.36
|
|
Pegfilgrastim-fpgk 6 mg/0.6 ml subcutaneous syringe
|
$645.60 |
$645.60 |
$645.60 |
$4,300.20
|
|
Pegfilgrastim-jmdb 6 mg/0.6 ml subcutaneous syringe
|
$2,112.00 |
$2,112.00 |
$2,112.00 |
$4,133.25
|
|
Pegfilgrastim-pbbk 6 mg/0.6 ml subcutaneous syringe
|
$395.40 |
$395.40 |
$395.40 |
$4,120.37
|
|
Pelvic CT scan (with and without contrast)
|
$1,533.00 |
$1,533.00 |
$1,533.00 |
$1,890.36
|
|
Pelvic CT scan (with contrast)
|
$1,368.00 |
$1,368.00 |
$1,368.00 |
$1,608.98
|
|
Pelvic CT scan (without contrast)
|
$1,226.40 |
$1,226.40 |
$1,226.40 |
$1,335.34
|
|
Pelvic MRI (with and without contrast)
|
$3,815.40 |
$3,815.40 |
$3,815.40 |
$2,860.00
|
|
Pelvic MRI (with contrast)
|
$3,442.80 |
$3,442.80 |
$3,442.80 |
$2,210.00
|
|
Pelvic MRI (without contrast)
|
$2,205.00 |
$2,205.00 |
$2,205.00 |
$1,916.50
|
|
Pelvic Ultrasound (complete)
|
$490.20 |
$490.20 |
$490.20 |
$643.80
|
|
Pelvic Ultrasound (limited)
|
$354.00 |
$354.00 |
$354.00 |
$430.80
|
|
Pelvis X-ray (1 to 2 views)
|
$168.00 |
$168.00 |
$168.00 |
$281.82
|
|
Pelvis X-ray (complete, 4 or more views)
|
$179.40 |
$179.40 |
$179.40 |
$351.75
|
|
Pembrolizumab 25 mg/ml intravenous solution
|
$199.20 |
$199.20 |
$199.20 |
$12,385.22
|
|
Pemetrexed disodium 100 mg intravenous powder for solution
|
$379.20 |
$379.20 |
$379.20 |
$7,089.13
|
|
Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe
|
$96.00 |
$96.00 |
$96.00 |
$824.70
|
|
Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr
|
$144.60 |
$144.60 |
$144.60 |
$97.85
|
|
Penile rear tip xtnd 0.5cm
|
$18,010.20 |
$18,010.20 |
$18,010.20 |
$18,764.94
|
|
Perflutren lipid microspheres 1.1 mg/ml intravenous suspension
|
$824.40 |
$824.40 |
$824.40 |
$332.84
|
|
Pericardiocentesis wwo imaging
|
$3,431.40 |
$3,431.40 |
$3,431.40 |
$2,375.00
|
|
Peritoneogram rs&i
|
$463.20 |
$463.20 |
$463.20 |
$698.50
|
|
Perit-vens shunt pat tst
|
$1,127.40 |
$1,127.40 |
$1,127.40 |
$752.49
|
|
Perq dev breast 1st strtctc
|
$1,787.40 |
$1,787.40 |
$1,787.40 |
$1,456.00
|
|
Pertuzumab 30 mg/ml desensitization
|
$30.00 |
$30.00 |
$30.00 |
$14,272.91
|
|
Pertuzu, trastuzu, 10 mg
|
$285.60 |
$285.60 |
$285.60 |
$27,858.08
|
|
Pet CT skull-mid thgh initial
|
$10,513.20 |
$10,513.20 |
$10,513.20 |
$4,707.00
|
|
Pet CT whole body initial
|
$12,895.20 |
$12,895.20 |
$12,895.20 |
$4,850.00
|
|
Pfc sigma fem post aug sz3 8mm
|
$26,256.60 |
$26,256.60 |
$26,256.60 |
$39,920.50
|
|
Ph body fluid
|
$27.00 |
$27.00 |
$27.00 |
$42.00
|
|
Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr
|
$13.60 |
$13.60 |
$13.60 |
$114.56
|
|
Phenobarbital therapeutic drug level
|
$89.40 |
$89.40 |
$89.40 |
$105.00
|
|
Phentolaine mesylate inj
|
$460.00 |
$460.00 |
$460.00 |
$1,028.40
|
|
Phenylephrine 10 mg/ml injection solution
|
$0.04 |
$0.04 |
$0.04 |
$62.98
|
|
Phenytoin in ns IV syringe 5 mg/ml (neo/ped) - cnr
|
$722.40 |
$722.40 |
$722.40 |
$10.80
|
|
Phenytoin total therapeutic drug level
|
$89.40 |
$89.40 |
$89.40 |
$111.27
|
|
Phlebotomy therapeutic
|
$331.80 |
$331.80 |
$331.80 |
$231.40
|
|
Phosphorus
|
$37.20 |
$37.20 |
$37.20 |
$49.20
|
|
Phosphorus 24 hour urine
|
$45.00 |
$45.00 |
$45.00 |
$42.25
|
|
Phys blood bank serv reactj
|
$201.60 |
$201.60 |
$201.60 |
$207.50
|
|
Physical Therapy Evaluation (high complexity)
|
$320.40 |
$320.40 |
$320.40 |
$294.00
|
|
Physical Therapy Evaluation (low complexity)
|
$320.40 |
$320.40 |
$320.40 |
$223.92
|
|
Physical Therapy Evaluation (moderate complexity)
|
$320.40 |
$320.40 |
$320.40 |
$256.20
|
|
Physical Therapy Re-Evaluation
|
$105.00 |
$105.00 |
$105.00 |
$154.80
|
|
Phytonadione (vitamin k1) 10 mg/ml injection solution
|
$34.00 |
$34.00 |
$34.00 |
$90.25
|
|
Piflu f-18, dia 1 millicurie
|
$1,033.80 |
$1,033.80 |
$1,033.80 |
$1,038.40
|
|
Pin caspar distraction 12mm
|
$2,681.40 |
$2,681.40 |
$2,681.40 |
$11,759.36
|
|
Pinworm exam
|
$58.80 |
$58.80 |
$58.80 |
$39.62
|
|
Piperacillin-tazobactam 3.375 gram intravenous solution
|
$115.20 |
$115.20 |
$115.20 |
$81.36
|
|
Place gastrostomy tube perc
|
$3,735.00 |
$3,735.00 |
$3,735.00 |
$2,289.60
|
|
Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides)
|
$1,593.00 |
$1,593.00 |
$1,593.00 |
$1,332.43
|
|
Placement nephrostomy catheter (both sides)
|
$2,483.40 |
$2,483.40 |
$2,483.40 |
$3,933.00
|
|
Placement occlusive device venous/arterial access site post procedure
|
$941.40 |
$941.40 |
$941.40 |
$572.00
|
