|
Mr safety determination physician/other qhp
|
$220.13 |
$220.13 |
$220.13 |
$161.40
|
|
Mr safety implant elec prepj
|
$229.48 |
$229.48 |
$229.48 |
$168.60
|
|
Mr safety implant&/fb assmt clin staff ea add 30
|
$104.08 |
$104.08 |
$104.08 |
$58.08
|
|
Mr safety implt pos&/immoblj
|
$148.50 |
$148.50 |
$148.50 |
$120.80
|
|
Mr sfty implt&/fb asmt stf 1
|
$104.08 |
$104.08 |
$104.08 |
$45.56
|
|
Mr sfty med physics xm cstmz
|
$604.30 |
$604.30 |
$604.30 |
$444.00
|
|
Multiple sleep latency test
|
$7,142.20 |
$7,142.20 |
$7,142.20 |
$2,466.00
|
|
Mycophenolate mofetil 250 mg capsule
|
$87.98 |
$87.98 |
$87.98 |
$10.79
|
|
Myelography neck spine
|
$3,342.96 |
$3,342.96 |
$3,342.96 |
$1,213.80
|
|
Myelography thoracic spine
|
$3,342.96 |
$3,342.96 |
$3,342.96 |
$1,255.00
|
|
Nafcillin 2 gram solution for injection
|
$270.00 |
$270.00 |
$270.00 |
$84.00
|
|
Nalbuphine 10 mg/ml injection solution
|
$157.92 |
$157.92 |
$157.92 |
$38.69
|
|
Neck (Cervical Spine) CT scan (with and without contrast)
|
$1,103.22 |
$1,103.22 |
$1,103.22 |
$2,055.15
|
|
Neck (Cervical Spine) MRI (with and without contrast)
|
$13,103.90 |
$13,103.90 |
$13,103.90 |
$2,881.80
|
|
Neck (Cervical Spine) MRI (with contrast)
|
$11,498.12 |
$11,498.12 |
$11,498.12 |
$2,305.71
|
|
Neck (Cervical Spine) MRI (without contrast)
|
$7,357.50 |
$7,357.50 |
$7,357.50 |
$2,054.72
|
|
Neck MRA (blood vessel MRI, with and without contrast)
|
$6,980.43 |
$6,980.43 |
$6,980.43 |
$2,743.78
|
|
Neck MRA (blood vessel MRI, without contrast)
|
$6,415.71 |
$6,415.71 |
$6,415.71 |
$1,824.90
|
|
New Patient Office Visit (level 2)
|
$723.44 |
$723.44 |
$723.44 |
$151.45
|
|
New Patient Office Visit (level 3)
|
$817.32 |
$817.32 |
$817.32 |
$205.20
|
|
New Patient Office Visit (level 4)
|
$1,114.54 |
$1,114.54 |
$1,114.54 |
$289.60
|
|
New Patient Office Visit (level 5)
|
$1,114.54 |
$1,114.54 |
$1,114.54 |
$349.70
|
|
Nicardipine 25 mg/10 ml intravenous solution
|
$256.61 |
$256.61 |
$256.61 |
$264.31
|
|
Nm imaging bone/joint 3 phase study
|
$4,475.85 |
$4,475.85 |
$4,475.85 |
$1,708.85
|
|
Nm imaging bone/joint whole body
|
$5,120.52 |
$5,120.52 |
$5,120.52 |
$1,570.65
|
|
Nm imaging cardiac blood pooling planar single study at rest or stress
|
$4,333.02 |
$4,333.02 |
$4,333.02 |
$1,397.69
|
|
Nm imaging gastric emptying study
|
$2,669.72 |
$2,669.72 |
$2,669.72 |
$1,340.40
|
|
Nm imaging gastrointestinal acute blood loss
|
$1,341.86 |
$1,341.86 |
$1,341.86 |
$1,197.47
|
|
Nm imaging hepatobiliary system w/pharmacologic intervention
|
$2,806.37 |
$2,806.37 |
$2,806.37 |
$1,612.00
|
|
Nm imaging kidney morphology vascular flow/function single study w/pharmacological intervention
|
$4,274.38 |
$4,274.38 |
$4,274.38 |
$1,530.60
|
|
Nm imaging pulmonary ventilation/perfusion
|
$3,028.85 |
$3,028.85 |
$3,028.85 |
$1,590.00
|
|
Nm imaging thyroid single/multiple uptake(s) quantitative measurement(s)
|
$1,932.23 |
$1,932.23 |
$1,932.23 |
$1,091.00
|
|
Nm radiopharmaceutical therapy oral administration
|
$2,408.82 |
$2,408.82 |
$2,408.82 |
$1,057.20
|
|
Nuclear Stress Test (Heart)
|
$15,510.51 |
$15,510.51 |
$15,510.51 |
$3,804.45
|
|
Octreotide,microspheres ER 20 mg intramuscular susp, extended release
|
$919.89 |
$919.89 |
$919.89 |
$12,151.03
|
|
Ondansetron hcl (pf) 2 mg/ml injection (wrapper)
|
$72.28 |
$72.28 |
$72.28 |
$22.62
|
|
Oral aprepitant
|
$743.04 |
$743.04 |
$743.04 |
$410.20
|
|
Orphenadrine citrate 30 mg/ml injection solution
|
$90.24 |
$90.24 |
$90.24 |
$50.63
|
|
Ot evaluation high complexity patient/family
|
$759.08 |
$759.08 |
$759.08 |
$292.80
|
|
Ot evaluation low complexity patient/family
|
$717.62 |
$717.62 |
$717.62 |
$226.80
|
|
Ot evaluation moderate complexity patient/family
|
$738.37 |
$738.37 |
$738.37 |
$263.50
|
|
Ot re-evaluation patient/family
|
$717.62 |
$717.62 |
$717.62 |
$160.80
|
|
Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes
|
$610.22 |
$610.22 |
$610.22 |
$86.65
|
|
Oxytocin 10 unit/ml injection solution
|
$125.72 |
$125.72 |
$125.72 |
$50.40
|
|
Pamidronate 30 mg/10 ml (3 mg/ml) intravenous solution
|
$880.18 |
$880.18 |
$880.18 |
$129.80
|
|
Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr
|
$58.32 |
$58.32 |
$58.32 |
$27.16
|
|
Papaverin hcl injection
|
$650.55 |
$650.55 |
$650.55 |
$76.40
|
|
Parathyroid planar imaging
|
$4,150.01 |
$4,150.01 |
$4,150.01 |
$1,073.82
|
|
Pelvic MRI (with and without contrast)
|
$11,342.99 |
$11,342.99 |
$11,342.99 |
$2,870.36
|
|
Pelvic MRI (with contrast)
|
$10,947.80 |
$10,947.80 |
$10,947.80 |
$2,210.00
|
|
Pelvic MRI (without contrast)
|
$8,109.85 |
$8,109.85 |
$8,109.85 |
$1,929.85
|
|
Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr
|
$242.02 |
$242.02 |
$242.02 |
$97.85
|
|
Perflutren lipid microspheres 1.1 mg/ml intravenous suspension
|
$1,133.41 |
$1,133.41 |
$1,133.41 |
$335.79
|
|
Phencyclidine (pcp)
|
$83.06 |
$83.06 |
$83.06 |
$90.00
|
|
Phentolaine mesylate inj
|
$2,433.26 |
$2,433.26 |
$2,433.26 |
$1,028.40
|
|
Platelet pheresis each unit
|
$842.24 |
$842.24 |
$842.24 |
$940.45
|
|
Platelets each unit
|
$898.24 |
$898.24 |
$898.24 |
$169.20
|
|
Platelets leukocytes reduced each unit
|
$256.14 |
$256.14 |
$256.14 |
$322.50
|
|
Platelets pheresis pathogen-reduced each unit
|
$597.30 |
$597.30 |
$597.30 |
$970.00
|
|
Polysomnography sleep staging >=4 parameters age >=6 years w/cpap bipap
|
$10,702.61 |
$10,702.61 |
$10,702.61 |
$3,751.48
|
|
Pralidoxime 1 gram solution for injection
|
$2,017.60 |
$2,017.60 |
$2,017.60 |
$267.69
|
|
Pr counseling smoke/tobacco intermediate greater 3 - 10 minutes
|
$141.28 |
$141.28 |
$141.28 |
$48.43
|
|
Prednisolone sodium phosphate 15 mg/5 ml (3 mg/ml) oral solution
|
$50.28 |
$50.28 |
$50.28 |
$13.80
|
|
Pretreat rbc density gradient separation reference
|
$825.38 |
$825.38 |
$825.38 |
$182.31
|
|
Pretreat rbc w enzyme reference
|
$825.38 |
$825.38 |
$825.38 |
$164.99
|
|
Prochlorperazine edisylate 10 mg/2 ml (5 mg/ml) injection solution
|
$502.96 |
$502.96 |
$502.96 |
$36.33
|
|
Promethazine hcl injection
|
$72.28 |
$72.28 |
$72.28 |
$12.96
|
|
Propranolol in ns IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$264.03 |
$264.03 |
$264.03 |
$30.26
|
|
Protamine 10 mg/ml intravenous solution
|
$197.13 |
$197.13 |
$197.13 |
$59.61
|
|
Protein c activity
|
$1,371.38 |
$1,371.38 |
$1,371.38 |
$119.60
|
|
Prothrombin complex kcentra
|
$36.34 |
$36.34 |
$36.34 |
$7.55
|
|
Pt evaluation high complexity patient/family
|
$759.72 |
$759.72 |
$759.72 |
$289.50
|
|
Pt evaluation low complexity patient/family
|
$717.62 |
$717.62 |
$717.62 |
$222.24
|
|
Pt evaluation moderate complexity patient/family
|
$738.37 |
$738.37 |
$738.37 |
$249.26
|
|
Pt re-evaluation patient/family
|
$717.62 |
$717.62 |
$717.62 |
$152.40
|
|
Pulse ox multiple
|
$488.82 |
$488.82 |
$488.82 |
$162.00
|
|
Pyridoxine hcl 100 mg
|
$67.65 |
$67.65 |
$67.65 |
$48.70
|
|
Rabies ig ht&sol human im/sc
|
$9,568.77 |
$9,568.77 |
$9,568.77 |
$2,997.00
|
|
Rbc count only automated
|
$12.08 |
$12.08 |
$12.08 |
$20.00
|
|
Rbc deglycerolized each unit
|
$1,089.80 |
$1,089.80 |
$1,089.80 |
$767.00
|
|
Red blood cells each unit
|
$462.81 |
$462.81 |
$462.81 |
$382.50
|
|
Red blood cells leukocytes reduced each unit
|
$1,264.64 |
$1,264.64 |
$1,264.64 |
$422.84
|
|
Red blood cells washed each unit
|
$958.06 |
$958.06 |
$958.06 |
$559.00
|
|
Regadenoson 0.4 mg/5 ml intravenous syringe
|
$6,824.77 |
$6,824.77 |
$6,824.77 |
$378.22
|
|
Remdesivir 100 mg intravenous powder for solution
|
$1,638.04 |
$1,638.04 |
$1,638.04 |
$1,524.70
|
|
Reticulocyte direct measurement automated
|
$216.00 |
$216.00 |
$216.00 |
$35.84
|
|
Rheumatoid factor quantitative
|
$657.00 |
$657.00 |
$657.00 |
$56.55
|
|
Rho(d) immune globulin 1,500 unit (300 mcg)/2 ml injection syringe
|
$2,770.51 |
$2,770.51 |
$2,770.51 |
$247.55
|
|
Rho d immune globulin inj
|
$309.88 |
$309.88 |
$309.88 |
$224.10
|
|
Rifampin in ns IV syringe 3 mg/ml (neo/ped) - cnr
|
$1,666.44 |
$1,666.44 |
$1,666.44 |
$459.00
|
|
Russell viper venom diluted
|
$1,386.00 |
$1,386.00 |
$1,386.00 |
$68.64
|
|
Scan duplex aorta/ivc/iliac unilateral/limited
|
$1,641.37 |
$1,641.37 |
$1,641.37 |
$468.30
|
|
Screening Mammogram
|
$949.78 |
$949.78 |
$949.78 |
$310.20
|
|
Sedimentation rate erythrocyte automated
|
$532.00 |
$532.00 |
$532.00 |
$44.20
|
|
Sialidase enzyme assay
|
$48.88 |
$48.88 |
$48.88 |
$54.60
|
|
Sildenafil citrate, 25 mg
|
$321.02 |
$321.02 |
$321.02 |
$182.99
|
|
Sirolimus, oral
|
$273.48 |
$273.48 |
$273.48 |
$41.25
|
|
Sleep Study (Polysomnography)
|
$10,702.61 |
$10,702.61 |
$10,702.61 |
$3,659.20
|
|
Sleep study unattended
|
$960.68 |
$960.68 |
$960.68 |
$576.54
|
|
Sodium chloride 0.9 % intravenous solution
|
$81.78 |
$81.78 |
$81.78 |
$48.00
|