|
MRI orbit/face/neck without contrast
|
$12,425.22 |
$12,425.22 |
$12,425.22 |
$1,902.00
|
|
MRI orbit/face/neck without & w/contrast
|
$19,972.64 |
$19,972.64 |
$19,972.64 |
$2,854.80
|
|
MRI tmj
|
$17,293.76 |
$17,293.76 |
$17,293.76 |
$1,787.50
|
|
MRI without fol w/cont, breast
|
$11,433.51 |
$11,433.51 |
$11,433.51 |
$2,301.04
|
|
Mr safety determination physician/other qhp
|
$373.33 |
$373.33 |
$373.33 |
$161.40
|
|
Mr safety implant elec prepj
|
$389.19 |
$389.19 |
$389.19 |
$168.60
|
|
Mr safety implant&/fb assmt clin staff ea add 30
|
$103.84 |
$103.84 |
$103.84 |
$58.08
|
|
Mr safety implt pos&/immoblj
|
$251.86 |
$251.86 |
$251.86 |
$120.80
|
|
Mr sfty implt&/fb asmt stf 1
|
$103.84 |
$103.84 |
$103.84 |
$45.56
|
|
Mr sfty med physics xm cstmz
|
$1,024.89 |
$1,024.89 |
$1,024.89 |
$444.00
|
|
Mthfr gene analy common variants
|
$128.30 |
$128.30 |
$128.30 |
$180.48
|
|
Multiple sleep latency test
|
$7,295.75 |
$7,295.75 |
$7,295.75 |
$2,466.00
|
|
Mycophenolate mofetil 250 mg capsule
|
$62.34 |
$62.34 |
$62.34 |
$10.79
|
|
Myd88 gene p.leu265pro vrnt
|
$600.00 |
$600.00 |
$600.00 |
$388.40
|
|
Myelography thoracic spine
|
$5,794.77 |
$5,794.77 |
$5,794.77 |
$1,255.00
|
|
Nalbuphine 10 mg/ml injection solution
|
$260.87 |
$260.87 |
$260.87 |
$38.69
|
|
Natural killer cells total count
|
$256.00 |
$256.00 |
$256.00 |
$132.60
|
|
Neck (Cervical Spine) MRI (with and without contrast)
|
$16,438.85 |
$16,438.85 |
$16,438.85 |
$2,881.80
|
|
Neck (Cervical Spine) MRI (with contrast)
|
$16,872.17 |
$16,872.17 |
$16,872.17 |
$2,305.71
|
|
Neck (Cervical Spine) MRI (without contrast)
|
$12,709.43 |
$12,709.43 |
$12,709.43 |
$2,054.72
|
|
Neck MRA (blood vessel MRI, with and without contrast)
|
$11,027.58 |
$11,027.58 |
$11,027.58 |
$2,743.78
|
|
Neck MRA (blood vessel MRI, without contrast)
|
$8,847.21 |
$8,847.21 |
$8,847.21 |
$1,824.90
|
|
Nerve teasing preparations
|
$567.00 |
$567.00 |
$567.00 |
$698.49
|
|
Nitroglycerin 50 mg/250 ml (200 mcg/ml) in 5 % dextrose intravenous
|
$333.13 |
$333.13 |
$333.13 |
$74.56
|
|
Nm imaging bone/joint 3 phase study
|
$6,975.69 |
$6,975.69 |
$6,975.69 |
$1,708.85
|
|
Nm imaging bone/joint whole body
|
$6,474.03 |
$6,474.03 |
$6,474.03 |
$1,570.65
|
|
Nm imaging cardiac blood pooling planar single study at rest or stress
|
$5,598.02 |
$5,598.02 |
$5,598.02 |
$1,397.69
|
|
Nm imaging gastric emptying study
|
$5,669.64 |
$5,669.64 |
$5,669.64 |
$1,340.40
|
|
Nm imaging gastrointestinal acute blood loss
|
$3,496.48 |
$3,496.48 |
$3,496.48 |
$1,197.47
|
|
Nm imaging hepatobiliary system w/pharmacologic intervention
|
$7,587.63 |
$7,587.63 |
$7,587.63 |
$1,612.00
|
|
Nm imaging pulmonary ventilation/perfusion
|
$2,160.16 |
$2,160.16 |
$2,160.16 |
$1,590.00
|
|
Nm imaging thyroid single/multiple uptake(s) quantitative measurement(s)
|
$4,125.72 |
$4,125.72 |
$4,125.72 |
$1,091.00
|
|
Nr lnr acclrtr tx max 5 sessions
|
$8,579.11 |
$8,579.11 |
$8,579.11 |
$7,421.70
|
|
Nuclear rx intra-arterial
|
$987.13 |
$987.13 |
$987.13 |
$761.95
|
|
Nuclear Stress Test (Heart)
|
$10,874.41 |
$10,874.41 |
$10,874.41 |
$3,804.45
|
|
Olanzapine 10 mg intramuscular solution
|
$212.81 |
$212.81 |
$212.81 |
$109.58
|
|
Onco (ovar) two proteins
|
$643.71 |
$643.71 |
$643.71 |
$291.76
|
|
Ondansetron 4 mg s0119
|
$101.35 |
$101.35 |
$101.35 |
$2.31
|
|
Ondansetron hcl (pf) 2 mg/ml injection (wrapper)
|
$29.86 |
$29.86 |
$29.86 |
$22.62
|
|
Oral aprepitant
|
$613.18 |
$613.18 |
$613.18 |
$410.20
|
|
Orphenadrine citrate 30 mg/ml injection solution
|
$423.92 |
$423.92 |
$423.92 |
$50.63
|
|
Oscillation chest wall mechanical per session
|
$1,180.24 |
$1,180.24 |
$1,180.24 |
$195.00
|
|
Osmolality blood
|
$161.00 |
$161.00 |
$161.00 |
$69.55
|
|
Osmolality urine
|
$190.00 |
$190.00 |
$190.00 |
$65.65
|
|
Ot evaluation high complexity patient/family
|
$479.98 |
$479.98 |
$479.98 |
$292.80
|
|
Ot evaluation low complexity patient/family
|
$441.81 |
$441.81 |
$441.81 |
$226.80
|
|
Ot evaluation moderate complexity patient/family
|
$460.90 |
$460.90 |
$460.90 |
$263.50
|
|
Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes
|
$467.70 |
$467.70 |
$467.70 |
$104.50
|
|
Ot re-evaluation patient/family
|
$291.48 |
$291.48 |
$291.48 |
$160.80
|
|
Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes
|
$375.15 |
$375.15 |
$375.15 |
$86.65
|
|
Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes
|
$375.15 |
$375.15 |
$375.15 |
$91.20
|
|
Ot therapeutic procedure neuromuscular reeducate each 15 minutes
|
$172.94 |
$172.94 |
$172.94 |
$100.65
|
|
Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr
|
$31.48 |
$31.48 |
$31.48 |
$27.16
|
|
Parathormone (pth) intact
|
$1,549.00 |
$1,549.00 |
$1,549.00 |
$201.50
|
|
Parathyroid planar imaging
|
$2,004.46 |
$2,004.46 |
$2,004.46 |
$1,073.82
|
|
Parathyroid planar img w/tomo spect
|
$3,336.62 |
$3,336.62 |
$3,336.62 |
$1,345.00
|
|
Pelvic MRI (with and without contrast)
|
$20,172.97 |
$20,172.97 |
$20,172.97 |
$2,870.36
|
|
Pelvic MRI (without contrast)
|
$12,707.09 |
$12,707.09 |
$12,707.09 |
$1,929.85
|
|
Perflutren lipid microspheres 1.1 mg/ml intravenous suspension
|
$1,033.41 |
$1,033.41 |
$1,033.41 |
$335.79
|
|
Pet fdg brain metoblic eval sb
|
$7,027.80 |
$7,027.80 |
$7,027.80 |
$3,789.00
|
|
Pet image skull-thigh
|
$7,027.80 |
$7,027.80 |
$7,027.80 |
$4,278.00
|
|
Phencyclidine (pcp)
|
$88.00 |
$88.00 |
$88.00 |
$90.00
|
|
Phenobarbital therapeutic drug level
|
$222.00 |
$222.00 |
$222.00 |
$104.50
|
|
Phentolaine mesylate inj
|
$1,005.46 |
$1,005.46 |
$1,005.46 |
$1,028.40
|
|
Phlebotomy therapeutic
|
$455.17 |
$455.17 |
$455.17 |
$231.66
|
|
Phosphorus 24 hour urine
|
$136.00 |
$136.00 |
$136.00 |
$41.58
|
|
Pillow shldr abduc inflat univ
|
$2,995.00 |
$2,995.00 |
$2,995.00 |
$446.60
|
|
Platelet pheresis each unit
|
$1,155.00 |
$1,155.00 |
$1,155.00 |
$940.45
|
|
Platelets each unit
|
$192.00 |
$192.00 |
$192.00 |
$169.20
|
|
Platelets leukocytes reduced each unit
|
$200.00 |
$200.00 |
$200.00 |
$322.50
|
|
Platelets pheresis leukocytes reduced each unit
|
$1,244.00 |
$1,244.00 |
$1,244.00 |
$1,108.08
|
|
Platelets pheresis pathogen-reduced each unit
|
$1,155.00 |
$1,155.00 |
$1,155.00 |
$970.00
|
|
Plethysmography lung volumes/airway resistance
|
$1,154.28 |
$1,154.28 |
$1,154.28 |
$399.50
|
|
Polysomnography sleep staging >=4 parameters age >=6 years w/cpap bipap
|
$12,532.80 |
$12,532.80 |
$12,532.80 |
$3,751.48
|
|
Potassium 24 hour urine
|
$258.00 |
$258.00 |
$258.00 |
$50.70
|
|
Pq dr cath chg w cont s&i
|
$3,935.13 |
$3,935.13 |
$3,935.13 |
$720.00
|
|
Pralidoxime 1 gram solution for injection
|
$864.31 |
$864.31 |
$864.31 |
$267.69
|
|
Pr debridement open wound topical appl/wound asmt per session 20 sq cm/<
|
$985.15 |
$985.15 |
$985.15 |
$350.98
|
|
Prealbumin
|
$308.00 |
$308.00 |
$308.00 |
$93.60
|
|
Prednisolone sodium phosphate 15 mg/5 ml (3 mg/ml) oral solution
|
$97.16 |
$97.16 |
$97.16 |
$13.80
|
|
Pretreatment serum by diff red cell adsorption patient rbc/known phenotype each adsorption ref
|
$285.00 |
$285.00 |
$285.00 |
$147.84
|
|
Pretreat rbc absorption reference
|
$386.00 |
$386.00 |
$386.00 |
$139.00
|
|
Pretreat rbc density gradient separation reference
|
$418.00 |
$418.00 |
$418.00 |
$182.31
|
|
Pretreat rbc w chem/drugs reference
|
$136.00 |
$136.00 |
$136.00 |
$106.15
|
|
Pretreat rbc w enzyme reference
|
$71.00 |
$71.00 |
$71.00 |
$164.99
|
|
Prgr stim/pace a/iv drug
|
$32,633.86 |
$32,633.86 |
$32,633.86 |
$4,709.90
|
|
Procainamide 100 mg/ml injection (wrapper)
|
$2,772.00 |
$2,772.00 |
$2,772.00 |
$655.08
|
|
Procalcitonin
|
$846.00 |
$846.00 |
$846.00 |
$157.56
|
|
Prochlorperazine edisylate 10 mg/2 ml (5 mg/ml) injection solution
|
$178.47 |
$178.47 |
$178.47 |
$36.33
|
|
Prochlorperazine maleate 5 mg tablet
|
$92.37 |
$92.37 |
$92.37 |
$1.16
|
|
Progesterone
|
$703.00 |
$703.00 |
$703.00 |
$113.24
|
|
Prolactin
|
$94.00 |
$94.00 |
$94.00 |
$123.50
|
|
Promethazine 25 mg tablet
|
$76.08 |
$76.08 |
$76.08 |
$4.62
|
|
Propranolol in ns IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$143.99 |
$143.99 |
$143.99 |
$30.26
|
|
Prostate biopsy, any mthd
|
$3,936.22 |
$3,936.22 |
$3,936.22 |
$462.66
|
|
Protamine 10 mg/ml intravenous solution
|
$108.71 |
$108.71 |
$108.71 |
$59.61
|
|
Protein c activity
|
$581.00 |
$581.00 |
$581.00 |
$119.60
|
|
Protein electrophoretic fractionation & quantitation serum
|
$132.00 |
$132.00 |
$132.00 |
$84.00
|
|
Protein s total
|
$554.00 |
$554.00 |
$554.00 |
$77.60
|
|
Protein total 24 hour urine
|
$608.00 |
$608.00 |
$608.00 |
$52.47
|
