|
Ot evaluation high complexity patient/family
|
$202.20 |
$202.20 |
$202.20 |
$297.00
|
|
Ot evaluation low complexity patient/family
|
$202.20 |
$202.20 |
$202.20 |
$231.60
|
|
Ot evaluation moderate complexity patient/family
|
$202.20 |
$202.20 |
$202.20 |
$263.90
|
|
Ot manual therpy techniques >=1 region each 15 minutes
|
$105.60 |
$105.60 |
$105.60 |
$105.00
|
|
Ot re-evaluation patient/family
|
$68.10 |
$68.10 |
$68.10 |
$160.80
|
|
Ot therapeutic activities direct patient contact each 15 minutes
|
$119.40 |
$119.40 |
$119.40 |
$101.38
|
|
Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes
|
$155.40 |
$155.40 |
$155.40 |
$98.58
|
|
Ot therapeutic procedure neuromuscular reeducate each 15 minutes
|
$119.40 |
$119.40 |
$119.40 |
$101.23
|
|
Ot training self care/home management direct contact each 15 minutes
|
$119.40 |
$119.40 |
$119.40 |
$94.25
|
|
Outrigger
|
$78.06 |
$78.06 |
$78.06 |
$123.81
|
|
Outrigger bil with vert extens
|
$261.29 |
$261.29 |
$261.29 |
$414.44
|
|
Oxytocin 10 unit/ml injection solution
|
$75.90 |
$75.90 |
$75.90 |
$50.40
|
|
Pacemaker leadless 19.5f 32.2mm ra
|
$41,279.77 |
$41,279.77 |
$41,279.77 |
$47,880.00
|
|
Paclitaxel 6 mg/ml concentrate,intravenous
|
$435.60 |
$435.60 |
$435.60 |
$216.00
|
|
Paclitaxel protein-bound 100 mg intravenous suspension
|
$5,972.63 |
$5,972.63 |
$5,972.63 |
$3,435.42
|
|
Palingen or palingen xplus
|
$9,612.64 |
$9,612.64 |
$9,612.64 |
$656.01
|
|
Panitumumab 20 mg/ml intravenous solution (wrapper)
|
$27,392.15 |
$27,392.15 |
$27,392.15 |
$13,051.61
|
|
Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr
|
$29.48 |
$29.48 |
$29.48 |
$27.16
|
|
Parathormone (pth) intact
|
$278.40 |
$278.40 |
$278.40 |
$206.18
|
|
Parathyroid planar imaging
|
$533.40 |
$533.40 |
$533.40 |
$1,129.91
|
|
Paricalcitol
|
$99.99 |
$99.99 |
$99.99 |
$47.15
|
|
Paring/cutting benign hyperkeratotic lesion single
|
$125.70 |
$125.70 |
$125.70 |
$249.00
|
|
Partial removal finger bone
|
$996.90 |
$996.90 |
$996.90 |
$2,018.00
|
|
Partial removal of toe
|
$14,045.87 |
$14,045.87 |
$14,045.87 |
$3,657.72
|
|
Particle matristem matrix 1000mg micron-q4118-cost per mg
|
$7,246.71 |
$7,246.71 |
$7,246.71 |
$4,746.60
|
|
Passy muir valve metal trach
|
$664.27 |
$664.27 |
$664.27 |
$275.75
|
|
Patten bottom
|
$477.42 |
$477.42 |
$477.42 |
$757.24
|
|
Pdgfra gene
|
$545.10 |
$545.10 |
$545.10 |
$743.34
|
|
Pd hl 3.5in 4d med rbr mld 6432
|
$34.12 |
$34.12 |
$34.12 |
$44.97
|
|
Pelv band/spread bar thigh c
|
$706.17 |
$706.17 |
$706.17 |
$802.87
|
|
Pelvic control band & belt b
|
$468.75 |
$468.75 |
$468.75 |
$743.50
|
|
Pelvic control band & belt u
|
$345.39 |
$345.39 |
$345.39 |
$547.83
|
|
Pelvic control hip heavy dut
|
$372.94 |
$372.94 |
$372.94 |
$591.53
|
|
Pelvic control pelvic sling
|
$647.37 |
$647.37 |
$647.37 |
$1,026.80
|
|
Pelvic CT scan (with and without contrast)
|
$913.80 |
$913.80 |
$913.80 |
$1,891.05
|
|
Pelvic CT scan (with contrast)
|
$898.50 |
$898.50 |
$898.50 |
$1,631.40
|
|
Pelvic CT scan (without contrast)
|
$422.70 |
$422.70 |
$422.70 |
$1,363.11
|
|
Pelvic & hip control thigh c
|
$1,583.92 |
$1,583.92 |
$1,583.92 |
$2,512.27
|
|
Pelvic MRI (with and without contrast)
|
$1,699.80 |
$1,699.80 |
$1,699.80 |
$2,860.00
|
|
Pelvic MRI (without contrast)
|
$913.50 |
$913.50 |
$913.50 |
$1,916.50
|
|
Pelvic Ultrasound (complete)
|
$457.50 |
$457.50 |
$457.50 |
$676.20
|
|
Pelvic Ultrasound (limited)
|
$354.00 |
$354.00 |
$354.00 |
$435.09
|
|
Pelv & thor control gluteal
|
$206.43 |
$206.43 |
$206.43 |
$327.43
|
|
Pembrolizumab 25 mg/ml intravenous solution
|
$22,739.27 |
$22,739.27 |
$22,739.27 |
$12,385.22
|
|
Penile rear tip xtnd 0.5cm
|
$19,622.83 |
$19,622.83 |
$19,622.83 |
$18,349.50
|
|
Pericardiocentesis wwo imaging
|
$1,033.50 |
$1,033.50 |
$1,033.50 |
$2,276.64
|
|
Pericardiotomy/clot/for bod remove 33020
|
$838.80 |
$838.80 |
$838.80 |
$1,696.80
|
|
Permanent tear duct plug
|
$190.27 |
$190.27 |
$190.27 |
$291.00
|
|
Peroneal straps pair pre ots
|
$25.50 |
$25.50 |
$25.50 |
$40.44
|
|
Pertuzu, trastuzu, 10 mg
|
$52,604.51 |
$52,604.51 |
$52,604.51 |
$27,833.07
|
|
Pessary 3.5 in 7 vag sil rng fold
|
$158.92 |
$158.92 |
$158.92 |
$141.60
|
|
Pfc sigma fem post aug sz3 8mm
|
$51,930.62 |
$51,930.62 |
$51,930.62 |
$35,919.52
|
|
Ph body fluid
|
$60.60 |
$60.60 |
$60.60 |
$40.04
|
|
Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr
|
$138.25 |
$138.25 |
$138.25 |
$116.25
|
|
Phenobarbital therapeutic drug level
|
$170.40 |
$170.40 |
$170.40 |
$106.40
|
|
Phentolaine mesylate inj
|
$2,770.68 |
$2,770.68 |
$2,770.68 |
$1,028.40
|
|
Phenylephrine 10 mg/ml injection solution
|
$9.00 |
$9.00 |
$9.00 |
$63.60
|
|
Phenylep ketorolac opth soln
|
$3,115.20 |
$3,115.20 |
$3,115.20 |
$934.56
|
|
Phenytoin in ns IV syringe 5 mg/ml (neo/ped) - cnr
|
$9.17 |
$9.17 |
$9.17 |
$10.80
|
|
Phenytoin total therapeutic drug level
|
$24.90 |
$24.90 |
$24.90 |
$113.00
|
|
Phlebotomy therapeutic
|
$222.00 |
$222.00 |
$222.00 |
$237.00
|
|
Phosphorus
|
$70.50 |
$70.50 |
$70.50 |
$50.76
|
|
Phys blood bank serv reactj
|
$134.70 |
$134.70 |
$134.70 |
$207.50
|
|
Phytonadione (vitamin k1) 10 mg/ml injection solution
|
$56.45 |
$56.45 |
$56.45 |
$86.46
|
|
Pillow shldr abduc inflat univ
|
$1,082.82 |
$1,082.82 |
$1,082.82 |
$446.60
|
|
Pin caspar distraction 12mm
|
$15,221.40 |
$15,221.40 |
$15,221.40 |
$11,672.88
|
|
Piperacillin-tazobactam 3.375 gram intravenous solution
|
$39.60 |
$39.60 |
$39.60 |
$83.75
|
|
Plas shoe insert w ank joint
|
$155.95 |
$155.95 |
$155.95 |
$246.72
|
|
Plastic mod low ext pad/line
|
$221.70 |
$221.70 |
$221.70 |
$244.53
|
|
Plastic mold recipro hip & c
|
$3,188.26 |
$3,188.26 |
$3,188.26 |
$5,056.93
|
|
Platelet automated
|
$41.70 |
$41.70 |
$41.70 |
$45.76
|
|
Platelets pheresis leukocytes reduced each unit
|
$855.00 |
$855.00 |
$855.00 |
$1,108.08
|
|
Platelets pheresis leukocytes reduced irradiated each unit
|
$855.90 |
$855.90 |
$855.90 |
$1,231.75
|
|
Plating chrome/nickel pr bar
|
$116.59 |
$116.59 |
$116.59 |
$184.93
|
|
Plethysmography lung volumes/airway resistance
|
$120.90 |
$120.90 |
$120.90 |
$408.00
|
|
Pneum full leg splnt pre ots
|
$195.13 |
$195.13 |
$195.13 |
$309.50
|
|
Poct blood gases ph pco2 po2 arterial calculated o2
|
$33.30 |
$33.30 |
$33.30 |
$189.60
|
|
Postop app non-wgt bear dsg
|
$377.09 |
$377.09 |
$377.09 |
$896.02
|
|
Postop app non-wgt bear dsg
|
$876.17 |
$876.17 |
$876.17 |
$1,389.71
|
|
Postop dsg & 1 cast chg ak/d
|
$2,105.15 |
$2,105.15 |
$2,105.15 |
$3,339.01
|
|
Post-operative body jacket
|
$2,677.91 |
$2,677.91 |
$2,677.91 |
$4,247.46
|
|
Potassium 24 hour urine
|
$57.90 |
$57.90 |
$57.90 |
$52.20
|
|
Potassium chloride 10 meq/100ml in sterile water intravenous piggyback
|
$264.00 |
$264.00 |
$264.00 |
$64.09
|
|
Potassium serum/plasma/whole blood
|
$57.90 |
$57.90 |
$57.90 |
$47.40
|
|
Pr amput fgr/thumb prim/sec any joint/phal sgl incl neurectomies w dir clsr
|
$2,067.90 |
$2,067.90 |
$2,067.90 |
$3,738.90
|
|
Pr application of long arm splint
|
$88.80 |
$88.80 |
$88.80 |
$329.00
|
|
Pr application splint static short arm
|
$143.40 |
$143.40 |
$143.40 |
$288.75
|
|
Pr biopsy skin punch single lesion
|
$259.20 |
$259.20 |
$259.20 |
$458.25
|
|
Pr correction hammertoe
|
$42,720.19 |
$42,720.19 |
$42,720.19 |
$3,839.54
|
|
Pr debridement open wound topical appl/wound asmt per session 20 sq cm/<
|
$125.70 |
$125.70 |
$125.70 |
$351.60
|
|
Prealbumin
|
$157.20 |
$157.20 |
$157.20 |
$96.00
|
|
Prednisolone sodium phosphate 15 mg/5 ml (3 mg/ml) oral solution
|
$9.00 |
$9.00 |
$9.00 |
$13.80
|
|
Prednisone 1 mg tablet
|
$9.00 |
$9.00 |
$9.00 |
$3.00
|
|
Pregnancy Ultrasound (complete, after first trimester)
|
$423.90 |
$423.90 |
$423.90 |
$596.40
|
|
Pregnancy Ultrasound (first trimester)
|
$423.90 |
$423.90 |
$423.90 |
$539.37
|
|
Prep bk ptb open end socket
|
$2,891.30 |
$2,891.30 |
$2,891.30 |
$4,585.93
|
|
Prep bk ptb thermopls molded
|
$2,521.01 |
$2,521.01 |
$2,521.01 |
$3,998.60
|
|
Pressure max expiratory/inspiratory
|
$151.50 |
$151.50 |
$151.50 |
$232.27
|
|
Pretreatment serum by diff red cell adsorption patient rbc/known phenotype each adsorption ref
|
$159.90 |
$159.90 |
$159.90 |
$152.85
|
|
Pretreat rbc absorption reference
|
$159.90 |
$159.90 |
$159.90 |
$148.80
|