|
Ot evaluation high complexity patient/family
|
$185.00 |
$185.00 |
$185.00 |
$297.00
|
|
Ot evaluation low complexity patient/family
|
$185.00 |
$185.00 |
$185.00 |
$231.60
|
|
Ot evaluation moderate complexity patient/family
|
$185.00 |
$185.00 |
$185.00 |
$263.50
|
|
Oth resp proc, group
|
$83.50 |
$83.50 |
$83.50 |
$123.05
|
|
Oth resp proc, indiv
|
$38.50 |
$38.50 |
$38.50 |
$82.50
|
|
Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes
|
$60.00 |
$60.00 |
$60.00 |
$98.40
|
|
Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes
|
$61.50 |
$61.50 |
$61.50 |
$105.00
|
|
Ot manual therpy techniques >=1 region each 15 minutes
|
$83.00 |
$83.00 |
$83.00 |
$105.00
|
|
Otolaryngo binocular microscopy 92504
|
$9.50 |
$9.50 |
$9.50 |
$60.45
|
|
Ot re-evaluation patient/family
|
$105.50 |
$105.50 |
$105.50 |
$160.80
|
|
Ot therapeutic activities direct patient contact each 15 minutes
|
$61.50 |
$61.50 |
$61.50 |
$101.38
|
|
Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes
|
$20.00 |
$20.00 |
$20.00 |
$87.00
|
|
Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes
|
$20.00 |
$20.00 |
$20.00 |
$91.80
|
|
Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes
|
$70.50 |
$70.50 |
$70.50 |
$98.15
|
|
Ot therapeutic procedure neuromuscular reeducate each 15 minutes
|
$50.50 |
$50.50 |
$50.50 |
$101.23
|
|
Ot training self care/home management direct contact each 15 minutes
|
$61.50 |
$61.50 |
$61.50 |
$94.25
|
|
Oxacillin in ns IV syringe 40 mg/ml (neo/ped) - cnr
|
$2.00 |
$2.00 |
$2.00 |
$83.08
|
|
Palb2 gene full gene seq
|
$126.00 |
$126.00 |
$126.00 |
$672.50
|
|
Paliperidone 117 mg/0.75 ml inj
|
$33.00 |
$33.00 |
$33.00 |
$6,238.82
|
|
Palivizumab 50 mg/0.5 ml inj
|
$4,096.50 |
$4,096.50 |
$4,096.50 |
$5,569.20
|
|
Parathormone (pth) intact
|
$309.00 |
$309.00 |
$309.00 |
$204.87
|
|
Parathyrd planar w/spect&ct
|
$1,134.00 |
$1,134.00 |
$1,134.00 |
$1,574.40
|
|
Parathyroid planar imaging
|
$787.00 |
$787.00 |
$787.00 |
$1,129.91
|
|
Parathyroid planar img w/tomo spect
|
$1,651.50 |
$1,651.50 |
$1,651.50 |
$1,350.60
|
|
Paring/cutting benign hyperkeratotic lesion single
|
$231.00 |
$231.00 |
$231.00 |
$245.00
|
|
Part hymenectomy/revi hymenal ring 56700
|
$4,348.50 |
$4,348.50 |
$4,348.50 |
$3,762.53
|
|
Partial excision bone tars/metatars exc talus/calcaneus (both sides) (rest meth ii cah)
|
$3,799.50 |
$3,799.50 |
$3,799.50 |
$4,914.00
|
|
Partial removal finger bone
|
$2,340.00 |
$2,340.00 |
$2,340.00 |
$2,049.27
|
|
Particle matristem matrix 1000mg micron-q4118-cost per mg
|
$8.00 |
$8.00 |
$8.00 |
$4,921.76
|
|
Part removal of metatarsal
|
$3,761.00 |
$3,761.00 |
$3,761.00 |
$3,134.00
|
|
Pca3/klk3 antigen
|
$330.00 |
$330.00 |
$330.00 |
$510.40
|
|
Pcv21 vaccine im
|
$222.50 |
$222.50 |
$222.50 |
$410.26
|
|
Pdgfra gene
|
$344.00 |
$344.00 |
$344.00 |
$717.23
|
|
Pdt dstr prmlg les phys/qhp
|
$231.00 |
$231.00 |
$231.00 |
$294.77
|
|
Pelvic CT scan (with and without contrast)
|
$1,328.50 |
$1,328.50 |
$1,328.50 |
$1,890.36
|
|
Pelvic CT scan (with contrast)
|
$935.00 |
$935.00 |
$935.00 |
$1,608.98
|
|
Pelvic CT scan (without contrast)
|
$1,119.00 |
$1,119.00 |
$1,119.00 |
$1,363.11
|
|
Pelvic MRI (with and without contrast)
|
$1,974.00 |
$1,974.00 |
$1,974.00 |
$2,860.00
|
|
Pelvic MRI (with contrast)
|
$1,886.00 |
$1,886.00 |
$1,886.00 |
$2,210.00
|
|
Pelvic MRI (without contrast)
|
$1,381.00 |
$1,381.00 |
$1,381.00 |
$1,902.00
|
|
Pelvic Ultrasound (complete)
|
$381.50 |
$381.50 |
$381.50 |
$643.80
|
|
Pelvic Ultrasound (limited)
|
$309.50 |
$309.50 |
$309.50 |
$430.00
|
|
Peng benzathine/procaine inj
|
$42.00 |
$42.00 |
$42.00 |
$375.32
|
|
Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe
|
$64.00 |
$64.00 |
$64.00 |
$826.47
|
|
Penile injection
|
$288.50 |
$288.50 |
$288.50 |
$418.00
|
|
Penile rear tip xtnd 0.5cm
|
$9,989.50 |
$9,989.50 |
$9,989.50 |
$18,764.94
|
|
Perc d-e cor revasc chro add
|
$10,440.50 |
$10,440.50 |
$10,440.50 |
$12,886.61
|
|
Perc d-e cor revasc chro sin
|
$9,546.00 |
$9,546.00 |
$9,546.00 |
$18,808.65
|
|
Perc d-e cor revasc t cabg b
|
$10,420.00 |
$10,420.00 |
$10,420.00 |
$11,088.63
|
|
Perc d-e cor revasc t cabg s
|
$19,288.50 |
$19,288.50 |
$19,288.50 |
$16,047.20
|
|
Perc d-e cor stent ather br
|
$10,420.00 |
$10,420.00 |
$10,420.00 |
$12,191.74
|
|
Perc d-e cor stent ather s
|
$9,515.00 |
$9,515.00 |
$9,515.00 |
$18,700.50
|
|
Perc drug-el cor stent bran
|
$5,980.00 |
$5,980.00 |
$5,980.00 |
$11,515.20
|
|
Perc drug-el cor stent sing
|
$18,898.00 |
$18,898.00 |
$18,898.00 |
$16,258.50
|
|
Pericardial drain w/cath pq w/ct guid
|
$2,148.00 |
$2,148.00 |
$2,148.00 |
$2,513.20
|
|
Pericardiocentesis wwo imaging
|
$2,930.00 |
$2,930.00 |
$2,930.00 |
$2,251.20
|
|
Perineoplasty rpr per nonob
|
$3,720.50 |
$3,720.50 |
$3,720.50 |
$3,522.35
|
|
Peripheral vascular rehab
|
$70.50 |
$70.50 |
$70.50 |
$132.50
|
|
Peri-proc device eval pm
|
$70.00 |
$70.00 |
$70.00 |
$159.90
|
|
Peritoneogram rs&i
|
$1,114.50 |
$1,114.50 |
$1,114.50 |
$695.89
|
|
Perit-vens shunt pat tst
|
$692.50 |
$692.50 |
$692.50 |
$758.37
|
|
Perq dev breast 1st strtctc
|
$822.00 |
$822.00 |
$822.00 |
$1,456.00
|
|
Perq trluml angp nt/recr coa
|
$4,777.00 |
$4,777.00 |
$4,777.00 |
$7,398.00
|
|
Pet CT skull-mid thgh initial
|
$4,320.50 |
$4,320.50 |
$4,320.50 |
$4,707.00
|
|
Pet CT whole body initial
|
$4,102.00 |
$4,102.00 |
$4,102.00 |
$4,850.00
|
|
Pet fdg brain metoblic eval sb
|
$1,541.50 |
$1,541.50 |
$1,541.50 |
$4,060.00
|
|
Pet image full body
|
$2,772.50 |
$2,772.50 |
$2,772.50 |
$5,070.50
|
|
Pet image ltd area
|
$2,448.50 |
$2,448.50 |
$2,448.50 |
$3,677.40
|
|
Pet image skull-thigh
|
$2,772.50 |
$2,772.50 |
$2,772.50 |
$4,256.70
|
|
Pet image w/ct lmtd
|
$4,366.50 |
$4,366.50 |
$4,366.50 |
$4,305.60
|
|
Pfc sigma fem post aug sz3 8mm
|
$4,756.50 |
$4,756.50 |
$4,756.50 |
$38,834.22
|
|
Ph body fluid
|
$25.00 |
$25.00 |
$25.00 |
$41.28
|
|
Phencyclidine (pcp)
|
$77.00 |
$77.00 |
$77.00 |
$96.00
|
|
Phenobarbital therapeutic drug level
|
$52.00 |
$52.00 |
$52.00 |
$104.50
|
|
Phenytoin total therapeutic drug level
|
$91.00 |
$91.00 |
$91.00 |
$110.88
|
|
Phlebotomy therapeutic
|
$150.50 |
$150.50 |
$150.50 |
$231.66
|
|
Phosphorus
|
$33.50 |
$33.50 |
$33.50 |
$48.80
|
|
Phosphorus 24 hour urine
|
$34.50 |
$34.50 |
$34.50 |
$41.51
|
|
Photo patch test
|
$71.50 |
$71.50 |
$71.50 |
$71.50
|
|
Photopheresis
|
$5,006.50 |
$5,006.50 |
$5,006.50 |
$7,967.00
|
|
Phys blood bank serv reactj
|
$177.00 |
$177.00 |
$177.00 |
$207.50
|
|
Phytonadione (vitamin k1) 10 mg/ml injection solution
|
$4.00 |
$4.00 |
$4.00 |
$87.50
|
|
Piflu f-18, dia 1 millicurie
|
$692.00 |
$692.00 |
$692.00 |
$1,035.81
|
|
Pik3ca gene trgt seq alys
|
$413.00 |
$413.00 |
$413.00 |
$463.20
|
|
Pillow shldr abduc inflat univ
|
$288.50 |
$288.50 |
$288.50 |
$614.36
|
|
Pin caspar distraction 12mm
|
$4,017.00 |
$4,017.00 |
$4,017.00 |
$11,925.00
|
|
Pinworm exam
|
$37.00 |
$37.00 |
$37.00 |
$39.75
|
|
Piperacillin-tazobactam 3.375 gram intravenous solution
|
$4.00 |
$4.00 |
$4.00 |
$83.03
|
|
Place cath xtrnl carotid
|
$6,825.00 |
$6,825.00 |
$6,825.00 |
$4,202.90
|
|
Place cecostomy tube perc
|
$1,386.00 |
$1,386.00 |
$1,386.00 |
$2,580.90
|
|
Place duod/jej tube perc
|
$2,175.00 |
$2,175.00 |
$2,175.00 |
$2,473.10
|
|
Place gastrostomy tube perc
|
$2,175.00 |
$2,175.00 |
$2,175.00 |
$2,289.60
|
|
Placement localization device(s) breast percutaneous mammographic guidance 1st lesion (both sides)
|
$1,232.00 |
$1,232.00 |
$1,232.00 |
$1,517.21
|
|
Placement localization device(s) breast percutaneous mammographic guide ea addl lesion left
|
$161.50 |
$161.50 |
$161.50 |
$795.00
|
|
Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides)
|
$822.00 |
$822.00 |
$822.00 |
$1,332.43
|
|
Placement nephrostomy catheter (both sides)
|
$2,417.50 |
$2,417.50 |
$2,417.50 |
$3,873.65
|
|
Placement occlusive device venous/arterial access site post procedure
|
$591.00 |
$591.00 |
$591.00 |
$571.45
|
|
Placement of seton
|
$3,682.00 |
$3,682.00 |
$3,682.00 |
$3,845.10
|
|
Placement stent(s) intravascular transcatheter artery initial
|
$16,000.00 |
$16,000.00 |
$16,000.00 |
$13,964.50
|
|
Place non-slctv cath thoracic arta
|
$2,865.50 |
$2,865.50 |
$2,865.50 |
$5,053.33
|
