|
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
|
$217.00 |
$217.00 |
$217.00 |
$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
|
$72.50 |
$72.50 |
$72.50 |
$105.00
|
|
Ot manual therpy techniques >=1 region each 15 minutes
|
$340.00 |
$340.00 |
$340.00 |
$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
|
$145.00 |
$145.00 |
$145.00 |
$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
|
$145.00 |
$145.00 |
$145.00 |
$98.15
|
|
Ot therapeutic procedure neuromuscular reeducate each 15 minutes
|
$78.50 |
$78.50 |
$78.50 |
$101.23
|
|
Ot training self care/home management direct contact each 15 minutes
|
$145.00 |
$145.00 |
$145.00 |
$94.25
|
|
Oxacillin in ns IV syringe 40 mg/ml (neo/ped) - cnr
|
$334.13 |
$334.13 |
$334.13 |
$83.08
|
|
Oxaliplatin 5 mg/ml desensitization
|
$73.66 |
$73.66 |
$73.66 |
$370.75
|
|
Oxytocin 10 unit/ml injection solution
|
$9.68 |
$9.68 |
$9.68 |
$50.40
|
|
Paclitaxel 6 mg/ml concentrate,intravenous
|
$192.33 |
$192.33 |
$192.33 |
$216.00
|
|
Paclitaxel protein-bound 100 mg intravenous suspension
|
$6,613.86 |
$6,613.86 |
$6,613.86 |
$3,435.42
|
|
Palb2 gene full gene seq
|
$126.00 |
$126.00 |
$126.00 |
$672.50
|
|
Paliperidone 117 mg/0.75 ml inj
|
$7,228.58 |
$7,228.58 |
$7,228.58 |
$6,238.82
|
|
Palivizumab 50 mg/0.5 ml inj
|
$4,096.50 |
$4,096.50 |
$4,096.50 |
$5,569.20
|
|
Palonosetron hcl
|
$266.99 |
$266.99 |
$266.99 |
$170.48
|
|
Panitumumab 20 mg/ml intravenous solution (wrapper)
|
$13,318.60 |
$13,318.60 |
$13,318.60 |
$13,051.61
|
|
Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr
|
$7.45 |
$7.45 |
$7.45 |
$29.31
|
|
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
|
|
Parial mast w/lymph removal 19302
|
$6,813.50 |
$6,813.50 |
$6,813.50 |
$5,509.55
|
|
Paring/cutting benign hyperkeratotic lesion single
|
$827.00 |
$827.00 |
$827.00 |
$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)
|
$14,281.00 |
$14,281.00 |
$14,281.00 |
$4,914.00
|
|
Partial removal finger bone
|
$3,063.50 |
$3,063.50 |
$3,063.50 |
$2,049.27
|
|
Partial removal foot fascia
|
$4,251.00 |
$4,251.00 |
$4,251.00 |
$3,762.00
|
|
Partial removal of fibula
|
$4,001.00 |
$4,001.00 |
$4,001.00 |
$3,786.00
|
|
Partial removal of foot bone
|
$1,392.17 |
$1,392.17 |
$1,392.17 |
$3,839.54
|
|
Partial removal of thyroid
|
$10,938.50 |
$10,938.50 |
$10,938.50 |
$6,457.82
|
|
Particle matristem matrix 1000mg micron-q4118-cost per mg
|
$2,054.82 |
$2,054.82 |
$2,054.82 |
$4,921.76
|
|
Part removal of metatarsal
|
$3,438.50 |
$3,438.50 |
$3,438.50 |
$3,795.71
|
|
Part removal of metatarsal
|
$3,761.00 |
$3,761.00 |
$3,761.00 |
$3,134.00
|
|
Part removal of metatarsal 28112
|
$2,184.13 |
$2,184.13 |
$2,184.13 |
$3,839.54
|
|
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
|
|
Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector
|
$9,522.59 |
$9,522.59 |
$9,522.59 |
$11,216.31
|
|
Pegfilgrastim-cbqv 6 mg/0.6 ml subcutaneous syringe
|
$7,265.37 |
$7,265.37 |
$7,265.37 |
$7,297.36
|
|
Pegfilgrastim-jmdb 6 mg/0.6 ml subcutaneous syringe
|
$3,908.25 |
$3,908.25 |
$3,908.25 |
$4,133.25
|
|
Pegloticase 8 mg/ml intravenous solution
|
$40,845.92 |
$40,845.92 |
$40,845.92 |
$49,135.11
|
|
Pelvic CT scan (with and without contrast)
|
$1,531.50 |
$1,531.50 |
$1,531.50 |
$1,890.36
|
|
Pelvic CT scan (with contrast)
|
$1,294.50 |
$1,294.50 |
$1,294.50 |
$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)
|
$2,707.00 |
$2,707.00 |
$2,707.00 |
$2,860.00
|
|
Pelvic MRI (with contrast)
|
$2,048.00 |
$2,048.00 |
$2,048.00 |
$2,210.00
|
|
Pelvic MRI (without contrast)
|
$1,942.50 |
$1,942.50 |
$1,942.50 |
$1,902.00
|
|
Pelvic Ultrasound (complete)
|
$442.50 |
$442.50 |
$442.50 |
$643.80
|
|
Pelvic Ultrasound (limited)
|
$442.50 |
$442.50 |
$442.50 |
$430.00
|
|
Pembrolizumab 25 mg/ml intravenous solution
|
$46,256.64 |
$46,256.64 |
$46,256.64 |
$12,385.22
|
|
Pemetrexed disodium 100 mg intravenous powder for solution
|
$14,045.40 |
$14,045.40 |
$14,045.40 |
$7,089.13
|
|
Peng benzathine/procaine inj
|
$42.00 |
$42.00 |
$42.00 |
$375.32
|
|
Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe
|
$1,169.02 |
$1,169.02 |
$1,169.02 |
$826.47
|
|
Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr
|
$8.28 |
$8.28 |
$8.28 |
$101.34
|
|
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
|
|
Pentamidine non-comp unit
|
$344.93 |
$344.93 |
$344.93 |
$294.39
|
|
Perc cryo ablate renal tum
|
$10,196.00 |
$10,196.00 |
$10,196.00 |
$11,458.04
|
|
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
|
$12,866.00 |
$12,866.00 |
$12,866.00 |
$11,515.20
|
|
Perc drug-el cor stent sing
|
$18,898.00 |
$18,898.00 |
$18,898.00 |
$16,258.50
|
|
Percut ablate liver rf
|
$6,185.00 |
$6,185.00 |
$6,185.00 |
$6,904.15
|
|
Perflutren lipid microspheres 1.1 mg/ml intravenous suspension
|
$255.38 |
$255.38 |
$255.38 |
$321.71
|
|
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
|
|
Peri-implt capslc brst compl
|
$6,813.50 |
$6,813.50 |
$6,813.50 |
$3,986.00
|
|
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 nl/pl lithotrp cplx>2cm
|
$27,652.50 |
$27,652.50 |
$27,652.50 |
$10,114.58
|
|
Perq nl/pl lithotrp smpl<2cm
|
$12,852.50 |
$12,852.50 |
$12,852.50 |
$9,442.38
|
|
Perq rplcmt g-tube req revsn gstrst trk
|
$758.50 |
$758.50 |
$758.50 |
$625.93
|
|
Perq trluml angp nt/recr coa
|
$4,777.00 |
$4,777.00 |
$4,777.00 |
$7,398.00
|
|
Pertuzumab 30 mg/ml desensitization
|
$13,053.57 |
$13,053.57 |
$13,053.57 |
$13,666.00
|
|
Pertuzu, trastuzu, 10 mg
|
$26,634.51 |
$26,634.51 |
$26,634.51 |
$27,833.07
|
|
Pet CT skull-mid thgh initial
|
$4,555.50 |
$4,555.50 |
$4,555.50 |
$4,707.00
|
|
Pet CT whole body initial
|
$5,061.00 |
$5,061.00 |
$5,061.00 |
$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
|
