|
Optx prox humrl fx w/int fix
|
$12,873.60 |
$12,873.60 |
$12,873.60 |
$13,938.00
|
|
Optx radial shaft fracture
|
$1,137.60 |
$1,137.60 |
$1,137.60 |
$5,301.66
|
|
Optx rad/uln dislc aqt/chrnc
|
$1,068.00 |
$1,068.00 |
$1,068.00 |
$5,883.95
|
|
Optx rdl&uln shft fx rds&uln
|
$1,528.00 |
$1,528.00 |
$1,528.00 |
$6,915.75
|
|
Optx rdl&uln shft fx rds/uln
|
$1,149.60 |
$1,149.60 |
$1,149.60 |
$6,665.84
|
|
Optx scapular fx w/int fixj
|
$1,632.80 |
$1,632.80 |
$1,632.80 |
$7,907.11
|
|
Optx sho dislc fx
|
$1,484.00 |
$1,484.00 |
$1,484.00 |
$5,339.00
|
|
Optx thigh fx
|
$2,066.40 |
$2,066.40 |
$2,066.40 |
$1,767.20
|
|
Optx ulnar shft fx int fixj
|
$5,778.40 |
$5,778.40 |
$5,778.40 |
$8,453.60
|
|
Optx ulnar styloid fracture
|
$1,057.60 |
$1,057.60 |
$1,057.60 |
$4,627.00
|
|
Orchiectomy partial
|
$976.00 |
$976.00 |
$976.00 |
$4,081.37
|
|
Orchiopexy ingun/scrot appr
|
$723.20 |
$723.20 |
$723.20 |
$4,176.15
|
|
Organic acids total quant ea spec
|
$446.40 |
$446.40 |
$446.40 |
$151.36
|
|
Oritavancin 1,200 mg intravenous solution
|
$98.40 |
$98.40 |
$98.40 |
$10,393.98
|
|
Oritavancin 400 mg intravenous solution
|
$64.00 |
$64.00 |
$64.00 |
$3,082.73
|
|
Orphenadrine citrate 30 mg/ml injection solution
|
$26.46 |
$26.46 |
$26.46 |
$50.63
|
|
Orthovisc inj per dose
|
$288.00 |
$288.00 |
$288.00 |
$537.58
|
|
Osmolality blood
|
$16.00 |
$16.00 |
$16.00 |
$67.60
|
|
Osmolality urine
|
$20.80 |
$20.80 |
$20.80 |
$65.00
|
|
Ostectomy complete 1st metatarsal head 28111
|
$540.00 |
$540.00 |
$540.00 |
$3,542.56
|
|
Osteochondral knee allograft
|
$1,684.80 |
$1,684.80 |
$1,684.80 |
$10,629.07
|
|
Osteopath manip tx/5-6 body region 98927
|
$73.60 |
$73.60 |
$73.60 |
$68.25
|
|
Ot evaluation high complexity patient/family
|
$204.80 |
$204.80 |
$204.80 |
$297.00
|
|
Ot evaluation low complexity patient/family
|
$204.80 |
$204.80 |
$204.80 |
$231.60
|
|
Ot evaluation moderate complexity patient/family
|
$204.80 |
$204.80 |
$204.80 |
$263.50
|
|
Other immunoelectrophoresis
|
$182.83 |
$182.83 |
$182.83 |
$107.52
|
|
Oth resp proc, group
|
$77.60 |
$77.60 |
$77.60 |
$123.05
|
|
Ot manual therpy techniques >=1 region each 15 minutes
|
$300.00 |
$300.00 |
$300.00 |
$105.00
|
|
Otolaryngo binocular microscopy 92504
|
$14.40 |
$14.40 |
$14.40 |
$60.45
|
|
Ot therapeutic activities direct patient contact each 15 minutes
|
$81.60 |
$81.60 |
$81.60 |
$101.38
|
|
Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes
|
$30.40 |
$30.40 |
$30.40 |
$87.00
|
|
Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes
|
$31.20 |
$31.20 |
$31.20 |
$91.80
|
|
Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes
|
$256.00 |
$256.00 |
$256.00 |
$98.15
|
|
Ot therapeutic procedure neuromuscular reeducate each 15 minutes
|
$147.20 |
$147.20 |
$147.20 |
$101.23
|
|
Ot training self care/home management direct contact each 15 minutes
|
$72.00 |
$72.00 |
$72.00 |
$94.25
|
|
Oxacillin in ns IV syringe 40 mg/ml (neo/ped) - cnr
|
$2.40 |
$2.40 |
$2.40 |
$83.08
|
|
Oxaliplatin 5 mg/ml desensitization
|
$165.36 |
$165.36 |
$165.36 |
$370.75
|
|
Oxytocin 10 unit/ml injection solution
|
$9.60 |
$9.60 |
$9.60 |
$50.40
|
|
Paclitaxel 6 mg/ml concentrate,intravenous
|
$285.12 |
$285.12 |
$285.12 |
$216.00
|
|
Paclitaxel protein-bound 100 mg intravenous suspension
|
$7,867.77 |
$7,867.77 |
$7,867.77 |
$3,435.42
|
|
Paliperidone 117 mg/0.75 ml inj
|
$34.40 |
$34.40 |
$34.40 |
$6,238.82
|
|
Palivizumab 50 mg/0.5 ml inj
|
$4,369.60 |
$4,369.60 |
$4,369.60 |
$5,569.20
|
|
Palonosetron hcl
|
$120.00 |
$120.00 |
$120.00 |
$170.48
|
|
Pamidronate 30 mg/10 ml (3 mg/ml) intravenous solution
|
$36.70 |
$36.70 |
$36.70 |
$128.07
|
|
Panitumumab 20 mg/ml intravenous solution (wrapper)
|
$31,964.64 |
$31,964.64 |
$31,964.64 |
$13,051.61
|
|
Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr
|
$7.95 |
$7.95 |
$7.95 |
$29.31
|
|
Parathormone (pth) intact
|
$33.60 |
$33.60 |
$33.60 |
$204.87
|
|
Parathyrd planar w/spect&ct
|
$1,109.60 |
$1,109.60 |
$1,109.60 |
$1,574.40
|
|
Parathyroid planar imaging
|
$851.20 |
$851.20 |
$851.20 |
$1,129.91
|
|
Parathyroid planar img w/tomo spect
|
$97.60 |
$97.60 |
$97.60 |
$1,350.60
|
|
Parial mast w/lymph removal 19302
|
$1,611.20 |
$1,611.20 |
$1,611.20 |
$5,509.55
|
|
Paring/cutting benign hyperkeratotic lesion single
|
$308.00 |
$308.00 |
$308.00 |
$245.00
|
|
Part hymenectomy/revi hymenal ring 56700
|
$328.00 |
$328.00 |
$328.00 |
$3,762.53
|
|
Partial excision bone tars/metatars exc talus/calcaneus (both sides) (rest meth ii cah)
|
$3,993.60 |
$3,993.60 |
$3,993.60 |
$4,914.00
|
|
Partial hip replacement
|
$1,896.00 |
$1,896.00 |
$1,896.00 |
$3,874.00
|
|
Partial hysterectomy
|
$1,613.60 |
$1,613.60 |
$1,613.60 |
$2,400.00
|
|
Partial proctectomy; perineal 45123
|
$1,904.00 |
$1,904.00 |
$1,904.00 |
$2,772.80
|
|
Partial removal finger bone
|
$830.40 |
$830.40 |
$830.40 |
$2,021.04
|
|
Partial removal finger bone
|
$5,241.60 |
$5,241.60 |
$5,241.60 |
$2,049.27
|
|
Partial removal foot fascia
|
$610.40 |
$610.40 |
$610.40 |
$3,762.00
|
|
Partial removal leg bone(s)
|
$1,535.20 |
$1,535.20 |
$1,535.20 |
$4,315.20
|
|
Partial removal of eye fluid
|
$720.00 |
$720.00 |
$720.00 |
$2,698.92
|
|
Partial removal of eye fluid
|
$819.20 |
$819.20 |
$819.20 |
$2,698.92
|
|
Partial removal of fibula
|
$1,100.80 |
$1,100.80 |
$1,100.80 |
$3,786.00
|
|
Partial removal of foot bone
|
$733.60 |
$733.60 |
$733.60 |
$3,839.54
|
|
Partial removal of heart sac 33030
|
$3,570.40 |
$3,570.40 |
$3,570.40 |
$4,877.60
|
|
Partial removal of lung 32480
|
$2,650.40 |
$2,650.40 |
$2,650.40 |
$2,868.60
|
|
Partial removal of thyroid
|
$1,180.00 |
$1,180.00 |
$1,180.00 |
$6,457.82
|
|
Partial removal of thyroid
|
$1,565.60 |
$1,565.60 |
$1,565.60 |
$5,855.00
|
|
Partial removal of toe
|
$450.40 |
$450.40 |
$450.40 |
$3,674.58
|
|
Partial thyroid excision
|
$1,196.80 |
$1,196.80 |
$1,196.80 |
$6,457.82
|
|
Particle matristem matrix 1000mg micron-q4118-cost per mg
|
$4,432.80 |
$4,432.80 |
$4,432.80 |
$4,921.76
|
|
Part removal of metatarsal
|
$498.40 |
$498.40 |
$498.40 |
$3,795.71
|
|
Part removal of metatarsal
|
$5,014.40 |
$5,014.40 |
$5,014.40 |
$3,134.00
|
|
Part removal of metatarsal 28112
|
$525.60 |
$525.60 |
$525.60 |
$3,839.54
|
|
Pcv21 vaccine im
|
$533.60 |
$533.60 |
$533.60 |
$410.26
|
|
Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector
|
$10,157.43 |
$10,157.43 |
$10,157.43 |
$11,216.31
|
|
Pegfilgrastim-pbbk 6 mg/0.6 ml subcutaneous syringe
|
$2,052.00 |
$2,052.00 |
$2,052.00 |
$4,067.80
|
|
Pelvic CT scan (with and without contrast)
|
$2,710.40 |
$2,710.40 |
$2,710.40 |
$1,890.36
|
|
Pelvic CT scan (with contrast)
|
$766.40 |
$766.40 |
$766.40 |
$1,608.98
|
|
Pelvic CT scan (without contrast)
|
$472.00 |
$472.00 |
$472.00 |
$1,363.11
|
|
Pelvic MRI (with and without contrast)
|
$1,588.80 |
$1,588.80 |
$1,588.80 |
$2,860.00
|
|
Pelvic MRI (without contrast)
|
$969.60 |
$969.60 |
$969.60 |
$1,902.00
|
|
Pelvic Ultrasound (complete)
|
$260.00 |
$260.00 |
$260.00 |
$643.80
|
|
Pelvic Ultrasound (limited)
|
$260.00 |
$260.00 |
$260.00 |
$430.00
|
|
Pembrolizumab 25 mg/ml intravenous solution
|
$28,875.26 |
$28,875.26 |
$28,875.26 |
$12,385.22
|
|
Pemetrexed disodium 100 mg intravenous powder for solution
|
$1,041.50 |
$1,041.50 |
$1,041.50 |
$7,089.13
|
|
Peng benzathine/procaine inj
|
$44.80 |
$44.80 |
$44.80 |
$375.32
|
|
Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe
|
$336.20 |
$336.20 |
$336.20 |
$826.47
|
|
Penile injection
|
$401.60 |
$401.60 |
$401.60 |
$418.00
|
|
Pericardiocentesis wwo imaging
|
$393.60 |
$393.60 |
$393.60 |
$2,251.20
|
|
Pericardiotomy/clot/for bod remove 33020
|
$1,476.80 |
$1,476.80 |
$1,476.80 |
$1,797.00
|
|
Peri-implt capslc brst compl
|
$1,175.20 |
$1,175.20 |
$1,175.20 |
$3,986.00
|
|
Perineoplasty rpr per nonob
|
$441.60 |
$441.60 |
$441.60 |
$3,522.35
|
|
Peri-proc device eval icd
|
$38.40 |
$38.40 |
$38.40 |
$192.40
|
|
Peri-proc device eval pm
|
$153.60 |
$153.60 |
$153.60 |
$159.90
|
|
Peritoneal cath sub q resv per
|
$732.80 |
$732.80 |
$732.80 |
$5,625.74
|
|
Perq rplcmt g-tube req revsn gstrst trk
|
$152.80 |
$152.80 |
$152.80 |
$625.93
|
|
Perq skel fix ulnar styld fx
|
$838.40 |
$838.40 |
$838.40 |
$3,839.54
|
|
Perq tx big toe fracture w/manip 28496
|
$484.00 |
$484.00 |
$484.00 |
$3,842.58
|
