|
Osmolality urine
|
$37.50 |
$37.50 |
$37.50 |
$65.00
|
|
Ot evaluation high complexity patient/family
|
$270.00 |
$270.00 |
$270.00 |
$297.00
|
|
Ot evaluation low complexity patient/family
|
$250.50 |
$250.50 |
$250.50 |
$231.60
|
|
Ot evaluation moderate complexity patient/family
|
$257.50 |
$257.50 |
$257.50 |
$263.50
|
|
Oth resp proc, group
|
$185.00 |
$185.00 |
$185.00 |
$123.05
|
|
Oth resp proc, indiv
|
$111.50 |
$111.50 |
$111.50 |
$82.50
|
|
Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes
|
$79.00 |
$79.00 |
$79.00 |
$98.40
|
|
Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes
|
$88.00 |
$88.00 |
$88.00 |
$105.00
|
|
Ot manual therpy techniques >=1 region each 15 minutes
|
$84.00 |
$84.00 |
$84.00 |
$105.00
|
|
Ot re-evaluation patient/family
|
$190.00 |
$190.00 |
$190.00 |
$160.80
|
|
Ot therapeutic activities direct patient contact each 15 minutes
|
$107.00 |
$107.00 |
$107.00 |
$101.38
|
|
Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes
|
$62.00 |
$62.00 |
$62.00 |
$87.00
|
|
Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes
|
$64.00 |
$64.00 |
$64.00 |
$91.80
|
|
Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes
|
$265.50 |
$265.50 |
$265.50 |
$98.15
|
|
Ot therapeutic procedure neuromuscular reeducate each 15 minutes
|
$277.50 |
$277.50 |
$277.50 |
$101.23
|
|
Ot training self care/home management direct contact each 15 minutes
|
$89.50 |
$89.50 |
$89.50 |
$94.25
|
|
Oxacillin in ns IV syringe 40 mg/ml (neo/ped) - cnr
|
$2.00 |
$2.00 |
$2.00 |
$83.08
|
|
Oxaliplatin 5 mg/ml desensitization
|
$27.68 |
$27.68 |
$27.68 |
$370.75
|
|
Oxytocin 10 unit/ml injection solution
|
$6.45 |
$6.45 |
$6.45 |
$50.04
|
|
Paclitaxel 6 mg/ml concentrate,intravenous
|
$53.99 |
$53.99 |
$53.99 |
$216.00
|
|
Paliperidone 117 mg/0.75 ml inj
|
$32.00 |
$32.00 |
$32.00 |
$6,238.82
|
|
Palivizumab 50 mg/0.5 ml inj
|
$4,096.50 |
$4,096.50 |
$4,096.50 |
$5,569.20
|
|
Palonosetron hcl
|
$43.42 |
$43.42 |
$43.42 |
$168.43
|
|
Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr
|
$5.79 |
$5.79 |
$5.79 |
$28.70
|
|
Parathormone (pth) intact
|
$200.50 |
$200.50 |
$200.50 |
$201.50
|
|
Parathyrd planar w/spect&ct
|
$1,378.50 |
$1,378.50 |
$1,378.50 |
$1,574.40
|
|
Parathyroid planar imaging
|
$871.00 |
$871.00 |
$871.00 |
$1,126.25
|
|
Paring/cutting benign hyperkeratotic lesion single
|
$445.50 |
$445.50 |
$445.50 |
$245.00
|
|
Particle matristem matrix 1000mg micron-q4118-cost per mg
|
$8.00 |
$8.00 |
$8.00 |
$4,921.76
|
|
Part removal of metatarsal
|
$3,210.50 |
$3,210.50 |
$3,210.50 |
$3,134.00
|
|
Pcv21 vaccine im
|
$222.50 |
$222.50 |
$222.50 |
$410.26
|
|
Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector
|
$9,522.59 |
$9,522.59 |
$9,522.59 |
$11,216.31
|
|
Pegfilgrastim-jmdb 6 mg/0.6 ml subcutaneous syringe
|
$3,847.50 |
$3,847.50 |
$3,847.50 |
$4,133.25
|
|
Pelvic CT scan (with and without contrast)
|
$630.00 |
$630.00 |
$630.00 |
$1,887.84
|
|
Pelvic CT scan (with contrast)
|
$625.00 |
$625.00 |
$625.00 |
$1,608.98
|
|
Pelvic CT scan (without contrast)
|
$296.00 |
$296.00 |
$296.00 |
$1,362.00
|
|
Pelvic MRI (with and without contrast)
|
$1,130.00 |
$1,130.00 |
$1,130.00 |
$2,860.00
|
|
Pelvic MRI (without contrast)
|
$871.00 |
$871.00 |
$871.00 |
$1,902.00
|
|
Pelvic Ultrasound (complete)
|
$289.00 |
$289.00 |
$289.00 |
$643.80
|
|
Pelvic Ultrasound (limited)
|
$289.00 |
$289.00 |
$289.00 |
$430.00
|
|
Pembrolizumab 25 mg/ml intravenous solution
|
$23,590.88 |
$23,590.88 |
$23,590.88 |
$12,385.22
|
|
Pemetrexed disodium 100 mg intravenous powder for solution
|
$199.35 |
$199.35 |
$199.35 |
$7,089.13
|
|
Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe
|
$64.00 |
$64.00 |
$64.00 |
$826.47
|
|
Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr
|
$2.63 |
$2.63 |
$2.63 |
$101.34
|
|
Perc d-e cor revasc chro sin
|
$9,515.00 |
$9,515.00 |
$9,515.00 |
$18,808.65
|
|
Perc d-e cor revasc t cabg s
|
$26,333.50 |
$26,333.50 |
$26,333.50 |
$16,047.20
|
|
Perc d-e cor stent ather s
|
$42,603.00 |
$42,603.00 |
$42,603.00 |
$18,700.50
|
|
Perc drug-el cor stent bran
|
$15,097.00 |
$15,097.00 |
$15,097.00 |
$11,515.20
|
|
Perc drug-el cor stent sing
|
$24,496.50 |
$24,496.50 |
$24,496.50 |
$16,258.50
|
|
Pericardiocentesis wwo imaging
|
$2,975.50 |
$2,975.50 |
$2,975.50 |
$2,251.20
|
|
Peripheral vascular rehab
|
$138.00 |
$138.00 |
$138.00 |
$132.50
|
|
Peri-proc device eval pm
|
$109.00 |
$109.00 |
$109.00 |
$159.90
|
|
Pet CT skull-mid thgh initial
|
$3,675.00 |
$3,675.00 |
$3,675.00 |
$4,645.20
|
|
Pet CT whole body initial
|
$3,675.00 |
$3,675.00 |
$3,675.00 |
$4,850.00
|
|
Pfc sigma fem post aug sz3 8mm
|
$13,539.65 |
$13,539.65 |
$13,539.65 |
$38,883.60
|
|
Ph body fluid
|
$21.00 |
$21.00 |
$21.00 |
$41.28
|
|
Phencyclidine (pcp)
|
$64.00 |
$64.00 |
$64.00 |
$95.55
|
|
Phenobarbital therapeutic drug level
|
$48.00 |
$48.00 |
$48.00 |
$104.25
|
|
Phenylephrine 10 mg/ml injection solution
|
$60.00 |
$60.00 |
$60.00 |
$67.89
|
|
Phenytoin total therapeutic drug level
|
$69.00 |
$69.00 |
$69.00 |
$110.88
|
|
Phlebotomy therapeutic
|
$278.00 |
$278.00 |
$278.00 |
$231.66
|
|
Phleb veins 1 extrm 10-20 stab
|
$6,363.00 |
$6,363.00 |
$6,363.00 |
$4,599.65
|
|
Phosphorus
|
$23.50 |
$23.50 |
$23.50 |
$47.81
|
|
Phosphorus 24 hour urine
|
$31.50 |
$31.50 |
$31.50 |
$40.95
|
|
Phytonadione (vitamin k1) 10 mg/ml injection solution
|
$4.00 |
$4.00 |
$4.00 |
$87.50
|
|
Piperacillin-tazobactam 3.375 gram intravenous solution
|
$8.27 |
$8.27 |
$8.27 |
$83.03
|
|
Place device/marker, non pro
|
$2,329.00 |
$2,329.00 |
$2,329.00 |
$1,969.20
|
|
Placement localization device(s) breast percutaneous mammographic guidance 1st lesion (both sides)
|
$1,903.50 |
$1,903.50 |
$1,903.50 |
$1,517.21
|
|
Placement localization device(s) breast percutaneous mammographic guide ea addl lesion left
|
$337.50 |
$337.50 |
$337.50 |
$795.00
|
|
Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides)
|
$1,637.00 |
$1,637.00 |
$1,637.00 |
$1,332.43
|
|
Placement nephrostomy catheter (both sides)
|
$4,348.00 |
$4,348.00 |
$4,348.00 |
$3,873.65
|
|
Placement occlusive device venous/arterial access site post procedure
|
$591.00 |
$591.00 |
$591.00 |
$571.45
|
|
Placement stent(s) intravascular transcatheter artery initial
|
$25,721.50 |
$25,721.50 |
$25,721.50 |
$13,964.50
|
|
Place slctv cath carotd art uni
|
$5,069.50 |
$5,069.50 |
$5,069.50 |
$10,014.40
|
|
Place slctv cath carotid/inom art excrn uni
|
$18,250.00 |
$18,250.00 |
$18,250.00 |
$6,498.00
|
|
Place slctv cath carotid/inom art intcrn uni
|
$4,841.50 |
$4,841.50 |
$4,841.50 |
$8,652.66
|
|
Place slctv cath vertebral art uni
|
$4,841.50 |
$4,841.50 |
$4,841.50 |
$8,971.00
|
|
Platelet aggregation each agent teg
|
$360.00 |
$360.00 |
$360.00 |
$148.80
|
|
Platelet automated
|
$24.50 |
$24.50 |
$24.50 |
$45.60
|
|
Platelet pheresis each unit
|
$1,143.00 |
$1,143.00 |
$1,143.00 |
$947.00
|
|
Platelets pheresis pathogen-reduced each unit
|
$2,331.00 |
$2,331.00 |
$2,331.00 |
$1,004.00
|
|
Plcmt sft tiss loc pq w/img 1st lsn
|
$831.00 |
$831.00 |
$831.00 |
$1,230.00
|
|
Plcmt xtn pros evasc rpr per vsl
|
$3,356.00 |
$3,356.00 |
$3,356.00 |
$3,579.75
|
|
Plc pq device breast ea addl lesion Ultrasound guide
|
$304.00 |
$304.00 |
$304.00 |
$758.52
|
|
Plmt nephroureteral catheter
|
$7,459.50 |
$7,459.50 |
$7,459.50 |
$4,081.37
|
|
Pm device progr eval dual
|
$42.50 |
$42.50 |
$42.50 |
$148.00
|
|
Pm device progr eval multi
|
$49.00 |
$49.00 |
$49.00 |
$139.00
|
|
Pmp22 gene dup/delet
|
$995.00 |
$995.00 |
$995.00 |
$1,029.75
|
|
Poct blood gases ph pco2 po2 arterial calculated o2
|
$97.00 |
$97.00 |
$97.00 |
$187.32
|
|
Polysom any age 1-3> param
|
$2,124.50 |
$2,124.50 |
$2,124.50 |
$1,424.80
|
|
Polysomnography sleep staging >=4 parameters age >=6 years w/cpap bipap
|
$2,284.00 |
$2,284.00 |
$2,284.00 |
$3,751.48
|
|
Postpartum Care Only
|
$117.00 |
$117.00 |
$117.00 |
$364.80
|
|
Potassium 24 hour urine
|
$23.50 |
$23.50 |
$23.50 |
$50.40
|
|
Potassium chloride 10 meq/100ml in sterile water intravenous piggyback
|
$42.30 |
$42.30 |
$42.30 |
$63.35
|
|
Potassium serum/plasma/whole blood
|
$24.50 |
$24.50 |
$24.50 |
$46.40
|
|
Pq dr cath chg w cont s&i
|
$205.00 |
$205.00 |
$205.00 |
$720.00
|
|
Pq thr inj ext pse
|
$1,577.50 |
$1,577.50 |
$1,577.50 |
$775.00
|
|
Pq vrtbrplst 1 bdy inj crv-thr w/img ini
|
$3,760.50 |
$3,760.50 |
$3,760.50 |
$4,565.03
|
|
Pr application of long arm splint
|
$368.00 |
$368.00 |
$368.00 |
$329.00
|
|
Pr application splint static short arm
|
$290.50 |
$290.50 |
$290.50 |
$287.70
|
