|
Ortho elbow without jnt cstm w/fit&adj
|
$349.80 |
$349.80 |
$349.80 |
$279.81
|
|
Ortho ewh rgd without jnt cstm w/fit&adj
|
$552.42 |
$552.42 |
$552.42 |
$708.88
|
|
Ortho hnd/fngr without jnt cstm w/fit&adj
|
$371.58 |
$371.58 |
$371.58 |
$238.34
|
|
Ortho hnd/fngr w/jnt cstm w/fit&adj
|
$283.80 |
$283.80 |
$283.80 |
$310.00
|
|
Ortho hnd without jnt w/fit&adj
|
$208.56 |
$208.56 |
$208.56 |
$231.00
|
|
Orthopantogram
|
$315.48 |
$315.48 |
$315.48 |
$241.50
|
|
Ortho whf rigd without jnt cstm w/fit&adj
|
$485.76 |
$485.76 |
$485.76 |
$420.76
|
|
Oscillation chest wall mechanical per session
|
$526.02 |
$526.02 |
$526.02 |
$195.00
|
|
Osmolality blood
|
$40.26 |
$40.26 |
$40.26 |
$67.60
|
|
Osmolality urine
|
$42.90 |
$42.90 |
$42.90 |
$65.00
|
|
Ot evaluation high complexity patient/family
|
$155.76 |
$155.76 |
$155.76 |
$297.00
|
|
Ot evaluation low complexity patient/family
|
$155.76 |
$155.76 |
$155.76 |
$231.60
|
|
Ot evaluation moderate complexity patient/family
|
$155.76 |
$155.76 |
$155.76 |
$263.50
|
|
Oth resp proc, group
|
$167.64 |
$167.64 |
$167.64 |
$123.05
|
|
Oth resp proc, indiv
|
$84.48 |
$84.48 |
$84.48 |
$82.50
|
|
Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes
|
$80.52 |
$80.52 |
$80.52 |
$98.40
|
|
Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes
|
$85.14 |
$85.14 |
$85.14 |
$105.00
|
|
Ot manual therpy techniques >=1 region each 15 minutes
|
$80.52 |
$80.52 |
$80.52 |
$105.00
|
|
Ot re-evaluation patient/family
|
$104.94 |
$104.94 |
$104.94 |
$160.80
|
|
Ot therapeutic activities direct patient contact each 15 minutes
|
$95.70 |
$95.70 |
$95.70 |
$101.38
|
|
Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes
|
$71.94 |
$71.94 |
$71.94 |
$87.00
|
|
Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes
|
$71.94 |
$71.94 |
$71.94 |
$91.80
|
|
Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes
|
$80.52 |
$80.52 |
$80.52 |
$98.15
|
|
Ot therapeutic procedure neuromuscular reeducate each 15 minutes
|
$93.72 |
$93.72 |
$93.72 |
$101.23
|
|
Ot training self care/home management direct contact each 15 minutes
|
$89.10 |
$89.10 |
$89.10 |
$94.25
|
|
Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr
|
$34.52 |
$34.52 |
$34.52 |
$29.31
|
|
Parathormone (pth) intact
|
$252.12 |
$252.12 |
$252.12 |
$204.87
|
|
Parathyroid planar imaging
|
$1,170.18 |
$1,170.18 |
$1,170.18 |
$1,129.91
|
|
Parathyroid planar img w/tomo spect
|
$1,609.74 |
$1,609.74 |
$1,609.74 |
$1,350.60
|
|
Paring/cutting benign hyperkeratotic lesion single
|
$199.98 |
$199.98 |
$199.98 |
$245.00
|
|
Partial removal finger bone
|
$3,032.04 |
$3,032.04 |
$3,032.04 |
$2,049.27
|
|
Passy muir valve metal trach
|
$203.94 |
$203.94 |
$203.94 |
$275.75
|
|
Path clin consltj sf 5-20
|
$107.58 |
$107.58 |
$107.58 |
$97.14
|
|
Pelvic CT scan (with and without contrast)
|
$1,818.96 |
$1,818.96 |
$1,818.96 |
$1,890.36
|
|
Pelvic CT scan (with contrast)
|
$1,539.12 |
$1,539.12 |
$1,539.12 |
$1,608.98
|
|
Pelvic CT scan (without contrast)
|
$1,259.28 |
$1,259.28 |
$1,259.28 |
$1,363.11
|
|
Pelvic MRI (with and without contrast)
|
$2,893.44 |
$2,893.44 |
$2,893.44 |
$2,860.00
|
|
Pelvic MRI (with contrast)
|
$2,504.70 |
$2,504.70 |
$2,504.70 |
$2,210.00
|
|
Pelvic MRI (without contrast)
|
$2,277.00 |
$2,277.00 |
$2,277.00 |
$1,902.00
|
|
Pelvic Ultrasound (complete)
|
$615.12 |
$615.12 |
$615.12 |
$643.80
|
|
Pelvic Ultrasound (limited)
|
$482.46 |
$482.46 |
$482.46 |
$430.00
|
|
Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe
|
$101.09 |
$101.09 |
$101.09 |
$826.47
|
|
Perflutren lipid microspheres 1.1 mg/ml intravenous suspension
|
$304.08 |
$304.08 |
$304.08 |
$321.71
|
|
Peripheral vascular rehab
|
$92.40 |
$92.40 |
$92.40 |
$132.50
|
|
Perq dev breast 1st mr guide
|
$314.16 |
$314.16 |
$314.16 |
$1,837.20
|
|
Perq rplcmt g-tube req revsn gstrst trk
|
$924.66 |
$924.66 |
$924.66 |
$625.93
|
|
Ph body fluid
|
$25.08 |
$25.08 |
$25.08 |
$41.28
|
|
Phencyclidine (pcp)
|
$89.76 |
$89.76 |
$89.76 |
$96.00
|
|
Phenobarbital therapeutic drug level
|
$77.88 |
$77.88 |
$77.88 |
$104.50
|
|
Phenylephrine 10 mg/ml injection solution
|
$0.07 |
$0.07 |
$0.07 |
$67.89
|
|
Phenytoin total therapeutic drug level
|
$77.88 |
$77.88 |
$77.88 |
$110.88
|
|
Phlebotomy therapeutic
|
$227.70 |
$227.70 |
$227.70 |
$231.66
|
|
Phosphorus
|
$29.04 |
$29.04 |
$29.04 |
$48.80
|
|
Phosphorus 24 hour urine
|
$31.68 |
$31.68 |
$31.68 |
$41.51
|
|
Phytonadione (vitamin k1) 10 mg/ml injection solution
|
$20.84 |
$20.84 |
$20.84 |
$87.50
|
|
Pinworm exam
|
$23.76 |
$23.76 |
$23.76 |
$39.75
|
|
Piperacillin-tazobactam 3.375 gram intravenous solution
|
$23.25 |
$23.25 |
$23.25 |
$83.03
|
|
Place gastrostomy tube perc
|
$2,191.20 |
$2,191.20 |
$2,191.20 |
$2,289.60
|
|
Placement localization device(s) breast percutaneous mammographic guidance 1st lesion (both sides)
|
$1,871.10 |
$1,871.10 |
$1,871.10 |
$1,517.21
|
|
Placement localization device(s) breast percutaneous mammographic guide ea addl lesion left
|
$137.94 |
$137.94 |
$137.94 |
$795.00
|
|
Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides)
|
$1,595.22 |
$1,595.22 |
$1,595.22 |
$1,332.43
|
|
Platelet aggregation each agent teg
|
$196.68 |
$196.68 |
$196.68 |
$148.80
|
|
Platelet automated
|
$34.32 |
$34.32 |
$34.32 |
$45.60
|
|
Platelets each unit
|
$188.76 |
$188.76 |
$188.76 |
$169.29
|
|
Platelets hla matched leukocytes reduced apheresis/pheresis each unit
|
$1,809.72 |
$1,809.72 |
$1,809.72 |
$1,504.10
|
|
Platelets leukocytes reduced each unit
|
$271.26 |
$271.26 |
$271.26 |
$302.25
|
|
Platelets leukocytes reduced irradiated each unit
|
$1,206.48 |
$1,206.48 |
$1,206.48 |
$411.20
|
|
Platelets leukoreduced cmv negative apheresis/phresis each unit
|
$1,227.60 |
$1,227.60 |
$1,227.60 |
$1,094.60
|
|
Platelets pheresis leukocytes reduced cmv negative irradiated each unit
|
$1,551.00 |
$1,551.00 |
$1,551.00 |
$1,170.65
|
|
Platelets pheresis leukocytes reduced each unit
|
$1,206.48 |
$1,206.48 |
$1,206.48 |
$1,139.20
|
|
Platelets pheresis leukocytes reduced irradiated each unit
|
$1,259.94 |
$1,259.94 |
$1,259.94 |
$1,278.55
|
|
Platelets pheresis pathogen-reduced each unit
|
$1,007.82 |
$1,007.82 |
$1,007.82 |
$1,004.00
|
|
Plc pq device breast ea addl lesion MRI guide
|
$97.02 |
$97.02 |
$97.02 |
$1,482.50
|
|
Plc pq device breast ea addl lesion Ultrasound guide
|
$120.12 |
$120.12 |
$120.12 |
$758.52
|
|
Plethysmography lung volumes/airway resistance
|
$476.52 |
$476.52 |
$476.52 |
$405.00
|
|
Pm device progr eval dual
|
$93.06 |
$93.06 |
$93.06 |
$148.00
|
|
#pnh-flow cytometry interp
|
$209.88 |
$209.88 |
$209.88 |
$123.75
|
|
Poct blood gases ph pco2 po2 arterial calculated o2
|
$117.48 |
$117.48 |
$117.48 |
$187.32
|
|
Polysomnography sleep staging >=4 parameters age >=6 years w/cpap bipap
|
$4,287.36 |
$4,287.36 |
$4,287.36 |
$3,751.48
|
|
Potassium 24 hour urine
|
$25.74 |
$25.74 |
$25.74 |
$50.40
|
|
Potassium chloride 10 meq/100ml in sterile water intravenous piggyback
|
$69.96 |
$69.96 |
$69.96 |
$63.35
|
|
Potassium serum/plasma/whole blood
|
$59.40 |
$59.40 |
$59.40 |
$46.75
|
|
Pq dr cath chg w cont s&i
|
$729.30 |
$729.30 |
$729.30 |
$720.00
|
|
Pr application of long arm splint
|
$388.08 |
$388.08 |
$388.08 |
$329.00
|
|
Pr application splint static short arm
|
$308.88 |
$308.88 |
$308.88 |
$287.70
|
|
Pr biopsy skin punch single lesion
|
$401.28 |
$401.28 |
$401.28 |
$458.25
|
|
Pr correction hammertoe
|
$3,747.48 |
$3,747.48 |
$3,747.48 |
$3,839.54
|
|
Pr counseling smoke/tobacco intermediate greater 3 - 10 minutes
|
$36.96 |
$36.96 |
$36.96 |
$46.56
|
|
Pr debridement open wound topical appl/wound asmt per session 20 sq cm/<
|
$615.78 |
$615.78 |
$615.78 |
$351.60
|
|
Prealbumin
|
$46.20 |
$46.20 |
$46.20 |
$93.36
|
|
Pr ecg 12 lead report only
|
$35.64 |
$35.64 |
$35.64 |
$20.40
|
|
Prednisolone sodium phosphate 15 mg/5 ml (3 mg/ml) oral solution
|
$1.06 |
$1.06 |
$1.06 |
$13.87
|
|
Prednisone 1 mg tablet
|
$2.64 |
$2.64 |
$2.64 |
$3.00
|
|
Pregabalin - sendout
|
$102.30 |
$102.30 |
$102.30 |
$74.75
|
|
Pregnancy Ultrasound (complete, after first trimester)
|
$573.54 |
$573.54 |
$573.54 |
$590.27
|
|
Pregnancy Ultrasound (first trimester)
|
$454.74 |
$454.74 |
$454.74 |
$539.37
|
|
Pretreat rbc absorption reference
|
$100.32 |
$100.32 |
$100.32 |
$150.00
|
|
Pretreat rbc density gradient separation reference
|
$217.14 |
$217.14 |
$217.14 |
$174.00
|
|
Pretreat rbc w enzyme reference
|
$413.82 |
$413.82 |
$413.82 |
$167.05
|
|
Pr exam init preventive phys new visit during 1st 12 mo of mcare enrollment
|
$149.16 |
$149.16 |
$149.16 |
$188.86
|