|
Epoetin alfa, 100 units esrd
|
$17.96 |
$17.96 |
$17.96 |
$6.00
|
|
Epstein barr early antigen antibody
|
$29.15 |
$29.15 |
$29.15 |
$60.00
|
|
Epstein barr nuclear antigen antibody
|
$28.62 |
$28.62 |
$28.62 |
$76.86
|
|
Epstein barr viral capsid antigen antibody igm
|
$32.86 |
$32.86 |
$32.86 |
$85.50
|
|
ER Visit (level 1, minor)
|
$249.00 |
$249.00 |
$249.00 |
$252.60
|
|
ER Visit (level 2)
|
$317.60 |
$317.60 |
$317.60 |
$463.00
|
|
ER Visit (level 3)
|
$921.59 |
$921.59 |
$921.59 |
$812.18
|
|
ER Visit (level 4)
|
$2,573.71 |
$2,573.71 |
$2,573.71 |
$1,291.00
|
|
ER Visit (level 5, high severity)
|
$3,139.06 |
$3,139.06 |
$3,139.06 |
$1,871.60
|
|
Esophagoscopy balloon <30mm
|
$144.60 |
$144.60 |
$144.60 |
$2,460.00
|
|
Esophagoscopy flex biopsy
|
$126.23 |
$126.23 |
$126.23 |
$2,132.00
|
|
Esophagoscopy/flex/diagnostic 43200
|
$107.39 |
$107.39 |
$107.39 |
$1,296.00
|
|
Esophagoscopy snare les remv
|
$196.41 |
$196.41 |
$196.41 |
$2,742.00
|
|
Esoph egd dilation <30 mm
|
$187.93 |
$187.93 |
$187.93 |
$2,656.80
|
|
Established Patient Office Visit (level 1)
|
$255.20 |
$255.20 |
$255.20 |
$122.20
|
|
Established Patient Office Visit (level 2)
|
$646.80 |
$646.80 |
$646.80 |
$139.20
|
|
Established Patient Office Visit (level 3)
|
$1,298.00 |
$1,298.00 |
$1,298.00 |
$186.94
|
|
Established Patient Office Visit (level 4)
|
$2,002.00 |
$2,002.00 |
$2,002.00 |
$239.25
|
|
Established Patient Office Visit (level 5)
|
$2,820.40 |
$2,820.40 |
$2,820.40 |
$290.68
|
|
Estradiol total
|
$47.12 |
$47.12 |
$47.12 |
$152.10
|
|
Estrogens total-sendout
|
$37.03 |
$37.03 |
$37.03 |
$97.50
|
|
Ethylene glycol -sendout
|
$45.44 |
$45.44 |
$45.44 |
$86.04
|
|
Euglobulin lysis
|
$14.25 |
$14.25 |
$14.25 |
$63.84
|
|
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen
|
$165.50 |
$165.50 |
$165.50 |
$213.15
|
|
Event monitor
|
$206.25 |
$206.25 |
$206.25 |
$231.00
|
|
Evoked oa emissions ltd
|
$113.43 |
$113.43 |
$113.43 |
$244.00
|
|
Exc abd les sc 3 cm/>
|
$540.71 |
$540.71 |
$540.71 |
$3,994.09
|
|
Exc arm/elbo les sc <3cm 24075
|
$603.82 |
$603.82 |
$603.82 |
$2,532.80
|
|
Exc back les sbq <3 cm 21930
|
$445.57 |
$445.57 |
$445.57 |
$2,711.00
|
|
Exc back tum deep 5 cm/>
|
$908.56 |
$908.56 |
$908.56 |
$3,994.09
|
|
Exc benign snhfg 3.1-4.0cm 11424
|
$217.60 |
$217.60 |
$217.60 |
$2,306.25
|
|
Exc benign tal 0.5 < cm 11400
|
$99.38 |
$99.38 |
$99.38 |
$832.60
|
|
Exc ben+marg excep skin tag feenlm <0.5cm 11440
|
$125.29 |
$125.29 |
$125.29 |
$969.60
|
|
Exc ben+marg excep skin tag feenlm 1.1-2cm 11442
|
$176.15 |
$176.15 |
$176.15 |
$1,152.96
|
|
Exc ben+marg excep skin tag feenlm 2.1-3cm 11443
|
$216.19 |
$216.19 |
$216.19 |
$2,069.20
|
|
Exc ben+marg excep skin tag snhfg 0.6-1cm 11421
|
$133.29 |
$133.29 |
$133.29 |
$1,501.50
|
|
Exc ben+marg excep skin tag snhfg 2.1-3cm 11423
|
$189.34 |
$189.34 |
$189.34 |
$2,271.01
|
|
Exc ben+marg excep skin tag snhfg >4cm 11426
|
$335.35 |
$335.35 |
$335.35 |
$3,483.00
|
|
Exc ben+marg excep skin tag tal 0.6-1cm 11401
|
$126.23 |
$126.23 |
$126.23 |
$779.35
|
|
Exc ben+marg excep skin tag tal 2.1-3/>cm 11403
|
$179.92 |
$179.92 |
$179.92 |
$1,314.67
|
|
Exc face tum deep 2cm/> 21014
|
$637.73 |
$637.73 |
$637.73 |
$3,421.60
|
|
Exc feenl mal+mrg 0.6-1 11641
|
$189.34 |
$189.34 |
$189.34 |
$999.50
|
|
Excise anal ext tag/papilla
|
$146.01 |
$146.01 |
$146.01 |
$2,272.02
|
|
Excision benign lesion face/ears/eyelids/nose/lips/muc memb 0.6 - 1.0 cm
|
$158.73 |
$158.73 |
$158.73 |
$914.34
|
|
Excision benign lesion scalp/neck/hands/feet/genitalia 1.1 - 2.0 cm
|
$165.32 |
$165.32 |
$165.32 |
$2,064.75
|
|
Excision benign lesion trunk/arms/legs 1.1 - 2.0 cm
|
$139.42 |
$139.42 |
$139.42 |
$1,072.24
|
|
Excision benign lesion trunk/arms/legs > 4.0 cm
|
$301.44 |
$301.44 |
$301.44 |
$2,865.00
|
|
Excision breast lesion
|
$850.16 |
$850.16 |
$850.16 |
$4,064.45
|
|
Excision of anal lesion(s)
|
$167.20 |
$167.20 |
$167.20 |
$3,823.00
|
|
Excision of meckels diverticulum 44800
|
$950.95 |
$950.95 |
$950.95 |
$1,373.40
|
|
Excision tumor soft tissue back/flank subcutaneous >= 3 cm
|
$578.86 |
$578.86 |
$578.86 |
$4,420.32
|
|
Exc malig feenl 1.1-2 11642
|
$221.84 |
$221.84 |
$221.84 |
$1,082.00
|
|
Exc malig tal 0.6-1.0cm 11601
|
$180.39 |
$180.39 |
$180.39 |
$832.60
|
|
Exc mal+marg tal 1.1-2 cm 11602
|
$196.88 |
$196.88 |
$196.88 |
$889.20
|
|
Exc mal+marg tal 2.1-3 cm 11603
|
$235.50 |
$235.50 |
$235.50 |
$1,207.80
|
|
Exc neck tum deep < 5 cm
|
$647.15 |
$647.15 |
$647.15 |
$3,813.50
|
|
Exc neck tum deep 5 cm/>
|
$898.20 |
$898.20 |
$898.20 |
$3,386.84
|
|
Exc rect tum transanal full
|
$999.46 |
$999.46 |
$999.46 |
$4,119.00
|
|
Exc rect tum transanal part
|
$743.71 |
$743.71 |
$743.71 |
$3,786.00
|
|
Exc snhfg mal+mrg 1.1-2 11622
|
$206.30 |
$206.30 |
$206.30 |
$1,274.00
|
|
Exc sq tum/neck/ant thorax 3cm/> 21552
|
$547.77 |
$547.77 |
$547.77 |
$4,744.88
|
|
Exc sq tum/neck or ant thorax <3cm 21555
|
$373.97 |
$373.97 |
$373.97 |
$3,322.80
|
|
Exc sq tumor/forearm/wrist/<3cm 25075
|
$579.80 |
$579.80 |
$579.80 |
$2,924.22
|
|
Exc sq tumor/leg/ankle 3cm/> 27632
|
$761.14 |
$761.14 |
$761.14 |
$4,425.20
|
|
Exc thigh/knee les sc<3cm 27327
|
$574.62 |
$574.62 |
$574.62 |
$3,229.48
|
|
Exc thrombosed hemorrhoid 46320
|
$137.06 |
$137.06 |
$137.06 |
$2,175.36
|
|
Exc tmr sft tiss shldr subq <3cm
|
$601.94 |
$601.94 |
$601.94 |
$3,059.15
|
|
Expander tiss 133s-mv-12-t 300ml natrelle smth
|
$5,095.75 |
$5,095.75 |
$5,095.75 |
$4,101.67
|
|
Expl lap celiotomy w/wo bx 49000
|
$1,363.82 |
$1,363.82 |
$1,363.82 |
$2,357.35
|
|
Exploration/repair of rectum 45563
|
$2,052.62 |
$2,052.62 |
$2,052.62 |
$3,086.40
|
|
Explore penetrating wnd/extremity 20103
|
$425.78 |
$425.78 |
$425.78 |
$1,788.80
|
|
Explore scrotum
|
$475.71 |
$475.71 |
$475.71 |
$3,863.60
|
|
Explore wound abdomen 20102
|
$316.04 |
$316.04 |
$316.04 |
$2,784.80
|
|
Ex sq tumor/face or scalp 2 cm/> 21012
|
$413.07 |
$413.07 |
$413.07 |
$2,896.40
|
|
External chromosome analysis 20-25 cells
|
$293.02 |
$293.02 |
$293.02 |
$415.01
|
|
External newborn metabolic screening panel
|
$148.60 |
$148.60 |
$148.60 |
$109.76
|
|
External pretreatment of serum for use in antibody identification by dilution
|
$28.09 |
$28.09 |
$28.09 |
$63.70
|
|
External tissue culture neoplastic disorders bone marrow/blood cells
|
$291.67 |
$291.67 |
$291.67 |
$457.07
|
|
Extractable nuclear antigen/antibody any method each antibody centromere
|
$68.90 |
$68.90 |
$68.90 |
$109.00
|
|
Eye Socket (Orbit) X-ray
|
$270.48 |
$270.48 |
$270.48 |
$328.35
|
|
Eye Socket, Pituitary or Ear CT Scan (with and without contrast)
|
$1,362.09 |
$1,362.09 |
$1,362.09 |
$1,705.20
|
|
Eye Socket, Pituitary or Ear CT Scan (with contrast)
|
$1,135.28 |
$1,135.28 |
$1,135.28 |
$1,543.00
|
|
Eye Socket, Pituitary or Ear CT Scan (without contrast)
|
$907.85 |
$907.85 |
$907.85 |
$1,320.00
|
|
Face, Eye Socket and Neck MRI (with and without contrast)
|
$3,577.37 |
$3,577.37 |
$3,577.37 |
$2,821.87
|
|
Face, Eye Socket and Neck MRI (without contrast)
|
$2,384.70 |
$2,384.70 |
$2,384.70 |
$1,883.25
|
|
Facial Bones X-ray (1 to 2 views)
|
$171.30 |
$171.30 |
$171.30 |
$252.60
|
|
Facial Bones X-ray (complete)
|
$314.92 |
$314.92 |
$314.92 |
$381.75
|
|
Factor ix
|
$43.29 |
$43.29 |
$43.29 |
$162.50
|
|
Factor viii
|
$36.17 |
$36.17 |
$36.17 |
$148.00
|
|
Fat/lipids feces qualitative
|
$38.15 |
$38.15 |
$38.15 |
$36.00
|
|
Fatty acids nonesterified
|
$38.71 |
$38.71 |
$38.71 |
$72.15
|
|
#fecal-sodium
|
$32.54 |
$32.54 |
$32.54 |
$37.53
|
|
Felbamate (felbatol(r)) - sendout
|
$41.51 |
$41.51 |
$41.51 |
$66.43
|
|
Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper)
|
$0.10 |
$0.10 |
$0.10 |
$101.40
|
|
Fern test
|
$37.03 |
$37.03 |
$37.03 |
$37.03
|
|
Ferritin
|
$33.66 |
$33.66 |
$33.66 |
$102.48
|
|
Fetal biophys profile w/nst 76818
|
$455.52 |
$455.52 |
$455.52 |
$541.74
|
|
Fetal contract stress test 59020 - 26
|
$583.27 |
$583.27 |
$583.27 |
$477.50
|
|
Fetal fibronectin
|
$108.83 |
$108.83 |
$108.83 |
$389.95
|
|
Fetal hemoglobin (kleihauer betke)
|
$32.33 |
$32.33 |
$32.33 |
$102.00
|