|
ER Visit (level 2)
|
$296.48 |
$296.48 |
$391.68 |
$487.50
|
|
ER Visit (level 3)
|
$566.15 |
$566.15 |
$747.94 |
$850.50
|
|
ER Visit (level 4)
|
$4,380.28 |
$4,380.28 |
$5,786.79 |
$1,359.15
|
|
ER Visit (level 5, high severity)
|
$8,113.75 |
$8,113.75 |
$10,719.08 |
$2,007.00
|
|
Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr
|
$209.28 |
$209.28 |
$276.48 |
$247.00
|
|
Esmolol 2,500 mg/250 ml (10 mg/ml) IV wrapper osm only
|
$1,880,904.00 |
$1,880,904.00 |
$2,484,864.00 |
$504.11
|
|
Esophageal dilat s&i
|
$225.63 |
$225.63 |
$298.08 |
$525.00
|
|
Esophageal motility
|
$1,106.57 |
$1,106.57 |
$1,461.89 |
$573.20
|
|
Esophagus motility study
|
$1,531.67 |
$1,531.67 |
$2,023.49 |
$1,289.20
|
|
Esoph imped function test
|
$1,105.70 |
$1,105.70 |
$1,460.74 |
$597.03
|
|
Establish access to artery
|
$1,128.59 |
$1,128.59 |
$1,490.98 |
$1,145.65
|
|
Established Patient Office Visit (level 1)
|
$63.66 |
$63.66 |
$84.10 |
$121.00
|
|
Established Patient Office Visit (level 2)
|
$70.20 |
$70.20 |
$92.74 |
$138.60
|
|
Established Patient Office Visit (level 3)
|
$80.66 |
$80.66 |
$106.56 |
$187.00
|
|
Established Patient Office Visit (level 4)
|
$100.50 |
$100.50 |
$132.77 |
$233.60
|
|
Established Patient Office Visit (level 5)
|
$106.39 |
$106.39 |
$140.55 |
$287.10
|
|
Estradiol valerate 10 mg inj
|
$25.29 |
$25.29 |
$33.41 |
$63.50
|
|
Estrogens total-sendout
|
$4.86 |
$4.86 |
$6.42 |
$89.25
|
|
Etanercept injection
|
$1,561.32 |
$1,561.32 |
$2,062.66 |
$1,801.80
|
|
Ethanolamine oleate 100 mg
|
$320.68 |
$320.68 |
$423.65 |
$1,032.48
|
|
Ethylene glycol -sendout
|
$6.92 |
$6.92 |
$9.14 |
$75.00
|
|
Etoposide 20 mg/ml intravenous solution
|
$18.15 |
$18.15 |
$73.03 |
$213.17
|
|
Etoposide 50 mg cap
|
$61.92 |
$61.92 |
$61.92 |
$184.44
|
|
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen
|
$118.81 |
$118.81 |
$156.96 |
$219.60
|
|
Evaluation heart device
|
$1,068.42 |
$1,068.42 |
$1,411.49 |
$2,368.17
|
|
Evasc prlng admn rx agnt 1st
|
$4,208.28 |
$4,208.28 |
$5,559.56 |
$4,462.80
|
|
Evasc prlng admn rx agnt add
|
$4,208.28 |
$4,208.28 |
$5,559.56 |
$3,484.88
|
|
Evasc rpr a-ao ndgft 34701
|
$3,148.80 |
$3,148.80 |
$4,159.88 |
$6,020.00
|
|
Evasc rpr a-ao ndgft rpt 34702
|
$986.24 |
$986.24 |
$1,302.92 |
$4,537.60
|
|
Evasc rpr a-biiliac ndgft rptr
|
$3,148.80 |
$3,148.80 |
$4,159.88 |
$10,294.05
|
|
Evasc rpr a-iliac ndgft 34717
|
$2,354.84 |
$2,354.84 |
$3,110.98 |
$6,925.05
|
|
Evasc rpr a-unilac ndgft 34703
|
$3,148.80 |
$3,148.80 |
$4,159.88 |
$7,465.20
|
|
Evasc rpr a-unilac ndgft rpt
|
$2,100.22 |
$2,100.22 |
$2,774.60 |
$9,282.60
|
|
Evasc rpr ilio-iliac ndgft
|
$3,148.80 |
$3,148.80 |
$4,159.88 |
$8,412.85
|
|
Evasc rpr ilio-iliac rpt
|
$986.24 |
$986.24 |
$1,302.92 |
$9,122.40
|
|
Event monitor
|
$40.55 |
$40.55 |
$53.57 |
$242.12
|
|
Exchange biliary drg cath
|
$2,509.40 |
$2,509.40 |
$3,315.17 |
$4,176.15
|
|
Exchange drainage catheter
|
$1,816.82 |
$1,816.82 |
$2,400.20 |
$2,256.80
|
|
Exchange nephrostomy cath
|
$2,849.92 |
$2,849.92 |
$3,765.03 |
$3,097.16
|
|
Exercise w/hemodynamic meas
|
$2,142.73 |
$2,142.73 |
$2,830.76 |
$971.00
|
|
Expander breast 300cc mod hght extra proj smth natrelle
|
$2,274.83 |
$2,274.83 |
$3,005.28 |
$2,647.92
|
|
Expander tiss 133s-mv-12-t 300ml natrelle smth
|
$1,749.45 |
$1,749.45 |
$2,311.20 |
$3,611.79
|
|
Ext ecg>48hr<7d scan a/r
|
$121.87 |
$121.87 |
$161.00 |
$251.71
|
|
Ext ecg>7d<15d scan a/r
|
$121.87 |
$121.87 |
$161.00 |
$262.20
|
|
External chromosome analysis 20-25 cells
|
$39.24 |
$39.24 |
$51.84 |
$389.35
|
|
External newborn metabolic screening panel
|
$49.05 |
$49.05 |
$64.80 |
$109.13
|
|
External tissue culture neoplastic disorders bone marrow/blood cells
|
$81.48 |
$81.48 |
$107.64 |
$458.73
|
|
Extractable nuclear antigen/antibody any method each antibody centromere
|
$5.45 |
$5.45 |
$7.20 |
$102.78
|
|
F-18 fdg pet diag
|
$113.36 |
$113.36 |
$149.76 |
$602.25
|
|
F-18 fluciclovine per mci
|
$989.72 |
$989.72 |
$1,307.52 |
$1,307.52
|
|
Facial bones <3
|
$208.85 |
$208.85 |
$275.91 |
$248.60
|
|
Factor ix
|
$7.18 |
$7.18 |
$9.48 |
$131.30
|
|
Factor ix recombinant nos
|
$1.53 |
$1.53 |
$1.53 |
$3.55
|
|
Factor viii
|
$4.36 |
$4.36 |
$5.76 |
$144.30
|
|
Factor viii recombinant nos
|
$1.97 |
$1.97 |
$2.60 |
$6.55
|
|
Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr
|
$10.90 |
$10.90 |
$14.40 |
$24.00
|
|
Fat/lipids feces qualitative
|
$3.06 |
$3.06 |
$4.04 |
$34.56
|
|
Fda ide #g240020 carry bag
|
$611.49 |
$611.49 |
$807.84 |
$882.06
|
|
Fecal microbiota, live-jslm 150 ml rectal suspension enema
|
$9,417.60 |
$9,417.60 |
$9,417.60 |
$25,080.72
|
|
#fecal-sodium
|
$2.57 |
$2.57 |
$3.39 |
$37.50
|
|
Feeding tube reposition
|
$420.74 |
$420.74 |
$555.84 |
$441.86
|
|
Fem/popl revasc w/stent
|
$6,438.63 |
$6,438.63 |
$8,506.08 |
$18,599.10
|
|
Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper)
|
$116.20 |
$116.20 |
$153.51 |
$115.35
|
|
Fern test
|
$30.96 |
$30.96 |
$40.90 |
$17.72
|
|
Ferric carboxymaltose 50 mg iron/ml intravenous solution
|
$1,082.16 |
$1,082.16 |
$1,082.16 |
$2,131.58
|
|
Ferritin
|
$162.63 |
$162.63 |
$214.85 |
$103.68
|
|
Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution
|
$1,212.74 |
$1,212.74 |
$1,212.74 |
$1,636.50
|
|
Ferumoxytol, esrd use
|
$1,212.74 |
$1,212.74 |
$1,212.74 |
$56.05
|
|
Fetal biophys profile w/nst 76818
|
$469.79 |
$469.79 |
$620.64 |
$541.74
|
|
Fetal contract stress test 59020 - 26
|
$396.76 |
$396.76 |
$524.16 |
$540.54
|
|
Fetal fibronectin
|
$235.66 |
$235.66 |
$311.33 |
$352.95
|
|
Fetal hemoglobin (kleihauer betke)
|
$65.40 |
$65.40 |
$86.40 |
$88.80
|
|
Fetal hemoglobin rosette
|
$25.29 |
$25.29 |
$33.41 |
$76.70
|
|
Fetal non stress test
|
$202.96 |
$202.96 |
$268.13 |
$507.90
|
|
Fibrin degradation d dimer quantitative
|
$66.93 |
$66.93 |
$88.42 |
$112.80
|
|
Fibrin degradation products
|
$75.00 |
$75.00 |
$99.08 |
$62.40
|
|
Fibrinogen activity
|
$64.31 |
$64.31 |
$84.96 |
$82.38
|
|
Fibrinolytic antiplasmin
|
$1.83 |
$1.83 |
$2.42 |
$56.00
|
|
Fibrinolytic plasminogen
|
$4.09 |
$4.09 |
$5.40 |
$109.45
|
|
Fibrinolytic plasminogen xcpt antgnc asa
|
$1.34 |
$1.34 |
$1.77 |
$59.89
|
|
Filgrastim-aafi 300 mcg/0.5 ml subcutaneous syringe
|
$366.68 |
$366.68 |
$366.68 |
$492.48
|
|
Filter spider fx 3mmx320cm
|
$5,000.92 |
$5,000.92 |
$6,606.72 |
$6,878.20
|
|
Filter vena cava fem denali
|
$2,958.26 |
$2,958.26 |
$3,908.16 |
$3,519.51
|
|
Fine needle aspiration biopsy w/fluor gdn;1st lesion 10007
|
$441.24 |
$441.24 |
$582.92 |
$1,081.52
|
|
Fine needle aspiration biopsy w/fluor gdn; ea addtl 10008
|
$317.63 |
$317.63 |
$419.62 |
$624.65
|
|
Fine needle aspiration biopsy without img gdn; ea addtl 10004
|
$172.01 |
$172.01 |
$227.24 |
$261.80
|
|
Fine needle aspiration biopsy w/us gdn; ea addtl 10006
|
$330.93 |
$330.93 |
$437.19 |
$806.40
|
|
Fine needle asp without image guide 10021
|
$282.31 |
$282.31 |
$372.96 |
$547.53
|
|
Fix g/colon tube w/device
|
$417.91 |
$417.91 |
$552.10 |
$1,236.90
|
|
Flebogamma injection
|
$984.39 |
$984.39 |
$1,490.03 |
$2,827.01
|
|
Flecainide (tambocor)-sendout
|
$5.50 |
$5.50 |
$7.27 |
$66.43
|
|
Fl exam g/colon tube w contrast
|
$124.48 |
$124.48 |
$164.45 |
$546.86
|
|
Flow cytometry marker each additional
|
$25.01 |
$25.01 |
$33.03 |
$103.00
|
|
Flow cytometry one marker technical component
|
$26.16 |
$26.16 |
$34.56 |
$270.75
|
|
Floxuridine injection
|
$130.80 |
$130.80 |
$130.80 |
$774.69
|
|
Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback
|
$111.18 |
$111.18 |
$146.88 |
$78.62
|
|
Fludarabine 50 mg intravenous solution
|
$320.25 |
$320.25 |
$423.08 |
$522.96
|
|
Fluorescent antibody titer dna
|
$31.29 |
$31.29 |
$41.33 |
$123.65
|
|
Fluoroguide for spine inject 77003-26
|
$504.46 |
$504.46 |
$666.44 |
$507.00
|
|
Fluoroguide needle placement
|
$650.73 |
$650.73 |
$859.68 |
$536.26
|
