|
Established Patient Office Visit (level 4)
|
$1,737.00 |
$1,737.00 |
$1,737.00 |
$231.00
|
|
Established Patient Office Visit (level 5)
|
$2,057.00 |
$2,057.00 |
$2,057.00 |
$283.28
|
|
Estradiol total
|
$2,316.00 |
$2,316.00 |
$2,316.00 |
$149.43
|
|
Estrogens total-sendout
|
$697.00 |
$697.00 |
$697.00 |
$89.25
|
|
Ethanolamine oleate 100 mg
|
$4,943.00 |
$4,943.00 |
$4,943.00 |
$933.59
|
|
Ethylene glycol -sendout
|
$308.00 |
$308.00 |
$308.00 |
$78.00
|
|
Etoposide 50 mg cap
|
$835.00 |
$835.00 |
$835.00 |
$203.41
|
|
Euglobulin lysis
|
$306.00 |
$306.00 |
$306.00 |
$37.70
|
|
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen
|
$1,017.00 |
$1,017.00 |
$1,017.00 |
$219.60
|
|
Evaluation heart device
|
$9,350.00 |
$9,350.00 |
$9,350.00 |
$2,523.52
|
|
Evaluation of speech fluency 92521
|
$3,642.00 |
$3,642.00 |
$3,642.00 |
$348.00
|
|
F-18 fdg pet diag
|
$754.00 |
$754.00 |
$754.00 |
$609.85
|
|
Facial bones <3
|
$737.00 |
$737.00 |
$737.00 |
$241.75
|
|
Factor ix
|
$2,276.00 |
$2,276.00 |
$2,276.00 |
$139.75
|
|
Factor ix non-recombinant
|
$10.00 |
$10.00 |
$10.00 |
$1.41
|
|
Factor viii
|
$2,794.00 |
$2,794.00 |
$2,794.00 |
$152.10
|
|
Factor viii
|
$23.00 |
$23.00 |
$23.00 |
$1.60
|
|
Factor viii nuwiq recomb 1iu
|
$41.00 |
$41.00 |
$41.00 |
$1.24
|
|
Factor viii recomb novoeight
|
$8,069.60 |
$8,069.60 |
$8,069.60 |
$1.38
|
|
Family therapy without pt 50min 90846
|
$610.00 |
$610.00 |
$610.00 |
$241.60
|
|
Fat/lipids feces qualitative
|
$792.00 |
$792.00 |
$792.00 |
$37.44
|
|
Fatty acids nonesterified
|
$306.00 |
$306.00 |
$306.00 |
$56.40
|
|
Felbamate (felbatol(r)) - sendout
|
$528.00 |
$528.00 |
$528.00 |
$66.43
|
|
Ferritin
|
$732.00 |
$732.00 |
$732.00 |
$103.95
|
|
Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution
|
$2,442.61 |
$2,442.61 |
$2,442.61 |
$2,232.93
|
|
Ferumoxytol, esrd use
|
$2,442.61 |
$2,442.61 |
$2,442.61 |
$0.34
|
|
Fetal fibronectin
|
$6,277.00 |
$6,277.00 |
$6,277.00 |
$343.88
|
|
Fetal hemoglobin (kleihauer betke)
|
$126.00 |
$126.00 |
$126.00 |
$85.00
|
|
Fetal hemoglobin rosette
|
$176.00 |
$176.00 |
$176.00 |
$76.70
|
|
Fetal non stress test
|
$798.00 |
$798.00 |
$798.00 |
$500.57
|
|
Fibrin degradation products
|
$1,386.00 |
$1,386.00 |
$1,386.00 |
$62.40
|
|
Fibrinogen activity
|
$1,330.00 |
$1,330.00 |
$1,330.00 |
$81.89
|
|
Fibrinolytic antiplasmin
|
$321.00 |
$321.00 |
$321.00 |
$58.25
|
|
Fibrinolytic plasminogen
|
$797.00 |
$797.00 |
$797.00 |
$112.02
|
|
Fibrinolytic plasminogen xcpt antgnc asa
|
$1,048.00 |
$1,048.00 |
$1,048.00 |
$59.89
|
|
Flecainide (tambocor)-sendout
|
$151.00 |
$151.00 |
$151.00 |
$66.43
|
|
Floxuridine injection
|
$4,676.00 |
$4,676.00 |
$4,676.00 |
$774.69
|
|
Fludarabine 50 mg intravenous solution
|
$5,517.00 |
$5,517.00 |
$5,517.00 |
$592.00
|
|
Fluidotherapy charges pt
|
$718.00 |
$718.00 |
$718.00 |
$101.40
|
|
Fluoroguide for spine inject 77003-26
|
$528.00 |
$528.00 |
$528.00 |
$507.00
|
|
Fluoroguide needle placement
|
$753.00 |
$753.00 |
$753.00 |
$539.38
|
|
Fluoro polarize fetal lung
|
$1,142.00 |
$1,142.00 |
$1,142.00 |
$62.81
|
|
Fluorouracil 50 mg/ml intravenous solution (wrapper)
|
$105.00 |
$105.00 |
$105.00 |
$97.74
|
|
Folic acid
|
$589.00 |
$589.00 |
$589.00 |
$87.50
|
|
Folic acid 5 mg/ml injection solution
|
$194.04 |
$194.04 |
$194.04 |
$49.34
|
|
Fomepizole 1 gram/ml intravenous solution
|
$3,946.95 |
$3,946.95 |
$3,946.95 |
$3,052.35
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$3,413.00 |
$3,413.00 |
$3,413.00 |
$470.29
|
|
Foscarnet sodium injection
|
$4,736.00 |
$4,736.00 |
$4,736.00 |
$714.25
|
|
Fresh frozen plasma thawing ea un
|
$175.00 |
$175.00 |
$175.00 |
$131.25
|
|
Galactokinase - sendout
|
$3,601.00 |
$3,601.00 |
$3,601.00 |
$175.00
|
|
Gammaglobulin ige
|
$1,885.00 |
$1,885.00 |
$1,885.00 |
$85.00
|
|
Gamma glutamyltransferase
|
$1,188.00 |
$1,188.00 |
$1,188.00 |
$55.28
|
|
Gastrin test
|
$1,587.00 |
$1,587.00 |
$1,587.00 |
$44.80
|
|
Gastroesophageal reflux study
|
$3,004.00 |
$3,004.00 |
$3,004.00 |
$917.28
|
|
Gated heart multiple
|
$3,813.00 |
$3,813.00 |
$3,813.00 |
$1,368.90
|
|
Gemcitabine 1 gram intravenous solution
|
$7,484.00 |
$7,484.00 |
$7,484.00 |
$248.38
|
|
Gentamicin peak therapeutic drug level
|
$626.00 |
$626.00 |
$626.00 |
$117.00
|
|
Ghs acetylcholinesterase, rbc
|
$178.00 |
$178.00 |
$178.00 |
$39.60
|
|
Ghs antibodies (torch) igm
|
$178.00 |
$178.00 |
$178.00 |
$77.60
|
|
Ghs bleeding time (ivy)
|
$926.00 |
$926.00 |
$926.00 |
$55.90
|
|
Ghs community re-entry 15 minutes
|
$714.00 |
$714.00 |
$714.00 |
$87.60
|
|
Ghs fish cytogen
|
$1,128.00 |
$1,128.00 |
$1,128.00 |
$176.93
|
|
Ghs fish hybrid in situ 100-300
|
$1,030.00 |
$1,030.00 |
$1,030.00 |
$229.45
|
|
Ghs hcv amplificaiton
|
$1,377.00 |
$1,377.00 |
$1,377.00 |
$195.60
|
|
Ghs hepatitis c virus (hcv riba)
|
$1,355.00 |
$1,355.00 |
$1,355.00 |
$106.05
|
|
Ghs hgb stability-thal
|
$694.00 |
$694.00 |
$694.00 |
$85.28
|
|
Ghs histoplasma antigen
|
$1,386.00 |
$1,386.00 |
$1,386.00 |
$144.50
|
|
Ghs HIV antibody
|
$142.00 |
$142.00 |
$142.00 |
$94.25
|
|
Ghs hla-dr/dq, multiple antigens
|
$1,076.00 |
$1,076.00 |
$1,076.00 |
$462.60
|
|
Ghs immun0electrophoresis
|
$402.00 |
$402.00 |
$402.00 |
$102.70
|
|
Ghs inhibitor screen
|
$632.00 |
$632.00 |
$632.00 |
$158.76
|
|
Ghs leukocyte alkaline phos (mayo)
|
$518.00 |
$518.00 |
$518.00 |
$59.40
|
|
Ghs mbp
|
$278.00 |
$278.00 |
$278.00 |
$77.35
|
|
Ghs ot dds rom
|
$1,261.00 |
$1,261.00 |
$1,261.00 |
$53.01
|
|
Ghs pacing - transcutaneous
|
$1,977.00 |
$1,977.00 |
$1,977.00 |
$854.70
|
|
Ghs prostatic acid phosphatase (mayo)
|
$949.00 |
$949.00 |
$949.00 |
$39.90
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$389.00 |
$389.00 |
$389.00 |
$45.05
|
|
Ghs quinidine
|
$614.00 |
$614.00 |
$614.00 |
$68.40
|
|
Ghs respiratory syncytical virus igg/m
|
$624.00 |
$624.00 |
$624.00 |
$42.40
|
|
Ghs sedimentation rate
|
$926.00 |
$926.00 |
$926.00 |
$45.50
|
|
Ghs sensitivity (per antimicro)
|
$91.00 |
$91.00 |
$91.00 |
$59.90
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$518.00 |
$518.00 |
$518.00 |
$93.60
|
|
Ghs urine, hydroxproline total
|
$378.00 |
$378.00 |
$378.00 |
$61.60
|
|
Giardia lamblia antibody
|
$475.00 |
$475.00 |
$475.00 |
$81.60
|
|
Gi inhouse confirmation
|
$1,835.00 |
$1,835.00 |
$1,835.00 |
$83.85
|
|
Glucagon 1 mg solution for injection
|
$2,163.00 |
$2,163.00 |
$2,163.00 |
$592.05
|
|
Glucagon plasma - sendout
|
$214.00 |
$214.00 |
$214.00 |
$57.00
|
|
Glucose-6-phosphate dhydrogenase screen
|
$39.00 |
$39.00 |
$39.00 |
$39.00
|
|
Glucose blood quantitative
|
$762.00 |
$762.00 |
$762.00 |
$44.76
|
|
Glucose body fluid
|
$1,308.00 |
$1,308.00 |
$1,308.00 |
$50.70
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$1,528.00 |
$1,528.00 |
$1,528.00 |
$107.55
|
|
Gonadotropin luteinizing hormone (lh)
|
$1,552.00 |
$1,552.00 |
$1,552.00 |
$124.00
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$9,240.00 |
$9,240.00 |
$9,240.00 |
$637.84
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$18,124.00 |
$18,124.00 |
$18,124.00 |
$925.29
|
|
Granisetron 1 mg tab
|
$1,477.00 |
$1,477.00 |
$1,477.00 |
$10.04
|
|
Granisetron hcl injection
|
$3,723.00 |
$3,723.00 |
$3,723.00 |
$40.33
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$700.00 |
$700.00 |
$700.00 |
$120.02
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$177.00 |
$177.00 |
$177.00 |
$27.20
|
|
Haptoglobin quantitative
|
$668.00 |
$668.00 |
$668.00 |
$80.24
|
|
Hcg qualitative
|
$1,200.00 |
$1,200.00 |
$1,200.00 |
$77.50
|
