|
ER Visit (level 5, high severity)
|
$1,707.12 |
$1,707.12 |
$1,707.12 |
$1,820.02
|
|
Esmolol 2,500 mg/250 ml (10 mg/ml) IV wrapper osm only
|
$5.44 |
$5.44 |
$5.44 |
$553.88
|
|
Established Patient Office Visit (level 1)
|
$478.08 |
$478.08 |
$478.08 |
$120.25
|
|
Established Patient Office Visit (level 2)
|
$244.08 |
$244.08 |
$244.08 |
$132.72
|
|
Established Patient Office Visit (level 3)
|
$285.84 |
$285.84 |
$285.84 |
$183.00
|
|
Established Patient Office Visit (level 4)
|
$446.40 |
$446.40 |
$446.40 |
$231.75
|
|
Established Patient Office Visit (level 5)
|
$519.12 |
$519.12 |
$519.12 |
$280.33
|
|
Estradiol total
|
$117.36 |
$117.36 |
$117.36 |
$146.50
|
|
Estrogens total-sendout
|
$38.16 |
$38.16 |
$38.16 |
$96.20
|
|
Ethylene glycol -sendout
|
$190.80 |
$190.80 |
$190.80 |
$89.40
|
|
Etoposide 20 mg/ml intravenous solution
|
$9.84 |
$9.84 |
$9.84 |
$235.20
|
|
Euflexxa inj per dose
|
$1,246.36 |
$1,246.36 |
$1,246.36 |
$587.51
|
|
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen
|
$191.52 |
$191.52 |
$191.52 |
$219.60
|
|
Event monitor
|
$743.04 |
$743.04 |
$743.04 |
$242.65
|
|
Evok oa screening qual
|
$128.16 |
$128.16 |
$128.16 |
$109.13
|
|
Exc benign tal 0.5 < cm 11400
|
$1,519.92 |
$1,519.92 |
$1,519.92 |
$827.40
|
|
Exc ben+marg excep skin tag tal 2.1-3/>cm 11403
|
$1,734.48 |
$1,734.48 |
$1,734.48 |
$1,247.50
|
|
Excision benign lesion trunk/arms/legs 1.1 - 2.0 cm
|
$1,591.20 |
$1,591.20 |
$1,591.20 |
$1,012.86
|
|
Exc mal+marg tal 3.1-4 cm 11604
|
$1,519.92 |
$1,519.92 |
$1,519.92 |
$1,294.80
|
|
Exc tr-ext mal+marg tal >4 cm 11606
|
$3,499.92 |
$3,499.92 |
$3,499.92 |
$1,917.33
|
|
External chromosome analysis 20-25 cells
|
$750.24 |
$750.24 |
$750.24 |
$384.15
|
|
External tissue culture neoplastic disorders bone marrow/blood cells
|
$665.28 |
$665.28 |
$665.28 |
$454.20
|
|
Extractable nuclear antigen/antibody any method each antibody centromere
|
$118.08 |
$118.08 |
$118.08 |
$108.60
|
|
Factor ix
|
$150.48 |
$150.48 |
$150.48 |
$156.13
|
|
Factor viii
|
$172.08 |
$172.08 |
$172.08 |
$133.81
|
|
Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr
|
$0.17 |
$0.17 |
$0.17 |
$22.20
|
|
Fat/lipids feces qualitative
|
$20.88 |
$20.88 |
$20.88 |
$38.35
|
|
Fatty acids nonesterified
|
$129.60 |
$129.60 |
$129.60 |
$64.28
|
|
#fecal-sodium
|
$38.16 |
$38.16 |
$38.16 |
$37.50
|
|
Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper)
|
$12.96 |
$12.96 |
$12.96 |
$101.40
|
|
Ferritin
|
$167.76 |
$167.76 |
$167.76 |
$100.94
|
|
Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution
|
$16.18 |
$16.18 |
$16.18 |
$1,776.61
|
|
Fetal biophys profile w/nst 76818
|
$945.36 |
$945.36 |
$945.36 |
$535.37
|
|
Fetal chrom aneuploidy gsa panel
|
$1,852.56 |
$1,852.56 |
$1,852.56 |
$1,206.81
|
|
Fetal fibronectin
|
$320.40 |
$320.40 |
$320.40 |
$373.41
|
|
Fetal hemoglobin (kleihauer betke)
|
$162.72 |
$162.72 |
$162.72 |
$105.12
|
|
Fetal non stress test
|
$1,066.32 |
$1,066.32 |
$1,066.32 |
$463.03
|
|
Fibrin degradation d dimer quantitative
|
$120.96 |
$120.96 |
$120.96 |
$117.70
|
|
Fibrin degradation products
|
$133.92 |
$133.92 |
$133.92 |
$62.64
|
|
Fibrinogen activity
|
$158.40 |
$158.40 |
$158.40 |
$83.50
|
|
Fibrinolytic plasminogen xcpt antgnc asa
|
$169.20 |
$169.20 |
$169.20 |
$65.00
|
|
Filgrastim-sndz 300 mcg/0.5 ml injection syringe
|
$1,517.15 |
$1,517.15 |
$1,517.15 |
$869.18
|
|
Fine needle asp without image guide 10021
|
$863.28 |
$863.28 |
$863.28 |
$503.76
|
|
Fl exam g/colon tube w contrast
|
$522.00 |
$522.00 |
$522.00 |
$511.92
|
|
Flow cytometry interp 16 or more
|
$270.00 |
$270.00 |
$270.00 |
$204.00
|
|
Flow cytometry marker each additional
|
$103.68 |
$103.68 |
$103.68 |
$97.50
|
|
Flow cytometry one marker technical component
|
$393.84 |
$393.84 |
$393.84 |
$284.40
|
|
#flow interp 9 - 15 markers
|
$112.32 |
$112.32 |
$112.32 |
$172.50
|
|
Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback
|
$65.52 |
$65.52 |
$65.52 |
$64.22
|
|
Fluorescent antibody titer dna
|
$229.68 |
$229.68 |
$229.68 |
$122.82
|
|
Fluoroguide for spine inject 77003-26
|
$403.20 |
$403.20 |
$403.20 |
$496.03
|
|
Fluoroguide needle placement
|
$458.64 |
$458.64 |
$458.64 |
$510.00
|
|
Fluoroscopy up to 1 hour
|
$962.64 |
$962.64 |
$962.64 |
$492.00
|
|
Fluorouracil 50 mg/ml intravenous solution (wrapper)
|
$77.33 |
$77.33 |
$77.33 |
$94.86
|
|
Folic acid
|
$73.44 |
$73.44 |
$73.44 |
$101.50
|
|
Folic acid 5 mg/ml injection solution
|
$1.30 |
$1.30 |
$1.30 |
$54.75
|
|
Foot X-ray
|
$446.40 |
$446.40 |
$446.40 |
$362.40
|
|
Forensic cytopathology
|
$104.40 |
$104.40 |
$104.40 |
$63.23
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$6.93 |
$6.93 |
$6.93 |
$457.50
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$7.78 |
$7.78 |
$7.78 |
$106.10
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$153.36 |
$153.36 |
$153.36 |
$151.58
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$182.16 |
$182.16 |
$182.16 |
$156.60
|
|
Fresh frozen plasma thawing ea un
|
$370.08 |
$370.08 |
$370.08 |
$122.00
|
|
Fructosamine glycated protein
|
$22.32 |
$22.32 |
$22.32 |
$60.75
|
|
Furosemide 10 mg/ml injection solution
|
$0.65 |
$0.65 |
$0.65 |
$19.00
|
|
Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution
|
$1.35 |
$1.35 |
$1.35 |
$177.52
|
|
Gammaglobulin iga
|
$50.40 |
$50.40 |
$50.40 |
$67.20
|
|
Gammaglobulin ige
|
$140.40 |
$140.40 |
$140.40 |
$83.85
|
|
Gamma glutamyltransferase
|
$120.96 |
$120.96 |
$120.96 |
$57.54
|
|
Gauze >16<=48 no w/sal without b
|
$108.72 |
$108.72 |
$108.72 |
$5.00
|
|
Gemcitabine 1 gram intravenous solution
|
$104.26 |
$104.26 |
$104.26 |
$207.51
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$65.52 |
$65.52 |
$65.52 |
$57.84
|
|
Gentamicin peak therapeutic drug level
|
$167.76 |
$167.76 |
$167.76 |
$126.00
|
|
G-esoph reflx tst w/electrod
|
$2,905.92 |
$2,905.92 |
$2,905.92 |
$1,418.18
|
|
Ghs abscess perianal iandd
|
$1,969.20 |
$1,969.20 |
$1,969.20 |
$1,410.90
|
|
Ghs abscess postoperative iandd complex
|
$6,181.92 |
$6,181.92 |
$6,181.92 |
$3,515.40
|
|
Ghs alcohol, methyl (methanol)-medtox
|
$117.36 |
$117.36 |
$117.36 |
$100.30
|
|
Ghs antibodies (torch) igm
|
$110.88 |
$110.88 |
$110.88 |
$69.30
|
|
Ghs bladder cath - complex-foley
|
$425.52 |
$425.52 |
$425.52 |
$344.00
|
|
Ghs change cysto/gastrost
|
$661.68 |
$661.68 |
$661.68 |
$565.49
|
|
Ghs chemo >8 hrs
|
$2,733.84 |
$2,733.84 |
$2,733.84 |
$714.87
|
|
Ghs chemo infusion >8 hrs
|
$1,025.28 |
$1,025.28 |
$1,025.28 |
$570.57
|
|
Ghs chemo IV push, ea addtl
|
$330.48 |
$330.48 |
$330.48 |
$286.00
|
|
Ghs chlamydia pneumoniae by pcr (arup) (306630)
|
$207.36 |
$207.36 |
$207.36 |
$132.00
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$518.40 |
$518.40 |
$518.40 |
$512.40
|
|
Ghs closed reduction ankle dislocation
|
$539.28 |
$539.28 |
$539.28 |
$653.80
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$3,456.72 |
$3,456.72 |
$3,456.72 |
$1,592.00
|
|
Ghs closed tx radiocarpal disloc w manip
|
$518.40 |
$518.40 |
$518.40 |
$520.80
|
|
Ghs closed tx tibial fracture w/manip
|
$3,456.72 |
$3,456.72 |
$3,456.72 |
$2,148.00
|
|
Ghs clsd red med malleolus fx w manip
|
$3,456.72 |
$3,456.72 |
$3,456.72 |
$2,184.00
|
|
Ghs cl tx knee disl; wo anesth
|
$518.40 |
$518.40 |
$518.40 |
$592.80
|
|
Ghs cl tx metacarpophal disloc without anes
|
$518.40 |
$518.40 |
$518.40 |
$495.55
|
|
Ghs conjunctiva foreign body-embed bil
|
$861.84 |
$861.84 |
$861.84 |
$419.22
|
|
Ghs conjunctiva foreign body-superf bil
|
$278.64 |
$278.64 |
$278.64 |
$283.80
|
|
Ghs corneal fb without slit lamp bilat
|
$861.84 |
$861.84 |
$861.84 |
$419.65
|
|
Ghs corneal fb with slit lamp bilat
|
$281.52 |
$281.52 |
$281.52 |
$339.60
|
|
Ghs diphtheria toxoid ab igg
|
$53.28 |
$53.28 |
$53.28 |
$62.05
|
|
Ghs dislocation elbow closed treatment
|
$518.40 |
$518.40 |
$518.40 |
$578.00
|
|
Ghs excision ingrown nail
|
$863.28 |
$863.28 |
$863.28 |
$439.50
|
|
Ghs eyelid foreign body-embedded - bil
|
$561.60 |
$561.60 |
$561.60 |
$501.04
|
