|
Established Patient Office Visit (level 3)
|
$243.00 |
$243.00 |
$243.00 |
$183.60
|
|
Established Patient Office Visit (level 4)
|
$291.60 |
$291.60 |
$291.60 |
$213.21
|
|
Established Patient Office Visit (level 5)
|
$451.80 |
$451.80 |
$451.80 |
$270.09
|
|
Estradiol total
|
$253.20 |
$253.20 |
$253.20 |
$142.20
|
|
Estrogens total-sendout
|
$214.20 |
$214.20 |
$214.20 |
$111.00
|
|
Ethylene glycol -sendout
|
$232.20 |
$232.20 |
$232.20 |
$81.25
|
|
Evaluation psychiatric diagnostic
|
$222.60 |
$222.60 |
$222.60 |
$325.65
|
|
Exercise tst brncspsm w/ecg
|
$312.00 |
$312.00 |
$312.00 |
$297.73
|
|
External chromosome analysis 20-25 cells
|
$390.60 |
$390.60 |
$390.60 |
$457.50
|
|
External tissue culture neoplastic disorders bone marrow/blood cells
|
$199.20 |
$199.20 |
$199.20 |
$569.60
|
|
Extractable nuclear antigen/antibody any method each antibody centromere
|
$140.40 |
$140.40 |
$140.40 |
$102.50
|
|
Facial bones <3
|
$120.00 |
$120.00 |
$120.00 |
$216.45
|
|
Factor ix
|
$325.80 |
$325.80 |
$325.80 |
$139.75
|
|
Factor viii
|
$253.80 |
$253.80 |
$253.80 |
$152.50
|
|
Family therapy without pt 50min 90846
|
$204.60 |
$204.60 |
$204.60 |
$230.40
|
|
Family therapy with patient 50 min 90847
|
$204.60 |
$204.60 |
$204.60 |
$224.80
|
|
Fat/lipids feces qualitative
|
$71.40 |
$71.40 |
$71.40 |
$43.66
|
|
Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper)
|
$43.23 |
$43.23 |
$43.23 |
$48.88
|
|
Ferritin
|
$217.20 |
$217.20 |
$217.20 |
$86.45
|
|
Fetal hemoglobin (kleihauer betke)
|
$102.00 |
$102.00 |
$102.00 |
$59.85
|
|
Fibrin degradation d dimer quantitative
|
$254.40 |
$254.40 |
$254.40 |
$87.60
|
|
Fibrin degradation products
|
$190.80 |
$190.80 |
$190.80 |
$56.16
|
|
Fibrin degrade semiquant
|
$198.00 |
$198.00 |
$198.00 |
$88.00
|
|
Fibrinogen activity
|
$83.40 |
$83.40 |
$83.40 |
$61.80
|
|
Filgrastim in d5w IV syringe 20 mcg/ml (neo) - cnr
|
$1,223.60 |
$1,223.60 |
$1,223.60 |
$1,223.60
|
|
Fine needle aspiration biopsy w/us gdn; ea addtl 10006
|
$1,482.00 |
$1,482.00 |
$1,482.00 |
$738.00
|
|
Flow cytometry marker each additional
|
$135.60 |
$135.60 |
$135.60 |
$103.00
|
|
Flow cytometry one marker technical component
|
$152.40 |
$152.40 |
$152.40 |
$304.43
|
|
Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback
|
$63.52 |
$63.52 |
$63.52 |
$48.56
|
|
Fluorescent antibody titer dna
|
$39.00 |
$39.00 |
$39.00 |
$123.65
|
|
Fluoroguide for spine inject 77003-26
|
$559.80 |
$559.80 |
$559.80 |
$497.25
|
|
Fluoroscopy up to 1 hour
|
$464.40 |
$464.40 |
$464.40 |
$474.50
|
|
Folic acid
|
$188.40 |
$188.40 |
$188.40 |
$85.50
|
|
Fondaparinux sodium
|
$126.88 |
$126.88 |
$126.88 |
$121.83
|
|
Foot X-ray
|
$602.40 |
$602.40 |
$602.40 |
$339.50
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$168.29 |
$168.29 |
$168.29 |
$66.38
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$342.60 |
$342.60 |
$342.60 |
$186.55
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$206.40 |
$206.40 |
$206.40 |
$217.30
|
|
Fresh frozen plasma thawing ea un
|
$56.40 |
$56.40 |
$56.40 |
$114.35
|
|
Fructosamine glycated protein
|
$112.80 |
$112.80 |
$112.80 |
$69.55
|
|
Ftl cgen abnor four anal
|
$754.80 |
$754.80 |
$754.80 |
$267.15
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$4.59 |
$4.59 |
$4.59 |
$2.04
|
|
Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution
|
$2.70 |
$2.70 |
$2.70 |
$13.18
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$25.56 |
$25.56 |
$25.56 |
$90.60
|
|
Galactose transferase test
|
$35.40 |
$35.40 |
$35.40 |
$25.00
|
|
Gammaglobulin iga
|
$127.80 |
$127.80 |
$127.80 |
$78.60
|
|
Gammaglobulin ige
|
$288.60 |
$288.60 |
$288.60 |
$87.10
|
|
Gamma glutamyltransferase
|
$96.00 |
$96.00 |
$96.00 |
$54.60
|
|
Gastric analy w/ph ea spec
|
$31.80 |
$31.80 |
$31.80 |
$25.61
|
|
Gastric emptying imag study
|
$1,509.60 |
$1,509.60 |
$1,509.60 |
$1,270.00
|
|
Gastric emptying imag study
|
$1,509.60 |
$1,509.60 |
$1,509.60 |
$1,665.50
|
|
General health panel
|
$427.80 |
$427.80 |
$427.80 |
$270.40
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$38.83 |
$38.83 |
$38.83 |
$30.76
|
|
Gentamicin peak therapeutic drug level
|
$233.40 |
$233.40 |
$233.40 |
$114.00
|
|
Ghs acetylcholinesterase, rbc
|
$27.00 |
$27.00 |
$27.00 |
$44.20
|
|
Ghs alcohol, methyl (methanol)-medtox
|
$153.60 |
$153.60 |
$153.60 |
$103.14
|
|
Ghs antibodies (torch) igm
|
$138.60 |
$138.60 |
$138.60 |
$82.50
|
|
Ghs central line insert < age 5, failed
|
$2,968.80 |
$2,968.80 |
$2,968.80 |
$2,489.25
|
|
Ghs chemo >8 hrs
|
$259.20 |
$259.20 |
$259.20 |
$714.87
|
|
Ghs chemo IV push, ea addtl
|
$223.20 |
$223.20 |
$223.20 |
$292.80
|
|
Ghs diphtheria toxoid ab igg
|
$186.00 |
$186.00 |
$186.00 |
$91.80
|
|
Ghs fish cytogen
|
$264.60 |
$264.60 |
$264.60 |
$173.40
|
|
Ghs fish hybrid in situ 100-300
|
$402.00 |
$402.00 |
$402.00 |
$229.45
|
|
Ghs gastric intub aspiration lavage
|
$435.60 |
$435.60 |
$435.60 |
$385.60
|
|
Ghs histoplasma antigen
|
$313.20 |
$313.20 |
$313.20 |
$157.30
|
|
Ghs HIV antibody
|
$148.80 |
$148.80 |
$148.80 |
$90.14
|
|
Ghs IV thrombolytics - cerebral
|
$718.20 |
$718.20 |
$718.20 |
$752.80
|
|
Ghs leukocyte alkaline phos (mayo)
|
$176.40 |
$176.40 |
$176.40 |
$62.28
|
|
Ghs mbp
|
$190.20 |
$190.20 |
$190.20 |
$97.20
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$309.60 |
$309.60 |
$309.60 |
$240.00
|
|
Ghs moderate sedation ea addtl 15 min
|
$254.40 |
$254.40 |
$254.40 |
$125.34
|
|
Ghs ng placement w fluoro guidance
|
$467.40 |
$467.40 |
$467.40 |
$423.76
|
|
Ghs o2 saturation
|
$27.00 |
$27.00 |
$27.00 |
$55.90
|
|
Ghs ot prosthetic training/15 min
|
$93.00 |
$93.00 |
$93.00 |
$92.35
|
|
Ghs pacing - transcutaneous
|
$1,303.80 |
$1,303.80 |
$1,303.80 |
$872.95
|
|
Ghs plt ct-manual
|
$97.20 |
$97.20 |
$97.20 |
$40.80
|
|
Ghs ppd (tb intradermal)
|
$52.80 |
$52.80 |
$52.80 |
$39.77
|
|
Ghs prostatic acid phosphatase (mayo)
|
$124.80 |
$124.80 |
$124.80 |
$49.77
|
|
Ghs protoporphyrins fract
|
$145.80 |
$145.80 |
$145.80 |
$68.38
|
|
Ghs pr without cont pulse ox
|
$231.00 |
$231.00 |
$231.00 |
$165.60
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$42.60 |
$42.60 |
$42.60 |
$55.25
|
|
Ghs reticulocyte count
|
$93.00 |
$93.00 |
$93.00 |
$33.57
|
|
Ghs sedimentation rate
|
$76.80 |
$76.80 |
$76.80 |
$36.57
|
|
Ghs sensitivity (per antimicro)
|
$130.80 |
$130.80 |
$130.80 |
$55.12
|
|
Ghs strapping shoulder - 29240
|
$108.00 |
$108.00 |
$108.00 |
$210.91
|
|
Ghs urine, porphyrins quant
|
$83.40 |
$83.40 |
$83.40 |
$85.15
|
|
Gi inhouse confirmation
|
$227.40 |
$227.40 |
$227.40 |
$79.50
|
|
Glucagon 1 mg solution for injection
|
$351.53 |
$351.53 |
$351.53 |
$351.53
|
|
Glucagon plasma - sendout
|
$172.80 |
$172.80 |
$172.80 |
$67.50
|
|
Glucose 1 hr post dose
|
$70.20 |
$70.20 |
$70.20 |
$40.00
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$47.40 |
$47.40 |
$47.40 |
$20.00
|
|
Glucose blood quantitative
|
$71.40 |
$71.40 |
$71.40 |
$40.80
|
|
Glucose body fluid
|
$88.20 |
$88.20 |
$88.20 |
$47.70
|
|
Glucose tolerance test (gtt) 3 specimens
|
$223.20 |
$223.20 |
$223.20 |
$92.75
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$13.80 |
$13.80 |
$13.80 |
$33.15
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$120.40 |
$120.40 |
$120.40 |
$11.60
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$277.20 |
$277.20 |
$277.20 |
$115.05
|
|
Gonadotropin luteinizing hormone (lh)
|
$334.80 |
$334.80 |
$334.80 |
$117.65
|
|
Guide endoanchr sg-64 aaa 62cm
|
$12,765.00 |
$12,765.00 |
$12,765.00 |
$2,108.25
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$51.04 |
$51.04 |
$51.04 |
$120.02
|
