|
ER Visit (level 1, minor)
|
$328.00 |
$328.00 |
$328.00 |
$246.24
|
|
ER Visit (level 2)
|
$556.50 |
$556.50 |
$556.50 |
$452.20
|
|
ER Visit (level 3)
|
$1,164.00 |
$1,164.00 |
$1,164.00 |
$770.04
|
|
ER Visit (level 4)
|
$2,135.50 |
$2,135.50 |
$2,135.50 |
$1,273.68
|
|
ER Visit (level 5, high severity)
|
$3,150.00 |
$3,150.00 |
$3,150.00 |
$1,820.02
|
|
Erwinaze injection
|
$6,423.46 |
$6,423.46 |
$6,423.46 |
$6,423.46
|
|
Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr
|
$306.45 |
$306.45 |
$306.45 |
$223.99
|
|
Esmolol 2,500 mg/250 ml (10 mg/ml) IV wrapper osm only
|
$429.78 |
$429.78 |
$429.78 |
$553.88
|
|
Esophagus motility study
|
$2,768.50 |
$2,768.50 |
$2,768.50 |
$1,289.20
|
|
Esoph balloon distension tst
|
$5,870.00 |
$5,870.00 |
$5,870.00 |
$1,040.00
|
|
Established Patient Office Visit (level 1)
|
$261.00 |
$261.00 |
$261.00 |
$120.25
|
|
Estradiol total
|
$144.00 |
$144.00 |
$144.00 |
$146.50
|
|
Estradiol valerate 10 mg inj
|
$817.35 |
$817.35 |
$817.35 |
$57.35
|
|
Estrogens total-sendout
|
$158.00 |
$158.00 |
$158.00 |
$96.20
|
|
Etanercept injection
|
$1,150.24 |
$1,150.24 |
$1,150.24 |
$3,172.86
|
|
Ethylene glycol -sendout
|
$401.50 |
$401.50 |
$401.50 |
$89.40
|
|
Etonogestrel implant system
|
$825.65 |
$825.65 |
$825.65 |
$2,081.30
|
|
Etoposide 20 mg/ml intravenous solution
|
$628.44 |
$628.44 |
$628.44 |
$235.20
|
|
Etoposide 50 mg cap
|
$89.11 |
$89.11 |
$89.11 |
$135.02
|
|
Euflexxa inj per dose
|
$510.68 |
$510.68 |
$510.68 |
$587.51
|
|
Eval/fit voice prosthesis iii, st
|
$370.00 |
$370.00 |
$370.00 |
$356.00
|
|
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen
|
$307.50 |
$307.50 |
$307.50 |
$219.60
|
|
Evaluation of speech fluency 92521
|
$297.00 |
$297.00 |
$297.00 |
$311.50
|
|
Evaluation psychiatric diagnostic
|
$251.00 |
$251.00 |
$251.00 |
$312.00
|
|
Event monitor
|
$251.50 |
$251.50 |
$251.50 |
$242.65
|
|
Evoked oa emissions ltd
|
$373.00 |
$373.00 |
$373.00 |
$234.32
|
|
Evoked potentials auditory screening automated analysis
|
$239.50 |
$239.50 |
$239.50 |
$249.71
|
|
Exercise tst brncspsm w/ecg
|
$794.50 |
$794.50 |
$794.50 |
$318.50
|
|
Expander tiss 133s-mv-12-t 300ml natrelle smth
|
$6,000.00 |
$6,000.00 |
$6,000.00 |
$4,048.38
|
|
External newborn metabolic screening panel
|
$73.50 |
$73.50 |
$73.50 |
$109.76
|
|
External recharg sys intern
|
$5,740.80 |
$5,740.80 |
$5,740.80 |
$2,635.20
|
|
External tissue culture neoplastic disorders bone marrow/blood cells
|
$568.50 |
$568.50 |
$568.50 |
$454.20
|
|
Extractable nuclear antigen/antibody any method each antibody centromere
|
$129.50 |
$129.50 |
$129.50 |
$108.60
|
|
F-18 fdg pet diag
|
$1,487.50 |
$1,487.50 |
$1,487.50 |
$551.72
|
|
Facial bones <3
|
$206.50 |
$206.50 |
$206.50 |
$252.60
|
|
Factor ix
|
$195.50 |
$195.50 |
$195.50 |
$156.13
|
|
Factor ix recombinant nos
|
$3,162.00 |
$3,162.00 |
$3,162.00 |
$4.65
|
|
Factor viii
|
$135.00 |
$135.00 |
$135.00 |
$133.81
|
|
Factor viii fc fusion recomb
|
$8,202.60 |
$8,202.60 |
$8,202.60 |
$8.28
|
|
Factor viii recombinant nos
|
$6,518.14 |
$6,518.14 |
$6,518.14 |
$6.56
|
|
Fam-trastuzumab deruxtecan-nxki 100 mg intravenous solution
|
$7,046.92 |
$7,046.92 |
$7,046.92 |
$5,800.72
|
|
Fat/lipids feces qualitative
|
$64.50 |
$64.50 |
$64.50 |
$38.35
|
|
Fecal microbiota, live-jslm 150 ml rectal suspension enema
|
$11,420.12 |
$11,420.12 |
$11,420.12 |
$14,956.68
|
|
Felbamate (felbatol(r)) - sendout
|
$128.00 |
$128.00 |
$128.00 |
$65.00
|
|
Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper)
|
$107.80 |
$107.80 |
$107.80 |
$101.40
|
|
Ferric carboxymaltose 50 mg iron/ml intravenous solution
|
$3,367.34 |
$3,367.34 |
$3,367.34 |
$2,590.25
|
|
Ferritin
|
$124.00 |
$124.00 |
$124.00 |
$100.94
|
|
Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution
|
$650.20 |
$650.20 |
$650.20 |
$1,776.61
|
|
Fetal biophys profile w/nst 76818
|
$477.00 |
$477.00 |
$477.00 |
$535.37
|
|
Fetal fibronectin
|
$353.00 |
$353.00 |
$353.00 |
$373.41
|
|
Fetal hemoglobin (kleihauer betke)
|
$108.50 |
$108.50 |
$108.50 |
$105.12
|
|
Fetal hemoglobin rosette
|
$90.00 |
$90.00 |
$90.00 |
$67.20
|
|
Fibrin degradation d dimer quantitative
|
$125.50 |
$125.50 |
$125.50 |
$117.70
|
|
Fibrinogen activity
|
$68.50 |
$68.50 |
$68.50 |
$83.50
|
|
Fibrinolysins/coagulopathy screen interpretation/report
|
$42.50 |
$42.50 |
$42.50 |
$64.05
|
|
Fibrinolytic plasminogen
|
$175.50 |
$175.50 |
$175.50 |
$107.50
|
|
Filgrastim-aafi 300 mcg/0.5 ml subcutaneous syringe
|
$537.36 |
$537.36 |
$537.36 |
$595.48
|
|
Filgrastim in d5w IV syringe 20 mcg/ml (neo) - cnr
|
$1,223.96 |
$1,223.96 |
$1,223.96 |
$1,096.24
|
|
Filgrastim-sndz 300 mcg/0.5 ml injection syringe
|
$474.94 |
$474.94 |
$474.94 |
$869.18
|
|
Filter spider fx 3mmx320cm
|
$11,797.05 |
$11,797.05 |
$11,797.05 |
$7,160.28
|
|
Filter vena cava fem denali
|
$5,360.00 |
$5,360.00 |
$5,360.00 |
$3,718.18
|
|
Fine needle aspiration biopsy w/us gdn; ea addtl 10006
|
$960.00 |
$960.00 |
$960.00 |
$823.90
|
|
Flecainide (tambocor)-sendout
|
$115.00 |
$115.00 |
$115.00 |
$66.43
|
|
Fl exam g/colon tube w contrast
|
$1,052.50 |
$1,052.50 |
$1,052.50 |
$511.92
|
|
Flow cytometry marker each additional
|
$86.00 |
$86.00 |
$86.00 |
$97.50
|
|
Flow cytometry one marker technical component
|
$255.00 |
$255.00 |
$255.00 |
$284.40
|
|
Flt3 gene
|
$318.50 |
$318.50 |
$318.50 |
$355.00
|
|
Flt3 gene analysis
|
$318.50 |
$318.50 |
$318.50 |
$213.92
|
|
Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback
|
$52.68 |
$52.68 |
$52.68 |
$64.22
|
|
Fludarabine 50 mg intravenous solution
|
$493.35 |
$493.35 |
$493.35 |
$493.35
|
|
Fluidotherapy charges pt
|
$77.50 |
$77.50 |
$77.50 |
$91.00
|
|
Fluocinol acet intravit imp
|
$12,350.00 |
$12,350.00 |
$12,350.00 |
$14,359.80
|
|
Fluorescent antibody titer dna
|
$62.00 |
$62.00 |
$62.00 |
$122.82
|
|
Fluoroguide needle placement
|
$357.00 |
$357.00 |
$357.00 |
$510.00
|
|
Fluoroscopy up to 1 hour
|
$628.00 |
$628.00 |
$628.00 |
$492.00
|
|
Fluorouracil 50 mg/ml intravenous solution (wrapper)
|
$2,593.09 |
$2,593.09 |
$2,593.09 |
$94.86
|
|
Fluphenazine decanoate 25 mg/ml injection solution
|
$210.68 |
$210.68 |
$210.68 |
$72.52
|
|
Fna bx w/ct gdn 1st les
|
$1,739.00 |
$1,739.00 |
$1,739.00 |
$1,420.80
|
|
Folic acid
|
$101.00 |
$101.00 |
$101.00 |
$101.50
|
|
Fomepizole 1 gram/ml intravenous solution
|
$1,717.41 |
$1,717.41 |
$1,717.41 |
$2,581.14
|
|
Fondaparinux sodium
|
$80.92 |
$80.92 |
$80.92 |
$185.12
|
|
Fo nontorsion joint cf
|
$237.50 |
$237.50 |
$237.50 |
$217.50
|
|
Foot X-ray
|
$302.50 |
$302.50 |
$302.50 |
$362.40
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$185.08 |
$185.08 |
$185.08 |
$457.50
|
|
Foscarnet sodium injection
|
$1,458.38 |
$1,458.38 |
$1,458.38 |
$879.58
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$106.25 |
$106.25 |
$106.25 |
$106.10
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$251.50 |
$251.50 |
$251.50 |
$156.60
|
|
Fresh frozen plasma thawing ea un
|
$420.50 |
$420.50 |
$420.50 |
$122.00
|
|
Fructosamine glycated protein
|
$95.50 |
$95.50 |
$95.50 |
$60.75
|
|
Furosemide in ns IV syringe 2 mg/ml (neo/ped) - cnr
|
$29.15 |
$29.15 |
$29.15 |
$27.08
|
|
Ga-67 gallium 0.1 mci
|
$47.57 |
$47.57 |
$47.57 |
$118.56
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$84.04 |
$84.04 |
$84.04 |
$102.00
|
|
Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper)
|
$155.61 |
$155.61 |
$155.61 |
$144.98
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$844.12 |
$844.12 |
$844.12 |
$250.83
|
|
Gammaglobulin iga
|
$61.50 |
$61.50 |
$61.50 |
$67.20
|
|
Gammaglobulin ige
|
$79.00 |
$79.00 |
$79.00 |
$83.85
|
|
Gamma glutamyltransferase
|
$28.50 |
$28.50 |
$28.50 |
$57.54
|
|
Gamunex-c/gammaked
|
$11,178.00 |
$11,178.00 |
$11,178.00 |
$7,634.20
|
|
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr
|
$187.68 |
$187.68 |
$187.68 |
$197.40
|
|
Gastroesophageal reflux test
|
$2,429.00 |
$2,429.00 |
$2,429.00 |
$1,321.45
|
