|
Established Patient Office Visit (level 2)
|
$120.00 |
$120.00 |
$120.00 |
$139.20
|
|
Established Patient Office Visit (level 3)
|
$799.00 |
$799.00 |
$799.00 |
$186.94
|
|
Established Patient Office Visit (level 4)
|
$803.00 |
$803.00 |
$803.00 |
$239.25
|
|
Established Patient Office Visit (level 5)
|
$382.00 |
$382.00 |
$382.00 |
$290.68
|
|
Estradiol total
|
$238.00 |
$238.00 |
$238.00 |
$152.10
|
|
Etoposide 20 mg/ml intravenous solution
|
$40.25 |
$40.25 |
$40.25 |
$235.20
|
|
Eval/fit voice prosthesis iii, st
|
$344.00 |
$344.00 |
$344.00 |
$359.50
|
|
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen
|
$321.00 |
$321.00 |
$321.00 |
$213.15
|
|
Exam pelvic add-on
|
$56.00 |
$56.00 |
$56.00 |
$46.85
|
|
Exc arm/elbo les sc >=3cm 24071
|
$11,350.53 |
$11,350.53 |
$11,350.53 |
$4,529.20
|
|
Exc arm/elbo les sc <3cm 24075
|
$2,130.00 |
$2,130.00 |
$2,130.00 |
$2,532.80
|
|
Exc back les sbq <3 cm 21930
|
$3,528.00 |
$3,528.00 |
$3,528.00 |
$2,711.00
|
|
Exc ben+marg excep skin tag feenlm <0.5cm 11440
|
$5,418.25 |
$5,418.25 |
$5,418.25 |
$969.60
|
|
Exc ben+marg excep skin tag tal 0.6-1cm 11401
|
$517.00 |
$517.00 |
$517.00 |
$779.35
|
|
Exc ben+marg excep skin tag tal 2.1-3/>cm 11403
|
$654.00 |
$654.00 |
$654.00 |
$1,314.67
|
|
Excision benign lesion face/ears/eyelids/nose/lips/muc memb 0.6 - 1.0 cm
|
$10,874.05 |
$10,874.05 |
$10,874.05 |
$914.34
|
|
Excision benign lesion trunk/arms/legs 1.1 - 2.0 cm
|
$9,635.12 |
$9,635.12 |
$9,635.12 |
$1,072.24
|
|
Excision benign lesion trunk/arms/legs > 4.0 cm
|
$12,764.43 |
$12,764.43 |
$12,764.43 |
$2,865.00
|
|
Excision tumor soft tissue back/flank subcutaneous >= 3 cm
|
$11,469.13 |
$11,469.13 |
$11,469.13 |
$4,420.32
|
|
Exc neck tum deep < 5 cm
|
$8,944.98 |
$8,944.98 |
$8,944.98 |
$3,813.50
|
|
Exc/pilonidal cyst/sinus/simple 11770
|
$602.00 |
$602.00 |
$602.00 |
$3,386.84
|
|
Exc rect tum transanal part
|
$8,227.00 |
$8,227.00 |
$8,227.00 |
$3,786.00
|
|
Exc thigh/knee les sc<3cm 27327
|
$5,760.00 |
$5,760.00 |
$5,760.00 |
$3,229.48
|
|
Expander breast 300cc mod hght extra proj smth natrelle
|
$3,723.25 |
$3,723.25 |
$3,723.25 |
$2,421.09
|
|
Expander tiss 133s-mv-12-t 300ml natrelle smth
|
$4,542.19 |
$4,542.19 |
$4,542.19 |
$4,101.67
|
|
Explore wound abdomen 20102
|
$861.00 |
$861.00 |
$861.00 |
$2,784.80
|
|
External chromosome analysis 20-25 cells
|
$722.00 |
$722.00 |
$722.00 |
$415.01
|
|
External newborn metabolic screening panel
|
$142.00 |
$142.00 |
$142.00 |
$109.76
|
|
External pretreatment of serum for use in antibody identification by dilution
|
$94.00 |
$94.00 |
$94.00 |
$63.70
|
|
External profiling gene expression oncology (breast) mrna 21 genes
|
$4,620.00 |
$4,620.00 |
$4,620.00 |
$4,388.25
|
|
External tissue culture neoplastic disorders bone marrow/blood cells
|
$431.00 |
$431.00 |
$431.00 |
$457.07
|
|
Extractable nuclear antigen/antibody any method each antibody centromere
|
$205.00 |
$205.00 |
$205.00 |
$109.00
|
|
Eye implant band 40
|
$1,756.25 |
$1,756.25 |
$1,756.25 |
$5,641.12
|
|
Eye Socket, Pituitary or Ear CT Scan (with contrast)
|
$2,346.00 |
$2,346.00 |
$2,346.00 |
$1,543.00
|
|
Eye Socket, Pituitary or Ear CT Scan (without contrast)
|
$2,244.00 |
$2,244.00 |
$2,244.00 |
$1,320.00
|
|
F-18 fdg pet diag
|
$1,768.20 |
$1,768.20 |
$1,768.20 |
$551.72
|
|
F-18 florbetapir less than or equal to 10 mci
|
$15,145.00 |
$15,145.00 |
$15,145.00 |
$5,224.83
|
|
F-18 fluciclovine per mci
|
$27,455.00 |
$27,455.00 |
$27,455.00 |
$1,042.30
|
|
F-18 sodium fluoride
|
$1,391.25 |
$1,391.25 |
$1,391.25 |
$492.56
|
|
Face, Eye Socket and Neck MRI (with and without contrast)
|
$5,714.00 |
$5,714.00 |
$5,714.00 |
$2,821.87
|
|
Face, Eye Socket and Neck MRI (without contrast)
|
$4,051.00 |
$4,051.00 |
$4,051.00 |
$1,883.25
|
|
Facial Bones X-ray (1 to 2 views)
|
$497.00 |
$497.00 |
$497.00 |
$252.60
|
|
Facial Bones X-ray (complete)
|
$618.00 |
$618.00 |
$618.00 |
$381.75
|
|
Factor ix
|
$225.00 |
$225.00 |
$225.00 |
$162.50
|
|
Factor viii
|
$379.00 |
$379.00 |
$379.00 |
$148.00
|
|
Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr
|
$4.10 |
$4.10 |
$4.10 |
$22.20
|
|
Fam-trastuzumab deruxtecan-nxki 100 mg intravenous solution
|
$9,722.40 |
$9,722.40 |
$9,722.40 |
$5,894.50
|
|
Fat/lipids feces qualitative
|
$70.00 |
$70.00 |
$70.00 |
$36.00
|
|
Fecal microbiota, live-jslm 150 ml rectal suspension enema
|
$28,233.45 |
$28,233.45 |
$28,233.45 |
$14,956.68
|
|
Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper)
|
$53.25 |
$53.25 |
$53.25 |
$101.40
|
|
Fern test
|
$63.00 |
$63.00 |
$63.00 |
$37.03
|
|
Ferric carboxymaltose 50 mg iron/ml intravenous solution
|
$5,262.00 |
$5,262.00 |
$5,262.00 |
$2,590.25
|
|
Ferritin
|
$1,117.00 |
$1,117.00 |
$1,117.00 |
$102.48
|
|
Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution
|
$712.85 |
$712.85 |
$712.85 |
$1,636.50
|
|
Fetal fibronectin
|
$680.00 |
$680.00 |
$680.00 |
$389.95
|
|
Fetal hemoglobin (kleihauer betke)
|
$75.00 |
$75.00 |
$75.00 |
$102.00
|
|
Fetal hemoglobin rosette
|
$126.00 |
$126.00 |
$126.00 |
$67.20
|
|
Fibrin degradation d dimer quantitative
|
$224.00 |
$224.00 |
$224.00 |
$120.64
|
|
Fibrinogen activity
|
$104.00 |
$104.00 |
$104.00 |
$87.00
|
|
Fibrinolysins/coagulopathy screen interpretation/report
|
$342.00 |
$342.00 |
$342.00 |
$61.00
|
|
Filgrastim-aafi 300 mcg/0.5 ml subcutaneous syringe
|
$1,611.50 |
$1,611.50 |
$1,611.50 |
$595.48
|
|
Filgrastim in d5w IV syringe 20 mcg/ml (neo) - cnr
|
$1,447.95 |
$1,447.95 |
$1,447.95 |
$1,197.83
|
|
Filgrastim-sndz 300 mcg/0.5 ml injection syringe
|
$2,018.90 |
$2,018.90 |
$2,018.90 |
$891.02
|
|
Filter spider fx 3mmx320cm
|
$26,937.16 |
$26,937.16 |
$26,937.16 |
$7,358.16
|
|
Filter vena cava fem denali
|
$35,888.87 |
$35,888.87 |
$35,888.87 |
$3,718.18
|
|
Finger joint sz00 swanson w/grommets
|
$3,239.60 |
$3,239.60 |
$3,239.60 |
$4,584.72
|
|
Finger X-ray (both hands)
|
$435.00 |
$435.00 |
$435.00 |
$241.50
|
|
Flow cytometry marker each additional
|
$131.00 |
$131.00 |
$131.00 |
$97.50
|
|
Flow cytometry one marker technical component
|
$383.00 |
$383.00 |
$383.00 |
$285.00
|
|
Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback
|
$74.00 |
$74.00 |
$74.00 |
$64.22
|
|
Fludarabine 50 mg intravenous solution
|
$434.65 |
$434.65 |
$434.65 |
$493.35
|
|
Fluidotherapy charges pt
|
$151.00 |
$151.00 |
$151.00 |
$101.40
|
|
Fluorescent antibody titer dna
|
$123.00 |
$123.00 |
$123.00 |
$123.65
|
|
Fluoroguide needle placement
|
$766.00 |
$766.00 |
$766.00 |
$497.92
|
|
Fluoroscopy (Live X-ray Guidance, up to 1 hour)
|
$693.00 |
$693.00 |
$693.00 |
$503.80
|
|
Fluorouracil 50 mg/ml intravenous solution (wrapper)
|
$147.00 |
$147.00 |
$147.00 |
$107.00
|
|
Folic acid
|
$145.00 |
$145.00 |
$145.00 |
$101.50
|
|
Folic acid 5 mg/ml injection solution
|
$133.50 |
$133.50 |
$133.50 |
$45.00
|
|
Followup eval of foot pt lop
|
$99.00 |
$99.00 |
$99.00 |
$170.95
|
|
Foot drp splt w/exp heel lg
|
$423.24 |
$423.24 |
$423.24 |
$143.14
|
|
Foot X-ray
|
$522.00 |
$522.00 |
$522.00 |
$355.20
|
|
Foot X-ray (2 views, both feet)
|
$416.00 |
$416.00 |
$416.00 |
$290.40
|
|
Forearm X-ray (both sides)
|
$537.00 |
$537.00 |
$537.00 |
$324.00
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$1,539.00 |
$1,539.00 |
$1,539.00 |
$490.67
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$9.20 |
$9.20 |
$9.20 |
$103.62
|
|
Fragmenting of kidney stone
|
$32,913.00 |
$32,913.00 |
$32,913.00 |
$10,312.25
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$519.00 |
$519.00 |
$519.00 |
$155.25
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$223.00 |
$223.00 |
$223.00 |
$164.84
|
|
Fructosamine glycated protein
|
$107.00 |
$107.00 |
$107.00 |
$63.50
|
|
Full Spine X-ray (Scoliosis Survey)
|
$354.00 |
$354.00 |
$354.00 |
$355.00
|
|
Furosemide 10 mg/ml injection solution
|
$21.92 |
$21.92 |
$21.92 |
$19.53
|
|
Furosemide in ns IV syringe 2 mg/ml (neo/ped) - cnr
|
$6.75 |
$6.75 |
$6.75 |
$26.40
|
|
Fusion of big toe joint
|
$25,723.53 |
$25,723.53 |
$25,723.53 |
$5,488.00
|
|
Fusion of foot bones
|
$41,998.05 |
$41,998.05 |
$41,998.05 |
$8,260.30
|
|
Fusion of foot bones
|
$40,572.70 |
$40,572.70 |
$40,572.70 |
$6,288.57
|
|
Ga-67 gallium 0.1 mci
|
$253.10 |
$253.10 |
$253.10 |
$121.73
|
|
Ga-68 gallium 68 dotatate
|
$15,600.00 |
$15,600.00 |
$15,600.00 |
$140.35
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$591.40 |
$591.40 |
$591.40 |
$108.40
|
|
Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper)
|
$231.00 |
$231.00 |
$231.00 |
$120.00
|
|
Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution
|
$50.15 |
$50.15 |
$50.15 |
$177.52
|
