|
ER Visit (level 4)
|
$1,292.80 |
$1,292.80 |
$1,292.80 |
$1,291.00
|
|
ER Visit (level 5, high severity)
|
$1,752.80 |
$1,752.80 |
$1,752.80 |
$1,871.60
|
|
Established Patient Office Visit (level 1)
|
$150.40 |
$150.40 |
$150.40 |
$122.20
|
|
Established Patient Office Visit (level 2)
|
$164.80 |
$164.80 |
$164.80 |
$139.20
|
|
Established Patient Office Visit (level 3)
|
$202.40 |
$202.40 |
$202.40 |
$186.94
|
|
Established Patient Office Visit (level 4)
|
$256.00 |
$256.00 |
$256.00 |
$239.25
|
|
Established Patient Office Visit (level 5)
|
$308.80 |
$308.80 |
$308.80 |
$290.68
|
|
Estradiol total
|
$282.40 |
$282.40 |
$282.40 |
$152.10
|
|
Estrogens total-sendout
|
$52.80 |
$52.80 |
$52.80 |
$97.50
|
|
Evaluation of speech fluency 92521
|
$400.80 |
$400.80 |
$400.80 |
$302.50
|
|
Event monitor
|
$409.60 |
$409.60 |
$409.60 |
$231.00
|
|
Exc ben+marg excep skin tag feenlm <0.5cm 11440
|
$1,568.80 |
$1,568.80 |
$1,568.80 |
$969.60
|
|
Exc ben+marg excep skin tag feenlm 1.1-2cm 11442
|
$2,127.20 |
$2,127.20 |
$2,127.20 |
$1,152.96
|
|
Exc ben+marg excep skin tag snhfg 0.6-1cm 11421
|
$906.40 |
$906.40 |
$906.40 |
$1,501.50
|
|
Exc ben+marg excep skin tag tal 0.6-1cm 11401
|
$421.60 |
$421.60 |
$421.60 |
$779.35
|
|
Exc ben+marg excep skin tag tal 2.1-3/>cm 11403
|
$1,119.20 |
$1,119.20 |
$1,119.20 |
$1,314.67
|
|
Exc feenl mal+mrg 0.6-1 11641
|
$2,005.60 |
$2,005.60 |
$2,005.60 |
$999.50
|
|
Exc foot/toe tum subq < 1.5 cm 28043
|
$4,485.60 |
$4,485.60 |
$4,485.60 |
$3,484.00
|
|
Excision benign lesion face/ears/eyelids/nose/lips/muc memb 0.6 - 1.0 cm
|
$583.20 |
$583.20 |
$583.20 |
$914.34
|
|
Excision benign lesion scalp/neck/hands/feet/genitalia 1.1 - 2.0 cm
|
$1,370.40 |
$1,370.40 |
$1,370.40 |
$2,064.75
|
|
Excision benign lesion trunk/arms/legs 1.1 - 2.0 cm
|
$802.40 |
$802.40 |
$802.40 |
$1,072.24
|
|
Excision benign lesion trunk/arms/legs > 4.0 cm
|
$4,390.40 |
$4,390.40 |
$4,390.40 |
$2,865.00
|
|
Exc malig feenl 1.1-2 11642
|
$1,113.60 |
$1,113.60 |
$1,113.60 |
$1,082.00
|
|
Exc mal+marg tal 1.1-2 cm 11602
|
$653.60 |
$653.60 |
$653.60 |
$889.20
|
|
Exc mal+marg tal 3.1-4 cm 11604
|
$2,541.60 |
$2,541.60 |
$2,541.60 |
$1,294.80
|
|
Exc snhfg mal+mrg 1.1-2 11622
|
$2,365.60 |
$2,365.60 |
$2,365.60 |
$1,274.00
|
|
Ext ecg>7d<15d scan a/r
|
$386.40 |
$386.40 |
$386.40 |
$345.60
|
|
Extractable nuclear antigen/antibody any method each antibody centromere
|
$104.80 |
$104.80 |
$104.80 |
$109.00
|
|
Eye Socket (Orbit) X-ray
|
$520.80 |
$520.80 |
$520.80 |
$328.35
|
|
Eye Socket, Pituitary or Ear CT Scan (with and without contrast)
|
$2,952.80 |
$2,952.80 |
$2,952.80 |
$1,705.20
|
|
Eye Socket, Pituitary or Ear CT Scan (with contrast)
|
$2,661.60 |
$2,661.60 |
$2,661.60 |
$1,543.00
|
|
Eye Socket, Pituitary or Ear CT Scan (without contrast)
|
$2,284.80 |
$2,284.80 |
$2,284.80 |
$1,320.00
|
|
Face, Eye Socket and Neck MRI (with and without contrast)
|
$4,758.40 |
$4,758.40 |
$4,758.40 |
$2,821.87
|
|
Face, Eye Socket and Neck MRI (without contrast)
|
$3,392.00 |
$3,392.00 |
$3,392.00 |
$1,883.25
|
|
Facial Bones X-ray (1 to 2 views)
|
$365.60 |
$365.60 |
$365.60 |
$252.60
|
|
Facial Bones X-ray (complete)
|
$597.60 |
$597.60 |
$597.60 |
$381.75
|
|
Factor viii
|
$349.60 |
$349.60 |
$349.60 |
$148.00
|
|
Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr
|
$60.52 |
$60.52 |
$60.52 |
$22.20
|
|
Fat/lipids feces qualitative
|
$234.40 |
$234.40 |
$234.40 |
$36.00
|
|
Felbamate (felbatol(r)) - sendout
|
$54.40 |
$54.40 |
$54.40 |
$66.43
|
|
Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper)
|
$61.42 |
$61.42 |
$61.42 |
$101.40
|
|
Ferric carboxymaltose 50 mg iron/ml intravenous solution
|
$1,335.15 |
$1,335.15 |
$1,335.15 |
$2,590.25
|
|
Ferritin
|
$156.80 |
$156.80 |
$156.80 |
$102.48
|
|
Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution
|
$619.78 |
$619.78 |
$619.78 |
$1,636.50
|
|
Fetal biophys profile w/nst 76818
|
$756.80 |
$756.80 |
$756.80 |
$541.74
|
|
Fetal hemoglobin rosette
|
$127.20 |
$127.20 |
$127.20 |
$67.20
|
|
Fibrin degradation d dimer quantitative
|
$219.20 |
$219.20 |
$219.20 |
$120.64
|
|
Fibrinogen activity
|
$48.00 |
$48.00 |
$48.00 |
$87.00
|
|
Fibrinolysins/coagulopathy screen interpretation/report
|
$90.40 |
$90.40 |
$90.40 |
$61.00
|
|
Filgrastim in d5w IV syringe 20 mcg/ml (neo) - cnr
|
$714.34 |
$714.34 |
$714.34 |
$1,197.83
|
|
Filgrastim-sndz 300 mcg/0.5 ml injection syringe
|
$316.80 |
$316.80 |
$316.80 |
$891.02
|
|
Fine needle asp without image guide 10021
|
$691.20 |
$691.20 |
$691.20 |
$504.45
|
|
Finger X-ray (both hands)
|
$345.60 |
$345.60 |
$345.60 |
$241.50
|
|
Flexible Sigmoidoscopy
|
$2,204.80 |
$2,204.80 |
$2,204.80 |
$1,284.13
|
|
Flow cytometry marker each additional
|
$216.00 |
$216.00 |
$216.00 |
$97.50
|
|
Flow cytometry one marker technical component
|
$242.40 |
$242.40 |
$242.40 |
$285.00
|
|
Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback
|
$108.82 |
$108.82 |
$108.82 |
$64.22
|
|
Fluorescent antibody titer dna
|
$56.80 |
$56.80 |
$56.80 |
$123.65
|
|
Fluorouracil 50 mg/ml intravenous solution (wrapper)
|
$331.90 |
$331.90 |
$331.90 |
$107.00
|
|
Folic acid
|
$134.40 |
$134.40 |
$134.40 |
$101.50
|
|
Folic acid 5 mg/ml injection solution
|
$60.09 |
$60.09 |
$60.09 |
$45.00
|
|
Fomepizole 1 gram/ml intravenous solution
|
$871.20 |
$871.20 |
$871.20 |
$2,511.73
|
|
Foot X-ray
|
$452.00 |
$452.00 |
$452.00 |
$355.20
|
|
Foot X-ray (2 views, both feet)
|
$340.80 |
$340.80 |
$340.80 |
$290.40
|
|
Forearm X-ray (both sides)
|
$412.80 |
$412.80 |
$412.80 |
$324.00
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$69.55 |
$69.55 |
$69.55 |
$103.62
|
|
_fragile x methylation-sendout
|
$120.80 |
$120.80 |
$120.80 |
$183.74
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$313.60 |
$313.60 |
$313.60 |
$164.84
|
|
Fructosamine glycated protein
|
$56.00 |
$56.00 |
$56.00 |
$63.50
|
|
Full Spine X-ray (Scoliosis Survey)
|
$520.80 |
$520.80 |
$520.80 |
$355.00
|
|
Furosemide 10 mg/ml injection solution
|
$60.78 |
$60.78 |
$60.78 |
$19.53
|
|
Fusion of big toe joint
|
$8,581.60 |
$8,581.60 |
$8,581.60 |
$5,488.00
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$102.00 |
$102.00 |
$102.00 |
$108.40
|
|
Gallbladder and Bile Duct Scan (HIDA Scan)
|
$1,925.60 |
$1,925.60 |
$1,925.60 |
$1,494.00
|
|
Gallbladder Function Scan (HIDA with Medication)
|
$2,131.20 |
$2,131.20 |
$2,131.20 |
$1,615.00
|
|
Gammaglobulin iga
|
$91.20 |
$91.20 |
$91.20 |
$69.60
|
|
Gammaglobulin ige
|
$188.00 |
$188.00 |
$188.00 |
$83.85
|
|
Gamma glutamyltransferase
|
$74.40 |
$74.40 |
$74.40 |
$57.54
|
|
General health panel
|
$333.60 |
$333.60 |
$333.60 |
$262.44
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$63.08 |
$63.08 |
$63.08 |
$52.54
|
|
Gentamicin peak therapeutic drug level
|
$172.00 |
$172.00 |
$172.00 |
$123.84
|
|
Ghs abscess perianal iandd
|
$1,628.00 |
$1,628.00 |
$1,628.00 |
$1,465.00
|
|
Ghs antibodies (torch) igm
|
$352.00 |
$352.00 |
$352.00 |
$69.12
|
|
Ghs bladder cath - complex-foley
|
$340.00 |
$340.00 |
$340.00 |
$344.00
|
|
Ghs chemo >8 hrs
|
$881.60 |
$881.60 |
$881.60 |
$714.87
|
|
Ghs chemo IV push, ea addtl
|
$355.20 |
$355.20 |
$355.20 |
$277.00
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$496.00 |
$496.00 |
$496.00 |
$513.15
|
|
Ghs closed reduction ankle dislocation
|
$560.80 |
$560.80 |
$560.80 |
$671.50
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$1,122.40 |
$1,122.40 |
$1,122.40 |
$1,592.00
|
|
Ghs closed tx tibial fracture w/manip
|
$1,490.40 |
$1,490.40 |
$1,490.40 |
$2,227.20
|
|
Ghs clsd red med malleolus fx without manip
|
$453.60 |
$453.60 |
$453.60 |
$513.80
|
|
Ghs clsd tx frac distal tibia w/manipulation
|
$2,496.00 |
$2,496.00 |
$2,496.00 |
$2,319.00
|
|
Ghs cl tx knee disl; wo anesth
|
$592.80 |
$592.80 |
$592.80 |
$581.90
|
|
Ghs cl tx metacarpophal disloc without anes
|
$500.00 |
$500.00 |
$500.00 |
$500.40
|
|
Ghs community re-entry 15 minutes
|
$143.20 |
$143.20 |
$143.20 |
$89.28
|
|
Ghs conjunctiva foreign body-superf bil
|
$186.40 |
$186.40 |
$186.40 |
$287.40
|
|
Ghs corneal fb without slit lamp bilat
|
$399.20 |
$399.20 |
$399.20 |
$422.25
|
|
Ghs corneal fb with slit lamp bilat
|
$344.00 |
$344.00 |
$344.00 |
$339.60
|
|
Ghs dislocation elbow closed treatment
|
$583.20 |
$583.20 |
$583.20 |
$602.00
|
|
Ghs excision ingrown nail
|
$460.80 |
$460.80 |
$460.80 |
$449.25
|