|
Epoetin alfa in ns IV syringe 100 unit/ml (neo/ped) - cnr
|
$481.42 |
$481.42 |
$481.42 |
$1,329.09
|
|
Epstein barr nuclear antigen antibody
|
$76.80 |
$76.80 |
$76.80 |
$76.86
|
|
Epstein barr viral capsid antigen antibody igm
|
$90.40 |
$90.40 |
$90.40 |
$85.50
|
|
Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr
|
$165.73 |
$165.73 |
$165.73 |
$232.12
|
|
ER Visit (level 1, minor)
|
$244.00 |
$244.00 |
$244.00 |
$252.60
|
|
ER Visit (level 2)
|
$372.00 |
$372.00 |
$372.00 |
$463.00
|
|
ER Visit (level 3)
|
$569.60 |
$569.60 |
$569.60 |
$812.18
|
|
ER Visit (level 4)
|
$957.60 |
$957.60 |
$957.60 |
$1,291.00
|
|
ER Visit (level 5, high severity)
|
$1,270.40 |
$1,270.40 |
$1,270.40 |
$1,871.60
|
|
Established Patient Office Visit (level 1)
|
$140.00 |
$140.00 |
$140.00 |
$122.20
|
|
Established Patient Office Visit (level 2)
|
$135.20 |
$135.20 |
$135.20 |
$139.20
|
|
Established Patient Office Visit (level 3)
|
$164.00 |
$164.00 |
$164.00 |
$186.94
|
|
Established Patient Office Visit (level 4)
|
$200.00 |
$200.00 |
$200.00 |
$239.25
|
|
Established Patient Office Visit (level 5)
|
$258.40 |
$258.40 |
$258.40 |
$290.68
|
|
Estradiol total
|
$157.60 |
$157.60 |
$157.60 |
$152.10
|
|
Evaluation of speech fluency 92521
|
$357.60 |
$357.60 |
$357.60 |
$302.50
|
|
Evaluation psychiatric diagnostic
|
$332.80 |
$332.80 |
$332.80 |
$318.24
|
|
Event monitor
|
$290.40 |
$290.40 |
$290.40 |
$231.00
|
|
Extractable nuclear antigen/antibody any method each antibody centromere
|
$67.20 |
$67.20 |
$67.20 |
$109.00
|
|
Eye Socket (Orbit) X-ray
|
$500.80 |
$500.80 |
$500.80 |
$328.35
|
|
Eye Socket, Pituitary or Ear CT Scan (with and without contrast)
|
$2,632.00 |
$2,632.00 |
$2,632.00 |
$1,705.20
|
|
Eye Socket, Pituitary or Ear CT Scan (with contrast)
|
$2,416.80 |
$2,416.80 |
$2,416.80 |
$1,543.00
|
|
Eye Socket, Pituitary or Ear CT Scan (without contrast)
|
$2,074.40 |
$2,074.40 |
$2,074.40 |
$1,320.00
|
|
Face, Eye Socket and Neck MRI (with and without contrast)
|
$4,076.80 |
$4,076.80 |
$4,076.80 |
$2,821.87
|
|
Face, Eye Socket and Neck MRI (without contrast)
|
$2,995.20 |
$2,995.20 |
$2,995.20 |
$1,883.25
|
|
Facial Bones X-ray (1 to 2 views)
|
$348.80 |
$348.80 |
$348.80 |
$252.60
|
|
Facial Bones X-ray (complete)
|
$532.00 |
$532.00 |
$532.00 |
$381.75
|
|
Factor viii
|
$70.40 |
$70.40 |
$70.40 |
$148.00
|
|
Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr
|
$24.53 |
$24.53 |
$24.53 |
$22.20
|
|
Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper)
|
$24.95 |
$24.95 |
$24.95 |
$101.40
|
|
Ferric carboxymaltose 50 mg iron/ml intravenous solution
|
$946.45 |
$946.45 |
$946.45 |
$2,590.25
|
|
Ferritin
|
$105.60 |
$105.60 |
$105.60 |
$102.48
|
|
Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution
|
$592.71 |
$592.71 |
$592.71 |
$1,636.50
|
|
Fetal biophys profile w/nst 76818
|
$887.20 |
$887.20 |
$887.20 |
$541.74
|
|
Fetal non stress test
|
$264.80 |
$264.80 |
$264.80 |
$478.50
|
|
Fibrin degradation d dimer quantitative
|
$115.20 |
$115.20 |
$115.20 |
$120.64
|
|
Fibrinogen activity
|
$48.00 |
$48.00 |
$48.00 |
$87.00
|
|
Fibrinolysins/coagulopathy screen interpretation/report
|
$104.00 |
$104.00 |
$104.00 |
$61.00
|
|
Filgrastim-sndz 300 mcg/0.5 ml injection syringe
|
$334.71 |
$334.71 |
$334.71 |
$891.02
|
|
Finger X-ray (both hands)
|
$223.20 |
$223.20 |
$223.20 |
$241.50
|
|
Flow cytometry marker each additional
|
$121.60 |
$121.60 |
$121.60 |
$97.50
|
|
Flow cytometry one marker technical component
|
$558.40 |
$558.40 |
$558.40 |
$285.00
|
|
Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback
|
$93.84 |
$93.84 |
$93.84 |
$64.22
|
|
Folic acid
|
$88.00 |
$88.00 |
$88.00 |
$101.50
|
|
Folic acid 5 mg/ml injection solution
|
$24.19 |
$24.19 |
$24.19 |
$45.00
|
|
Foot X-ray
|
$292.80 |
$292.80 |
$292.80 |
$355.20
|
|
Foot X-ray (2 views, both feet)
|
$264.80 |
$264.80 |
$264.80 |
$290.40
|
|
Forearm X-ray (both sides)
|
$296.80 |
$296.80 |
$296.80 |
$324.00
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$57.72 |
$57.72 |
$57.72 |
$490.67
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$35.04 |
$35.04 |
$35.04 |
$103.62
|
|
_fragile x methylation-sendout
|
$120.80 |
$120.80 |
$120.80 |
$183.74
|
|
Fructosamine glycated protein
|
$54.40 |
$54.40 |
$54.40 |
$63.50
|
|
Ftl cgen abnor four anal
|
$371.20 |
$371.20 |
$371.20 |
$211.83
|
|
Full Spine X-ray (Scoliosis Survey)
|
$452.00 |
$452.00 |
$452.00 |
$355.00
|
|
Furosemide 10 mg/ml injection solution
|
$25.96 |
$25.96 |
$25.96 |
$19.53
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$36.00 |
$36.00 |
$36.00 |
$108.40
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$48.00 |
$48.00 |
$48.00 |
$249.80
|
|
Gallbladder and Bile Duct Scan (HIDA Scan)
|
$1,769.60 |
$1,769.60 |
$1,769.60 |
$1,494.00
|
|
Gallbladder Function Scan (HIDA with Medication)
|
$1,907.20 |
$1,907.20 |
$1,907.20 |
$1,615.00
|
|
Gammaglobulin iga
|
$84.80 |
$84.80 |
$84.80 |
$69.60
|
|
Gammaglobulin ige
|
$93.60 |
$93.60 |
$93.60 |
$83.85
|
|
Gamma glutamyltransferase
|
$71.20 |
$71.20 |
$71.20 |
$57.54
|
|
Gamunex-c/gammaked
|
$5,408.00 |
$5,408.00 |
$5,408.00 |
$7,435.88
|
|
General health panel
|
$318.40 |
$318.40 |
$318.40 |
$262.44
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$51.00 |
$51.00 |
$51.00 |
$52.54
|
|
Gentamicin peak therapeutic drug level
|
$83.20 |
$83.20 |
$83.20 |
$123.84
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$385.60 |
$385.60 |
$385.60 |
$513.15
|
|
Ghs closed reduction ankle dislocation
|
$716.00 |
$716.00 |
$716.00 |
$671.50
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$1,004.00 |
$1,004.00 |
$1,004.00 |
$1,592.00
|
|
Ghs clsd red med malleolus fx without manip
|
$561.60 |
$561.60 |
$561.60 |
$513.80
|
|
Ghs cl tx knee disl; wo anesth
|
$510.40 |
$510.40 |
$510.40 |
$581.90
|
|
Ghs cl tx metacarpophal disloc without anes
|
$603.20 |
$603.20 |
$603.20 |
$500.40
|
|
Ghs community re-entry 15 minutes
|
$118.40 |
$118.40 |
$118.40 |
$89.28
|
|
Ghs conjunctiva foreign body-embed bil
|
$447.20 |
$447.20 |
$447.20 |
$436.10
|
|
Ghs conjunctiva foreign body-superf bil
|
$348.80 |
$348.80 |
$348.80 |
$287.40
|
|
Ghs corneal fb without slit lamp bilat
|
$440.00 |
$440.00 |
$440.00 |
$422.25
|
|
Ghs dislocation elbow closed treatment
|
$724.80 |
$724.80 |
$724.80 |
$602.00
|
|
Ghs excision ingrown nail
|
$471.20 |
$471.20 |
$471.20 |
$449.25
|
|
Ghs fb removal - incisional
|
$2,355.20 |
$2,355.20 |
$2,355.20 |
$2,323.75
|
|
Ghs fish cytogen
|
$241.60 |
$241.60 |
$241.60 |
$175.00
|
|
Ghs fish hybrid in situ 100-300
|
$144.80 |
$144.80 |
$144.80 |
$226.20
|
|
Ghs hcv amplificaiton
|
$87.20 |
$87.20 |
$87.20 |
$196.20
|
|
Ghs HIV antibody
|
$66.40 |
$66.40 |
$66.40 |
$89.70
|
|
Ghs i and d pilonidal cyst simple
|
$720.80 |
$720.80 |
$720.80 |
$707.25
|
|
Ghs incision thrombosed ext hemorrhoid
|
$407.20 |
$407.20 |
$407.20 |
$526.50
|
|
Ghs indirect laryngoscopy/w fb removal
|
$696.80 |
$696.80 |
$696.80 |
$350.90
|
|
Ghs inhibitor screen
|
$36.00 |
$36.00 |
$36.00 |
$191.88
|
|
Ghs init tx 1st degree burn
|
$266.40 |
$266.40 |
$266.40 |
$275.88
|
|
Ghs inj tendon origin/insertion
|
$416.80 |
$416.80 |
$416.80 |
$434.12
|
|
Ghs insertion of needle - bone
|
$494.40 |
$494.40 |
$494.40 |
$431.28
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$887.20 |
$887.20 |
$887.20 |
$886.07
|
|
Ghs intermed repair 20.1 - 30.0 cm-12036
|
$1,088.00 |
$1,088.00 |
$1,088.00 |
$1,051.20
|
|
Ghs intermed repair over 30 cm - 12037
|
$3,100.00 |
$3,100.00 |
$3,100.00 |
$2,164.64
|
|
Ghs IV thrombolytics - cerebral
|
$852.80 |
$852.80 |
$852.80 |
$663.00
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$520.80 |
$520.80 |
$520.80 |
$489.67
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$887.20 |
$887.20 |
$887.20 |
$591.00
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$540.80 |
$540.80 |
$540.80 |
$583.10
|
|
Ghs layer closure 2.5cm or less - 12051
|
$634.40 |
$634.40 |
$634.40 |
$603.20
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$787.20 |
$787.20 |
$787.20 |
$672.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$715.20 |
$715.20 |
$715.20 |
$700.33
|
