|
ER Visit (level 5, high severity)
|
$880.00 |
$880.00 |
$880.00 |
$1,820.02
|
|
Established Patient Office Visit (level 1)
|
$193.92 |
$193.92 |
$193.92 |
$120.25
|
|
Established Patient Office Visit (level 2)
|
$149.12 |
$149.12 |
$149.12 |
$132.72
|
|
Established Patient Office Visit (level 3)
|
$164.96 |
$164.96 |
$164.96 |
$183.00
|
|
Established Patient Office Visit (level 4)
|
$260.48 |
$260.48 |
$260.48 |
$231.75
|
|
Established Patient Office Visit (level 5)
|
$260.48 |
$260.48 |
$260.48 |
$280.33
|
|
Estradiol total
|
$147.84 |
$147.84 |
$147.84 |
$146.50
|
|
Ethanolamine oleate 100 mg
|
$1,540.24 |
$1,540.24 |
$1,540.24 |
$751.36
|
|
Eth estr and eton monthly
|
$537.72 |
$537.72 |
$537.72 |
$266.45
|
|
Etonogestrel implant system
|
$2,572.48 |
$2,572.48 |
$2,572.48 |
$2,081.30
|
|
Eval/fit voice prosthesis iii, st
|
$105.60 |
$105.60 |
$105.60 |
$356.00
|
|
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen
|
$160.00 |
$160.00 |
$160.00 |
$219.60
|
|
Evaluation of speech fluency 92521
|
$89.60 |
$89.60 |
$89.60 |
$311.50
|
|
Ex arm/elbow tum deep < 5 cm
|
$908.80 |
$908.80 |
$908.80 |
$3,386.84
|
|
Exc abd tum 5 cm or less 49203
|
$1,416.96 |
$1,416.96 |
$1,416.96 |
$5,487.53
|
|
Exc arm/elbo les sc <3cm 24075
|
$705.60 |
$705.60 |
$705.60 |
$2,413.45
|
|
Exc back les sbq <3 cm 21930
|
$630.40 |
$630.40 |
$630.40 |
$2,676.58
|
|
Exc benign tal 0.5 < cm 11400
|
$147.20 |
$147.20 |
$147.20 |
$827.40
|
|
Exc ben+marg excep skin tag feenlm <0.5cm 11440
|
$168.32 |
$168.32 |
$168.32 |
$914.34
|
|
Exc ben+marg excep skin tag snhfg 0.6-1cm 11421
|
$179.84 |
$179.84 |
$179.84 |
$1,372.15
|
|
Exc ben+marg excep skin tag snhfg 2.1-3cm 11423
|
$241.28 |
$241.28 |
$241.28 |
$2,166.78
|
|
Exc ben+marg excep skin tag tal 0.6-1cm 11401
|
$169.60 |
$169.60 |
$169.60 |
$765.50
|
|
Exc ben+marg excep skin tag tal 2.1-3/>cm 11403
|
$219.20 |
$219.20 |
$219.20 |
$1,247.50
|
|
Exc/crtg b1 cst/b9 tum rds
|
$735.20 |
$735.20 |
$735.20 |
$2,617.60
|
|
Exc face tum deep 2cm/> 21014
|
$910.40 |
$910.40 |
$910.40 |
$3,386.84
|
|
Exc feenl mal+mrg 0.6-1 11641
|
$280.00 |
$280.00 |
$280.00 |
$973.71
|
|
Exc hand les sc < 1.5 cm
|
$627.20 |
$627.20 |
$627.20 |
$1,897.50
|
|
Exchange drainage catheter
|
$824.38 |
$824.38 |
$824.38 |
$2,205.50
|
|
Exchange nephrostomy cath
|
$1,076.00 |
$1,076.00 |
$1,076.00 |
$2,958.80
|
|
Excise subq tumor/abd wall <3 cm 22902
|
$689.60 |
$689.60 |
$689.60 |
$2,623.00
|
|
Excise wrist tendon sheath
|
$741.76 |
$741.76 |
$741.76 |
$1,893.86
|
|
Excision benign lesion face/ears/eyelids/nose/lips/muc memb 0.6 - 1.0 cm
|
$197.12 |
$197.12 |
$197.12 |
$832.60
|
|
Excision benign lesion scalp/neck/hands/feet/genitalia 1.1 - 2.0 cm
|
$200.32 |
$200.32 |
$200.32 |
$1,973.12
|
|
Excision benign lesion trunk/arms/legs 1.1 - 2.0 cm
|
$192.00 |
$192.00 |
$192.00 |
$1,012.86
|
|
Excision benign lesion trunk/arms/legs > 4.0 cm
|
$316.80 |
$316.80 |
$316.80 |
$2,865.00
|
|
Excision breast lesion
|
$600.32 |
$600.32 |
$600.32 |
$3,749.85
|
|
Excision of anal lesion(s)
|
$320.80 |
$320.80 |
$320.80 |
$3,786.00
|
|
Excision olecranon bursa
|
$600.96 |
$600.96 |
$600.96 |
$2,889.60
|
|
Excision radial head
|
$896.80 |
$896.80 |
$896.80 |
$3,839.54
|
|
Excision tumor soft tissue back/flank subcutaneous >= 3 cm
|
$827.52 |
$827.52 |
$827.52 |
$3,650.40
|
|
Exc leg/ankle tum dep 5 cm/ > 27634
|
$402.11 |
$402.11 |
$402.11 |
$3,386.84
|
|
Exc malig feenl 1.1-2 11642
|
$328.00 |
$328.00 |
$328.00 |
$1,082.00
|
|
Exc malig tal 0.6-1.0cm 11601
|
$227.84 |
$227.84 |
$227.84 |
$832.60
|
|
Exc mal+marg tal 1.1-2 cm 11602
|
$245.76 |
$245.76 |
$245.76 |
$889.20
|
|
Exc mal+marg tal 2.1-3 cm 11603
|
$275.20 |
$275.20 |
$275.20 |
$1,131.50
|
|
Exc neck tum deep < 5 cm
|
$598.40 |
$598.40 |
$598.40 |
$3,501.81
|
|
Exc/pilonidal cyst/sinus/simple 11770
|
$296.32 |
$296.32 |
$296.32 |
$3,386.84
|
|
Exc rect tum transanal part
|
$826.24 |
$826.24 |
$826.24 |
$3,245.23
|
|
Exc shoulder tum deep < 5 cm
|
$964.80 |
$964.80 |
$964.80 |
$3,786.00
|
|
Exc skn hdrdnt ax smpl/ntrm
|
$705.28 |
$705.28 |
$705.28 |
$3,386.84
|
|
Exc snhfg mal+mrg 1.1-2 11622
|
$272.00 |
$272.00 |
$272.00 |
$1,274.00
|
|
Exc sq tum/leg or ankle area <3 cm 27618
|
$903.20 |
$903.20 |
$903.20 |
$2,310.40
|
|
Exc sq tum/neck/ant thorax 3cm/> 21552
|
$789.60 |
$789.60 |
$789.60 |
$4,576.00
|
|
Exc sq tum/neck or ant thorax <3cm 21555
|
$571.52 |
$571.52 |
$571.52 |
$3,322.80
|
|
Exc sq tumor/forearm/wrist/<3cm 25075
|
$694.40 |
$694.40 |
$694.40 |
$2,557.92
|
|
Exc sq tumor/leg/ankle 3cm/> 27632
|
$726.40 |
$726.40 |
$726.40 |
$3,994.09
|
|
Exc tendon sheath or cap lesion 26160
|
$977.92 |
$977.92 |
$977.92 |
$2,650.53
|
|
Exc thigh/knee les sc<3cm 27327
|
$815.36 |
$815.36 |
$815.36 |
$3,188.10
|
|
Exc thigh/knee tum dep 5cm/>
|
$1,328.00 |
$1,328.00 |
$1,328.00 |
$3,520.00
|
|
Exc thrombosed hemorrhoid 46320
|
$1,640.96 |
$1,640.96 |
$1,640.96 |
$2,099.00
|
|
Exc tmr sft tiss shldr subq <3cm
|
$506.24 |
$506.24 |
$506.24 |
$2,448.00
|
|
Exc tr-ext mal+marg tal >4 cm 11606
|
$389.76 |
$389.76 |
$389.76 |
$1,917.33
|
|
Explore penetrating wnd/extremity 20103
|
$1,686.46 |
$1,686.46 |
$1,686.46 |
$1,788.80
|
|
Explore/treat finger joint
|
$591.20 |
$591.20 |
$591.20 |
$2,146.20
|
|
Explore/treat knee joint
|
$719.36 |
$719.36 |
$719.36 |
$3,839.54
|
|
Explore wound abdomen 20102
|
$2,593.92 |
$2,593.92 |
$2,593.92 |
$2,568.80
|
|
Explore wound neck 20100
|
$816.00 |
$816.00 |
$816.00 |
$1,185.00
|
|
Ex sq tumor/face or scalp < 2 cm 21011
|
$293.12 |
$293.12 |
$293.12 |
$2,286.96
|
|
Ext ecg>48hr<7d rev&interpj
|
$25.60 |
$25.60 |
$25.60 |
$57.00
|
|
Ext ecg>7d<15d rev&interpj
|
$28.16 |
$28.16 |
$28.16 |
$63.20
|
|
Extractable nuclear antigen/antibody any method each antibody centromere
|
$76.80 |
$76.80 |
$76.80 |
$108.60
|
|
Fat/lipids feces qualitative
|
$53.76 |
$53.76 |
$53.76 |
$38.35
|
|
Ferric carboxymaltose 50 mg iron/ml intravenous solution
|
$3,717.23 |
$3,717.23 |
$3,717.23 |
$2,590.25
|
|
Ferritin
|
$48.00 |
$48.00 |
$48.00 |
$100.94
|
|
Fetal fibronectin
|
$288.00 |
$288.00 |
$288.00 |
$373.41
|
|
Fetal hemoglobin rosette
|
$24.96 |
$24.96 |
$24.96 |
$67.20
|
|
Fetal non stress test
|
$220.80 |
$220.80 |
$220.80 |
$463.03
|
|
Fibrin degradation products
|
$26.88 |
$26.88 |
$26.88 |
$62.64
|
|
Fibrin degrade semiquant
|
$38.40 |
$38.40 |
$38.40 |
$78.09
|
|
Filgrastim in d5w IV syringe 20 mcg/ml (neo) - cnr
|
$1,132.88 |
$1,132.88 |
$1,132.88 |
$1,096.24
|
|
Filgrastim-sndz 300 mcg/0.5 ml injection syringe
|
$1,375.53 |
$1,375.53 |
$1,375.53 |
$869.18
|
|
Fine needle asp without image guide 10021
|
$526.08 |
$526.08 |
$526.08 |
$503.76
|
|
Fixation of knee joint
|
$281.60 |
$281.60 |
$281.60 |
$1,893.86
|
|
Fixtn pq skel dstl rad fx/epiphysl sep
|
$1,032.80 |
$1,032.80 |
$1,032.80 |
$4,242.15
|
|
Flexible Sigmoidoscopy
|
$128.00 |
$128.00 |
$128.00 |
$1,284.13
|
|
Flow cytometry one marker technical component
|
$197.12 |
$197.12 |
$197.12 |
$284.40
|
|
Fluidotherapy charges pt
|
$56.96 |
$56.96 |
$56.96 |
$91.00
|
|
Fluid pressure muscle 20950
|
$970.24 |
$970.24 |
$970.24 |
$768.94
|
|
Fluorescent antibody titer dna
|
$83.52 |
$83.52 |
$83.52 |
$122.82
|
|
Fluoroguide for spine inject 77003-26
|
$115.20 |
$115.20 |
$115.20 |
$496.03
|
|
Fluoroguide needle placement
|
$102.40 |
$102.40 |
$102.40 |
$510.00
|
|
Fluoroscopy up to 1 hour
|
$155.84 |
$155.84 |
$155.84 |
$492.00
|
|
Fna bx w/ct gdn 1st les
|
$896.00 |
$896.00 |
$896.00 |
$1,420.80
|
|
Folic acid
|
$40.32 |
$40.32 |
$40.32 |
$101.50
|
|
Fomepizole 1 gram/ml intravenous solution
|
$3,744.00 |
$3,744.00 |
$3,744.00 |
$2,581.14
|
|
Foot X-ray
|
$105.60 |
$105.60 |
$105.60 |
$362.40
|
|
Foreskn manip w/lss preputial ads+stretching 54450
|
$387.84 |
$387.84 |
$387.84 |
$532.80
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$435.96 |
$435.96 |
$435.96 |
$106.10
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$224.00 |
$224.00 |
$224.00 |
$156.60
|
|
Full thick gft/scalp/arm/leg/20sqcm or< 15220
|
$876.00 |
$876.00 |
$876.00 |
$2,469.00
|
