|
Established Patient Office Visit (level 4)
|
$170.95 |
$170.95 |
$170.95 |
$213.21
|
|
Established Patient Office Visit (level 5)
|
$226.85 |
$226.85 |
$226.85 |
$270.09
|
|
Estradiol total
|
$137.15 |
$137.15 |
$137.15 |
$142.20
|
|
Ethylene glycol -sendout
|
$108.55 |
$108.55 |
$108.55 |
$81.25
|
|
Eval/fit voice prosthesis iii, st
|
$321.75 |
$321.75 |
$321.75 |
$384.94
|
|
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen
|
$172.25 |
$172.25 |
$172.25 |
$219.60
|
|
Exercise tst brncspsm w/ecg
|
$239.20 |
$239.20 |
$239.20 |
$297.73
|
|
External chromosome analysis 20-25 cells
|
$376.35 |
$376.35 |
$376.35 |
$457.50
|
|
External tissue culture neoplastic disorders bone marrow/blood cells
|
$295.10 |
$295.10 |
$295.10 |
$569.60
|
|
Extractable nuclear antigen/antibody any method each antibody centromere
|
$111.80 |
$111.80 |
$111.80 |
$102.50
|
|
Facial bones <3
|
$251.55 |
$251.55 |
$251.55 |
$216.45
|
|
Factor ix
|
$139.75 |
$139.75 |
$139.75 |
$139.75
|
|
Factor viii
|
$138.45 |
$138.45 |
$138.45 |
$152.50
|
|
Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr
|
$7.15 |
$7.15 |
$7.15 |
$7.15
|
|
Fatty acids nonesterified
|
$79.30 |
$79.30 |
$79.30 |
$64.28
|
|
#fecal-sodium
|
$39.65 |
$39.65 |
$39.65 |
$40.30
|
|
Felbamate (felbatol(r)) - sendout
|
$119.60 |
$119.60 |
$119.60 |
$83.85
|
|
Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper)
|
$25.56 |
$25.56 |
$25.56 |
$48.88
|
|
Ferritin
|
$92.30 |
$92.30 |
$92.30 |
$86.45
|
|
Fetal chrom aneuploidy gsa panel
|
$1,140.10 |
$1,140.10 |
$1,140.10 |
$1,231.20
|
|
Fetal fibronectin
|
$354.25 |
$354.25 |
$354.25 |
$309.40
|
|
Fetal hemoglobin (kleihauer betke)
|
$113.75 |
$113.75 |
$113.75 |
$59.85
|
|
Fibrin degradation d dimer quantitative
|
$114.40 |
$114.40 |
$114.40 |
$87.60
|
|
Fibrinogen activity
|
$89.05 |
$89.05 |
$89.05 |
$61.80
|
|
Fibrinolysins/coagulopathy screen interpretation/report
|
$53.95 |
$53.95 |
$53.95 |
$69.55
|
|
Fibrinolytic antiplasmin
|
$69.55 |
$69.55 |
$69.55 |
$68.40
|
|
Fibrinolytic plasminogen
|
$75.40 |
$75.40 |
$75.40 |
$120.00
|
|
Fibrinolytic plasminogen xcpt antgnc asa
|
$86.45 |
$86.45 |
$86.45 |
$70.80
|
|
Filgrastim in d5w IV syringe 20 mcg/ml (neo) - cnr
|
$889.33 |
$889.33 |
$889.33 |
$1,223.60
|
|
Finasteride, 5 mg
|
$4.87 |
$4.87 |
$4.87 |
$4.87
|
|
Flecainide (tambocor)-sendout
|
$130.00 |
$130.00 |
$130.00 |
$86.40
|
|
Flow cytometry marker each additional
|
$100.10 |
$100.10 |
$100.10 |
$103.00
|
|
Flow cytometry one marker technical component
|
$229.45 |
$229.45 |
$229.45 |
$304.43
|
|
#flow interp 9 - 15 markers
|
$189.15 |
$189.15 |
$189.15 |
$202.15
|
|
Flt3 gene
|
$421.20 |
$421.20 |
$421.20 |
$355.00
|
|
Flt3 gene analysis
|
$460.85 |
$460.85 |
$460.85 |
$262.80
|
|
Fluidotherapy charges pt
|
$101.40 |
$101.40 |
$101.40 |
$101.40
|
|
Fluorescent antibody titer dna
|
$137.80 |
$137.80 |
$137.80 |
$123.65
|
|
Folic acid
|
$81.90 |
$81.90 |
$81.90 |
$85.50
|
|
Folic acid 5 mg/ml injection solution
|
$355.19 |
$355.19 |
$355.19 |
$3.00
|
|
Foot X-ray
|
$304.20 |
$304.20 |
$304.20 |
$339.50
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$208.00 |
$208.00 |
$208.00 |
$217.30
|
|
Fructosamine glycated protein
|
$63.05 |
$63.05 |
$63.05 |
$69.55
|
|
Ftl cgen abnor four anal
|
$200.85 |
$200.85 |
$200.85 |
$267.15
|
|
Furosemide 10 mg/ml injection solution
|
$7.15 |
$7.15 |
$7.15 |
$7.15
|
|
Galac-1-phosphate uridyltran - sendout
|
$151.45 |
$151.45 |
$151.45 |
$85.50
|
|
Gammaglobulin iga
|
$98.80 |
$98.80 |
$98.80 |
$78.60
|
|
Gammaglobulin ige
|
$87.10 |
$87.10 |
$87.10 |
$87.10
|
|
Gamma glutamyltransferase
|
$63.70 |
$63.70 |
$63.70 |
$54.60
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$34.27 |
$34.27 |
$34.27 |
$30.76
|
|
Gentamicin peak therapeutic drug level
|
$84.50 |
$84.50 |
$84.50 |
$114.00
|
|
Ghs abscess perianal iandd
|
$399.10 |
$399.10 |
$399.10 |
$1,512.80
|
|
Ghs acetylcholinesterase, rbc
|
$59.15 |
$59.15 |
$59.15 |
$44.20
|
|
Ghs antibodies (torch) igm
|
$79.95 |
$79.95 |
$79.95 |
$82.50
|
|
Ghs bladder cath - complex-foley
|
$330.20 |
$330.20 |
$330.20 |
$333.18
|
|
Ghs change cysto/gastrost
|
$286.00 |
$286.00 |
$286.00 |
$727.35
|
|
Ghs chlamydia pneumoniae by pcr (arup) (306630)
|
$133.25 |
$133.25 |
$133.25 |
$135.85
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$437.45 |
$437.45 |
$437.45 |
$540.80
|
|
Ghs closed reduction ankle dislocation
|
$777.40 |
$777.40 |
$777.40 |
$720.00
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$930.80 |
$930.80 |
$930.80 |
$1,655.78
|
|
Ghs closed tx radiocarpal disloc w manip
|
$653.90 |
$653.90 |
$653.90 |
$534.99
|
|
Ghs closed tx tibial fracture w/manip
|
$1,363.70 |
$1,363.70 |
$1,363.70 |
$2,275.20
|
|
Ghs clsd red med malleolus fx without manip
|
$589.55 |
$589.55 |
$589.55 |
$581.60
|
|
Ghs cl tx metacarpophal disloc without anes
|
$622.05 |
$622.05 |
$622.05 |
$544.70
|
|
Ghs conjunctiva foreign body-superf bil
|
$105.95 |
$105.95 |
$105.95 |
$278.00
|
|
Ghs corneal fb without slit lamp bilat
|
$200.85 |
$200.85 |
$200.85 |
$422.25
|
|
Ghs corneal fb with slit lamp bilat
|
$157.30 |
$157.30 |
$157.30 |
$362.21
|
|
Ghs dislocation elbow closed treatment
|
$683.80 |
$683.80 |
$683.80 |
$687.73
|
|
Ghs excision ingrown nail
|
$175.50 |
$175.50 |
$175.50 |
$436.80
|
|
Ghs eyelid foreign body-embedded - bil
|
$310.05 |
$310.05 |
$310.05 |
$585.60
|
|
Ghs fb removal - incisional
|
$500.50 |
$500.50 |
$500.50 |
$2,454.00
|
|
Ghs fish cytogen
|
$266.50 |
$266.50 |
$266.50 |
$173.40
|
|
Ghs fish hybrid in situ 100-300
|
$126.10 |
$126.10 |
$126.10 |
$229.45
|
|
Ghs flow volume loop
|
$275.60 |
$275.60 |
$275.60 |
$291.75
|
|
Ghs gastric intub aspiration lavage
|
$286.00 |
$286.00 |
$286.00 |
$385.60
|
|
Ghs hgb stability-thal
|
$82.55 |
$82.55 |
$82.55 |
$85.20
|
|
Ghs histoplasma antigen
|
$176.80 |
$176.80 |
$176.80 |
$157.30
|
|
Ghs HIV antibody
|
$87.75 |
$87.75 |
$87.75 |
$90.14
|
|
Ghs i and d pilonidal cyst complex
|
$557.05 |
$557.05 |
$557.05 |
$1,468.35
|
|
Ghs i and d pilonidal cyst simple
|
$267.15 |
$267.15 |
$267.15 |
$762.75
|
|
Ghs immun0electrophoresis
|
$131.95 |
$131.95 |
$131.95 |
$110.00
|
|
Ghs inhibitor screen
|
$167.05 |
$167.05 |
$167.05 |
$138.06
|
|
Ghs init tx 1st degree burn
|
$117.65 |
$117.65 |
$117.65 |
$295.00
|
|
Ghs insertion of needle - bone
|
$221.00 |
$221.00 |
$221.00 |
$436.10
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$613.60 |
$613.60 |
$613.60 |
$876.00
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$399.10 |
$399.10 |
$399.10 |
$558.97
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$382.20 |
$382.20 |
$382.20 |
$573.60
|
|
Ghs layer closure 2.5cm or less - 12051
|
$458.25 |
$458.25 |
$458.25 |
$610.40
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$433.55 |
$433.55 |
$433.55 |
$675.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$433.55 |
$433.55 |
$433.55 |
$738.40
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$586.30 |
$586.30 |
$586.30 |
$741.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$573.30 |
$573.30 |
$573.30 |
$795.20
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$542.75 |
$542.75 |
$542.75 |
$740.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$703.95 |
$703.95 |
$703.95 |
$740.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$707.85 |
$707.85 |
$707.85 |
$779.35
|
|
Ghs mbp
|
$115.05 |
$115.05 |
$115.05 |
$97.20
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$180.70 |
$180.70 |
$180.70 |
$240.00
|
|
Ghs moderate sedation ea addtl 15 min
|
$167.70 |
$167.70 |
$167.70 |
$125.34
|
|
Ghs nailbed repair/nail removal
|
$444.60 |
$444.60 |
$444.60 |
$818.00
|
|
Ghs ot dds rom
|
$56.55 |
$56.55 |
$56.55 |
$53.01
|
