|
ER Visit (level 5, high severity)
|
$3,073.60 |
$3,073.60 |
$3,073.60 |
$1,844.80
|
|
Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr
|
$553.60 |
$553.60 |
$553.60 |
$223.99
|
|
Esmolol 2,500 mg/250 ml (10 mg/ml) IV wrapper osm only
|
$642.00 |
$642.00 |
$642.00 |
$521.65
|
|
Established Patient Office Visit (level 1)
|
$460.00 |
$460.00 |
$460.00 |
$122.40
|
|
Established Patient Office Visit (level 2)
|
$675.20 |
$675.20 |
$675.20 |
$138.82
|
|
Established Patient Office Visit (level 3)
|
$868.00 |
$868.00 |
$868.00 |
$186.60
|
|
Established Patient Office Visit (level 4)
|
$1,034.40 |
$1,034.40 |
$1,034.40 |
$235.00
|
|
Established Patient Office Visit (level 5)
|
$1,136.00 |
$1,136.00 |
$1,136.00 |
$287.10
|
|
Estradiol total
|
$116.80 |
$116.80 |
$116.80 |
$149.43
|
|
Estrogens total-sendout
|
$90.40 |
$90.40 |
$90.40 |
$96.63
|
|
Ethylene glycol -sendout
|
$62.40 |
$62.40 |
$62.40 |
$85.00
|
|
Etonogestrel implant system
|
$4,771.20 |
$4,771.20 |
$4,771.20 |
$2,071.74
|
|
Evaluation of speech fluency 92521
|
$412.80 |
$412.80 |
$412.80 |
$307.75
|
|
Event monitor
|
$228.00 |
$228.00 |
$228.00 |
$237.60
|
|
Evoked potentials auditory screening automated analysis
|
$77.60 |
$77.60 |
$77.60 |
$259.20
|
|
Exchange biliary drg cath
|
$6,028.00 |
$6,028.00 |
$6,028.00 |
$3,797.76
|
|
Exchange drainage catheter
|
$2,845.60 |
$2,845.60 |
$2,845.60 |
$2,191.20
|
|
Exchange nephrostomy cath
|
$3,552.80 |
$3,552.80 |
$3,552.80 |
$2,958.80
|
|
Expander breast 300cc mod hght extra proj smth natrelle
|
$1,443.72 |
$1,443.72 |
$1,443.72 |
$2,421.09
|
|
External chromosome analysis 20-25 cells
|
$601.60 |
$601.60 |
$601.60 |
$403.00
|
|
External tissue culture neoplastic disorders bone marrow/blood cells
|
$604.00 |
$604.00 |
$604.00 |
$445.60
|
|
Extractable nuclear antigen/antibody any method each antibody centromere
|
$75.20 |
$75.20 |
$75.20 |
$109.00
|
|
F-18 fdg pet diag
|
$1,481.60 |
$1,481.60 |
$1,481.60 |
$551.72
|
|
Factor ix
|
$111.20 |
$111.20 |
$111.20 |
$154.50
|
|
Factor ix recombinant nos
|
$3,835.80 |
$3,835.80 |
$3,835.80 |
$4.65
|
|
Factor viii
|
$448.00 |
$448.00 |
$448.00 |
$144.82
|
|
Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr
|
$13.80 |
$13.80 |
$13.80 |
$22.23
|
|
Fat/lipids feces qualitative
|
$21.60 |
$21.60 |
$21.60 |
$36.00
|
|
Fatty acids nonesterified
|
$78.40 |
$78.40 |
$78.40 |
$64.28
|
|
#fecal-sodium
|
$19.20 |
$19.20 |
$19.20 |
$37.50
|
|
Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper)
|
$290.80 |
$290.80 |
$290.80 |
$101.40
|
|
Ferritin
|
$40.00 |
$40.00 |
$40.00 |
$102.07
|
|
Fetal biophys profile w/nst 76818
|
$864.80 |
$864.80 |
$864.80 |
$541.74
|
|
Fetal hemoglobin (kleihauer betke)
|
$84.00 |
$84.00 |
$84.00 |
$104.00
|
|
Fetal hemoglobin rosette
|
$39.20 |
$39.20 |
$39.20 |
$67.20
|
|
Fetal non stress test
|
$490.40 |
$490.40 |
$490.40 |
$478.50
|
|
Fibrin degradation d dimer quantitative
|
$115.20 |
$115.20 |
$115.20 |
$120.05
|
|
Fibrin degradation products
|
$87.20 |
$87.20 |
$87.20 |
$74.25
|
|
Fibrinogen activity
|
$81.60 |
$81.60 |
$81.60 |
$85.86
|
|
Fine needle aspiration biopsy w/us gdn; ea addtl 10006
|
$1,301.60 |
$1,301.60 |
$1,301.60 |
$823.90
|
|
Flecainide (tambocor)-sendout
|
$77.60 |
$77.60 |
$77.60 |
$65.24
|
|
Flow cytometry marker each additional
|
$129.60 |
$129.60 |
$129.60 |
$97.50
|
|
Flow cytometry one marker technical component
|
$129.60 |
$129.60 |
$129.60 |
$276.60
|
|
Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback
|
$77.40 |
$77.40 |
$77.40 |
$64.15
|
|
Fluidotherapy charges pt
|
$216.80 |
$216.80 |
$216.80 |
$98.40
|
|
Fluorescent antibody titer dna
|
$49.60 |
$49.60 |
$49.60 |
$123.65
|
|
Fluoroguide for spine inject 77003-26
|
$1,244.00 |
$1,244.00 |
$1,244.00 |
$495.95
|
|
Fluoroguide needle placement
|
$1,275.20 |
$1,275.20 |
$1,275.20 |
$497.20
|
|
Fluoroscopy up to 1 hour
|
$659.20 |
$659.20 |
$659.20 |
$497.40
|
|
Fna bx w/ct gdn 1st les
|
$1,301.60 |
$1,301.60 |
$1,301.60 |
$1,427.65
|
|
Folic acid
|
$45.00 |
$45.00 |
$45.00 |
$99.96
|
|
Folic acid 5 mg/ml injection solution
|
$177.00 |
$177.00 |
$177.00 |
$50.70
|
|
Fondaparinux sodium
|
$230.80 |
$230.80 |
$230.80 |
$186.87
|
|
Fo nontorsion joint cf
|
$127.20 |
$127.20 |
$127.20 |
$217.50
|
|
Foot X-ray
|
$348.00 |
$348.00 |
$348.00 |
$352.08
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$167.20 |
$167.20 |
$167.20 |
$490.67
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$130.60 |
$130.60 |
$130.60 |
$106.25
|
|
Frenectomy 41115
|
$2,520.80 |
$2,520.80 |
$2,520.80 |
$1,939.47
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$580.00 |
$580.00 |
$580.00 |
$164.16
|
|
Fructosamine glycated protein
|
$69.60 |
$69.60 |
$69.60 |
$61.75
|
|
Ftl cgen abnor four anal
|
$639.20 |
$639.20 |
$639.20 |
$205.80
|
|
Furosemide 10 mg/ml injection solution
|
$19.60 |
$19.60 |
$19.60 |
$19.53
|
|
Fxn gene detc abnor alleles
|
$569.60 |
$569.60 |
$569.60 |
$200.88
|
|
Fxn gene full gene sequence
|
$1,143.20 |
$1,143.20 |
$1,143.20 |
$379.27
|
|
Ga-68 gallium 68 dotatate
|
$358.40 |
$358.40 |
$358.40 |
$139.70
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$13.60 |
$13.60 |
$13.60 |
$107.11
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$46.40 |
$46.40 |
$46.40 |
$249.80
|
|
Gallium illuccix 1 millicure
|
$2,760.80 |
$2,760.80 |
$2,760.80 |
$2,046.76
|
|
Gammaglobulin iga
|
$35.00 |
$35.00 |
$35.00 |
$69.42
|
|
Gammaglobulin ige
|
$68.00 |
$68.00 |
$68.00 |
$83.40
|
|
Gamma glutamyltransferase
|
$29.60 |
$29.60 |
$29.60 |
$57.54
|
|
Gamunex-c/gammaked
|
$5,234.60 |
$5,234.60 |
$5,234.60 |
$7,435.88
|
|
Gauze >16<=48 no w/sal without b
|
$52.00 |
$52.00 |
$52.00 |
$5.00
|
|
General health panel
|
$70.00 |
$70.00 |
$70.00 |
$262.44
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$41.60 |
$41.60 |
$41.60 |
$53.78
|
|
Gentamicin peak therapeutic drug level
|
$68.00 |
$68.00 |
$68.00 |
$123.84
|
|
Ghs abscess perianal iandd
|
$5,424.80 |
$5,424.80 |
$5,424.80 |
$1,452.00
|
|
Ghs bladder cath - complex-foley
|
$651.20 |
$651.20 |
$651.20 |
$343.68
|
|
Ghs block ilioinguinal/gentitofemoral
|
$2,204.00 |
$2,204.00 |
$2,204.00 |
$1,045.65
|
|
Ghs change cysto/gastrost
|
$1,094.40 |
$1,094.40 |
$1,094.40 |
$594.55
|
|
Ghs chlamydia pneumoniae by pcr (arup) (306630)
|
$145.60 |
$145.60 |
$145.60 |
$133.00
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$1,780.80 |
$1,780.80 |
$1,780.80 |
$510.40
|
|
Ghs closed reduction ankle dislocation
|
$1,000.00 |
$1,000.00 |
$1,000.00 |
$677.25
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$1,165.60 |
$1,165.60 |
$1,165.60 |
$1,554.70
|
|
Ghs clsd tx frac distal tibia w/manipulation
|
$7,144.80 |
$7,144.80 |
$7,144.80 |
$2,319.00
|
|
Ghs cl tx knee disl; wo anesth
|
$1,556.00 |
$1,556.00 |
$1,556.00 |
$578.00
|
|
Ghs community re-entry 15 minutes
|
$176.00 |
$176.00 |
$176.00 |
$89.00
|
|
Ghs corneal fb without slit lamp bilat
|
$1,024.80 |
$1,024.80 |
$1,024.80 |
$422.25
|
|
Ghs corneal fb with slit lamp bilat
|
$606.40 |
$606.40 |
$606.40 |
$339.60
|
|
Ghs diphtheria toxoid ab igg
|
$63.20 |
$63.20 |
$63.20 |
$55.02
|
|
Ghs dislocation elbow closed treatment
|
$512.00 |
$512.00 |
$512.00 |
$583.80
|
|
Ghs eeg cont rec w/video by tec min 8 chnls
|
$2,904.00 |
$2,904.00 |
$2,904.00 |
$560.00
|
|
Ghs fish cytogen
|
$92.80 |
$92.80 |
$92.80 |
$173.40
|
|
Ghs flow volume loop
|
$912.80 |
$912.80 |
$912.80 |
$308.69
|
|
Ghs gastric intub aspiration lavage
|
$456.00 |
$456.00 |
$456.00 |
$365.40
|
|
Ghs histoplasma antigen
|
$55.20 |
$55.20 |
$55.20 |
$141.00
|
|
Ghs i and d pilonidal cyst complex
|
$6,002.40 |
$6,002.40 |
$6,002.40 |
$1,402.80
|
|
Ghs i and d pilonidal cyst simple
|
$1,149.60 |
$1,149.60 |
$1,149.60 |
$696.80
|
|
Ghs incision thrombosed ext hemorrhoid
|
$2,182.40 |
$2,182.40 |
$2,182.40 |
$520.80
|
|
Ghs inf midline insertion
|
$582.40 |
$582.40 |
$582.40 |
$1,219.20
|
