|
ER Visit (level 3)
|
$1,740.80 |
$1,740.80 |
$1,740.80 |
$793.20
|
|
ER Visit (level 4)
|
$2,678.40 |
$2,678.40 |
$2,678.40 |
$1,277.65
|
|
ER Visit (level 5, high severity)
|
$2,981.60 |
$2,981.60 |
$2,981.60 |
$1,844.80
|
|
Esmolol 2,500 mg/250 ml (10 mg/ml) IV wrapper osm only
|
$38.00 |
$38.00 |
$38.00 |
$521.65
|
|
Established Patient Office Visit (level 1)
|
$61.60 |
$61.60 |
$61.60 |
$122.40
|
|
Established Patient Office Visit (level 3)
|
$113.60 |
$113.60 |
$113.60 |
$186.60
|
|
Established Patient Office Visit (level 4)
|
$168.00 |
$168.00 |
$168.00 |
$235.00
|
|
Established Patient Office Visit (level 5)
|
$206.40 |
$206.40 |
$206.40 |
$287.10
|
|
Ethylene glycol -sendout
|
$62.40 |
$62.40 |
$62.40 |
$85.00
|
|
Eval/fit voice prosthesis iii, st
|
$373.60 |
$373.60 |
$373.60 |
$356.00
|
|
Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr
|
$28.60 |
$28.60 |
$28.60 |
$22.23
|
|
Fat/lipids feces qualitative
|
$21.60 |
$21.60 |
$21.60 |
$36.00
|
|
Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper)
|
$30.60 |
$30.60 |
$30.60 |
$101.40
|
|
Ferritin
|
$40.00 |
$40.00 |
$40.00 |
$102.07
|
|
Fibrin degradation d dimer quantitative
|
$50.40 |
$50.40 |
$50.40 |
$120.05
|
|
Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback
|
$71.00 |
$71.00 |
$71.00 |
$64.15
|
|
Fluoroguide needle placement
|
$641.60 |
$641.60 |
$641.60 |
$497.20
|
|
Fluoroscopy up to 1 hour
|
$534.40 |
$534.40 |
$534.40 |
$497.40
|
|
Folic acid
|
$45.00 |
$45.00 |
$45.00 |
$99.96
|
|
Folic acid 5 mg/ml injection solution
|
$185.80 |
$185.80 |
$185.80 |
$50.70
|
|
Fondaparinux sodium
|
$75.40 |
$75.40 |
$75.40 |
$186.87
|
|
Foot X-ray
|
$290.40 |
$290.40 |
$290.40 |
$352.08
|
|
Furosemide 10 mg/ml injection solution
|
$44.00 |
$44.00 |
$44.00 |
$19.53
|
|
Gammaglobulin iga
|
$35.00 |
$35.00 |
$35.00 |
$69.42
|
|
Gamma glutamyltransferase
|
$29.60 |
$29.60 |
$29.60 |
$57.54
|
|
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr
|
$245.60 |
$245.60 |
$245.60 |
$197.40
|
|
General health panel
|
$70.00 |
$70.00 |
$70.00 |
$262.44
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$16.80 |
$16.80 |
$16.80 |
$53.78
|
|
Ghs community re-entry 15 minutes
|
$126.40 |
$126.40 |
$126.40 |
$89.00
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$188.80 |
$188.80 |
$188.80 |
$230.55
|
|
Ghs moderate sedation ea addtl 15 min
|
$179.20 |
$179.20 |
$179.20 |
$150.00
|
|
Ghs ot prosthetic training/15 min
|
$118.40 |
$118.40 |
$118.40 |
$92.35
|
|
Ghs ot sensory integrative tech/15min
|
$120.80 |
$120.80 |
$120.80 |
$96.00
|
|
Ghs ppd (tb intradermal)
|
$104.80 |
$104.80 |
$104.80 |
$37.44
|
|
Ghs protoporphyrins fract
|
$60.00 |
$60.00 |
$60.00 |
$60.75
|
|
Ghs sensitivity (per antimicro)
|
$30.40 |
$30.40 |
$30.40 |
$56.40
|
|
Ghs sp train/fitting sp device - kx
|
$263.20 |
$263.20 |
$263.20 |
$249.60
|
|
Ghs st - re-eval for alt comm
|
$737.60 |
$737.60 |
$737.60 |
$309.00
|
|
Gi inhouse confirmation
|
$38.40 |
$38.40 |
$38.40 |
$86.40
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$1,624.60 |
$1,624.60 |
$1,624.60 |
$491.67
|
|
Glucose blood quantitative
|
$16.00 |
$16.00 |
$16.00 |
$41.40
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$31.20 |
$31.20 |
$31.20 |
$37.16
|
|
Guided cath fluid drainage 10030
|
$1,156.00 |
$1,156.00 |
$1,156.00 |
$1,327.76
|
|
Guid loc target vol rad tx
|
$875.20 |
$875.20 |
$875.20 |
$535.60
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$25.80 |
$25.80 |
$25.80 |
$24.41
|
|
Handle/convey/speciman/office-lab 99000
|
$28.00 |
$28.00 |
$28.00 |
$23.30
|
|
Hand X-ray
|
$296.80 |
$296.80 |
$296.80 |
$345.87
|
|
Haptoglobin quantitative
|
$45.00 |
$45.00 |
$45.00 |
$91.80
|
|
Hcg quantitative
|
$55.00 |
$55.00 |
$55.00 |
$137.15
|
|
Head CT scan (without contrast)
|
$296.00 |
$296.00 |
$296.00 |
$1,268.90
|
|
Hematocrit
|
$13.60 |
$13.60 |
$13.60 |
$33.57
|
|
Hemodialysis one evaluation
|
$516.00 |
$516.00 |
$516.00 |
$1,338.00
|
|
Hemoglobin
|
$13.60 |
$13.60 |
$13.60 |
$32.76
|
|
Hemoglobin plasma
|
$30.40 |
$30.40 |
$30.40 |
$41.25
|
|
Heparin assay
|
$94.40 |
$94.40 |
$94.40 |
$138.84
|
|
Heparin bolus from bag
|
$68.00 |
$68.00 |
$68.00 |
$68.00
|
|
Hepatitis b core antibody igm
|
$48.80 |
$48.80 |
$48.80 |
$88.80
|
|
Hepatitis b core antibody total
|
$49.60 |
$49.60 |
$49.60 |
$77.50
|
|
Hepatitis b surface antibody
|
$44.80 |
$44.80 |
$44.80 |
$81.12
|
|
Hepatitis c antibody
|
$55.00 |
$55.00 |
$55.00 |
$108.00
|
|
Hip X-ray
|
$344.80 |
$344.80 |
$344.80 |
$296.05
|
|
Homogenization tissue
|
$24.00 |
$24.00 |
$24.00 |
$41.00
|
|
Hydralazine 20 mg/ml injection solution
|
$136.40 |
$136.40 |
$136.40 |
$46.74
|
|
Hydrocortisone in ns IV syringe 1 mg/ml (neo/ped) - cnr
|
$218.80 |
$218.80 |
$218.80 |
$153.08
|
|
Hydromorphone 0.2 mg/ml in 0.9% nacl IV pca opioid naive - 4 hr dose limit (wrapper)
|
$59.20 |
$59.20 |
$59.20 |
$120.72
|
|
Hydromorphone 20-0.9 mg/100ml-% soln 100 ml cartridge
|
$126.20 |
$126.20 |
$126.20 |
$294.92
|
|
Hydroxyurea 500 mg
|
$2.20 |
$2.20 |
$2.20 |
$13.02
|
|
Ihc/icc per specimen each additional single antibody stain
|
$198.40 |
$198.40 |
$198.40 |
$191.52
|
|
Ihc/icc per specimen initial single antibody stain
|
$253.60 |
$253.60 |
$253.60 |
$272.30
|
|
Immobilizer shldr dlx str 24-36in med
|
$57.35 |
$57.35 |
$57.35 |
$114.60
|
|
Immunofixation electrophoresis serum
|
$92.80 |
$92.80 |
$92.80 |
$142.50
|
|
In-111 autol wbc diag per dose
|
$6,836.00 |
$6,836.00 |
$6,836.00 |
$3,523.65
|
|
Incision of achilles tendon
|
$1,291.20 |
$1,291.20 |
$1,291.20 |
$3,172.80
|
|
Incision of foot fascia
|
$2,590.40 |
$2,590.40 |
$2,590.40 |
$4,570.33
|
|
Incision of hip tendons
|
$2,590.40 |
$2,590.40 |
$2,590.40 |
$3,839.54
|
|
Incision of tendon & muscle
|
$5,725.60 |
$5,725.60 |
$5,725.60 |
$5,624.45
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$60.00 |
$60.00 |
$60.00 |
$100.02
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$42.40 |
$42.40 |
$42.40 |
$81.20
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$48.80 |
$48.80 |
$48.80 |
$129.00
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$48.80 |
$48.80 |
$48.80 |
$55.31
|
|
Infectious agent nucleic acid amplified probe
|
$143.20 |
$143.20 |
$143.20 |
$276.90
|
|
Infectious agent nucleic acid amplified probe chlamydia trachomatis
|
$147.20 |
$147.20 |
$147.20 |
$139.68
|
|
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s)
|
$152.00 |
$152.00 |
$152.00 |
$167.00
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$145.60 |
$145.60 |
$145.60 |
$179.92
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$140.00 |
$140.00 |
$140.00 |
$147.55
|
|
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae
|
$147.20 |
$147.20 |
$147.20 |
$136.03
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$100.00 |
$100.00 |
$100.00 |
$103.20
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv
|
$100.00 |
$100.00 |
$100.00 |
$236.08
|
|
Infectious agent nucleic acid amplified probe streptococcus group a
|
$122.40 |
$122.40 |
$122.40 |
$92.50
|
|
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets
|
$515.20 |
$515.20 |
$515.20 |
$727.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$178.40 |
$178.40 |
$178.40 |
$252.00
|
|
Infectious agent nucleic acid quantification hiv-1
|
$354.40 |
$354.40 |
$354.40 |
$374.00
|
|
Initiation & management bipap/cpap initial day
|
$1,171.20 |
$1,171.20 |
$1,171.20 |
$576.00
|
|
Inj, bupivacaine liposome
|
$1,345.20 |
$1,345.20 |
$1,345.20 |
$699.38
|
|
Inj cefazolin sodium, hikma
|
$71.20 |
$71.20 |
$71.20 |
$28.08
|
|
Injection for bladder x-ray
|
$653.60 |
$653.60 |
$653.60 |
$459.20
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$147.20 |
$147.20 |
$147.20 |
$166.38
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$147.20 |
$147.20 |
$147.20 |
$249.32
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$113.60 |
$113.60 |
$113.60 |
$135.60
|
|
Inj, lidocaine w epinephrine
|
$99.40 |
$99.40 |
$99.40 |
$47.52
|