|
Established Patient Office Visit (level 3)
|
$54.45 |
$54.45 |
$54.45 |
$183.00
|
|
Established Patient Office Visit (level 4)
|
$68.31 |
$68.31 |
$68.31 |
$231.75
|
|
Established Patient Office Visit (level 5)
|
$91.08 |
$91.08 |
$91.08 |
$280.33
|
|
Estradiol total
|
$87.78 |
$87.78 |
$87.78 |
$146.50
|
|
Estradiol valerate 10 mg inj
|
$358.54 |
$358.54 |
$358.54 |
$57.35
|
|
Ethanolamine oleate 100 mg
|
$566.71 |
$566.71 |
$566.71 |
$751.36
|
|
Etoposide 20 mg/ml intravenous solution
|
$158.51 |
$158.51 |
$158.51 |
$235.20
|
|
Euflexxa inj per dose
|
$142.81 |
$142.81 |
$142.81 |
$587.51
|
|
Eval/fit voice prosthesis iii, st
|
$93.72 |
$93.72 |
$93.72 |
$356.00
|
|
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen
|
$48.51 |
$48.51 |
$48.51 |
$219.60
|
|
Evaluation of speech fluency 92521
|
$60.06 |
$60.06 |
$60.06 |
$311.50
|
|
Evasc prlng admn rx agnt 1st
|
$790.68 |
$790.68 |
$790.68 |
$3,822.00
|
|
Evasc prlng admn rx agnt add
|
$790.68 |
$790.68 |
$790.68 |
$2,734.40
|
|
Evoked potentials upper limbs
|
$371.58 |
$371.58 |
$371.58 |
$908.54
|
|
Evoked potential visual not glaucoma
|
$235.62 |
$235.62 |
$235.62 |
$814.61
|
|
Ewho w/joint(s) cf
|
$302.61 |
$302.61 |
$302.61 |
$907.92
|
|
Exchange biliary drg cath
|
$1,935.12 |
$1,935.12 |
$1,935.12 |
$3,909.56
|
|
Exchange drainage catheter
|
$551.10 |
$551.10 |
$551.10 |
$2,205.50
|
|
Exchange nephrostomy cath
|
$2,687.52 |
$2,687.52 |
$2,687.52 |
$2,958.80
|
|
Exc malig feenl <0.5cm 11640
|
$358.05 |
$358.05 |
$358.05 |
$1,055.20
|
|
Exc mal+marg tal 3.1-4 cm 11604
|
$563.31 |
$563.31 |
$563.31 |
$1,294.80
|
|
Exc snhfg mal+mrg 1.1-2 11622
|
$358.05 |
$358.05 |
$358.05 |
$1,274.00
|
|
Exercise w/hemodynamic meas
|
$2,115.96 |
$2,115.96 |
$2,115.96 |
$901.60
|
|
Expander tiss 133s-mv-12-t 300ml natrelle smth
|
$2,338.05 |
$2,338.05 |
$2,338.05 |
$4,048.38
|
|
External chromosome analysis 20-25 cells
|
$118.47 |
$118.47 |
$118.47 |
$384.15
|
|
External tissue culture neoplastic disorders bone marrow/blood cells
|
$120.12 |
$120.12 |
$120.12 |
$454.20
|
|
Extractable nuclear antigen/antibody any method each antibody centromere
|
$18.15 |
$18.15 |
$18.15 |
$108.60
|
|
Facial bones <3
|
$53.46 |
$53.46 |
$53.46 |
$252.60
|
|
Factor ix
|
$55.11 |
$55.11 |
$55.11 |
$156.13
|
|
Factor ix complex
|
$1.74 |
$1.74 |
$1.74 |
$5.91
|
|
Factor ix recombinant nos
|
$4.03 |
$4.03 |
$4.03 |
$4.65
|
|
Factor viii
|
$43.89 |
$43.89 |
$43.89 |
$133.81
|
|
Factor viii recombinant nos
|
$4.67 |
$4.67 |
$4.67 |
$6.56
|
|
Fam-trastuzumab deruxtecan-nxki 100 mg intravenous solution
|
$3,471.17 |
$3,471.17 |
$3,471.17 |
$5,800.72
|
|
Felbamate (felbatol(r)) - sendout
|
$29.70 |
$29.70 |
$29.70 |
$65.00
|
|
Ferric carboxymaltose 50 mg iron/ml intravenous solution
|
$1,725.14 |
$1,725.14 |
$1,725.14 |
$2,590.25
|
|
Ferritin
|
$45.21 |
$45.21 |
$45.21 |
$100.94
|
|
Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution
|
$2,221.10 |
$2,221.10 |
$2,221.10 |
$1,776.61
|
|
Fetal biophys profile w/nst 76818
|
$159.72 |
$159.72 |
$159.72 |
$535.37
|
|
Fetal contract stress test 59020 - 26
|
$107.25 |
$107.25 |
$107.25 |
$475.50
|
|
Fetal fibronectin
|
$214.17 |
$214.17 |
$214.17 |
$373.41
|
|
Fetal hemoglobin (kleihauer betke)
|
$45.54 |
$45.54 |
$45.54 |
$105.12
|
|
Fetal hemoglobin rosette
|
$22.11 |
$22.11 |
$22.11 |
$67.20
|
|
Fetal non stress test
|
$102.30 |
$102.30 |
$102.30 |
$463.03
|
|
Fibrin degradation d dimer quantitative
|
$49.50 |
$49.50 |
$49.50 |
$117.70
|
|
Fibrinogen activity
|
$28.38 |
$28.38 |
$28.38 |
$83.50
|
|
Fibrinolysins/coagulopathy screen interpretation/report
|
$27.72 |
$27.72 |
$27.72 |
$64.05
|
|
Fibrinolytic plasminogen xcpt antgnc asa
|
$48.84 |
$48.84 |
$48.84 |
$65.00
|
|
Filgrastim-aafi 300 mcg/0.5 ml subcutaneous syringe
|
$394.07 |
$394.07 |
$394.07 |
$595.48
|
|
Filgrastim in d5w IV syringe 20 mcg/ml (neo) - cnr
|
$597.66 |
$597.66 |
$597.66 |
$1,096.24
|
|
Filgrastim-sndz 300 mcg/0.5 ml injection syringe
|
$493.70 |
$493.70 |
$493.70 |
$869.18
|
|
Filter spider fx 3mmx320cm
|
$1,841.66 |
$1,841.66 |
$1,841.66 |
$7,160.28
|
|
Filter vena cava fem denali
|
$2,763.75 |
$2,763.75 |
$2,763.75 |
$3,718.18
|
|
Fine needle aspiration biopsy w/fluor gdn;1st lesion 10007
|
$575.85 |
$575.85 |
$575.85 |
$1,081.52
|
|
Fine needle aspiration biopsy w/us gdn; ea addtl 10006
|
$646.80 |
$646.80 |
$646.80 |
$823.90
|
|
Fix g/colon tube w/device
|
$463.98 |
$463.98 |
$463.98 |
$1,183.00
|
|
Flebogamma injection
|
$3,729.83 |
$3,729.83 |
$3,729.83 |
$3,438.30
|
|
Fl exam g/colon tube w contrast
|
$120.78 |
$120.78 |
$120.78 |
$511.92
|
|
Flow cytometry marker each additional
|
$23.10 |
$23.10 |
$23.10 |
$97.50
|
|
Flow cytometry one marker technical component
|
$106.59 |
$106.59 |
$106.59 |
$284.40
|
|
Floxuridine injection
|
$4,697.25 |
$4,697.25 |
$4,697.25 |
$5,929.92
|
|
Flt3 gene analysis
|
$58.08 |
$58.08 |
$58.08 |
$213.92
|
|
Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback
|
$32.38 |
$32.38 |
$32.38 |
$64.22
|
|
Fludarabine 50 mg intravenous solution
|
$244.61 |
$244.61 |
$244.61 |
$493.35
|
|
Fluidotherapy charges pt
|
$28.38 |
$28.38 |
$28.38 |
$91.00
|
|
Fluorescent antibody titer dna
|
$313.50 |
$313.50 |
$313.50 |
$122.82
|
|
Fluoroguide for spine inject 77003-26
|
$67.65 |
$67.65 |
$67.65 |
$496.03
|
|
Fluoroguide needle placement
|
$67.65 |
$67.65 |
$67.65 |
$510.00
|
|
Fluoroscopy up to 1 hour
|
$120.78 |
$120.78 |
$120.78 |
$492.00
|
|
Fluorouracil 50 mg/ml intravenous solution (wrapper)
|
$67.76 |
$67.76 |
$67.76 |
$94.86
|
|
Fluphenazine decanoate 25 mg/ml injection solution
|
$29.90 |
$29.90 |
$29.90 |
$72.52
|
|
Fna bx w/ct gdn 1st les
|
$955.35 |
$955.35 |
$955.35 |
$1,420.80
|
|
Fna bx w/ct gdn ea addl
|
$955.35 |
$955.35 |
$955.35 |
$833.25
|
|
Folic acid
|
$48.84 |
$48.84 |
$48.84 |
$101.50
|
|
Follow-up angiography
|
$566.28 |
$566.28 |
$566.28 |
$2,040.78
|
|
Fomepizole 1 gram/ml intravenous solution
|
$1,947.44 |
$1,947.44 |
$1,947.44 |
$2,581.14
|
|
Fondaparinux sodium
|
$127.27 |
$127.27 |
$127.27 |
$185.12
|
|
Fo nontorsion joint cf
|
$84.48 |
$84.48 |
$84.48 |
$217.50
|
|
Foot drp splt w/exp heel lg
|
$618.01 |
$618.01 |
$618.01 |
$143.87
|
|
Foot X-ray
|
$144.54 |
$144.54 |
$144.54 |
$362.40
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$301.08 |
$301.08 |
$301.08 |
$457.50
|
|
Foscarnet sodium injection
|
$1,109.80 |
$1,109.80 |
$1,109.80 |
$879.58
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$232.48 |
$232.48 |
$232.48 |
$106.10
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$114.84 |
$114.84 |
$114.84 |
$151.58
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$73.59 |
$73.59 |
$73.59 |
$156.60
|
|
Fresh frozen plasma thawing ea un
|
$304.92 |
$304.92 |
$304.92 |
$122.00
|
|
Fructosamine glycated protein
|
$16.83 |
$16.83 |
$16.83 |
$60.75
|
|
Furosemide 10 mg/ml injection solution
|
$6.78 |
$6.78 |
$6.78 |
$19.00
|
|
Ga-67 gallium 0.1 mci
|
$68.74 |
$68.74 |
$68.74 |
$118.56
|
|
Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper)
|
$243.07 |
$243.07 |
$243.07 |
$144.98
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$272.09 |
$272.09 |
$272.09 |
$250.83
|
|
Galac-1-phosphate uridyltran - sendout
|
$15.51 |
$15.51 |
$15.51 |
$96.94
|
|
Galectin-3
|
$67.98 |
$67.98 |
$67.98 |
$111.60
|
|
Gammaglobulin iga
|
$40.59 |
$40.59 |
$40.59 |
$67.20
|
|
Gammaglobulin ige
|
$37.95 |
$37.95 |
$37.95 |
$83.85
|
|
Gamma glutamyltransferase
|
$24.09 |
$24.09 |
$24.09 |
$57.54
|
|
Gamunex-c/gammaked
|
$3,705.25 |
$3,705.25 |
$3,705.25 |
$7,634.20
|
|
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr
|
$109.40 |
$109.40 |
$109.40 |
$197.40
|
|
Gastroesophageal reflux study
|
$202.29 |
$202.29 |
$202.29 |
$949.80
|
|
Gel-one
|
$455.40 |
$455.40 |
$455.40 |
$1,341.67
|