|
ER Visit (level 1, minor)
|
$184.50 |
$184.50 |
$184.50 |
$246.24
|
|
ER Visit (level 2)
|
$298.65 |
$298.65 |
$298.65 |
$452.20
|
|
ER Visit (level 3)
|
$579.15 |
$579.15 |
$579.15 |
$770.04
|
|
ER Visit (level 4)
|
$845.10 |
$845.10 |
$845.10 |
$1,273.68
|
|
ER Visit (level 5, high severity)
|
$1,591.20 |
$1,591.20 |
$1,591.20 |
$1,820.02
|
|
Erwinaze injection
|
$9.00 |
$9.00 |
$9.00 |
$6,423.46
|
|
Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr
|
$182.60 |
$182.60 |
$182.60 |
$223.99
|
|
Esmolol 2,500 mg/250 ml (10 mg/ml) in sterile water intravenous soln
|
$279.72 |
$279.72 |
$279.72 |
$279.72
|
|
Esmolol 2,500 mg/250 ml (10 mg/ml) IV wrapper osm only
|
$997.76 |
$997.76 |
$997.76 |
$553.88
|
|
Esophagosc dilate balloon 30
|
$1,138.20 |
$1,138.20 |
$1,138.20 |
$2,244.82
|
|
Esophagoscop stent placement
|
$3,571.80 |
$3,571.80 |
$3,571.80 |
$6,821.10
|
|
Esophagoscopy balloon <30mm
|
$1,138.20 |
$1,138.20 |
$1,138.20 |
$2,460.00
|
|
Esophagoscopy flex biopsy
|
$1,138.20 |
$1,138.20 |
$1,138.20 |
$2,132.00
|
|
Esophagoscopy/flex/diagnostic 43200
|
$1,824.75 |
$1,824.75 |
$1,824.75 |
$1,296.00
|
|
Esophagoscopy flex remove fb
|
$1,138.20 |
$1,138.20 |
$1,138.20 |
$2,099.70
|
|
Esophagoscopy lesion ablate
|
$2,282.85 |
$2,282.85 |
$2,282.85 |
$4,502.13
|
|
Esophagoscopy w/us needle bx
|
$1,138.20 |
$1,138.20 |
$1,138.20 |
$2,638.57
|
|
Esophagus motility study
|
$771.00 |
$771.00 |
$771.00 |
$1,289.20
|
|
Esoph egd dilation <30 mm
|
$1,138.20 |
$1,138.20 |
$1,138.20 |
$2,656.80
|
|
Esoph endoscopy dilation
|
$1,138.20 |
$1,138.20 |
$1,138.20 |
$2,221.83
|
|
Esoph imped function test
|
$325.65 |
$325.65 |
$325.65 |
$597.03
|
|
Established Patient Office Visit (level 1)
|
$387.00 |
$387.00 |
$387.00 |
$120.25
|
|
Established Patient Office Visit (level 2)
|
$508.20 |
$508.20 |
$508.20 |
$132.72
|
|
Established Patient Office Visit (level 3)
|
$710.40 |
$710.40 |
$710.40 |
$183.00
|
|
Established Patient Office Visit (level 4)
|
$872.85 |
$872.85 |
$872.85 |
$231.75
|
|
Established Patient Office Visit (level 5)
|
$1,074.90 |
$1,074.90 |
$1,074.90 |
$280.33
|
|
Estradiol total
|
$30.90 |
$30.90 |
$30.90 |
$146.50
|
|
Estradiol valerate 10 mg inj
|
$57.35 |
$57.35 |
$57.35 |
$57.35
|
|
Etanercept injection
|
$3,172.86 |
$3,172.86 |
$3,172.86 |
$3,172.86
|
|
Ethanolamine oleate 100 mg
|
$713.40 |
$713.40 |
$713.40 |
$751.36
|
|
Ethylene glycol -sendout
|
$138.00 |
$138.00 |
$138.00 |
$89.40
|
|
Etoposide 20 mg/ml intravenous solution
|
$367.96 |
$367.96 |
$367.96 |
$235.20
|
|
Etoposide 50 mg cap
|
$90.40 |
$90.40 |
$90.40 |
$135.02
|
|
Euflexxa inj per dose
|
$778.96 |
$778.96 |
$778.96 |
$587.51
|
|
Eval/fit voice prosthesis iii, st
|
$345.75 |
$345.75 |
$345.75 |
$356.00
|
|
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen
|
$492.45 |
$492.45 |
$492.45 |
$219.60
|
|
Evaluation of speech fluency 92521
|
$610.35 |
$610.35 |
$610.35 |
$311.50
|
|
Evasc prlng admn rx agnt 1st
|
$2,606.85 |
$2,606.85 |
$2,606.85 |
$3,822.00
|
|
Evasc prlng admn rx agnt add
|
$2,606.85 |
$2,606.85 |
$2,606.85 |
$2,734.40
|
|
Evasc rpr a-ao ndgft 34701
|
$11,756.40 |
$11,756.40 |
$11,756.40 |
$5,230.40
|
|
Evasc rpr a-ao ndgft rpt 34702
|
$11,304.15 |
$11,304.15 |
$11,304.15 |
$4,670.40
|
|
Evasc rpr a-biiliac ndgft rptr
|
$11,756.40 |
$11,756.40 |
$11,756.40 |
$8,565.60
|
|
Evasc rpr a-unilac ndgft 34703
|
$11,756.40 |
$11,756.40 |
$11,756.40 |
$5,578.73
|
|
Evasc rpr ilio-iliac ndgft
|
$11,756.40 |
$11,756.40 |
$11,756.40 |
$6,931.00
|
|
Evasc rpr ilio-iliac rpt
|
$11,756.40 |
$11,756.40 |
$11,756.40 |
$8,996.13
|
|
Exc benign tal 0.5 < cm 11400
|
$827.40 |
$827.40 |
$827.40 |
$827.40
|
|
Exc ben+marg excep skin tag feenlm <0.5cm 11440
|
$549.60 |
$549.60 |
$549.60 |
$914.34
|
|
Exc ben+marg excep skin tag snhfg 0.6-1cm 11421
|
$827.40 |
$827.40 |
$827.40 |
$1,372.15
|
|
Exc ben+marg excep skin tag snhfg 2.1-3cm 11423
|
$1,896.60 |
$1,896.60 |
$1,896.60 |
$2,166.78
|
|
Exc ben+marg excep skin tag snhfg >4cm 11426
|
$3,295.35 |
$3,295.35 |
$3,295.35 |
$3,446.50
|
|
Exc ben+marg excep skin tag tal 0.6-1cm 11401
|
$431.85 |
$431.85 |
$431.85 |
$765.50
|
|
Exc ben+marg excep skin tag tal 2.1-3/>cm 11403
|
$827.40 |
$827.40 |
$827.40 |
$1,247.50
|
|
Exc hand les sc < 1.5 cm
|
$1,743.60 |
$1,743.60 |
$1,743.60 |
$1,897.50
|
|
Exchange nephrostomy cath
|
$3,009.45 |
$3,009.45 |
$3,009.45 |
$2,958.80
|
|
Excision benign lesion scalp/neck/hands/feet/genitalia 1.1 - 2.0 cm
|
$1,896.60 |
$1,896.60 |
$1,896.60 |
$1,973.12
|
|
Excision benign lesion trunk/arms/legs 1.1 - 2.0 cm
|
$827.40 |
$827.40 |
$827.40 |
$1,012.86
|
|
Excision benign lesion trunk/arms/legs > 4.0 cm
|
$1,896.60 |
$1,896.60 |
$1,896.60 |
$2,865.00
|
|
Exc/pilonidal cyst/sinus/simple 11770
|
$1,813.35 |
$1,813.35 |
$1,813.35 |
$3,386.84
|
|
Exc sq tum/vasc malform/hand/fngr 26111
|
$2,409.00 |
$2,409.00 |
$2,409.00 |
$1,898.50
|
|
Exc thrombosed hemorrhoid 46320
|
$1,915.20 |
$1,915.20 |
$1,915.20 |
$2,099.00
|
|
Exc vagina lesion 57135
|
$3,843.60 |
$3,843.60 |
$3,843.60 |
$4,232.80
|
|
Exercise tst brncspsm w/ecg
|
$324.00 |
$324.00 |
$324.00 |
$318.50
|
|
Expander breast 300cc mod hght extra proj smth natrelle
|
$60.27 |
$60.27 |
$60.27 |
$2,470.50
|
|
Expander tiss 133s-mv-12-t 300ml natrelle smth
|
$5,520.00 |
$5,520.00 |
$5,520.00 |
$4,048.38
|
|
Explore wound abdomen 20102
|
$1,681.65 |
$1,681.65 |
$1,681.65 |
$2,568.80
|
|
Expose endoprosth brachial 34834
|
$1,300.20 |
$1,300.20 |
$1,300.20 |
$1,560.90
|
|
Exp w remove/deep fb/forearm/wrist 25248
|
$4,662.30 |
$4,662.30 |
$4,662.30 |
$3,623.43
|
|
Extension drainage tubing
|
$27.60 |
$27.60 |
$27.60 |
$27.60
|
|
External chromosome analysis 20-25 cells
|
$263.25 |
$263.25 |
$263.25 |
$384.15
|
|
External newborn metabolic screening panel
|
$176.10 |
$176.10 |
$176.10 |
$109.76
|
|
External tissue culture neoplastic disorders bone marrow/blood cells
|
$241.91 |
$241.91 |
$241.91 |
$454.20
|
|
Extractable nuclear antigen/antibody any method each antibody centromere
|
$177.37 |
$177.37 |
$177.37 |
$108.60
|
|
Facial bones <3
|
$252.60 |
$252.60 |
$252.60 |
$252.60
|
|
Factor ix
|
$269.55 |
$269.55 |
$269.55 |
$156.13
|
|
Factor ix complex
|
$3.70 |
$3.70 |
$3.70 |
$5.91
|
|
Factor ix non-recombinant
|
$4.63 |
$4.63 |
$4.63 |
$4.63
|
|
Factor ix recombinant nos
|
$4.65 |
$4.65 |
$4.65 |
$4.65
|
|
Factor viii
|
$252.75 |
$252.75 |
$252.75 |
$133.81
|
|
Factor viii
|
$4.38 |
$4.38 |
$4.38 |
$5.02
|
|
Factor viii nuwiq recomb 1iu
|
$5.20 |
$5.20 |
$5.20 |
$5.20
|
|
Factor viii recombinant nos
|
$5.20 |
$5.20 |
$5.20 |
$6.56
|
|
Factor viii recomb novoeight
|
$5.91 |
$5.91 |
$5.91 |
$7.39
|
|
Fam-trastuzumab deruxtecan-nxki 100 mg intravenous solution
|
$5,349.71 |
$5,349.71 |
$5,349.71 |
$5,800.72
|
|
Fat/lipids feces qualitative
|
$52.20 |
$52.20 |
$52.20 |
$38.35
|
|
Fatty acids nonesterified
|
$129.15 |
$129.15 |
$129.15 |
$64.28
|
|
#fecal-sodium
|
$108.30 |
$108.30 |
$108.30 |
$37.50
|
|
Feeding tube reposition
|
$945.00 |
$945.00 |
$945.00 |
$532.61
|
|
Femoral lgth sock fx or equa
|
$126.42 |
$126.42 |
$126.42 |
$126.42
|
|
Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper)
|
$101.40 |
$101.40 |
$101.40 |
$101.40
|
|
Ferric carboxymaltose 50 mg iron/ml intravenous solution
|
$2,748.37 |
$2,748.37 |
$2,748.37 |
$2,590.25
|
|
Ferritin
|
$76.65 |
$76.65 |
$76.65 |
$100.94
|
|
Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution
|
$2,363.39 |
$2,363.39 |
$2,363.39 |
$1,776.61
|
|
Fetal aneuploidy trisom risk
|
$1,077.00 |
$1,077.00 |
$1,077.00 |
$1,077.00
|
|
Fetal chrom aneuploidy gsa panel
|
$870.00 |
$870.00 |
$870.00 |
$1,206.81
|
|
Fetal fibronectin
|
$547.65 |
$547.65 |
$547.65 |
$373.41
|
|
Fetal hemoglobin (kleihauer betke)
|
$335.40 |
$335.40 |
$335.40 |
$105.12
|
|
Fetal hemoglobin rosette
|
$102.00 |
$102.00 |
$102.00 |
$67.20
|
|
Fetal non stress test
|
$337.50 |
$337.50 |
$337.50 |
$463.03
|
|
Fibrin degradation d dimer quantitative
|
$407.55 |
$407.55 |
$407.55 |
$117.70
|
|
Fibrin degradation products
|
$279.90 |
$279.90 |
$279.90 |
$62.64
|
