|
Excision benign lesion scalp/neck/hands/feet/genitalia 1.1 - 2.0 cm
|
$1,999.20 |
$1,999.20 |
$1,999.20 |
$1,981.25
|
|
Excision benign lesion trunk/arms/legs 1.1 - 2.0 cm
|
$865.20 |
$865.20 |
$865.20 |
$1,064.30
|
|
Excision benign lesion trunk/arms/legs > 4.0 cm
|
$1,999.20 |
$1,999.20 |
$1,999.20 |
$2,916.96
|
|
Excision of gum lesion 41825
|
$3,793.02 |
$3,793.02 |
$3,793.02 |
$3,920.70
|
|
Excision tumor soft tissue back/flank subcutaneous >= 3 cm
|
$115.50 |
$115.50 |
$115.50 |
$3,255.75
|
|
Exc les conjunctiva <1 cm
|
$268.38 |
$268.38 |
$268.38 |
$2,760.73
|
|
Exc les/mucos/sub/ves mouth/no rpr 40810
|
$210.00 |
$210.00 |
$210.00 |
$3,401.25
|
|
Exc malig feenl <0.5cm 11640
|
$165.06 |
$165.06 |
$165.06 |
$1,206.78
|
|
Exc malig feenl 1.1-2 11642
|
$294.00 |
$294.00 |
$294.00 |
$1,113.60
|
|
Exc malig feenl 3.1-4.0 11644
|
$420.00 |
$420.00 |
$420.00 |
$2,070.30
|
|
Exc malig feenl >4cm 11646
|
$504.00 |
$504.00 |
$504.00 |
$3,386.84
|
|
Exc malig snhfg 0.5cm or less 11620
|
$147.00 |
$147.00 |
$147.00 |
$1,273.80
|
|
Exc malig snhfg 0.6-1.0 cm 11621
|
$865.20 |
$865.20 |
$865.20 |
$973.71
|
|
Exc malig snhfg 2.1-3 cm 11623
|
$287.70 |
$287.70 |
$287.70 |
$1,917.33
|
|
Exc malig tal <0.5cm 11600
|
$119.70 |
$119.70 |
$119.70 |
$894.66
|
|
Exc malig tal 0.6-1.0cm 11601
|
$147.00 |
$147.00 |
$147.00 |
$828.59
|
|
Exc mal+marg tal 2.1-3 cm 11603
|
$231.00 |
$231.00 |
$231.00 |
$1,246.00
|
|
Exc/pilonidal cyst/sinus/simple 11770
|
$3,444.42 |
$3,444.42 |
$3,444.42 |
$3,588.30
|
|
Exc prtl bn phlnx toe
|
$4,326.00 |
$4,326.00 |
$4,326.00 |
$3,752.25
|
|
Exc snhfg mal+mrg 1.1-2 11622
|
$243.60 |
$243.60 |
$243.60 |
$1,329.08
|
|
Exc snhfg mal+mrg >4 cm 11626
|
$378.00 |
$378.00 |
$378.00 |
$3,370.52
|
|
Exc sq tumor/forearm/wrist/<3cm 25075
|
$1,999.20 |
$1,999.20 |
$1,999.20 |
$2,473.60
|
|
Exc tendon sheath or cap lesion 26160
|
$1,912.68 |
$1,912.68 |
$1,912.68 |
$2,650.53
|
|
Exc thrombosed hemorrhoid 46320
|
$2,140.32 |
$2,140.32 |
$2,140.32 |
$2,491.20
|
|
Exc tr-ext mal+marg tal >4 cm 11606
|
$390.60 |
$390.60 |
$390.60 |
$1,917.33
|
|
Exc vagina lesion 57135
|
$4,109.28 |
$4,109.28 |
$4,109.28 |
$4,107.36
|
|
Expander tiss 133s-mv-12-t 300ml natrelle smth
|
$4,461.16 |
$4,461.16 |
$4,461.16 |
$3,473.04
|
|
Exploration of knee joint
|
$3,969.00 |
$3,969.00 |
$3,969.00 |
$3,850.53
|
|
Explore/irrigate tear ducts
|
$385.14 |
$385.14 |
$385.14 |
$436.44
|
|
Explore penetrating wnd/extremity 20103
|
$1,999.20 |
$1,999.20 |
$1,999.20 |
$1,917.33
|
|
Explore/repair chest 32110
|
$131.88 |
$131.88 |
$131.88 |
$3,668.70
|
|
Explore/treat eye socket 67413
|
$420.00 |
$420.00 |
$420.00 |
$3,786.00
|
|
Explore/treat finger joint
|
$1,912.68 |
$1,912.68 |
$1,912.68 |
$2,615.25
|
|
Explore wound abdomen 20102
|
$2,301.18 |
$2,301.18 |
$2,301.18 |
$2,837.09
|
|
Explore woundchest 20101
|
$2,301.18 |
$2,301.18 |
$2,301.18 |
$2,179.44
|
|
Explore wound neck 20100
|
$609.42 |
$609.42 |
$609.42 |
$1,185.00
|
|
Exp w remove/deep fb/forearm/wrist 25248
|
$1,912.68 |
$1,912.68 |
$1,912.68 |
$3,559.50
|
|
Extended visual field xm
|
$63.00 |
$63.00 |
$63.00 |
$162.75
|
|
External cannula declotting
|
$2,038.68 |
$2,038.68 |
$2,038.68 |
$1,829.42
|
|
External newborn metabolic screening panel
|
$142.38 |
$142.38 |
$142.38 |
$114.75
|
|
Extnd color vision xm
|
$36.96 |
$36.96 |
$36.96 |
$105.04
|
|
Extractable nuclear antigen/antibody any method each antibody centromere
|
$154.14 |
$154.14 |
$154.14 |
$102.78
|
|
Eye implant band 40
|
$133.82 |
$133.82 |
$133.82 |
$125.00
|
|
Facial bones <3
|
$179.76 |
$179.76 |
$179.76 |
$248.60
|
|
Factor viii
|
$170.94 |
$170.94 |
$170.94 |
$144.30
|
|
Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr
|
$56.70 |
$56.70 |
$56.70 |
$27.81
|
|
Fda ide #g240020 carry bag
|
$1,143.98 |
$1,143.98 |
$1,143.98 |
$933.57
|
|
Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper)
|
$601.65 |
$601.65 |
$601.65 |
$120.15
|
|
Ferric carboxymaltose 50 mg iron/ml intravenous solution
|
$6,728.35 |
$6,728.35 |
$6,728.35 |
$2,027.60
|
|
Ferritin
|
$80.64 |
$80.64 |
$80.64 |
$103.68
|
|
Fetal biophys profile w/nst 76818
|
$375.06 |
$375.06 |
$375.06 |
$541.74
|
|
Fetal contract stress test 59020 - 26
|
$237.72 |
$237.72 |
$237.72 |
$540.54
|
|
Fetal fibronectin
|
$380.10 |
$380.10 |
$380.10 |
$352.95
|
|
Fetal hemoglobin (kleihauer betke)
|
$74.34 |
$74.34 |
$74.34 |
$88.80
|
|
Fetal hemoglobin rosette
|
$74.34 |
$74.34 |
$74.34 |
$76.70
|
|
Fetal non stress test
|
$237.72 |
$237.72 |
$237.72 |
$507.90
|
|
Fibrin degradation d dimer quantitative
|
$97.44 |
$97.44 |
$97.44 |
$112.80
|
|
Fibrin degradation products
|
$65.94 |
$65.94 |
$65.94 |
$62.40
|
|
Fibrinogen activity
|
$92.82 |
$92.82 |
$92.82 |
$82.38
|
|
Filgrastim-aafi 300 mcg/0.5 ml subcutaneous syringe
|
$1,003.56 |
$1,003.56 |
$1,003.56 |
$460.87
|
|
Filgrastim in d5w IV syringe 20 mcg/ml (neo) - cnr
|
$3,665.46 |
$3,665.46 |
$3,665.46 |
$1,405.40
|
|
Filleted finger/toe flap
|
$2,301.18 |
$2,301.18 |
$2,301.18 |
$2,164.64
|
|
Filter spider fx 3mmx320cm
|
$7,130.56 |
$7,130.56 |
$7,130.56 |
$6,152.59
|
|
Filter vena cava fem denali
|
$4,073.27 |
$4,073.27 |
$4,073.27 |
$3,467.25
|
|
Fine needle aspiration biopsy without img gdn; ea addtl 10004
|
$249.06 |
$249.06 |
$249.06 |
$261.80
|
|
Fine needle aspiration biopsy w/us gdn; ea addtl 10006
|
$898.38 |
$898.38 |
$898.38 |
$806.40
|
|
Fine needle asp without image guide 10021
|
$432.60 |
$432.60 |
$432.60 |
$547.53
|
|
Fixation of knee joint
|
$1,663.20 |
$1,663.20 |
$1,663.20 |
$1,963.35
|
|
Fix g/colon tube w/device
|
$1,199.94 |
$1,199.94 |
$1,199.94 |
$1,236.90
|
|
Fixtn pq skel dstl rad fx/epiphysl sep
|
$3,969.00 |
$3,969.00 |
$3,969.00 |
$3,981.06
|
|
Flexible Sigmoidoscopy
|
$963.48 |
$963.48 |
$963.48 |
$1,284.13
|
|
Floor of mouth biopsy 41108
|
$1,999.20 |
$1,999.20 |
$1,999.20 |
$2,040.09
|
|
Flow cytometry marker each additional
|
$97.44 |
$97.44 |
$97.44 |
$103.00
|
|
Flow cytometry one marker technical component
|
$1,029.42 |
$1,029.42 |
$1,029.42 |
$270.75
|
|
Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback
|
$134.89 |
$134.89 |
$134.89 |
$86.42
|
|
Fluid pressure muscle 20950
|
$865.20 |
$865.20 |
$865.20 |
$779.45
|
|
Fluorescein angrph mltiframe
|
$127.68 |
$127.68 |
$127.68 |
$344.68
|
|
Fluoroguide for spine inject 77003-26
|
$412.86 |
$412.86 |
$412.86 |
$507.00
|
|
Fluoroguide needle placement
|
$412.86 |
$412.86 |
$412.86 |
$536.26
|
|
Fluoroscopy up to 1 hour
|
$539.70 |
$539.70 |
$539.70 |
$494.52
|
|
Fna bx w/ct gdn 1st les
|
$2,446.92 |
$2,446.92 |
$2,446.92 |
$1,588.65
|
|
Folic acid
|
$86.94 |
$86.94 |
$86.94 |
$90.60
|
|
Folic acid 5 mg/ml injection solution
|
$56.70 |
$56.70 |
$56.70 |
$55.66
|
|
Follow-up angiography
|
$6,708.66 |
$6,708.66 |
$6,708.66 |
$1,939.14
|
|
Foot X-ray
|
$179.76 |
$179.76 |
$179.76 |
$362.40
|
|
Forehead flap w/vasc pedicle 15731
|
$4,727.52 |
$4,727.52 |
$4,727.52 |
$4,332.25
|
|
Foreskn manip w/lss preputial ads+stretching 54450
|
$501.06 |
$501.06 |
$501.06 |
$595.80
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$296.60 |
$296.60 |
$296.60 |
$107.31
|
|
Frenectomy 41115
|
$42.00 |
$42.00 |
$42.00 |
$1,744.44
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$18.23 |
$18.23 |
$18.23 |
$168.75
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$21.63 |
$21.63 |
$21.63 |
$149.50
|
|
Fresh frozen plasma thawing ea un
|
$233.10 |
$233.10 |
$233.10 |
$123.90
|
|
Full thick gft/nose/ear/lid/lip/20sqcm or< 15260
|
$2,508.24 |
$2,508.24 |
$2,508.24 |
$2,919.95
|
|
Full thick gft w/close donor fccmnaghf <=20sqcm 15240
|
$2,508.24 |
$2,508.24 |
$2,508.24 |
$2,501.10
|
|
Fundus photography with i&r 92250
|
$52.50 |
$52.50 |
$52.50 |
$200.42
|
|
Furosemide 10 mg/ml injection solution
|
$56.70 |
$56.70 |
$56.70 |
$27.69
|
|
Fusion of finger joint
|
$3,969.00 |
$3,969.00 |
$3,969.00 |
$3,986.00
|
|
Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper)
|
$37.80 |
$37.80 |
$37.80 |
$138.37
|
|
Gamma globulin 1 cc inj
|
$3,547.91 |
$3,547.91 |
$3,547.91 |
$158.67
|
|
Gammaglobulin iga
|
$55.02 |
$55.02 |
$55.02 |
$75.30
|
