|
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
|
|
Esophagus motility study
|
$771.00 |
$771.00 |
$771.00 |
$1,289.20
|
|
Esoph balloon distension tst
|
$784.65 |
$784.65 |
$784.65 |
$1,040.00
|
|
Esoph egd dilation <30 mm
|
$1,138.20 |
$1,138.20 |
$1,138.20 |
$2,656.80
|
|
Esoph imped function test
|
$325.65 |
$325.65 |
$325.65 |
$597.03
|
|
Established Patient Office Visit (level 1)
|
$103.50 |
$103.50 |
$103.50 |
$120.25
|
|
Established Patient Office Visit (level 2)
|
$123.90 |
$123.90 |
$123.90 |
$132.72
|
|
Established Patient Office Visit (level 3)
|
$154.65 |
$154.65 |
$154.65 |
$183.00
|
|
Established Patient Office Visit (level 4)
|
$205.20 |
$205.20 |
$205.20 |
$231.75
|
|
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
|
|
Euglobulin lysis
|
$93.15 |
$93.15 |
$93.15 |
$56.70
|
|
Evoked potentials upper limbs
|
$812.40 |
$812.40 |
$812.40 |
$908.54
|
|
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
|
|
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
|
|
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
|
|
Extractable nuclear antigen/antibody any method each antibody centromere
|
$169.65 |
$169.65 |
$169.65 |
$108.60
|
|
Facial bones <3
|
$252.60 |
$252.60 |
$252.60 |
$252.60
|
|
Factor ix
|
$91.95 |
$91.95 |
$91.95 |
$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
|
$47.97 |
$47.97 |
$47.97 |
$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
|
|
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 biophys profile w/nst 76818
|
$381.75 |
$381.75 |
$381.75 |
$535.37
|
|
Fetal fibronectin
|
$547.65 |
$547.65 |
$547.65 |
$373.41
|
|
Fibrin degradation d dimer quantitative
|
$407.55 |
$407.55 |
$407.55 |
$117.70
|
|
Fibrin degradation products
|
$279.90 |
$279.90 |
$279.90 |
$62.64
|
|
Fibrinogen activity
|
$246.00 |
$246.00 |
$246.00 |
$83.50
|
|
Fibrinolysins/coagulopathy screen interpretation/report
|
$59.10 |
$59.10 |
$59.10 |
$64.05
|
|
Fibrinolytic plasminogen
|
$156.15 |
$156.15 |
$156.15 |
$107.50
|
|
Filgrastim-aafi 300 mcg/0.5 ml subcutaneous syringe
|
$756.87 |
$756.87 |
$756.87 |
$595.48
|
|
Filgrastim in d5w IV syringe 20 mcg/ml (neo) - cnr
|
$1,052.24 |
$1,052.24 |
$1,052.24 |
$1,096.24
|
|
Filgrastim-sndz 300 mcg/0.5 ml injection syringe
|
$869.18 |
$869.18 |
$869.18 |
$869.18
|
|
Filter spider fx 3mmx320cm
|
$9,600.00 |
$9,600.00 |
$9,600.00 |
$7,160.28
|
|
Filter vena cava fem denali
|
$6,359.98 |
$6,359.98 |
$6,359.98 |
$3,718.18
|
|
Fine needle aspiration biopsy w/us gdn; ea addtl 10006
|
$390.00 |
$390.00 |
$390.00 |
$823.90
|
|
Flexible Sigmoidoscopy
|
$1,094.55 |
$1,094.55 |
$1,094.55 |
$1,284.13
|
|
Flex thermoplastic collar mo
|
$17.66 |
$17.66 |
$17.66 |
$187.60
|
|
Flotufolastat f18 diag 1 mci
|
$7,377.60 |
$7,377.60 |
$7,377.60 |
$2,324.00
|
|
Flow cytometry marker each additional
|
$75.15 |
$75.15 |
$75.15 |
$97.50
|
|
Flow cytometry one marker technical component
|
$75.15 |
$75.15 |
$75.15 |
$284.40
|
|
Floxuridine injection
|
$7,208.41 |
$7,208.41 |
$7,208.41 |
$5,929.92
|
|
Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback
|
$57.00 |
$57.00 |
$57.00 |
$64.22
|
|
Fludarabine 50 mg intravenous solution
|
$237.60 |
$237.60 |
$237.60 |
$493.35
|
|
Fluidotherapy charges pt
|
$168.00 |
$168.00 |
$168.00 |
$91.00
|
|
Fluocinolone acetonide implt
|
$37,669.50 |
$37,669.50 |
$37,669.50 |
$30,686.32
|
|
Fluorescent antibody titer dna
|
$513.45 |
$513.45 |
$513.45 |
$122.82
|
|
Fluoroguide for spine inject 77003-26
|
$535.80 |
$535.80 |
$535.80 |
$496.03
|
|
Fluoroguide needle placement
|
$425.40 |
$425.40 |
$425.40 |
$510.00
|
|
Fluoroscopy up to 1 hour
|
$417.15 |
$417.15 |
$417.15 |
$492.00
|
|
Fluorouracil 50 mg/ml intravenous solution (wrapper)
|
$73.92 |
$73.92 |
$73.92 |
$94.86
|
|
Fluphenazine decanoate 25 mg/ml injection solution
|
$33.48 |
$33.48 |
$33.48 |
$72.52
|
|
Foam drg >16<=48 sq in w/bdr
|
$318.48 |
$318.48 |
$318.48 |
$62.09
|
|
Foam drg >16<=48 sq in without b
|
$118.55 |
$118.55 |
$118.55 |
$41.14
|
|
Foam drg <=16 sq in w/border
|
$112.25 |
$112.25 |
$112.25 |
$16.37
|
|
Foam drg > 48 sq in w/border
|
$23.63 |
$23.63 |
$23.63 |
$23.63
|
|
Foam drg > 48 sq in without brdr
|
$144.75 |
$144.75 |
$144.75 |
$33.49
|
|
Foam drsg <=16 sq in without bdr
|
$59.76 |
$59.76 |
$59.76 |
$21.74
|
|
Folic acid
|
$128.10 |
$128.10 |
$128.10 |
$101.50
|
|
Fomepizole 1 gram/ml intravenous solution
|
$2,033.07 |
$2,033.07 |
$2,033.07 |
$2,581.14
|
|
Fondaparinux sodium
|
$244.44 |
$244.44 |
$244.44 |
$185.12
|
|
Foot arch supp premold metat
|
$12.89 |
$12.89 |
$12.89 |
$70.22
|
|
Foot drp splt w/exp heel lg
|
$161.23 |
$161.23 |
$161.23 |
$143.87
|
|
Foot lamin/prepreg composite
|
$246.40 |
$246.40 |
$246.40 |
$289.76
|
|
Foot longitudinal arch suppo
|
$366.96 |
$366.96 |
$366.96 |
$295.47
|
|
Foot X-ray
|
$371.85 |
$371.85 |
$371.85 |
$362.40
|
|
Forearm/arm cuffs ext/flex a
|
$105.83 |
$105.83 |
$105.83 |
$580.42
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$578.25 |
$578.25 |
$578.25 |
$457.50
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$262.01 |
$262.01 |
$262.01 |
$106.10
|
|
Fragmenting of kidney stone
|
$18,406.05 |
$18,406.05 |
$18,406.05 |
$10,057.42
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$226.20 |
$226.20 |
$226.20 |
$156.60
|
|
Fresh frozen plasma thawing ea un
|
$102.90 |
$102.90 |
$102.90 |
$122.00
|
|
Ft arch suprt premold longit
|
$94.69 |
$94.69 |
$94.69 |
$79.82
|
|
Ftl cgen abnor four anal
|
$107.55 |
$107.55 |
$107.55 |
$204.52
|
