|
Established Patient Office Visit (level 4)
|
$267.50 |
$267.50 |
$267.50 |
$231.75
|
|
Established Patient Office Visit (level 5)
|
$332.50 |
$332.50 |
$332.50 |
$279.90
|
|
Estradiol total
|
$122.50 |
$122.50 |
$122.50 |
$147.00
|
|
Ethylene glycol -sendout
|
$112.50 |
$112.50 |
$112.50 |
$89.40
|
|
Eval aud funcj ea addl 15
|
$67.50 |
$67.50 |
$67.50 |
$85.80
|
|
Eval aud rehab status/first hr 92626
|
$270.00 |
$270.00 |
$270.00 |
$285.60
|
|
Eval/fit voice prosthesis iii, st
|
$350.00 |
$350.00 |
$350.00 |
$357.00
|
|
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen
|
$392.50 |
$392.50 |
$392.50 |
$219.60
|
|
Evaluation of speech fluency 92521
|
$227.50 |
$227.50 |
$227.50 |
$310.20
|
|
Evasc prlng admn rx agnt 1st
|
$4,365.00 |
$4,365.00 |
$4,365.00 |
$3,885.63
|
|
Evasc prlng admn rx agnt add
|
$3,265.00 |
$3,265.00 |
$3,265.00 |
$2,750.97
|
|
Event monitor
|
$210.00 |
$210.00 |
$210.00 |
$242.65
|
|
Evoked oa emissions ltd
|
$115.00 |
$115.00 |
$115.00 |
$234.32
|
|
Evoked potentials auditory screening automated analysis
|
$85.00 |
$85.00 |
$85.00 |
$249.71
|
|
Exam plvc w/anes othr thn lcl
|
$3,235.00 |
$3,235.00 |
$3,235.00 |
$3,762.53
|
|
Exchange biliary drg cath
|
$6,310.00 |
$6,310.00 |
$6,310.00 |
$3,909.56
|
|
Exchange drainage catheter
|
$1,585.00 |
$1,585.00 |
$1,585.00 |
$2,205.50
|
|
Exchange nephrostomy cath
|
$7,620.00 |
$7,620.00 |
$7,620.00 |
$2,955.48
|
|
Exercise tst brncspsm w/ecg
|
$187.50 |
$187.50 |
$187.50 |
$318.50
|
|
Exercise tst brncspsm wo ecg
|
$112.50 |
$112.50 |
$112.50 |
$114.50
|
|
External chromosome analysis 20-25 cells
|
$427.50 |
$427.50 |
$427.50 |
$386.40
|
|
External pretreatment of serum for use in antibody identification by dilution
|
$52.50 |
$52.50 |
$52.50 |
$61.10
|
|
External tissue culture neoplastic disorders bone marrow/blood cells
|
$317.50 |
$317.50 |
$317.50 |
$454.20
|
|
Extractable nuclear antigen/antibody any method each antibody centromere
|
$55.00 |
$55.00 |
$55.00 |
$108.60
|
|
F-18 fluciclovine per mci
|
$735.00 |
$735.00 |
$735.00 |
$940.00
|
|
Facial bones <3
|
$272.50 |
$272.50 |
$272.50 |
$252.60
|
|
Factor ix
|
$170.00 |
$170.00 |
$170.00 |
$154.50
|
|
Factor viii
|
$170.00 |
$170.00 |
$170.00 |
$133.50
|
|
Fatty acids nonesterified
|
$60.00 |
$60.00 |
$60.00 |
$64.28
|
|
#fecal-sodium
|
$25.00 |
$25.00 |
$25.00 |
$37.50
|
|
Felbamate (felbatol(r)) - sendout
|
$110.00 |
$110.00 |
$110.00 |
$65.00
|
|
Fem/popl revasc w/stent
|
$7,850.00 |
$7,850.00 |
$7,850.00 |
$16,843.00
|
|
Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper)
|
$42.95 |
$42.95 |
$42.95 |
$101.40
|
|
Fern test
|
$22.50 |
$22.50 |
$22.50 |
$39.65
|
|
Ferritin
|
$90.00 |
$90.00 |
$90.00 |
$100.94
|
|
Fetal biophys profile w/nst 76818
|
$615.00 |
$615.00 |
$615.00 |
$535.37
|
|
Fetal chrom aneuploidy gsa panel
|
$462.50 |
$462.50 |
$462.50 |
$1,206.81
|
|
Fetal contract stress test 59020 - 26
|
$477.50 |
$477.50 |
$477.50 |
$475.50
|
|
Fetal fibronectin
|
$320.00 |
$320.00 |
$320.00 |
$373.41
|
|
Fetal hemoglobin (kleihauer betke)
|
$122.50 |
$122.50 |
$122.50 |
$105.12
|
|
Fetal hemoglobin rosette
|
$62.50 |
$62.50 |
$62.50 |
$67.20
|
|
Fetal lung maturity assess lam body dnst
|
$62.50 |
$62.50 |
$62.50 |
$69.60
|
|
Fetal non stress test
|
$132.50 |
$132.50 |
$132.50 |
$467.46
|
|
#_fet/norfentcnfrmur
|
$65.00 |
$65.00 |
$65.00 |
$95.68
|
|
Fibrin degradation d dimer quantitative
|
$60.00 |
$60.00 |
$60.00 |
$117.60
|
|
Fibrinogen activity
|
$65.00 |
$65.00 |
$65.00 |
$83.50
|
|
Fibrinolysins/coagulopathy screen interpretation/report
|
$47.50 |
$47.50 |
$47.50 |
$63.94
|
|
Fibrinolytic plasminogen
|
$105.00 |
$105.00 |
$105.00 |
$107.50
|
|
Fibrinolytic plasminogen xcpt antgnc asa
|
$122.50 |
$122.50 |
$122.50 |
$65.40
|
|
Filter spider fx 3mmx320cm
|
$2,128.50 |
$2,128.50 |
$2,128.50 |
$7,130.56
|
|
Filter vena cava fem denali
|
$2,750.00 |
$2,750.00 |
$2,750.00 |
$3,718.18
|
|
Fine needle aspiration biopsy w/fluor gdn;1st lesion 10007
|
$910.00 |
$910.00 |
$910.00 |
$1,081.52
|
|
Fine needle aspiration biopsy w/fluor gdn; ea addtl 10008
|
$685.00 |
$685.00 |
$685.00 |
$685.00
|
|
Fine needle aspiration biopsy without img gdn; ea addtl 10004
|
$277.50 |
$277.50 |
$277.50 |
$272.70
|
|
Fine needle aspiration biopsy w/us gdn; ea addtl 10006
|
$840.00 |
$840.00 |
$840.00 |
$823.90
|
|
Fine needle asp without image guide 10021
|
$377.50 |
$377.50 |
$377.50 |
$503.76
|
|
Fix g/colon tube w/device
|
$665.00 |
$665.00 |
$665.00 |
$1,183.00
|
|
Flecainide (tambocor)-sendout
|
$90.00 |
$90.00 |
$90.00 |
$66.43
|
|
Fl exam g/colon tube w contrast
|
$615.00 |
$615.00 |
$615.00 |
$511.92
|
|
Flow cytometry marker each additional
|
$97.50 |
$97.50 |
$97.50 |
$97.50
|
|
Flow cytometry one marker technical component
|
$195.00 |
$195.00 |
$195.00 |
$284.40
|
|
Flt3 gene
|
$367.50 |
$367.50 |
$367.50 |
$355.00
|
|
Flt3 gene analysis
|
$185.00 |
$185.00 |
$185.00 |
$213.92
|
|
Fluidotherapy charges pt
|
$102.50 |
$102.50 |
$102.50 |
$91.00
|
|
Fluorescent antibody titer dna
|
$307.50 |
$307.50 |
$307.50 |
$121.20
|
|
Fluoroestradiol f 18
|
$960.00 |
$960.00 |
$960.00 |
$1,491.00
|
|
Fluoroguide for spine inject 77003-26
|
$460.00 |
$460.00 |
$460.00 |
$496.03
|
|
Fluoroguide needle placement
|
$460.00 |
$460.00 |
$460.00 |
$510.00
|
|
Fluoroscopy up to 1 hour
|
$460.00 |
$460.00 |
$460.00 |
$492.75
|
|
Fna bx w/ct gdn 1st les
|
$1,750.00 |
$1,750.00 |
$1,750.00 |
$1,420.80
|
|
Fna bx w/ct gdn ea addl
|
$1,315.00 |
$1,315.00 |
$1,315.00 |
$833.25
|
|
Foam drg >16<=48 sq in w/bdr
|
$22.50 |
$22.50 |
$22.50 |
$62.09
|
|
Foam drg >16<=48 sq in without b
|
$45.48 |
$45.48 |
$45.48 |
$41.14
|
|
Foam drg <=16 sq in w/border
|
$38.43 |
$38.43 |
$38.43 |
$16.25
|
|
Foam drg > 48 sq in w/border
|
$42.50 |
$42.50 |
$42.50 |
$23.63
|
|
Foam drsg <=16 sq in without bdr
|
$16.22 |
$16.22 |
$16.22 |
$21.74
|
|
Folic acid
|
$137.50 |
$137.50 |
$137.50 |
$101.00
|
|
Follow-up angiography
|
$590.00 |
$590.00 |
$590.00 |
$2,040.78
|
|
Fo nontorsion joint cf
|
$145.00 |
$145.00 |
$145.00 |
$217.50
|
|
Foot arch support remov prem
|
$55.00 |
$55.00 |
$55.00 |
$106.20
|
|
Foot longitudinal arch suppo
|
$127.50 |
$127.50 |
$127.50 |
$295.47
|
|
Foot longitud/metatarsal sup
|
$145.00 |
$145.00 |
$145.00 |
$221.20
|
|
Foot X-ray
|
$750.00 |
$750.00 |
$750.00 |
$362.40
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$115.00 |
$115.00 |
$115.00 |
$151.58
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$97.50 |
$97.50 |
$97.50 |
$156.60
|
|
Fresh frozen plasma thawing ea un
|
$50.00 |
$50.00 |
$50.00 |
$123.01
|
|
Fructosamine glycated protein
|
$67.50 |
$67.50 |
$67.50 |
$60.75
|
|
Ftl cgen abnor two proteins
|
$110.00 |
$110.00 |
$110.00 |
$110.00
|
|
Furosemide in ns IV syringe 2 mg/ml (neo/ped) - cnr
|
$28.55 |
$28.55 |
$28.55 |
$27.08
|
|
G6pc gene
|
$195.00 |
$195.00 |
$195.00 |
$123.00
|
|
Ga-67 gallium 0.1 mci
|
$67.50 |
$67.50 |
$67.50 |
$118.56
|
|
Ga-68 gallium 68 dotatate
|
$100.00 |
$100.00 |
$100.00 |
$119.90
|
|
Gabapentin non-blood
|
$185.00 |
$185.00 |
$185.00 |
$36.30
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$2.02 |
$2.02 |
$2.02 |
$102.00
|
|
Galac-1-phosphate uridyltran - sendout
|
$15.00 |
$15.00 |
$15.00 |
$96.94
|
|
Galectin-3
|
$92.50 |
$92.50 |
$92.50 |
$111.60
|
|
Gammaglobulin iga
|
$37.50 |
$37.50 |
$37.50 |
$67.20
|
|
Gammaglobulin ige
|
$107.50 |
$107.50 |
$107.50 |
$83.85
|
|
Gamma glutamyltransferase
|
$75.00 |
$75.00 |
$75.00 |
$57.54
|
|
Gamunex-c/gammaked
|
$97.00 |
$97.00 |
$97.00 |
$7,634.20
|
