|
Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr
|
$50.70 |
$50.70 |
$50.70 |
$22.20
|
|
Fat/lipids feces qualitative
|
$55.38 |
$55.38 |
$55.38 |
$38.00
|
|
Fatty acids nonesterified
|
$68.64 |
$68.64 |
$68.64 |
$56.70
|
|
Felbamate (felbatol(r)) - sendout
|
$28.86 |
$28.86 |
$28.86 |
$66.95
|
|
Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper)
|
$54.60 |
$54.60 |
$54.60 |
$102.69
|
|
Ferric carboxymaltose 50 mg iron/ml intravenous solution
|
$4,974.33 |
$4,974.33 |
$4,974.33 |
$1,360.14
|
|
Ferritin
|
$166.92 |
$166.92 |
$166.92 |
$103.95
|
|
Fetal biophys profile w/nst 76818
|
$989.04 |
$989.04 |
$989.04 |
$541.74
|
|
Fetal chrom aneuploidy gsa panel
|
$656.76 |
$656.76 |
$656.76 |
$1,231.20
|
|
Fetal contract stress test 59020 - 26
|
$347.10 |
$347.10 |
$347.10 |
$579.00
|
|
Fetal fibronectin
|
$131.82 |
$131.82 |
$131.82 |
$345.05
|
|
Fetal non stress test
|
$347.88 |
$347.88 |
$347.88 |
$507.90
|
|
#_fet/norfentcnfrmur
|
$85.80 |
$85.80 |
$85.80 |
$120.85
|
|
Fibrin degradation d dimer quantitative
|
$192.66 |
$192.66 |
$192.66 |
$112.20
|
|
Fibrin degradation products
|
$39.00 |
$39.00 |
$39.00 |
$64.94
|
|
Fibrinogen activity
|
$134.94 |
$134.94 |
$134.94 |
$82.38
|
|
Fibrinolytic antiplasmin
|
$74.10 |
$74.10 |
$74.10 |
$58.85
|
|
Fibrinolytic plasminogen
|
$39.78 |
$39.78 |
$39.78 |
$113.10
|
|
Filleted finger/toe flap
|
$3,365.70 |
$3,365.70 |
$3,365.70 |
$2,122.77
|
|
Fine needle asp without image guide 10021
|
$1,599.78 |
$1,599.78 |
$1,599.78 |
$547.53
|
|
Fixation of knee joint
|
$2,797.08 |
$2,797.08 |
$2,797.08 |
$1,863.75
|
|
Fix g/colon tube w/device
|
$1,851.72 |
$1,851.72 |
$1,851.72 |
$1,183.00
|
|
Fixtn pq skel dstl rad fx/epiphysl sep
|
$5,804.76 |
$5,804.76 |
$5,804.76 |
$3,967.08
|
|
Flecainide (tambocor)-sendout
|
$49.14 |
$49.14 |
$49.14 |
$66.43
|
|
Flexible Sigmoidoscopy
|
$1,620.84 |
$1,620.84 |
$1,620.84 |
$1,284.13
|
|
Floor of mouth biopsy 41108
|
$2,924.22 |
$2,924.22 |
$2,924.22 |
$1,908.09
|
|
Fluid pressure muscle 20950
|
$1,265.16 |
$1,265.16 |
$1,265.16 |
$738.87
|
|
Fluorescent antibody titer dna
|
$283.92 |
$283.92 |
$283.92 |
$132.86
|
|
Folic acid
|
$181.74 |
$181.74 |
$181.74 |
$87.50
|
|
Folic acid 5 mg/ml injection solution
|
$50.70 |
$50.70 |
$50.70 |
$48.78
|
|
Foot X-ray
|
$622.44 |
$622.44 |
$622.44 |
$364.80
|
|
Forehead flap w/vasc pedicle 15731
|
$7,295.34 |
$7,295.34 |
$7,295.34 |
$4,055.70
|
|
Foreskn manip w/lss preputial ads+stretching 54450
|
$418.86 |
$418.86 |
$418.86 |
$616.80
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$89.47 |
$89.47 |
$89.47 |
$94.85
|
|
_fragile x methylation-sendout
|
$151.32 |
$151.32 |
$151.32 |
$181.35
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$167.70 |
$167.70 |
$167.70 |
$186.55
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$375.96 |
$375.96 |
$375.96 |
$174.85
|
|
Ftl cgen abnor four anal
|
$73.32 |
$73.32 |
$73.32 |
$211.83
|
|
Full thick gft/nose/ear/lid/lip/20sqcm or< 15260
|
$3,870.36 |
$3,870.36 |
$3,870.36 |
$2,896.00
|
|
Full thick gft w/close donor fccmnaghf <=20sqcm 15240
|
$3,870.36 |
$3,870.36 |
$3,870.36 |
$2,329.60
|
|
Furosemide 10 mg/ml injection solution
|
$50.70 |
$50.70 |
$50.70 |
$19.53
|
|
Fusion of finger joint
|
$5,804.76 |
$5,804.76 |
$5,804.76 |
$3,821.05
|
|
Gammaglobulin iga
|
$143.52 |
$143.52 |
$143.52 |
$76.61
|
|
Gammaglobulin ige
|
$123.24 |
$123.24 |
$123.24 |
$85.00
|
|
Gamma glutamyltransferase
|
$61.62 |
$61.62 |
$61.62 |
$55.28
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$50.70 |
$50.70 |
$50.70 |
$44.63
|
|
Gentamicin peak therapeutic drug level
|
$42.12 |
$42.12 |
$42.12 |
$117.82
|
|
Ghs abscess perianal iandd
|
$2,148.12 |
$2,148.12 |
$2,148.12 |
$1,530.50
|
|
Ghs abscess postoperative iandd complex
|
$2,871.96 |
$2,871.96 |
$2,871.96 |
$3,776.00
|
|
Ghs alcohol, methyl (methanol)-medtox
|
$80.34 |
$80.34 |
$80.34 |
$104.61
|
|
Ghs alpha thalasemia, 7 deletions
|
$342.42 |
$342.42 |
$342.42 |
$441.50
|
|
Ghs antibodies (torch) igm
|
$105.30 |
$105.30 |
$105.30 |
$77.85
|
|
Ghs aspiration bladder - needle
|
$418.86 |
$418.86 |
$418.86 |
$590.85
|
|
Ghs bladder cath - complex-foley
|
$696.54 |
$696.54 |
$696.54 |
$344.48
|
|
Ghs block ilioinguinal/gentitofemoral
|
$1,256.58 |
$1,256.58 |
$1,256.58 |
$1,000.08
|
|
Ghs central line insert < age 5, failed
|
$5,808.66 |
$5,808.66 |
$5,808.66 |
$2,475.00
|
|
Ghs change cysto/gastrost
|
$971.10 |
$971.10 |
$971.10 |
$664.20
|
|
Ghs chemo >8 hrs
|
$1,588.08 |
$1,588.08 |
$1,588.08 |
$714.87
|
|
Ghs chlamydia pneumoniae by pcr (arup) (306630)
|
$89.70 |
$89.70 |
$89.70 |
$132.00
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$1,292.46 |
$1,292.46 |
$1,292.46 |
$599.00
|
|
Ghs closed reduction ankle dislocation
|
$3,198.78 |
$3,198.78 |
$3,198.78 |
$732.75
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$3,531.06 |
$3,531.06 |
$3,531.06 |
$1,655.78
|
|
Ghs closed tx radiocarpal disloc w manip
|
$1,078.74 |
$1,078.74 |
$1,078.74 |
$534.99
|
|
Ghs closed tx tibial fracture w/manip
|
$4,724.46 |
$4,724.46 |
$4,724.46 |
$2,335.80
|
|
Ghs closure surg wound/dehiscence-13160
|
$3,250.26 |
$3,250.26 |
$3,250.26 |
$2,973.33
|
|
Ghs clsd red med malleolus fx without manip
|
$1,078.74 |
$1,078.74 |
$1,078.74 |
$599.00
|
|
Ghs clsd red med malleolus fx w manip
|
$4,015.44 |
$4,015.44 |
$4,015.44 |
$2,316.00
|
|
Ghs clsd tx frac distal tibia w/manipulation
|
$4,191.72 |
$4,191.72 |
$4,191.72 |
$2,319.00
|
|
Ghs cl tx knee disl; wo anesth
|
$1,078.74 |
$1,078.74 |
$1,078.74 |
$720.73
|
|
Ghs cl tx metacarpophal disloc without anes
|
$2,439.06 |
$2,439.06 |
$2,439.06 |
$546.00
|
|
Ghs conjunctiva foreign body-embed bil
|
$865.80 |
$865.80 |
$865.80 |
$441.68
|
|
Ghs conjunctiva foreign body-superf bil
|
$569.40 |
$569.40 |
$569.40 |
$316.25
|
|
Ghs corneal fb without slit lamp bilat
|
$866.58 |
$866.58 |
$866.58 |
$435.07
|
|
Ghs corneal fb with slit lamp bilat
|
$953.16 |
$953.16 |
$953.16 |
$365.43
|
|
Ghs cricothyroidotomy
|
$3,930.42 |
$3,930.42 |
$3,930.42 |
$1,207.80
|
|
Ghs cutdown placement age 1 and over
|
$736.32 |
$736.32 |
$736.32 |
$309.14
|
|
Ghs cutdown placement under 1 yr
|
$226.20 |
$226.20 |
$226.20 |
$142.67
|
|
Ghs dislocation elbow closed treatment
|
$1,506.96 |
$1,506.96 |
$1,506.96 |
$687.73
|
|
Ghs ed peritoneal lavage w guidance if performed
|
$2,923.44 |
$2,923.44 |
$2,923.44 |
$1,339.20
|
|
Ghs ed rmvl or bivalving cast
|
$215.28 |
$215.28 |
$215.28 |
$335.08
|
|
Ghs ed therapeutic lp, drain csf w fluoro
|
$1,256.58 |
$1,256.58 |
$1,256.58 |
$1,388.18
|
|
Ghs excision ingrown nail
|
$453.18 |
$453.18 |
$453.18 |
$453.18
|
|
Ghs eye exam
|
$235.56 |
$235.56 |
$235.56 |
$162.24
|
|
Ghs eyelid foreign body-embedded - bil
|
$593.58 |
$593.58 |
$593.58 |
$553.80
|
|
Ghs fb removal foot - deep - left
|
$6,353.10 |
$6,353.10 |
$6,353.10 |
$2,873.34
|
|
Ghs fb removal from muscle - complicated
|
$2,937.48 |
$2,937.48 |
$2,937.48 |
$3,170.64
|
|
Ghs fb removal - incisional
|
$2,096.64 |
$2,096.64 |
$2,096.64 |
$2,444.00
|
|
Ghs fb removal - non-incisional
|
$1,315.86 |
$1,315.86 |
$1,315.86 |
$1,770.73
|
|
Ghs fish cytogen
|
$116.22 |
$116.22 |
$116.22 |
$176.93
|
|
Ghs fish hybrid in situ 100-300
|
$116.22 |
$116.22 |
$116.22 |
$229.45
|
|
Ghs gastric intub aspiration lavage
|
$546.00 |
$546.00 |
$546.00 |
$383.35
|
|
Ghs hcv amplificaiton
|
$122.46 |
$122.46 |
$122.46 |
$195.60
|
|
Ghs hepatitis c virus (hcv riba)
|
$196.56 |
$196.56 |
$196.56 |
$108.46
|
|
Ghs histoplasma antigen
|
$106.08 |
$106.08 |
$106.08 |
$144.50
|
|
Ghs HIV antibody
|
$167.70 |
$167.70 |
$167.70 |
$94.25
|
|
Ghs i and d abscess/hematoma scrotum
|
$3,616.86 |
$3,616.86 |
$3,616.86 |
$3,922.28
|
|
Ghs i and d perirectal abscess 46040
|
$2,270.58 |
$2,270.58 |
$2,270.58 |
$3,007.55
|
|
Ghs i and d pilonidal cyst complex
|
$1,808.82 |
$1,808.82 |
$1,808.82 |
$1,574.63
|
|
Ghs i and d pilonidal cyst simple
|
$786.24 |
$786.24 |
$786.24 |
$794.82
|
|
Ghs incision thrombosed ext hemorrhoid
|
$1,049.88 |
$1,049.88 |
$1,049.88 |
$542.16
|
