|
Fluoroscopy up to 1 hour
|
$369.60 |
$369.60 |
$369.60 |
$494.52
|
|
Fluorouracil 50 mg/ml intravenous solution (wrapper)
|
$92.69 |
$92.69 |
$92.69 |
$136.92
|
|
Fmri brain by tech
|
$460.60 |
$460.60 |
$460.60 |
$1,486.75
|
|
Fna bx w/ct gdn 1st les
|
$3,208.80 |
$3,208.80 |
$3,208.80 |
$1,588.65
|
|
Fna bx w/ct gdn ea addl
|
$1,604.05 |
$1,604.05 |
$1,604.05 |
$775.14
|
|
Folic acid
|
$152.60 |
$152.60 |
$152.60 |
$90.60
|
|
Folic acid 5 mg/ml injection solution
|
$32.83 |
$32.83 |
$32.83 |
$56.70
|
|
Follow-up angiography
|
$651.00 |
$651.00 |
$651.00 |
$1,939.14
|
|
Fomepizole 1 gram/ml intravenous solution
|
$3,542.74 |
$3,542.74 |
$3,542.74 |
$2,581.14
|
|
Fondaparinux sodium
|
$116.35 |
$116.35 |
$116.35 |
$176.54
|
|
Foot X-ray
|
$364.00 |
$364.00 |
$364.00 |
$362.40
|
|
Forehead flap w/vasc pedicle 15731
|
$3,684.10 |
$3,684.10 |
$3,684.10 |
$4,332.25
|
|
Foreskn manip w/lss preputial ads+stretching 54450
|
$310.45 |
$310.45 |
$310.45 |
$595.80
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$82.67 |
$82.67 |
$82.67 |
$425.16
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$87.16 |
$87.16 |
$87.16 |
$86.40
|
|
Fracture assessment via dxa
|
$95.55 |
$95.55 |
$95.55 |
$146.80
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$28.70 |
$28.70 |
$28.70 |
$168.75
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$18.55 |
$18.55 |
$18.55 |
$164.16
|
|
Fresh frozen plasma thawing ea un
|
$157.15 |
$157.15 |
$157.15 |
$123.90
|
|
Frozen blood thaw
|
$306.60 |
$306.60 |
$306.60 |
$189.84
|
|
Full thick gft/nose/ear/lid/lip/20sqcm or< 15260
|
$1,702.05 |
$1,702.05 |
$1,702.05 |
$2,919.95
|
|
Full thick gft/scalp/arm/leg/20sqcm or< 15220
|
$1,084.65 |
$1,084.65 |
$1,084.65 |
$2,465.10
|
|
Full thick gft/scalp/arm/leg/add 20sqcm 15221
|
$542.50 |
$542.50 |
$542.50 |
$429.55
|
|
Full thick gft w/close donor fccmnaghf <=20sqcm 15240
|
$1,910.30 |
$1,910.30 |
$1,910.30 |
$2,501.10
|
|
Furosemide 10 mg/ml injection solution
|
$96.74 |
$96.74 |
$96.74 |
$27.48
|
|
Fusion of finger joint
|
$2,457.00 |
$2,457.00 |
$2,457.00 |
$3,986.00
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$51.45 |
$51.45 |
$51.45 |
$162.68
|
|
Galactose transferase test
|
$13.30 |
$13.30 |
$13.30 |
$22.40
|
|
Gamma globulin 1 cc inj
|
$1,598.22 |
$1,598.22 |
$1,598.22 |
$158.67
|
|
Gammaglobulin iga
|
$66.15 |
$66.15 |
$66.15 |
$75.30
|
|
Gammaglobulin ige
|
$66.15 |
$66.15 |
$66.15 |
$85.00
|
|
Gamma glutamyltransferase
|
$105.70 |
$105.70 |
$105.70 |
$55.28
|
|
Gamunex-c/gammaked
|
$5,103.06 |
$5,103.06 |
$5,103.06 |
$6,963.60
|
|
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr
|
$435.44 |
$435.44 |
$435.44 |
$197.40
|
|
Gastric emptying imag study
|
$1,340.15 |
$1,340.15 |
$1,340.15 |
$1,270.50
|
|
Gastric emptying imag study
|
$1,474.55 |
$1,474.55 |
$1,474.55 |
$1,664.33
|
|
Gastric mucosa imaging
|
$676.55 |
$676.55 |
$676.55 |
$497.25
|
|
Gastroesophageal reflux study
|
$923.65 |
$923.65 |
$923.65 |
$957.25
|
|
Gastroesophageal reflux test
|
$1,759.45 |
$1,759.45 |
$1,759.45 |
$1,129.63
|
|
Gated heart multiple
|
$1,247.75 |
$1,247.75 |
$1,247.75 |
$1,370.99
|
|
Gemcitabine 1 gram intravenous solution
|
$227.73 |
$227.73 |
$227.73 |
$269.06
|
|
Gemtuzumab ozogamicin 4.5 mg (1 mg/ml initial concentration) IV soln
|
$17,753.23 |
$17,753.23 |
$17,753.23 |
$20,893.87
|
|
Generator barostim neo2 2014
|
$54,121.91 |
$54,121.91 |
$54,121.91 |
$54,121.91
|
|
Generator emblem MRI sicd subq
|
$28,469.00 |
$28,469.00 |
$28,469.00 |
$36,467.76
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$89.61 |
$89.61 |
$89.61 |
$63.08
|
|
Gentamicin peak therapeutic drug level
|
$280.00 |
$280.00 |
$280.00 |
$119.00
|
|
Ghs abscess perianal iandd
|
$878.85 |
$878.85 |
$878.85 |
$1,530.50
|
|
Ghs abscess postoperative iandd complex
|
$2,266.60 |
$2,266.60 |
$2,266.60 |
$3,776.00
|
|
Ghs analysis neurostim without reprogramming
|
$108.85 |
$108.85 |
$108.85 |
$313.95
|
|
Ghs aspiration bladder - needle
|
$286.65 |
$286.65 |
$286.65 |
$590.84
|
|
Ghs bladder cath - complex-foley
|
$230.30 |
$230.30 |
$230.30 |
$344.48
|
|
Ghs block ilioinguinal/gentitofemoral
|
$2,213.05 |
$2,213.05 |
$2,213.05 |
$1,050.00
|
|
Ghs central line insert < age 5, failed
|
$3,508.05 |
$3,508.05 |
$3,508.05 |
$2,676.75
|
|
Ghs change cysto/gastrost
|
$1,702.05 |
$1,702.05 |
$1,702.05 |
$699.60
|
|
Ghs chemo >8 hrs
|
$958.65 |
$958.65 |
$958.65 |
$714.87
|
|
Ghs chemo IV push, ea addtl
|
$275.10 |
$275.10 |
$275.10 |
$291.60
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$675.85 |
$675.85 |
$675.85 |
$596.55
|
|
Ghs closed reduction ankle dislocation
|
$675.85 |
$675.85 |
$675.85 |
$731.04
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$1,554.70 |
$1,554.70 |
$1,554.70 |
$1,707.42
|
|
Ghs closed tx radiocarpal disloc w manip
|
$497.00 |
$497.00 |
$497.00 |
$534.99
|
|
Ghs closed tx tibial fracture w/manip
|
$2,329.60 |
$2,329.60 |
$2,329.60 |
$2,621.64
|
|
Ghs closure surg wound/dehiscence-13160
|
$5,436.55 |
$5,436.55 |
$5,436.55 |
$2,973.33
|
|
Ghs clsd red med malleolus fx without manip
|
$497.00 |
$497.00 |
$497.00 |
$581.60
|
|
Ghs clsd red med malleolus fx w manip
|
$2,329.60 |
$2,329.60 |
$2,329.60 |
$2,459.25
|
|
Ghs clsd tx frac distal tibia w/manipulation
|
$1,937.95 |
$1,937.95 |
$1,937.95 |
$2,399.46
|
|
Ghs cl tx knee disl; wo anesth
|
$675.85 |
$675.85 |
$675.85 |
$716.95
|
|
Ghs cl tx metacarpophal disloc without anes
|
$675.85 |
$675.85 |
$675.85 |
$547.94
|
|
Ghs community re-entry 15 minutes
|
$67.20 |
$67.20 |
$67.20 |
$89.28
|
|
Ghs conjunctiva foreign body-embed bil
|
$282.80 |
$282.80 |
$282.80 |
$448.80
|
|
Ghs conjunctiva foreign body-superf bil
|
$199.85 |
$199.85 |
$199.85 |
$316.25
|
|
Ghs corneal fb without slit lamp bilat
|
$457.10 |
$457.10 |
$457.10 |
$435.07
|
|
Ghs corneal fb with slit lamp bilat
|
$548.45 |
$548.45 |
$548.45 |
$368.16
|
|
Ghs cricothyroidotomy
|
$1,227.10 |
$1,227.10 |
$1,227.10 |
$1,207.80
|
|
Ghs cutdown placement age 1 and over
|
$372.40 |
$372.40 |
$372.40 |
$411.84
|
|
Ghs cutdown placement under 1 yr
|
$242.20 |
$242.20 |
$242.20 |
$152.54
|
|
Ghs dislocation elbow closed treatment
|
$675.85 |
$675.85 |
$675.85 |
$687.73
|
|
Ghs ed peritoneal lavage w guidance if performed
|
$1,081.50 |
$1,081.50 |
$1,081.50 |
$1,313.95
|
|
Ghs ed rmvl or bivalving cast
|
$222.25 |
$222.25 |
$222.25 |
$351.46
|
|
Ghs ed therapeutic lp, drain csf w fluoro
|
$1,881.95 |
$1,881.95 |
$1,881.95 |
$1,439.40
|
|
Ghs eeg cont rec w/video by tec min 8 chnls
|
$380.45 |
$380.45 |
$380.45 |
$586.80
|
|
Ghs epidermal shaving diameter >2.0 cm
|
$1,010.45 |
$1,010.45 |
$1,010.45 |
$470.51
|
|
Ghs excision ingrown nail
|
$576.45 |
$576.45 |
$576.45 |
$457.60
|
|
Ghs eye exam
|
$113.40 |
$113.40 |
$113.40 |
$162.24
|
|
Ghs eyelid foreign body-embedded - bil
|
$351.40 |
$351.40 |
$351.40 |
$536.77
|
|
Ghs fb removal foot - deep - left
|
$1,642.20 |
$1,642.20 |
$1,642.20 |
$2,880.30
|
|
Ghs fb removal from muscle - complicated
|
$3,181.85 |
$3,181.85 |
$3,181.85 |
$3,386.84
|
|
Ghs fb removal - incisional
|
$1,625.05 |
$1,625.05 |
$1,625.05 |
$2,425.20
|
|
Ghs fb removal - non-incisional
|
$2,344.30 |
$2,344.30 |
$2,344.30 |
$1,794.93
|
|
Ghs flow volume loop
|
$147.35 |
$147.35 |
$147.35 |
$309.12
|
|
Ghs gastric intub aspiration lavage
|
$441.35 |
$441.35 |
$441.35 |
$403.20
|
|
Ghs i and d abscess/hematoma scrotum
|
$2,015.30 |
$2,015.30 |
$2,015.30 |
$3,822.00
|
|
Ghs i and d perirectal abscess 46040
|
$1,728.30 |
$1,728.30 |
$1,728.30 |
$3,034.00
|
|
Ghs i and d pilonidal cyst complex
|
$1,351.35 |
$1,351.35 |
$1,351.35 |
$1,572.00
|
|
Ghs i and d pilonidal cyst simple
|
$1,036.70 |
$1,036.70 |
$1,036.70 |
$794.82
|
|
Ghs incision thrombosed ext hemorrhoid
|
$473.20 |
$473.20 |
$473.20 |
$543.60
|
|
Ghs indirect laryngoscopy/w fb removal
|
$412.30 |
$412.30 |
$412.30 |
$293.58
|
|
Ghs inf midline insertion
|
$679.70 |
$679.70 |
$679.70 |
$1,234.20
|
|
Ghs inhibitor screen
|
$108.50 |
$108.50 |
$108.50 |
$143.32
|
|
Ghs init tx 1st degree burn
|
$231.00 |
$231.00 |
$231.00 |
$300.30
|
|
Ghs inj tendon origin/insertion
|
$813.05 |
$813.05 |
$813.05 |
$431.07
|
