|
Folic acid
|
$251.82 |
$251.82 |
$251.82 |
$87.75
|
|
Folic acid 5 mg/ml injection solution
|
$49.34 |
$49.34 |
$49.34 |
$56.70
|
|
Fomepizole 1 gram/ml intravenous solution
|
$4,596.98 |
$4,596.98 |
$4,596.98 |
$2,926.05
|
|
Fondaparinux sodium
|
$196.89 |
$196.89 |
$196.89 |
$176.54
|
|
Foot X-ray
|
$879.14 |
$879.14 |
$879.14 |
$364.00
|
|
Foreskn manip w/lss preputial ads+stretching 54450
|
$3,003.13 |
$3,003.13 |
$3,003.13 |
$584.12
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$342.07 |
$342.07 |
$342.07 |
$110.69
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$1,450.26 |
$1,450.26 |
$1,450.26 |
$168.75
|
|
Fructosamine glycated protein
|
$334.61 |
$334.61 |
$334.61 |
$60.42
|
|
Ftl cgen abnor four anal
|
$3,064.63 |
$3,064.63 |
$3,064.63 |
$211.83
|
|
Furosemide in ns IV syringe 2 mg/ml (neo/ped) - cnr
|
$168.45 |
$168.45 |
$168.45 |
$26.40
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$255.12 |
$255.12 |
$255.12 |
$176.62
|
|
Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper)
|
$422.45 |
$422.45 |
$422.45 |
$138.37
|
|
Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution
|
$602.45 |
$602.45 |
$602.45 |
$86.54
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$770.77 |
$770.77 |
$770.77 |
$210.50
|
|
Gammaglobulin iga
|
$204.19 |
$204.19 |
$204.19 |
$76.05
|
|
Gammaglobulin ige
|
$184.77 |
$184.77 |
$184.77 |
$85.00
|
|
Gamma glutamyltransferase
|
$181.39 |
$181.39 |
$181.39 |
$55.28
|
|
Gamunex-c/gammaked
|
$29,036.20 |
$29,036.20 |
$29,036.20 |
$7,372.04
|
|
Gemcitabine 1 gram intravenous solution
|
$975.17 |
$975.17 |
$975.17 |
$263.34
|
|
General health panel
|
$23.64 |
$23.64 |
$23.64 |
$280.50
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$164.29 |
$164.29 |
$164.29 |
$57.84
|
|
Gentamicin peak therapeutic drug level
|
$332.72 |
$332.72 |
$332.72 |
$119.90
|
|
Ghs antibodies (torch) igm
|
$287.30 |
$287.30 |
$287.30 |
$73.70
|
|
Ghs bladder cath - complex-foley
|
$2,811.47 |
$2,811.47 |
$2,811.47 |
$344.48
|
|
Ghs change cysto/gastrost
|
$3,003.13 |
$3,003.13 |
$3,003.13 |
$695.93
|
|
Ghs closed reduction ankle dislocation
|
$4,176.08 |
$4,176.08 |
$4,176.08 |
$732.75
|
|
Ghs closed tx radiocarpal disloc w manip
|
$4,176.08 |
$4,176.08 |
$4,176.08 |
$534.99
|
|
Ghs cl tx metacarpophal disloc without anes
|
$4,176.08 |
$4,176.08 |
$4,176.08 |
$547.94
|
|
Ghs conjunctiva foreign body-superf bil
|
$2,061.19 |
$2,061.19 |
$2,061.19 |
$317.85
|
|
Ghs eeg cont rec w/video by tec min 8 chnls
|
$5,289.34 |
$5,289.34 |
$5,289.34 |
$586.80
|
|
Ghs excision ingrown nail
|
$6,986.36 |
$6,986.36 |
$6,986.36 |
$453.39
|
|
Ghs histoplasma antigen
|
$264.54 |
$264.54 |
$264.54 |
$137.80
|
|
Ghs i and d perirectal abscess 46040
|
$20,029.89 |
$20,029.89 |
$20,029.89 |
$3,034.00
|
|
Ghs inf midline insertion
|
$1,659.88 |
$1,659.88 |
$1,659.88 |
$1,234.20
|
|
Ghs insertion of needle - bone
|
$4,533.25 |
$4,533.25 |
$4,533.25 |
$448.00
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$6,986.36 |
$6,986.36 |
$6,986.36 |
$943.20
|
|
Ghs IV thrombolytics - cerebral
|
$21.53 |
$21.53 |
$21.53 |
$663.00
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$4,533.25 |
$4,533.25 |
$4,533.25 |
$547.95
|
|
Ghs layer closure 2.5cm or less - 12051
|
$6,986.36 |
$6,986.36 |
$6,986.36 |
$648.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$6,986.36 |
$6,986.36 |
$6,986.36 |
$818.40
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$10,354.45 |
$10,354.45 |
$10,354.45 |
$782.40
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$6,986.36 |
$6,986.36 |
$6,986.36 |
$776.10
|
|
Ghs mbp
|
$343.40 |
$343.40 |
$343.40 |
$74.19
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$1,199.00 |
$1,199.00 |
$1,199.00 |
$257.56
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$1,094.48 |
$1,094.48 |
$1,094.48 |
$250.00
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$899.62 |
$899.62 |
$899.62 |
$230.55
|
|
Ghs moderate sedation ea addtl 15 min
|
$1,022.05 |
$1,022.05 |
$1,022.05 |
$145.98
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$276.36 |
$276.36 |
$276.36 |
$140.00
|
|
Ghs nailbed repair/nail removal
|
$10,354.45 |
$10,354.45 |
$10,354.45 |
$800.00
|
|
Ghs nerve block sciatic nerve
|
$2,162.88 |
$2,162.88 |
$2,162.88 |
$1,671.61
|
|
Ghs ng placement w fluoro guidance
|
$4,533.25 |
$4,533.25 |
$4,533.25 |
$466.83
|
|
Ghs ot sensory integrative tech/15min
|
$333.49 |
$333.49 |
$333.49 |
$101.50
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$247.61 |
$247.61 |
$247.61 |
$90.15
|
|
Ghs picc line insert < 5
|
$21,361.35 |
$21,361.35 |
$21,361.35 |
$2,060.40
|
|
Ghs plngl fx pm cl
|
$4,176.08 |
$4,176.08 |
$4,176.08 |
$662.20
|
|
Ghs ppd (tb intradermal)
|
$227.57 |
$227.57 |
$227.57 |
$43.45
|
|
Ghs prostatic acid phosphatase (mayo)
|
$192.86 |
$192.86 |
$192.86 |
$40.56
|
|
Ghs removal intranasal foreign body
|
$2,061.19 |
$2,061.19 |
$2,061.19 |
$321.60
|
|
Ghs removal pharyngeal foreign body
|
$4,533.25 |
$4,533.25 |
$4,533.25 |
$460.00
|
|
Ghs sensitivity (per antimicro)
|
$149.34 |
$149.34 |
$149.34 |
$59.90
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$6,986.36 |
$6,986.36 |
$6,986.36 |
$712.80
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$6,986.36 |
$6,986.36 |
$6,986.36 |
$665.00
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$3,506.66 |
$3,506.66 |
$3,506.66 |
$538.64
|
|
Ghs sp train/fitting sp device - kx
|
$533.25 |
$533.25 |
$533.25 |
$260.65
|
|
Ghs st - re-eval for alt comm
|
$703.80 |
$703.80 |
$703.80 |
$309.00
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$541.66 |
$541.66 |
$541.66 |
$342.40
|
|
Ghs superficial wnd dehiscence simp12020
|
$10,354.45 |
$10,354.45 |
$10,354.45 |
$951.20
|
|
Glucagon plasma - sendout
|
$285.31 |
$285.31 |
$285.31 |
$58.20
|
|
Glucose 1 hr post dose
|
$94.84 |
$94.84 |
$94.84 |
$46.28
|
|
Glucose blood quantitative
|
$360.61 |
$360.61 |
$360.61 |
$45.00
|
|
Glucose body fluid
|
$78.47 |
$78.47 |
$78.47 |
$50.70
|
|
Glucose tolerance test (gtt) 3 specimens
|
$256.96 |
$256.96 |
$256.96 |
$100.10
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$78.27 |
$78.27 |
$78.27 |
$34.45
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$122.73 |
$122.73 |
$122.73 |
$56.70
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$6,057.01 |
$6,057.01 |
$6,057.01 |
$4,880.83
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$112.70 |
$112.70 |
$112.70 |
$107.55
|
|
Gonadotropin luteinizing hormone (lh)
|
$171.50 |
$171.50 |
$171.50 |
$121.09
|
|
Guided cath fluid drainage 10030
|
$11,796.52 |
$11,796.52 |
$11,796.52 |
$1,454.66
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$203.97 |
$203.97 |
$203.97 |
$120.02
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$35.65 |
$35.65 |
$35.65 |
$33.22
|
|
Hand X-ray
|
$863.65 |
$863.65 |
$863.65 |
$333.75
|
|
Haptoglobin quantitative
|
$251.16 |
$251.16 |
$251.16 |
$88.40
|
|
Hcg qualitative
|
$329.20 |
$329.20 |
$329.20 |
$77.50
|
|
Hcg quantitative
|
$300.48 |
$300.48 |
$300.48 |
$125.40
|
|
Head CT scan (with and without contrast)
|
$10,381.65 |
$10,381.65 |
$10,381.65 |
$1,881.36
|
|
Head CT scan (with contrast)
|
$8,633.21 |
$8,633.21 |
$8,633.21 |
$1,545.60
|
|
Head CT scan (without contrast)
|
$7,467.27 |
$7,467.27 |
$7,467.27 |
$1,268.90
|
|
Helicobacter pylori antibody igm
|
$336.41 |
$336.41 |
$336.41 |
$84.80
|
|
Hematocrit
|
$160.66 |
$160.66 |
$160.66 |
$33.57
|
|
Hemodialysis one evaluation
|
$2,739.00 |
$2,739.00 |
$2,739.00 |
$1,305.12
|
|
Hemoglobin
|
$90.28 |
$90.28 |
$90.28 |
$32.50
|
|
Hemoglobin urine
|
$78.87 |
$78.87 |
$78.87 |
$23.31
|
|
Heparin assay
|
$396.78 |
$396.78 |
$396.78 |
$130.20
|
|
Heparin bolus from bag
|
$242.76 |
$242.76 |
$242.76 |
$79.04
|
|
Heparin neutralization
|
$236.39 |
$236.39 |
$236.39 |
$46.80
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$50.66 |
$50.66 |
$50.66 |
$29.00
|
|
Hepatitis a antibody igm
|
$224.81 |
$224.81 |
$224.81 |
$85.92
|
|
Hepatitis b core antibody igm
|
$49.84 |
$49.84 |
$49.84 |
$88.41
|
|
Hepatitis b core antibody total
|
$240.58 |
$240.58 |
$240.58 |
$84.75
|