|
Folic acid
|
$163.15 |
$163.15 |
$579.00 |
$101.50
|
|
Folic acid 5 mg/ml injection solution
|
$3.25 |
$3.25 |
$193.00 |
$45.00
|
|
Follow-up angiography
|
$2,208.05 |
$2,208.05 |
$2,208.05 |
$1,983.00
|
|
Fomepizole 1 gram/ml intravenous solution
|
$83.20 |
$83.20 |
$12,241.00 |
$2,511.73
|
|
Fondaparinux sodium
|
$486.20 |
$486.20 |
$486.20 |
$186.20
|
|
Foot X-ray
|
$600.60 |
$600.60 |
$600.60 |
$355.20
|
|
Foot X-ray (2 views, both feet)
|
$434.85 |
$434.85 |
$483.60 |
$290.40
|
|
Forearm X-ray (both sides)
|
$560.30 |
$560.30 |
$560.30 |
$324.00
|
|
Forehead flap w/vasc pedicle 15731
|
$11,737.05 |
$11,737.05 |
$11,737.05 |
$4,872.75
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$5.20 |
$5.20 |
$3,415.00 |
$490.67
|
|
Foscarnet sodium injection
|
$559.65 |
$559.65 |
$559.65 |
$988.21
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$785.85 |
$785.85 |
$785.85 |
$103.62
|
|
Fractionation ketosteroids
|
$627.00 |
$627.00 |
$627.00 |
$160.89
|
|
Frenulotomy of penis
|
$4,968.60 |
$4,968.60 |
$4,968.60 |
$3,969.73
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$0.01 |
$0.01 |
$0.01 |
$164.84
|
|
Fresh frozen plasma thawing ea un
|
$42.90 |
$42.90 |
$176.00 |
$131.25
|
|
Frozen blood freeze/thaw
|
$250.25 |
$250.25 |
$250.25 |
$179.01
|
|
Fructosamine glycated protein
|
$125.45 |
$125.45 |
$125.45 |
$63.50
|
|
Fth/gft fr n/e/e/l each addl
|
$1,263.60 |
$1,263.60 |
$1,263.60 |
$1,368.50
|
|
Fth/gft fr trnk each addl
|
$2,066.35 |
$2,066.35 |
$2,066.35 |
$1,368.50
|
|
Full mouth x-ray of teeth
|
$570.70 |
$570.70 |
$570.70 |
$286.04
|
|
Full Spine X-ray (Scoliosis Survey)
|
$433.55 |
$433.55 |
$433.55 |
$355.00
|
|
Full thick gft/nose/ear/lid/lip/20sqcm or< 15260
|
$5,120.05 |
$5,120.05 |
$5,120.05 |
$3,155.50
|
|
Full thick gft/scalp/arm/leg/20sqcm or< 15220
|
$5,630.95 |
$5,630.95 |
$5,630.95 |
$2,499.37
|
|
Full thick gft/scalp/arm/leg/add 20sqcm 15221
|
$1,263.60 |
$1,263.60 |
$1,263.60 |
$1,056.41
|
|
Full thick gft w/close donor fccmnaghf <=20sqcm 15240
|
$2,527.20 |
$2,527.20 |
$2,527.20 |
$2,798.50
|
|
Functional brain mapping
|
$514.80 |
$514.80 |
$514.80 |
$514.80
|
|
Furosemide 10 mg/ml injection solution
|
$3.25 |
$3.25 |
$3.25 |
$19.53
|
|
Ga-67 gallium 0.1 mci
|
$204.75 |
$204.75 |
$1,170.00 |
$121.73
|
|
Ga-68 gallium 68 dotatate
|
$287.30 |
$287.30 |
$287.30 |
$140.35
|
|
Gabapentin non-blood
|
$34.45 |
$34.45 |
$34.45 |
$42.35
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$2.60 |
$2.60 |
$2.60 |
$108.40
|
|
Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper)
|
$15.60 |
$15.60 |
$15.60 |
$120.00
|
|
Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution
|
$140.40 |
$140.40 |
$140.40 |
$177.52
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$68.25 |
$68.25 |
$1,626.00 |
$249.80
|
|
Galactokinase - sendout
|
$3,489.00 |
$3,489.00 |
$3,489.00 |
$204.97
|
|
Galectin-3
|
$250.25 |
$250.25 |
$250.25 |
$111.60
|
|
Gallbladder and Bile Duct Scan (HIDA Scan)
|
$2,037.75 |
$2,037.75 |
$5,351.00 |
$1,494.00
|
|
Gallbladder Function Scan (HIDA with Medication)
|
$2,037.75 |
$2,037.75 |
$5,351.00 |
$1,615.00
|
|
Gallium illuccix 1 millicure
|
$2,317.90 |
$2,317.90 |
$6,192.00 |
$1,696.55
|
|
Gallium locametz 1 millicuri
|
$1,853.80 |
$1,853.80 |
$1,853.80 |
$1,853.80
|
|
Gamma globulin 1 cc inj
|
$363.35 |
$363.35 |
$2,277.00 |
$407.60
|
|
Gammaglobulin iga
|
$289.25 |
$289.25 |
$289.25 |
$69.60
|
|
Gammaglobulin ige
|
$638.30 |
$638.30 |
$1,829.00 |
$83.85
|
|
Gamma glutamyltransferase
|
$54.60 |
$54.60 |
$1,156.00 |
$57.54
|
|
Gammagraft
|
$1.00 |
$1.00 |
$1.00 |
$1.00
|
|
Gamunex-c/gammaked
|
$332.80 |
$332.80 |
$332.80 |
$7,435.88
|
|
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr
|
$592.80 |
$592.80 |
$592.80 |
$197.40
|
|
Ganciclovir long act implant
|
$68,716.05 |
$68,716.05 |
$68,716.05 |
$68,716.05
|
|
Gastric analy w/ph ea spec
|
$32.50 |
$32.50 |
$32.50 |
$31.50
|
|
Gastric emptying imag study
|
$2,379.00 |
$2,379.00 |
$2,379.00 |
$1,665.50
|
|
Gastric motility studies
|
$1,072.50 |
$1,072.50 |
$1,072.50 |
$972.00
|
|
Gastrin test
|
$1,360.00 |
$1,360.00 |
$1,360.00 |
$61.80
|
|
Gastroesophageal reflux study
|
$1,103.05 |
$1,103.05 |
$3,559.00 |
$1,031.60
|
|
Gastroesophageal reflux test
|
$1,600.95 |
$1,600.95 |
$10,700.00 |
$1,352.00
|
|
Gated heart multiple
|
$2,194.40 |
$2,194.40 |
$4,515.00 |
$1,405.04
|
|
Gauze <=16 in no w/sal without b
|
$2.60 |
$2.60 |
$2.60 |
$6.40
|
|
Gefitinib oral
|
$832.00 |
$832.00 |
$832.00 |
$423.82
|
|
Gemcitabine 1 gram intravenous solution
|
$78.65 |
$78.65 |
$162.80 |
$207.51
|
|
Gemtuzumab ozogamicin 4.5 mg (1 mg/ml initial concentration) IV soln
|
$1,020.50 |
$1,020.50 |
$1,020.50 |
$19,305.62
|
|
Generator barostim neo2 2014
|
$117,198.90 |
$117,198.90 |
$117,198.90 |
$52,020.00
|
|
Generator emblem MRI sicd subq
|
$68,948.10 |
$68,948.10 |
$68,948.10 |
$36,467.76
|
|
Generator stim baroreceptor neo legacy implant pulse
|
$116,298.00 |
$116,298.00 |
$116,298.00 |
$66,636.36
|
|
Gen, neuro, clo loop, rechg
|
$142,880.40 |
$142,880.40 |
$142,880.40 |
$38,632.78
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$59.15 |
$59.15 |
$59.15 |
$52.54
|
|
Gentamicin peak therapeutic drug level
|
$375.70 |
$375.70 |
$375.70 |
$123.84
|
|
G-esoph reflx tst w/electrod
|
$2,119.00 |
$2,119.00 |
$5,975.00 |
$1,514.00
|
|
Gfrg autol fat lipo ea addl
|
$5,825.30 |
$5,825.30 |
$5,825.30 |
$5,825.30
|
|
Ghs abscess perianal iandd
|
$2,746.25 |
$2,746.25 |
$2,746.25 |
$1,465.00
|
|
Ghs abscess postoperative iandd complex
|
$6,184.75 |
$6,184.75 |
$6,184.75 |
$3,776.00
|
|
Ghs acetylcholinesterase, rbc
|
$26.65 |
$26.65 |
$153.00 |
$43.06
|
|
Ghs antibodies (torch) igm
|
$35.10 |
$35.10 |
$153.00 |
$69.12
|
|
Ghs bladder cath - complex-foley
|
$199.55 |
$199.55 |
$199.55 |
$344.00
|
|
Ghs bleeding time (ivy)
|
$905.00 |
$905.00 |
$905.00 |
$61.29
|
|
Ghs block ilioinguinal/gentitofemoral
|
$3,907.80 |
$3,907.80 |
$3,907.80 |
$1,059.85
|
|
Ghs central line insert < age 5, failed
|
$1,274.65 |
$1,274.65 |
$1,274.65 |
$2,519.49
|
|
Ghs change cysto/gastrost
|
$827.45 |
$827.45 |
$827.45 |
$594.55
|
|
Ghs chemo >8 hrs
|
$848.25 |
$848.25 |
$848.25 |
$714.87
|
|
Ghs chemo IV push, ea addtl
|
$308.10 |
$308.10 |
$308.10 |
$277.00
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$674.05 |
$674.05 |
$674.05 |
$513.15
|
|
Ghs closure surg wound/dehiscence-13160
|
$5,933.20 |
$5,933.20 |
$5,933.20 |
$3,567.20
|
|
Ghs cl tx metacarpophal disloc without anes
|
$674.05 |
$674.05 |
$674.05 |
$500.40
|
|
Ghs community re-entry 15 minutes
|
$173.55 |
$173.55 |
$173.55 |
$89.28
|
|
Ghs ed peritoneal lavage w guidance if performed
|
$1,823.90 |
$1,823.90 |
$1,823.90 |
$1,109.47
|
|
Ghs ed rmvl or bivalving cast
|
$297.70 |
$297.70 |
$297.70 |
$338.40
|
|
Ghs ed therapeutic lp, drain csf w fluoro
|
$2,246.40 |
$2,246.40 |
$2,246.40 |
$1,429.20
|
|
Ghs eeg cont rec w/video by tec min 8 chnls
|
$826.15 |
$826.15 |
$826.15 |
$586.80
|
|
Ghs epidermal shaving diameter >2.0 cm
|
$1,127.10 |
$1,127.10 |
$1,127.10 |
$467.00
|
|
Ghs excision ingrown nail
|
$540.15 |
$540.15 |
$540.15 |
$449.25
|
|
Ghs fb removal - incisional
|
$4,937.40 |
$4,937.40 |
$4,937.40 |
$2,323.75
|
|
Ghs fb removal - non-incisional
|
$4,591.60 |
$4,591.60 |
$4,591.60 |
$1,706.20
|
|
Ghs fish cytogen
|
$77.35 |
$77.35 |
$1,099.00 |
$175.00
|
|
Ghs fish hybrid in situ 100-300
|
$127.40 |
$127.40 |
$1,004.00 |
$226.20
|
|
Ghs flow volume loop
|
$572.65 |
$572.65 |
$893.00 |
$308.69
|
|
Ghs hcv amplificaiton
|
$1,181.00 |
$1,181.00 |
$1,181.00 |
$196.20
|
|
Ghs hepatitis c virus (hcv riba)
|
$1,317.00 |
$1,317.00 |
$1,317.00 |
$144.54
|
|
Ghs hgb stability-thal
|
$676.00 |
$676.00 |
$676.00 |
$89.91
|
|
Ghs histoplasma antigen
|
$157.30 |
$157.30 |
$1,346.00 |
$142.00
|
|
Ghs HIV antibody
|
$142.00 |
$245.05 |
$245.05 |
$89.70
|
|
Ghs hla-dr/dq, multiple antigens
|
$554.45 |
$554.45 |
$1,045.00 |
$513.64
|
