|
Fluoroscopy up to 1 hour
|
$1,202.55 |
$1,202.55 |
$1,202.55 |
$494.52
|
|
Fluorouracil 50 mg/ml intravenous solution (wrapper)
|
$926.96 |
$926.96 |
$926.96 |
$107.46
|
|
Fluphenazine decanoate 25 mg/ml injection solution
|
$199.54 |
$199.54 |
$199.54 |
$142.87
|
|
Folic acid
|
$242.70 |
$242.70 |
$242.70 |
$90.60
|
|
Folic acid 5 mg/ml injection solution
|
$60.45 |
$60.45 |
$60.45 |
$55.66
|
|
Fomepizole 1 gram/ml intravenous solution
|
$5,276.12 |
$5,276.12 |
$5,276.12 |
$2,860.43
|
|
Fondaparinux sodium
|
$286.58 |
$286.58 |
$286.58 |
$176.81
|
|
Foot X-ray
|
$443.28 |
$443.28 |
$443.28 |
$362.40
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$508.52 |
$508.52 |
$508.52 |
$107.31
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$369.87 |
$369.87 |
$369.87 |
$168.75
|
|
Fructosamine glycated protein
|
$93.63 |
$93.63 |
$93.63 |
$60.42
|
|
Furosemide in ns IV syringe 2 mg/ml (neo/ped) - cnr
|
$243.28 |
$243.28 |
$243.28 |
$26.40
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$237.73 |
$237.73 |
$237.73 |
$162.68
|
|
Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper)
|
$393.65 |
$393.65 |
$393.65 |
$138.37
|
|
Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution
|
$561.37 |
$561.37 |
$561.37 |
$86.54
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$718.22 |
$718.22 |
$718.22 |
$210.50
|
|
Gammaglobulin iga
|
$485.67 |
$485.67 |
$485.67 |
$75.30
|
|
Gammaglobulin ige
|
$226.80 |
$226.80 |
$226.80 |
$85.00
|
|
Gamma glutamyltransferase
|
$131.46 |
$131.46 |
$131.46 |
$55.28
|
|
Gamunex-c/gammaked
|
$55,861.12 |
$55,861.12 |
$55,861.12 |
$7,372.04
|
|
Gemcitabine 1 gram intravenous solution
|
$377.84 |
$377.84 |
$377.84 |
$252.84
|
|
General health panel
|
$1,053.29 |
$1,053.29 |
$1,053.29 |
$280.50
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$239.24 |
$239.24 |
$239.24 |
$62.84
|
|
Gentamicin peak therapeutic drug level
|
$343.56 |
$343.56 |
$343.56 |
$119.00
|
|
Ghs abscess perianal iandd
|
$5,112.20 |
$5,112.20 |
$5,112.20 |
$1,530.50
|
|
Ghs antibodies (torch) igm
|
$287.33 |
$287.33 |
$287.33 |
$73.70
|
|
Ghs bladder cath - complex-foley
|
$1,687.63 |
$1,687.63 |
$1,687.63 |
$344.48
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$1,715.84 |
$1,715.84 |
$1,715.84 |
$596.55
|
|
Ghs closed reduction ankle dislocation
|
$1,884.98 |
$1,884.98 |
$1,884.98 |
$731.04
|
|
Ghs closed tx tibial fracture w/manip
|
$8,962.32 |
$8,962.32 |
$8,962.32 |
$2,621.64
|
|
Ghs cl tx metacarpophal disloc without anes
|
$1,715.84 |
$1,715.84 |
$1,715.84 |
$547.94
|
|
Ghs conjunctiva foreign body-embed bil
|
$1,578.27 |
$1,578.27 |
$1,578.27 |
$448.80
|
|
Ghs conjunctiva foreign body-superf bil
|
$789.49 |
$789.49 |
$789.49 |
$316.25
|
|
Ghs corneal fb without slit lamp bilat
|
$1,587.25 |
$1,587.25 |
$1,587.25 |
$435.07
|
|
Ghs corneal fb with slit lamp bilat
|
$955.19 |
$955.19 |
$955.19 |
$368.16
|
|
Ghs dislocation elbow closed treatment
|
$1,884.98 |
$1,884.98 |
$1,884.98 |
$687.73
|
|
Ghs excision ingrown nail
|
$1,185.20 |
$1,185.20 |
$1,185.20 |
$457.60
|
|
Ghs fb removal - non-incisional
|
$9,686.50 |
$9,686.50 |
$9,686.50 |
$1,794.93
|
|
Ghs i and d perirectal abscess 46040
|
$6,670.98 |
$6,670.98 |
$6,670.98 |
$3,034.00
|
|
Ghs i and d pilonidal cyst complex
|
$3,950.70 |
$3,950.70 |
$3,950.70 |
$1,572.00
|
|
Ghs i and d pilonidal cyst simple
|
$3,964.75 |
$3,964.75 |
$3,964.75 |
$794.82
|
|
Ghs incision thrombosed ext hemorrhoid
|
$1,236.10 |
$1,236.10 |
$1,236.10 |
$543.60
|
|
Ghs init tx 1st degree burn
|
$848.53 |
$848.53 |
$848.53 |
$300.30
|
|
Ghs inj neurolytic intercostal nerve
|
$5,835.31 |
$5,835.31 |
$5,835.31 |
$2,037.10
|
|
Ghs inj neurolytic other perph nerve
|
$2,945.37 |
$2,945.37 |
$2,945.37 |
$1,972.69
|
|
Ghs inj tendon origin/insertion
|
$1,331.57 |
$1,331.57 |
$1,331.57 |
$431.07
|
|
Ghs inj transforaminal cerv ea add bil
|
$1,095.54 |
$1,095.54 |
$1,095.54 |
$1,126.23
|
|
Ghs inj transforaminal cerv single bil
|
$2,553.34 |
$2,553.34 |
$2,553.34 |
$1,861.60
|
|
Ghs insertion of needle - bone
|
$1,175.90 |
$1,175.90 |
$1,175.90 |
$461.58
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$2,296.87 |
$2,296.87 |
$2,296.87 |
$943.80
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$6,029.39 |
$6,029.39 |
$6,029.39 |
$617.60
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$2,452.06 |
$2,452.06 |
$2,452.06 |
$619.20
|
|
Ghs layer closure 2.5cm or less - 12051
|
$2,487.54 |
$2,487.54 |
$2,487.54 |
$648.00
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$2,296.87 |
$2,296.87 |
$2,296.87 |
$741.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$2,280.02 |
$2,280.02 |
$2,280.02 |
$741.00
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$2,296.87 |
$2,296.87 |
$2,296.87 |
$779.35
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$2,296.87 |
$2,296.87 |
$2,296.87 |
$810.00
|
|
Ghs layered repair over 3.0 cm -12057
|
$2,296.87 |
$2,296.87 |
$2,296.87 |
$1,064.98
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$1,870.43 |
$1,870.43 |
$1,870.43 |
$261.80
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$1,870.43 |
$1,870.43 |
$1,870.43 |
$252.50
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$1,870.43 |
$1,870.43 |
$1,870.43 |
$239.20
|
|
Ghs moderate sedation ea addtl 15 min
|
$424.84 |
$424.84 |
$424.84 |
$145.60
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$235.20 |
$235.20 |
$235.20 |
$140.00
|
|
Ghs myocardial strain img spckl track
|
$773.68 |
$773.68 |
$773.68 |
$503.85
|
|
Ghs nailbed repair/nail removal
|
$1,715.99 |
$1,715.99 |
$1,715.99 |
$808.80
|
|
Ghs nerve blk intercostal, ea addtl level
|
$2,432.44 |
$2,432.44 |
$2,432.44 |
$1,618.50
|
|
Ghs nerve blk intercostal, single level
|
$2,245.22 |
$2,245.22 |
$2,245.22 |
$1,230.80
|
|
Ghs nerve block axillary nerve
|
$5,656.22 |
$5,656.22 |
$5,656.22 |
$1,541.40
|
|
Ghs nerve block celiac plexus
|
$2,271.50 |
$2,271.50 |
$2,271.50 |
$1,712.00
|
|
Ghs nerve block lumbar or thoracic symp
|
$2,400.57 |
$2,400.57 |
$2,400.57 |
$2,042.60
|
|
Ghs ot sensory integrative tech/15min
|
$187.11 |
$187.11 |
$187.11 |
$101.05
|
|
Ghs ot work hardening-additional hours
|
$205.50 |
$205.50 |
$205.50 |
$121.54
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$1,672.25 |
$1,672.25 |
$1,672.25 |
$855.60
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$1,308.11 |
$1,308.11 |
$1,308.11 |
$1,003.00
|
|
Ghs plngl fx pm cl
|
$1,771.38 |
$1,771.38 |
$1,771.38 |
$662.20
|
|
Ghs ppd (tb intradermal)
|
$333.29 |
$333.29 |
$333.29 |
$43.45
|
|
Ghs pt - work hardening/int 2hrs
|
$429.73 |
$429.73 |
$429.73 |
$255.60
|
|
Ghs removal intranasal foreign body
|
$808.56 |
$808.56 |
$808.56 |
$324.35
|
|
Ghs removal pharyngeal foreign body
|
$242.25 |
$242.25 |
$242.25 |
$460.00
|
|
Ghs rsv eia (respir synctial vrs)
|
$196.82 |
$196.82 |
$196.82 |
$101.15
|
|
Ghs sensitivity (per antimicro)
|
$123.55 |
$123.55 |
$123.55 |
$59.90
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$2,316.53 |
$2,316.53 |
$2,316.53 |
$590.40
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$2,301.93 |
$2,301.93 |
$2,301.93 |
$670.08
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$1,390.11 |
$1,390.11 |
$1,390.11 |
$487.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$1,164.26 |
$1,164.26 |
$1,164.26 |
$470.47
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$1,539.54 |
$1,539.54 |
$1,539.54 |
$538.64
|
|
Ghs strapping shoulder - 29240
|
$1,339.81 |
$1,339.81 |
$1,339.81 |
$243.07
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$621.22 |
$621.22 |
$621.22 |
$351.45
|
|
Ghs tx distal phalangeal fx with manipulation
|
$1,472.70 |
$1,472.70 |
$1,472.70 |
$591.00
|
|
Gi inhouse confirmation
|
$277.25 |
$277.25 |
$277.25 |
$87.00
|
|
Glucose blood quantitative
|
$146.99 |
$146.99 |
$146.99 |
$44.76
|
|
Glucose body fluid
|
$118.57 |
$118.57 |
$118.57 |
$50.70
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$169.66 |
$169.66 |
$169.66 |
$56.70
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$6,953.70 |
$6,953.70 |
$6,953.70 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$279.17 |
$279.17 |
$279.17 |
$110.04
|
|
Gonadotropin luteinizing hormone (lh)
|
$279.17 |
$279.17 |
$279.17 |
$123.75
|
|
Guid loc target vol rad tx
|
$409.66 |
$409.66 |
$409.66 |
$503.80
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$297.35 |
$297.35 |
$297.35 |
$112.36
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$40.31 |
$40.31 |
$40.31 |
$35.40
|
|
Hand X-ray
|
$681.92 |
$681.92 |
$681.92 |
$338.58
|