|
Foot X-ray (2 views, both feet)
|
$195.00 |
$294.10 |
$473.75 |
|
|
Forearm X-ray (both sides)
|
$197.15 |
$332.00 |
$473.75 |
|
|
Foreskn manip w/lss preputial ads+stretching 54450
|
$332.35 |
$572.30 |
$968.90 |
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$230.33 |
$634.39 |
$1,526.62 |
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$137.57 |
$331.79 |
$1,183.86 |
|
|
Fracture assessment via dxa
|
$133.65 |
$133.65 |
$229.50 |
|
|
Fragmenting of kidney stone
|
$2,675.05 |
$2,675.05 |
$2,675.05 |
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$184.50 |
$280.80 |
$534.45 |
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$157.80 |
$402.25 |
$534.45 |
|
|
Fructosamine glycated protein
|
$48.90 |
$64.20 |
$154.50 |
|
|
Ftl cgen abnor 3 proteins
|
$2,091.50 |
$3,535.40 |
$10,606.20 |
|
|
Ftl cgen abnor four anal
|
$309.00 |
$456.05 |
$1,094.55 |
|
|
Ftl cgen abnor two proteins
|
$220.30 |
$223.45 |
$223.45 |
|
|
Full Spine X-ray (Scoliosis Survey)
|
$331.40 |
$473.75 |
$1,166.15 |
|
|
Full thick gft/scalp/arm/leg/20sqcm or< 15220
|
$1,434.25 |
$3,355.55 |
$5,802.10 |
|
|
Full thick gft/scalp/arm/leg/add 20sqcm 15221
|
$254.65 |
$3,639.30 |
$3,639.30 |
|
|
Full thick gft w/close donor fccmnaghf <=20sqcm 15240
|
$3,112.60 |
$3,112.60 |
$5,544.55 |
|
|
Furosemide 10 mg/ml injection solution
|
$44.83 |
$62.65 |
$133.55 |
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$126.16 |
$126.16 |
$126.16 |
|
|
Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper)
|
$136.63 |
$136.63 |
$234.97 |
|
|
Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution
|
$36.00 |
$60.00 |
$922.00 |
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$184.55 |
$185.97 |
$573.52 |
|
|
Galectin-3
|
$70.35 |
$70.35 |
$110.65 |
|
|
Gallbladder and Bile Duct Scan (HIDA Scan)
|
$1,348.35 |
$1,433.45 |
$2,295.75 |
|
|
Gallbladder Function Scan (HIDA with Medication)
|
$1,402.40 |
$1,718.70 |
$2,488.30 |
|
|
Gammaglobulin iga
|
$46.05 |
$84.60 |
$164.25 |
|
|
Gammaglobulin ige
|
$36.20 |
$86.35 |
$256.80 |
|
|
Gamma glutamyltransferase
|
$62.00 |
$80.75 |
$118.75 |
|
|
Gamunex-c/gammaked
|
$3,580.80 |
$15,259.34 |
$17,761.78 |
|
|
Gardner vag dna amp probe
|
$65.30 |
$251.05 |
$315.35 |
|
|
Gastric emptying imag study
|
$1,094.60 |
$1,094.60 |
$1,936.85 |
|
|
Gastric emptying imag study
|
$1,453.30 |
$1,453.30 |
$1,453.30 |
|
|
Gastric mucosa imaging
|
$795.55 |
$795.55 |
$1,020.35 |
|
|
Gastroesophageal reflux study
|
$795.55 |
$1,784.30 |
$3,459.90 |
|
|
Gastroesophageal reflux test
|
$688.40 |
$688.40 |
$688.40 |
|
|
Gated heart multiple
|
$155.00 |
$2,032.85 |
$2,262.10 |
|
|
Gauze >16<=48 no w/sal without b
|
$4.00 |
$4.00 |
$4.00 |
|
|
Gba gene
|
$87.10 |
$158.10 |
$336.95 |
|
|
Gc stocking thighlngth 18-30
|
$131.00 |
$131.00 |
$131.00 |
|
|
Gel cap for trach voice pros
|
$126.60 |
$126.60 |
$126.60 |
|
|
Gemcitabine 1 gram intravenous solution
|
$218.84 |
$272.87 |
$1,022.85 |
|
|
Gemtuzumab ozogamicin 4.5 mg (1 mg/ml initial concentration) IV soln
|
$30,550.87 |
$30,550.87 |
$30,550.87 |
|
|
General health panel
|
$400.45 |
$400.50 |
$669.35 |
|
|
Generator barostim neo2 2014
|
$11,634.00 |
$11,680.00 |
$17,100.00 |
|
|
Genetic tstg severe inh cond
|
$1,721.60 |
$2,910.00 |
$9,829.25 |
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$12.11 |
$106.87 |
$325.20 |
|
|
Gentamicin peak therapeutic drug level
|
$178.30 |
$180.65 |
$334.05 |
|
|
G-esoph reflx tst w/electrod
|
$1,928.90 |
$1,928.90 |
$1,928.90 |
|
|
Ghs abscess perianal iandd
|
$179.10 |
$439.95 |
$2,494.20 |
|
|
Ghs abscess postoperative iandd complex
|
$328.00 |
$548.05 |
$4,182.65 |
|
|
Ghs alcohol, methyl (methanol)-medtox
|
$35.65 |
$176.65 |
$440.95 |
|
|
Ghs alpha thalasemia, 7 deletions
|
$145.60 |
$188.50 |
$729.20 |
|
|
Ghs analysis neurostim without reprogramming
|
$179.50 |
$204.95 |
$374.25 |
|
|
Ghs aspiration bladder - needle
|
$114.65 |
$128.60 |
$458.90 |
|
|
Ghs bladder cath - complex-foley
|
$176.60 |
$194.10 |
$703.15 |
|
|
Ghs block ilioinguinal/gentitofemoral
|
$286.10 |
$1,073.10 |
$2,211.20 |
|
|
Ghs central line insert < age 5, failed
|
$301.50 |
$1,485.95 |
$2,730.40 |
|
|
Ghs change cysto/gastrost
|
$165.25 |
$449.90 |
$868.70 |
|
|
Ghs chemo >8 hrs
|
$290.15 |
$466.40 |
$811.20 |
|
|
Ghs chemo IV push, ea addtl
|
$120.05 |
$202.25 |
$374.40 |
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$156.20 |
$596.55 |
$936.90 |
|
|
Ghs closed reduction ankle dislocation
|
$644.55 |
$882.70 |
$1,132.30 |
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$693.75 |
$1,016.30 |
$2,911.75 |
|
|
Ghs closed tx radiocarpal disloc w manip
|
$262.15 |
$917.80 |
$1,119.75 |
|
|
Ghs closed tx tibial fracture w/manip
|
$782.10 |
$1,129.85 |
$4,931.10 |
|
|
Ghs closure surg wound/dehiscence-13160
|
$739.45 |
$2,546.95 |
$5,311.20 |
|
|
Ghs clsd red med malleolus fx without manip
|
$308.70 |
$616.80 |
$774.75 |
|
|
Ghs clsd red med malleolus fx w manip
|
$654.70 |
$874.60 |
$4,709.60 |
|
|
Ghs clsd tx frac distal tibia w/manipulation
|
$654.75 |
$1,056.60 |
$4,931.10 |
|
|
Ghs cl tx knee disl; wo anesth
|
$668.55 |
$1,116.25 |
$1,241.65 |
|
|
Ghs cl tx metacarpophal disloc without anes
|
$466.70 |
$703.15 |
$1,550.85 |
|
|
Ghs community re-entry 15 minutes
|
$79.65 |
$159.35 |
$198.15 |
|
|
Ghs conjunctiva foreign body-embed bil
|
$107.15 |
$144.30 |
$487.25 |
|
|
Ghs conjunctiva foreign body-superf bil
|
$94.65 |
$175.50 |
$377.95 |
|
|
Ghs corneal fb without slit lamp bilat
|
$111.00 |
$175.50 |
$711.65 |
|
|
Ghs corneal fb with slit lamp bilat
|
$116.05 |
$195.75 |
$583.10 |
|
|
Ghs cricothyroidotomy
|
$509.60 |
$982.55 |
$4,575.75 |
|
|
Ghs cutdown placement under 1 yr
|
$70.90 |
$70.90 |
$70.90 |
|
|
Ghs dislocation elbow closed treatment
|
$466.70 |
$792.25 |
$2,129.80 |
|
|
Ghs ed peritoneal lavage w guidance if performed
|
$203.85 |
$203.85 |
$210.55 |
|
|
Ghs ed rmvl or bivalving cast
|
$64.30 |
$391.40 |
$884.30 |
|
|
Ghs ed therapeutic lp, drain csf w fluoro
|
$1,594.05 |
$2,434.85 |
$2,519.55 |
|
|
Ghs eeg cont rec w/video by tec min 8 chnls
|
$512.05 |
$512.05 |
$671.00 |
|
|
Ghs electrostagmgraphy
|
$577.70 |
$577.70 |
$988.00 |
|
|
Ghs elect torsion swing
|
$240.80 |
$240.80 |
$240.80 |
|
|
Ghs elect vertical elct
|
$247.00 |
$247.00 |
$255.85 |
|
|
Ghs excision ingrown nail
|
$214.60 |
$363.10 |
$487.25 |
|
|
Ghs eyelid foreign body-embedded - bil
|
$162.20 |
$539.85 |
$956.90 |
|
|
Ghs fb removal foot - deep - left
|
$654.70 |
$882.70 |
$5,392.05 |
|
|
Ghs fb removal from muscle - complicated
|
$886.80 |
$886.80 |
$4,823.75 |
|
|
Ghs fb removal - incisional
|
$301.50 |
$726.10 |
$3,679.25 |
|
|
Ghs fb removal - non-incisional
|
$377.95 |
$377.95 |
$943.45 |
|
|
Ghs fish cytogen
|
$130.90 |
$252.10 |
$652.45 |
|
|
Ghs fish hybrid in situ 100-300
|
$127.20 |
$214.80 |
$394.80 |
|
|
Ghs gastric intub aspiration lavage
|
$117.70 |
$380.60 |
$534.45 |
|
|
Ghs hgb stability-thal
|
$23.70 |
$23.70 |
$23.70 |
|
|
Ghs histoplasma antigen
|
$34.50 |
$174.40 |
$276.60 |
|
|
Ghs HIV antibody
|
$21.95 |
$95.85 |
$163.65 |
|
|
Ghs i and d abscess/hematoma scrotum
|
$483.20 |
$544.30 |
$6,064.65 |
|
|
Ghs i and d perirectal abscess 46040
|
$702.55 |
$1,172.85 |
$5,197.65 |
|
