|
Foam drg > 48 sq in w/border
|
$20.26 |
$20.26 |
$20.26 |
$23.63
|
|
Foam drg > 48 sq in without brdr
|
$57.77 |
$57.77 |
$57.77 |
$33.49
|
|
Foam drsg <=16 sq in without bdr
|
$14.70 |
$14.70 |
$14.70 |
$21.74
|
|
Foam/fabric leg strap
|
$14.96 |
$14.96 |
$14.96 |
$14.96
|
|
Foam stability fetal lung
|
$26.10 |
$26.10 |
$26.10 |
$48.00
|
|
Folic acid
|
$20.29 |
$20.29 |
$20.29 |
$101.00
|
|
Folic acid 5 mg/ml injection solution
|
$0.07 |
$0.07 |
$0.07 |
$45.00
|
|
Follow-up angiography
|
$4,341.66 |
$4,341.66 |
$4,341.66 |
$1,983.00
|
|
Followup eval of foot pt lop
|
$183.07 |
$183.07 |
$183.07 |
$152.50
|
|
Follow-up surgery of eye
|
$3,269.14 |
$3,269.14 |
$3,269.14 |
$3,572.40
|
|
Fomepizole 1 gram/ml intravenous solution
|
$8.88 |
$8.88 |
$8.88 |
$2,481.61
|
|
Fondaparinux sodium
|
$1.21 |
$1.21 |
$1.21 |
$186.20
|
|
Fo nontorsion joint cf
|
$340.96 |
$340.96 |
$340.96 |
$217.50
|
|
Foot arch support remov prem
|
$129.40 |
$129.40 |
$129.40 |
$141.41
|
|
Foot arch supp premold metat
|
$79.82 |
$79.82 |
$79.82 |
$79.82
|
|
Foot drp splt w/exp heel lg
|
$130.99 |
$130.99 |
$130.99 |
$143.14
|
|
Foot external keel sach foot
|
$369.11 |
$369.11 |
$369.11 |
$470.57
|
|
Foot insert plastazote or eq
|
$273.90 |
$273.90 |
$273.90 |
$349.16
|
|
Foot insert remov molded spe
|
$224.33 |
$224.33 |
$224.33 |
$285.99
|
|
Foot insert silicone gel eac
|
$295.47 |
$295.47 |
$295.47 |
$322.85
|
|
Foot lamin/prepreg composite
|
$207.70 |
$207.70 |
$207.70 |
$289.76
|
|
Foot longitudinal arch suppo
|
$295.47 |
$295.47 |
$295.47 |
$299.65
|
|
Foot longitud/metatarsal sup
|
$336.49 |
$336.49 |
$336.49 |
$221.20
|
|
Foot plas heel stabi pre ots
|
$86.28 |
$86.28 |
$86.28 |
$76.32
|
|
Foot plate molded stirrup at
|
$566.49 |
$566.49 |
$566.49 |
$601.78
|
|
Foot single axis ankle/foot
|
$393.70 |
$393.70 |
$393.70 |
$350.00
|
|
Foot X-ray
|
$119.66 |
$119.66 |
$119.66 |
$355.32
|
|
Foot X-ray (2 views, both feet)
|
$119.66 |
$119.66 |
$119.66 |
$290.40
|
|
Forearm/arm cuffs ext/flex a
|
$1,398.85 |
$1,398.85 |
$1,398.85 |
$669.13
|
|
Forearm/arm cuffs free motio
|
$1,054.62 |
$1,054.62 |
$1,054.62 |
$901.60
|
|
Forearm X-ray (both sides)
|
$119.66 |
$119.66 |
$119.66 |
$324.00
|
|
Forehead flap w/vasc pedicle 15731
|
$4,872.75 |
$4,872.75 |
$4,872.75 |
$4,872.75
|
|
Forensic cytopathology
|
$71.65 |
$71.65 |
$71.65 |
$63.23
|
|
Foreskn manip w/lss preputial ads+stretching 54450
|
$343.55 |
$343.55 |
$343.55 |
$544.50
|
|
Formoterol fumarate, inh
|
$3.03 |
$3.03 |
$3.03 |
$59.40
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$0.14 |
$0.14 |
$0.14 |
$490.67
|
|
Foscarnet sodium injection
|
$9.26 |
$9.26 |
$9.26 |
$975.28
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$1.85 |
$1.85 |
$1.85 |
$103.62
|
|
Fractionation ketosteroids
|
$39.33 |
$39.33 |
$39.33 |
$148.00
|
|
Fracture assessment via dxa
|
$119.66 |
$119.66 |
$119.66 |
$175.50
|
|
_fragile x methylation-sendout
|
$61.95 |
$61.95 |
$61.95 |
$183.74
|
|
Fragmenting of kidney stone
|
$4,846.99 |
$4,846.99 |
$4,846.99 |
$10,312.25
|
|
Frame typ sock above elb/dis
|
$1,078.51 |
$1,078.51 |
$1,078.51 |
$711.20
|
|
Frame typ socket bel elbow/w
|
$974.50 |
$974.50 |
$974.50 |
$658.00
|
|
Frame typ socket shoulder di
|
$1,285.39 |
$1,285.39 |
$1,285.39 |
$812.00
|
|
Frame typ sock interscap-tho
|
$1,513.35 |
$1,513.35 |
$1,513.35 |
$940.80
|
|
Free fascial flap microvasc
|
$2,833.65 |
$2,833.65 |
$2,833.65 |
$2,833.65
|
|
Freeing of bowel adhesion 44005
|
$1,538.78 |
$1,538.78 |
$1,538.78 |
$2,062.20
|
|
Free myo/skin flap microvasc
|
$2,866.61 |
$2,866.61 |
$2,866.61 |
$7,906.00
|
|
Free/remove chest lining 32320
|
$2,303.39 |
$2,303.39 |
$2,303.39 |
$3,859.99
|
|
Free skin flap microvasc
|
$2,839.16 |
$2,839.16 |
$2,839.16 |
$2,839.16
|
|
Frenectomy 41115
|
$2,133.48 |
$2,133.48 |
$2,133.48 |
$1,939.47
|
|
Frenotomy 40806
|
$741.60 |
$741.60 |
$741.60 |
$620.00
|
|
Frenulotomy of penis
|
$2,874.36 |
$2,874.36 |
$2,874.36 |
$3,969.73
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$99.29 |
$99.29 |
$99.29 |
$155.40
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$115.71 |
$115.71 |
$115.71 |
$165.17
|
|
Fresh frozen plasma thawing ea un
|
$234.27 |
$234.27 |
$234.27 |
$131.25
|
|
Fr frz plasma donor retested
|
$71.66 |
$71.66 |
$71.66 |
$130.00
|
|
Frozen blood freeze/thaw
|
$51.36 |
$51.36 |
$51.36 |
$179.01
|
|
Frozen blood prep
|
$234.27 |
$234.27 |
$234.27 |
$209.50
|
|
Frozen blood thaw
|
$234.27 |
$234.27 |
$234.27 |
$212.30
|
|
Frozen cell preparation
|
$16.68 |
$16.68 |
$16.68 |
$31.81
|
|
Frozen plasma, pooled, sd
|
$75.32 |
$75.32 |
$75.32 |
$170.00
|
|
Fructosamine glycated protein
|
$23.13 |
$23.13 |
$23.13 |
$63.50
|
|
Ft arch suprt premold longit
|
$79.82 |
$79.82 |
$79.82 |
$94.69
|
|
Fth/gft fr n/e/e/l each addl
|
$163.36 |
$163.36 |
$163.36 |
$1,298.50
|
|
Fth/gft fr trnk each addl
|
$96.02 |
$96.02 |
$96.02 |
$1,368.50
|
|
Ft insert ucb berkeley shell
|
$532.76 |
$532.76 |
$532.76 |
$651.56
|
|
Ftl cgen abnor 3 proteins
|
$2,052.57 |
$2,052.57 |
$2,052.57 |
$2,712.50
|
|
Ftl cgen abnor five anal
|
$95.94 |
$95.94 |
$95.94 |
$159.04
|
|
Ftl cgen abnor four anal
|
$211.83 |
$211.83 |
$211.83 |
$211.83
|
|
Ftl cgen abnor three anal
|
$76.65 |
$76.65 |
$76.65 |
$126.56
|
|
Ftl cgen abnor two proteins
|
$74.93 |
$74.93 |
$74.93 |
$109.00
|
|
Ft prosth multiaxial ankl/ft
|
$529.15 |
$529.15 |
$529.15 |
$439.60
|
|
Full field erg w/i&r
|
$296.91 |
$296.91 |
$296.91 |
$393.12
|
|
Full mouth x-ray of teeth
|
$328.08 |
$328.08 |
$328.08 |
$286.04
|
|
Full sole/heel wedge btween
|
$92.75 |
$92.75 |
$92.75 |
$101.33
|
|
Full Spine X-ray (Scoliosis Survey)
|
$143.75 |
$143.75 |
$143.75 |
$355.00
|
|
Full thick gft/nose/ear/lid/lip/20sqcm or< 15260
|
$2,837.09 |
$2,837.09 |
$2,837.09 |
$3,091.20
|
|
Full thick gft/scalp/arm/leg/20sqcm or< 15220
|
$2,837.09 |
$2,837.09 |
$2,837.09 |
$2,469.00
|
|
Full thick gft/scalp/arm/leg/add 20sqcm 15221
|
$85.46 |
$85.46 |
$85.46 |
$1,056.41
|
|
Full thick gft w/close donor fccmnaghf <=20sqcm 15240
|
$2,837.09 |
$2,837.09 |
$2,837.09 |
$2,707.20
|
|
Functional brain mapping
|
$212.31 |
$212.31 |
$212.31 |
$514.80
|
|
Fundus photography with i&r 92250
|
$182.95 |
$182.95 |
$182.95 |
$182.95
|
|
Furnsh initial orthosis only
|
$3,034.95 |
$3,034.95 |
$3,034.95 |
$2,873.32
|
|
Furosemide 10 mg/ml injection solution
|
$0.03 |
$0.03 |
$0.03 |
$19.53
|
|
Fuse bile ducts and bowel 47785
|
$4,512.93 |
$4,512.93 |
$4,512.93 |
$7,967.20
|
|
Fuse esophagus & intestine
|
$1,956.50 |
$1,956.50 |
$1,956.50 |
$1,956.50
|
|
Fuse esophagus & intestine
|
$2,017.60 |
$2,017.60 |
$2,017.60 |
$2,017.60
|
|
Fuse esophagus & stomach
|
$1,980.56 |
$1,980.56 |
$1,980.56 |
$3,421.60
|
|
Fuse gallbladder & bowel
|
$1,866.49 |
$1,866.49 |
$1,866.49 |
$3,220.80
|
|
Fuse gallbladder & bowel
|
$2,091.91 |
$2,091.91 |
$2,091.91 |
$2,091.91
|
|
Fuse/graft added joint
|
$284.69 |
$284.69 |
$284.69 |
$1,011.40
|
|
Fuse liver ducts & bowel
|
$4,255.26 |
$4,255.26 |
$4,255.26 |
$4,255.26
|
|
Fuse pancreas and bowel
|
$2,361.44 |
$2,361.44 |
$2,361.44 |
$1,496.88
|
|
Fuse pancreas cyst and bowel
|
$1,849.90 |
$1,849.90 |
$1,849.90 |
$3,209.60
|
|
Fuse pancreas cyst and bowel 48520
|
$1,563.62 |
$1,563.62 |
$1,563.62 |
$2,683.20
|
|
Fuse upper gi structures
|
$1,924.15 |
$1,924.15 |
$1,924.15 |
$3,321.60
|
|
Fusion/graft of finger joint
|
$4,499.12 |
$4,499.12 |
$4,499.12 |
$3,986.00
|
|
Fusion/graft of hand joint
|
$9,977.57 |
$9,977.57 |
$9,977.57 |
$6,588.00
|
