|
F-18 florbetapir less than or equal to 10 mci
|
$3,442.64 |
$3,442.64 |
$3,442.64 |
$4,960.80
|
|
F-18 fluciclovine per mci
|
$882.84 |
$882.84 |
$882.84 |
$1,042.30
|
|
F-18 sodium fluoride
|
$133.14 |
$133.14 |
$133.14 |
$532.20
|
|
Fabrication & fitting
|
$92.24 |
$92.24 |
$92.24 |
$182.27
|
|
Facial bones <3
|
$75.18 |
$75.18 |
$75.18 |
$252.60
|
|
Facility svs dental rehab
|
$1,226.82 |
$1,226.82 |
$1,226.82 |
$4,558.89
|
|
Factor ix
|
$342.30 |
$342.30 |
$342.30 |
$164.00
|
|
Factor ix complex
|
$41.79 |
$41.79 |
$41.79 |
$5.91
|
|
Factor ix recombinant nos
|
$41.79 |
$41.79 |
$41.79 |
$4.65
|
|
Factor viii
|
$75.60 |
$75.60 |
$75.60 |
$139.68
|
|
Factor viii
|
$41.79 |
$41.79 |
$41.79 |
$6.10
|
|
Factor viii recombinant nos
|
$41.79 |
$41.79 |
$41.79 |
$6.88
|
|
Family therapy without pt 50min 90846
|
$202.44 |
$202.44 |
$202.44 |
$241.60
|
|
Family therapy with patient 50 min 90847
|
$202.44 |
$202.44 |
$202.44 |
$234.60
|
|
Fam-trastuzumab deruxtecan-nxki 100 mg intravenous solution
|
$6,141.41 |
$6,141.41 |
$6,141.41 |
$5,508.16
|
|
Fat/lipids feces qualitative
|
$39.48 |
$39.48 |
$39.48 |
$37.70
|
|
Fecal microbiota, live-jslm 150 ml rectal suspension enema
|
$15,120.00 |
$15,120.00 |
$15,120.00 |
$14,956.68
|
|
#fecal-sodium
|
$32.34 |
$32.34 |
$32.34 |
$38.50
|
|
Feeding tube reposition
|
$693.42 |
$693.42 |
$693.42 |
$532.61
|
|
Felbamate (felbatol(r)) - sendout
|
$184.38 |
$184.38 |
$184.38 |
$58.20
|
|
Fem/popl revasc w/stent
|
$11,362.26 |
$11,362.26 |
$11,362.26 |
$16,843.00
|
|
Feno poc
|
$36.54 |
$36.54 |
$36.54 |
$97.50
|
|
Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper)
|
$141.75 |
$141.75 |
$141.75 |
$101.40
|
|
Ferric carboxymaltose 50 mg iron/ml intravenous solution
|
$1,716.63 |
$1,716.63 |
$1,716.63 |
$2,515.99
|
|
Ferritin
|
$102.48 |
$102.48 |
$102.48 |
$102.48
|
|
Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution
|
$384.14 |
$384.14 |
$384.14 |
$1,636.50
|
|
Fetal biophys profile w/nst 76818
|
$346.92 |
$346.92 |
$346.92 |
$541.74
|
|
Fetal contract stress test 59020 - 26
|
$194.04 |
$194.04 |
$194.04 |
$477.50
|
|
Fetal cord puncture prenatal
|
$280.14 |
$280.14 |
$280.14 |
$764.92
|
|
Fetal fibronectin
|
$493.92 |
$493.92 |
$493.92 |
$389.95
|
|
Fetal fluid drainage w/us
|
$135.66 |
$135.66 |
$135.66 |
$626.34
|
|
Fetal hemoglobin (kleihauer betke)
|
$207.48 |
$207.48 |
$207.48 |
$106.20
|
|
Fetal hemoglobin rosette
|
$91.98 |
$91.98 |
$91.98 |
$67.20
|
|
Fetal lung maturity assess lam body dnst
|
$28.56 |
$28.56 |
$28.56 |
$69.60
|
|
Fetal monitor w/report
|
$133.56 |
$133.56 |
$133.56 |
$295.50
|
|
Fetal non stress test
|
$242.34 |
$242.34 |
$242.34 |
$478.50
|
|
Fibrin degradation d dimer quantitative
|
$165.90 |
$165.90 |
$165.90 |
$120.05
|
|
Fibrin degradation products
|
$85.26 |
$85.26 |
$85.26 |
$67.55
|
|
Fibrin degrade semiquant
|
$180.18 |
$180.18 |
$180.18 |
$81.00
|
|
Fibrinogen activity
|
$108.36 |
$108.36 |
$108.36 |
$85.50
|
|
Fibrinolysins/coagulopathy screen interpretation/report
|
$179.76 |
$179.76 |
$179.76 |
$64.05
|
|
Fibrinolytic antiplasmin
|
$108.36 |
$108.36 |
$108.36 |
$72.80
|
|
Fibrinolytic plasminogen
|
$132.72 |
$132.72 |
$132.72 |
$107.50
|
|
Fibrinolytic plasminogen xcpt antgnc asa
|
$126.84 |
$126.84 |
$126.84 |
$66.60
|
|
Filgrastim-aafi 300 mcg/0.5 ml subcutaneous syringe
|
$263.87 |
$263.87 |
$263.87 |
$571.09
|
|
Filgrastim in d5w IV syringe 20 mcg/ml (neo) - cnr
|
$41.79 |
$41.79 |
$41.79 |
$1,101.99
|
|
Filgrastim-sndz 300 mcg/0.5 ml injection syringe
|
$940.30 |
$940.30 |
$940.30 |
$869.18
|
|
Filter spider fx 3mmx320cm
|
$7,717.50 |
$7,717.50 |
$7,717.50 |
$7,130.56
|
|
Filter vena cava fem denali
|
$2,667.42 |
$2,667.42 |
$2,667.42 |
$3,816.40
|
|
Fine needle aspiration biopsy w/fluor gdn;1st lesion 10007
|
$636.30 |
$636.30 |
$636.30 |
$1,087.02
|
|
Fine needle aspiration biopsy w/fluor gdn; ea addtl 10008
|
$636.30 |
$636.30 |
$636.30 |
$685.00
|
|
Fine needle aspiration biopsy w/us gdn; ea addtl 10006
|
$636.30 |
$636.30 |
$636.30 |
$823.90
|
|
Fine needle asp without image guide 10021
|
$254.52 |
$254.52 |
$254.52 |
$503.76
|
|
Finger joint sz00 swanson w/grommets
|
$2,355.97 |
$2,355.97 |
$2,355.97 |
$4,584.72
|
|
Fixation of knee joint
|
$1,826.16 |
$1,826.16 |
$1,826.16 |
$1,893.86
|
|
Fix g/colon tube w/device
|
$360.78 |
$360.78 |
$360.78 |
$1,183.00
|
|
Fl exam g/colon tube w contrast
|
$347.76 |
$347.76 |
$347.76 |
$532.80
|
|
Florbetaben f18 diagnostic
|
$2,074.38 |
$2,074.38 |
$2,074.38 |
$4,339.99
|
|
Flow cytometry marker each additional
|
$57.96 |
$57.96 |
$57.96 |
$97.50
|
|
Flow cytometry one marker technical component
|
$428.82 |
$428.82 |
$428.82 |
$276.60
|
|
Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback
|
$86.84 |
$86.84 |
$86.84 |
$64.22
|
|
Fludarabine 50 mg intravenous solution
|
$522.19 |
$522.19 |
$522.19 |
$493.35
|
|
Fluidotherapy charges pt
|
$41.16 |
$41.16 |
$41.16 |
$95.00
|
|
Fluid pressure muscle 20950
|
$450.66 |
$450.66 |
$450.66 |
$778.78
|
|
Fluorescent antibody titer dna
|
$100.80 |
$100.80 |
$100.80 |
$123.65
|
|
Fluoroguide for spine inject 77003-26
|
$438.90 |
$438.90 |
$438.90 |
$497.25
|
|
Fluoroguide needle placement
|
$538.44 |
$538.44 |
$538.44 |
$510.98
|
|
Fluoroscopy up to 1 hour
|
$433.44 |
$433.44 |
$433.44 |
$497.40
|
|
Fluorouracil 50 mg/ml intravenous solution (wrapper)
|
$124.74 |
$124.74 |
$124.74 |
$105.07
|
|
Fluphenazine decanoate 25 mg/ml injection solution
|
$116.34 |
$116.34 |
$116.34 |
$72.52
|
|
Flutemetamol f18 diagnostic
|
$2,191.14 |
$2,191.14 |
$2,191.14 |
$5,215.08
|
|
Fmri brain by phys/psych
|
$1,186.08 |
$1,186.08 |
$1,186.08 |
$1,560.51
|
|
Fmri brain by tech
|
$1,138.62 |
$1,138.62 |
$1,138.62 |
$1,558.05
|
|
Fna bx w/ct gdn 1st les
|
$636.30 |
$636.30 |
$636.30 |
$1,462.20
|
|
Fna bx w/ct gdn ea addl
|
$636.30 |
$636.30 |
$636.30 |
$834.90
|
|
Fna bx w/mr gdn 1st les
|
$636.30 |
$636.30 |
$636.30 |
$1,294.80
|
|
Fna bx w/mr gdn ea addl
|
$636.30 |
$636.30 |
$636.30 |
$766.70
|
|
Foam drg >16<=48 sq in w/bdr
|
$37.30 |
$37.30 |
$37.30 |
$58.10
|
|
Foam drg <=16 sq in w/border
|
$8.29 |
$8.29 |
$8.29 |
$13.62
|
|
Foam drsg <=16 sq in without bdr
|
$63.42 |
$63.42 |
$63.42 |
$21.74
|
|
Folic acid
|
$105.42 |
$105.42 |
$105.42 |
$102.00
|
|
Follow-up angiography
|
$2,040.78 |
$2,040.78 |
$2,040.78 |
$2,040.78
|
|
Fomepizole 1 gram/ml intravenous solution
|
$2,880.99 |
$2,880.99 |
$2,880.99 |
$2,546.45
|
|
Fondaparinux sodium
|
$182.67 |
$182.67 |
$182.67 |
$186.20
|
|
Foot X-ray
|
$189.00 |
$189.00 |
$189.00 |
$364.80
|
|
Foreskn manip w/lss preputial ads+stretching 54450
|
$204.96 |
$204.96 |
$204.96 |
$534.00
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$642.63 |
$642.63 |
$642.63 |
$482.62
|
|
Foscarnet sodium injection
|
$653.94 |
$653.94 |
$653.94 |
$883.03
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$232.96 |
$232.96 |
$232.96 |
$104.97
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$91.14 |
$91.14 |
$91.14 |
$155.40
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$78.54 |
$78.54 |
$78.54 |
$157.20
|
|
Fresh frozen plasma thawing ea un
|
$90.72 |
$90.72 |
$90.72 |
$122.00
|
|
Fructosamine glycated protein
|
$149.94 |
$149.94 |
$149.94 |
$61.75
|
|
Full thick gft w/close donor fccmnaghf <=20sqcm 15240
|
$3,352.86 |
$3,352.86 |
$3,352.86 |
$2,707.20
|
|
Functional brain mapping
|
$143.22 |
$143.22 |
$143.22 |
$514.80
|
|
Furosemide in ns IV syringe 2 mg/ml (neo/ped) - cnr
|
$41.79 |
$41.79 |
$41.79 |
$27.08
|
|
Ga-67 gallium 0.1 mci
|
$95.76 |
$95.76 |
$95.76 |
$114.60
|
|
Ga-68 gallium 68 dotatate
|
$141.54 |
$141.54 |
$141.54 |
$120.15
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$76.55 |
$76.55 |
$76.55 |
$102.90
|
|
Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper)
|
$93.69 |
$93.69 |
$93.69 |
$135.79
|
