|
Foam drsg <=16 sq in without bdr
|
$31.97 |
$31.97 |
$31.97 |
$21.74
|
|
Folic acid
|
$224.28 |
$224.28 |
$224.28 |
$102.05
|
|
Fomepizole 1 gram/ml intravenous solution
|
$5,761.98 |
$5,761.98 |
$5,761.98 |
$2,581.14
|
|
Fondaparinux sodium
|
$365.33 |
$365.33 |
$365.33 |
$186.20
|
|
Foot plas heel stabi pre ots
|
$133.56 |
$133.56 |
$133.56 |
$78.00
|
|
Foot X-ray
|
$355.32 |
$355.32 |
$355.32 |
$364.80
|
|
Foreskn manip w/lss preputial ads+stretching 54450
|
$286.44 |
$286.44 |
$286.44 |
$534.00
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$1,285.25 |
$1,285.25 |
$1,285.25 |
$482.62
|
|
Foscarnet sodium injection
|
$1,307.88 |
$1,307.88 |
$1,307.88 |
$970.94
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$465.91 |
$465.91 |
$465.91 |
$106.10
|
|
Fracture assessment via dxa
|
$378.84 |
$378.84 |
$378.84 |
$173.18
|
|
Frenotomy 40806
|
$467.88 |
$467.88 |
$467.88 |
$729.70
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$134.40 |
$134.40 |
$134.40 |
$155.25
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$149.52 |
$149.52 |
$149.52 |
$157.20
|
|
Fresh frozen plasma thawing ea un
|
$37.80 |
$37.80 |
$37.80 |
$122.00
|
|
Fructosamine glycated protein
|
$152.04 |
$152.04 |
$152.04 |
$62.64
|
|
Full thick gft w/close donor fccmnaghf <=20sqcm 15240
|
$4,882.08 |
$4,882.08 |
$4,882.08 |
$2,707.20
|
|
Furosemide in ns IV syringe 2 mg/ml (neo/ped) - cnr
|
$83.58 |
$83.58 |
$83.58 |
$27.08
|
|
Ga-67 gallium 0.1 mci
|
$162.12 |
$162.12 |
$162.12 |
$116.09
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$153.09 |
$153.09 |
$153.09 |
$102.90
|
|
Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper)
|
$187.37 |
$187.37 |
$187.37 |
$136.16
|
|
Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution
|
$318.85 |
$318.85 |
$318.85 |
$177.52
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$545.29 |
$545.29 |
$545.29 |
$249.80
|
|
Galac-1-phosphate uridyltran - sendout
|
$198.24 |
$198.24 |
$198.24 |
$100.00
|
|
Galactose transferase test
|
$34.44 |
$34.44 |
$34.44 |
$31.35
|
|
Gallbladder Removal (Laparoscopic)
|
$1,495.20 |
$1,495.20 |
$1,495.20 |
$11,117.34
|
|
Gamma globulin 1 cc inj
|
$1,850.02 |
$1,850.02 |
$1,850.02 |
$363.35
|
|
Gammaglobulin iga
|
$161.28 |
$161.28 |
$161.28 |
$69.60
|
|
Gammaglobulin ige
|
$120.12 |
$120.12 |
$120.12 |
$85.00
|
|
Gamma glutamyltransferase
|
$80.64 |
$80.64 |
$80.64 |
$57.75
|
|
Gamunex-c/gammaked
|
$13,087.20 |
$13,087.20 |
$13,087.20 |
$7,372.04
|
|
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr
|
$192.07 |
$192.07 |
$192.07 |
$197.40
|
|
Gastroduodenostomy
|
$2,292.36 |
$2,292.36 |
$2,292.36 |
$2,265.07
|
|
Gastroesophageal reflux study
|
$1,069.32 |
$1,069.32 |
$1,069.32 |
$1,021.80
|
|
Gastrojejunostomy;w/o vagotomy 43820
|
$3,031.56 |
$3,031.56 |
$3,031.56 |
$2,376.00
|
|
Gastrojejunostomy w/vagotomy
|
$2,955.12 |
$2,955.12 |
$2,955.12 |
$2,919.94
|
|
Gastro/jejuno tube, std
|
$333.98 |
$333.98 |
$333.98 |
$334.57
|
|
Gated heart multiple
|
$1,669.92 |
$1,669.92 |
$1,669.92 |
$1,405.04
|
|
Gemcitabine 1 gram intravenous solution
|
$435.71 |
$435.71 |
$435.71 |
$207.51
|
|
General health panel
|
$679.56 |
$679.56 |
$679.56 |
$276.76
|
|
Generator barostim neo2 2014
|
$74,415.86 |
$74,415.86 |
$74,415.86 |
$48,147.60
|
|
Generator emblem MRI sicd subq
|
$63,025.20 |
$63,025.20 |
$63,025.20 |
$36,771.84
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$173.67 |
$173.67 |
$173.67 |
$57.84
|
|
Gentamicin peak therapeutic drug level
|
$184.80 |
$184.80 |
$184.80 |
$126.00
|
|
Ghs abscess perianal iandd
|
$567.00 |
$567.00 |
$567.00 |
$1,410.90
|
|
Ghs abscess postoperative iandd complex
|
$940.80 |
$940.80 |
$940.80 |
$3,638.88
|
|
Ghs acetylcholinesterase, rbc
|
$115.92 |
$115.92 |
$115.92 |
$44.12
|
|
Ghs alcohol, methyl (methanol)-medtox
|
$186.48 |
$186.48 |
$186.48 |
$100.30
|
|
Ghs analysis neurostim without reprogramming
|
$157.92 |
$157.92 |
$157.92 |
$246.98
|
|
Ghs antibodies (torch) igm
|
$139.44 |
$139.44 |
$139.44 |
$69.30
|
|
Ghs bladder cath - complex-foley
|
$379.68 |
$379.68 |
$379.68 |
$344.00
|
|
Ghs bleeding time (ivy)
|
$185.64 |
$185.64 |
$185.64 |
$62.40
|
|
Ghs central line insert < age 5, failed
|
$1,808.52 |
$1,808.52 |
$1,808.52 |
$2,555.77
|
|
Ghs change cysto/gastrost
|
$554.40 |
$554.40 |
$554.40 |
$585.00
|
|
Ghs chemo >8 hrs
|
$209.16 |
$209.16 |
$209.16 |
$714.87
|
|
Ghs chemo IV push, ea addtl
|
$320.04 |
$320.04 |
$320.04 |
$287.76
|
|
Ghs chlamydia pneumoniae by pcr (arup) (306630)
|
$147.84 |
$147.84 |
$147.84 |
$130.70
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$670.32 |
$670.32 |
$670.32 |
$501.50
|
|
Ghs closed reduction ankle dislocation
|
$889.56 |
$889.56 |
$889.56 |
$672.60
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$1,102.92 |
$1,102.92 |
$1,102.92 |
$1,568.40
|
|
Ghs closed tx radiocarpal disloc w manip
|
$1,045.80 |
$1,045.80 |
$1,045.80 |
$523.85
|
|
Ghs closed tx tibial fracture w/manip
|
$1,246.56 |
$1,246.56 |
$1,246.56 |
$2,179.20
|
|
Ghs closure surg wound/dehiscence-13160
|
$1,839.60 |
$1,839.60 |
$1,839.60 |
$3,127.80
|
|
Ghs clsd red med malleolus fx without manip
|
$784.56 |
$784.56 |
$784.56 |
$490.00
|
|
Ghs cl tx knee disl; wo anesth
|
$1,199.52 |
$1,199.52 |
$1,199.52 |
$581.90
|
|
Ghs cl tx metacarpophal disloc without anes
|
$792.96 |
$792.96 |
$792.96 |
$497.53
|
|
Ghs community re-entry 15 minutes
|
$1,585.92 |
$1,585.92 |
$1,585.92 |
$89.00
|
|
Ghs conjunctiva foreign body-embed bil
|
$409.92 |
$409.92 |
$409.92 |
$436.10
|
|
Ghs conjunctiva foreign body-superf bil
|
$288.96 |
$288.96 |
$288.96 |
$288.96
|
|
Ghs corneal fb without slit lamp bilat
|
$299.88 |
$299.88 |
$299.88 |
$422.25
|
|
Ghs corneal fb with slit lamp bilat
|
$409.92 |
$409.92 |
$409.92 |
$339.60
|
|
Ghs cricothyroidotomy
|
$1,395.24 |
$1,395.24 |
$1,395.24 |
$1,103.75
|
|
Ghs cutdown placement age 1 and over
|
$556.92 |
$556.92 |
$556.92 |
$377.89
|
|
Ghs cutdown placement under 1 yr
|
$556.92 |
$556.92 |
$556.92 |
$189.07
|
|
Ghs dislocation elbow closed treatment
|
$874.44 |
$874.44 |
$874.44 |
$583.80
|
|
Ghs ed peritoneal lavage w guidance if performed
|
$617.40 |
$617.40 |
$617.40 |
$1,162.40
|
|
Ghs ed rmvl or bivalving cast
|
$141.96 |
$141.96 |
$141.96 |
$335.08
|
|
Ghs ed therapeutic lp, drain csf w fluoro
|
$874.44 |
$874.44 |
$874.44 |
$1,381.60
|
|
Ghs elect torsion swing
|
$192.36 |
$192.36 |
$192.36 |
$253.00
|
|
Ghs epidermal shaving diameter >2.0 cm
|
$1,558.20 |
$1,558.20 |
$1,558.20 |
$467.00
|
|
Ghs excision ingrown nail
|
$395.64 |
$395.64 |
$395.64 |
$442.22
|
|
Ghs eyelid foreign body-embedded - bil
|
$655.20 |
$655.20 |
$655.20 |
$529.80
|
|
Ghs fb removal foot - deep - left
|
$1,090.32 |
$1,090.32 |
$1,090.32 |
$2,593.97
|
|
Ghs fb removal from muscle - complicated
|
$1,669.08 |
$1,669.08 |
$1,669.08 |
$3,311.10
|
|
Ghs fb removal - incisional
|
$980.28 |
$980.28 |
$980.28 |
$2,289.60
|
|
Ghs fb removal - non-incisional
|
$514.08 |
$514.08 |
$514.08 |
$1,616.45
|
|
Ghs febrile agglutinns(mayo)
|
$76.44 |
$76.44 |
$76.44 |
$48.10
|
|
Ghs fish cytogen
|
$178.92 |
$178.92 |
$178.92 |
$176.93
|
|
Ghs fish hybrid in situ 100-300
|
$354.48 |
$354.48 |
$354.48 |
$228.50
|
|
Ghs gastric intub aspiration lavage
|
$191.52 |
$191.52 |
$191.52 |
$368.50
|
|
Ghs hcv amplificaiton
|
$406.56 |
$406.56 |
$406.56 |
$201.60
|
|
Ghs hepatitis c virus (hcv riba)
|
$1,255.80 |
$1,255.80 |
$1,255.80 |
$144.54
|
|
Ghs hgb stability-thal
|
$153.72 |
$153.72 |
$153.72 |
$89.91
|
|
Ghs histoplasma antigen
|
$236.04 |
$236.04 |
$236.04 |
$141.60
|
|
Ghs HIV antibody
|
$135.24 |
$135.24 |
$135.24 |
$91.20
|
|
Ghs hla-dr/dq, multiple antigens
|
$1,908.48 |
$1,908.48 |
$1,908.48 |
$476.80
|
|
Ghs i and d abscess/hematoma scrotum
|
$2,322.60 |
$2,322.60 |
$2,322.60 |
$3,245.90
|
|
Ghs i and d perirectal abscess 46040
|
$1,805.16 |
$1,805.16 |
$1,805.16 |
$2,631.20
|
|
Ghs i and d pilonidal cyst complex
|
$824.88 |
$824.88 |
$824.88 |
$1,402.80
|
|
Ghs i and d pilonidal cyst simple
|
$608.16 |
$608.16 |
$608.16 |
$691.95
|
