|
Folic acid
|
$65.65 |
$65.65 |
$65.65 |
$101.50
|
|
Folic acid 5 mg/ml injection solution
|
$14.96 |
$14.96 |
$14.96 |
$45.00
|
|
Follow-up angiography
|
$14,116.70 |
$14,116.70 |
$14,116.70 |
$1,983.00
|
|
Fomepizole 1 gram/ml intravenous solution
|
$2,701.32 |
$2,701.32 |
$2,701.32 |
$2,511.73
|
|
Fondaparinux sodium
|
$626.98 |
$626.98 |
$626.98 |
$186.20
|
|
Fo nontorsion joint cf
|
$172.90 |
$172.90 |
$172.90 |
$217.50
|
|
Foot longitud/metatarsal sup
|
$78.00 |
$78.00 |
$78.00 |
$221.20
|
|
Foot X-ray
|
$395.20 |
$395.20 |
$395.20 |
$355.20
|
|
Foot X-ray (2 views, both feet)
|
$395.20 |
$395.20 |
$395.20 |
$290.40
|
|
Forearm X-ray (both sides)
|
$395.20 |
$395.20 |
$395.20 |
$324.00
|
|
Foreskn manip w/lss preputial ads+stretching 54450
|
$727.35 |
$727.35 |
$727.35 |
$534.00
|
|
Foscarnet sodium injection
|
$4.49 |
$4.49 |
$4.49 |
$988.21
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$47.31 |
$47.31 |
$47.31 |
$103.62
|
|
Fracture assessment via dxa
|
$395.20 |
$395.20 |
$395.20 |
$175.50
|
|
Fragmenting of kidney stone
|
$10,312.25 |
$10,312.25 |
$10,312.25 |
$10,312.25
|
|
Frenectomy 41115
|
$4,429.10 |
$4,429.10 |
$4,429.10 |
$1,939.47
|
|
Frenulotomy of penis
|
$6,124.95 |
$6,124.95 |
$6,124.95 |
$3,969.73
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$319.15 |
$319.15 |
$319.15 |
$155.25
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$378.30 |
$378.30 |
$378.30 |
$164.84
|
|
Fresh frozen plasma thawing ea un
|
$768.30 |
$768.30 |
$768.30 |
$131.25
|
|
Fr frz plasma donor retested
|
$219.70 |
$219.70 |
$219.70 |
$130.00
|
|
Fructosamine glycated protein
|
$75.40 |
$75.40 |
$75.40 |
$63.50
|
|
Ftl cgen abnor four anal
|
$688.35 |
$688.35 |
$688.35 |
$211.83
|
|
Full mouth x-ray of teeth
|
$1,084.20 |
$1,084.20 |
$1,084.20 |
$286.04
|
|
Full Spine X-ray (Scoliosis Survey)
|
$477.10 |
$477.10 |
$477.10 |
$355.00
|
|
Fundus photography with i&r 92250
|
$385.45 |
$385.45 |
$385.45 |
$182.95
|
|
Furosemide 10 mg/ml injection solution
|
$4.89 |
$4.89 |
$4.89 |
$19.53
|
|
G6pc gene
|
$262.60 |
$262.60 |
$262.60 |
$138.40
|
|
Ga-67 gallium 0.1 mci
|
$1,706.90 |
$1,706.90 |
$1,706.90 |
$121.73
|
|
Ga-68 gallium 68 dotatate
|
$98.80 |
$98.80 |
$98.80 |
$140.35
|
|
Gabapentin non-blood
|
$20.80 |
$20.80 |
$20.80 |
$42.35
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$1.94 |
$1.94 |
$1.94 |
$108.40
|
|
Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper)
|
$20.80 |
$20.80 |
$20.80 |
$120.00
|
|
Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution
|
$13.18 |
$13.18 |
$13.18 |
$177.52
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$95.55 |
$95.55 |
$95.55 |
$249.80
|
|
Galac-1-phosphate uridyltran - sendout
|
$94.25 |
$94.25 |
$94.25 |
$100.00
|
|
Galactose transferase test
|
$52.65 |
$52.65 |
$52.65 |
$31.35
|
|
Gallbladder and Bile Duct Scan (HIDA Scan)
|
$1,802.45 |
$1,802.45 |
$1,802.45 |
$1,494.00
|
|
Gallbladder Function Scan (HIDA with Medication)
|
$2,414.10 |
$2,414.10 |
$2,414.10 |
$1,615.00
|
|
Gallbladder Removal (Laparoscopic)
|
$17,444.70 |
$17,444.70 |
$17,444.70 |
$13,208.00
|
|
Gallium ga-68 psma-11, ucla
|
$10,617.75 |
$10,617.75 |
$10,617.75 |
$187.20
|
|
Galsulfase injection
|
$1,163.92 |
$1,163.92 |
$1,163.92 |
$4,037.51
|
|
Gamma globulin 1 cc inj
|
$121.72 |
$121.72 |
$121.72 |
$407.60
|
|
Gammaglobulin iga
|
$41.60 |
$41.60 |
$41.60 |
$69.60
|
|
Gammaglobulin ige
|
$74.10 |
$74.10 |
$74.10 |
$83.85
|
|
Gamma glutamyltransferase
|
$32.50 |
$32.50 |
$32.50 |
$57.54
|
|
Gamunex-c/gammaked
|
$35.84 |
$35.84 |
$35.84 |
$7,435.88
|
|
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr
|
$227.60 |
$227.60 |
$227.60 |
$197.40
|
|
Gba gene
|
$211.90 |
$211.90 |
$211.90 |
$160.72
|
|
Gefitinib oral
|
$405.03 |
$405.03 |
$405.03 |
$423.82
|
|
Gel-one
|
$897.00 |
$897.00 |
$897.00 |
$1,561.21
|
|
Gel-syn injection 0.1 mg
|
$453.96 |
$453.96 |
$453.96 |
$680.71
|
|
Gemcitabine 1 gram intravenous solution
|
$158.44 |
$158.44 |
$158.44 |
$207.51
|
|
Gemtuzumab ozogamicin 4.5 mg (1 mg/ml initial concentration) IV soln
|
$32,764.84 |
$32,764.84 |
$32,764.84 |
$19,305.62
|
|
Generator barostim neo2 2014
|
$6,987.50 |
$6,987.50 |
$6,987.50 |
$52,020.00
|
|
Generator emblem MRI sicd subq
|
$33,150.00 |
$33,150.00 |
$33,150.00 |
$36,467.76
|
|
Genetic tstg severe inh cond
|
$3,978.65 |
$3,978.65 |
$3,978.65 |
$3,978.65
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$6.34 |
$6.34 |
$6.34 |
$52.54
|
|
Gentamicin peak therapeutic drug level
|
$73.45 |
$73.45 |
$73.45 |
$123.84
|
|
G-esoph reflx tst w/electrod
|
$1,586.65 |
$1,586.65 |
$1,586.65 |
$1,514.00
|
|
Ghs abscess perianal iandd
|
$2,726.10 |
$2,726.10 |
$2,726.10 |
$1,465.00
|
|
Ghs abscess postoperative iandd complex
|
$5,580.90 |
$5,580.90 |
$5,580.90 |
$3,776.00
|
|
Ghs acetylcholinesterase, rbc
|
$44.20 |
$44.20 |
$44.20 |
$43.06
|
|
Ghs alcohol, methyl (methanol)-medtox
|
$76.70 |
$76.70 |
$76.70 |
$100.30
|
|
Ghs alpha thalasemia, 7 deletions
|
$458.90 |
$458.90 |
$458.90 |
$394.20
|
|
Ghs analysis neurostim without reprogramming
|
$577.85 |
$577.85 |
$577.85 |
$262.35
|
|
Ghs antibodies (torch) igm
|
$64.35 |
$64.35 |
$64.35 |
$69.12
|
|
Ghs aspiration bladder - needle
|
$727.35 |
$727.35 |
$727.35 |
$582.00
|
|
Ghs bladder cath - complex-foley
|
$468.00 |
$468.00 |
$468.00 |
$344.00
|
|
Ghs block ilioinguinal/gentitofemoral
|
$3,105.70 |
$3,105.70 |
$3,105.70 |
$1,059.85
|
|
Ghs central line insert < age 5, failed
|
$11,763.70 |
$11,763.70 |
$11,763.70 |
$2,519.49
|
|
Ghs change cysto/gastrost
|
$727.35 |
$727.35 |
$727.35 |
$594.55
|
|
Ghs chemo >8 hrs
|
$1,487.85 |
$1,487.85 |
$1,487.85 |
$714.87
|
|
Ghs chemo infusion >8 hrs
|
$1,487.85 |
$1,487.85 |
$1,487.85 |
$655.65
|
|
Ghs chemo IV push, ea addtl
|
$319.15 |
$319.15 |
$319.15 |
$277.00
|
|
Ghs chlamydia pneumoniae by pcr (arup) (306630)
|
$157.30 |
$157.30 |
$157.30 |
$133.70
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$716.95 |
$716.95 |
$716.95 |
$513.15
|
|
Ghs closed reduction ankle dislocation
|
$716.95 |
$716.95 |
$716.95 |
$671.50
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$4,785.30 |
$4,785.30 |
$4,785.30 |
$1,592.00
|
|
Ghs closed tx radiocarpal disloc w manip
|
$716.95 |
$716.95 |
$716.95 |
$523.85
|
|
Ghs closed tx tibial fracture w/manip
|
$4,785.30 |
$4,785.30 |
$4,785.30 |
$2,227.20
|
|
Ghs closure surg wound/dehiscence-13160
|
$3,567.20 |
$3,567.20 |
$3,567.20 |
$3,567.20
|
|
Ghs clsd red med malleolus fx without manip
|
$716.95 |
$716.95 |
$716.95 |
$513.80
|
|
Ghs clsd red med malleolus fx w manip
|
$4,785.30 |
$4,785.30 |
$4,785.30 |
$2,211.05
|
|
Ghs clsd tx frac distal tibia w/manipulation
|
$4,785.30 |
$4,785.30 |
$4,785.30 |
$2,319.00
|
|
Ghs cl tx knee disl; wo anesth
|
$716.95 |
$716.95 |
$716.95 |
$581.90
|
|
Ghs cl tx metacarpophal disloc without anes
|
$716.95 |
$716.95 |
$716.95 |
$500.40
|
|
Ghs community re-entry 15 minutes
|
$114.40 |
$114.40 |
$114.40 |
$89.28
|
|
Ghs conjunctiva foreign body-embed bil
|
$1,193.40 |
$1,193.40 |
$1,193.40 |
$436.10
|
|
Ghs conjunctiva foreign body-superf bil
|
$385.45 |
$385.45 |
$385.45 |
$287.40
|
|
Ghs corneal fb without slit lamp bilat
|
$1,193.40 |
$1,193.40 |
$1,193.40 |
$422.25
|
|
Ghs corneal fb with slit lamp bilat
|
$385.45 |
$385.45 |
$385.45 |
$339.60
|
|
Ghs cricothyroidotomy
|
$694.20 |
$694.20 |
$694.20 |
$1,104.00
|
|
Ghs dislocation elbow closed treatment
|
$716.95 |
$716.95 |
$716.95 |
$602.00
|
|
Ghs ed peritoneal lavage w guidance if performed
|
$2,803.45 |
$2,803.45 |
$2,803.45 |
$1,109.47
|
|
Ghs ed therapeutic lp, drain csf w fluoro
|
$3,105.70 |
$3,105.70 |
$3,105.70 |
$1,429.20
|
|
Ghs eeg cont rec w/video by tec min 8 chnls
|
$702.00 |
$702.00 |
$702.00 |
$586.80
|
|
Ghs electrostagmgraphy
|
$406.90 |
$406.90 |
$406.90 |
$322.00
|
|
Ghs epidermal shaving diameter >2.0 cm
|
$779.35 |
$779.35 |
$779.35 |
$467.00
|
|
Ghs excision ingrown nail
|
$779.35 |
$779.35 |
$779.35 |
$449.25
|
