|
Formoterol fumarate, inh
|
$61.50 |
$61.50 |
$61.50 |
$59.40
|
|
Foscarnet sodium injection
|
$1,555.20 |
$1,555.20 |
$1,555.20 |
$879.58
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$24.72 |
$24.72 |
$24.72 |
$106.10
|
|
Fracture assessment via dxa
|
$723.60 |
$723.60 |
$723.60 |
$173.18
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$1,069.20 |
$1,069.20 |
$1,069.20 |
$151.58
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$1,069.20 |
$1,069.20 |
$1,069.20 |
$156.60
|
|
Fructosamine glycated protein
|
$22.20 |
$22.20 |
$22.20 |
$60.75
|
|
Ft insert ucb berkeley shell
|
$743.29 |
$743.29 |
$743.29 |
$743.29
|
|
Ftl cgen abnor four anal
|
$238.80 |
$238.80 |
$238.80 |
$204.52
|
|
Ftl cgen abnor two proteins
|
$103.80 |
$103.80 |
$103.80 |
$110.00
|
|
Full sole/heel wedge btween
|
$129.40 |
$129.40 |
$129.40 |
$129.40
|
|
Furnsh initial orthosis only
|
$4,234.18 |
$4,234.18 |
$4,234.18 |
$2,873.32
|
|
Furosemide 10 mg/ml injection solution
|
$18.90 |
$18.90 |
$18.90 |
$19.00
|
|
Fusion of big toe joint
|
$32,483.59 |
$32,483.59 |
$32,483.59 |
$6,839.00
|
|
G6pc gene
|
$123.00 |
$123.00 |
$123.00 |
$123.00
|
|
G6pd full gene sequence
|
$1,008.00 |
$1,008.00 |
$1,008.00 |
$1,320.00
|
|
G6pd gene alys cmn variant
|
$279.60 |
$279.60 |
$279.60 |
$243.00
|
|
Ga-68 gallium 68 dotatate
|
$4,500.00 |
$4,500.00 |
$4,500.00 |
$119.90
|
|
Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper)
|
$60.00 |
$60.00 |
$60.00 |
$144.98
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$342.00 |
$342.00 |
$342.00 |
$250.83
|
|
Galac-1-phosphate uridyltran - sendout
|
$188.40 |
$188.40 |
$188.40 |
$96.94
|
|
Galectin-3
|
$111.60 |
$111.60 |
$111.60 |
$111.60
|
|
Gallbladder Removal (Laparoscopic)
|
$19,184.46 |
$19,184.46 |
$19,184.46 |
$11,117.34
|
|
Gammaglobulin iga
|
$60.60 |
$60.60 |
$60.60 |
$67.20
|
|
Gammaglobulin ige
|
$74.40 |
$74.40 |
$74.40 |
$83.85
|
|
Gamma glutamyltransferase
|
$96.60 |
$96.60 |
$96.60 |
$57.54
|
|
Gastrin test
|
$37.80 |
$37.80 |
$37.80 |
$61.80
|
|
Gba gene
|
$391.20 |
$391.20 |
$391.20 |
$160.72
|
|
General health panel
|
$54.60 |
$54.60 |
$54.60 |
$275.00
|
|
Generator barostim neo2 2014
|
$102,132.02 |
$102,132.02 |
$102,132.02 |
$48,147.60
|
|
Generator emblem MRI sicd subq
|
$77,676.91 |
$77,676.91 |
$77,676.91 |
$36,467.76
|
|
Generator stim baroreceptor neo legacy implant pulse
|
$91,847.70 |
$91,847.70 |
$91,847.70 |
$66,636.36
|
|
Genetic tstg severe inh cond
|
$2,395.20 |
$2,395.20 |
$2,395.20 |
$3,978.65
|
|
Gen, neuro, clo loop, rechg
|
$57,732.84 |
$57,732.84 |
$57,732.84 |
$36,800.00
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$18.06 |
$18.06 |
$18.06 |
$57.84
|
|
Gentamicin peak therapeutic drug level
|
$141.60 |
$141.60 |
$141.60 |
$126.00
|
|
Ghs abscess postoperative iandd complex
|
$4,511.40 |
$4,511.40 |
$4,511.40 |
$3,515.40
|
|
Ghs acetylcholinesterase, rbc
|
$72.00 |
$72.00 |
$72.00 |
$42.72
|
|
Ghs alcohol, methyl (methanol)-medtox
|
$87.60 |
$87.60 |
$87.60 |
$100.30
|
|
Ghs antibodies (torch) igm
|
$88.80 |
$88.80 |
$88.80 |
$69.30
|
|
Ghs block ilioinguinal/gentitofemoral
|
$1,701.60 |
$1,701.60 |
$1,701.60 |
$1,045.65
|
|
Ghs central line insert < age 5, failed
|
$5,202.60 |
$5,202.60 |
$5,202.60 |
$2,535.60
|
|
Ghs change cysto/gastrost
|
$1,472.40 |
$1,472.40 |
$1,472.40 |
$565.49
|
|
Ghs chemo >8 hrs
|
$901.20 |
$901.20 |
$901.20 |
$714.87
|
|
Ghs chemo IV push, ea addtl
|
$489.00 |
$489.00 |
$489.00 |
$286.00
|
|
Ghs chlamydia pneumoniae by pcr (arup) (306630)
|
$189.00 |
$189.00 |
$189.00 |
$132.00
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$592.20 |
$592.20 |
$592.20 |
$512.40
|
|
Ghs closed reduction ankle dislocation
|
$593.40 |
$593.40 |
$593.40 |
$653.80
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$3,579.60 |
$3,579.60 |
$3,579.60 |
$1,592.00
|
|
Ghs closed tx radiocarpal disloc w manip
|
$520.80 |
$520.80 |
$520.80 |
$520.80
|
|
Ghs closed tx tibial fracture w/manip
|
$3,585.60 |
$3,585.60 |
$3,585.60 |
$2,148.00
|
|
Ghs closure surg wound/dehiscence-13160
|
$3,750.00 |
$3,750.00 |
$3,750.00 |
$3,086.00
|
|
Ghs clsd red med malleolus fx without manip
|
$520.80 |
$520.80 |
$520.80 |
$496.80
|
|
Ghs clsd red med malleolus fx w manip
|
$3,619.80 |
$3,619.80 |
$3,619.80 |
$2,184.00
|
|
Ghs clsd tx frac distal tibia w/manipulation
|
$3,520.20 |
$3,520.20 |
$3,520.20 |
$2,211.05
|
|
Ghs cl tx knee disl; wo anesth
|
$520.80 |
$520.80 |
$520.80 |
$592.80
|
|
Ghs cl tx metacarpophal disloc without anes
|
$584.40 |
$584.40 |
$584.40 |
$495.55
|
|
Ghs community re-entry 15 minutes
|
$66.60 |
$66.60 |
$66.60 |
$88.50
|
|
Ghs dislocation elbow closed treatment
|
$583.80 |
$583.80 |
$583.80 |
$578.00
|
|
Ghs excision ingrown nail
|
$837.00 |
$837.00 |
$837.00 |
$439.50
|
|
Ghs fat & muscle
|
$30.00 |
$30.00 |
$30.00 |
$38.08
|
|
Ghs fb removal from muscle - complicated
|
$5,495.40 |
$5,495.40 |
$5,495.40 |
$3,295.35
|
|
Ghs fb removal - incisional
|
$3,178.80 |
$3,178.80 |
$3,178.80 |
$2,271.01
|
|
Ghs fb removal - non-incisional
|
$3,178.80 |
$3,178.80 |
$3,178.80 |
$1,706.20
|
|
Ghs fish cytogen
|
$446.40 |
$446.40 |
$446.40 |
$170.80
|
|
Ghs fish hybrid in situ 100-300
|
$213.00 |
$213.00 |
$213.00 |
$223.00
|
|
Ghs hcv amplificaiton
|
$103.20 |
$103.20 |
$103.20 |
$187.00
|
|
Ghs hepatitis c virus (hcv riba)
|
$196.20 |
$196.20 |
$196.20 |
$142.50
|
|
Ghs histoplasma antigen
|
$134.40 |
$134.40 |
$134.40 |
$141.00
|
|
Ghs HIV antibody
|
$126.00 |
$126.00 |
$126.00 |
$90.14
|
|
Ghs i and d abscess/hematoma scrotum
|
$13,094.04 |
$13,094.04 |
$13,094.04 |
$3,165.00
|
|
Ghs i and d pilonidal cyst complex
|
$1,552.80 |
$1,552.80 |
$1,552.80 |
$1,372.15
|
|
Ghs i and d pilonidal cyst simple
|
$1,546.20 |
$1,546.20 |
$1,546.20 |
$703.15
|
|
Ghs inf midline insertion
|
$751.20 |
$751.20 |
$751.20 |
$1,219.20
|
|
Ghs inhibitor screen
|
$216.00 |
$216.00 |
$216.00 |
$187.32
|
|
Ghs init tx 1st degree burn
|
$504.60 |
$504.60 |
$504.60 |
$275.50
|
|
Ghs inj tendon origin/insertion
|
$571.80 |
$571.80 |
$571.80 |
$431.07
|
|
Ghs inj transforaminal cerv ea add bil
|
$2,107.20 |
$2,107.20 |
$2,107.20 |
$1,110.90
|
|
Ghs inj transforaminal cerv single bil
|
$5,264.40 |
$5,264.40 |
$5,264.40 |
$1,727.25
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$833.40 |
$833.40 |
$833.40 |
$863.28
|
|
Ghs intermed repair 20.1 - 30.0 cm-12036
|
$1,309.20 |
$1,309.20 |
$1,309.20 |
$1,035.60
|
|
Ghs intermed repair over 30 cm - 12037
|
$3,579.60 |
$3,579.60 |
$3,579.60 |
$2,164.64
|
|
Ghs intro needle/intracath vein - 36000
|
$442.80 |
$442.80 |
$442.80 |
$213.75
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$7,323.00 |
$7,323.00 |
$7,323.00 |
$584.00
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$5,275.50 |
$5,275.50 |
$5,275.50 |
$563.75
|
|
Ghs layer closure 2.5cm or less - 12051
|
$837.00 |
$837.00 |
$837.00 |
$593.00
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$5,269.80 |
$5,269.80 |
$5,269.80 |
$675.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$837.00 |
$837.00 |
$837.00 |
$689.04
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$835.80 |
$835.80 |
$835.80 |
$741.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$835.80 |
$835.80 |
$835.80 |
$770.22
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$1,305.00 |
$1,305.00 |
$1,305.00 |
$750.12
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$837.00 |
$837.00 |
$837.00 |
$740.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$1,116.00 |
$1,116.00 |
$1,116.00 |
$964.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$725.40 |
$725.40 |
$725.40 |
$790.40
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$725.40 |
$725.40 |
$725.40 |
$1,126.40
|
|
Ghs layered repair 20.1 - 30.0 cm -12056
|
$725.40 |
$725.40 |
$725.40 |
$907.50
|
|
Ghs layered repair over 30.0 cm -12047
|
$3,579.60 |
$3,579.60 |
$3,579.60 |
$1,930.50
|
|
Ghs layered repair over 3.0 cm -12057
|
$725.40 |
$725.40 |
$725.40 |
$1,064.98
|
|
Ghs leukocyte alkaline phos (mayo)
|
$76.20 |
$76.20 |
$76.20 |
$76.20
|
|
Ghs mbp
|
$99.00 |
$99.00 |
$99.00 |
$77.35
|
