|
Foam drg > 48 sq in without brdr
|
$27.27 |
$27.27 |
$27.27 |
$33.49
|
|
Folic acid
|
$85.50 |
$85.50 |
$85.50 |
$101.00
|
|
Folic acid 5 mg/ml injection solution
|
$78.99 |
$78.99 |
$78.99 |
$45.00
|
|
Follow-up angiography
|
$2,489.25 |
$2,489.25 |
$2,489.25 |
$1,983.00
|
|
Fomepizole 1 gram/ml intravenous solution
|
$1,261.49 |
$1,261.49 |
$1,261.49 |
$2,481.61
|
|
Fondaparinux sodium
|
$121.83 |
$121.83 |
$121.83 |
$186.20
|
|
Foot arch support remov prem
|
$82.50 |
$82.50 |
$82.50 |
$141.41
|
|
Foot insert plastazote or eq
|
$101.25 |
$101.25 |
$101.25 |
$349.16
|
|
Foot X-ray
|
$452.25 |
$452.25 |
$452.25 |
$355.32
|
|
Foot X-ray (2 views, both feet)
|
$353.25 |
$353.25 |
$353.25 |
$290.40
|
|
Forearm X-ray (both sides)
|
$320.25 |
$320.25 |
$320.25 |
$324.00
|
|
Forensic autopsy (necropsy)
|
$162.00 |
$162.00 |
$162.00 |
$1,657.60
|
|
Foreskn manip w/lss preputial ads+stretching 54450
|
$285.00 |
$285.00 |
$285.00 |
$544.50
|
|
Formoterol fumarate, inh
|
$59.40 |
$59.40 |
$59.40 |
$59.40
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$1,233.17 |
$1,233.17 |
$1,233.17 |
$490.67
|
|
Foscarnet sodium injection
|
$1,101.86 |
$1,101.86 |
$1,101.86 |
$975.28
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$94.85 |
$94.85 |
$94.85 |
$103.62
|
|
Fracture assessment via dxa
|
$616.50 |
$616.50 |
$616.50 |
$175.50
|
|
Fragmenting of kidney stone
|
$10,126.50 |
$10,126.50 |
$10,126.50 |
$10,312.25
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$315.00 |
$315.00 |
$315.00 |
$155.40
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$258.00 |
$258.00 |
$258.00 |
$165.17
|
|
Fructosamine glycated protein
|
$80.25 |
$80.25 |
$80.25 |
$63.50
|
|
Full Spine X-ray (Scoliosis Survey)
|
$291.00 |
$291.00 |
$291.00 |
$355.00
|
|
Full thick gft/scalp/arm/leg/20sqcm or< 15220
|
$2,910.75 |
$2,910.75 |
$2,910.75 |
$2,469.00
|
|
Fundus photography with i&r 92250
|
$202.50 |
$202.50 |
$202.50 |
$182.95
|
|
Furosemide 10 mg/ml injection solution
|
$19.53 |
$19.53 |
$19.53 |
$19.53
|
|
Ga-68 gallium 68 dotatate
|
$156.00 |
$156.00 |
$156.00 |
$140.35
|
|
Gabapentin non-blood
|
$62.25 |
$62.25 |
$62.25 |
$42.35
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$177.43 |
$177.43 |
$177.43 |
$108.40
|
|
Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution
|
$119.29 |
$119.29 |
$119.29 |
$177.52
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$486.60 |
$486.60 |
$486.60 |
$249.80
|
|
Galac-1-phosphate uridyltran - sendout
|
$85.50 |
$85.50 |
$85.50 |
$100.00
|
|
Galectin-3
|
$1,755.00 |
$1,755.00 |
$1,755.00 |
$111.60
|
|
Gallbladder and Bile Duct Scan (HIDA Scan)
|
$1,587.00 |
$1,587.00 |
$1,587.00 |
$1,493.98
|
|
Gallbladder Function Scan (HIDA with Medication)
|
$1,885.50 |
$1,885.50 |
$1,885.50 |
$1,612.00
|
|
Gammaglobulin iga
|
$183.00 |
$183.00 |
$183.00 |
$69.60
|
|
Gammaglobulin ige
|
$148.50 |
$148.50 |
$148.50 |
$83.85
|
|
Gamma glutamyltransferase
|
$69.75 |
$69.75 |
$69.75 |
$57.54
|
|
Gamunex-c/gammaked
|
$8,519.04 |
$8,519.04 |
$8,519.04 |
$7,435.88
|
|
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr
|
$94.28 |
$94.28 |
$94.28 |
$197.40
|
|
Gastric motility studies
|
$1,688.25 |
$1,688.25 |
$1,688.25 |
$972.00
|
|
Gastrin test
|
$159.00 |
$159.00 |
$159.00 |
$61.80
|
|
Gastroesophageal reflux study
|
$1,232.25 |
$1,232.25 |
$1,232.25 |
$1,031.60
|
|
Gastroesophageal reflux test
|
$1,451.25 |
$1,451.25 |
$1,451.25 |
$1,352.00
|
|
Gel-syn injection 0.1 mg
|
$1,330.04 |
$1,330.04 |
$1,330.04 |
$680.71
|
|
Gemcitabine 1 gram intravenous solution
|
$168.02 |
$168.02 |
$168.02 |
$207.51
|
|
Gemtuzumab ozogamicin 4.5 mg (1 mg/ml initial concentration) IV soln
|
$37,698.54 |
$37,698.54 |
$37,698.54 |
$19,305.62
|
|
Generator barostim neo2 2014
|
$83,687.18 |
$83,687.18 |
$83,687.18 |
$52,020.00
|
|
Generator emblem MRI sicd subq
|
$61,875.00 |
$61,875.00 |
$61,875.00 |
$36,467.76
|
|
Genetic tstg severe inh cond
|
$11,208.75 |
$11,208.75 |
$11,208.75 |
$3,978.65
|
|
Gen, neuro, clo loop, rechg
|
$44,928.00 |
$44,928.00 |
$44,928.00 |
$38,632.78
|
|
Genome sequence analysis
|
$8,306.25 |
$8,306.25 |
$8,306.25 |
$5,031.20
|
|
Genome sequence analysis
|
$5,081.25 |
$5,081.25 |
$5,081.25 |
$3,455.25
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$85.57 |
$85.57 |
$85.57 |
$51.02
|
|
Gentamicin peak therapeutic drug level
|
$156.75 |
$156.75 |
$156.75 |
$123.84
|
|
G-esoph reflx tst w/electrod
|
$1,475.25 |
$1,475.25 |
$1,475.25 |
$1,500.00
|
|
Ghs abscess perianal iandd
|
$1,668.75 |
$1,668.75 |
$1,668.75 |
$1,469.60
|
|
Ghs abscess postoperative iandd complex
|
$4,398.75 |
$4,398.75 |
$4,398.75 |
$3,776.00
|
|
Ghs acetylcholinesterase, rbc
|
$191.25 |
$191.25 |
$191.25 |
$44.12
|
|
Ghs alcohol, methyl (methanol)-medtox
|
$858.00 |
$858.00 |
$858.00 |
$100.30
|
|
Ghs analysis neurostim without reprogramming
|
$714.00 |
$714.00 |
$714.00 |
$257.50
|
|
Ghs antibodies (torch) igm
|
$140.25 |
$140.25 |
$140.25 |
$69.12
|
|
Ghs bladder cath - complex-foley
|
$277.50 |
$277.50 |
$277.50 |
$344.00
|
|
Ghs block ilioinguinal/gentitofemoral
|
$1,471.50 |
$1,471.50 |
$1,471.50 |
$1,059.85
|
|
Ghs central line insert < age 5, failed
|
$2,489.25 |
$2,489.25 |
$2,489.25 |
$2,535.44
|
|
Ghs change cysto/gastrost
|
$1,143.75 |
$1,143.75 |
$1,143.75 |
$596.00
|
|
Ghs chemo >8 hrs
|
$899.25 |
$899.25 |
$899.25 |
$714.87
|
|
Ghs chemo infusion >8 hrs
|
$560.25 |
$560.25 |
$560.25 |
$655.65
|
|
Ghs chemo IV push, ea addtl
|
$899.25 |
$899.25 |
$899.25 |
$277.00
|
|
Ghs chlamydia pneumoniae by pcr (arup) (306630)
|
$744.75 |
$744.75 |
$744.75 |
$133.70
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$630.00 |
$630.00 |
$630.00 |
$514.80
|
|
Ghs closed reduction ankle dislocation
|
$732.75 |
$732.75 |
$732.75 |
$671.50
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$1,198.50 |
$1,198.50 |
$1,198.50 |
$1,592.00
|
|
Ghs closed tx radiocarpal disloc w manip
|
$273.00 |
$273.00 |
$273.00 |
$523.85
|
|
Ghs closed tx tibial fracture w/manip
|
$1,198.50 |
$1,198.50 |
$1,198.50 |
$2,242.80
|
|
Ghs closure surg wound/dehiscence-13160
|
$2,182.50 |
$2,182.50 |
$2,182.50 |
$3,494.52
|
|
Ghs clsd red med malleolus fx without manip
|
$255.75 |
$255.75 |
$255.75 |
$518.15
|
|
Ghs clsd red med malleolus fx w manip
|
$1,955.25 |
$1,955.25 |
$1,955.25 |
$2,211.05
|
|
Ghs clsd tx frac distal tibia w/manipulation
|
$2,421.00 |
$2,421.00 |
$2,421.00 |
$2,340.00
|
|
Ghs cl tx knee disl; wo anesth
|
$2,155.50 |
$2,155.50 |
$2,155.50 |
$581.90
|
|
Ghs cl tx metacarpophal disloc without anes
|
$472.50 |
$472.50 |
$472.50 |
$514.50
|
|
Ghs community re-entry 15 minutes
|
$121.50 |
$121.50 |
$121.50 |
$89.28
|
|
Ghs conjunctiva foreign body-embed bil
|
$315.75 |
$315.75 |
$315.75 |
$440.81
|
|
Ghs conjunctiva foreign body-superf bil
|
$225.00 |
$225.00 |
$225.00 |
$290.40
|
|
Ghs corneal fb without slit lamp bilat
|
$422.25 |
$422.25 |
$422.25 |
$422.25
|
|
Ghs corneal fb with slit lamp bilat
|
$372.00 |
$372.00 |
$372.00 |
$339.60
|
|
Ghs cricothyroidotomy
|
$271.50 |
$271.50 |
$271.50 |
$1,104.00
|
|
Ghs cutdown placement under 1 yr
|
$138.00 |
$138.00 |
$138.00 |
$190.30
|
|
Ghs dislocation elbow closed treatment
|
$525.75 |
$525.75 |
$525.75 |
$602.00
|
|
Ghs ed peritoneal lavage w guidance if performed
|
$3,175.50 |
$3,175.50 |
$3,175.50 |
$1,109.47
|
|
Ghs eeg cont rec w/video by tec min 8 chnls
|
$843.75 |
$843.75 |
$843.75 |
$586.80
|
|
Ghs electrostagmgraphy
|
$745.50 |
$745.50 |
$745.50 |
$315.28
|
|
Ghs elect torsion swing
|
$183.00 |
$183.00 |
$183.00 |
$266.29
|
|
Ghs elect vertical elct
|
$256.50 |
$256.50 |
$256.50 |
$116.00
|
|
Ghs epidermal shaving diameter >2.0 cm
|
$377.25 |
$377.25 |
$377.25 |
$449.50
|
|
Ghs excision ingrown nail
|
$1,305.75 |
$1,305.75 |
$1,305.75 |
$449.25
|
|
Ghs eye exam
|
$136.50 |
$136.50 |
$136.50 |
$162.24
|
|
Ghs eyelid foreign body-embedded - bil
|
$349.50 |
$349.50 |
$349.50 |
$523.77
|
|
Ghs fat & muscle
|
$47.25 |
$47.25 |
$47.25 |
$38.08
|
|
Ghs fb removal foot - deep - left
|
$2,538.75 |
$2,538.75 |
$2,538.75 |
$2,873.34
|
