|
F-18 florbetapir less than or equal to 10 mci
|
$5,863.67 |
$5,863.67 |
$5,863.67 |
$5,224.83
|
|
Facial bones <3
|
$60.03 |
$60.03 |
$60.03 |
$216.45
|
|
Factor ix
|
$104.16 |
$104.16 |
$104.16 |
$139.75
|
|
Factor ix complex
|
$9.25 |
$9.25 |
$9.25 |
$3.23
|
|
Factor ix recombinant nos
|
$21.16 |
$21.16 |
$21.16 |
$1.88
|
|
Factor viii
|
$117.57 |
$117.57 |
$117.57 |
$152.50
|
|
Factor viii
|
$1.61 |
$1.61 |
$1.61 |
$1.35
|
|
Factor viii recombinant nos
|
$9.25 |
$9.25 |
$9.25 |
$3.30
|
|
Factor xiii anti-hem factor
|
$23.98 |
$23.98 |
$23.98 |
$14.73
|
|
Family therapy without pt 50min 90846
|
$210.44 |
$210.44 |
$210.44 |
$230.40
|
|
Family therapy with patient 50 min 90847
|
$210.44 |
$210.44 |
$210.44 |
$224.80
|
|
Fat/lipids feces qualitative
|
$50.04 |
$50.04 |
$50.04 |
$43.66
|
|
Fatty acids nonesterified
|
$43.85 |
$43.85 |
$43.85 |
$64.28
|
|
#fecal-sodium
|
$101.84 |
$101.84 |
$101.84 |
$40.30
|
|
Felbamate (felbatol(r)) - sendout
|
$50.69 |
$50.69 |
$50.69 |
$83.85
|
|
Fem/popl revasc w/stent
|
$28,500.73 |
$28,500.73 |
$28,500.73 |
$21,553.12
|
|
Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper)
|
$96.11 |
$96.11 |
$96.11 |
$48.88
|
|
Ferric carboxymaltose 50 mg iron/ml intravenous solution
|
$10.34 |
$10.34 |
$10.34 |
$2,131.58
|
|
Ferritin
|
$44.40 |
$44.40 |
$44.40 |
$86.45
|
|
Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution
|
$9.71 |
$9.71 |
$9.71 |
$2,289.60
|
|
Fetal contract stress test 59020 - 26
|
$101.47 |
$101.47 |
$101.47 |
$555.60
|
|
Fetal fibronectin
|
$214.97 |
$214.97 |
$214.97 |
$309.40
|
|
Fetal hemoglobin (kleihauer betke)
|
$46.99 |
$46.99 |
$46.99 |
$59.85
|
|
Fetal hemoglobin rosette
|
$45.79 |
$45.79 |
$45.79 |
$48.35
|
|
Fetal lung maturity assess lam body dnst
|
$62.90 |
$62.90 |
$62.90 |
$64.28
|
|
Fetal non stress test
|
$76.68 |
$76.68 |
$76.68 |
$507.90
|
|
Fibrin degradation d dimer quantitative
|
$58.28 |
$58.28 |
$58.28 |
$87.60
|
|
Fibrinogen activity
|
$31.17 |
$31.17 |
$31.17 |
$61.80
|
|
Fibrinolytic antiplasmin
|
$93.24 |
$93.24 |
$93.24 |
$68.40
|
|
Fibrinolytic plasminogen
|
$112.02 |
$112.02 |
$112.02 |
$120.00
|
|
Fibrinolytic plasminogen xcpt antgnc asa
|
$47.08 |
$47.08 |
$47.08 |
$70.80
|
|
Filgrastim in d5w IV syringe 20 mcg/ml (neo) - cnr
|
$683.63 |
$683.63 |
$683.63 |
$1,223.60
|
|
Fine needle asp without image guide 10021
|
$191.94 |
$191.94 |
$191.94 |
$547.53
|
|
Finger joint sz00 swanson w/grommets
|
$7,356.19 |
$7,356.19 |
$7,356.19 |
$4,413.60
|
|
Fixation of knee joint
|
$1,188.07 |
$1,188.07 |
$1,188.07 |
$1,858.61
|
|
Fix g/colon tube w/device
|
$714.47 |
$714.47 |
$714.47 |
$1,165.45
|
|
Flebogamma injection
|
$68.52 |
$68.52 |
$68.52 |
$68.52
|
|
Flecainide (tambocor)-sendout
|
$39.31 |
$39.31 |
$39.31 |
$86.40
|
|
Fl exam g/colon tube w contrast
|
$219.78 |
$219.78 |
$219.78 |
$522.75
|
|
Flow cytometry marker each additional
|
$58.92 |
$58.92 |
$58.92 |
$103.00
|
|
Flow cytometry one marker technical component
|
$174.83 |
$174.83 |
$174.83 |
$304.43
|
|
#flow interp 9 - 15 markers
|
$82.90 |
$82.90 |
$82.90 |
$202.15
|
|
Floxuridine injection
|
$82.29 |
$82.29 |
$82.29 |
$4,125.55
|
|
Flt3 gene
|
$209.88 |
$209.88 |
$209.88 |
$355.00
|
|
Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback
|
$48.56 |
$48.56 |
$48.56 |
$48.56
|
|
Fludarabine 50 mg intravenous solution
|
$264.59 |
$264.59 |
$264.59 |
$417.96
|
|
Fluidotherapy charges pt
|
$36.45 |
$36.45 |
$36.45 |
$101.40
|
|
Fluid pressure muscle 20950
|
$579.70 |
$579.70 |
$579.70 |
$738.87
|
|
Fluorescent antibody titer dna
|
$183.15 |
$183.15 |
$183.15 |
$123.65
|
|
Fluoroguide for spine inject 77003-26
|
$45.79 |
$45.79 |
$45.79 |
$497.25
|
|
Fluoroguide needle placement
|
$46.81 |
$46.81 |
$46.81 |
$510.00
|
|
Fluoro polarize fetal lung
|
$62.81 |
$62.81 |
$62.81 |
$127.20
|
|
Fluoroscopy up to 1 hour
|
$164.47 |
$164.47 |
$164.47 |
$474.50
|
|
Fluorouracil 50 mg/ml intravenous solution (wrapper)
|
$9.25 |
$9.25 |
$9.25 |
$73.16
|
|
Fluphenazine decanoate 25 mg/ml injection solution
|
$18.70 |
$18.70 |
$18.70 |
$66.60
|
|
Folic acid
|
$58.28 |
$58.28 |
$58.28 |
$85.50
|
|
Follow-up angiography
|
$429.76 |
$429.76 |
$429.76 |
$1,939.14
|
|
Followup eval of foot pt lop
|
$128.95 |
$128.95 |
$128.95 |
$142.64
|
|
Fomepizole 1 gram/ml intravenous solution
|
$18.44 |
$18.44 |
$18.44 |
$18.44
|
|
Fondaparinux sodium
|
$184.00 |
$184.00 |
$184.00 |
$121.83
|
|
Foot X-ray
|
$273.99 |
$273.99 |
$273.99 |
$339.50
|
|
Foreskn manip w/lss preputial ads+stretching 54450
|
$174.73 |
$174.73 |
$174.73 |
$572.30
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$201.52 |
$201.52 |
$201.52 |
$201.52
|
|
Foscarnet sodium injection
|
$184.93 |
$184.93 |
$184.93 |
$1,082.06
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$21.86 |
$21.86 |
$21.86 |
$66.38
|
|
Fracture assessment via dxa
|
$87.14 |
$87.14 |
$87.14 |
$170.40
|
|
_fragile x methylation-sendout
|
$105.10 |
$105.10 |
$105.10 |
$175.75
|
|
Fresh frozen plasma thawing ea un
|
$100.73 |
$100.73 |
$100.73 |
$114.35
|
|
Fructosamine glycated protein
|
$59.76 |
$59.76 |
$59.76 |
$69.55
|
|
Full thick gft w/close donor fccmnaghf <=20sqcm 15240
|
$1,291.76 |
$1,291.76 |
$1,291.76 |
$2,315.04
|
|
G6pc gene
|
$314.78 |
$314.78 |
$314.78 |
$140.00
|
|
Ga-67 gallium 0.1 mci
|
$45.33 |
$45.33 |
$45.33 |
$156.23
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$0.74 |
$0.74 |
$0.74 |
$2.04
|
|
Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper)
|
$9.25 |
$9.25 |
$9.25 |
$15.60
|
|
Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution
|
$2.16 |
$2.16 |
$2.16 |
$13.18
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$31.52 |
$31.52 |
$31.52 |
$90.60
|
|
Galac-1-phosphate uridyltran - sendout
|
$96.94 |
$96.94 |
$96.94 |
$85.50
|
|
Gamma globulin 1 cc inj
|
$29.56 |
$29.56 |
$29.56 |
$106.20
|
|
Gammaglobulin iga
|
$72.15 |
$72.15 |
$72.15 |
$78.60
|
|
Gammaglobulin ige
|
$58.18 |
$58.18 |
$58.18 |
$87.10
|
|
Gamma glutamyltransferase
|
$49.03 |
$49.03 |
$49.03 |
$54.60
|
|
Gamunex-c/gammaked
|
$140.60 |
$140.60 |
$140.60 |
$100.40
|
|
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr
|
$131.15 |
$131.15 |
$131.15 |
$154.86
|
|
Gardner vag dna quant
|
$63.27 |
$63.27 |
$63.27 |
$104.80
|
|
Gastric emptying imag study
|
$585.53 |
$585.53 |
$585.53 |
$1,270.00
|
|
Gastroesophageal reflux study
|
$395.62 |
$395.62 |
$395.62 |
$887.62
|
|
Gemcitabine 1 gram intravenous solution
|
$184.50 |
$184.50 |
$184.50 |
$168.02
|
|
Gemtuzumab ozogamicin 4.5 mg (1 mg/ml initial concentration) IV soln
|
$10,030.70 |
$10,030.70 |
$10,030.70 |
$15,276.60
|
|
General health panel
|
$161.14 |
$161.14 |
$161.14 |
$270.40
|
|
Genetic tstg severe inh cond
|
$1,358.64 |
$1,358.64 |
$1,358.64 |
$4,897.60
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$10.93 |
$10.93 |
$10.93 |
$30.76
|
|
Gentamicin peak therapeutic drug level
|
$88.43 |
$88.43 |
$88.43 |
$114.00
|
|
Ghs abscess perianal iandd
|
$1,410.90 |
$1,410.90 |
$1,410.90 |
$1,512.80
|
|
Ghs abscess postoperative iandd complex
|
$1,244.68 |
$1,244.68 |
$1,244.68 |
$3,776.00
|
|
Ghs acetylcholinesterase, rbc
|
$44.12 |
$44.12 |
$44.12 |
$44.20
|
|
Ghs alcohol, methyl (methanol)-medtox
|
$103.14 |
$103.14 |
$103.14 |
$103.14
|
|
Ghs alpha thalasemia, 7 deletions
|
$213.03 |
$213.03 |
$213.03 |
$437.58
|
|
Ghs analysis neurostim without reprogramming
|
$62.72 |
$62.72 |
$62.72 |
$275.60
|
|
Ghs antibodies (torch) igm
|
$49.03 |
$49.03 |
$49.03 |
$82.50
|
|
Ghs bladder cath - complex-foley
|
$190.55 |
$190.55 |
$190.55 |
$333.18
|
