|
Forearm X-ray (both sides)
|
$405.00 |
$456.60 |
$686.40 |
$324.00
|
|
Forehead flap w/vasc pedicle 15731
|
$4,228.20 |
$4,228.20 |
$4,228.20 |
$4,872.75
|
|
Foreskn manip w/lss preputial ads+stretching 54450
|
$2,487.00 |
$2,487.00 |
$6,114.60 |
$534.00
|
|
Formoterol fumarate, inh
|
$40.20 |
$40.20 |
$124.20 |
$59.40
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$10.20 |
$1,111.20 |
$1,537.20 |
$490.67
|
|
Foscarnet sodium injection
|
$215.20 |
$393.00 |
$2,358.00 |
$988.21
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$22.40 |
$137.40 |
$516.00 |
$103.62
|
|
Fracture assessment via dxa
|
$198.60 |
$201.00 |
$316.20 |
$175.50
|
|
_fragile x methylation-sendout
|
$669.60 |
$669.60 |
$1,007.40 |
$183.74
|
|
Fragmenting of kidney stone
|
$9,055.80 |
$9,055.80 |
$9,055.80 |
$10,312.25
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$399.60 |
$399.60 |
$399.60 |
$155.25
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$222.00 |
$379.20 |
$1,694.40 |
$164.84
|
|
Fresh frozen plasma thawing ea un
|
$93.60 |
$119.40 |
$129.00 |
$131.25
|
|
Frozen cell preparation
|
$63.00 |
$63.00 |
$138.00 |
$31.81
|
|
Fructosamine glycated protein
|
$94.80 |
$106.80 |
$282.60 |
$63.50
|
|
Fth/gft fr n/e/e/l each addl
|
$4,170.00 |
$4,170.00 |
$4,170.00 |
$1,368.50
|
|
Fth/gft fr trnk each addl
|
$3,768.60 |
$3,768.60 |
$3,768.60 |
$1,368.50
|
|
Ftl cgen abnor five anal
|
$262.80 |
$262.80 |
$262.80 |
$155.10
|
|
Ftl cgen abnor two proteins
|
$103.80 |
$103.80 |
$103.80 |
$109.00
|
|
Full Spine X-ray (Scoliosis Survey)
|
$268.80 |
$682.20 |
$1,154.40 |
$355.00
|
|
Full thick gft/nose/ear/lid/lip/20sqcm or< 15260
|
$3,448.20 |
$3,448.20 |
$3,448.20 |
$3,155.50
|
|
Full thick gft/scalp/arm/leg/20sqcm or< 15220
|
$3,448.20 |
$3,448.20 |
$3,448.20 |
$2,499.37
|
|
Full thick gft/scalp/arm/leg/add 20sqcm 15221
|
$3,448.20 |
$3,448.20 |
$3,448.20 |
$1,056.41
|
|
Full thick gft w/close donor fccmnaghf <=20sqcm 15240
|
$3,955.80 |
$4,035.60 |
$6,063.00 |
$2,798.50
|
|
Functional brain mapping
|
$2,565.00 |
$2,565.00 |
$2,565.00 |
$514.80
|
|
Fundus photography with i&r 92250
|
$98.40 |
$102.00 |
$178.20 |
$182.95
|
|
Furosemide 10 mg/ml injection solution
|
$0.40 |
$0.60 |
$1.20 |
$19.53
|
|
Furosemide in ns IV syringe 2 mg/ml (neo/ped) - cnr
|
$6.60 |
$12.00 |
$43.80 |
$26.40
|
|
Fuse esophagus & stomach
|
$17,967.60 |
$17,967.60 |
$17,967.60 |
$3,421.60
|
|
Fxn gene detc abnor alleles
|
$283.80 |
$283.80 |
$2,408.40 |
$200.88
|
|
G6pc gene
|
$343.80 |
$364.20 |
$1,288.20 |
$138.40
|
|
G6pd full gene sequence
|
$3,029.40 |
$3,029.40 |
$3,115.80 |
$1,320.00
|
|
Ga-67 gallium 0.1 mci
|
$190.20 |
$520.80 |
$1,032.60 |
$121.73
|
|
Ga-68 gallium 68 dotatate
|
$191.40 |
$191.40 |
$286.80 |
$140.35
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$4.80 |
$7.20 |
$10.80 |
$108.40
|
|
Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper)
|
$14.40 |
$15.00 |
$282.00 |
$120.00
|
|
Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution
|
$0.60 |
$0.60 |
$0.60 |
$177.52
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$25.80 |
$66.00 |
$111.60 |
$249.80
|
|
Galac-1-phosphate uridyltran - sendout
|
$26.40 |
$26.40 |
$26.40 |
$100.00
|
|
Galectin-3
|
$55.80 |
$66.00 |
$83.40 |
$111.60
|
|
Gallbladder and Bile Duct Scan (HIDA Scan)
|
$1,359.00 |
$1,663.20 |
$4,581.00 |
$1,494.00
|
|
Gallbladder Function Scan (HIDA with Medication)
|
$1,359.00 |
$1,663.20 |
$4,581.00 |
$1,615.00
|
|
Gallium illuccix 1 millicure
|
$1,900.80 |
$2,142.60 |
$2,848.80 |
$1,696.55
|
|
Gamma globulin 1 cc inj
|
$106.20 |
$106.20 |
$106.20 |
$407.60
|
|
Gammaglobulin iga
|
$57.00 |
$171.60 |
$404.40 |
$69.60
|
|
Gammaglobulin ige
|
$112.80 |
$144.60 |
$678.60 |
$83.85
|
|
Gamma glutamyltransferase
|
$49.20 |
$134.40 |
$282.60 |
$57.54
|
|
Gammagraft
|
$877.80 |
$1,333.80 |
$4,537.80 |
$1.00
|
|
Gammaplex injection
|
$100.20 |
$100.20 |
$100.20 |
$7,464.29
|
|
Gamunex-c/gammaked
|
$259.20 |
$345.60 |
$19,430.40 |
$7,435.88
|
|
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr
|
$264.80 |
$1,251.60 |
$1,251.60 |
$197.40
|
|
Gardner vag dna quant
|
$330.60 |
$410.40 |
$505.20 |
$104.80
|
|
Gastric mucosa imaging
|
$1,186.20 |
$1,186.20 |
$1,186.20 |
$565.00
|
|
Gastroesophageal reflux study
|
$1,507.20 |
$1,507.20 |
$1,507.20 |
$1,031.60
|
|
Gastroesophageal reflux test
|
$1,531.20 |
$1,531.20 |
$1,531.20 |
$1,352.00
|
|
Gastro/jejuno tube, std
|
$702.60 |
$1,145.40 |
$2,332.20 |
$379.50
|
|
Gated heart multiple
|
$1,971.00 |
$1,971.00 |
$1,971.00 |
$1,405.04
|
|
Gauze >16<=48 no w/sal without b
|
$7.20 |
$27.00 |
$2,152.80 |
$5.00
|
|
Gauze >16 <=48 sq in w/bordr
|
$3.00 |
$3.00 |
$3.00 |
$4.20
|
|
Gauze <=16 in no w/sal without b
|
$0.60 |
$0.60 |
$2.40 |
$6.40
|
|
Gauze > 48 in no w/sal without b
|
$8.40 |
$9.00 |
$13.80 |
$7.08
|
|
Gba gene
|
$1,191.60 |
$1,191.60 |
$1,191.60 |
$160.72
|
|
Gc stocking thighlngth 18-30
|
$23.40 |
$23.40 |
$23.40 |
$68.30
|
|
Gc stocking waistlngth 18-30
|
$3.00 |
$3.00 |
$3.00 |
$42.00
|
|
Gel cap app device for trach
|
$919.20 |
$1,102.20 |
$1,629.60 |
$70.00
|
|
Gemcitabine 1 gram intravenous solution
|
$1,333.20 |
$2,500.80 |
$13,330.80 |
$207.51
|
|
Gemtuzumab ozogamicin 4.5 mg (1 mg/ml initial concentration) IV soln
|
$74.40 |
$704.40 |
$31,680.60 |
$19,305.62
|
|
Generator barostim neo2 2014
|
$43,439.40 |
$52,543.20 |
$115,299.00 |
$52,020.00
|
|
Generator emblem MRI sicd subq
|
$47,875.80 |
$96,952.20 |
$128,662.20 |
$36,467.76
|
|
Genetic counseling 30 min
|
$138.00 |
$138.00 |
$138.00 |
$193.00
|
|
Genetic tstg severe inh cond
|
$4,156.20 |
$12,863.40 |
$18,150.60 |
$3,978.65
|
|
Genome sequence analysis
|
$4,439.40 |
$4,439.40 |
$7,352.40 |
$5,031.20
|
|
Genome sequence analysis
|
$4,439.40 |
$4,439.40 |
$4,439.40 |
$3,455.25
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$27.00 |
$80.40 |
$1,068.60 |
$52.54
|
|
Gentamicin peak therapeutic drug level
|
$100.20 |
$239.40 |
$919.20 |
$123.84
|
|
G-esoph reflx tst w/electrod
|
$1,296.60 |
$1,306.80 |
$2,314.80 |
$1,514.00
|
|
Ghs abscess perianal iandd
|
$1,468.80 |
$2,005.80 |
$3,560.40 |
$1,465.00
|
|
Ghs abscess postoperative iandd complex
|
$2,065.20 |
$2,180.40 |
$4,322.40 |
$3,776.00
|
|
Ghs alcohol, methyl (methanol)-medtox
|
$138.00 |
$171.60 |
$2,878.80 |
$100.30
|
|
Ghs alpha thalasemia, 7 deletions
|
$1,687.20 |
$1,687.20 |
$2,017.20 |
$394.20
|
|
Ghs analysis neurostim without reprogramming
|
$517.20 |
$517.20 |
$517.20 |
$262.35
|
|
Ghs antibodies (torch) igm
|
$71.40 |
$90.60 |
$513.00 |
$69.12
|
|
Ghs aspiration bladder - needle
|
$528.60 |
$616.80 |
$915.00 |
$582.00
|
|
Ghs bladder cath - complex-foley
|
$903.60 |
$1,070.40 |
$1,717.20 |
$344.00
|
|
Ghs block ilioinguinal/gentitofemoral
|
$417.00 |
$866.40 |
$1,647.60 |
$1,059.85
|
|
Ghs central line insert < age 5, failed
|
$2,397.00 |
$2,667.00 |
$3,606.00 |
$2,519.49
|
|
Ghs change cysto/gastrost
|
$1,265.40 |
$1,761.60 |
$2,815.20 |
$594.55
|
|
Ghs chemo >8 hrs
|
$3,246.60 |
$3,246.60 |
$3,246.60 |
$714.87
|
|
Ghs chemo IV push, ea addtl
|
$298.20 |
$379.20 |
$554.40 |
$277.00
|
|
Ghs chlamydia pneumoniae by pcr (arup) (306630)
|
$330.00 |
$360.00 |
$652.20 |
$133.70
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$454.20 |
$609.00 |
$865.80 |
$513.15
|
|
Ghs closed reduction ankle dislocation
|
$1,547.40 |
$1,980.60 |
$3,560.40 |
$671.50
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$1,635.60 |
$2,005.80 |
$3,560.40 |
$1,592.00
|
|
Ghs closed tx radiocarpal disloc w manip
|
$3,964.20 |
$3,964.20 |
$3,964.20 |
$523.85
|
|
Ghs closed tx tibial fracture w/manip
|
$1,810.80 |
$2,712.00 |
$3,560.40 |
$2,227.20
|
|
Ghs closure surg wound/dehiscence-13160
|
$3,040.20 |
$3,040.20 |
$3,040.20 |
$3,567.20
|
|
Ghs clsd red med malleolus fx without manip
|
$2,665.20 |
$2,665.20 |
$3,560.40 |
$513.80
|
|
Ghs clsd red med malleolus fx w manip
|
$1,810.80 |
$2,150.40 |
$3,772.80 |
$2,211.05
|
|
Ghs clsd tx frac distal tibia w/manipulation
|
$1,810.80 |
$2,418.00 |
$4,185.00 |
$2,319.00
|
|
Ghs cl tx knee disl; wo anesth
|
$2,370.60 |
$3,009.60 |
$3,222.60 |
$581.90
|
