|
Forearm X-ray (both sides)
|
$407.20 |
$407.20 |
$407.20 |
$324.00
|
|
Foreskn manip w/lss preputial ads+stretching 54450
|
$737.60 |
$737.60 |
$737.60 |
$534.00
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$990.13 |
$990.13 |
$990.13 |
$490.67
|
|
Foscarnet sodium injection
|
$1,464.00 |
$1,464.00 |
$1,464.00 |
$988.21
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$339.94 |
$339.94 |
$339.94 |
$103.62
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$300.80 |
$300.80 |
$300.80 |
$155.25
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$324.80 |
$324.80 |
$324.80 |
$164.84
|
|
Ft insert ucb berkeley shell
|
$268.80 |
$268.80 |
$268.80 |
$651.56
|
|
Full mouth x-ray of teeth
|
$353.60 |
$353.60 |
$353.60 |
$286.04
|
|
Full Spine X-ray (Scoliosis Survey)
|
$634.40 |
$634.40 |
$634.40 |
$355.00
|
|
Functional brain mapping
|
$652.80 |
$652.80 |
$652.80 |
$514.80
|
|
Furosemide 10 mg/ml injection solution
|
$312.69 |
$312.69 |
$312.69 |
$19.53
|
|
Ga-67 gallium 0.1 mci
|
$192.80 |
$192.80 |
$192.80 |
$121.73
|
|
Ga-68 gallium 68 dotatate
|
$170.40 |
$170.40 |
$170.40 |
$140.35
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$72.00 |
$72.00 |
$72.00 |
$108.40
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$48.00 |
$48.00 |
$48.00 |
$249.80
|
|
Gallbladder and Bile Duct Scan (HIDA Scan)
|
$2,272.00 |
$2,272.00 |
$2,272.00 |
$1,494.00
|
|
Gallbladder Function Scan (HIDA with Medication)
|
$2,271.20 |
$2,271.20 |
$2,271.20 |
$1,615.00
|
|
Gallium illuccix 1 millicure
|
$1,377.60 |
$1,377.60 |
$1,377.60 |
$1,696.55
|
|
Galsulfase injection
|
$6,386.40 |
$6,386.40 |
$6,386.40 |
$4,037.51
|
|
Gamma globulin 1 cc inj
|
$1,382.69 |
$1,382.69 |
$1,382.69 |
$407.60
|
|
Gammagraft
|
$256.00 |
$256.00 |
$256.00 |
$1.00
|
|
Gamunex-c/gammaked
|
$12,707.68 |
$12,707.68 |
$12,707.68 |
$7,435.88
|
|
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr
|
$388.50 |
$388.50 |
$388.50 |
$197.40
|
|
Gastroesophageal reflux study
|
$1,687.20 |
$1,687.20 |
$1,687.20 |
$1,031.60
|
|
Gastroesophageal reflux test
|
$2,619.20 |
$2,619.20 |
$2,619.20 |
$1,352.00
|
|
Gel-one
|
$3,340.00 |
$3,340.00 |
$3,340.00 |
$1,561.21
|
|
Gemcitabine 1 gram intravenous solution
|
$261.56 |
$261.56 |
$261.56 |
$207.51
|
|
Gemtuzumab ozogamicin 4.5 mg (1 mg/ml initial concentration) IV soln
|
$23,160.00 |
$23,160.00 |
$23,160.00 |
$19,305.62
|
|
Generator barostim neo2 2014
|
$69,958.40 |
$69,958.40 |
$69,958.40 |
$52,020.00
|
|
Generator emblem MRI sicd subq
|
$65,577.60 |
$65,577.60 |
$65,577.60 |
$36,467.76
|
|
Gen, neuro, clo loop, rechg
|
$36,800.00 |
$36,800.00 |
$36,800.00 |
$38,632.78
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$329.03 |
$329.03 |
$329.03 |
$52.54
|
|
G-esoph reflx tst w/electrod
|
$2,723.20 |
$2,723.20 |
$2,723.20 |
$1,514.00
|
|
Ghs abscess perianal iandd
|
$1,602.40 |
$1,602.40 |
$1,602.40 |
$1,465.00
|
|
Ghs abscess postoperative iandd complex
|
$4,495.20 |
$4,495.20 |
$4,495.20 |
$3,776.00
|
|
Ghs aspiration bladder - needle
|
$806.40 |
$806.40 |
$806.40 |
$582.00
|
|
Ghs bladder cath - complex-foley
|
$264.80 |
$264.80 |
$264.80 |
$344.00
|
|
Ghs block ilioinguinal/gentitofemoral
|
$1,417.60 |
$1,417.60 |
$1,417.60 |
$1,059.85
|
|
Ghs central line insert < age 5, failed
|
$2,584.80 |
$2,584.80 |
$2,584.80 |
$2,519.49
|
|
Ghs change cysto/gastrost
|
$505.60 |
$505.60 |
$505.60 |
$594.55
|
|
Ghs chemo >8 hrs
|
$887.20 |
$887.20 |
$887.20 |
$714.87
|
|
Ghs chemo IV push, ea addtl
|
$363.20 |
$363.20 |
$363.20 |
$277.00
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$636.80 |
$636.80 |
$636.80 |
$513.15
|
|
Ghs closed reduction ankle dislocation
|
$743.20 |
$743.20 |
$743.20 |
$671.50
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$1,869.60 |
$1,869.60 |
$1,869.60 |
$1,592.00
|
|
Ghs closed tx radiocarpal disloc w manip
|
$424.80 |
$424.80 |
$424.80 |
$523.85
|
|
Ghs closed tx tibial fracture w/manip
|
$2,187.20 |
$2,187.20 |
$2,187.20 |
$2,227.20
|
|
Ghs closure surg wound/dehiscence-13160
|
$6,665.60 |
$6,665.60 |
$6,665.60 |
$3,567.20
|
|
Ghs clsd red med malleolus fx without manip
|
$494.40 |
$494.40 |
$494.40 |
$513.80
|
|
Ghs clsd red med malleolus fx w manip
|
$2,103.20 |
$2,103.20 |
$2,103.20 |
$2,211.05
|
|
Ghs clsd tx frac distal tibia w/manipulation
|
$3,148.00 |
$3,148.00 |
$3,148.00 |
$2,319.00
|
|
Ghs cl tx knee disl; wo anesth
|
$396.00 |
$396.00 |
$396.00 |
$581.90
|
|
Ghs cl tx metacarpophal disloc without anes
|
$600.00 |
$600.00 |
$600.00 |
$500.40
|
|
Ghs community re-entry 15 minutes
|
$155.20 |
$155.20 |
$155.20 |
$89.28
|
|
Ghs conjunctiva foreign body-embed bil
|
$448.00 |
$448.00 |
$448.00 |
$436.10
|
|
Ghs conjunctiva foreign body-superf bil
|
$512.00 |
$512.00 |
$512.00 |
$287.40
|
|
Ghs corneal fb without slit lamp bilat
|
$461.60 |
$461.60 |
$461.60 |
$422.25
|
|
Ghs corneal fb with slit lamp bilat
|
$387.20 |
$387.20 |
$387.20 |
$339.60
|
|
Ghs cricothyroidotomy
|
$1,430.40 |
$1,430.40 |
$1,430.40 |
$1,104.00
|
|
Ghs dislocation elbow closed treatment
|
$494.40 |
$494.40 |
$494.40 |
$602.00
|
|
Ghs ed rmvl or bivalving cast
|
$438.40 |
$438.40 |
$438.40 |
$338.40
|
|
Ghs ed therapeutic lp, drain csf w fluoro
|
$2,000.80 |
$2,000.80 |
$2,000.80 |
$1,429.20
|
|
Ghs eeg cont rec w/video by tec min 8 chnls
|
$1,429.60 |
$1,429.60 |
$1,429.60 |
$586.80
|
|
Ghs excision ingrown nail
|
$457.60 |
$457.60 |
$457.60 |
$449.25
|
|
Ghs eyelid foreign body-embedded - bil
|
$764.80 |
$764.80 |
$764.80 |
$510.00
|
|
Ghs fb removal foot - deep - left
|
$3,394.40 |
$3,394.40 |
$3,394.40 |
$2,873.34
|
|
Ghs fb removal from muscle - complicated
|
$3,551.20 |
$3,551.20 |
$3,551.20 |
$3,311.10
|
|
Ghs fb removal - incisional
|
$4,160.00 |
$4,160.00 |
$4,160.00 |
$2,323.75
|
|
Ghs fb removal - non-incisional
|
$1,832.00 |
$1,832.00 |
$1,832.00 |
$1,706.20
|
|
Ghs gastric intub aspiration lavage
|
$424.80 |
$424.80 |
$424.80 |
$368.50
|
|
Ghs i and d abscess/hematoma scrotum
|
$4,949.60 |
$4,949.60 |
$4,949.60 |
$3,503.00
|
|
Ghs i and d perirectal abscess 46040
|
$4,336.00 |
$4,336.00 |
$4,336.00 |
$2,798.50
|
|
Ghs i and d pilonidal cyst complex
|
$1,844.00 |
$1,844.00 |
$1,844.00 |
$1,421.40
|
|
Ghs i and d pilonidal cyst simple
|
$1,011.20 |
$1,011.20 |
$1,011.20 |
$707.25
|
|
Ghs incision thrombosed ext hemorrhoid
|
$624.80 |
$624.80 |
$624.80 |
$526.50
|
|
Ghs indirect laryngoscopy/w fb removal
|
$232.80 |
$232.80 |
$232.80 |
$350.90
|
|
Ghs inf midline insertion
|
$1,832.80 |
$1,832.80 |
$1,832.80 |
$1,238.25
|
|
Ghs init tx 1st degree burn
|
$404.80 |
$404.80 |
$404.80 |
$275.88
|
|
Ghs inj neurolytic intercostal nerve
|
$2,829.60 |
$2,829.60 |
$2,829.60 |
$2,047.92
|
|
Ghs inj neurolytic other perph nerve
|
$2,137.60 |
$2,137.60 |
$2,137.60 |
$1,710.80
|
|
Ghs inj tendon origin/insertion
|
$415.20 |
$415.20 |
$415.20 |
$434.12
|
|
Ghs inj transforaminal cerv ea add bil
|
$1,356.80 |
$1,356.80 |
$1,356.80 |
$1,118.00
|
|
Ghs inj transforaminal cerv single bil
|
$1,854.40 |
$1,854.40 |
$1,854.40 |
$1,814.80
|
|
Ghs insertion of needle - bone
|
$511.20 |
$511.20 |
$511.20 |
$431.28
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$985.60 |
$985.60 |
$985.60 |
$886.07
|
|
Ghs intermed repair 20.1 - 30.0 cm-12036
|
$965.60 |
$965.60 |
$965.60 |
$1,051.20
|
|
Ghs intermed repair over 30 cm - 12037
|
$3,084.00 |
$3,084.00 |
$3,084.00 |
$2,164.64
|
|
Ghs intro needle/intracath vein - 36000
|
$339.20 |
$339.20 |
$339.20 |
$200.20
|
|
Ghs irrigate corpora cavernosa for priapism
|
$432.80 |
$432.80 |
$432.80 |
$551.20
|
|
Ghs IV inf sq injection, on-body injector
|
$145.60 |
$145.60 |
$145.60 |
$110.00
|
|
Ghs IV thrombolytics - cerebral
|
$798.40 |
$798.40 |
$798.40 |
$663.00
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$488.80 |
$488.80 |
$488.80 |
$489.67
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$979.20 |
$979.20 |
$979.20 |
$591.00
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$613.60 |
$613.60 |
$613.60 |
$583.10
|
|
Ghs layer closure 2.5cm or less - 12051
|
$679.20 |
$679.20 |
$679.20 |
$603.20
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$679.20 |
$679.20 |
$679.20 |
$672.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$679.20 |
$679.20 |
$679.20 |
$700.33
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$638.40 |
$638.40 |
$638.40 |
$741.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$679.20 |
$679.20 |
$679.20 |
$779.35
|
