|
Fna bx w/ct gdn ea addl
|
$390.00 |
$390.00 |
$390.00 |
$833.25
|
|
Foam drg >16<=48 sq in w/bdr
|
$318.48 |
$318.48 |
$318.48 |
$62.09
|
|
Foam drg >16<=48 sq in without b
|
$118.55 |
$118.55 |
$118.55 |
$41.14
|
|
Foam drg <=16 sq in w/border
|
$112.25 |
$112.25 |
$112.25 |
$16.37
|
|
Foam drg > 48 sq in w/border
|
$23.63 |
$23.63 |
$23.63 |
$23.63
|
|
Foam drg > 48 sq in without brdr
|
$144.75 |
$144.75 |
$144.75 |
$33.49
|
|
Foam drsg <=16 sq in without bdr
|
$59.76 |
$59.76 |
$59.76 |
$21.74
|
|
Folic acid
|
$128.10 |
$128.10 |
$128.10 |
$101.50
|
|
Follow-up angiography
|
$2,416.65 |
$2,416.65 |
$2,416.65 |
$2,040.78
|
|
Fomepizole 1 gram/ml intravenous solution
|
$2,033.07 |
$2,033.07 |
$2,033.07 |
$2,581.14
|
|
Fondaparinux sodium
|
$244.44 |
$244.44 |
$244.44 |
$185.12
|
|
Foot arch supp premold metat
|
$12.89 |
$12.89 |
$12.89 |
$70.22
|
|
Foot drp splt w/exp heel lg
|
$161.23 |
$161.23 |
$161.23 |
$143.87
|
|
Foot lamin/prepreg composite
|
$246.40 |
$246.40 |
$246.40 |
$289.76
|
|
Foot longitudinal arch suppo
|
$366.96 |
$366.96 |
$366.96 |
$295.47
|
|
Foot X-ray
|
$371.85 |
$371.85 |
$371.85 |
$362.40
|
|
Forearm/arm cuffs ext/flex a
|
$105.83 |
$105.83 |
$105.83 |
$580.42
|
|
Foreskn manip w/lss preputial ads+stretching 54450
|
$756.45 |
$756.45 |
$756.45 |
$532.80
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$578.25 |
$578.25 |
$578.25 |
$457.50
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$262.01 |
$262.01 |
$262.01 |
$106.10
|
|
_fragile x methylation-sendout
|
$855.00 |
$855.00 |
$855.00 |
$174.00
|
|
Fragmenting of kidney stone
|
$18,406.05 |
$18,406.05 |
$18,406.05 |
$10,057.42
|
|
Frenectomy 41115
|
$1,183.95 |
$1,183.95 |
$1,183.95 |
$1,752.89
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$132.30 |
$132.30 |
$132.30 |
$151.58
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$232.80 |
$232.80 |
$232.80 |
$156.60
|
|
Fresh frozen plasma thawing ea un
|
$102.90 |
$102.90 |
$102.90 |
$122.00
|
|
Frozen blood thaw
|
$410.55 |
$410.55 |
$410.55 |
$209.50
|
|
Fructosamine glycated protein
|
$31.95 |
$31.95 |
$31.95 |
$60.75
|
|
Ft arch suprt premold longit
|
$94.69 |
$94.69 |
$94.69 |
$79.82
|
|
Furosemide in ns IV syringe 2 mg/ml (neo/ped) - cnr
|
$11.45 |
$11.45 |
$11.45 |
$27.08
|
|
Ga-67 gallium 0.1 mci
|
$125.70 |
$125.70 |
$125.70 |
$118.56
|
|
Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper)
|
$73.80 |
$73.80 |
$73.80 |
$144.98
|
|
Galac-1-phosphate uridyltran - sendout
|
$213.90 |
$213.90 |
$213.90 |
$96.94
|
|
Gallium illuccix 1 millicure
|
$10,451.70 |
$10,451.70 |
$10,451.70 |
$1,395.27
|
|
Gammaglobulin iga
|
$221.85 |
$221.85 |
$221.85 |
$67.20
|
|
Gammaglobulin ige
|
$79.05 |
$79.05 |
$79.05 |
$83.85
|
|
Gamma glutamyltransferase
|
$161.85 |
$161.85 |
$161.85 |
$57.54
|
|
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr
|
$210.11 |
$210.11 |
$210.11 |
$197.40
|
|
Gastroesophageal reflux test
|
$780.45 |
$780.45 |
$780.45 |
$1,321.45
|
|
Gauze >16<=48 no w/sal without b
|
$9.89 |
$9.89 |
$9.89 |
$5.00
|
|
Gauze <=16 in no w/sal without b
|
$17.01 |
$17.01 |
$17.01 |
$6.40
|
|
Gauze <= 16 sq in w/border
|
$26.06 |
$26.06 |
$26.06 |
$13.65
|
|
Gauze > 48 in no w/sal without b
|
$16.29 |
$16.29 |
$16.29 |
$7.08
|
|
Gel-one
|
$2,277.00 |
$2,277.00 |
$2,277.00 |
$1,341.67
|
|
Gemcitabine 1 gram intravenous solution
|
$195.71 |
$195.71 |
$195.71 |
$207.51
|
|
Gemtuzumab ozogamicin 4.5 mg (1 mg/ml initial concentration) IV soln
|
$19,305.62 |
$19,305.62 |
$19,305.62 |
$19,305.62
|
|
Generator barostim neo2 2014
|
$48,147.60 |
$48,147.60 |
$48,147.60 |
$48,147.60
|
|
Generator emblem MRI sicd subq
|
$30,006.00 |
$30,006.00 |
$30,006.00 |
$36,467.76
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$30.00 |
$30.00 |
$30.00 |
$57.84
|
|
Gentamicin peak therapeutic drug level
|
$302.10 |
$302.10 |
$302.10 |
$126.00
|
|
G-esoph reflx tst w/electrod
|
$1,551.45 |
$1,551.45 |
$1,551.45 |
$1,418.18
|
|
Ghs abscess perianal iandd
|
$1,020.15 |
$1,020.15 |
$1,020.15 |
$1,410.90
|
|
Ghs abscess postoperative iandd complex
|
$3,295.35 |
$3,295.35 |
$3,295.35 |
$3,515.40
|
|
Ghs antibodies (torch) igm
|
$30.75 |
$30.75 |
$30.75 |
$69.30
|
|
Ghs bladder cath - complex-foley
|
$375.00 |
$375.00 |
$375.00 |
$344.00
|
|
Ghs bleeding time (ivy)
|
$153.90 |
$153.90 |
$153.90 |
$64.40
|
|
Ghs block ilioinguinal/gentitofemoral
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$1,045.65
|
|
Ghs central line insert < age 5, failed
|
$2,899.95 |
$2,899.95 |
$2,899.95 |
$2,535.60
|
|
Ghs change cysto/gastrost
|
$446.55 |
$446.55 |
$446.55 |
$565.49
|
|
Ghs chemo >8 hrs
|
$681.75 |
$681.75 |
$681.75 |
$714.87
|
|
Ghs chemo infusion >8 hrs
|
$655.65 |
$655.65 |
$655.65 |
$570.57
|
|
Ghs chemo IV push, ea addtl
|
$265.50 |
$265.50 |
$265.50 |
$286.00
|
|
Ghs chlamydia pneumoniae by pcr (arup) (306630)
|
$454.80 |
$454.80 |
$454.80 |
$132.00
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$211.95 |
$211.95 |
$211.95 |
$512.40
|
|
Ghs closed reduction ankle dislocation
|
$520.80 |
$520.80 |
$520.80 |
$653.80
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$1,396.80 |
$1,396.80 |
$1,396.80 |
$1,592.00
|
|
Ghs closed tx radiocarpal disloc w manip
|
$256.95 |
$256.95 |
$256.95 |
$520.80
|
|
Ghs closed tx tibial fracture w/manip
|
$1,650.90 |
$1,650.90 |
$1,650.90 |
$2,148.00
|
|
Ghs closure surg wound/dehiscence-13160
|
$2,105.40 |
$2,105.40 |
$2,105.40 |
$3,086.00
|
|
Ghs clsd red med malleolus fx without manip
|
$256.95 |
$256.95 |
$256.95 |
$496.80
|
|
Ghs clsd red med malleolus fx w manip
|
$1,650.90 |
$1,650.90 |
$1,650.90 |
$2,184.00
|
|
Ghs clsd tx frac distal tibia w/manipulation
|
$1,650.90 |
$1,650.90 |
$1,650.90 |
$2,211.05
|
|
Ghs cl tx knee disl; wo anesth
|
$279.90 |
$279.90 |
$279.90 |
$592.80
|
|
Ghs cl tx metacarpophal disloc without anes
|
$211.95 |
$211.95 |
$211.95 |
$495.55
|
|
Ghs community re-entry 15 minutes
|
$225.45 |
$225.45 |
$225.45 |
$88.50
|
|
Ghs conjunctiva foreign body-embed bil
|
$339.60 |
$339.60 |
$339.60 |
$419.22
|
|
Ghs conjunctiva foreign body-superf bil
|
$339.60 |
$339.60 |
$339.60 |
$283.80
|
|
Ghs corneal fb without slit lamp bilat
|
$339.60 |
$339.60 |
$339.60 |
$419.65
|
|
Ghs corneal fb with slit lamp bilat
|
$339.60 |
$339.60 |
$339.60 |
$339.60
|
|
Ghs cricothyroidotomy
|
$1,591.05 |
$1,591.05 |
$1,591.05 |
$1,067.30
|
|
Ghs dislocation elbow closed treatment
|
$279.90 |
$279.90 |
$279.90 |
$578.00
|
|
Ghs ed peritoneal lavage w guidance if performed
|
$980.10 |
$980.10 |
$980.10 |
$1,109.47
|
|
Ghs ed rmvl or bivalving cast
|
$389.40 |
$389.40 |
$389.40 |
$329.60
|
|
Ghs ed therapeutic lp, drain csf w fluoro
|
$2,776.65 |
$2,776.65 |
$2,776.65 |
$1,432.20
|
|
Ghs eeg cont rec w/video by tec min 8 chnls
|
$554.70 |
$554.70 |
$554.70 |
$593.91
|
|
Ghs excision ingrown nail
|
$449.25 |
$449.25 |
$449.25 |
$439.50
|
|
Ghs eyelid foreign body-embedded - bil
|
$360.45 |
$360.45 |
$360.45 |
$501.04
|
|
Ghs fb removal foot - deep - left
|
$1,355.85 |
$1,355.85 |
$1,355.85 |
$2,538.75
|
|
Ghs fb removal from muscle - complicated
|
$3,295.35 |
$3,295.35 |
$3,295.35 |
$3,295.35
|
|
Ghs fb removal - incisional
|
$1,896.60 |
$1,896.60 |
$1,896.60 |
$2,271.01
|
|
Ghs fb removal - non-incisional
|
$1,896.60 |
$1,896.60 |
$1,896.60 |
$1,706.20
|
|
Ghs febrile agglutinns(mayo)
|
$90.90 |
$90.90 |
$90.90 |
$48.57
|
|
Ghs fish cytogen
|
$589.05 |
$589.05 |
$589.05 |
$170.80
|
|
Ghs fish hybrid in situ 100-300
|
$316.05 |
$316.05 |
$316.05 |
$223.00
|
|
Ghs flow volume loop
|
$454.65 |
$454.65 |
$454.65 |
$308.69
|
|
Ghs gastric intub aspiration lavage
|
$196.95 |
$196.95 |
$196.95 |
$368.50
|
|
Ghs histoplasma antigen
|
$270.60 |
$270.60 |
$270.60 |
$141.00
|
|
Ghs HIV antibody
|
$192.45 |
$192.45 |
$192.45 |
$90.14
|
|
Ghs i and d abscess/hematoma scrotum
|
$3,085.80 |
$3,085.80 |
$3,085.80 |
$3,165.00
|
|
Ghs i and d perirectal abscess 46040
|
$1,915.20 |
$1,915.20 |
$1,915.20 |
$2,630.53
|
