|
Factor ix
|
$627.00 |
$627.00 |
$627.00 |
$156.13
|
|
Factor viii
|
$627.00 |
$627.00 |
$627.00 |
$133.81
|
|
Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr
|
$4.20 |
$4.20 |
$4.20 |
$22.20
|
|
Fam-trastuzumab deruxtecan-nxki 100 mg intravenous solution
|
$8,338.80 |
$8,338.80 |
$8,338.80 |
$5,800.72
|
|
Fat/lipids feces qualitative
|
$40.80 |
$40.80 |
$40.80 |
$38.35
|
|
Fecal microbiota, live-jslm 150 ml rectal suspension enema
|
$36,174.60 |
$36,174.60 |
$36,174.60 |
$14,956.68
|
|
Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper)
|
$37.20 |
$37.20 |
$37.20 |
$101.40
|
|
Ferric carboxymaltose 50 mg iron/ml intravenous solution
|
$3,310.20 |
$3,310.20 |
$3,310.20 |
$2,590.25
|
|
Ferritin
|
$240.60 |
$240.60 |
$240.60 |
$100.94
|
|
Fibrin degradation products
|
$196.20 |
$196.20 |
$196.20 |
$62.64
|
|
Fibrin degrade semiquant
|
$69.60 |
$69.60 |
$69.60 |
$78.09
|
|
Fibrinogen activity
|
$151.20 |
$151.20 |
$151.20 |
$83.50
|
|
Filgrastim-sndz 300 mcg/0.5 ml injection syringe
|
$1,464.60 |
$1,464.60 |
$1,464.60 |
$869.18
|
|
Filter vena cava fem denali
|
$1,640.50 |
$1,640.50 |
$1,640.50 |
$3,718.18
|
|
Fine needle aspiration biopsy w/us gdn; ea addtl 10006
|
$49.80 |
$49.80 |
$49.80 |
$823.90
|
|
Fine needle asp without image guide 10021
|
$82.80 |
$82.80 |
$82.80 |
$503.76
|
|
Floor of mouth biopsy 41108
|
$552.00 |
$552.00 |
$552.00 |
$2,168.40
|
|
Flow cytometry marker each additional
|
$24.00 |
$24.00 |
$24.00 |
$97.50
|
|
Flow cytometry one marker technical component
|
$640.80 |
$640.80 |
$640.80 |
$284.40
|
|
Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback
|
$32.40 |
$32.40 |
$32.40 |
$64.22
|
|
Fluidotherapy charges pt
|
$185.40 |
$185.40 |
$185.40 |
$91.00
|
|
Fluoroguide needle placement
|
$540.00 |
$540.00 |
$540.00 |
$510.00
|
|
Fluoroscopy up to 1 hour
|
$393.60 |
$393.60 |
$393.60 |
$492.00
|
|
Fluorouracil 50 mg/ml intravenous solution (wrapper)
|
$184.20 |
$184.20 |
$184.20 |
$94.86
|
|
Fluphenazine decanoate 25 mg/ml injection solution
|
$94.20 |
$94.20 |
$94.20 |
$72.52
|
|
Folic acid
|
$266.40 |
$266.40 |
$266.40 |
$101.50
|
|
Folic acid 5 mg/ml injection solution
|
$139.80 |
$139.80 |
$139.80 |
$54.75
|
|
Fomepizole 1 gram/ml intravenous solution
|
$3,584.40 |
$3,584.40 |
$3,584.40 |
$2,581.14
|
|
Fondaparinux sodium
|
$372.60 |
$372.60 |
$372.60 |
$185.12
|
|
Foot X-ray
|
$501.60 |
$501.60 |
$501.60 |
$362.40
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$96.60 |
$96.60 |
$96.60 |
$457.50
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$333.00 |
$333.00 |
$333.00 |
$106.10
|
|
Frenectomy 41115
|
$258.60 |
$258.60 |
$258.60 |
$1,752.89
|
|
Frenotomy 40806
|
$183.60 |
$183.60 |
$183.60 |
$729.70
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$176.40 |
$176.40 |
$176.40 |
$156.60
|
|
Full thick gft/nose/ear/lid/lip/20sqcm or< 15260
|
$1,401.60 |
$1,401.60 |
$1,401.60 |
$3,026.40
|
|
Full thick gft w/close donor fccmnaghf <=20sqcm 15240
|
$1,350.00 |
$1,350.00 |
$1,350.00 |
$2,703.50
|
|
Furosemide 10 mg/ml injection solution
|
$14.40 |
$14.40 |
$14.40 |
$19.00
|
|
Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper)
|
$349.80 |
$349.80 |
$349.80 |
$144.98
|
|
Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution
|
$363.00 |
$363.00 |
$363.00 |
$177.52
|
|
Gallium illuccix 1 millicure
|
$1,255.20 |
$1,255.20 |
$1,255.20 |
$1,395.27
|
|
Gammaglobulin iga
|
$16.80 |
$16.80 |
$16.80 |
$67.20
|
|
Gammaglobulin ige
|
$192.60 |
$192.60 |
$192.60 |
$83.85
|
|
Gamma glutamyltransferase
|
$133.80 |
$133.80 |
$133.80 |
$57.54
|
|
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr
|
$326.40 |
$326.40 |
$326.40 |
$197.40
|
|
Gemcitabine 1 gram intravenous solution
|
$346.80 |
$346.80 |
$346.80 |
$207.51
|
|
Generator barostim neo2 2014
|
$70,776.97 |
$70,776.97 |
$70,776.97 |
$48,147.60
|
|
Generator emblem MRI sicd subq
|
$29,122.58 |
$29,122.58 |
$29,122.58 |
$36,467.76
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$29.40 |
$29.40 |
$29.40 |
$57.84
|
|
Gentamicin peak therapeutic drug level
|
$199.80 |
$199.80 |
$199.80 |
$126.00
|
|
Ghs abscess perianal iandd
|
$1,156.80 |
$1,156.80 |
$1,156.80 |
$1,410.90
|
|
Ghs bladder cath - complex-foley
|
$332.40 |
$332.40 |
$332.40 |
$344.00
|
|
Ghs central line insert < age 5, failed
|
$1,791.00 |
$1,791.00 |
$1,791.00 |
$2,535.60
|
|
Ghs change cysto/gastrost
|
$365.40 |
$365.40 |
$365.40 |
$565.49
|
|
Ghs chemo >8 hrs
|
$481.20 |
$481.20 |
$481.20 |
$714.87
|
|
Ghs chemo IV push, ea addtl
|
$343.20 |
$343.20 |
$343.20 |
$286.00
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$286.80 |
$286.80 |
$286.80 |
$512.40
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$1,012.20 |
$1,012.20 |
$1,012.20 |
$1,592.00
|
|
Ghs closed tx radiocarpal disloc w manip
|
$286.80 |
$286.80 |
$286.80 |
$520.80
|
|
Ghs clsd red med malleolus fx without manip
|
$320.40 |
$320.40 |
$320.40 |
$496.80
|
|
Ghs conjunctiva foreign body-superf bil
|
$262.80 |
$262.80 |
$262.80 |
$283.80
|
|
Ghs corneal fb without slit lamp bilat
|
$292.20 |
$292.20 |
$292.20 |
$419.65
|
|
Ghs corneal fb with slit lamp bilat
|
$292.20 |
$292.20 |
$292.20 |
$339.60
|
|
Ghs dislocation elbow closed treatment
|
$286.80 |
$286.80 |
$286.80 |
$578.00
|
|
Ghs ed rmvl or bivalving cast
|
$48.00 |
$48.00 |
$48.00 |
$329.60
|
|
Ghs electrostagmgraphy
|
$227.40 |
$227.40 |
$227.40 |
$295.50
|
|
Ghs elect torsion swing
|
$135.00 |
$135.00 |
$135.00 |
$242.40
|
|
Ghs fat & muscle
|
$57.60 |
$57.60 |
$57.60 |
$38.08
|
|
Ghs fb removal - incisional
|
$363.00 |
$363.00 |
$363.00 |
$2,271.01
|
|
Ghs fish cytogen
|
$101.40 |
$101.40 |
$101.40 |
$170.80
|
|
Ghs fish hybrid in situ 100-300
|
$222.60 |
$222.60 |
$222.60 |
$223.00
|
|
Ghs gastric intub aspiration lavage
|
$463.20 |
$463.20 |
$463.20 |
$368.50
|
|
Ghs histoplasma antigen
|
$370.80 |
$370.80 |
$370.80 |
$141.00
|
|
Ghs i and d perirectal abscess 46040
|
$1,378.80 |
$1,378.80 |
$1,378.80 |
$2,630.53
|
|
Ghs i and d pilonidal cyst simple
|
$234.00 |
$234.00 |
$234.00 |
$703.15
|
|
Ghs inf midline insertion
|
$644.40 |
$644.40 |
$644.40 |
$1,219.20
|
|
Ghs inhibitor screen
|
$359.40 |
$359.40 |
$359.40 |
$187.32
|
|
Ghs init tx 1st degree burn
|
$195.60 |
$195.60 |
$195.60 |
$275.50
|
|
Ghs inj tendon origin/insertion
|
$49.80 |
$49.80 |
$49.80 |
$431.07
|
|
Ghs insertion of needle - bone
|
$435.60 |
$435.60 |
$435.60 |
$422.40
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$922.80 |
$922.80 |
$922.80 |
$863.28
|
|
Ghs intermed repair over 30 cm - 12037
|
$829.80 |
$829.80 |
$829.80 |
$2,164.64
|
|
Ghs intro needle/intracath vein - 36000
|
$286.80 |
$286.80 |
$286.80 |
$213.75
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$480.00 |
$480.00 |
$480.00 |
$584.00
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$339.00 |
$339.00 |
$339.00 |
$563.75
|
|
Ghs layer closure 2.5cm or less - 12051
|
$304.80 |
$304.80 |
$304.80 |
$593.00
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$206.40 |
$206.40 |
$206.40 |
$675.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$304.80 |
$304.80 |
$304.80 |
$689.04
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$328.80 |
$328.80 |
$328.80 |
$770.22
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$327.00 |
$327.00 |
$327.00 |
$750.12
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$655.20 |
$655.20 |
$655.20 |
$740.00
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$301.20 |
$301.20 |
$301.20 |
$242.31
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$301.20 |
$301.20 |
$301.20 |
$230.00
|
|
Ghs moderate sedation ea addtl 15 min
|
$150.00 |
$150.00 |
$150.00 |
$151.50
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$150.00 |
$150.00 |
$150.00 |
$147.75
|
|
Ghs optokenetic
|
$135.00 |
$135.00 |
$135.00 |
$211.20
|
|
Ghs oscillating trac
|
$150.00 |
$150.00 |
$150.00 |
$344.68
|
|
Ghs ot prosthetic training/15 min
|
$100.80 |
$100.80 |
$100.80 |
$90.50
|
|
Ghs ot sensory integrative tech/15min
|
$163.20 |
$163.20 |
$163.20 |
$94.80
|
|
Ghs pacing - transcutaneous
|
$819.60 |
$819.60 |
$819.60 |
$815.20
|
