|
Foscarnet sodium injection
|
$59.00 |
$59.00 |
$59.00 |
$1,008.91
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$16.42 |
$16.42 |
$16.42 |
$106.25
|
|
Fracture assessment via dxa
|
$172.00 |
$172.00 |
$172.00 |
$175.50
|
|
_fragile x methylation-sendout
|
$58.50 |
$58.50 |
$58.50 |
$183.74
|
|
Fragmenting of kidney stone
|
$6,006.00 |
$6,006.00 |
$6,006.00 |
$10,312.25
|
|
Frenectomy 41115
|
$1,783.50 |
$1,783.50 |
$1,783.50 |
$1,939.47
|
|
Frenotomy 40806
|
$1,438.50 |
$1,438.50 |
$1,438.50 |
$679.80
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$272.00 |
$272.00 |
$272.00 |
$153.02
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$181.00 |
$181.00 |
$181.00 |
$164.16
|
|
Frozen cell preparation
|
$46.50 |
$46.50 |
$46.50 |
$31.81
|
|
Fructosamine glycated protein
|
$35.50 |
$35.50 |
$35.50 |
$61.75
|
|
Fth/gft fr n/e/e/l each addl
|
$1,603.50 |
$1,603.50 |
$1,603.50 |
$1,368.50
|
|
Fth/gft fr trnk each addl
|
$1,158.00 |
$1,158.00 |
$1,158.00 |
$1,331.00
|
|
Ftl cgen abnor five anal
|
$319.00 |
$319.00 |
$319.00 |
$155.10
|
|
Ftl cgen abnor four anal
|
$95.50 |
$95.50 |
$95.50 |
$205.80
|
|
Ftl cgen abnor two proteins
|
$31.00 |
$31.00 |
$31.00 |
$109.00
|
|
Full thick gft/nose/ear/lid/lip/20sqcm or< 15260
|
$3,392.33 |
$3,392.33 |
$3,392.33 |
$3,026.40
|
|
Full thick gft/scalp/arm/leg/20sqcm or< 15220
|
$2,371.50 |
$2,371.50 |
$2,371.50 |
$2,469.00
|
|
Full thick gft/scalp/arm/leg/add 20sqcm 15221
|
$1,575.25 |
$1,575.25 |
$1,575.25 |
$1,021.00
|
|
Full thick gft w/close donor fccmnaghf <=20sqcm 15240
|
$2,404.50 |
$2,404.50 |
$2,404.50 |
$2,706.60
|
|
Fundus photography with i&r 92250
|
$249.50 |
$249.50 |
$249.50 |
$178.20
|
|
Furosemide 10 mg/ml injection solution
|
$6.70 |
$6.70 |
$6.70 |
$19.53
|
|
Fusion of big toe joint
|
$7,862.51 |
$7,862.51 |
$7,862.51 |
$5,488.00
|
|
Fusion of big toe joint
|
$6,377.00 |
$6,377.00 |
$6,377.00 |
$6,839.00
|
|
Fusion of foot bones
|
$12,256.67 |
$12,256.67 |
$12,256.67 |
$6,411.60
|
|
Fusion of foot bones
|
$10,723.50 |
$10,723.50 |
$10,723.50 |
$5,110.00
|
|
Ga-67 gallium 0.1 mci
|
$230.50 |
$230.50 |
$230.50 |
$121.73
|
|
Gabapentin non-blood
|
$28.00 |
$28.00 |
$28.00 |
$42.35
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$80.32 |
$80.32 |
$80.32 |
$107.11
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$293.43 |
$293.43 |
$293.43 |
$249.80
|
|
Galac-1-phosphate uridyltran - sendout
|
$985.00 |
$985.00 |
$985.00 |
$100.00
|
|
Galactose transferase test
|
$9.00 |
$9.00 |
$9.00 |
$32.00
|
|
Gallbladder Removal (Laparoscopic)
|
$5,617.00 |
$5,617.00 |
$5,617.00 |
$12,906.50
|
|
Gamma globulin 1 cc inj
|
$107.00 |
$107.00 |
$107.00 |
$406.90
|
|
Gammaglobulin iga
|
$349.00 |
$349.00 |
$349.00 |
$69.42
|
|
Gammaglobulin ige
|
$107.00 |
$107.00 |
$107.00 |
$83.40
|
|
Gamma glutamyltransferase
|
$50.00 |
$50.00 |
$50.00 |
$57.54
|
|
Gammagraft
|
$143.50 |
$143.50 |
$143.50 |
$143.50
|
|
Gamunex-c/gammaked
|
$133.00 |
$133.00 |
$133.00 |
$7,435.88
|
|
Gardner vag dna quant
|
$43.00 |
$43.00 |
$43.00 |
$104.80
|
|
Gastroesophageal reflux study
|
$1,102.00 |
$1,102.00 |
$1,102.00 |
$1,031.60
|
|
Gastroesophageal reflux test
|
$938.50 |
$938.50 |
$938.50 |
$1,352.00
|
|
Gastro/jejuno tube, std
|
$70.00 |
$70.00 |
$70.00 |
$337.96
|
|
Gauze <=16 in no w/sal without b
|
$1.50 |
$1.50 |
$1.50 |
$6.40
|
|
Gel-one
|
$1,114.00 |
$1,114.00 |
$1,114.00 |
$1,561.21
|
|
Gel-syn injection 0.1 mg
|
$5.50 |
$5.50 |
$5.50 |
$680.71
|
|
Gemcitabine 1 gram intravenous solution
|
$36.45 |
$36.45 |
$36.45 |
$208.92
|
|
General health panel
|
$259.00 |
$259.00 |
$259.00 |
$262.44
|
|
Generator barostim neo2 2014
|
$8,526.00 |
$8,526.00 |
$8,526.00 |
$49,450.20
|
|
Generator emblem MRI sicd subq
|
$19,482.00 |
$19,482.00 |
$19,482.00 |
$36,771.84
|
|
Genetic tstg severe inh cond
|
$2,039.50 |
$2,039.50 |
$2,039.50 |
$3,978.65
|
|
Gen, neuro, clo loop, rechg
|
$18,622.50 |
$18,622.50 |
$18,622.50 |
$40,800.00
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$29.68 |
$29.68 |
$29.68 |
$53.78
|
|
Gentamicin peak therapeutic drug level
|
$116.50 |
$116.50 |
$116.50 |
$123.84
|
|
G-esoph reflx tst w/electrod
|
$935.00 |
$935.00 |
$935.00 |
$1,500.00
|
|
Ghs abscess perianal iandd
|
$1,459.00 |
$1,459.00 |
$1,459.00 |
$1,452.00
|
|
Ghs abscess postoperative iandd complex
|
$16,640.00 |
$16,640.00 |
$16,640.00 |
$3,515.40
|
|
Ghs alcohol, methyl (methanol)-medtox
|
$89.50 |
$89.50 |
$89.50 |
$100.30
|
|
Ghs analysis neurostim without reprogramming
|
$257.50 |
$257.50 |
$257.50 |
$247.06
|
|
Ghs antibodies (torch) igm
|
$79.50 |
$79.50 |
$79.50 |
$69.12
|
|
Ghs bladder cath - complex-foley
|
$277.50 |
$277.50 |
$277.50 |
$343.68
|
|
Ghs bleeding time (ivy)
|
$24.50 |
$24.50 |
$24.50 |
$64.08
|
|
Ghs block ilioinguinal/gentitofemoral
|
$2,332.00 |
$2,332.00 |
$2,332.00 |
$1,045.65
|
|
Ghs central line insert < age 5, failed
|
$2,865.50 |
$2,865.50 |
$2,865.50 |
$2,499.90
|
|
Ghs change cysto/gastrost
|
$756.00 |
$756.00 |
$756.00 |
$594.55
|
|
Ghs chemo >8 hrs
|
$669.00 |
$669.00 |
$669.00 |
$714.87
|
|
Ghs chemo IV push, ea addtl
|
$343.50 |
$343.50 |
$343.50 |
$276.02
|
|
Ghs chlamydia pneumoniae by pcr (arup) (306630)
|
$65.50 |
$65.50 |
$65.50 |
$133.00
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$348.50 |
$348.50 |
$348.50 |
$510.40
|
|
Ghs closed reduction ankle dislocation
|
$348.50 |
$348.50 |
$348.50 |
$677.25
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$2,340.00 |
$2,340.00 |
$2,340.00 |
$1,554.70
|
|
Ghs closed tx radiocarpal disloc w manip
|
$284.00 |
$284.00 |
$284.00 |
$523.85
|
|
Ghs closed tx tibial fracture w/manip
|
$2,413.00 |
$2,413.00 |
$2,413.00 |
$2,187.20
|
|
Ghs closure surg wound/dehiscence-13160
|
$4,073.50 |
$4,073.50 |
$4,073.50 |
$3,448.80
|
|
Ghs clsd red med malleolus fx without manip
|
$338.50 |
$338.50 |
$338.50 |
$494.40
|
|
Ghs clsd red med malleolus fx w manip
|
$1,848.50 |
$1,848.50 |
$1,848.50 |
$2,184.00
|
|
Ghs clsd tx frac distal tibia w/manipulation
|
$3,251.00 |
$3,251.00 |
$3,251.00 |
$2,319.00
|
|
Ghs cl tx knee disl; wo anesth
|
$392.50 |
$392.50 |
$392.50 |
$578.00
|
|
Ghs cl tx metacarpophal disloc without anes
|
$378.50 |
$378.50 |
$378.50 |
$497.53
|
|
Ghs community re-entry 15 minutes
|
$61.50 |
$61.50 |
$61.50 |
$89.00
|
|
Ghs conjunctiva foreign body-embed bil
|
$513.50 |
$513.50 |
$513.50 |
$424.90
|
|
Ghs conjunctiva foreign body-superf bil
|
$171.50 |
$171.50 |
$171.50 |
$287.40
|
|
Ghs corneal fb without slit lamp bilat
|
$807.50 |
$807.50 |
$807.50 |
$422.25
|
|
Ghs corneal fb with slit lamp bilat
|
$179.00 |
$179.00 |
$179.00 |
$339.60
|
|
Ghs diphtheria toxoid ab igg
|
$20.00 |
$20.00 |
$20.00 |
$55.02
|
|
Ghs dislocation elbow closed treatment
|
$348.50 |
$348.50 |
$348.50 |
$583.80
|
|
Ghs ed rmvl or bivalving cast
|
$341.50 |
$341.50 |
$341.50 |
$335.08
|
|
Ghs ed therapeutic lp, drain csf w fluoro
|
$1,073.50 |
$1,073.50 |
$1,073.50 |
$1,381.60
|
|
Ghs eeg cont rec w/video by tec min 8 chnls
|
$513.00 |
$513.00 |
$513.00 |
$560.00
|
|
Ghs electrostagmgraphy
|
$213.00 |
$213.00 |
$213.00 |
$295.50
|
|
Ghs epidermal shaving diameter >2.0 cm
|
$467.50 |
$467.50 |
$467.50 |
$467.00
|
|
Ghs excision ingrown nail
|
$466.50 |
$466.50 |
$466.50 |
$442.61
|
|
Ghs eye exam
|
$153.50 |
$153.50 |
$153.50 |
$162.24
|
|
Ghs eyelid foreign body-embedded - bil
|
$432.00 |
$432.00 |
$432.00 |
$501.04
|
|
Ghs fb removal foot - deep - left
|
$3,549.00 |
$3,549.00 |
$3,549.00 |
$2,723.00
|
|
Ghs fb removal from muscle - complicated
|
$3,533.50 |
$3,533.50 |
$3,533.50 |
$3,295.35
|
|
Ghs fb removal - incisional
|
$4,813.50 |
$4,813.50 |
$4,813.50 |
$2,289.60
|
|
Ghs fb removal - non-incisional
|
$6,304.00 |
$6,304.00 |
$6,304.00 |
$1,706.20
|
|
Ghs febrile agglutinns(mayo)
|
$36.00 |
$36.00 |
$36.00 |
$48.10
|
|
Ghs fish cytogen
|
$4,522.50 |
$4,522.50 |
$4,522.50 |
$173.40
|
