|
Excision benign lesion trunk/arms/legs 1.1 - 2.0 cm
|
$201.60 |
$201.60 |
$201.60 |
$1,012.86
|
|
Excision benign lesion trunk/arms/legs > 4.0 cm
|
$434.40 |
$434.40 |
$434.40 |
$2,865.00
|
|
Excision breast lesion
|
$898.80 |
$898.80 |
$898.80 |
$3,749.85
|
|
Excision of anal lesion(s)
|
$267.00 |
$267.00 |
$267.00 |
$3,786.00
|
|
Excision of stomach lesion
|
$1,638.00 |
$1,638.00 |
$1,638.00 |
$1,494.24
|
|
Excision tumor soft tissue back/flank subcutaneous >= 3 cm
|
$928.80 |
$928.80 |
$928.80 |
$3,650.40
|
|
Exc malig feenl <0.5cm 11640
|
$201.60 |
$201.60 |
$201.60 |
$1,055.20
|
|
Exc malig feenl 1.1-2 11642
|
$510.60 |
$510.60 |
$510.60 |
$1,082.00
|
|
Exc malig feenl 3.1-4.0 11644
|
$714.60 |
$714.60 |
$714.60 |
$2,070.30
|
|
Exc malig feenl >4cm 11646
|
$741.00 |
$741.00 |
$741.00 |
$3,083.21
|
|
Exc malig snhfg 2.1-3 cm 11623
|
$583.80 |
$583.80 |
$583.80 |
$1,917.33
|
|
Exc malig tal 0.6-1.0cm 11601
|
$202.20 |
$202.20 |
$202.20 |
$832.60
|
|
Exc mal+marg tal 1.1-2 cm 11602
|
$344.40 |
$344.40 |
$344.40 |
$889.20
|
|
Exc mal+marg tal 2.1-3 cm 11603
|
$390.00 |
$390.00 |
$390.00 |
$1,131.50
|
|
Exc mal+marg tal 3.1-4 cm 11604
|
$583.80 |
$583.80 |
$583.80 |
$1,294.80
|
|
Exc neck tum deep < 5 cm
|
$749.40 |
$749.40 |
$749.40 |
$3,501.81
|
|
Exc/pilonidal cyst/sinus/simple 11770
|
$480.60 |
$480.60 |
$480.60 |
$3,386.84
|
|
Exc shoulder tum deep < 5 cm
|
$708.00 |
$708.00 |
$708.00 |
$3,786.00
|
|
Exc snhfg mal+mrg 1.1-2 11622
|
$408.60 |
$408.60 |
$408.60 |
$1,274.00
|
|
Exc snhfg mal+mrg >4 cm 11626
|
$657.60 |
$657.60 |
$657.60 |
$3,370.52
|
|
Exc sq tum/neck/ant thorax 3cm/> 21552
|
$574.80 |
$574.80 |
$574.80 |
$4,576.00
|
|
Exc sq tumor/forearm/wrist/<3cm 25075
|
$471.60 |
$471.60 |
$471.60 |
$2,557.92
|
|
Exc sq tumor/shoulder area 3cm/> 23071
|
$563.40 |
$563.40 |
$563.40 |
$4,014.40
|
|
Exc thrombosed hemorrhoid 46320
|
$271.80 |
$271.80 |
$271.80 |
$2,099.00
|
|
Exc tr-ext mal+marg tal >4 cm 11606
|
$552.00 |
$552.00 |
$552.00 |
$1,917.33
|
|
Expander tiss 133s-mv-12-t 300ml natrelle smth
|
$61.94 |
$61.94 |
$61.94 |
$4,048.38
|
|
Expl lap celiotomy w/wo bx 49000
|
$1,366.80 |
$1,366.80 |
$1,366.80 |
$1,944.80
|
|
Exp w remove/deep fb/forearm/wrist 25248
|
$3,752.40 |
$3,752.40 |
$3,752.40 |
$3,623.43
|
|
Ex sq tumor/face or scalp 2 cm/> 21012
|
$615.00 |
$615.00 |
$615.00 |
$2,734.20
|
|
Ext ecg>48hr<7d rev&interpj
|
$57.00 |
$57.00 |
$57.00 |
$57.00
|
|
Extractable nuclear antigen/antibody any method each antibody centromere
|
$198.00 |
$198.00 |
$198.00 |
$108.60
|
|
F-18 fdg pet diag
|
$1,429.20 |
$1,429.20 |
$1,429.20 |
$551.72
|
|
Facial bones <3
|
$237.60 |
$237.60 |
$237.60 |
$252.60
|
|
Factor viii
|
$244.80 |
$244.80 |
$244.80 |
$133.81
|
|
Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr
|
$4.20 |
$4.20 |
$4.20 |
$22.20
|
|
Fat/lipids feces qualitative
|
$13.80 |
$13.80 |
$13.80 |
$38.35
|
|
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
|
$219.00 |
$219.00 |
$219.00 |
$100.94
|
|
Fetal biophys profile w/nst 76818
|
$975.00 |
$975.00 |
$975.00 |
$535.37
|
|
Fetal chrom aneuploidy gsa panel
|
$2,273.40 |
$2,273.40 |
$2,273.40 |
$1,206.81
|
|
Fetal hemoglobin (kleihauer betke)
|
$102.00 |
$102.00 |
$102.00 |
$105.12
|
|
Fibrin degradation products
|
$179.40 |
$179.40 |
$179.40 |
$62.64
|
|
Fibrin degrade semiquant
|
$69.60 |
$69.60 |
$69.60 |
$78.09
|
|
Fibrinogen activity
|
$82.20 |
$82.20 |
$82.20 |
$83.50
|
|
Filgrastim-sndz 300 mcg/0.5 ml injection syringe
|
$1,464.60 |
$1,464.60 |
$1,464.60 |
$869.18
|
|
Flexible Sigmoidoscopy
|
$189.00 |
$189.00 |
$189.00 |
$1,284.13
|
|
Flow cytometry marker each additional
|
$24.00 |
$24.00 |
$24.00 |
$97.50
|
|
Flow cytometry one marker technical component
|
$325.20 |
$325.20 |
$325.20 |
$284.40
|
|
Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback
|
$21.00 |
$21.00 |
$21.00 |
$64.22
|
|
Fluoroguide needle placement
|
$414.00 |
$414.00 |
$414.00 |
$510.00
|
|
Fluoroscopy up to 1 hour
|
$387.60 |
$387.60 |
$387.60 |
$492.00
|
|
Folic acid
|
$244.80 |
$244.80 |
$244.80 |
$101.50
|
|
Folic acid 5 mg/ml injection solution
|
$139.80 |
$139.80 |
$139.80 |
$54.75
|
|
Foot X-ray
|
$490.80 |
$490.80 |
$490.80 |
$362.40
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$333.00 |
$333.00 |
$333.00 |
$106.10
|
|
Freeing of bowel adhesion 44005
|
$1,694.40 |
$1,694.40 |
$1,694.40 |
$2,062.20
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$55.80 |
$55.80 |
$55.80 |
$156.60
|
|
Fructosamine glycated protein
|
$139.20 |
$139.20 |
$139.20 |
$60.75
|
|
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
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$1,011.60 |
$1,011.60 |
$1,011.60 |
$250.83
|
|
Gallbladder Removal (Laparoscopic)
|
$1,827.60 |
$1,827.60 |
$1,827.60 |
$11,117.34
|
|
Gammaglobulin iga
|
$16.80 |
$16.80 |
$16.80 |
$67.20
|
|
Gammaglobulin ige
|
$24.00 |
$24.00 |
$24.00 |
$83.85
|
|
Gamma glutamyltransferase
|
$100.20 |
$100.20 |
$100.20 |
$57.54
|
|
Gamunex-c/gammaked
|
$16,686.60 |
$16,686.60 |
$16,686.60 |
$7,634.20
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$12.00 |
$12.00 |
$12.00 |
$57.84
|
|
Gentamicin peak therapeutic drug level
|
$183.00 |
$183.00 |
$183.00 |
$126.00
|
|
Ghs abscess postoperative iandd complex
|
$374.40 |
$374.40 |
$374.40 |
$3,515.40
|
|
Ghs bladder cath - complex-foley
|
$292.80 |
$292.80 |
$292.80 |
$344.00
|
|
Ghs block ilioinguinal/gentitofemoral
|
$176.40 |
$176.40 |
$176.40 |
$1,045.65
|
|
Ghs change cysto/gastrost
|
$504.00 |
$504.00 |
$504.00 |
$565.49
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$258.60 |
$258.60 |
$258.60 |
$512.40
|
|
Ghs closed reduction ankle dislocation
|
$258.60 |
$258.60 |
$258.60 |
$653.80
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$922.20 |
$922.20 |
$922.20 |
$1,592.00
|
|
Ghs closed tx tibial fracture w/manip
|
$3,402.60 |
$3,402.60 |
$3,402.60 |
$2,148.00
|
|
Ghs closure surg wound/dehiscence-13160
|
$1,327.20 |
$1,327.20 |
$1,327.20 |
$3,086.00
|
|
Ghs cl tx knee disl; wo anesth
|
$258.60 |
$258.60 |
$258.60 |
$592.80
|
|
Ghs conjunctiva foreign body-embed bil
|
$152.40 |
$152.40 |
$152.40 |
$419.22
|
|
Ghs corneal fb without slit lamp bilat
|
$258.60 |
$258.60 |
$258.60 |
$419.65
|
|
Ghs cricothyroidotomy
|
$1,663.20 |
$1,663.20 |
$1,663.20 |
$1,067.30
|
|
Ghs dislocation elbow closed treatment
|
$258.60 |
$258.60 |
$258.60 |
$578.00
|
|
Ghs ed peritoneal lavage w guidance if performed
|
$207.60 |
$207.60 |
$207.60 |
$1,109.47
|
|
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 fb removal - non-incisional
|
$1,315.20 |
$1,315.20 |
$1,315.20 |
$1,706.20
|
|
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
|
$408.60 |
$408.60 |
$408.60 |
$368.50
|
|
Ghs histoplasma antigen
|
$319.80 |
$319.80 |
$319.80 |
$141.00
|
|
Ghs i and d perirectal abscess 46040
|
$3,982.80 |
$3,982.80 |
$3,982.80 |
$2,630.53
|
|
Ghs i and d pilonidal cyst complex
|
$2,127.00 |
$2,127.00 |
$2,127.00 |
$1,372.15
|
|
Ghs i and d pilonidal cyst simple
|
$272.40 |
$272.40 |
$272.40 |
$703.15
|
|
Ghs incision thrombosed ext hemorrhoid
|
$240.00 |
$240.00 |
$240.00 |
$523.73
|
|
Ghs init tx 1st degree burn
|
$172.20 |
$172.20 |
$172.20 |
$275.50
|
|
Ghs inj tendon origin/insertion
|
$49.80 |
$49.80 |
$49.80 |
$431.07
|
|
Ghs insertion of needle - bone
|
$385.20 |
$385.20 |
$385.20 |
$422.40
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$645.60 |
$645.60 |
$645.60 |
$863.28
|
