|
Full thick gft/scalp/arm/leg/20sqcm or< 15220
|
$2,154.21 |
$2,154.21 |
$2,154.21 |
$2,469.00
|
|
Full thick gft w/close donor fccmnaghf <=20sqcm 15240
|
$2,154.21 |
$2,154.21 |
$2,154.21 |
$2,315.04
|
|
Fundus photography with i&r 92250
|
$151.80 |
$151.80 |
$151.80 |
$209.46
|
|
Fusion/graft of finger joint
|
$3,821.05 |
$3,821.05 |
$3,821.05 |
$3,591.33
|
|
Fusion/graft of hand joint
|
$8,412.89 |
$8,412.89 |
$8,412.89 |
$5,886.74
|
|
Fusion of ankle joint open
|
$15,152.74 |
$15,152.74 |
$15,152.74 |
$8,827.37
|
|
Fusion of big toe joint
|
$8,412.89 |
$8,412.89 |
$8,412.89 |
$5,663.11
|
|
Fusion of big toe joint
|
$8,412.89 |
$8,412.89 |
$8,412.89 |
$5,396.08
|
|
Fusion of finger joint
|
$3,821.05 |
$3,821.05 |
$3,821.05 |
$3,545.97
|
|
Fusion of finger tendons
|
$3,821.05 |
$3,821.05 |
$3,821.05 |
$2,484.97
|
|
Fusion of finger tendons
|
$1,884.74 |
$1,884.74 |
$1,884.74 |
$1,772.97
|
|
Fusion of foot bones
|
$15,152.74 |
$15,152.74 |
$15,152.74 |
$6,697.18
|
|
Fusion of foot bones
|
$15,152.74 |
$15,152.74 |
$15,152.74 |
$10,629.07
|
|
Fusion of foot bones
|
$8,412.89 |
$8,412.89 |
$8,412.89 |
$4,485.13
|
|
Fusion of hand joint
|
$8,412.89 |
$8,412.89 |
$8,412.89 |
$5,886.74
|
|
Fusion of knuckle
|
$8,412.89 |
$8,412.89 |
$8,412.89 |
$4,228.56
|
|
Fusion of knuckle joint
|
$3,821.05 |
$3,821.05 |
$3,821.05 |
$3,521.60
|
|
Fusion of knuckle joints
|
$3,821.05 |
$3,821.05 |
$3,821.05 |
$4,110.40
|
|
Fusion of knuckle joints
|
$8,412.89 |
$8,412.89 |
$8,412.89 |
$7,807.24
|
|
Fusion of knuckle with graft
|
$8,412.89 |
$8,412.89 |
$8,412.89 |
$4,776.03
|
|
Fusion of spermatic ducts
|
$2,412.45 |
$2,412.45 |
$2,412.45 |
$2,355.42
|
|
Fusion of spermatic ducts
|
$4,061.71 |
$4,061.71 |
$4,061.71 |
$3,673.67
|
|
Fusion of tendons at wrist
|
$3,821.05 |
$3,821.05 |
$3,821.05 |
$3,594.44
|
|
Fusion of tendons at wrist
|
$3,821.05 |
$3,821.05 |
$3,821.05 |
$3,273.55
|
|
Fusion of thumb
|
$8,412.89 |
$8,412.89 |
$8,412.89 |
$5,886.74
|
|
Fusion of tibiofibular joint
|
$15,152.74 |
$15,152.74 |
$15,152.74 |
$8,299.09
|
|
Fusion of toes
|
$3,821.05 |
$3,821.05 |
$3,821.05 |
$2,927.44
|
|
G6pc gene
|
$58.49 |
$58.49 |
$58.49 |
$140.00
|
|
G6pd full gene sequence
|
$600.00 |
$600.00 |
$600.00 |
$1,200.00
|
|
G6pd gene alys cmn variant
|
$174.81 |
$174.81 |
$174.81 |
$243.00
|
|
G6pd known familial variant
|
$375.25 |
$375.25 |
$375.25 |
$517.85
|
|
Ga-68 gallium 68 dotatate
|
$51.09 |
$51.09 |
$51.09 |
$118.19
|
|
Galac-1-phosphate uridyltran - sendout
|
$21.07 |
$21.07 |
$21.07 |
$85.50
|
|
Galactokinase - sendout
|
$21.48 |
$21.48 |
$21.48 |
$193.50
|
|
Galactose transferase test
|
$11.74 |
$11.74 |
$11.74 |
$25.00
|
|
Galectin-3
|
$44.25 |
$44.25 |
$44.25 |
$96.00
|
|
Gallbladder Removal (Laparoscopic)
|
$6,870.89 |
$6,870.89 |
$6,870.89 |
$6,870.89
|
|
Gallium ga-68 dotatoc
|
$4.05 |
$4.05 |
$4.05 |
$4.05
|
|
Gallium ga-68 psma-11, ucla
|
$372.17 |
$372.17 |
$372.17 |
$1,537.26
|
|
Gallium ga-68 psma-11 ucsf
|
$534.91 |
$534.91 |
$534.91 |
$534.91
|
|
Gallium illuccix 1 millicure
|
$1,026.05 |
$1,026.05 |
$1,026.05 |
$1,377.60
|
|
Gallium locametz 1 millicuri
|
$873.44 |
$873.44 |
$873.44 |
$873.44
|
|
Gamma globulin > 10 cc inj
|
$498.52 |
$498.52 |
$498.52 |
$167.06
|
|
Gamma globulin 1 cc inj
|
$49.85 |
$49.85 |
$49.85 |
$106.20
|
|
Gammaglobulin iga
|
$9.30 |
$9.30 |
$9.30 |
$78.60
|
|
Gammaglobulin ige
|
$16.46 |
$16.46 |
$16.46 |
$87.10
|
|
Gamma glutamyltransferase
|
$7.20 |
$7.20 |
$7.20 |
$54.60
|
|
Gammaplex injection
|
$57.93 |
$57.93 |
$57.93 |
$62.47
|
|
Gamunex-c/gammaked
|
$48.81 |
$48.81 |
$48.81 |
$100.40
|
|
Gardner vag dna quant
|
$41.76 |
$41.76 |
$41.76 |
$104.80
|
|
Gastric analy w/ph ea spec
|
$6.71 |
$6.71 |
$6.71 |
$25.61
|
|
Gastric emptying imag study
|
$473.22 |
$473.22 |
$473.22 |
$1,270.00
|
|
Gastric emptying imag study
|
$633.90 |
$633.90 |
$633.90 |
$1,665.50
|
|
Gastric motility studies
|
$624.87 |
$624.87 |
$624.87 |
$972.00
|
|
Gastric mucosa imaging
|
$473.22 |
$473.22 |
$473.22 |
$549.70
|
|
Gastrin test
|
$17.69 |
$17.69 |
$17.69 |
$61.80
|
|
Gastroesophageal reflux study
|
$473.22 |
$473.22 |
$473.22 |
$887.62
|
|
Gastroesophageal reflux test
|
$624.87 |
$624.87 |
$624.87 |
$1,110.80
|
|
Gastrostomy open neonatal
|
$1,104.13 |
$1,104.13 |
$1,104.13 |
$1,154.78
|
|
Gated heart multiple
|
$473.22 |
$473.22 |
$473.22 |
$1,177.70
|
|
Gba gene
|
$47.25 |
$47.25 |
$47.25 |
$140.00
|
|
Gel-one
|
$534.48 |
$534.48 |
$534.48 |
$524.02
|
|
Gemtuzumab ozogamicin 4.5 mg (1 mg/ml initial concentration) IV soln
|
$229.67 |
$229.67 |
$229.67 |
$15,276.60
|
|
Genetic tstg severe inh cond
|
$2,448.56 |
$2,448.56 |
$2,448.56 |
$4,897.60
|
|
Genioplasty augmentation
|
$6,966.64 |
$6,966.64 |
$6,966.64 |
$4,555.73
|
|
Geniop sldg augmentation
|
$3,819.23 |
$3,819.23 |
$3,819.23 |
$3,544.29
|
|
Geniop sldg osteot 1
|
$3,819.23 |
$3,819.23 |
$3,819.23 |
$2,903.97
|
|
Geniop sldg osteot 2/>
|
$6,966.64 |
$6,966.64 |
$6,966.64 |
$6,465.11
|
|
Genome sequence analysis
|
$5,031.20 |
$5,031.20 |
$5,031.20 |
$6,404.58
|
|
Gentamicin peak therapeutic drug level
|
$16.38 |
$16.38 |
$16.38 |
$114.00
|
|
Genvisc 850, inj, 1mg
|
$5.90 |
$5.90 |
$5.90 |
$6.02
|
|
G-esoph reflx tst w/electrod
|
$624.87 |
$624.87 |
$624.87 |
$1,413.78
|
|
Ghs abscess perianal iandd
|
$1,073.68 |
$1,073.68 |
$1,073.68 |
$1,512.80
|
|
Ghs abscess postoperative iandd complex
|
$3,370.52 |
$3,370.52 |
$3,370.52 |
$3,776.00
|
|
Ghs acetylcholinesterase, rbc
|
$9.81 |
$9.81 |
$9.81 |
$44.20
|
|
Ghs alcohol, methyl (methanol)-medtox
|
$17.11 |
$17.11 |
$17.11 |
$103.14
|
|
Ghs alpha thalasemia, 7 deletions
|
$102.26 |
$102.26 |
$102.26 |
$437.58
|
|
Ghs analysis neurostim without reprogramming
|
$151.80 |
$151.80 |
$151.80 |
$275.60
|
|
Ghs antibodies (torch) igm
|
$14.39 |
$14.39 |
$14.39 |
$82.50
|
|
Ghs aspiration bladder - needle
|
$286.42 |
$286.42 |
$286.42 |
$590.85
|
|
Ghs bladder cath - complex-foley
|
$184.26 |
$184.26 |
$184.26 |
$333.18
|
|
Ghs bleeding time (ivy)
|
$4.82 |
$4.82 |
$4.82 |
$55.90
|
|
Ghs block ilioinguinal/gentitofemoral
|
$815.55 |
$815.55 |
$815.55 |
$1,000.08
|
|
Ghs central line insert < age 5, failed
|
$3,706.68 |
$3,706.68 |
$3,706.68 |
$2,489.25
|
|
Ghs change cysto/gastrost
|
$286.42 |
$286.42 |
$286.42 |
$727.35
|
|
Ghs chemo >8 hrs
|
$390.62 |
$390.62 |
$390.62 |
$714.87
|
|
Ghs chemo infusion >8 hrs
|
$390.62 |
$390.62 |
$390.62 |
$503.81
|
|
Ghs chemo IV push, ea addtl
|
$83.81 |
$83.81 |
$83.81 |
$292.80
|
|
Ghs chlamydia pneumoniae by pcr (arup) (306630)
|
$35.09 |
$35.09 |
$35.09 |
$135.85
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$282.50 |
$282.50 |
$282.50 |
$540.80
|
|
Ghs closed reduction ankle dislocation
|
$282.50 |
$282.50 |
$282.50 |
$720.00
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$1,884.74 |
$1,884.74 |
$1,884.74 |
$1,655.78
|
|
Ghs closed tx radiocarpal disloc w manip
|
$282.50 |
$282.50 |
$282.50 |
$534.99
|
|
Ghs closed tx tibial fracture w/manip
|
$1,884.74 |
$1,884.74 |
$1,884.74 |
$2,275.20
|
|
Ghs closure surg wound/dehiscence-13160
|
$2,154.21 |
$2,154.21 |
$2,154.21 |
$2,973.33
|
|
Ghs clsd red med malleolus fx without manip
|
$282.50 |
$282.50 |
$282.50 |
$581.60
|
|
Ghs clsd red med malleolus fx w manip
|
$1,884.74 |
$1,884.74 |
$1,884.74 |
$2,347.20
|
|
Ghs clsd tx frac distal tibia w/manipulation
|
$1,884.74 |
$1,884.74 |
$1,884.74 |
$2,418.00
|
|
Ghs cl tx knee disl; wo anesth
|
$282.50 |
$282.50 |
$282.50 |
$750.17
|
|
Ghs cl tx metacarpophal disloc without anes
|
$282.50 |
$282.50 |
$282.50 |
$544.70
|
