|
Fluoroestradiol f 18
|
$588.50 |
$588.50 |
$588.50 |
$1,491.00
|
|
Fluoroguide for spine inject 77003-26
|
$310.00 |
$310.00 |
$310.00 |
$496.03
|
|
Fluoroguide needle placement
|
$339.50 |
$339.50 |
$339.50 |
$510.00
|
|
Fluoroscopy up to 1 hour
|
$443.50 |
$443.50 |
$443.50 |
$492.00
|
|
Fmri brain by phys/psych
|
$2,309.00 |
$2,309.00 |
$2,309.00 |
$1,558.05
|
|
Fmri brain by tech
|
$2,866.00 |
$2,866.00 |
$2,866.00 |
$1,500.00
|
|
Fna bx w/ct gdn 1st les
|
$1,041.00 |
$1,041.00 |
$1,041.00 |
$1,420.80
|
|
Fna bx w/ct gdn ea addl
|
$482.50 |
$482.50 |
$482.50 |
$833.25
|
|
Foam drg >16<=48 sq in w/bdr
|
$7.50 |
$7.50 |
$7.50 |
$62.09
|
|
Foam drg >16<=48 sq in without b
|
$41.40 |
$41.40 |
$41.40 |
$41.14
|
|
Foam drg <=16 sq in w/border
|
$8.28 |
$8.28 |
$8.28 |
$16.37
|
|
Foam drg > 48 sq in w/border
|
$6.50 |
$6.50 |
$6.50 |
$23.63
|
|
Foam drg > 48 sq in without brdr
|
$57.44 |
$57.44 |
$57.44 |
$33.49
|
|
Foam drsg <=16 sq in without bdr
|
$91.08 |
$91.08 |
$91.08 |
$21.74
|
|
Folic acid
|
$120.00 |
$120.00 |
$120.00 |
$101.50
|
|
Follow-up angiography
|
$1,513.50 |
$1,513.50 |
$1,513.50 |
$2,040.78
|
|
Followup eval of foot pt lop
|
$175.00 |
$175.00 |
$175.00 |
$170.95
|
|
Fo nontorsion joint cf
|
$125.24 |
$125.24 |
$125.24 |
$217.50
|
|
Foot arch support remov prem
|
$152.66 |
$152.66 |
$152.66 |
$106.20
|
|
Foot arch supp premold metat
|
$26.91 |
$26.91 |
$26.91 |
$70.22
|
|
Foot plas heel stabi pre ots
|
$26.50 |
$26.50 |
$26.50 |
$76.32
|
|
Foot X-ray
|
$315.50 |
$315.50 |
$315.50 |
$362.40
|
|
Forearm/arm cuffs ext/flex a
|
$669.13 |
$669.13 |
$669.13 |
$580.42
|
|
Forearm/arm cuffs free motio
|
$349.32 |
$349.32 |
$349.32 |
$901.60
|
|
Foreskn manip w/lss preputial ads+stretching 54450
|
$674.50 |
$674.50 |
$674.50 |
$532.80
|
|
Fractionation ketosteroids
|
$119.00 |
$119.00 |
$119.00 |
$135.95
|
|
Fracture assessment via dxa
|
$112.50 |
$112.50 |
$112.50 |
$173.18
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$223.00 |
$223.00 |
$223.00 |
$151.58
|
|
Fresh frozen plasma thawing ea un
|
$75.00 |
$75.00 |
$75.00 |
$122.00
|
|
Frozen plasma, pooled, sd
|
$223.00 |
$223.00 |
$223.00 |
$140.80
|
|
Fructosamine glycated protein
|
$59.00 |
$59.00 |
$59.00 |
$60.75
|
|
Ft arch suprt premold longit
|
$28.46 |
$28.46 |
$28.46 |
$79.82
|
|
Fth/gft fr n/e/e/l each addl
|
$1,298.50 |
$1,298.50 |
$1,298.50 |
$1,368.50
|
|
Fth/gft fr trnk each addl
|
$1,298.50 |
$1,298.50 |
$1,298.50 |
$1,331.00
|
|
Ftl cgen abnor four anal
|
$133.00 |
$133.00 |
$133.00 |
$204.52
|
|
Ftl cgen abnor two proteins
|
$109.00 |
$109.00 |
$109.00 |
$110.00
|
|
Full mouth x-ray of teeth
|
$167.00 |
$167.00 |
$167.00 |
$286.04
|
|
Full thick gft/nose/ear/lid/lip/20sqcm or< 15260
|
$2,564.00 |
$2,564.00 |
$2,564.00 |
$3,026.40
|
|
Full thick gft/scalp/arm/leg/20sqcm or< 15220
|
$2,564.00 |
$2,564.00 |
$2,564.00 |
$2,469.00
|
|
Full thick gft/scalp/arm/leg/add 20sqcm 15221
|
$1,298.50 |
$1,298.50 |
$1,298.50 |
$1,056.41
|
|
Full thick gft w/close donor fccmnaghf <=20sqcm 15240
|
$2,564.00 |
$2,564.00 |
$2,564.00 |
$2,703.50
|
|
Fundus photography with i&r 92250
|
$156.50 |
$156.50 |
$156.50 |
$182.95
|
|
Ga-67 gallium 0.1 mci
|
$396.00 |
$396.00 |
$396.00 |
$118.56
|
|
Ga-68 gallium 68 dotatate
|
$43.00 |
$43.00 |
$43.00 |
$119.90
|
|
Galac-1-phosphate uridyltran - sendout
|
$96.50 |
$96.50 |
$96.50 |
$96.94
|
|
Gammaglobulin iga
|
$41.50 |
$41.50 |
$41.50 |
$67.20
|
|
Gammaglobulin ige
|
$64.00 |
$64.00 |
$64.00 |
$83.85
|
|
Gamma glutamyltransferase
|
$35.50 |
$35.50 |
$35.50 |
$57.54
|
|
Gastric analy w/ph ea spec
|
$19.50 |
$19.50 |
$19.50 |
$31.80
|
|
Gastric emptying imag study
|
$1,098.50 |
$1,098.50 |
$1,098.50 |
$1,291.55
|
|
Gastric emptying imag study
|
$1,313.50 |
$1,313.50 |
$1,313.50 |
$1,621.36
|
|
Gastroesophageal reflux study
|
$696.50 |
$696.50 |
$696.50 |
$949.80
|
|
Gated heart multiple
|
$1,220.00 |
$1,220.00 |
$1,220.00 |
$1,400.64
|
|
Gauze >16<=48 no w/sal without b
|
$3.62 |
$3.62 |
$3.62 |
$5.00
|
|
Gauze <=16 in no w/sal without b
|
$3.62 |
$3.62 |
$3.62 |
$6.40
|
|
Gauze <= 16 sq in w/border
|
$1.00 |
$1.00 |
$1.00 |
$13.65
|
|
Gauze > 48 in no w/sal without b
|
$3.62 |
$3.62 |
$3.62 |
$7.08
|
|
Generator emblem MRI sicd subq
|
$45,186.03 |
$45,186.03 |
$45,186.03 |
$36,467.76
|
|
Genetic tstg severe inh cond
|
$3,234.50 |
$3,234.50 |
$3,234.50 |
$3,978.65
|
|
Gentamicin peak therapeutic drug level
|
$108.50 |
$108.50 |
$108.50 |
$126.00
|
|
Ghs abscess perianal iandd
|
$1,433.50 |
$1,433.50 |
$1,433.50 |
$1,410.90
|
|
Ghs abscess postoperative iandd complex
|
$4,450.50 |
$4,450.50 |
$4,450.50 |
$3,515.40
|
|
Ghs acetylcholinesterase, rbc
|
$76.50 |
$76.50 |
$76.50 |
$42.72
|
|
Ghs alcohol, methyl (methanol)-medtox
|
$54.00 |
$54.00 |
$54.00 |
$100.30
|
|
Ghs alpha thalasemia, 7 deletions
|
$232.00 |
$232.00 |
$232.00 |
$371.84
|
|
Ghs analysis neurostim without reprogramming
|
$246.50 |
$246.50 |
$246.50 |
$246.50
|
|
Ghs antibodies (torch) igm
|
$82.00 |
$82.00 |
$82.00 |
$69.30
|
|
Ghs bladder cath - complex-foley
|
$175.50 |
$175.50 |
$175.50 |
$344.00
|
|
Ghs block ilioinguinal/gentitofemoral
|
$1,008.50 |
$1,008.50 |
$1,008.50 |
$1,045.65
|
|
Ghs central line insert < age 5, failed
|
$1,419.00 |
$1,419.00 |
$1,419.00 |
$2,535.60
|
|
Ghs change cysto/gastrost
|
$731.50 |
$731.50 |
$731.50 |
$565.49
|
|
Ghs chemo >8 hrs
|
$1,162.00 |
$1,162.00 |
$1,162.00 |
$714.87
|
|
Ghs chemo IV push, ea addtl
|
$197.00 |
$197.00 |
$197.00 |
$286.00
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$184.50 |
$184.50 |
$184.50 |
$512.40
|
|
Ghs closed reduction ankle dislocation
|
$527.50 |
$527.50 |
$527.50 |
$653.80
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$729.00 |
$729.00 |
$729.00 |
$1,592.00
|
|
Ghs closed tx radiocarpal disloc w manip
|
$142.00 |
$142.00 |
$142.00 |
$520.80
|
|
Ghs closed tx tibial fracture w/manip
|
$3,071.50 |
$3,071.50 |
$3,071.50 |
$2,148.00
|
|
Ghs closure surg wound/dehiscence-13160
|
$2,683.50 |
$2,683.50 |
$2,683.50 |
$3,086.00
|
|
Ghs clsd red med malleolus fx without manip
|
$228.50 |
$228.50 |
$228.50 |
$496.80
|
|
Ghs clsd red med malleolus fx w manip
|
$1,670.50 |
$1,670.50 |
$1,670.50 |
$2,184.00
|
|
Ghs clsd tx frac distal tibia w/manipulation
|
$2,061.50 |
$2,061.50 |
$2,061.50 |
$2,211.05
|
|
Ghs cl tx knee disl; wo anesth
|
$188.50 |
$188.50 |
$188.50 |
$592.80
|
|
Ghs cl tx metacarpophal disloc without anes
|
$271.50 |
$271.50 |
$271.50 |
$495.55
|
|
Ghs community re-entry 15 minutes
|
$129.00 |
$129.00 |
$129.00 |
$88.50
|
|
Ghs conjunctiva foreign body-embed bil
|
$384.00 |
$384.00 |
$384.00 |
$419.22
|
|
Ghs conjunctiva foreign body-superf bil
|
$334.00 |
$334.00 |
$334.00 |
$283.80
|
|
Ghs corneal fb without slit lamp bilat
|
$210.00 |
$210.00 |
$210.00 |
$419.65
|
|
Ghs corneal fb with slit lamp bilat
|
$210.00 |
$210.00 |
$210.00 |
$339.60
|
|
Ghs cricothyroidotomy
|
$963.00 |
$963.00 |
$963.00 |
$1,067.30
|
|
Ghs diphtheria toxoid ab igg
|
$20.00 |
$20.00 |
$20.00 |
$62.05
|
|
Ghs dislocation elbow closed treatment
|
$272.50 |
$272.50 |
$272.50 |
$578.00
|
|
Ghs ed peritoneal lavage w guidance if performed
|
$813.50 |
$813.50 |
$813.50 |
$1,109.47
|
|
Ghs ed rmvl or bivalving cast
|
$455.00 |
$455.00 |
$455.00 |
$329.60
|
|
Ghs ed therapeutic lp, drain csf w fluoro
|
$1,465.00 |
$1,465.00 |
$1,465.00 |
$1,432.20
|
|
Ghs eeg cont rec w/video by tec min 8 chnls
|
$2,563.00 |
$2,563.00 |
$2,563.00 |
$593.91
|
|
Ghs electrostagmgraphy
|
$283.00 |
$283.00 |
$283.00 |
$295.50
|
|
Ghs epidermal shaving diameter >2.0 cm
|
$317.00 |
$317.00 |
$317.00 |
$467.00
|
|
Ghs excision ingrown nail
|
$225.00 |
$225.00 |
$225.00 |
$439.50
|
|
Ghs eye exam
|
$204.50 |
$204.50 |
$204.50 |
$153.50
|
