|
Full thick gft/scalp/arm/leg/20sqcm or< 15220
|
$3,189.12 |
$3,189.12 |
$3,189.12 |
$2,469.00
|
|
Full thick gft/scalp/arm/leg/add 20sqcm 15221
|
$1,594.08 |
$1,594.08 |
$1,594.08 |
$1,056.41
|
|
Full thick gft w/close donor fccmnaghf <=20sqcm 15240
|
$3,189.12 |
$3,189.12 |
$3,189.12 |
$2,707.20
|
|
Furosemide in ns IV syringe 2 mg/ml (neo/ped) - cnr
|
$60.90 |
$60.90 |
$60.90 |
$27.08
|
|
Fusion of ankle joint open
|
$1,548.48 |
$1,548.48 |
$1,548.48 |
$10,629.07
|
|
Fusion of big toe joint
|
$1,192.80 |
$1,192.80 |
$1,192.80 |
$5,488.00
|
|
Fusion of big toe joint
|
$771.36 |
$771.36 |
$771.36 |
$6,839.00
|
|
Fusion of finger joint
|
$950.40 |
$950.40 |
$950.40 |
$4,350.00
|
|
Fusion of foot bones
|
$1,116.00 |
$1,116.00 |
$1,116.00 |
$6,411.60
|
|
Fusion of foot bones
|
$1,192.32 |
$1,192.32 |
$1,192.32 |
$14,061.89
|
|
Fusion of foot bones
|
$1,264.32 |
$1,264.32 |
$1,264.32 |
$4,881.00
|
|
Fusion of knuckle
|
$1,137.12 |
$1,137.12 |
$1,137.12 |
$5,886.74
|
|
Fusion of tibiofibular joint
|
$1,067.52 |
$1,067.52 |
$1,067.52 |
$8,299.09
|
|
Fusion of toes
|
$771.36 |
$771.36 |
$771.36 |
$3,839.54
|
|
Ga-67 gallium 0.1 mci
|
$168.92 |
$168.92 |
$168.92 |
$116.09
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$203.04 |
$203.04 |
$203.04 |
$102.90
|
|
Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper)
|
$256.08 |
$256.08 |
$256.08 |
$136.16
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$344.54 |
$344.54 |
$344.54 |
$249.80
|
|
Gallbladder Removal (Laparoscopic)
|
$1,013.76 |
$1,013.76 |
$1,013.76 |
$11,117.34
|
|
Gamma globulin 1 cc inj
|
$277.72 |
$277.72 |
$277.72 |
$363.35
|
|
Gammaglobulin iga
|
$98.71 |
$98.71 |
$98.71 |
$69.60
|
|
Gammaglobulin ige
|
$57.49 |
$57.49 |
$57.49 |
$85.00
|
|
Gamma glutamyltransferase
|
$29.00 |
$29.00 |
$29.00 |
$57.75
|
|
Gardner vag dna quant
|
$47.32 |
$47.32 |
$47.32 |
$104.80
|
|
Gastric emptying imag study
|
$722.88 |
$722.88 |
$722.88 |
$1,364.00
|
|
Gastric emptying imag study
|
$927.36 |
$927.36 |
$927.36 |
$1,669.23
|
|
Gauze <= 16 sq in w/border
|
$16.24 |
$16.24 |
$16.24 |
$13.65
|
|
Gemcitabine 1 gram intravenous solution
|
$250.75 |
$250.75 |
$250.75 |
$207.51
|
|
General health panel
|
$137.88 |
$137.88 |
$137.88 |
$276.76
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$121.57 |
$121.57 |
$121.57 |
$57.84
|
|
Gentamicin peak therapeutic drug level
|
$69.71 |
$69.71 |
$69.71 |
$126.00
|
|
Ghs abscess perianal iandd
|
$575.04 |
$575.04 |
$575.04 |
$1,410.90
|
|
Ghs abscess postoperative iandd complex
|
$4,657.92 |
$4,657.92 |
$4,657.92 |
$3,638.88
|
|
Ghs acetylcholinesterase, rbc
|
$51.90 |
$51.90 |
$51.90 |
$44.12
|
|
Ghs analysis neurostim without reprogramming
|
$28.80 |
$28.80 |
$28.80 |
$246.98
|
|
Ghs bladder cath - complex-foley
|
$278.40 |
$278.40 |
$278.40 |
$344.00
|
|
Ghs block ilioinguinal/gentitofemoral
|
$168.96 |
$168.96 |
$168.96 |
$1,059.85
|
|
Ghs central line insert < age 5, failed
|
$285.12 |
$285.12 |
$285.12 |
$2,555.77
|
|
Ghs change cysto/gastrost
|
$468.96 |
$468.96 |
$468.96 |
$585.00
|
|
Ghs chemo >8 hrs
|
$252.96 |
$252.96 |
$252.96 |
$714.87
|
|
Ghs chemo IV push, ea addtl
|
$277.44 |
$277.44 |
$277.44 |
$287.76
|
|
Ghs chlamydia pneumoniae by pcr (arup) (306630)
|
$76.63 |
$76.63 |
$76.63 |
$130.70
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$462.24 |
$462.24 |
$462.24 |
$501.50
|
|
Ghs closed reduction ankle dislocation
|
$610.56 |
$610.56 |
$610.56 |
$672.60
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$2,736.96 |
$2,736.96 |
$2,736.96 |
$1,568.40
|
|
Ghs closed tx tibial fracture w/manip
|
$2,736.96 |
$2,736.96 |
$2,736.96 |
$2,179.20
|
|
Ghs closure surg wound/dehiscence-13160
|
$1,215.84 |
$1,215.84 |
$1,215.84 |
$3,127.80
|
|
Ghs clsd red med malleolus fx without manip
|
$530.88 |
$530.88 |
$530.88 |
$490.00
|
|
Ghs clsd red med malleolus fx w manip
|
$772.32 |
$772.32 |
$772.32 |
$2,184.00
|
|
Ghs clsd tx frac distal tibia w/manipulation
|
$2,758.56 |
$2,758.56 |
$2,758.56 |
$2,240.00
|
|
Ghs cl tx knee disl; wo anesth
|
$804.96 |
$804.96 |
$804.96 |
$581.90
|
|
Ghs cl tx metacarpophal disloc without anes
|
$541.44 |
$541.44 |
$541.44 |
$497.53
|
|
Ghs community re-entry 15 minutes
|
$44.77 |
$44.77 |
$44.77 |
$89.00
|
|
Ghs conjunctiva foreign body-superf bil
|
$214.20 |
$214.20 |
$214.20 |
$288.96
|
|
Ghs corneal fb without slit lamp bilat
|
$629.28 |
$629.28 |
$629.28 |
$422.25
|
|
Ghs corneal fb with slit lamp bilat
|
$214.71 |
$214.71 |
$214.71 |
$339.60
|
|
Ghs diphtheria toxoid ab igg
|
$33.19 |
$33.19 |
$33.19 |
$54.43
|
|
Ghs dislocation elbow closed treatment
|
$599.52 |
$599.52 |
$599.52 |
$583.80
|
|
Ghs ed peritoneal lavage w guidance if performed
|
$161.76 |
$161.76 |
$161.76 |
$1,162.40
|
|
Ghs ed rmvl or bivalving cast
|
$99.36 |
$99.36 |
$99.36 |
$335.08
|
|
Ghs epidermal shaving diameter >2.0 cm
|
$232.32 |
$232.32 |
$232.32 |
$467.00
|
|
Ghs excision ingrown nail
|
$635.52 |
$635.52 |
$635.52 |
$442.22
|
|
Ghs fat & muscle
|
$25.44 |
$25.44 |
$25.44 |
$38.08
|
|
Ghs fb removal foot - deep - left
|
$700.32 |
$700.32 |
$700.32 |
$2,593.97
|
|
Ghs fb removal from muscle - complicated
|
$709.92 |
$709.92 |
$709.92 |
$3,311.10
|
|
Ghs fb removal - incisional
|
$405.60 |
$405.60 |
$405.60 |
$2,289.60
|
|
Ghs fb removal - non-incisional
|
$335.04 |
$335.04 |
$335.04 |
$1,616.45
|
|
Ghs febrile agglutinns(mayo)
|
$13.72 |
$13.72 |
$13.72 |
$48.10
|
|
Ghs fish cytogen
|
$42.10 |
$42.10 |
$42.10 |
$176.93
|
|
Ghs fish hybrid in situ 100-300
|
$100.60 |
$100.60 |
$100.60 |
$228.50
|
|
Ghs hcv amplificaiton
|
$255.36 |
$255.36 |
$255.36 |
$201.60
|
|
Ghs hepatitis c virus (hcv riba)
|
$150.60 |
$150.60 |
$150.60 |
$144.54
|
|
Ghs histoplasma antigen
|
$84.46 |
$84.46 |
$84.46 |
$141.60
|
|
Ghs i and d abscess/hematoma scrotum
|
$3,921.12 |
$3,921.12 |
$3,921.12 |
$3,245.90
|
|
Ghs i and d perirectal abscess 46040
|
$1,914.24 |
$1,914.24 |
$1,914.24 |
$2,631.20
|
|
Ghs i and d pilonidal cyst complex
|
$527.04 |
$527.04 |
$527.04 |
$1,402.80
|
|
Ghs i and d pilonidal cyst simple
|
$1,170.72 |
$1,170.72 |
$1,170.72 |
$691.95
|
|
Ghs incision thrombosed ext hemorrhoid
|
$468.96 |
$468.96 |
$468.96 |
$526.50
|
|
Ghs inf midline insertion
|
$768.00 |
$768.00 |
$768.00 |
$1,241.85
|
|
Ghs inhibitor screen
|
$25.29 |
$25.29 |
$25.29 |
$191.88
|
|
Ghs init tx 1st degree burn
|
$345.60 |
$345.60 |
$345.60 |
$275.50
|
|
Ghs inj neurolytic other perph nerve
|
$379.68 |
$379.68 |
$379.68 |
$1,710.80
|
|
Ghs inj tendon origin/insertion
|
$88.32 |
$88.32 |
$88.32 |
$431.07
|
|
Ghs insertion of needle - bone
|
$163.32 |
$163.32 |
$163.32 |
$415.20
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$628.32 |
$628.32 |
$628.32 |
$876.00
|
|
Ghs intermed repair 20.1 - 30.0 cm-12036
|
$664.32 |
$664.32 |
$664.32 |
$1,046.70
|
|
Ghs intermed repair over 30 cm - 12037
|
$745.92 |
$745.92 |
$745.92 |
$2,164.64
|
|
Ghs intro needle/intracath vein - 36000
|
$47.52 |
$47.52 |
$47.52 |
$213.75
|
|
Ghs irrigate corpora cavernosa for priapism
|
$523.68 |
$523.68 |
$523.68 |
$551.20
|
|
Ghs IV inf sq injection, on-body injector
|
$139.92 |
$139.92 |
$139.92 |
$108.00
|
|
Ghs IV infusion casirivimab/imdevimab
|
$885.60 |
$885.60 |
$885.60 |
$573.60
|
|
Ghs IV thrombolytics - cerebral
|
$225.40 |
$225.40 |
$225.40 |
$680.40
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$434.40 |
$434.40 |
$434.40 |
$503.48
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$635.52 |
$635.52 |
$635.52 |
$602.70
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$498.24 |
$498.24 |
$498.24 |
$576.19
|
|
Ghs layer closure 2.5cm or less - 12051
|
$635.04 |
$635.04 |
$635.04 |
$606.60
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$635.52 |
$635.52 |
$635.52 |
$675.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$635.52 |
$635.52 |
$635.52 |
$703.20
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$635.52 |
$635.52 |
$635.52 |
$737.55
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$635.52 |
$635.52 |
$635.52 |
$779.35
|
