|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$115.38 |
$115.38 |
$115.38 |
$106.10
|
|
Fracture assessment via dxa
|
$29.70 |
$29.70 |
$29.70 |
$173.18
|
|
Fragmenting of kidney stone
|
$1,210.41 |
$1,210.41 |
$1,210.41 |
$10,057.42
|
|
Freeing of bowel adhesion 44005
|
$2,324.97 |
$2,324.97 |
$2,324.97 |
$2,062.20
|
|
Frenectomy 41115
|
$540.54 |
$540.54 |
$540.54 |
$1,752.89
|
|
Frenotomy 40806
|
$211.68 |
$211.68 |
$211.68 |
$729.70
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$148.50 |
$148.50 |
$148.50 |
$151.58
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$135.54 |
$135.54 |
$135.54 |
$156.60
|
|
Full thick gft/nose/ear/lid/lip/20sqcm or< 15260
|
$1,784.16 |
$1,784.16 |
$1,784.16 |
$3,026.40
|
|
Full thick gft/scalp/arm/leg/20sqcm or< 15220
|
$1,563.03 |
$1,563.03 |
$1,563.03 |
$2,469.00
|
|
Full thick gft/scalp/arm/leg/add 20sqcm 15221
|
$230.04 |
$230.04 |
$230.04 |
$1,056.41
|
|
Full thick gft w/close donor fccmnaghf <=20sqcm 15240
|
$1,676.70 |
$1,676.70 |
$1,676.70 |
$2,703.50
|
|
Furosemide 10 mg/ml injection solution
|
$18.16 |
$18.16 |
$18.16 |
$19.00
|
|
Fusion of ankle joint open
|
$2,378.97 |
$2,378.97 |
$2,378.97 |
$10,629.07
|
|
Fusion of big toe joint
|
$1,883.79 |
$1,883.79 |
$1,883.79 |
$5,488.00
|
|
Fusion of big toe joint
|
$717.12 |
$717.12 |
$717.12 |
$6,839.00
|
|
Fusion of finger joint
|
$1,293.30 |
$1,293.30 |
$1,293.30 |
$4,350.00
|
|
Fusion of foot bones
|
$1,530.90 |
$1,530.90 |
$1,530.90 |
$6,411.60
|
|
Fusion of foot bones
|
$1,301.40 |
$1,301.40 |
$1,301.40 |
$4,881.00
|
|
Fusion of tibiofibular joint
|
$1,595.16 |
$1,595.16 |
$1,595.16 |
$8,299.09
|
|
Gallbladder Removal (Laparoscopic)
|
$1,580.04 |
$1,580.04 |
$1,580.04 |
$11,117.34
|
|
Gamma globulin 1 cc inj
|
$56.70 |
$56.70 |
$56.70 |
$363.35
|
|
Gamunex-c/gammaked
|
$30.24 |
$30.24 |
$30.24 |
$7,634.20
|
|
Gastrojejunostomy;w/o vagotomy 43820
|
$2,753.46 |
$2,753.46 |
$2,753.46 |
$2,376.00
|
|
Gated heart multiple
|
$253.26 |
$253.26 |
$253.26 |
$1,400.64
|
|
Gemcitabine 1 gram intravenous solution
|
$148.18 |
$148.18 |
$148.18 |
$207.51
|
|
General health panel
|
$262.44 |
$262.44 |
$262.44 |
$275.00
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$12.45 |
$12.45 |
$12.45 |
$57.84
|
|
Ghs abscess perianal iandd
|
$392.85 |
$392.85 |
$392.85 |
$1,410.90
|
|
Ghs abscess postoperative iandd complex
|
$626.94 |
$626.94 |
$626.94 |
$3,515.40
|
|
Ghs analysis neurostim without reprogramming
|
$34.02 |
$34.02 |
$34.02 |
$246.50
|
|
Ghs aspiration bladder - needle
|
$99.63 |
$99.63 |
$99.63 |
$583.80
|
|
Ghs bladder cath - complex-foley
|
$309.96 |
$309.96 |
$309.96 |
$344.00
|
|
Ghs block ilioinguinal/gentitofemoral
|
$241.11 |
$241.11 |
$241.11 |
$1,045.65
|
|
Ghs central line insert < age 5, failed
|
$425.52 |
$425.52 |
$425.52 |
$2,535.60
|
|
Ghs change cysto/gastrost
|
$461.16 |
$461.16 |
$461.16 |
$565.49
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$636.66 |
$636.66 |
$636.66 |
$512.40
|
|
Ghs closed reduction ankle dislocation
|
$834.84 |
$834.84 |
$834.84 |
$653.80
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$922.32 |
$922.32 |
$922.32 |
$1,592.00
|
|
Ghs closed tx radiocarpal disloc w manip
|
$974.16 |
$974.16 |
$974.16 |
$520.80
|
|
Ghs closed tx tibial fracture w/manip
|
$1,048.14 |
$1,048.14 |
$1,048.14 |
$2,148.00
|
|
Ghs closure surg wound/dehiscence-13160
|
$1,664.82 |
$1,664.82 |
$1,664.82 |
$3,086.00
|
|
Ghs clsd red med malleolus fx without manip
|
$734.40 |
$734.40 |
$734.40 |
$496.80
|
|
Ghs clsd red med malleolus fx w manip
|
$942.84 |
$942.84 |
$942.84 |
$2,184.00
|
|
Ghs clsd tx frac distal tibia w/manipulation
|
$1,056.24 |
$1,056.24 |
$1,056.24 |
$2,211.05
|
|
Ghs cl tx knee disl; wo anesth
|
$1,122.12 |
$1,122.12 |
$1,122.12 |
$592.80
|
|
Ghs cl tx metacarpophal disloc without anes
|
$745.74 |
$745.74 |
$745.74 |
$495.55
|
|
Ghs conjunctiva foreign body-embed bil
|
$107.46 |
$107.46 |
$107.46 |
$419.22
|
|
Ghs conjunctiva foreign body-superf bil
|
$90.45 |
$90.45 |
$90.45 |
$283.80
|
|
Ghs corneal fb without slit lamp bilat
|
$126.36 |
$126.36 |
$126.36 |
$419.65
|
|
Ghs corneal fb with slit lamp bilat
|
$142.56 |
$142.56 |
$142.56 |
$339.60
|
|
Ghs cricothyroidotomy
|
$672.30 |
$672.30 |
$672.30 |
$1,067.30
|
|
Ghs cutdown placement age 1 and over
|
$97.47 |
$97.47 |
$97.47 |
$377.89
|
|
Ghs cutdown placement under 1 yr
|
$128.79 |
$128.79 |
$128.79 |
$182.95
|
|
Ghs dislocation elbow closed treatment
|
$743.58 |
$743.58 |
$743.58 |
$578.00
|
|
Ghs ed peritoneal lavage w guidance if performed
|
$254.88 |
$254.88 |
$254.88 |
$1,109.47
|
|
Ghs ed rmvl or bivalving cast
|
$73.17 |
$73.17 |
$73.17 |
$329.60
|
|
Ghs electrostagmgraphy
|
$76.68 |
$76.68 |
$76.68 |
$295.50
|
|
Ghs epidermal shaving diameter >2.0 cm
|
$316.98 |
$316.98 |
$316.98 |
$467.00
|
|
Ghs excision ingrown nail
|
$347.76 |
$347.76 |
$347.76 |
$439.50
|
|
Ghs eyelid foreign body-embedded - bil
|
$542.70 |
$542.70 |
$542.70 |
$501.04
|
|
Ghs fb removal foot - deep - left
|
$961.74 |
$961.74 |
$961.74 |
$2,538.75
|
|
Ghs fb removal from muscle - complicated
|
$521.64 |
$521.64 |
$521.64 |
$3,295.35
|
|
Ghs fb removal - incisional
|
$554.58 |
$554.58 |
$554.58 |
$2,271.01
|
|
Ghs fb removal - non-incisional
|
$313.20 |
$313.20 |
$313.20 |
$1,706.20
|
|
Ghs gastric intub aspiration lavage
|
$58.05 |
$58.05 |
$58.05 |
$368.50
|
|
Ghs i and d abscess/hematoma scrotum
|
$481.41 |
$481.41 |
$481.41 |
$3,165.00
|
|
Ghs i and d perirectal abscess 46040
|
$1,168.56 |
$1,168.56 |
$1,168.56 |
$2,630.53
|
|
Ghs i and d pilonidal cyst complex
|
$707.40 |
$707.40 |
$707.40 |
$1,372.15
|
|
Ghs i and d pilonidal cyst simple
|
$516.78 |
$516.78 |
$516.78 |
$703.15
|
|
Ghs incision thrombosed ext hemorrhoid
|
$432.54 |
$432.54 |
$432.54 |
$523.73
|
|
Ghs indirect laryngoscopy/w fb removal
|
$279.18 |
$279.18 |
$279.18 |
$350.90
|
|
Ghs init tx 1st degree burn
|
$167.94 |
$167.94 |
$167.94 |
$275.50
|
|
Ghs inj neurolytic other perph nerve
|
$252.18 |
$252.18 |
$252.18 |
$1,702.20
|
|
Ghs inj tendon origin/insertion
|
$120.96 |
$120.96 |
$120.96 |
$431.07
|
|
Ghs inj transforaminal cerv ea add bil
|
$132.03 |
$132.03 |
$132.03 |
$1,110.90
|
|
Ghs inj transforaminal cerv single bil
|
$410.94 |
$410.94 |
$410.94 |
$1,727.25
|
|
Ghs insertion of needle - bone
|
$153.36 |
$153.36 |
$153.36 |
$422.40
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$812.70 |
$812.70 |
$812.70 |
$863.28
|
|
Ghs intermed repair 20.1 - 30.0 cm-12036
|
$906.12 |
$906.12 |
$906.12 |
$1,035.60
|
|
Ghs intermed repair over 30 cm - 12037
|
$677.70 |
$677.70 |
$677.70 |
$2,164.64
|
|
Ghs intro needle/intracath vein - 36000
|
$23.22 |
$23.22 |
$23.22 |
$213.75
|
|
Ghs irrigate corpora cavernosa for priapism
|
$307.80 |
$307.80 |
$307.80 |
$544.80
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$322.92 |
$322.92 |
$322.92 |
$492.00
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$548.10 |
$548.10 |
$548.10 |
$584.00
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$550.26 |
$550.26 |
$550.26 |
$563.75
|
|
Ghs layer closure 2.5cm or less - 12051
|
$590.22 |
$590.22 |
$590.22 |
$593.00
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$659.34 |
$659.34 |
$659.34 |
$675.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$648.54 |
$648.54 |
$648.54 |
$689.04
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$758.16 |
$758.16 |
$758.16 |
$741.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$698.76 |
$698.76 |
$698.76 |
$770.22
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$799.74 |
$799.74 |
$799.74 |
$750.12
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$795.96 |
$795.96 |
$795.96 |
$740.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$861.84 |
$861.84 |
$861.84 |
$964.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$1,089.45 |
$1,089.45 |
$1,089.45 |
$790.40
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$658.26 |
$658.26 |
$658.26 |
$1,126.40
|
|
Ghs layered repair 20.1 - 30.0 cm -12056
|
$802.98 |
$802.98 |
$802.98 |
$907.50
|
|
Ghs layered repair over 30.0 cm -12047
|
$727.92 |
$727.92 |
$727.92 |
$1,930.50
|
|
Ghs layered repair over 3.0 cm -12057
|
$875.34 |
$875.34 |
$875.34 |
$1,064.98
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$170.10 |
$170.10 |
$170.10 |
$230.00
|
