|
Full thick gft/nose/ear/lid/lip/20sqcm or< 15260
|
$1,417.20 |
$2,477.50 |
$3,448.20 |
|
|
Full thick gft/scalp/arm/leg/20sqcm or< 15220
|
$2,371.50 |
$2,512.80 |
$3,448.20 |
|
|
Full thick gft/scalp/arm/leg/add 20sqcm 15221
|
$923.00 |
$923.00 |
$3,448.20 |
|
|
Full thick gft w/close donor fccmnaghf <=20sqcm 15240
|
$1,327.20 |
$3,955.80 |
$6,063.00 |
|
|
Functional brain mapping
|
$2,565.00 |
$2,565.00 |
$2,565.00 |
|
|
Fundus photography with i&r 92250
|
$98.40 |
$139.80 |
$247.80 |
|
|
Furosemide 10 mg/ml injection solution
|
$0.40 |
$2.40 |
$44.00 |
|
|
Furosemide in ns IV syringe 2 mg/ml (neo/ped) - cnr
|
$3.00 |
$13.80 |
$43.80 |
|
|
Fuse esophagus & stomach
|
$17,967.60 |
$17,967.60 |
$17,967.60 |
|
|
Fuse liver ducts & bowel
|
$8,024.40 |
$8,024.40 |
$8,024.40 |
|
|
Fusion of ankle joint open
|
$1,972.20 |
$1,972.20 |
$3,712.67 |
|
|
Fusion of big toe joint
|
$1,111.20 |
$1,111.20 |
$2,843.50 |
|
|
Fusion of big toe joint
|
$635.40 |
$635.40 |
$2,344.50 |
|
|
Fusion of finger joint
|
$1,206.60 |
$1,206.60 |
$1,206.60 |
|
|
Fusion of foot bones
|
$1,544.40 |
$1,544.40 |
$2,435.67 |
|
|
Fusion of foot bones
|
$1,262.40 |
$1,262.40 |
$1,262.40 |
|
|
Fusion of foot bones
|
$1,143.00 |
$1,143.00 |
$3,515.00 |
|
|
Fusion of tibiofibular joint
|
$1,350.60 |
$1,350.60 |
$1,350.60 |
|
|
Fusion of toes
|
$516.00 |
$516.00 |
$579.17 |
|
|
Fusion of ureter & kidney
|
$4,503.00 |
$4,503.00 |
$4,503.00 |
|
|
Fxn gene detc abnor alleles
|
$283.80 |
$569.60 |
$2,408.40 |
|
|
Fxn gene full gene sequence
|
$1,143.20 |
$1,143.20 |
$1,143.20 |
|
|
G0180 home health certification
|
$93.60 |
$93.60 |
$93.60 |
|
|
G6pc gene
|
$343.80 |
$364.20 |
$1,288.20 |
|
|
G6pd full gene sequence
|
$3,029.40 |
$3,029.40 |
$3,115.80 |
|
|
Ga-67 gallium 0.1 mci
|
$42.60 |
$117.00 |
$1,032.60 |
|
|
Ga-68 gallium 68 dotatate
|
$161.40 |
$217.80 |
$358.40 |
|
|
Gabapentin non-blood
|
$57.00 |
$57.00 |
$57.00 |
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$1.60 |
$4.80 |
$13.60 |
|
|
Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper)
|
$2.40 |
$14.40 |
$376.20 |
|
|
Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution
|
$0.60 |
$0.60 |
$65.40 |
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$8.40 |
$49.60 |
$211.20 |
|
|
Galac-1-phosphate uridyltran - sendout
|
$26.40 |
$41.40 |
$256.00 |
|
|
Galectin-3
|
$55.80 |
$70.80 |
$102.60 |
|
|
Gallbladder and Bile Duct Scan (HIDA Scan)
|
$424.50 |
$1,404.00 |
$4,581.00 |
|
|
Gallbladder Function Scan (HIDA with Medication)
|
$550.50 |
$1,646.40 |
$4,581.00 |
|
|
Gallbladder Removal (Laparoscopic)
|
$1,009.80 |
$3,396.50 |
$8,289.60 |
|
|
Gallium illuccix 1 millicure
|
$1,900.80 |
$2,235.60 |
$2,848.80 |
|
|
Gamma globulin 1 cc inj
|
$21.60 |
$31.20 |
$381.00 |
|
|
Gammaglobulin iga
|
$35.00 |
$67.20 |
$404.40 |
|
|
Gammaglobulin ige
|
$34.50 |
$99.00 |
$678.60 |
|
|
Gamma glutamyltransferase
|
$25.80 |
$45.00 |
$282.60 |
|
|
Gammagraft
|
$143.50 |
$877.80 |
$4,537.80 |
|
|
Gammaplex injection
|
$6.00 |
$6.00 |
$100.20 |
|
|
Gamunex-c/gammaked
|
$7.80 |
$359.20 |
$20,308.80 |
|
|
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr
|
$3.60 |
$359.20 |
$1,251.60 |
|
|
Gardner vag dna quant
|
$123.00 |
$290.40 |
$615.60 |
|
|
Gastric analy w/ph ea spec
|
$55.80 |
$55.80 |
$55.80 |
|
|
Gastric emptying imag study
|
$1,228.80 |
$1,228.80 |
$1,228.80 |
|
|
Gastric motility studies
|
$972.00 |
$972.00 |
$1,578.60 |
|
|
Gastric mucosa imaging
|
$1,186.20 |
$1,228.80 |
$1,228.80 |
|
|
Gastroesophageal reflux study
|
$639.60 |
$1,228.80 |
$1,960.80 |
|
|
Gastroesophageal reflux test
|
$1,115.40 |
$1,115.40 |
$2,960.00 |
|
|
Gastro/jejuno tube, std
|
$67.50 |
$790.80 |
$2,332.20 |
|
|
Gated heart multiple
|
$1,120.20 |
$1,228.80 |
$2,779.20 |
|
|
Gauze >16<=48 no w/sal without b
|
$7.20 |
$27.00 |
$2,152.80 |
|
|
Gauze >16 <=48 sq in w/bordr
|
$3.00 |
$3.00 |
$5.20 |
|
|
Gauze <=16 in no w/sal without b
|
$0.60 |
$0.60 |
$2.40 |
|
|
Gauze <= 16 sq in w/border
|
$12.00 |
$12.00 |
$12.00 |
|
|
Gauze > 48 in no w/sal without b
|
$8.40 |
$9.00 |
$13.80 |
|
|
Gba gene
|
$1,191.60 |
$1,191.60 |
$1,191.60 |
|
|
Gc stocking thighlngth 18-30
|
$23.40 |
$23.40 |
$93.00 |
|
|
Gc stocking thighlngth 30-40
|
$44.40 |
$44.40 |
$44.40 |
|
|
Gc stocking waistlngth 18-30
|
$3.00 |
$3.00 |
$3.00 |
|
|
Gel cap app device for trach
|
$919.20 |
$1,097.40 |
$1,629.60 |
|
|
Gel-one
|
$1,114.00 |
$1,149.60 |
$2,173.80 |
|
|
Gel-syn injection 0.1 mg
|
$3.00 |
$8.40 |
$1,746.00 |
|
|
Gemcitabine 1 gram intravenous solution
|
$0.60 |
$365.40 |
$13,330.80 |
|
|
Gemtuzumab ozogamicin 4.5 mg (1 mg/ml initial concentration) IV soln
|
$44.40 |
$362.40 |
$37,978.20 |
|
|
General health panel
|
$70.00 |
$70.00 |
$255.00 |
|
|
Generator barostim neo2 2014
|
$13,385.00 |
$46,045.80 |
$115,299.00 |
|
|
Generator emblem MRI sicd subq
|
$27,720.00 |
$58,640.40 |
$135,789.00 |
|
|
Genetic counseling 30 min
|
$138.00 |
$138.00 |
$138.00 |
|
|
Genetic tstg severe inh cond
|
$510.50 |
$10,186.40 |
$18,150.60 |
|
|
Gen, neuro, clo loop, rechg
|
$18,145.00 |
$18,145.00 |
$18,145.00 |
|
|
Genome sequence analysis
|
$4,188.00 |
$4,439.40 |
$7,352.40 |
|
|
Genome sequence analysis
|
$4,188.00 |
$4,439.40 |
$4,439.40 |
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$1.80 |
$33.40 |
$1,068.60 |
|
|
Gentamicin peak therapeutic drug level
|
$51.50 |
$117.00 |
$919.20 |
|
|
G-esoph reflx tst w/electrod
|
$740.40 |
$1,296.60 |
$5,380.80 |
|
|
Ghs abscess perianal iandd
|
$847.20 |
$1,512.60 |
$5,424.80 |
|
|
Ghs abscess postoperative iandd complex
|
$330.00 |
$3,515.40 |
$5,002.80 |
|
|
Ghs acetylcholinesterase, rbc
|
$34.80 |
$34.80 |
$145.20 |
|
|
Ghs alcohol, methyl (methanol)-medtox
|
$76.80 |
$136.20 |
$2,878.80 |
|
|
Ghs alpha thalasemia, 7 deletions
|
$408.80 |
$1,593.00 |
$2,017.20 |
|
|
Ghs analysis neurostim without reprogramming
|
$171.00 |
$517.20 |
$574.80 |
|
|
Ghs antibodies (torch) igm
|
$52.20 |
$81.00 |
$551.20 |
|
|
Ghs aspiration bladder - needle
|
$431.40 |
$446.40 |
$915.00 |
|
|
Ghs bladder cath - complex-foley
|
$409.20 |
$871.20 |
$2,310.60 |
|
|
Ghs bleeding time (ivy)
|
$46.80 |
$46.80 |
$46.80 |
|
|
Ghs block ilioinguinal/gentitofemoral
|
$123.00 |
$940.80 |
$2,204.00 |
|
|
Ghs central line insert < age 5, failed
|
$1,098.60 |
$3,229.80 |
$3,606.00 |
|
|
Ghs change cysto/gastrost
|
$77.40 |
$1,112.80 |
$2,815.20 |
|
|
Ghs chemo >8 hrs
|
$330.40 |
$580.80 |
$3,246.60 |
|
|
Ghs chemo IV push, ea addtl
|
$104.00 |
$446.40 |
$568.20 |
|
|
Ghs chlamydia pneumoniae by pcr (arup) (306630)
|
$54.00 |
$211.20 |
$665.40 |
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$210.00 |
$532.80 |
$1,780.80 |
|
|
Ghs closed reduction ankle dislocation
|
$308.00 |
$998.40 |
$3,560.40 |
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$718.20 |
$2,055.00 |
$4,526.40 |
|
|
Ghs closed tx radiocarpal disloc w manip
|
$466.80 |
$466.80 |
$3,964.20 |
|
