|
Fna bx w/ct gdn ea addl
|
$638.00 |
$638.00 |
$638.00 |
$833.25
|
|
Foam drg >16<=48 sq in w/bdr
|
$7.76 |
$7.76 |
$7.76 |
$62.09
|
|
Foam drg >16<=48 sq in without b
|
$33.40 |
$33.40 |
$33.40 |
$41.14
|
|
Foam drg <=16 sq in w/border
|
$8.28 |
$8.28 |
$8.28 |
$16.37
|
|
Foam drg > 48 sq in w/border
|
$6.73 |
$6.73 |
$6.73 |
$23.63
|
|
Foam drg > 48 sq in without brdr
|
$32.08 |
$32.08 |
$32.08 |
$33.49
|
|
Foam drsg <=16 sq in without bdr
|
$21.74 |
$21.74 |
$21.74 |
$21.74
|
|
Folic acid
|
$179.50 |
$179.50 |
$179.50 |
$101.50
|
|
Follow-up angiography
|
$1,619.50 |
$1,619.50 |
$1,619.50 |
$2,040.78
|
|
Followup eval of foot pt lop
|
$182.50 |
$182.50 |
$182.50 |
$170.95
|
|
Follow-up surgery of eye
|
$3,144.50 |
$3,144.50 |
$3,144.50 |
$3,572.40
|
|
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 insert silicone gel eac
|
$87.98 |
$87.98 |
$87.98 |
$295.47
|
|
Foot plas heel stabi pre ots
|
$27.43 |
$27.43 |
$27.43 |
$76.32
|
|
Foot X-ray
|
$316.50 |
$316.50 |
$316.50 |
$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
|
$775.50 |
$775.50 |
$775.50 |
$532.80
|
|
Fractionation ketosteroids
|
$191.50 |
$191.50 |
$191.50 |
$135.95
|
|
Fracture assessment via dxa
|
$160.00 |
$160.00 |
$160.00 |
$173.18
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$270.00 |
$270.00 |
$270.00 |
$151.58
|
|
Frozen plasma, pooled, sd
|
$270.00 |
$270.00 |
$270.00 |
$140.80
|
|
Fructosamine glycated protein
|
$95.50 |
$95.50 |
$95.50 |
$60.75
|
|
Ft arch suprt premold longit
|
$28.46 |
$28.46 |
$28.46 |
$79.82
|
|
Fth/gft fr n/e/e/l each addl
|
$1,368.50 |
$1,368.50 |
$1,368.50 |
$1,368.50
|
|
Fth/gft fr trnk each addl
|
$1,368.50 |
$1,368.50 |
$1,368.50 |
$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
|
$165.50 |
$165.50 |
$165.50 |
$286.04
|
|
Full thick gft/nose/ear/lid/lip/20sqcm or< 15260
|
$2,703.50 |
$2,703.50 |
$2,703.50 |
$3,026.40
|
|
Full thick gft/scalp/arm/leg/20sqcm or< 15220
|
$2,703.50 |
$2,703.50 |
$2,703.50 |
$2,469.00
|
|
Full thick gft/scalp/arm/leg/add 20sqcm 15221
|
$1,368.50 |
$1,368.50 |
$1,368.50 |
$1,056.41
|
|
Full thick gft w/close donor fccmnaghf <=20sqcm 15240
|
$2,703.50 |
$2,703.50 |
$2,703.50 |
$2,703.50
|
|
Fundus photography with i&r 92250
|
$163.50 |
$163.50 |
$163.50 |
$182.95
|
|
Ga-67 gallium 0.1 mci
|
$47.50 |
$47.50 |
$47.50 |
$118.56
|
|
Ga-68 gallium 68 dotatate
|
$44.50 |
$44.50 |
$44.50 |
$119.90
|
|
Galac-1-phosphate uridyltran - sendout
|
$154.50 |
$154.50 |
$154.50 |
$96.94
|
|
Gammaglobulin iga
|
$55.50 |
$55.50 |
$55.50 |
$67.20
|
|
Gammaglobulin ige
|
$69.50 |
$69.50 |
$69.50 |
$83.85
|
|
Gamma glutamyltransferase
|
$106.00 |
$106.00 |
$106.00 |
$57.54
|
|
Gastric analy w/ph ea spec
|
$31.50 |
$31.50 |
$31.50 |
$31.80
|
|
Gastric emptying imag study
|
$1,364.00 |
$1,364.00 |
$1,364.00 |
$1,291.55
|
|
Gastric emptying imag study
|
$1,544.00 |
$1,544.00 |
$1,544.00 |
$1,621.36
|
|
Gastroesophageal reflux study
|
$651.00 |
$651.00 |
$651.00 |
$949.80
|
|
Gastro/jejuno tube, std
|
$379.50 |
$379.50 |
$379.50 |
$334.57
|
|
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 > 48 in no w/sal without b
|
$3.62 |
$3.62 |
$3.62 |
$7.08
|
|
Generator barostim neo2 2014
|
$24,546.10 |
$24,546.10 |
$24,546.10 |
$48,147.60
|
|
Generator emblem MRI sicd subq
|
$45,186.03 |
$45,186.03 |
$45,186.03 |
$36,467.76
|
|
Generator stim baroreceptor neo legacy implant pulse
|
$23,287.50 |
$23,287.50 |
$23,287.50 |
$66,636.36
|
|
Genetic tstg severe inh cond
|
$2,949.50 |
$2,949.50 |
$2,949.50 |
$3,978.65
|
|
Gen, neuro, clo loop, rechg
|
$18,952.50 |
$18,952.50 |
$18,952.50 |
$36,800.00
|
|
Gentamicin peak therapeutic drug level
|
$151.00 |
$151.00 |
$151.00 |
$126.00
|
|
Ghs abscess perianal iandd
|
$1,648.50 |
$1,648.50 |
$1,648.50 |
$1,410.90
|
|
Ghs abscess postoperative iandd complex
|
$5,118.00 |
$5,118.00 |
$5,118.00 |
$3,515.40
|
|
Ghs acetylcholinesterase, rbc
|
$124.00 |
$124.00 |
$124.00 |
$42.72
|
|
Ghs alcohol, methyl (methanol)-medtox
|
$87.00 |
$87.00 |
$87.00 |
$100.30
|
|
Ghs alpha thalasemia, 7 deletions
|
$232.00 |
$232.00 |
$232.00 |
$371.84
|
|
Ghs analysis neurostim without reprogramming
|
$326.00 |
$326.00 |
$326.00 |
$246.50
|
|
Ghs antibodies (torch) igm
|
$94.50 |
$94.50 |
$94.50 |
$69.30
|
|
Ghs bladder cath - complex-foley
|
$234.00 |
$234.00 |
$234.00 |
$344.00
|
|
Ghs block ilioinguinal/gentitofemoral
|
$1,160.00 |
$1,160.00 |
$1,160.00 |
$1,045.65
|
|
Ghs central line insert < age 5, failed
|
$1,971.00 |
$1,971.00 |
$1,971.00 |
$2,535.60
|
|
Ghs change cysto/gastrost
|
$967.00 |
$967.00 |
$967.00 |
$565.49
|
|
Ghs chemo >8 hrs
|
$1,215.00 |
$1,215.00 |
$1,215.00 |
$714.87
|
|
Ghs chemo IV push, ea addtl
|
$269.00 |
$269.00 |
$269.00 |
$286.00
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$212.00 |
$212.00 |
$212.00 |
$512.40
|
|
Ghs closed reduction ankle dislocation
|
$732.00 |
$732.00 |
$732.00 |
$653.80
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$838.50 |
$838.50 |
$838.50 |
$1,592.00
|
|
Ghs closed tx radiocarpal disloc w manip
|
$198.00 |
$198.00 |
$198.00 |
$520.80
|
|
Ghs closed tx tibial fracture w/manip
|
$4,266.50 |
$4,266.50 |
$4,266.50 |
$2,148.00
|
|
Ghs closure surg wound/dehiscence-13160
|
$3,086.00 |
$3,086.00 |
$3,086.00 |
$3,086.00
|
|
Ghs clsd red med malleolus fx without manip
|
$263.00 |
$263.00 |
$263.00 |
$496.80
|
|
Ghs clsd red med malleolus fx w manip
|
$2,320.00 |
$2,320.00 |
$2,320.00 |
$2,184.00
|
|
Ghs clsd tx frac distal tibia w/manipulation
|
$2,863.50 |
$2,863.50 |
$2,863.50 |
$2,211.05
|
|
Ghs cl tx knee disl; wo anesth
|
$263.00 |
$263.00 |
$263.00 |
$592.80
|
|
Ghs cl tx metacarpophal disloc without anes
|
$377.00 |
$377.00 |
$377.00 |
$495.55
|
|
Ghs community re-entry 15 minutes
|
$89.00 |
$89.00 |
$89.00 |
$88.50
|
|
Ghs conjunctiva foreign body-embed bil
|
$410.50 |
$410.50 |
$410.50 |
$419.22
|
|
Ghs conjunctiva foreign body-superf bil
|
$398.50 |
$398.50 |
$398.50 |
$283.80
|
|
Ghs corneal fb without slit lamp bilat
|
$238.50 |
$238.50 |
$238.50 |
$419.65
|
|
Ghs corneal fb with slit lamp bilat
|
$172.50 |
$172.50 |
$172.50 |
$339.60
|
|
Ghs cricothyroidotomy
|
$1,066.50 |
$1,066.50 |
$1,066.50 |
$1,067.30
|
|
Ghs diphtheria toxoid ab igg
|
$20.00 |
$20.00 |
$20.00 |
$62.05
|
|
Ghs dislocation elbow closed treatment
|
$379.00 |
$379.00 |
$379.00 |
$578.00
|
|
Ghs ed peritoneal lavage w guidance if performed
|
$900.50 |
$900.50 |
$900.50 |
$1,109.47
|
|
Ghs ed rmvl or bivalving cast
|
$523.00 |
$523.00 |
$523.00 |
$329.60
|
|
Ghs ed therapeutic lp, drain csf w fluoro
|
$1,938.00 |
$1,938.00 |
$1,938.00 |
$1,432.20
|
|
Ghs eeg cont rec w/video by tec min 8 chnls
|
$2,592.00 |
$2,592.00 |
$2,592.00 |
$593.91
|
|
Ghs electrostagmgraphy
|
$295.50 |
$295.50 |
$295.50 |
$295.50
|
|
Ghs epidermal shaving diameter >2.0 cm
|
$364.50 |
$364.50 |
$364.50 |
$467.00
|
|
Ghs excision ingrown nail
|
$259.00 |
$259.00 |
$259.00 |
$439.50
|
|
Ghs eyelid foreign body-embedded - bil
|
$881.00 |
$881.00 |
$881.00 |
$501.04
|
|
Ghs fb removal foot - deep - left
|
$2,723.00 |
$2,723.00 |
$2,723.00 |
$2,538.75
|
|
Ghs fb removal from muscle - complicated
|
$5,758.00 |
$5,758.00 |
$5,758.00 |
$3,295.35
|
|
Ghs fb removal - incisional
|
$3,401.50 |
$3,401.50 |
$3,401.50 |
$2,271.01
|
|
Ghs fb removal - non-incisional
|
$876.50 |
$876.50 |
$876.50 |
$1,706.20
|
