G0033 |
Isolated limb perfusion in patient with sarcoma |
98 016,00 |
G0035 |
Interventional neuroradiology for intracranial aneurysm embolization/occlusion by catheterization, including use of stent, eg, SILK, and coils |
86 099,00 |
G0036 |
Insertion of intraocular lens, lens included |
7 589,00 |
G0037 |
Tension free vaging tape for incontinence (TVT) |
7 770,00 |
G0045 |
Mastectomy, bilateral |
23 776,00 |
G0047 |
Breast reconstruction, bilateral |
26 098,00 |
G0048 |
Breast reconstruction following mastectomy, bilateral |
45 692,00 |
G0049 |
Breast reconstruction following mastectomy, unilateral |
27 697,00 |
G0050 |
Breast reconstruction, unilateral, including nipple reconstruction |
22 960,00 |
G0051 |
Mastectomy, unilateral |
15 848,00 |
G0054 |
Lower extremities veins surgery, including varicose veins |
10 718,00 |
G0055 |
Blood vessels surgery, including nonautogenous graft |
56 044,00 |
G0057 |
Lung transplantation |
341 603,00 |
G0058 |
Heart-lung transplant |
478 248,00 |
G0059 |
Bone marrow transplantation; allogenic |
317 168,00 |
G0060 |
Bone marrow transplantation; autologous |
208 378,00 |
G0061 |
Renal and/or pancreas transplantation |
227 736,00 |
G0062 |
Heart transplantation |
341 603,00 |
G0063 |
Liver transplantation |
984 369,00 |
G0064 |
Corneal surgery, including cost of cornea |
19 516,00 |
G0066 |
Inguinal/femoral hernia repair, hospital day care |
5 196,00 |
G0067 |
Craniotomy |
63 558,00 |
G0070 |
Open prostatectomy |
18 011,00 |
G0072 |
Heart surgery, including bypass |
74 142,00 |
G0073 |
Diagnostic catheterization |
14 341,00 |
G0074 |
Therapeutic catheterization, excluding cardiac catheterization |
33 607,00 |
G0075 |
Hysterectomy |
14 837,00 |
G0077 |
Transurethral prostatectomy |
11 128,00 |
G0078 |
Hospital circumcision, excluding newborn |
3 485,00 |
G0083 |
Osteotomy of spine, including implants, diskectomy |
27 655,00 |
G0084 |
Osteotomy of spine, including implants - other surgeries |
50 785,00 |
G0085 |
Cardiac catheterization, therapeutic, including insertion of drug eluting stent(s) |
40 303,00 |
G0089 |
Treatment of heavy burns |
193 637,00 |
G0090 |
Treatment of medium burns |
110 645,00 |
G0096 |
Laparoscopic gastric banding, excluding band cost |
12 131,00 |
G0100 |
Additional charge for DRG in multiple trauma, admission from ER |
11 480,00 |
G0101 |
ORIF/CRIF of pelvis, closed/open fracture |
59 900,00 |
G0102 |
Arthroplasty with prosthetic replacement/implant of radial head, excluding open fracture |
35 016,00 |
G0103 |
Arthroplasty with prosthetic replacement/implant of radial head, open fracture |
57 600,00 |
G0104 |
ORIF of foot, closed fracture, excluding calcaneus |
37 856,00 |
G0105 |
ORIF of foot, open fracture, excluding calcaneus |
57 600,00 |
G0106 |
ORIF of calcaneus/operation on femur, excluding neck, closed fracture |
30 413,00 |
G0107 |
ORIF of calcaneus/operation on femur, excluding neck, open fracture |
47 633,00 |
G0108 |
Operation on clavicle/humerus/forearm, closed fracture, including closed dislocation of acromioclavicular joint, excluding distal humerus and shaft of radius/ulna, including bone graft |
26 050,00 |
G0109 |
Operation on clavicle/humerus/forearm, open fracture, including open dislocation of acromioclavicular joint, excluding distal humerus and shaft of radius/ulna |
38 792,00 |
G0110 |
ORIF/CRIF/EF of tibia and/or fibula, closed fracture |
35 125,00 |
G0111 |
ORIF/CRIF/EF of tibia and/or fibula, open fracture, including use of bone marrow aspiration concentrate |
60 466,00 |
G0112 |
ORIF of patella/ankle / CRIF of calcaneus, closed fracture |
21 333,00 |
G0113 |
ORIF of patella/ankle / CRIF of calcaneus, open fracture |
35 349,00 |
G0114 |
CRIF of ankle/foot, closed fracture, excluding calcaneus |
11 970,00 |
G0115 |
CRIF of ankle/foot, open fracture, excluding calcaneus |
22 527,00 |
G0116 |
Exploration of tendon/nerve of upper limb, including ganglion decompression/lysis of adhesions |
7 490,00 |
G0117 |
Suture of extensor tendons of hand, including delayed suture |
12 642,00 |
G0118 |
Suture of tendons/nerves of upper limb, including delayed suture, excluding extensor tendons of hand |
21 641,00 |
G0120 |
ORIF/EF of phalange of hand, closed fracture, including bone graft |
12 909,00 |
G0121 |
ORIF/EF of phalange of hand, open/complex fracture |
19 122,00 |
G0122 |
ORIF/EF of phalange of hand, with suture of tendons/nerves, closed/open fracture |
28 874,00 |
G0123 |
ORIF/EF of phalanges of hand, closed fractures, including bone graft |
18 779,00 |
G0124 |
ORIF/EF of phalanges of hand, open/complex fractures |
25 467,00 |
G0125 |
ORIF/EF of phalanges of hand, with suture of tendons/nerves, closed/open fractures |
35 219,00 |
G0126 |
ORIF/EF of metacarpal, closed fracture, including bone graft |
14 219,00 |
G0127 |
ORIF/EF of metacarpal, open/complex fracture |
20 539,00 |
G0128 |
ORIF/EF of metacarpal, with suture of tendons/nerves, closed/open fracture |
30 291,00 |
G0129 |
ORIF/EF of metacarpals, closed fractures, including bone graft |
22 109,00 |
G0130 |
ORIF/EF of metacarpals, open/complex fractures |
29 067,00 |
G0131 |
ORIF/EF of metacarpals, with suture of tendons/nerves, closed/open fractures |
38 821,00 |
G0132 |
ORIF of carpal(s), closed fracture, including bone graft |
18 817,00 |
G0133 |
ORIF of carpal(s), open/complex fracture, including bone graft |
25 507,00 |
G0134 |
ORIF of carpal(s), with suture of tendons/nerves, closed/open fracture, including bone graft |
35 260,00 |
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