|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$2,077.23 |
$2,077.23 |
$2,077.23 |
$779.35
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$2,077.23 |
$2,077.23 |
$2,077.23 |
$810.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$2,077.23 |
$2,077.23 |
$2,077.23 |
$795.20
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$2,077.23 |
$2,077.23 |
$2,077.23 |
$779.35
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$2,077.23 |
$2,077.23 |
$2,077.23 |
$995.20
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$2,077.23 |
$2,077.23 |
$2,077.23 |
$879.60
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$2,077.23 |
$2,077.23 |
$2,077.23 |
$1,188.80
|
|
Ghs layered repair 20.1 - 30.0 cm -12056
|
$2,077.23 |
$2,077.23 |
$2,077.23 |
$1,030.80
|
|
Ghs layered repair over 30.0 cm -12047
|
$3,908.64 |
$3,908.64 |
$3,908.64 |
$2,024.70
|
|
Ghs layered repair over 3.0 cm -12057
|
$2,077.23 |
$2,077.23 |
$2,077.23 |
$1,064.98
|
|
Ghs mbp
|
$60.51 |
$60.51 |
$60.51 |
$74.19
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$225.42 |
$225.42 |
$225.42 |
$261.80
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$225.42 |
$225.42 |
$225.42 |
$252.50
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$225.42 |
$225.42 |
$225.42 |
$239.20
|
|
Ghs moderate sedation ea addtl 15 min
|
$176.97 |
$176.97 |
$176.97 |
$145.60
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$176.97 |
$176.97 |
$176.97 |
$140.00
|
|
Ghs myocardial strain img spckl track
|
$1,491.75 |
$1,491.75 |
$1,491.75 |
$503.85
|
|
Ghs nailbed repair/nail removal
|
$1,312.74 |
$1,312.74 |
$1,312.74 |
$808.80
|
|
Ghs nerve blk intercostal, ea addtl level
|
$7,588.80 |
$7,588.80 |
$7,588.80 |
$1,618.50
|
|
Ghs nerve blk intercostal, single level
|
$7,588.80 |
$7,588.80 |
$7,588.80 |
$1,230.80
|
|
Ghs nerve block axillary nerve
|
$5,498.82 |
$5,498.82 |
$5,498.82 |
$1,541.40
|
|
Ghs nerve block brachial plexus
|
$5,498.82 |
$5,498.82 |
$5,498.82 |
$1,768.00
|
|
Ghs nerve block celiac plexus
|
$1,929.84 |
$1,929.84 |
$1,929.84 |
$1,712.00
|
|
Ghs nerve block interscaline
|
$7,588.80 |
$7,588.80 |
$7,588.80 |
$1,607.45
|
|
Ghs nerve block lumbar or thoracic symp
|
$7,588.80 |
$7,588.80 |
$7,588.80 |
$2,042.60
|
|
Ghs nerve block sciatic nerve
|
$1,459.62 |
$1,459.62 |
$1,459.62 |
$1,636.80
|
|
Ghs nerve block suprascapular
|
$6,598.38 |
$6,598.38 |
$6,598.38 |
$1,223.00
|
|
Ghs ng placement w fluoro guidance
|
$5,978.73 |
$5,978.73 |
$5,978.73 |
$468.75
|
|
Ghs ob unlisted IV or art inj or infusion
|
$81.09 |
$81.09 |
$81.09 |
$86.19
|
|
Ghs opcc repair cvp without subq port
|
$1,310.19 |
$1,310.19 |
$1,310.19 |
$1,302.54
|
|
Ghs opcc repair cvp w subq port
|
$2,356.71 |
$2,356.71 |
$2,356.71 |
$2,430.56
|
|
Ghs pacing - transcutaneous
|
$1,668.72 |
$1,668.72 |
$1,668.72 |
$868.68
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$5,496.27 |
$5,496.27 |
$5,496.27 |
$855.60
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$7,588.80 |
$7,588.80 |
$7,588.80 |
$1,003.00
|
|
Ghs peritonsillar abscess i andd
|
$631.38 |
$631.38 |
$631.38 |
$694.20
|
|
Ghs phenylketonurid
|
$5.61 |
$5.61 |
$5.61 |
$51.58
|
|
Ghs picc line insert < 5
|
$3,787.26 |
$3,787.26 |
$3,787.26 |
$2,060.40
|
|
Ghs plngl fx pm cl
|
$1,638.63 |
$1,638.63 |
$1,638.63 |
$662.20
|
|
Ghs polysom <6 yrs 4/> parameters
|
$7,313.40 |
$7,313.40 |
$7,313.40 |
$3,705.80
|
|
Ghs pr without cont pulse ox
|
$150.45 |
$150.45 |
$150.45 |
$156.70
|
|
Ghs refill of implantable pump
|
$431.97 |
$431.97 |
$431.97 |
$539.13
|
|
Ghs removal intranasal foreign body
|
$319.26 |
$319.26 |
$319.26 |
$324.35
|
|
Ghs removal pharyngeal foreign body
|
$855.27 |
$855.27 |
$855.27 |
$460.00
|
|
Ghs repair extensor tendon hand, ea tendon
|
$3,507.27 |
$3,507.27 |
$3,507.27 |
$2,211.05
|
|
Ghs repair tendon ext forearm/wrist ea
|
$6,740.16 |
$6,740.16 |
$6,740.16 |
$4,150.20
|
|
Ghs rsv eia (respir synctial vrs)
|
$160.14 |
$160.14 |
$160.14 |
$101.15
|
|
Ghs sedimentation rate
|
$99.96 |
$99.96 |
$99.96 |
$45.50
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$1,312.74 |
$1,312.74 |
$1,312.74 |
$590.40
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$1,312.74 |
$1,312.74 |
$1,312.74 |
$705.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$1,312.74 |
$1,312.74 |
$1,312.74 |
$670.08
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$1,312.74 |
$1,312.74 |
$1,312.74 |
$585.90
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$1,312.74 |
$1,312.74 |
$1,312.74 |
$487.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$1,312.74 |
$1,312.74 |
$1,312.74 |
$470.47
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$1,312.74 |
$1,312.74 |
$1,312.74 |
$538.64
|
|
Ghs simple repair over 30 cm - 12007
|
$1,312.74 |
$1,312.74 |
$1,312.74 |
$660.00
|
|
Ghs simple repair over 30 cm - 12018
|
$1,312.74 |
$1,312.74 |
$1,312.74 |
$589.18
|
|
Ghs sleep study unattended
|
$1,015.41 |
$1,015.41 |
$1,015.41 |
$503.38
|
|
Ghs sphenopalatine ganglion block
|
$616.08 |
$616.08 |
$616.08 |
$706.56
|
|
Ghs sp train/fitting sp device - kx
|
$361.59 |
$361.59 |
$361.59 |
$261.95
|
|
Ghs strapping shoulder - 29240
|
$332.52 |
$332.52 |
$332.52 |
$243.07
|
|
Ghs st - re-eval for alt comm
|
$372.30 |
$372.30 |
$372.30 |
$309.00
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$81.09 |
$81.09 |
$81.09 |
$93.75
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$393.72 |
$393.72 |
$393.72 |
$351.45
|
|
Ghs superficial wnd dehiscence simp12020
|
$1,312.74 |
$1,312.74 |
$1,312.74 |
$976.98
|
|
Ghs superficial wnd dehis w packing12021
|
$1,098.03 |
$1,098.03 |
$1,098.03 |
$761.28
|
|
Ghs tracheostomy emergency - transtracheal
|
$2,732.58 |
$2,732.58 |
$2,732.58 |
$2,225.73
|
|
Ghs tx distal phalangeal fx with manipulation
|
$1,638.63 |
$1,638.63 |
$1,638.63 |
$591.00
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$540.60 |
$540.60 |
$540.60 |
$540.00
|
|
Ghs urine, porphyrins quant
|
$66.94 |
$66.94 |
$66.94 |
$70.20
|
|
Ghs vaginal delivery only
|
$5,817.06 |
$5,817.06 |
$5,817.06 |
$3,525.06
|
|
Ghs veeg 12-26 hr intmt mont
|
$1,929.84 |
$1,929.84 |
$1,929.84 |
$1,843.00
|
|
Ghs windowing of cast
|
$329.97 |
$329.97 |
$329.97 |
$204.00
|
|
Gi inhouse confirmation
|
$268.77 |
$268.77 |
$268.77 |
$87.00
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$402.35 |
$402.35 |
$402.35 |
$509.06
|
|
Glucagon plasma - sendout
|
$69.32 |
$69.32 |
$69.32 |
$58.56
|
|
Glucose 1 hr post dose
|
$70.89 |
$70.89 |
$70.89 |
$46.28
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$35.70 |
$35.70 |
$35.70 |
$22.00
|
|
Glucose blood quantitative
|
$70.89 |
$70.89 |
$70.89 |
$44.76
|
|
Glucose body fluid
|
$70.89 |
$70.89 |
$70.89 |
$50.70
|
|
Glucose tolerance test (gtt) 3 specimens
|
$188.70 |
$188.70 |
$188.70 |
$100.10
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$57.63 |
$57.63 |
$57.63 |
$34.45
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$84.15 |
$84.15 |
$84.15 |
$56.70
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$4,478.72 |
$4,478.72 |
$4,478.72 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$148.92 |
$148.92 |
$148.92 |
$110.04
|
|
Gonadotropin luteinizing hormone (lh)
|
$134.64 |
$134.64 |
$134.64 |
$123.75
|
|
Goserelin 10.8 mg subcutaneous implant
|
$9,256.25 |
$9,256.25 |
$9,256.25 |
$2,802.00
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$2,913.12 |
$2,913.12 |
$2,913.12 |
$2,648.81
|
|
Graft axiofill 1000mg
|
$11,046.00 |
$11,046.00 |
$11,046.00 |
$5,278.73
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$13,301.60 |
$13,301.60 |
$13,301.60 |
$1,679.75
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$21,934.33 |
$21,934.33 |
$21,934.33 |
$25,762.70
|
|
Graft nerve adv 3-4x70mm
|
$28,560.00 |
$28,560.00 |
$28,560.00 |
$27,495.00
|
|
Graft patch felt ptfe 2x2
|
$25,728.84 |
$25,728.84 |
$25,728.84 |
$25,728.84
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$22,263.56 |
$22,263.56 |
$22,263.56 |
$10,989.38
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$6,357.61 |
$6,357.61 |
$6,357.61 |
$1,560.21
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$10,924.20 |
$10,924.20 |
$10,924.20 |
$2,369.10
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$27,367.40 |
$27,367.40 |
$27,367.40 |
$35,824.13
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$4,199.85 |
$4,199.85 |
$4,199.85 |
$3,070.00
|
|
Graft xenmtrx sft rect 15x20cm
|
$36,734.28 |
$36,734.28 |
$36,734.28 |
$43,312.93
|
|
Graft xenmtrx sft rect 19x28cm
|
$3,572.04 |
$3,572.04 |
$3,572.04 |
$2,653.10
|
|
Great toe with reduction 28495
|
$655.35 |
$655.35 |
$655.35 |
$577.03
|