|
Ghs moderate sedation < 5 yr, 30 min
|
$87.50 |
$87.50 |
$87.50 |
$261.80
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$87.50 |
$87.50 |
$87.50 |
$252.50
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$87.50 |
$87.50 |
$87.50 |
$239.20
|
|
Ghs moderate sedation ea addtl 15 min
|
$70.00 |
$70.00 |
$70.00 |
$145.60
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$70.00 |
$70.00 |
$70.00 |
$140.00
|
|
Ghs musc test done w/n test comp
|
$420.35 |
$420.35 |
$420.35 |
$349.80
|
|
Ghs musc tst done w/nerv tst lim
|
$348.60 |
$348.60 |
$348.60 |
$269.15
|
|
Ghs musc tst done w/n tst non ext
|
$147.70 |
$147.70 |
$147.70 |
$222.60
|
|
Ghs myocardial strain img spckl track
|
$316.75 |
$316.75 |
$316.75 |
$503.85
|
|
Ghs nailbed repair/nail removal
|
$582.75 |
$582.75 |
$582.75 |
$808.80
|
|
Ghs nerve blk intercostal, ea addtl level
|
$796.25 |
$796.25 |
$796.25 |
$1,618.50
|
|
Ghs nerve blk intercostal, single level
|
$649.60 |
$649.60 |
$649.60 |
$1,230.80
|
|
Ghs nerve block axillary nerve
|
$796.25 |
$796.25 |
$796.25 |
$1,541.40
|
|
Ghs nerve block brachial plexus
|
$915.60 |
$915.60 |
$915.60 |
$1,768.00
|
|
Ghs nerve block celiac plexus
|
$995.40 |
$995.40 |
$995.40 |
$1,712.00
|
|
Ghs nerve block interscaline
|
$796.25 |
$796.25 |
$796.25 |
$1,607.45
|
|
Ghs nerve block lumbar or thoracic symp
|
$1,856.75 |
$1,856.75 |
$1,856.75 |
$2,042.60
|
|
Ghs nerve block sciatic nerve
|
$649.60 |
$649.60 |
$649.60 |
$1,636.80
|
|
Ghs nerve block suprascapular
|
$649.60 |
$649.60 |
$649.60 |
$1,223.00
|
|
Ghs ng placement w fluoro guidance
|
$259.35 |
$259.35 |
$259.35 |
$468.75
|
|
Ghs o2 saturation
|
$65.80 |
$65.80 |
$65.80 |
$72.45
|
|
Ghs opcc repair cvp without subq port
|
$788.90 |
$788.90 |
$788.90 |
$1,302.54
|
|
Ghs opcc repair cvp w subq port
|
$1,563.45 |
$1,563.45 |
$1,563.45 |
$2,430.56
|
|
Ghs ot prosthetic training/15 min
|
$89.95 |
$89.95 |
$89.95 |
$92.35
|
|
Ghs ot sensory integrative tech/15min
|
$89.95 |
$89.95 |
$89.95 |
$101.05
|
|
Ghs pacing - transcutaneous
|
$839.65 |
$839.65 |
$839.65 |
$868.68
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$1,836.10 |
$1,836.10 |
$1,836.10 |
$855.60
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$862.05 |
$862.05 |
$862.05 |
$1,003.00
|
|
Ghs peritonsillar abscess i andd
|
$189.00 |
$189.00 |
$189.00 |
$694.20
|
|
Ghs picc line insert < 5
|
$1,563.45 |
$1,563.45 |
$1,563.45 |
$2,060.40
|
|
Ghs plngl fx pm cl
|
$189.00 |
$189.00 |
$189.00 |
$662.20
|
|
Ghs ppd (tb intradermal)
|
$29.40 |
$29.40 |
$29.40 |
$43.45
|
|
Ghs removal intranasal foreign body
|
$101.50 |
$101.50 |
$101.50 |
$324.35
|
|
Ghs removal pharyngeal foreign body
|
$302.05 |
$302.05 |
$302.05 |
$460.00
|
|
Ghs repair extensor tendon hand, ea tendon
|
$1,548.40 |
$1,548.40 |
$1,548.40 |
$2,211.05
|
|
Ghs repair tendon ext forearm/wrist ea
|
$3,148.95 |
$3,148.95 |
$3,148.95 |
$4,150.20
|
|
Ghs rsv eia (respir synctial vrs)
|
$207.20 |
$207.20 |
$207.20 |
$101.15
|
|
Ghs sedimentation rate
|
$115.50 |
$115.50 |
$115.50 |
$45.50
|
|
Ghs semen analysis fert
|
$201.60 |
$201.60 |
$201.60 |
$123.20
|
|
Ghs sensitivity (per antimicro)
|
$56.00 |
$56.00 |
$56.00 |
$59.90
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$384.65 |
$384.65 |
$384.65 |
$590.40
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$405.30 |
$405.30 |
$405.30 |
$705.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$397.25 |
$397.25 |
$397.25 |
$670.08
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$405.30 |
$405.30 |
$405.30 |
$585.90
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$189.00 |
$189.00 |
$189.00 |
$487.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$210.35 |
$210.35 |
$210.35 |
$470.47
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$189.00 |
$189.00 |
$189.00 |
$538.64
|
|
Ghs simple repair over 30 cm - 12007
|
$407.40 |
$407.40 |
$407.40 |
$660.00
|
|
Ghs simple repair over 30 cm - 12018
|
$405.30 |
$405.30 |
$405.30 |
$589.18
|
|
Ghs somatosensory testing lower extremit
|
$1,060.15 |
$1,060.15 |
$1,060.15 |
$947.48
|
|
Ghs somatosensory testing upper & lower limbs
|
$2,119.25 |
$2,119.25 |
$2,119.25 |
$1,435.00
|
|
Ghs speech-gen aug dev eval iii, st
|
$163.10 |
$163.10 |
$163.10 |
$124.80
|
|
Ghs sphenopalatine ganglion block
|
$253.05 |
$253.05 |
$253.05 |
$706.56
|
|
Ghs sp train/fitting sp device - kx
|
$262.85 |
$262.85 |
$262.85 |
$261.95
|
|
Ghs strapping shoulder - 29240
|
$95.20 |
$95.20 |
$95.20 |
$243.07
|
|
Ghs st - re-eval for alt comm
|
$325.85 |
$325.85 |
$325.85 |
$309.00
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$219.80 |
$219.80 |
$219.80 |
$93.75
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$219.80 |
$219.80 |
$219.80 |
$351.45
|
|
Ghs superficial wnd dehiscence simp12020
|
$582.75 |
$582.75 |
$582.75 |
$976.98
|
|
Ghs superficial wnd dehis w packing12021
|
$384.65 |
$384.65 |
$384.65 |
$761.28
|
|
Ghs tracheostomy emergency - transtracheal
|
$1,050.00 |
$1,050.00 |
$1,050.00 |
$2,225.73
|
|
Ghs tx distal phalangeal fx with manipulation
|
$189.00 |
$189.00 |
$189.00 |
$591.00
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$164.50 |
$164.50 |
$164.50 |
$540.00
|
|
Ghs vaginal delivery only
|
$2,422.70 |
$2,422.70 |
$2,422.70 |
$3,525.06
|
|
Ghs veeg 12-26 hr intmt mont
|
$2,261.70 |
$2,261.70 |
$2,261.70 |
$1,843.00
|
|
Ghs windowing of cast
|
$164.50 |
$164.50 |
$164.50 |
$204.00
|
|
Gi inhouse confirmation
|
$51.45 |
$51.45 |
$51.45 |
$87.00
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$1,041.95 |
$1,041.95 |
$1,041.95 |
$2,382.90
|
|
Glove finger flexion right lg xl
|
$26.95 |
$26.95 |
$26.95 |
$69.99
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$443.39 |
$443.39 |
$443.39 |
$496.93
|
|
Glucose 1 hr post dose
|
$148.40 |
$148.40 |
$148.40 |
$46.28
|
|
Glucose blood quantitative
|
$64.75 |
$64.75 |
$64.75 |
$44.76
|
|
Glucose body fluid
|
$166.25 |
$166.25 |
$166.25 |
$50.70
|
|
Glucose tolerance test (gtt) 3 specimens
|
$257.95 |
$257.95 |
$257.95 |
$100.10
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$64.75 |
$64.75 |
$64.75 |
$34.45
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$33.90 |
$33.90 |
$33.90 |
$49.20
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$182.35 |
$182.35 |
$182.35 |
$110.04
|
|
Gonadotropin luteinizing hormone (lh)
|
$182.35 |
$182.35 |
$182.35 |
$123.75
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$2,052.75 |
$2,052.75 |
$2,052.75 |
$672.50
|
|
Graft axiofill 1000mg
|
$19,901.45 |
$19,901.45 |
$19,901.45 |
$3,591.00
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$16,032.49 |
$16,032.49 |
$16,032.49 |
$944.03
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$27,279.40 |
$27,279.40 |
$27,279.40 |
$27,279.40
|
|
Graft nerve adv 3-4x70mm
|
$46,027.63 |
$46,027.63 |
$46,027.63 |
$20,782.10
|
|
Graft patch felt ptfe 2x2
|
$31,998.58 |
$31,998.58 |
$31,998.58 |
$25,515.36
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$27,688.86 |
$27,688.86 |
$27,688.86 |
$1,366.45
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$7,541.10 |
$7,541.10 |
$7,541.10 |
$1,057.31
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$13,167.00 |
$13,167.00 |
$13,167.00 |
$765.06
|
|
Graft tis hmatrix dermis 10x5 -cost per sq cm
|
$2,610.56 |
$2,610.56 |
$2,610.56 |
$3,431.03
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$34,036.43 |
$34,036.43 |
$34,036.43 |
$35,824.13
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$4,063.50 |
$4,063.50 |
$4,063.50 |
$821.11
|
|
Graft xenmtrx sft rect 15x20cm
|
$46,981.90 |
$46,981.90 |
$46,981.90 |
$33,720.69
|
|
Graft xenmtrx sft rect 19x28cm
|
$2,677.50 |
$2,677.50 |
$2,677.50 |
$2,677.50
|
|
Granisetron 1 mg tab
|
$2.72 |
$2.72 |
$2.72 |
$62.30
|
|
Granisetron hcl injection
|
$67.85 |
$67.85 |
$67.85 |
$40.83
|
|
Great toe with reduction 28495
|
$189.00 |
$189.00 |
$189.00 |
$577.03
|
|
G-tube reposition
|
$296.10 |
$296.10 |
$296.10 |
$741.00
|
|
Gu dilat ureter/urethra s&i
|
$1,725.50 |
$1,725.50 |
$1,725.50 |
$1,793.00
|
|
Guided cath fluid drainage 10030
|
$856.10 |
$856.10 |
$856.10 |
$1,461.15
|
|
Guide endoanchr sg-64 aaa 62cm
|
$6,494.37 |
$6,494.37 |
$6,494.37 |
$7,499.50
|
|
Guide wire threaded 1.4x150mm
|
$3,836.25 |
$3,836.25 |
$3,836.25 |
$2,622.00
|
