|
Ghs IV thrombolytics - cerebral
|
$466.56 |
$466.56 |
$466.56 |
$657.60
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$382.08 |
$382.08 |
$382.08 |
$547.95
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$1,375.20 |
$1,375.20 |
$1,375.20 |
$617.60
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$1,375.20 |
$1,375.20 |
$1,375.20 |
$619.20
|
|
Ghs layer closure 2.5cm or less - 12051
|
$1,375.20 |
$1,375.20 |
$1,375.20 |
$648.00
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$1,375.20 |
$1,375.20 |
$1,375.20 |
$741.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$1,375.20 |
$1,375.20 |
$1,375.20 |
$741.00
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$1,375.20 |
$1,375.20 |
$1,375.20 |
$779.35
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$1,375.20 |
$1,375.20 |
$1,375.20 |
$810.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$1,375.20 |
$1,375.20 |
$1,375.20 |
$795.20
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$1,375.20 |
$1,375.20 |
$1,375.20 |
$779.35
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$1,375.20 |
$1,375.20 |
$1,375.20 |
$995.20
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$1,375.20 |
$1,375.20 |
$1,375.20 |
$879.60
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$1,375.20 |
$1,375.20 |
$1,375.20 |
$1,188.80
|
|
Ghs layered repair 20.1 - 30.0 cm -12056
|
$1,375.20 |
$1,375.20 |
$1,375.20 |
$1,030.80
|
|
Ghs layered repair over 30.0 cm -12047
|
$2,688.00 |
$2,688.00 |
$2,688.00 |
$2,024.70
|
|
Ghs layered repair over 3.0 cm -12057
|
$1,375.20 |
$1,375.20 |
$1,375.20 |
$1,064.98
|
|
Ghs mbp
|
$56.95 |
$56.95 |
$56.95 |
$74.19
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$225.60 |
$225.60 |
$225.60 |
$261.80
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$225.60 |
$225.60 |
$225.60 |
$252.50
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$225.60 |
$225.60 |
$225.60 |
$239.20
|
|
Ghs moderate sedation ea addtl 15 min
|
$188.64 |
$188.64 |
$188.64 |
$145.60
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$168.00 |
$168.00 |
$168.00 |
$140.00
|
|
Ghs myocardial strain img spckl track
|
$309.12 |
$309.12 |
$309.12 |
$503.85
|
|
Ghs nailbed repair/nail removal
|
$1,177.44 |
$1,177.44 |
$1,177.44 |
$808.80
|
|
Ghs nerve blk intercostal, ea addtl level
|
$1,636.80 |
$1,636.80 |
$1,636.80 |
$1,618.50
|
|
Ghs nerve blk intercostal, single level
|
$1,636.80 |
$1,636.80 |
$1,636.80 |
$1,230.80
|
|
Ghs nerve block axillary nerve
|
$548.64 |
$548.64 |
$548.64 |
$1,541.40
|
|
Ghs nerve block brachial plexus
|
$548.64 |
$548.64 |
$548.64 |
$1,768.00
|
|
Ghs nerve block celiac plexus
|
$3,060.48 |
$3,060.48 |
$3,060.48 |
$1,712.00
|
|
Ghs nerve block interscaline
|
$1,645.44 |
$1,645.44 |
$1,645.44 |
$1,607.45
|
|
Ghs nerve block lumbar or thoracic symp
|
$3,084.48 |
$3,084.48 |
$3,084.48 |
$2,042.60
|
|
Ghs nerve block sciatic nerve
|
$1,280.64 |
$1,280.64 |
$1,280.64 |
$1,636.80
|
|
Ghs ng placement w fluoro guidance
|
$404.64 |
$404.64 |
$404.64 |
$468.75
|
|
Ghs o2 saturation
|
$59.04 |
$59.04 |
$59.04 |
$72.45
|
|
Ghs o2 uptake rest & exercise
|
$782.88 |
$782.88 |
$782.88 |
$185.15
|
|
Ghs ob unlisted IV or art inj or infusion
|
$114.24 |
$114.24 |
$114.24 |
$86.19
|
|
Ghs opcc repair cvp without subq port
|
$2,804.16 |
$2,804.16 |
$2,804.16 |
$1,302.54
|
|
Ghs opcc repair cvp w subq port
|
$2,719.68 |
$2,719.68 |
$2,719.68 |
$2,430.56
|
|
Ghs ot sensory integrative tech/15min
|
$72.96 |
$72.96 |
$72.96 |
$101.05
|
|
Ghs pacing - transcutaneous
|
$1,712.16 |
$1,712.16 |
$1,712.16 |
$868.68
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$2,487.36 |
$2,487.36 |
$2,487.36 |
$855.60
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$3,504.48 |
$3,504.48 |
$3,504.48 |
$1,003.00
|
|
Ghs peritonsillar abscess i andd
|
$1,132.80 |
$1,132.80 |
$1,132.80 |
$694.20
|
|
Ghs picc line insert < 5
|
$3,084.48 |
$3,084.48 |
$3,084.48 |
$2,060.40
|
|
Ghs plngl fx pm cl
|
$547.20 |
$547.20 |
$547.20 |
$662.20
|
|
Ghs polysom <6 yrs 4/> parameters
|
$1,382.88 |
$1,382.88 |
$1,382.88 |
$3,705.80
|
|
Ghs pr without cont pulse ox
|
$105.60 |
$105.60 |
$105.60 |
$156.70
|
|
Ghs removal intranasal foreign body
|
$221.28 |
$221.28 |
$221.28 |
$324.35
|
|
Ghs removal pharyngeal foreign body
|
$337.44 |
$337.44 |
$337.44 |
$460.00
|
|
Ghs repair extensor tendon hand, ea tendon
|
$5,680.80 |
$5,680.80 |
$5,680.80 |
$2,211.05
|
|
Ghs repair tendon ext forearm/wrist ea
|
$4,885.44 |
$4,885.44 |
$4,885.44 |
$4,150.20
|
|
Ghs rsv eia (respir synctial vrs)
|
$144.00 |
$144.00 |
$144.00 |
$101.15
|
|
Ghs sedimentation rate
|
$6.24 |
$6.24 |
$6.24 |
$45.50
|
|
Ghs sensitivity (per antimicro)
|
$67.20 |
$67.20 |
$67.20 |
$59.90
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$1,056.48 |
$1,056.48 |
$1,056.48 |
$590.40
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$1,056.48 |
$1,056.48 |
$1,056.48 |
$705.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$1,056.48 |
$1,056.48 |
$1,056.48 |
$670.08
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$731.04 |
$731.04 |
$731.04 |
$585.90
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$1,056.48 |
$1,056.48 |
$1,056.48 |
$487.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$1,056.48 |
$1,056.48 |
$1,056.48 |
$470.47
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$1,056.48 |
$1,056.48 |
$1,056.48 |
$538.64
|
|
Ghs simple repair over 30 cm - 12007
|
$1,056.48 |
$1,056.48 |
$1,056.48 |
$660.00
|
|
Ghs simple repair over 30 cm - 12018
|
$1,056.48 |
$1,056.48 |
$1,056.48 |
$589.18
|
|
Ghs somatosensory testing lower extremit
|
$530.40 |
$530.40 |
$530.40 |
$947.48
|
|
Ghs sphenopalatine ganglion block
|
$740.16 |
$740.16 |
$740.16 |
$706.56
|
|
Ghs sp train/fitting sp device - kx
|
$290.88 |
$290.88 |
$290.88 |
$261.95
|
|
Ghs strapping shoulder - 29240
|
$338.88 |
$338.88 |
$338.88 |
$243.07
|
|
Ghs st - re-eval for alt comm
|
$305.76 |
$305.76 |
$305.76 |
$309.00
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$114.24 |
$114.24 |
$114.24 |
$93.75
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$252.96 |
$252.96 |
$252.96 |
$351.45
|
|
Ghs superficial wnd dehiscence simp12020
|
$1,512.48 |
$1,512.48 |
$1,512.48 |
$976.98
|
|
Ghs superficial wnd dehis w packing12021
|
$1,375.20 |
$1,375.20 |
$1,375.20 |
$761.28
|
|
Ghs tracheostomy emergency - transtracheal
|
$2,244.48 |
$2,244.48 |
$2,244.48 |
$2,225.73
|
|
Ghs tx distal phalangeal fx with manipulation
|
$618.24 |
$618.24 |
$618.24 |
$591.00
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$547.20 |
$547.20 |
$547.20 |
$540.00
|
|
Ghs urine, porphyrins quant
|
$63.00 |
$63.00 |
$63.00 |
$70.20
|
|
Ghs vaginal delivery only
|
$5,116.32 |
$5,116.32 |
$5,116.32 |
$3,525.06
|
|
Ghs veeg 12-26 hr intmt mont
|
$1,504.80 |
$1,504.80 |
$1,504.80 |
$1,843.00
|
|
Ghs windowing of cast
|
$324.48 |
$324.48 |
$324.48 |
$204.00
|
|
Gi inhouse confirmation
|
$129.12 |
$129.12 |
$129.12 |
$87.00
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$815.52 |
$815.52 |
$815.52 |
$2,382.90
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$379.92 |
$379.92 |
$379.92 |
$496.93
|
|
Glucagon plasma - sendout
|
$65.24 |
$65.24 |
$65.24 |
$58.56
|
|
Glucose 1 hr post dose
|
$89.28 |
$89.28 |
$89.28 |
$46.28
|
|
Glucose blood quantitative
|
$61.92 |
$61.92 |
$61.92 |
$44.76
|
|
Glucose body fluid
|
$59.04 |
$59.04 |
$59.04 |
$50.70
|
|
Glucose tolerance test (gtt) 3 specimens
|
$59.04 |
$59.04 |
$59.04 |
$100.10
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$59.04 |
$59.04 |
$59.04 |
$34.45
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$44.76 |
$44.76 |
$44.76 |
$49.20
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$103.68 |
$103.68 |
$103.68 |
$110.04
|
|
Gonadotropin luteinizing hormone (lh)
|
$103.68 |
$103.68 |
$103.68 |
$123.75
|
|
Goserelin 10.8 mg subcutaneous implant
|
$1,690.91 |
$1,690.91 |
$1,690.91 |
$3,358.00
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$3,384.36 |
$3,384.36 |
$3,384.36 |
$672.50
|
|
Graft axiofill 1000mg
|
$27,504.00 |
$27,504.00 |
$27,504.00 |
$3,591.00
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$25,774.72 |
$25,774.72 |
$25,774.72 |
$944.03
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$43,722.17 |
$43,722.17 |
$43,722.17 |
$27,279.40
|
|
Graft nerve adv 3-4x70mm
|
$57,600.00 |
$57,600.00 |
$57,600.00 |
$20,782.10
|
|
Graft patch felt ptfe 2x2
|
$51,285.84 |
$51,285.84 |
$51,285.84 |
$25,515.36
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$44,378.43 |
$44,378.43 |
$44,378.43 |
$1,366.45
|
