|
Ghs inj transforaminal cerv ea add bil
|
$725.90 |
$725.90 |
$725.90 |
$1,126.23
|
|
Ghs inj transforaminal cerv single bil
|
$1,199.10 |
$1,199.10 |
$1,199.10 |
$1,861.60
|
|
Ghs insertion of needle - bone
|
$356.65 |
$356.65 |
$356.65 |
$461.58
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$593.25 |
$593.25 |
$593.25 |
$943.80
|
|
Ghs intermed repair 20.1 - 30.0 cm-12036
|
$593.25 |
$593.25 |
$593.25 |
$1,160.28
|
|
Ghs intermed repair over 30 cm - 12037
|
$2,854.60 |
$2,854.60 |
$2,854.60 |
$2,164.64
|
|
Ghs intro needle/intracath vein - 36000
|
$77.00 |
$77.00 |
$77.00 |
$213.75
|
|
Ghs irrigate corpora cavernosa for priapism
|
$310.45 |
$310.45 |
$310.45 |
$637.92
|
|
Ghs IV thrombolytics - cerebral
|
$148.75 |
$148.75 |
$148.75 |
$657.60
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$506.45 |
$506.45 |
$506.45 |
$547.95
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$576.45 |
$576.45 |
$576.45 |
$617.60
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$576.45 |
$576.45 |
$576.45 |
$619.20
|
|
Ghs layer closure 2.5cm or less - 12051
|
$576.45 |
$576.45 |
$576.45 |
$648.00
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$576.45 |
$576.45 |
$576.45 |
$741.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$576.45 |
$576.45 |
$576.45 |
$741.00
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$576.45 |
$576.45 |
$576.45 |
$779.35
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$593.25 |
$593.25 |
$593.25 |
$810.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$872.55 |
$872.55 |
$872.55 |
$795.20
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$576.45 |
$576.45 |
$576.45 |
$779.35
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$872.55 |
$872.55 |
$872.55 |
$995.20
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$576.45 |
$576.45 |
$576.45 |
$879.60
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$680.40 |
$680.40 |
$680.40 |
$1,188.80
|
|
Ghs layered repair 20.1 - 30.0 cm -12056
|
$675.85 |
$675.85 |
$675.85 |
$1,030.80
|
|
Ghs layered repair over 30.0 cm -12047
|
$2,292.50 |
$2,292.50 |
$2,292.50 |
$2,024.70
|
|
Ghs layered repair over 3.0 cm -12057
|
$675.85 |
$675.85 |
$675.85 |
$1,064.98
|
|
Ghs low level laser therapy
|
$35.70 |
$35.70 |
$35.70 |
$106.00
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$161.70 |
$161.70 |
$161.70 |
$261.80
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$161.70 |
$161.70 |
$161.70 |
$252.50
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$161.70 |
$161.70 |
$161.70 |
$239.20
|
|
Ghs moderate sedation ea addtl 15 min
|
$161.70 |
$161.70 |
$161.70 |
$145.60
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$129.50 |
$129.50 |
$129.50 |
$140.00
|
|
Ghs myocardial strain img spckl track
|
$301.35 |
$301.35 |
$301.35 |
$503.85
|
|
Ghs nailbed repair/nail removal
|
$872.55 |
$872.55 |
$872.55 |
$808.80
|
|
Ghs nerve blk intercostal, ea addtl level
|
$1,160.60 |
$1,160.60 |
$1,160.60 |
$1,618.50
|
|
Ghs nerve blk intercostal, single level
|
$1,057.70 |
$1,057.70 |
$1,057.70 |
$1,230.80
|
|
Ghs nerve block axillary nerve
|
$1,160.60 |
$1,160.60 |
$1,160.60 |
$1,541.40
|
|
Ghs nerve block brachial plexus
|
$1,371.30 |
$1,371.30 |
$1,371.30 |
$1,768.00
|
|
Ghs nerve block celiac plexus
|
$1,160.60 |
$1,160.60 |
$1,160.60 |
$1,712.00
|
|
Ghs nerve block interscaline
|
$1,160.60 |
$1,160.60 |
$1,160.60 |
$1,607.45
|
|
Ghs nerve block sciatic nerve
|
$1,057.70 |
$1,057.70 |
$1,057.70 |
$1,636.80
|
|
Ghs ng placement w fluoro guidance
|
$488.25 |
$488.25 |
$488.25 |
$468.75
|
|
Ghs o2 saturation
|
$294.35 |
$294.35 |
$294.35 |
$72.45
|
|
Ghs opcc repair cvp without subq port
|
$994.35 |
$994.35 |
$994.35 |
$1,302.54
|
|
Ghs opcc repair cvp w subq port
|
$1,317.40 |
$1,317.40 |
$1,317.40 |
$2,430.56
|
|
Ghs ot prosthetic training/15 min
|
$74.20 |
$74.20 |
$74.20 |
$92.35
|
|
Ghs ot sensory integrative tech/15min
|
$65.10 |
$65.10 |
$65.10 |
$101.05
|
|
Ghs pacing - transcutaneous
|
$1,878.80 |
$1,878.80 |
$1,878.80 |
$868.68
|
|
Ghs peritonsillar abscess i andd
|
$473.20 |
$473.20 |
$473.20 |
$694.20
|
|
Ghs phenylketonurid
|
$5.25 |
$5.25 |
$5.25 |
$51.58
|
|
Ghs picc line insert < 5
|
$2,041.20 |
$2,041.20 |
$2,041.20 |
$2,060.40
|
|
Ghs plngl fx pm cl
|
$675.85 |
$675.85 |
$675.85 |
$662.20
|
|
Ghs refill of implantable pump
|
$1,175.65 |
$1,175.65 |
$1,175.65 |
$539.13
|
|
Ghs removal intranasal foreign body
|
$280.35 |
$280.35 |
$280.35 |
$324.35
|
|
Ghs removal pharyngeal foreign body
|
$591.15 |
$591.15 |
$591.15 |
$460.00
|
|
Ghs repair extensor tendon hand, ea tendon
|
$1,763.65 |
$1,763.65 |
$1,763.65 |
$2,211.05
|
|
Ghs repair tendon ext forearm/wrist ea
|
$3,490.55 |
$3,490.55 |
$3,490.55 |
$4,150.20
|
|
Ghs rsv eia (respir synctial vrs)
|
$83.30 |
$83.30 |
$83.30 |
$101.15
|
|
Ghs sensitivity (per antimicro)
|
$88.55 |
$88.55 |
$88.55 |
$59.90
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$326.90 |
$326.90 |
$326.90 |
$590.40
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$408.80 |
$408.80 |
$408.80 |
$705.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$408.80 |
$408.80 |
$408.80 |
$670.08
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$510.65 |
$510.65 |
$510.65 |
$585.90
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$261.45 |
$261.45 |
$261.45 |
$487.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$261.45 |
$261.45 |
$261.45 |
$470.47
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$326.90 |
$326.90 |
$326.90 |
$538.64
|
|
Ghs simple repair over 30 cm - 12007
|
$510.65 |
$510.65 |
$510.65 |
$660.00
|
|
Ghs simple repair over 30 cm - 12018
|
$638.40 |
$638.40 |
$638.40 |
$589.18
|
|
Ghs somatosensory testing lower extremit
|
$1,024.45 |
$1,024.45 |
$1,024.45 |
$947.48
|
|
Ghs somatosensory testing upper & lower limbs
|
$1,793.05 |
$1,793.05 |
$1,793.05 |
$1,435.00
|
|
Ghs speech-gen aug dev eval iii, st
|
$113.75 |
$113.75 |
$113.75 |
$124.80
|
|
Ghs sphenopalatine ganglion block
|
$375.20 |
$375.20 |
$375.20 |
$706.56
|
|
Ghs sp train/fitting sp device - kx
|
$236.60 |
$236.60 |
$236.60 |
$261.95
|
|
Ghs strapping shoulder - 29240
|
$203.35 |
$203.35 |
$203.35 |
$243.07
|
|
Ghs st - re-eval for alt comm
|
$71.75 |
$71.75 |
$71.75 |
$309.00
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$83.30 |
$83.30 |
$83.30 |
$93.75
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$139.65 |
$139.65 |
$139.65 |
$351.45
|
|
Ghs superficial wnd dehiscence simp12020
|
$1,186.15 |
$1,186.15 |
$1,186.15 |
$976.98
|
|
Ghs superficial wnd dehis w packing12021
|
$661.50 |
$661.50 |
$661.50 |
$761.28
|
|
Ghs tracheostomy emergency - transtracheal
|
$1,227.10 |
$1,227.10 |
$1,227.10 |
$2,225.73
|
|
Ghs tx distal phalangeal fx with manipulation
|
$675.85 |
$675.85 |
$675.85 |
$591.00
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$497.00 |
$497.00 |
$497.00 |
$540.00
|
|
Ghs vaginal delivery only
|
$2,732.10 |
$2,732.10 |
$2,732.10 |
$3,525.06
|
|
Ghs veeg 12-26 hr intmt mont
|
$1,437.45 |
$1,437.45 |
$1,437.45 |
$1,843.00
|
|
Ghs windowing of cast
|
$163.10 |
$163.10 |
$163.10 |
$204.00
|
|
Gi inhouse confirmation
|
$273.35 |
$273.35 |
$273.35 |
$87.00
|
|
Glucagon 1 mg solution for injection
|
$623.51 |
$623.51 |
$623.51 |
$655.20
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$772.47 |
$772.47 |
$772.47 |
$496.93
|
|
Glucose 1 hr post dose
|
$112.35 |
$112.35 |
$112.35 |
$46.28
|
|
Glucose-6-phosphate dhydrogenase screen
|
$134.75 |
$134.75 |
$134.75 |
$45.34
|
|
Glucose blood quantitative
|
$97.30 |
$97.30 |
$97.30 |
$44.76
|
|
Glucose body fluid
|
$89.95 |
$89.95 |
$89.95 |
$50.70
|
|
Glucose tolerance test (gtt) 3 specimens
|
$218.40 |
$218.40 |
$218.40 |
$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
|
$33.20 |
$33.20 |
$33.20 |
$49.20
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$7,179.63 |
$7,179.63 |
$7,179.63 |
$4,880.83
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$89.25 |
$89.25 |
$89.25 |
$110.04
|
|
Gonadotropin luteinizing hormone (lh)
|
$89.25 |
$89.25 |
$89.25 |
$123.75
|
|
Goserelin 10.8 mg subcutaneous implant
|
$11,127.94 |
$11,127.94 |
$11,127.94 |
$3,358.00
|
|
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
|