|
Ghs mbp
|
$3.06 |
$3.06 |
$3.06 |
$75.50
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$165.60 |
$165.60 |
$165.60 |
$242.64
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$157.80 |
$157.80 |
$157.80 |
$228.45
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$165.60 |
$165.60 |
$165.60 |
$230.55
|
|
Ghs moderate sedation ea addtl 15 min
|
$75.00 |
$75.00 |
$75.00 |
$150.00
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$165.60 |
$165.60 |
$165.60 |
$141.00
|
|
Ghs musc test done w/n test comp
|
$48.20 |
$48.20 |
$48.20 |
$324.80
|
|
Ghs musc tst done w/nerv tst lim
|
$31.20 |
$31.20 |
$31.20 |
$272.25
|
|
Ghs musc tst done w/n tst non ext
|
$42.00 |
$42.00 |
$42.00 |
$184.80
|
|
Ghs myocardial strain img spckl track
|
$128.60 |
$128.60 |
$128.60 |
$444.60
|
|
Ghs nailbed repair/nail removal
|
$173.20 |
$173.20 |
$173.20 |
$724.37
|
|
Ghs nerve blk intercostal, ea addtl level
|
$26.20 |
$26.20 |
$26.20 |
$1,545.05
|
|
Ghs nerve blk intercostal, single level
|
$69.60 |
$69.60 |
$69.60 |
$1,121.00
|
|
Ghs nerve block axillary nerve
|
$114.60 |
$114.60 |
$114.60 |
$1,540.00
|
|
Ghs nerve block brachial plexus
|
$94.40 |
$94.40 |
$94.40 |
$1,695.24
|
|
Ghs nerve block celiac plexus
|
$65.60 |
$65.60 |
$65.60 |
$1,556.40
|
|
Ghs nerve block interscaline
|
$53.00 |
$53.00 |
$53.00 |
$1,526.09
|
|
Ghs nerve block lumbar or thoracic symp
|
$163.40 |
$163.40 |
$163.40 |
$1,671.75
|
|
Ghs nerve block sciatic nerve
|
$111.40 |
$111.40 |
$111.40 |
$1,450.80
|
|
Ghs nerve block suprascapular
|
$60.40 |
$60.40 |
$60.40 |
$1,183.50
|
|
Ghs ng placement w fluoro guidance
|
$350.00 |
$350.00 |
$350.00 |
$478.50
|
|
Ghs o2 saturation
|
$40.80 |
$40.80 |
$40.80 |
$69.50
|
|
Ghs o2 uptake rest & exercise
|
$6.00 |
$6.00 |
$6.00 |
$239.05
|
|
Ghs opcc repair cvp without subq port
|
$22.40 |
$22.40 |
$22.40 |
$1,229.24
|
|
Ghs opcc repair cvp w subq port
|
$122.60 |
$122.60 |
$122.60 |
$2,194.40
|
|
Ghs optokenetic
|
$15.60 |
$15.60 |
$15.60 |
$211.20
|
|
Ghs oscillating trac
|
$15.60 |
$15.60 |
$15.60 |
$291.75
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$15.80 |
$15.80 |
$15.80 |
$58.00
|
|
Ghs osteopathic manipulative tx, 3-4 regions
|
$22.80 |
$22.80 |
$22.80 |
$64.50
|
|
Ghs ot prosthetic training/15 min
|
$37.40 |
$37.40 |
$37.40 |
$92.35
|
|
Ghs ot sensory integrative tech/15min
|
$40.00 |
$40.00 |
$40.00 |
$96.00
|
|
Ghs pacing - transcutaneous
|
$445.40 |
$445.40 |
$445.40 |
$822.00
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$172.60 |
$172.60 |
$172.60 |
$809.67
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$35.20 |
$35.20 |
$35.20 |
$962.00
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$4.74 |
$4.74 |
$4.74 |
$75.00
|
|
Ghs peritonsillar abscess i andd
|
$136.80 |
$136.80 |
$136.80 |
$545.40
|
|
Ghs picc line insert < 5
|
$61.00 |
$61.00 |
$61.00 |
$1,996.00
|
|
Ghs plngl fx pm cl
|
$253.20 |
$253.20 |
$253.20 |
$564.50
|
|
Ghs polysom <6 yrs 4/> parameters
|
$509.00 |
$509.00 |
$509.00 |
$3,557.58
|
|
Ghs pos nystagmus
|
$15.60 |
$15.60 |
$15.60 |
$229.10
|
|
Ghs ppd (tb intradermal)
|
$33.80 |
$33.80 |
$33.80 |
$37.44
|
|
Ghs prostatic acid phosphatase (mayo)
|
$1.72 |
$1.72 |
$1.72 |
$43.55
|
|
Ghs protoporphyrins fract
|
$2.55 |
$2.55 |
$2.55 |
$60.75
|
|
Ghs pr without cont pulse ox
|
$8.60 |
$8.60 |
$8.60 |
$146.86
|
|
Ghs refill of implantable pump
|
$45.80 |
$45.80 |
$45.80 |
$539.13
|
|
Ghs removal intranasal foreign body
|
$149.60 |
$149.60 |
$149.60 |
$283.51
|
|
Ghs removal pharyngeal foreign body
|
$145.60 |
$145.60 |
$145.60 |
$436.10
|
|
Ghs repair extensor tendon hand, ea tendon
|
$430.40 |
$430.40 |
$430.40 |
$2,408.00
|
|
Ghs repair tendon ext forearm/wrist ea
|
$354.20 |
$354.20 |
$354.20 |
$4,108.00
|
|
Ghs reticulocyte count
|
$23.60 |
$23.60 |
$23.60 |
$35.40
|
|
Ghs sedimentation rate
|
$30.20 |
$30.20 |
$30.20 |
$45.50
|
|
Ghs semen analysis fert
|
$67.80 |
$67.80 |
$67.80 |
$124.80
|
|
Ghs semen analysis, post-vas
|
$7.80 |
$7.80 |
$7.80 |
$32.37
|
|
Ghs sensitivity (per antimicro)
|
$24.00 |
$24.00 |
$24.00 |
$56.40
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$123.20 |
$123.20 |
$123.20 |
$563.75
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$152.60 |
$152.60 |
$152.60 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$142.40 |
$142.40 |
$142.40 |
$575.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$100.00 |
$100.00 |
$100.00 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$99.00 |
$99.00 |
$99.00 |
$451.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$1,220.60 |
$1,220.60 |
$1,220.60 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$120.00 |
$120.00 |
$120.00 |
$492.00
|
|
Ghs simple repair over 30 cm - 12007
|
$158.00 |
$158.00 |
$158.00 |
$584.00
|
|
Ghs simple repair over 30 cm - 12018
|
$113.20 |
$113.20 |
$113.20 |
$537.60
|
|
Ghs sleep study unattended
|
$19.00 |
$19.00 |
$19.00 |
$503.38
|
|
Ghs speech-gen aug dev eval iii, st
|
$39.80 |
$39.80 |
$39.80 |
$161.76
|
|
Ghs sphenopalatine ganglion block
|
$152.20 |
$152.20 |
$152.20 |
$616.00
|
|
Ghs spont nystagmus
|
$15.60 |
$15.60 |
$15.60 |
$228.00
|
|
Ghs sp train/fitting sp device - kx
|
$164.80 |
$164.80 |
$164.80 |
$249.60
|
|
Ghs st - eval for alt comm
|
$15.60 |
$15.60 |
$15.60 |
$94.60
|
|
Ghs strapping shoulder - 29240
|
$21.00 |
$21.00 |
$21.00 |
$217.60
|
|
Ghs st - re-eval for alt comm
|
$55.60 |
$55.60 |
$55.60 |
$309.00
|
|
Ghs superficial wnd dehiscence simp12020
|
$714.00 |
$714.00 |
$714.00 |
$909.00
|
|
Ghs superficial wnd dehis w packing12021
|
$124.20 |
$124.20 |
$124.20 |
$692.80
|
|
Ghs tracheostomy emergency - transtracheal
|
$212.00 |
$212.00 |
$212.00 |
$1,752.89
|
|
Ghs tx distal phalangeal fx with manipulation
|
$239.00 |
$239.00 |
$239.00 |
$525.60
|
|
Ghs vaginal delivery only
|
$521.40 |
$521.40 |
$521.40 |
$3,338.40
|
|
Ghs windowing of cast
|
$46.00 |
$46.00 |
$46.00 |
$212.55
|
|
Gi inhouse confirmation
|
$41.00 |
$41.00 |
$41.00 |
$86.40
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$365.80 |
$365.80 |
$365.80 |
$2,195.76
|
|
Glucagon 1 mg solution for injection
|
$90.20 |
$90.20 |
$90.20 |
$601.79
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$340.64 |
$340.64 |
$340.64 |
$491.67
|
|
Glucagon plasma - sendout
|
$2.54 |
$2.54 |
$2.54 |
$63.20
|
|
Glucose 1 hr post dose
|
$24.40 |
$24.40 |
$24.40 |
$48.25
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$19.00 |
$19.00 |
$19.00 |
$22.75
|
|
Glucose blood quantitative
|
$20.20 |
$20.20 |
$20.20 |
$41.40
|
|
Glucose body fluid
|
$22.80 |
$22.80 |
$22.80 |
$51.30
|
|
Glucose monitoring continual min 72hr pt
|
$34.60 |
$34.60 |
$34.60 |
$126.80
|
|
Glucose tolerance test (gtt) 3 specimens
|
$91.20 |
$91.20 |
$91.20 |
$104.50
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$14.60 |
$14.60 |
$14.60 |
$36.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$40.40 |
$40.40 |
$40.40 |
$37.16
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$1,439.42 |
$1,439.42 |
$1,439.42 |
$4,977.60
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$47.00 |
$47.00 |
$47.00 |
$115.80
|
|
Gonadotropin luteinizing hormone (lh)
|
$68.40 |
$68.40 |
$68.40 |
$129.00
|
|
Gonioscopy
|
$38.60 |
$38.60 |
$38.60 |
$135.52
|
|
Goniotomy
|
$577.20 |
$577.20 |
$577.20 |
$4,456.60
|
|
Goserelin 10.8 mg subcutaneous implant
|
$360.80 |
$360.80 |
$360.80 |
$4,496.37
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$33.80 |
$33.80 |
$33.80 |
$143.50
|
|
Graft axiofill 1000mg
|
$60.90 |
$60.90 |
$60.90 |
$5,125.68
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$448.80 |
$448.80 |
$448.80 |
$601.50
|
|
Graft hand or finger tendon
|
$648.40 |
$648.40 |
$648.40 |
$3,839.54
|
