|
Ghs moderate sedation < 5 yr, 30 min
|
$1,512.15 |
$1,512.15 |
$1,512.15 |
$261.80
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$955.76 |
$955.76 |
$955.76 |
$252.50
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$1,444.33 |
$1,444.33 |
$1,444.33 |
$239.20
|
|
Ghs moderate sedation ea addtl 15 min
|
$405.80 |
$405.80 |
$405.80 |
$145.60
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$498.41 |
$498.41 |
$498.41 |
$140.00
|
|
Ghs musc test done w/n test comp
|
$511.94 |
$511.94 |
$511.94 |
$349.80
|
|
Ghs musc tst done w/nerv tst lim
|
$419.91 |
$419.91 |
$419.91 |
$269.15
|
|
Ghs musc tst done w/n tst non ext
|
$442.64 |
$442.64 |
$442.64 |
$222.60
|
|
Ghs myocardial strain img spckl track
|
$663.26 |
$663.26 |
$663.26 |
$503.85
|
|
Ghs nailbed repair/nail removal
|
$2,025.45 |
$2,025.45 |
$2,025.45 |
$808.80
|
|
Ghs nerve blk intercostal, single level
|
$1,876.88 |
$1,876.88 |
$1,876.88 |
$1,230.80
|
|
Ghs nerve block axillary nerve
|
$2,882.49 |
$2,882.49 |
$2,882.49 |
$1,541.40
|
|
Ghs nerve block brachial plexus
|
$2,882.49 |
$2,882.49 |
$2,882.49 |
$1,768.00
|
|
Ghs nerve block celiac plexus
|
$9,323.14 |
$9,323.14 |
$9,323.14 |
$1,712.00
|
|
Ghs nerve block interscaline
|
$2,845.74 |
$2,845.74 |
$2,845.74 |
$1,607.45
|
|
Ghs nerve block lumbar or thoracic symp
|
$3,359.06 |
$3,359.06 |
$3,359.06 |
$2,042.60
|
|
Ghs nerve block sciatic nerve
|
$1,876.88 |
$1,876.88 |
$1,876.88 |
$1,636.80
|
|
Ghs nerve block suprascapular
|
$1,876.88 |
$1,876.88 |
$1,876.88 |
$1,223.00
|
|
Ghs ng placement w fluoro guidance
|
$1,177.06 |
$1,177.06 |
$1,177.06 |
$468.75
|
|
Ghs o2 saturation
|
$150.80 |
$150.80 |
$150.80 |
$72.45
|
|
Ghs opcc repair cvp without subq port
|
$6,317.82 |
$6,317.82 |
$6,317.82 |
$1,302.54
|
|
Ghs opcc repair cvp w subq port
|
$12,975.70 |
$12,975.70 |
$12,975.70 |
$2,430.56
|
|
Ghs ot group caregiver training
|
$36.65 |
$36.65 |
$36.65 |
$43.20
|
|
Ghs ot sensory integrative tech/15min
|
$248.29 |
$248.29 |
$248.29 |
$101.05
|
|
Ghs pacing - transcutaneous
|
$2,623.71 |
$2,623.71 |
$2,623.71 |
$868.68
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$201.01 |
$201.01 |
$201.01 |
$90.15
|
|
Ghs peritonsillar abscess i andd
|
$2,553.81 |
$2,553.81 |
$2,553.81 |
$694.20
|
|
Ghs phenylketonurid
|
$82.09 |
$82.09 |
$82.09 |
$51.58
|
|
Ghs picc line insert < 5
|
$12,975.70 |
$12,975.70 |
$12,975.70 |
$2,060.40
|
|
Ghs plngl fx pm cl
|
$2,536.71 |
$2,536.71 |
$2,536.71 |
$662.20
|
|
Ghs polysom <6 yrs 4/> parameters
|
$4,713.25 |
$4,713.25 |
$4,713.25 |
$3,705.80
|
|
Ghs ppd (tb intradermal)
|
$356.84 |
$356.84 |
$356.84 |
$43.45
|
|
Ghs prostatic acid phosphatase (mayo)
|
$149.10 |
$149.10 |
$149.10 |
$40.56
|
|
Ghs protoporphyrins fract
|
$221.50 |
$221.50 |
$221.50 |
$64.35
|
|
Ghs pr without cont pulse ox
|
$350.07 |
$350.07 |
$350.07 |
$156.70
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$189.08 |
$189.08 |
$189.08 |
$45.05
|
|
Ghs pt - work hardening/int 2hrs
|
$425.13 |
$425.13 |
$425.13 |
$255.60
|
|
Ghs removal intranasal foreign body
|
$1,252.04 |
$1,252.04 |
$1,252.04 |
$324.35
|
|
Ghs removal pharyngeal foreign body
|
$1,177.06 |
$1,177.06 |
$1,177.06 |
$460.00
|
|
Ghs reticulocyte count
|
$66.53 |
$66.53 |
$66.53 |
$33.57
|
|
Ghs rsv eia (respir synctial vrs)
|
$505.17 |
$505.17 |
$505.17 |
$101.15
|
|
Ghs sensitivity (per antimicro)
|
$129.71 |
$129.71 |
$129.71 |
$59.90
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$2,827.66 |
$2,827.66 |
$2,827.66 |
$590.40
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$4,765.88 |
$4,765.88 |
$4,765.88 |
$705.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$3,457.14 |
$3,457.14 |
$3,457.14 |
$670.08
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$2,801.99 |
$2,801.99 |
$2,801.99 |
$487.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$2,198.18 |
$2,198.18 |
$2,198.18 |
$470.47
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$3,514.99 |
$3,514.99 |
$3,514.99 |
$538.64
|
|
Ghs simple repair over 30 cm - 12007
|
$4,296.44 |
$4,296.44 |
$4,296.44 |
$660.00
|
|
Ghs somatosensory testing lower extremit
|
$3,044.60 |
$3,044.60 |
$3,044.60 |
$947.48
|
|
Ghs somatosensory testing upper & lower limbs
|
$5,921.18 |
$5,921.18 |
$5,921.18 |
$1,435.00
|
|
Ghs sphenopalatine ganglion block
|
$432.38 |
$432.38 |
$432.38 |
$706.56
|
|
Ghs sp train/fitting sp device - kx
|
$432.87 |
$432.87 |
$432.87 |
$261.95
|
|
Ghs strapping shoulder - 29240
|
$1,252.04 |
$1,252.04 |
$1,252.04 |
$243.07
|
|
Ghs st - re-eval for alt comm
|
$533.81 |
$533.81 |
$533.81 |
$309.00
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$329.02 |
$329.02 |
$329.02 |
$351.45
|
|
Ghs superficial wnd dehiscence simp12020
|
$6,289.69 |
$6,289.69 |
$6,289.69 |
$976.98
|
|
Ghs superficial wnd dehis w packing12021
|
$4,243.77 |
$4,243.77 |
$4,243.77 |
$761.28
|
|
Ghs tracheostomy emergency - transtracheal
|
$4,910.50 |
$4,910.50 |
$4,910.50 |
$2,225.73
|
|
Ghs tx distal phalangeal fx with manipulation
|
$2,536.71 |
$2,536.71 |
$2,536.71 |
$591.00
|
|
Ghs urine, porphyrins quant
|
$227.05 |
$227.05 |
$227.05 |
$70.20
|
|
Ghs vaginal delivery only
|
$11,100.44 |
$11,100.44 |
$11,100.44 |
$3,525.06
|
|
Ghs veeg 12-26 hr intmt mont
|
$1,908.85 |
$1,908.85 |
$1,908.85 |
$1,843.00
|
|
Giardia lamblia antibody
|
$227.20 |
$227.20 |
$227.20 |
$81.60
|
|
Gi inhouse confirmation
|
$297.14 |
$297.14 |
$297.14 |
$87.00
|
|
Glucagon plasma - sendout
|
$220.56 |
$220.56 |
$220.56 |
$58.56
|
|
Glucose 1 hr post dose
|
$73.32 |
$73.32 |
$73.32 |
$46.28
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$50.63 |
$50.63 |
$50.63 |
$22.00
|
|
Glucose blood quantitative
|
$66.62 |
$66.62 |
$66.62 |
$44.76
|
|
Glucose body fluid
|
$278.39 |
$278.39 |
$278.39 |
$50.70
|
|
Glucose tolerance test (gtt) 3 specimens
|
$440.69 |
$440.69 |
$440.69 |
$100.10
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$60.50 |
$60.50 |
$60.50 |
$34.45
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$184.43 |
$184.43 |
$184.43 |
$56.70
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$8,891.95 |
$8,891.95 |
$8,891.95 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$93.35 |
$93.35 |
$93.35 |
$110.04
|
|
Gonadotropin luteinizing hormone (lh)
|
$142.05 |
$142.05 |
$142.05 |
$123.75
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$180.29 |
$180.29 |
$180.29 |
$2,648.81
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$507.05 |
$507.05 |
$507.05 |
$1,679.75
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$293.05 |
$293.05 |
$293.05 |
$25,762.70
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$338.03 |
$338.03 |
$338.03 |
$10,989.38
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$811.26 |
$811.26 |
$811.26 |
$1,560.21
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$689.57 |
$689.57 |
$689.57 |
$2,369.10
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$196.06 |
$196.06 |
$196.06 |
$336.78
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$238.40 |
$238.40 |
$238.40 |
$35,824.13
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$730.14 |
$730.14 |
$730.14 |
$3,070.00
|
|
Great toe with reduction 28495
|
$2,536.71 |
$2,536.71 |
$2,536.71 |
$577.03
|
|
Guided cath fluid drainage 10030
|
$5,322.16 |
$5,322.16 |
$5,322.16 |
$1,461.15
|
|
Guid loc target vol rad tx
|
$483.51 |
$483.51 |
$483.51 |
$503.80
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$318.19 |
$318.19 |
$318.19 |
$112.36
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$42.11 |
$42.11 |
$42.11 |
$35.40
|
|
Hand X-ray
|
$1,231.66 |
$1,231.66 |
$1,231.66 |
$338.58
|
|
Haptoglobin quantitative
|
$194.18 |
$194.18 |
$194.18 |
$89.95
|
|
Hast w/i&r phys/qhp
|
$1,252.04 |
$1,252.04 |
$1,252.04 |
$301.95
|
|
Hast w/oxygen titrate
|
$1,252.04 |
$1,252.04 |
$1,252.04 |
$310.40
|
|
Hba1/hba2 full gene sequence
|
$2,100.00 |
$2,100.00 |
$2,100.00 |
$777.60
|
|
Hba1/hba2 gene dup/del vrnts
|
$3,124.04 |
$3,124.04 |
$3,124.04 |
$406.25
|
|
Hbb full gene sequence
|
$1,519.50 |
$1,519.50 |
$1,519.50 |
$633.25
|
|
Hcg qualitative
|
$400.94 |
$400.94 |
$400.94 |
$77.50
|
|
Hcg quantitative
|
$367.62 |
$367.62 |
$367.62 |
$124.80
|
|
Hc metata joint dislocation anes
|
$16,347.39 |
$16,347.39 |
$16,347.39 |
$2,423.85
|
