|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$474.50 |
$474.50 |
$474.50 |
$233.28
|
|
Ghs moderate sedation ea addtl 15 min
|
$224.25 |
$224.25 |
$224.25 |
$150.00
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$325.00 |
$325.00 |
$325.00 |
$142.40
|
|
Ghs musc test done w/n test comp
|
$1,191.45 |
$1,191.45 |
$1,191.45 |
$331.20
|
|
Ghs musc tst done w/nerv tst lim
|
$809.90 |
$809.90 |
$809.90 |
$272.48
|
|
Ghs musc tst done w/n tst non ext
|
$656.50 |
$656.50 |
$656.50 |
$184.80
|
|
Ghs myocardial strain img spckl track
|
$68.90 |
$68.90 |
$68.90 |
$457.80
|
|
Ghs nailbed repair/nail removal
|
$1,491.75 |
$1,491.75 |
$1,491.75 |
$724.37
|
|
Ghs nerve blk intercostal, ea addtl level
|
$143.00 |
$143.00 |
$143.00 |
$1,556.24
|
|
Ghs nerve blk intercostal, single level
|
$3,882.45 |
$3,882.45 |
$3,882.45 |
$1,160.00
|
|
Ghs nerve block axillary nerve
|
$374.40 |
$374.40 |
$374.40 |
$1,563.66
|
|
Ghs nerve block brachial plexus
|
$4,991.35 |
$4,991.35 |
$4,991.35 |
$1,710.80
|
|
Ghs nerve block celiac plexus
|
$4,991.35 |
$4,991.35 |
$4,991.35 |
$1,661.40
|
|
Ghs nerve block interscaline
|
$4,991.35 |
$4,991.35 |
$4,991.35 |
$1,540.61
|
|
Ghs nerve block lumbar or thoracic symp
|
$4,991.35 |
$4,991.35 |
$4,991.35 |
$1,704.63
|
|
Ghs nerve block sciatic nerve
|
$3,882.45 |
$3,882.45 |
$3,882.45 |
$1,450.80
|
|
Ghs nerve block suprascapular
|
$3,882.45 |
$3,882.45 |
$3,882.45 |
$1,198.62
|
|
Ghs ng placement w fluoro guidance
|
$1,491.75 |
$1,491.75 |
$1,491.75 |
$485.00
|
|
Ghs o2 saturation
|
$57.85 |
$57.85 |
$57.85 |
$69.50
|
|
Ghs o2 uptake rest & exercise
|
$67.60 |
$67.60 |
$67.60 |
$230.01
|
|
Ghs o2 uptake rest & indirect
|
$18.20 |
$18.20 |
$18.20 |
$173.50
|
|
Ghs opcc repair cvp without subq port
|
$2,888.60 |
$2,888.60 |
$2,888.60 |
$1,236.67
|
|
Ghs opcc repair cvp w subq port
|
$7,257.25 |
$7,257.25 |
$7,257.25 |
$2,194.40
|
|
Ghs optokenetic
|
$77.35 |
$77.35 |
$77.35 |
$214.00
|
|
Ghs oscillating trac
|
$71.50 |
$71.50 |
$71.50 |
$325.00
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$131.30 |
$131.30 |
$131.30 |
$58.00
|
|
Ghs osteopathic manipulative tx, 3-4 regions
|
$202.80 |
$202.80 |
$202.80 |
$64.50
|
|
Ghs ot dds rom
|
$41.60 |
$41.60 |
$41.60 |
$69.00
|
|
Ghs ot group caregiver training
|
$720.85 |
$720.85 |
$720.85 |
$34.80
|
|
Ghs ot prosthetic training/15 min
|
$219.70 |
$219.70 |
$219.70 |
$93.00
|
|
Ghs ot sensory integrative tech/15min
|
$152.75 |
$152.75 |
$152.75 |
$96.20
|
|
Ghs ot work hardening-additional hours
|
$408.85 |
$408.85 |
$408.85 |
$126.40
|
|
Ghs pacing - transcutaneous
|
$3,057.60 |
$3,057.60 |
$3,057.60 |
$830.53
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$533.00 |
$533.00 |
$533.00 |
$853.65
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$1,023.75 |
$1,023.75 |
$1,023.75 |
$962.00
|
|
Ghs peritonsillar abscess i andd
|
$867.75 |
$867.75 |
$867.75 |
$555.00
|
|
Ghs phenylketonurid
|
$8.45 |
$8.45 |
$8.45 |
$53.76
|
|
Ghs picc line insert < 5
|
$7,257.25 |
$7,257.25 |
$7,257.25 |
$2,019.50
|
|
Ghs plngl fx pm cl
|
$995.15 |
$995.15 |
$995.15 |
$564.80
|
|
Ghs plt ct-manual
|
$79.95 |
$79.95 |
$79.95 |
$37.96
|
|
Ghs polysom <6 yrs 4/> parameters
|
$5,703.75 |
$5,703.75 |
$5,703.75 |
$3,557.58
|
|
Ghs pos nystagmus
|
$137.15 |
$137.15 |
$137.15 |
$241.80
|
|
Ghs ppd (tb intradermal)
|
$37.70 |
$37.70 |
$37.70 |
$37.44
|
|
Ghs pr without cont pulse ox
|
$221.65 |
$221.65 |
$221.65 |
$147.00
|
|
Ghs pt - work hardening/int 2hrs
|
$815.75 |
$815.75 |
$815.75 |
$285.60
|
|
Ghs refill of implantable pump
|
$141.05 |
$141.05 |
$141.05 |
$539.13
|
|
Ghs removal intranasal foreign body
|
$481.65 |
$481.65 |
$481.65 |
$283.24
|
|
Ghs removal pharyngeal foreign body
|
$1,491.75 |
$1,491.75 |
$1,491.75 |
$441.68
|
|
Ghs repair tendon ext forearm/wrist ea
|
$1,604.20 |
$1,604.20 |
$1,604.20 |
$4,150.20
|
|
Ghs reticulocyte count
|
$48.10 |
$48.10 |
$48.10 |
$34.50
|
|
Ghs rsv eia (respir synctial vrs)
|
$52.00 |
$52.00 |
$52.00 |
$99.00
|
|
Ghs sensitivity (per antimicro)
|
$46.80 |
$46.80 |
$46.80 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$974.35 |
$974.35 |
$974.35 |
$570.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$974.35 |
$974.35 |
$974.35 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$974.35 |
$974.35 |
$974.35 |
$586.50
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$974.35 |
$974.35 |
$974.35 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$484.25 |
$484.25 |
$484.25 |
$449.15
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$484.25 |
$484.25 |
$484.25 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$566.15 |
$566.15 |
$566.15 |
$489.72
|
|
Ghs simple repair over 30 cm - 12007
|
$829.40 |
$829.40 |
$829.40 |
$590.88
|
|
Ghs simple repair over 30 cm - 12018
|
$484.25 |
$484.25 |
$484.25 |
$537.60
|
|
Ghs sleep study unattended
|
$221.00 |
$221.00 |
$221.00 |
$503.38
|
|
Ghs somatosensory testing lower extremit
|
$1,745.90 |
$1,745.90 |
$1,745.90 |
$925.91
|
|
Ghs somatosensory testing upper & lower limbs
|
$2,974.40 |
$2,974.40 |
$2,974.40 |
$1,416.80
|
|
Ghs speech-gen aug dev eval iii, st
|
$182.00 |
$182.00 |
$182.00 |
$157.50
|
|
Ghs sphenopalatine ganglion block
|
$1,654.90 |
$1,654.90 |
$1,654.90 |
$630.24
|
|
Ghs spont nystagmus
|
$114.40 |
$114.40 |
$114.40 |
$246.50
|
|
Ghs sp train/fitting sp device - kx
|
$510.90 |
$510.90 |
$510.90 |
$252.75
|
|
Ghs st - eval for alt comm
|
$57.20 |
$57.20 |
$57.20 |
$96.40
|
|
Ghs strapping shoulder - 29240
|
$481.65 |
$481.65 |
$481.65 |
$217.60
|
|
Ghs st - re-eval for alt comm
|
$516.75 |
$516.75 |
$516.75 |
$309.60
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$51.35 |
$51.35 |
$51.35 |
$99.98
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$59.80 |
$59.80 |
$59.80 |
$360.80
|
|
Ghs superficial wnd dehiscence simp12020
|
$1,491.75 |
$1,491.75 |
$1,491.75 |
$953.27
|
|
Ghs superficial wnd dehis w packing12021
|
$974.35 |
$974.35 |
$974.35 |
$695.93
|
|
Ghs tracheostomy emergency - transtracheal
|
$5,536.70 |
$5,536.70 |
$5,536.70 |
$1,867.84
|
|
Ghs tx distal phalangeal fx with manipulation
|
$896.35 |
$896.35 |
$896.35 |
$529.65
|
|
Ghs vaginal delivery only
|
$4,109.95 |
$4,109.95 |
$4,109.95 |
$3,341.93
|
|
Ghs veeg 12-26 hr intmt mont
|
$2,974.40 |
$2,974.40 |
$2,974.40 |
$1,932.00
|
|
Ghs windowing of cast
|
$590.20 |
$590.20 |
$590.20 |
$212.55
|
|
Gi endoscopic ultrasound
|
$210.60 |
$210.60 |
$210.60 |
$582.31
|
|
Gi inhouse confirmation
|
$47.45 |
$47.45 |
$47.45 |
$87.75
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$3,504.15 |
$3,504.15 |
$3,504.15 |
$2,215.20
|
|
Gi trc img intral colon i&r
|
$626.60 |
$626.60 |
$626.60 |
$1,959.88
|
|
Gi trc img intral esophagus
|
$257.40 |
$257.40 |
$257.40 |
$1,897.82
|
|
Gi wireless capsule measure
|
$3,504.15 |
$3,504.15 |
$3,504.15 |
$1,579.30
|
|
Glaucoma scrn hgh risk direc
|
$128.70 |
$128.70 |
$128.70 |
$116.17
|
|
Glaucoma scrn hgh risk direc
|
$48.75 |
$48.75 |
$48.75 |
$88.00
|
|
Glucagon 1 mg solution for injection
|
$655.20 |
$655.20 |
$655.20 |
$613.79
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$654.73 |
$654.73 |
$654.73 |
$491.67
|
|
Glucose 1 hr post dose
|
$23.40 |
$23.40 |
$23.40 |
$49.00
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$15.60 |
$15.60 |
$15.60 |
$23.12
|
|
Glucose blood quantitative
|
$52.00 |
$52.00 |
$52.00 |
$42.25
|
|
Glucose body fluid
|
$37.05 |
$37.05 |
$37.05 |
$51.30
|
|
Glucose monitoring continual min 72hr pt
|
$193.70 |
$193.70 |
$193.70 |
$130.00
|
|
Glucose tolerance test (gtt) 3 specimens
|
$118.30 |
$118.30 |
$118.30 |
$105.60
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$33.15 |
$33.15 |
$33.15 |
$36.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$30.42 |
$30.42 |
$30.42 |
$37.40
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$29,700.35 |
$29,700.35 |
$29,700.35 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$118.30 |
$118.30 |
$118.30 |
$116.64
|
