|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$240.00 |
$240.00 |
$240.00 |
$233.28
|
|
Ghs moderate sedation ea addtl 15 min
|
$240.00 |
$240.00 |
$240.00 |
$150.00
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$240.00 |
$240.00 |
$240.00 |
$142.40
|
|
Ghs musc test done w/n test comp
|
$698.00 |
$698.00 |
$698.00 |
$331.20
|
|
Ghs musc tst done w/nerv tst lim
|
$649.00 |
$649.00 |
$649.00 |
$272.48
|
|
Ghs musc tst done w/n tst non ext
|
$649.00 |
$649.00 |
$649.00 |
$184.80
|
|
Ghs myocardial strain img spckl track
|
$1,869.00 |
$1,869.00 |
$1,869.00 |
$457.80
|
|
Ghs nailbed repair/nail removal
|
$8,661.00 |
$8,661.00 |
$8,661.00 |
$724.37
|
|
Ghs nerve blk intercostal, ea addtl level
|
$4,862.00 |
$4,862.00 |
$4,862.00 |
$1,556.24
|
|
Ghs nerve blk intercostal, single level
|
$4,862.00 |
$4,862.00 |
$4,862.00 |
$1,160.00
|
|
Ghs nerve block axillary nerve
|
$4,862.00 |
$4,862.00 |
$4,862.00 |
$1,563.66
|
|
Ghs nerve block brachial plexus
|
$4,862.00 |
$4,862.00 |
$4,862.00 |
$1,710.80
|
|
Ghs nerve block celiac plexus
|
$4,862.00 |
$4,862.00 |
$4,862.00 |
$1,661.40
|
|
Ghs nerve block interscaline
|
$4,862.00 |
$4,862.00 |
$4,862.00 |
$1,540.61
|
|
Ghs nerve block lumbar or thoracic symp
|
$4,862.00 |
$4,862.00 |
$4,862.00 |
$1,704.63
|
|
Ghs nerve block sciatic nerve
|
$4,862.00 |
$4,862.00 |
$4,862.00 |
$1,450.80
|
|
Ghs nerve block suprascapular
|
$4,609.00 |
$4,609.00 |
$4,609.00 |
$1,198.62
|
|
Ghs ng placement w fluoro guidance
|
$1,103.00 |
$1,103.00 |
$1,103.00 |
$485.00
|
|
Ghs o2 saturation
|
$209.00 |
$209.00 |
$209.00 |
$69.50
|
|
Ghs o2 uptake rest & indirect
|
$1,275.00 |
$1,275.00 |
$1,275.00 |
$173.50
|
|
Ghs ob unlisted IV or art inj or infusion
|
$6,039.00 |
$6,039.00 |
$6,039.00 |
$82.62
|
|
Ghs opcc repair cvp without subq port
|
$2,769.00 |
$2,769.00 |
$2,769.00 |
$1,236.67
|
|
Ghs opcc repair cvp w subq port
|
$4,943.00 |
$4,943.00 |
$4,943.00 |
$2,194.40
|
|
Ghs optokenetic
|
$707.00 |
$707.00 |
$707.00 |
$214.00
|
|
Ghs oscillating trac
|
$707.00 |
$707.00 |
$707.00 |
$325.00
|
|
Ghs ot group caregiver training
|
$37.00 |
$37.00 |
$37.00 |
$34.80
|
|
Ghs ot prosthetic training/15 min
|
$127.00 |
$127.00 |
$127.00 |
$93.00
|
|
Ghs ot sensory integrative tech/15min
|
$164.00 |
$164.00 |
$164.00 |
$96.20
|
|
Ghs pacing - transcutaneous
|
$994.00 |
$994.00 |
$994.00 |
$830.53
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$5,778.00 |
$5,778.00 |
$5,778.00 |
$853.65
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$4,862.00 |
$4,862.00 |
$4,862.00 |
$962.00
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$36.68 |
$36.68 |
$36.68 |
$74.10
|
|
Ghs peritonsillar abscess i andd
|
$996.00 |
$996.00 |
$996.00 |
$555.00
|
|
Ghs phenylketonurid
|
$140.00 |
$140.00 |
$140.00 |
$53.76
|
|
Ghs picc line insert < 5
|
$4,943.00 |
$4,943.00 |
$4,943.00 |
$2,019.50
|
|
Ghs plngl fx pm cl
|
$8,209.00 |
$8,209.00 |
$8,209.00 |
$564.80
|
|
Ghs pos nystagmus
|
$497.00 |
$497.00 |
$497.00 |
$241.80
|
|
Ghs ppd (tb intradermal)
|
$80.00 |
$80.00 |
$80.00 |
$37.44
|
|
Ghs pr without cont pulse ox
|
$206.00 |
$206.00 |
$206.00 |
$147.00
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$278.00 |
$278.00 |
$278.00 |
$47.55
|
|
Ghs quinidine
|
$432.00 |
$432.00 |
$432.00 |
$85.00
|
|
Ghs removal intranasal foreign body
|
$208.00 |
$208.00 |
$208.00 |
$283.24
|
|
Ghs repair extensor tendon hand, ea tendon
|
$6,653.00 |
$6,653.00 |
$6,653.00 |
$2,517.00
|
|
Ghs repair tendon ext forearm/wrist ea
|
$7,811.00 |
$7,811.00 |
$7,811.00 |
$4,150.20
|
|
Ghs rsv eia (respir synctial vrs)
|
$235.00 |
$235.00 |
$235.00 |
$99.00
|
|
Ghs sensitivity (per antimicro)
|
$79.00 |
$79.00 |
$79.00 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$805.00 |
$805.00 |
$805.00 |
$570.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$445.00 |
$445.00 |
$445.00 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$976.00 |
$976.00 |
$976.00 |
$586.50
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$398.00 |
$398.00 |
$398.00 |
$449.15
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$588.00 |
$588.00 |
$588.00 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$426.00 |
$426.00 |
$426.00 |
$489.72
|
|
Ghs simple repair over 30 cm - 12007
|
$1,084.00 |
$1,084.00 |
$1,084.00 |
$590.88
|
|
Ghs sleep study unattended
|
$886.00 |
$886.00 |
$886.00 |
$503.38
|
|
Ghs somatosensory testing lower extremit
|
$1,438.00 |
$1,438.00 |
$1,438.00 |
$925.91
|
|
Ghs somatosensory testing upper & lower limbs
|
$2,586.00 |
$2,586.00 |
$2,586.00 |
$1,416.80
|
|
Ghs speech-gen aug dev eval iii, st
|
$117.00 |
$117.00 |
$117.00 |
$157.50
|
|
Ghs sphenopalatine ganglion block
|
$4,862.00 |
$4,862.00 |
$4,862.00 |
$630.24
|
|
Ghs spont nystagmus
|
$497.00 |
$497.00 |
$497.00 |
$246.50
|
|
Ghs sp train/fitting sp device - kx
|
$396.00 |
$396.00 |
$396.00 |
$252.75
|
|
Ghs st - eval for alt comm
|
$420.00 |
$420.00 |
$420.00 |
$96.40
|
|
Ghs st - re-eval for alt comm
|
$456.00 |
$456.00 |
$456.00 |
$309.60
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$236.00 |
$236.00 |
$236.00 |
$99.98
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$1,754.00 |
$1,754.00 |
$1,754.00 |
$360.80
|
|
Ghs superficial wnd dehiscence simp12020
|
$4,609.00 |
$4,609.00 |
$4,609.00 |
$953.27
|
|
Ghs tracheostomy emergency - transtracheal
|
$3,832.00 |
$3,832.00 |
$3,832.00 |
$1,867.84
|
|
Ghs tx distal phalangeal fx with manipulation
|
$620.00 |
$620.00 |
$620.00 |
$529.65
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$662.00 |
$662.00 |
$662.00 |
$513.80
|
|
Ghs urine, porphyrins quant
|
$337.00 |
$337.00 |
$337.00 |
$73.80
|
|
Ghs vaginal delivery only
|
$11,459.00 |
$11,459.00 |
$11,459.00 |
$3,341.93
|
|
Ghs veeg 12-26 hr intmt mont
|
$2,038.00 |
$2,038.00 |
$2,038.00 |
$1,932.00
|
|
Gi inhouse confirmation
|
$192.00 |
$192.00 |
$192.00 |
$87.75
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$5,016.00 |
$5,016.00 |
$5,016.00 |
$2,215.20
|
|
Gi trc img intral esophagus
|
$2,384.00 |
$2,384.00 |
$2,384.00 |
$1,897.82
|
|
Glaucoma surgery
|
$4,684.00 |
$4,684.00 |
$4,684.00 |
$4,684.00
|
|
Glaucoma surgery
|
$6,644.00 |
$6,644.00 |
$6,644.00 |
$4,786.53
|
|
Glucagon 1 mg solution for injection
|
$1,092.83 |
$1,092.83 |
$1,092.83 |
$613.79
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$1,210.25 |
$1,210.25 |
$1,210.25 |
$491.67
|
|
Glucagon plasma - sendout
|
$590.00 |
$590.00 |
$590.00 |
$64.35
|
|
Glucose 1 hr post dose
|
$108.00 |
$108.00 |
$108.00 |
$49.00
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$56.00 |
$56.00 |
$56.00 |
$23.12
|
|
Glucose blood quantitative
|
$105.00 |
$105.00 |
$105.00 |
$42.25
|
|
Glucose body fluid
|
$92.00 |
$92.00 |
$92.00 |
$51.30
|
|
Glucose monitoring continual min 72hr pt
|
$140.00 |
$140.00 |
$140.00 |
$130.00
|
|
Glucose tolerance test (gtt) 3 specimens
|
$294.00 |
$294.00 |
$294.00 |
$105.60
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$105.00 |
$105.00 |
$105.00 |
$36.00
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$98.90 |
$98.90 |
$98.90 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$415.00 |
$415.00 |
$415.00 |
$116.64
|
|
Gonadotropin luteinizing hormone (lh)
|
$415.00 |
$415.00 |
$415.00 |
$129.03
|
|
Goniotomy
|
$3,920.00 |
$3,920.00 |
$3,920.00 |
$4,396.50
|
|
Goserelin 10.8 mg subcutaneous implant
|
$2,268.86 |
$2,268.86 |
$2,268.86 |
$4,417.13
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$17,532.90 |
$17,532.90 |
$17,532.90 |
$605.00
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$15,480.90 |
$15,480.90 |
$15,480.90 |
$23,233.80
|
|
Graft nerve adv 3-4x70mm
|
$20,642.60 |
$20,642.60 |
$20,642.60 |
$20,782.10
|
|
Graft patch felt ptfe 2x2
|
$14,968.80 |
$14,968.80 |
$14,968.80 |
$29,293.39
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$251.15 |
$251.15 |
$251.15 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$133.27 |
$133.27 |
$133.27 |
$349.41
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$42.50 |
$42.50 |
$42.50 |
$28,894.71
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$164.47 |
$164.47 |
$164.47 |
$1,103.05
|
|
Graft xenmtrx sft rect 15x20cm
|
$23,006.50 |
$23,006.50 |
$23,006.50 |
$29,676.26
|
