|
Ghs moderate sedation ea addtl 15 min, other
|
$125.40 |
$125.40 |
$125.40 |
$123.30
|
|
Ghs musc test done w/n test comp
|
$349.80 |
$349.80 |
$349.80 |
$352.97
|
|
Ghs musc tst done w/nerv tst lim
|
$349.80 |
$349.80 |
$349.80 |
$277.25
|
|
Ghs musc tst done w/n tst non ext
|
$184.80 |
$184.80 |
$184.80 |
$219.05
|
|
Ghs myocardial strain img spckl track
|
$568.80 |
$568.80 |
$568.80 |
$503.85
|
|
Ghs nerve blk intercostal, ea addtl level
|
$2,319.60 |
$2,319.60 |
$2,319.60 |
$1,546.50
|
|
Ghs nerve blk intercostal, single level
|
$2,319.60 |
$2,319.60 |
$2,319.60 |
$1,232.23
|
|
Ghs nerve block celiac plexus
|
$2,307.60 |
$2,307.60 |
$2,307.60 |
$1,681.24
|
|
Ghs nerve block interscaline
|
$2,397.60 |
$2,397.60 |
$2,397.60 |
$1,574.21
|
|
Ghs ng placement w fluoro guidance
|
$321.00 |
$321.00 |
$321.00 |
$423.76
|
|
Ghs o2 saturation
|
$161.40 |
$161.40 |
$161.40 |
$55.90
|
|
Ghs opcc repair cvp without subq port
|
$2,071.80 |
$2,071.80 |
$2,071.80 |
$1,289.00
|
|
Ghs opcc repair cvp w subq port
|
$4,704.60 |
$4,704.60 |
$4,704.60 |
$2,449.60
|
|
Ghs optokenetic
|
$211.20 |
$211.20 |
$211.20 |
$198.98
|
|
Ghs oscillating trac
|
$233.40 |
$233.40 |
$233.40 |
$256.50
|
|
Ghs ot prosthetic training/15 min
|
$75.60 |
$75.60 |
$75.60 |
$92.35
|
|
Ghs ot sensory integrative tech/15min
|
$79.80 |
$79.80 |
$79.80 |
$89.73
|
|
Ghs ot work hardening-additional hours
|
$181.80 |
$181.80 |
$181.80 |
$113.35
|
|
Ghs pacing - transcutaneous
|
$1,282.80 |
$1,282.80 |
$1,421.40 |
$872.95
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$3,252.60 |
$3,252.60 |
$3,252.60 |
$880.00
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$2,124.60 |
$2,124.60 |
$2,124.60 |
$849.47
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$100.20 |
$100.20 |
$100.20 |
$82.80
|
|
Ghs picc line insert < 5
|
$4,980.60 |
$4,980.60 |
$4,980.60 |
$1,990.40
|
|
Ghs plt ct-manual
|
$85.80 |
$85.80 |
$85.80 |
$40.80
|
|
Ghs polysom <6 yrs 4/> parameters
|
$5,539.20 |
$5,539.20 |
$5,539.20 |
$3,557.58
|
|
Ghs pos nystagmus
|
$289.20 |
$289.20 |
$289.20 |
$228.00
|
|
Ghs ppd (tb intradermal)
|
$57.00 |
$57.00 |
$57.00 |
$39.77
|
|
Ghs prostatic acid phosphatase (mayo)
|
$118.20 |
$118.20 |
$118.20 |
$49.77
|
|
Ghs protein, misc fluid
|
$19.80 |
$19.80 |
$39.00 |
$24.60
|
|
Ghs protoporphyrins fract
|
$129.60 |
$129.60 |
$129.60 |
$68.38
|
|
Ghs pr without cont pulse ox
|
$289.20 |
$289.20 |
$289.20 |
$165.60
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$47.40 |
$47.40 |
$90.60 |
$55.25
|
|
Ghs pt - work hardening/int 2hrs
|
$315.60 |
$315.60 |
$315.60 |
$230.40
|
|
Ghs reticulocyte count
|
$105.60 |
$105.60 |
$105.60 |
$33.57
|
|
Ghs sensitivity (per antimicro)
|
$148.20 |
$148.20 |
$148.20 |
$55.12
|
|
Ghs somatosensory testing lower extremit
|
$1,046.40 |
$1,046.40 |
$1,046.40 |
$917.80
|
|
Ghs somatosensory testing upper & lower limbs
|
$1,959.60 |
$1,959.60 |
$1,959.60 |
$1,506.58
|
|
Ghs speech-gen aug dev eval iii, st
|
$108.00 |
$108.00 |
$108.00 |
$134.50
|
|
Ghs spont nystagmus
|
$300.60 |
$300.60 |
$300.60 |
$228.00
|
|
Ghs sp train/fitting sp device - kx
|
$270.00 |
$270.00 |
$270.00 |
$240.80
|
|
Ghs st - eval for alt comm
|
$138.00 |
$138.00 |
$138.00 |
$100.98
|
|
Ghs strapping shoulder - 29240
|
$160.80 |
$160.80 |
$160.80 |
$210.91
|
|
Ghs st - re-eval for alt comm
|
$329.40 |
$329.40 |
$329.40 |
$321.00
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$354.00 |
$354.00 |
$354.00 |
$342.40
|
|
Ghs superficial wnd dehiscence simp12020
|
$340.80 |
$340.80 |
$340.80 |
$1,016.25
|
|
Ghs urine, hydroxproline total
|
$162.60 |
$162.60 |
$162.60 |
$119.40
|
|
Ghs urine, porphyrins quant
|
$195.00 |
$195.00 |
$195.00 |
$85.15
|
|
Ghs veeg 12-26 hr intmt mont
|
$1,191.00 |
$1,191.00 |
$1,191.00 |
$1,990.20
|
|
Gi inhouse confirmation
|
$43.20 |
$43.20 |
$227.40 |
$79.50
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$3,570.60 |
$3,570.60 |
$3,570.60 |
$2,418.92
|
|
Glucagon 1 mg solution for injection
|
$351.53 |
$351.53 |
$351.53 |
$351.53
|
|
Glucagon plasma - sendout
|
$162.00 |
$162.00 |
$162.00 |
$67.50
|
|
Glucose 1 hr post dose
|
$130.20 |
$130.20 |
$130.20 |
$40.00
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$68.40 |
$68.40 |
$68.40 |
$20.00
|
|
Glucose blood quantitative
|
$78.00 |
$78.00 |
$78.00 |
$40.80
|
|
Glucose body fluid
|
$102.00 |
$102.00 |
$102.00 |
$47.70
|
|
Glucose tolerance test (gtt) 3 specimens
|
$259.80 |
$259.80 |
$259.80 |
$92.75
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$14.40 |
$14.40 |
$28.80 |
$33.15
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$120.40 |
$120.40 |
$120.40 |
$11.60
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$61.21 |
$61.21 |
$61.21 |
$61.21
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$413.40 |
$413.40 |
$413.40 |
$115.05
|
|
Gonadotropin luteinizing hormone (lh)
|
$430.20 |
$430.20 |
$430.20 |
$117.65
|
|
Goserelin 10.8 mg subcutaneous implant
|
$1,577.10 |
$1,577.10 |
$1,577.10 |
$1,598.97
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$3,642.00 |
$3,642.00 |
$3,642.00 |
$56.71
|
|
Graft axiofill 1000mg
|
$2,890.20 |
$2,890.20 |
$2,890.20 |
$2,890.20
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$10,096.80 |
$10,096.80 |
$10,096.80 |
$9,693.72
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$23,233.80 |
$23,233.80 |
$23,233.80 |
$23,233.80
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$4,177.80 |
$4,177.80 |
$4,177.80 |
$3,735.34
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$10,983.60 |
$10,983.60 |
$10,983.60 |
$486.45
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$5,781.00 |
$5,781.00 |
$5,781.00 |
$1,123.34
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$5,176.20 |
$5,176.20 |
$5,176.20 |
$5,533.20
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$19,062.00 |
$19,062.00 |
$34,428.00 |
$53,576.40
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$9,120.60 |
$9,120.60 |
$9,120.60 |
$543.12
|
|
Granisetron 1 mg tab
|
$10.04 |
$10.04 |
$10.04 |
$40.18
|
|
Granisetron hcl injection
|
$41.81 |
$41.81 |
$41.81 |
$21.42
|
|
G-tube reposition
|
$1,395.00 |
$1,395.00 |
$1,395.00 |
$727.35
|
|
Guided cath fluid drainage 10030
|
$3,337.20 |
$3,337.20 |
$3,337.20 |
$1,451.40
|
|
Guide endoanchr sg-64 aaa 62cm
|
$5,511.60 |
$5,511.60 |
$21,526.80 |
$2,108.25
|
|
Guid loc target vol rad tx
|
$526.20 |
$526.20 |
$526.20 |
$620.91
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$130.49 |
$130.49 |
$130.49 |
$120.02
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$38.87 |
$38.87 |
$38.87 |
$11.25
|
|
Hand X-ray
|
$403.20 |
$403.20 |
$403.20 |
$317.78
|
|
Haptoglobin quantitative
|
$243.00 |
$243.00 |
$243.00 |
$75.00
|
|
Hbb gene known fam variant
|
$1,033.20 |
$1,033.20 |
$1,033.20 |
$751.20
|
|
Hbot, full body chamber, 30m
|
$490.80 |
$490.80 |
$490.80 |
$524.17
|
|
Hc ea ha check monaural
|
$90.00 |
$90.00 |
$90.00 |
$57.00
|
|
Hc fl sm bowel enteroclss tube w kub double contrast
|
$258.00 |
$258.00 |
$258.00 |
$527.13
|
|
Hcg qualitative
|
$189.00 |
$189.00 |
$189.00 |
$72.50
|
|
Hcg quantitative
|
$315.60 |
$315.60 |
$315.60 |
$105.00
|
|
Hc hearing aid chck binaurl
|
$98.40 |
$98.40 |
$98.40 |
$75.00
|
|
Hc hearing aid chck monarl
|
$73.20 |
$73.20 |
$73.20 |
$48.00
|
|
Hc hearing aid exam both ears
|
$214.80 |
$214.80 |
$214.80 |
$175.20
|
|
Hc hearing aid exam one ear
|
$131.40 |
$131.40 |
$131.40 |
$150.00
|
|
Hc i-131 sodium iodide cap dx per mci
|
$22.20 |
$22.20 |
$22.20 |
$184.20
|
|
Hc nm cardiac blood pool planar 1 stdy wal motn eject fract
|
$2,135.40 |
$2,135.40 |
$2,135.40 |
$645.06
|
|
Hc nm fusion spect CT unlisted
|
$6,829.80 |
$6,829.80 |
$6,829.80 |
$463.68
|
|
Hc transcatheter placement and sbsq removal cepd perq
|
$18,754.80 |
$18,754.80 |
$18,754.80 |
$3,046.80
|
|
Hdr rdncl ntrstl/icav brchtx
|
$7,490.40 |
$7,490.40 |
$7,490.40 |
$2,668.85
|
|
Hdr rdncl ntrstl/icav brchtx
|
$9,365.40 |
$9,365.40 |
$9,365.40 |
$2,960.63
|
|
Hdr rdncl ntrstl/icav brchtx
|
$9,830.40 |
$9,830.40 |
$9,830.40 |
$3,111.55
|
