|
Ghs o2 uptake rest & exercise
|
$333.00 |
$333.00 |
$333.00 |
$230.01
|
|
Ghs o2 uptake rest & indirect
|
$118.20 |
$118.20 |
$118.20 |
$173.50
|
|
Ghs ob unlisted IV or art inj or infusion
|
$132.60 |
$132.60 |
$132.60 |
$82.62
|
|
Ghs opcc repair cvp without subq port
|
$343.80 |
$343.80 |
$343.80 |
$1,236.67
|
|
Ghs opcc repair cvp w subq port
|
$1,187.40 |
$1,187.40 |
$1,187.40 |
$2,194.40
|
|
Ghs optokenetic
|
$157.20 |
$157.20 |
$157.20 |
$214.00
|
|
Ghs oscillating trac
|
$157.20 |
$157.20 |
$157.20 |
$325.00
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$61.80 |
$61.80 |
$61.80 |
$58.00
|
|
Ghs osteopathic manipulative tx, 3-4 regions
|
$87.60 |
$87.60 |
$87.60 |
$64.50
|
|
Ghs ot dds rom
|
$76.80 |
$76.80 |
$76.80 |
$69.00
|
|
Ghs ot group caregiver training
|
$33.00 |
$33.00 |
$33.00 |
$34.80
|
|
Ghs ot prosthetic training/15 min
|
$66.60 |
$66.60 |
$66.60 |
$93.00
|
|
Ghs ot sensory integrative tech/15min
|
$64.80 |
$64.80 |
$64.80 |
$96.20
|
|
Ghs ot work hardening-additional hours
|
$59.40 |
$59.40 |
$59.40 |
$126.40
|
|
Ghs pacing - transcutaneous
|
$484.20 |
$484.20 |
$484.20 |
$830.53
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$931.20 |
$931.20 |
$931.20 |
$853.65
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$1,212.60 |
$1,212.60 |
$1,212.60 |
$962.00
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$23.40 |
$23.40 |
$23.40 |
$74.10
|
|
Ghs peritonsillar abscess i andd
|
$451.20 |
$451.20 |
$451.20 |
$555.00
|
|
Ghs phenylketonurid
|
$120.60 |
$120.60 |
$120.60 |
$53.76
|
|
Ghs picc line insert < 5
|
$960.00 |
$960.00 |
$960.00 |
$2,019.50
|
|
Ghs plngl fx pm cl
|
$636.60 |
$636.60 |
$636.60 |
$564.80
|
|
Ghs plt ct-manual
|
$23.40 |
$23.40 |
$23.40 |
$37.96
|
|
Ghs polysom <6 yrs 4/> parameters
|
$3,161.40 |
$3,161.40 |
$3,161.40 |
$3,557.58
|
|
Ghs pos nystagmus
|
$157.20 |
$157.20 |
$157.20 |
$241.80
|
|
Ghs ppd (tb intradermal)
|
$30.60 |
$30.60 |
$30.60 |
$37.44
|
|
Ghs prostatic acid phosphatase (mayo)
|
$103.20 |
$103.20 |
$103.20 |
$43.55
|
|
Ghs protein, misc fluid
|
$31.80 |
$31.80 |
$31.80 |
$24.60
|
|
Ghs protoporphyrins fract
|
$95.40 |
$95.40 |
$95.40 |
$60.75
|
|
Ghs pr without cont pulse ox
|
$119.40 |
$119.40 |
$119.40 |
$147.00
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$80.40 |
$80.40 |
$80.40 |
$47.55
|
|
Ghs pt - work hardening/int 2hrs
|
$144.60 |
$144.60 |
$144.60 |
$285.60
|
|
Ghs quinidine
|
$124.20 |
$124.20 |
$124.20 |
$85.00
|
|
Ghs refill of implantable pump
|
$311.40 |
$311.40 |
$311.40 |
$539.13
|
|
Ghs removal intranasal foreign body
|
$445.80 |
$445.80 |
$445.80 |
$283.24
|
|
Ghs removal pharyngeal foreign body
|
$336.60 |
$336.60 |
$336.60 |
$441.68
|
|
Ghs repair extensor tendon hand, ea tendon
|
$1,062.00 |
$1,062.00 |
$1,062.00 |
$2,517.00
|
|
Ghs repair tendon ext forearm/wrist ea
|
$1,148.40 |
$1,148.40 |
$1,148.40 |
$4,150.20
|
|
Ghs respiratory syncytical virus igg/m
|
$193.80 |
$193.80 |
$193.80 |
$74.82
|
|
Ghs reticulocyte count
|
$42.60 |
$42.60 |
$42.60 |
$34.50
|
|
Ghs rsv eia (respir synctial vrs)
|
$75.60 |
$75.60 |
$75.60 |
$99.00
|
|
Ghs sedimentation rate
|
$21.00 |
$21.00 |
$21.00 |
$45.50
|
|
Ghs semen analysis fert
|
$124.80 |
$124.80 |
$124.80 |
$124.80
|
|
Ghs semen analysis, post-vas
|
$66.00 |
$66.00 |
$66.00 |
$32.37
|
|
Ghs sensitivity (per antimicro)
|
$70.80 |
$70.80 |
$70.80 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$341.40 |
$341.40 |
$341.40 |
$570.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$418.80 |
$418.80 |
$418.80 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$390.60 |
$390.60 |
$390.60 |
$586.50
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$578.40 |
$578.40 |
$578.40 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$326.40 |
$326.40 |
$326.40 |
$449.15
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$324.60 |
$324.60 |
$324.60 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$343.20 |
$343.20 |
$343.20 |
$489.72
|
|
Ghs simple repair over 30 cm - 12007
|
$453.00 |
$453.00 |
$453.00 |
$590.88
|
|
Ghs simple repair over 30 cm - 12018
|
$378.00 |
$378.00 |
$378.00 |
$537.60
|
|
Ghs sleep study unattended
|
$889.80 |
$889.80 |
$889.80 |
$503.38
|
|
Ghs somatosensory testing lower extremit
|
$280.80 |
$280.80 |
$280.80 |
$925.91
|
|
Ghs somatosensory testing upper & lower limbs
|
$753.60 |
$753.60 |
$753.60 |
$1,416.80
|
|
Ghs speech-gen aug dev eval iii, st
|
$172.20 |
$172.20 |
$172.20 |
$157.50
|
|
Ghs sphenopalatine ganglion block
|
$511.80 |
$511.80 |
$511.80 |
$630.24
|
|
Ghs spont nystagmus
|
$144.00 |
$144.00 |
$144.00 |
$246.50
|
|
Ghs sp train/fitting sp device - kx
|
$183.00 |
$183.00 |
$183.00 |
$252.75
|
|
Ghs st - eval for alt comm
|
$133.20 |
$133.20 |
$133.20 |
$96.40
|
|
Ghs strapping shoulder - 29240
|
$156.00 |
$156.00 |
$156.00 |
$217.60
|
|
Ghs st - re-eval for alt comm
|
$140.40 |
$140.40 |
$140.40 |
$309.60
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$42.60 |
$42.60 |
$42.60 |
$99.98
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$351.60 |
$351.60 |
$351.60 |
$360.80
|
|
Ghs superficial wnd dehiscence simp12020
|
$520.20 |
$520.20 |
$520.20 |
$953.27
|
|
Ghs superficial wnd dehis w packing12021
|
$315.00 |
$315.00 |
$315.00 |
$695.93
|
|
Ghs tracheostomy emergency - transtracheal
|
$1,206.00 |
$1,206.00 |
$1,206.00 |
$1,867.84
|
|
Ghs trypsin (fecal)
|
$108.60 |
$108.60 |
$108.60 |
$55.59
|
|
Ghs tx distal phalangeal fx with manipulation
|
$591.00 |
$591.00 |
$591.00 |
$529.65
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$475.80 |
$475.80 |
$475.80 |
$513.80
|
|
Ghs urine, hydroxproline total
|
$224.40 |
$224.40 |
$224.40 |
$109.60
|
|
Ghs urine, porphyrins quant
|
$160.20 |
$160.20 |
$160.20 |
$73.80
|
|
Ghs vaginal delivery only
|
$2,466.60 |
$2,466.60 |
$2,466.60 |
$3,341.93
|
|
Ghs veeg 12-26 hr intmt mont
|
$1,576.80 |
$1,576.80 |
$1,576.80 |
$1,932.00
|
|
Ghs windowing of cast
|
$151.20 |
$151.20 |
$151.20 |
$212.55
|
|
Gi inhouse confirmation
|
$62.40 |
$62.40 |
$62.40 |
$87.75
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$1,345.80 |
$1,345.80 |
$1,345.80 |
$2,215.20
|
|
Gi trc img intral esophagus
|
$76.20 |
$76.20 |
$76.20 |
$1,897.82
|
|
Glassia injection
|
$40.24 |
$40.24 |
$40.24 |
$20.32
|
|
Glucagon 1 mg solution for injection
|
$509.77 |
$509.77 |
$509.77 |
$613.79
|
|
Glucagon plasma - sendout
|
$58.20 |
$58.20 |
$58.20 |
$64.35
|
|
Glucose 1 hr post dose
|
$30.00 |
$30.00 |
$30.00 |
$49.00
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$29.40 |
$29.40 |
$29.40 |
$23.12
|
|
Glucose blood quantitative
|
$41.40 |
$41.40 |
$41.40 |
$42.25
|
|
Glucose body fluid
|
$45.00 |
$45.00 |
$45.00 |
$51.30
|
|
Glucose monitoring continual min 72hr pt
|
$179.40 |
$179.40 |
$179.40 |
$130.00
|
|
Glucose tolerance test (gtt) 3 specimens
|
$75.00 |
$75.00 |
$75.00 |
$105.60
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$67.80 |
$67.80 |
$67.80 |
$36.00
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$3,570.58 |
$3,570.58 |
$3,570.58 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$99.60 |
$99.60 |
$99.60 |
$116.64
|
|
Gonadotropin luteinizing hormone (lh)
|
$105.60 |
$105.60 |
$105.60 |
$129.03
|
|
Goserelin 10.8 mg subcutaneous implant
|
$5,489.50 |
$5,489.50 |
$5,489.50 |
$4,417.13
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$2,868.60 |
$2,868.60 |
$2,868.60 |
$73.83
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$31,054.80 |
$31,054.80 |
$31,054.80 |
$23,233.80
|
|
Graft nerve adv 3-4x70mm
|
$26,257.80 |
$26,257.80 |
$26,257.80 |
$20,782.10
|
|
Graft patch felt ptfe 2x2
|
$10,269.00 |
$10,269.00 |
$10,269.00 |
$29,293.39
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$11,542.80 |
$11,542.80 |
$11,542.80 |
$886.17
|
|
Graft repair of spine defect 63710
|
$2,054.40 |
$2,054.40 |
$2,054.40 |
$2,054.40
|
