|
Ghs moderate sedation < 5 yr, 30 min
|
$239.40 |
$239.40 |
$239.40 |
$242.31
|
|
Ghs moderate sedation ea addtl 15 min
|
$174.00 |
$174.00 |
$174.00 |
$151.50
|
|
Ghs musc test done w/n test comp
|
$259.80 |
$259.80 |
$259.80 |
$318.75
|
|
Ghs musc tst done w/nerv tst lim
|
$259.80 |
$259.80 |
$259.80 |
$266.59
|
|
Ghs nailbed repair/nail removal
|
$1,179.00 |
$1,179.00 |
$1,179.00 |
$724.37
|
|
Ghs nerve blk intercostal, single level
|
$1,132.80 |
$1,132.80 |
$1,132.80 |
$1,107.00
|
|
Ghs nerve block brachial plexus
|
$2,583.60 |
$2,583.60 |
$2,583.60 |
$1,689.00
|
|
Ghs o2 saturation
|
$96.60 |
$96.60 |
$96.60 |
$70.80
|
|
Ghs opcc repair cvp without subq port
|
$1,371.60 |
$1,371.60 |
$1,371.60 |
$1,229.24
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$64.80 |
$64.80 |
$64.80 |
$55.77
|
|
Ghs ot dds rom
|
$130.20 |
$130.20 |
$130.20 |
$62.28
|
|
Ghs ot group caregiver training
|
$33.60 |
$33.60 |
$33.60 |
$34.92
|
|
Ghs ot sensory integrative tech/15min
|
$95.40 |
$95.40 |
$95.40 |
$94.80
|
|
Ghs ot work hardening-additional hours
|
$96.60 |
$96.60 |
$96.60 |
$127.80
|
|
Ghs pacing - transcutaneous
|
$1,218.60 |
$1,218.60 |
$1,218.60 |
$815.20
|
|
Ghs peritonsillar abscess i andd
|
$462.00 |
$462.00 |
$462.00 |
$546.36
|
|
Ghs phenylketonurid
|
$46.80 |
$46.80 |
$46.80 |
$53.76
|
|
Ghs plngl fx pm cl
|
$519.60 |
$519.60 |
$519.60 |
$564.80
|
|
Ghs plt ct-manual
|
$10.20 |
$10.20 |
$10.20 |
$37.96
|
|
Ghs prostatic acid phosphatase (mayo)
|
$17.40 |
$17.40 |
$17.40 |
$43.55
|
|
Ghs protein, misc fluid
|
$10.20 |
$10.20 |
$10.20 |
$24.60
|
|
Ghs protoporphyrins fract
|
$44.40 |
$44.40 |
$44.40 |
$64.28
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$22.80 |
$22.80 |
$22.80 |
$50.05
|
|
Ghs pt - work hardening/int 2hrs
|
$636.60 |
$636.60 |
$636.60 |
$275.60
|
|
Ghs quinidine
|
$53.40 |
$53.40 |
$53.40 |
$85.00
|
|
Ghs removal intranasal foreign body
|
$260.40 |
$260.40 |
$260.40 |
$287.50
|
|
Ghs removal pharyngeal foreign body
|
$685.80 |
$685.80 |
$685.80 |
$459.90
|
|
Ghs repair tendon ext forearm/wrist ea
|
$5,274.60 |
$5,274.60 |
$5,274.60 |
$4,041.79
|
|
Ghs respiratory syncytical virus igg/m
|
$79.20 |
$79.20 |
$79.20 |
$71.20
|
|
Ghs sedimentation rate
|
$34.20 |
$34.20 |
$34.20 |
$45.50
|
|
Ghs semen analysis fert
|
$286.80 |
$286.80 |
$286.80 |
$129.00
|
|
Ghs sensitivity (per antimicro)
|
$36.60 |
$36.60 |
$36.60 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$861.00 |
$861.00 |
$861.00 |
$553.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$910.80 |
$910.80 |
$910.80 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$1,066.80 |
$1,066.80 |
$1,066.80 |
$575.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$1,015.80 |
$1,015.80 |
$1,015.80 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$598.80 |
$598.80 |
$598.80 |
$448.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$610.20 |
$610.20 |
$610.20 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$805.80 |
$805.80 |
$805.80 |
$484.80
|
|
Ghs simple repair over 30 cm - 12007
|
$1,170.00 |
$1,170.00 |
$1,170.00 |
$582.00
|
|
Ghs sp train/fitting sp device - kx
|
$184.80 |
$184.80 |
$184.80 |
$250.50
|
|
Ghs strapping shoulder - 29240
|
$141.60 |
$141.60 |
$141.60 |
$213.20
|
|
Ghs st - re-eval for alt comm
|
$441.00 |
$441.00 |
$441.00 |
$309.00
|
|
Ghs superficial wnd dehiscence simp12020
|
$1,179.00 |
$1,179.00 |
$1,179.00 |
$861.75
|
|
Ghs tracheostomy emergency - transtracheal
|
$2,701.80 |
$2,701.80 |
$2,701.80 |
$1,752.89
|
|
Ghs tx distal phalangeal fx with manipulation
|
$519.60 |
$519.60 |
$519.60 |
$523.00
|
|
Ghs urine, hydroxproline total
|
$52.20 |
$52.20 |
$52.20 |
$109.60
|
|
Ghs urine, porphyrins quant
|
$63.00 |
$63.00 |
$63.00 |
$75.00
|
|
Ghs vaginal delivery only
|
$4,984.80 |
$4,984.80 |
$4,984.80 |
$3,152.00
|
|
Giardia lamblia antibody
|
$70.80 |
$70.80 |
$70.80 |
$83.44
|
|
Gi inhouse confirmation
|
$30.60 |
$30.60 |
$30.60 |
$83.70
|
|
Gjb2 gene full sequence
|
$502.80 |
$502.80 |
$502.80 |
$502.80
|
|
Gjb6 gene com variants
|
$250.20 |
$250.20 |
$250.20 |
$106.40
|
|
Glove finger flexion right lg xl
|
$226.87 |
$226.87 |
$226.87 |
$100.48
|
|
Glucagon 1 mg solution for injection
|
$1,263.36 |
$1,263.36 |
$1,263.36 |
$601.79
|
|
Glucagon plasma - sendout
|
$27.00 |
$27.00 |
$27.00 |
$63.00
|
|
Glucose 1 hr post dose
|
$42.60 |
$42.60 |
$42.60 |
$47.20
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$37.20 |
$37.20 |
$37.20 |
$23.86
|
|
Glucose blood quantitative
|
$47.40 |
$47.40 |
$47.40 |
$40.00
|
|
Glucose body fluid
|
$50.40 |
$50.40 |
$50.40 |
$52.20
|
|
Glucose tolerance test (gtt) 3 specimens
|
$90.60 |
$90.60 |
$90.60 |
$100.16
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$36.00 |
$36.00 |
$36.00 |
$35.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$6.00 |
$6.00 |
$6.00 |
$37.04
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$8,636.52 |
$8,636.52 |
$8,636.52 |
$4,977.60
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$139.80 |
$139.80 |
$139.80 |
$115.05
|
|
Gonadotropin luteinizing hormone (lh)
|
$135.60 |
$135.60 |
$135.60 |
$129.00
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$4,471.67 |
$4,471.67 |
$4,471.67 |
$672.50
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$60,265.21 |
$60,265.21 |
$60,265.21 |
$584.99
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$43,438.72 |
$43,438.72 |
$43,438.72 |
$24,469.57
|
|
Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm
|
$3,901.64 |
$3,901.64 |
$3,901.64 |
$3,432.00
|
|
Graft nerve adv 3-4x70mm
|
$110,978.26 |
$110,978.26 |
$110,978.26 |
$19,620.00
|
|
Graft patch felt ptfe 2x2
|
$83,975.04 |
$83,975.04 |
$83,975.04 |
$27,300.00
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$36,739.08 |
$36,739.08 |
$36,739.08 |
$1,455.76
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$13,462.25 |
$13,462.25 |
$13,462.25 |
$1,181.41
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$22,830.71 |
$22,830.71 |
$22,830.71 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$8,868.02 |
$8,868.02 |
$8,868.02 |
$373.00
|
|
Graft tis hmatrix dermis 10x5 -cost per sq cm
|
$3,936.33 |
$3,936.33 |
$3,936.33 |
$3,822.00
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$82,752.16 |
$82,752.16 |
$82,752.16 |
$27,367.40
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$6,954.19 |
$6,954.19 |
$6,954.19 |
$1,132.47
|
|
Graft xenmtrx sft rect 15x20cm
|
$82,899.11 |
$82,899.11 |
$82,899.11 |
$30,392.04
|
|
Graft xenmtrx sft rect 19x28cm
|
$39,264.89 |
$39,264.89 |
$39,264.89 |
$2,701.58
|
|
Granulocyte pheresis ea unit
|
$2,746.80 |
$2,746.80 |
$2,746.80 |
$2,309.40
|
|
Great toe with reduction 28495
|
$519.60 |
$519.60 |
$519.60 |
$482.40
|
|
Growth hormone antibody
|
$174.60 |
$174.60 |
$174.60 |
$72.60
|
|
Growth stimulation gene 2
|
$112.80 |
$112.80 |
$112.80 |
$170.04
|
|
Guide endoanchr sg-64 aaa 62cm
|
$13,603.96 |
$13,603.96 |
$13,603.96 |
$7,728.17
|
|
Guide wire threaded 1.4x150mm
|
$20,941.28 |
$20,941.28 |
$20,941.28 |
$3,284.50
|
|
Guide worley csg 9fx50cm std
|
$1,836.95 |
$1,836.95 |
$1,836.95 |
$1,105.00
|
|
Gw stiffened micro access kit
|
$17,912.93 |
$17,912.93 |
$17,912.93 |
$6,696.00
|
|
Hallus-valgus nt dyn pre ots
|
$102.37 |
$102.37 |
$102.37 |
$102.37
|
|
Halo cervical into jckt vest
|
$17,713.49 |
$17,713.49 |
$17,713.49 |
$5,015.12
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$6.00 |
$6.00 |
$6.00 |
$23.06
|
|
Halo repl liner/interface
|
$3,002.11 |
$3,002.11 |
$3,002.11 |
$1,931.10
|
|
Hand orthosis metacarpal fracture orthosis prefa l3918
|
$227.39 |
$227.39 |
$227.39 |
$115.00
|
|
Handpiece aquabeam hp2000
|
$8,528.72 |
$8,528.72 |
$8,528.72 |
$6,628.05
|
|
Hand X-ray
|
$447.60 |
$447.60 |
$447.60 |
$356.00
|
|
Haptoglobin quantitative
|
$93.60 |
$93.60 |
$93.60 |
$91.14
|
|
Hba1/hba2 full gene sequence
|
$992.40 |
$992.40 |
$992.40 |
$769.95
|
|
Hba1/hba2 gene dup/del vrnts
|
$421.20 |
$421.20 |
$421.20 |
$404.80
|
|
Hbb full gene sequence
|
$380.40 |
$380.40 |
$380.40 |
$633.25
|
