|
Ghs layer closure 2.5 cm or less - 12041
|
$676.00 |
$676.00 |
$676.00 |
$583.10
|
|
Ghs layer closure 2.5cm or less - 12051
|
$836.00 |
$836.00 |
$836.00 |
$603.20
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$806.40 |
$806.40 |
$806.40 |
$672.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$788.00 |
$788.00 |
$788.00 |
$700.33
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$809.60 |
$809.60 |
$809.60 |
$741.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$917.60 |
$917.60 |
$917.60 |
$779.35
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$804.00 |
$804.00 |
$804.00 |
$760.20
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$718.40 |
$718.40 |
$718.40 |
$740.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$1,476.80 |
$1,476.80 |
$1,476.80 |
$969.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$1,156.00 |
$1,156.00 |
$1,156.00 |
$784.80
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$584.80 |
$584.80 |
$584.80 |
$1,016.25
|
|
Ghs layered repair 20.1 - 30.0 cm -12056
|
$611.20 |
$611.20 |
$611.20 |
$913.90
|
|
Ghs layered repair over 30.0 cm -12047
|
$1,020.80 |
$1,020.80 |
$1,020.80 |
$1,930.50
|
|
Ghs layered repair over 3.0 cm -12057
|
$560.00 |
$560.00 |
$560.00 |
$1,064.98
|
|
Ghs nailbed repair/nail removal
|
$628.80 |
$628.80 |
$628.80 |
$724.37
|
|
Ghs nerve block lumbar or thoracic symp
|
$2,087.20 |
$2,087.20 |
$2,087.20 |
$1,704.63
|
|
Ghs ng placement w fluoro guidance
|
$631.20 |
$631.20 |
$631.20 |
$485.00
|
|
Ghs ob unlisted IV or art inj or infusion
|
$155.20 |
$155.20 |
$155.20 |
$82.62
|
|
Ghs ot dds rom
|
$84.80 |
$84.80 |
$84.80 |
$69.00
|
|
Ghs ot group caregiver training
|
$59.20 |
$59.20 |
$59.20 |
$34.80
|
|
Ghs ot prosthetic training/15 min
|
$123.20 |
$123.20 |
$123.20 |
$93.00
|
|
Ghs ot sensory integrative tech/15min
|
$124.80 |
$124.80 |
$124.80 |
$96.20
|
|
Ghs ot work hardening-additional hours
|
$208.80 |
$208.80 |
$208.80 |
$126.40
|
|
Ghs pacing - transcutaneous
|
$738.40 |
$738.40 |
$738.40 |
$830.53
|
|
Ghs peritonsillar abscess i andd
|
$593.60 |
$593.60 |
$593.60 |
$555.00
|
|
Ghs plngl fx pm cl
|
$636.00 |
$636.00 |
$636.00 |
$564.80
|
|
Ghs pr without cont pulse ox
|
$165.60 |
$165.60 |
$165.60 |
$147.00
|
|
Ghs pt - work hardening/int 2hrs
|
$402.40 |
$402.40 |
$402.40 |
$285.60
|
|
Ghs removal intranasal foreign body
|
$283.20 |
$283.20 |
$283.20 |
$283.24
|
|
Ghs removal pharyngeal foreign body
|
$608.00 |
$608.00 |
$608.00 |
$441.68
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$553.60 |
$553.60 |
$553.60 |
$570.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$733.60 |
$733.60 |
$733.60 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$573.60 |
$573.60 |
$573.60 |
$586.50
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$892.80 |
$892.80 |
$892.80 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$565.60 |
$565.60 |
$565.60 |
$449.15
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$539.20 |
$539.20 |
$539.20 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$588.80 |
$588.80 |
$588.80 |
$489.72
|
|
Ghs simple repair over 30 cm - 12007
|
$665.60 |
$665.60 |
$665.60 |
$590.88
|
|
Ghs simple repair over 30 cm - 12018
|
$358.40 |
$358.40 |
$358.40 |
$537.60
|
|
Ghs speech-gen aug dev eval iii, st
|
$207.20 |
$207.20 |
$207.20 |
$157.50
|
|
Ghs sp train/fitting sp device - kx
|
$315.20 |
$315.20 |
$315.20 |
$252.75
|
|
Ghs strapping shoulder - 29240
|
$203.20 |
$203.20 |
$203.20 |
$217.60
|
|
Ghs superficial wnd dehiscence simp12020
|
$1,839.20 |
$1,839.20 |
$1,839.20 |
$953.27
|
|
Ghs superficial wnd dehis w packing12021
|
$980.80 |
$980.80 |
$980.80 |
$695.93
|
|
Ghs tracheostomy emergency - transtracheal
|
$2,300.00 |
$2,300.00 |
$2,300.00 |
$1,867.84
|
|
Ghs tx distal phalangeal fx with manipulation
|
$700.00 |
$700.00 |
$700.00 |
$529.65
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$761.60 |
$761.60 |
$761.60 |
$513.80
|
|
Ghs vaginal delivery only
|
$3,480.80 |
$3,480.80 |
$3,480.80 |
$3,341.93
|
|
Glucagon 1 mg solution for injection
|
$334.09 |
$334.09 |
$334.09 |
$613.79
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$186.10 |
$186.10 |
$186.10 |
$491.67
|
|
Graft xenmtrx sft rect 15x20cm
|
$1,517.76 |
$1,517.76 |
$1,517.76 |
$29,676.26
|
|
Great toe with reduction 28495
|
$600.80 |
$600.80 |
$600.80 |
$495.00
|
|
Ground mileage
|
$29.60 |
$29.60 |
$29.60 |
$17.60
|
|
Group train without patient
|
$59.20 |
$59.20 |
$59.20 |
$47.60
|
|
Guide wire threaded 1.4x150mm
|
$1,231.92 |
$1,231.92 |
$1,231.92 |
$3,284.36
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$48.67 |
$48.67 |
$48.67 |
$24.30
|
|
Hands-On Manual Therapy (each 15 minutes)
|
$132.80 |
$132.80 |
$132.80 |
$105.30
|
|
Hand X-ray
|
$505.60 |
$505.60 |
$505.60 |
$350.35
|
|
Hand X-ray (2 views, both hands)
|
$348.80 |
$348.80 |
$348.80 |
$294.90
|
|
Head CT scan (with and without contrast)
|
$2,363.20 |
$2,363.20 |
$2,363.20 |
$1,818.96
|
|
Head CT scan (with contrast)
|
$2,047.20 |
$2,047.20 |
$2,047.20 |
$1,527.60
|
|
Head CT scan (without contrast)
|
$1,863.20 |
$1,863.20 |
$1,863.20 |
$1,268.90
|
|
Heel (Calcaneus) X-ray (both feet)
|
$408.00 |
$408.00 |
$408.00 |
$276.00
|
|
Heparin bolus from bag
|
$50.51 |
$50.51 |
$50.51 |
$66.06
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$8.91 |
$8.91 |
$8.91 |
$12.00
|
|
Hinge extension/flex wrist/f
|
$2,491.32 |
$2,491.32 |
$2,491.32 |
$1,653.00
|
|
Hip and Pelvis X-ray (2 views, both hips)
|
$506.40 |
$506.40 |
$506.40 |
$374.40
|
|
Hip and Pelvis X-ray (3 to 4 views, both hips)
|
$582.40 |
$582.40 |
$582.40 |
$424.80
|
|
Hip and Pelvis X-ray (single view, left side)
|
$292.80 |
$292.80 |
$292.80 |
$233.50
|
|
Hip X-ray
|
$350.40 |
$350.40 |
$350.40 |
$294.75
|
|
Hla class i high defin qual
|
$776.80 |
$776.80 |
$776.80 |
$631.15
|
|
Hla class ii high defin qual
|
$782.40 |
$782.40 |
$782.40 |
$569.25
|
|
Hopd mntl hlt, 15-29 min
|
$428.80 |
$428.80 |
$428.80 |
$60.00
|
|
Hopd mntl hlt, 30-60 min
|
$1,500.00 |
$1,500.00 |
$1,500.00 |
$152.25
|
|
Hydralazine 20 mg/ml injection solution
|
$51.20 |
$51.20 |
$51.20 |
$48.00
|
|
Hydrocortisone in ns IV syringe 1 mg/ml (neo/ped) - cnr
|
$65.45 |
$65.45 |
$65.45 |
$140.54
|
|
Hydromorphone 0.2 mg/ml in 0.9% nacl IV pca opioid naive - 4 hr dose limit (wrapper)
|
$49.24 |
$49.24 |
$49.24 |
$112.66
|
|
Hydromorphone 20-0.9 mg/100ml-% soln 100 ml cartridge
|
$53.40 |
$53.40 |
$53.40 |
$294.92
|
|
I-123 sod iodide diag per 100 uci
|
$224.80 |
$224.80 |
$224.80 |
$147.46
|
|
I&d upper arm/elbow deep abscess/hematoma
|
$767.20 |
$767.20 |
$767.20 |
$3,371.02
|
|
Ihc/icc per specimen each additional single antibody stain
|
$187.20 |
$187.20 |
$187.20 |
$191.52
|
|
Ihc/icc per specimen initial single antibody stain
|
$265.60 |
$265.60 |
$265.60 |
$277.90
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$1,894.40 |
$1,894.40 |
$1,894.40 |
$2,086.70
|
|
Infliximab 100 mg intravenous solution
|
$1,172.08 |
$1,172.08 |
$1,172.08 |
$2,047.13
|
|
Inj acetaminophen -fresenius
|
$49.60 |
$49.60 |
$49.60 |
$36.60
|
|
Inj cefazolin sodium, hikma
|
$51.40 |
$51.40 |
$51.40 |
$27.38
|
|
Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides)
|
$1,194.40 |
$1,194.40 |
$1,194.40 |
$1,043.72
|
|
Injection(s) tendon sheath/ligament aponeurosis single (both sides)
|
$543.20 |
$543.20 |
$543.20 |
$475.80
|
|
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s)
|
$706.40 |
$706.40 |
$706.40 |
$548.80
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug
|
$215.20 |
$215.20 |
$215.20 |
$145.60
|
|
Inj, lidocaine w epinephrine
|
$48.53 |
$48.53 |
$48.53 |
$45.60
|
|
Inj pantoprazole(hikma) 40mg
|
$51.04 |
$51.04 |
$51.04 |
$34.67
|
|
Inj pegfilgrastim-bmez 0.5mg
|
$2,108.52 |
$2,108.52 |
$2,108.52 |
$6,614.40
|
|
Inj testosterone cypionate
|
$51.49 |
$51.49 |
$51.49 |
$64.96
|
|
Insert cath pleura with image
|
$2,742.40 |
$2,742.40 |
$2,742.40 |
$2,194.40
|
|
Insert cath pleura without image
|
$2,030.40 |
$2,030.40 |
$2,030.40 |
$2,099.70
|
|
Insertion catheter bladder non indwelling
|
$220.80 |
$220.80 |
$220.80 |
$208.01
|
|
Insertion nontunneled centrally inserted central venous catheter >= 5 years old
|
$2,311.20 |
$2,311.20 |
$2,311.20 |
$2,585.25
|
|
Interdental fixation
|
$2,273.60 |
$2,273.60 |
$2,273.60 |
$2,133.48
|
|
Intubation endotracheal emergency procedure
|
$798.40 |
$798.40 |
$798.40 |
$601.28
|