|
Ghs ob unlisted IV or art inj or infusion
|
$29.50 |
$29.50 |
$285.66 |
$83.04
|
|
Ghs opcc repair cvp without subq port
|
$780.50 |
$780.50 |
$1,769.62 |
$1,229.24
|
|
Ghs opcc repair cvp w subq port
|
$2,153.50 |
$2,153.50 |
$2,153.50 |
$2,194.40
|
|
Ghs ot prosthetic training/15 min
|
$43.50 |
$43.50 |
$54.74 |
$90.50
|
|
Ghs ot sensory integrative tech/15min
|
$33.12 |
$33.12 |
$43.00 |
$96.00
|
|
Ghs pacing - transcutaneous
|
$285.20 |
$285.20 |
$437.50 |
$819.60
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$507.50 |
$507.50 |
$507.50 |
$851.04
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$442.50 |
$442.50 |
$442.50 |
$962.00
|
|
Ghs peritonsillar abscess i andd
|
$260.50 |
$260.50 |
$260.50 |
$544.44
|
|
Ghs phenylketonurid
|
$93.50 |
$93.50 |
$93.50 |
$53.76
|
|
Ghs picc line insert < 5
|
$397.90 |
$397.90 |
$815.50 |
$1,999.46
|
|
Ghs plngl fx pm cl
|
$421.50 |
$421.50 |
$421.50 |
$580.32
|
|
Ghs polysom <6 yrs 4/> parameters
|
$609.50 |
$609.50 |
$662.50 |
$3,557.58
|
|
Ghs ppd (tb intradermal)
|
$48.88 |
$48.88 |
$53.13 |
$37.70
|
|
Ghs protoporphyrins fract
|
$164.50 |
$164.50 |
$164.50 |
$64.28
|
|
Ghs pr without cont pulse ox
|
$114.54 |
$114.54 |
$157.50 |
$147.95
|
|
Ghs quinidine
|
$62.50 |
$62.50 |
$62.50 |
$85.00
|
|
Ghs refill of implantable pump
|
$431.00 |
$431.00 |
$431.00 |
$550.00
|
|
Ghs removal intranasal foreign body
|
$170.50 |
$170.50 |
$170.50 |
$287.50
|
|
Ghs removal pharyngeal foreign body
|
$377.50 |
$377.50 |
$377.50 |
$441.68
|
|
Ghs repair extensor tendon hand, ea tendon
|
$1,504.00 |
$1,504.00 |
$1,504.00 |
$2,211.05
|
|
Ghs repair tendon ext forearm/wrist ea
|
$2,421.50 |
$2,421.50 |
$2,421.50 |
$4,108.00
|
|
Ghs rsv eia (respir synctial vrs)
|
$50.00 |
$50.00 |
$201.94 |
$99.00
|
|
Ghs sedimentation rate
|
$14.26 |
$14.26 |
$14.26 |
$44.85
|
|
Ghs sensitivity (per antimicro)
|
$53.50 |
$53.50 |
$82.80 |
$58.95
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$255.00 |
$255.00 |
$255.00 |
$558.97
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$349.00 |
$349.00 |
$349.00 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$271.50 |
$271.50 |
$271.50 |
$575.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$362.50 |
$362.50 |
$362.50 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$295.50 |
$295.50 |
$295.50 |
$451.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$240.50 |
$240.50 |
$240.50 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$323.50 |
$323.50 |
$323.50 |
$492.80
|
|
Ghs simple repair over 30 cm - 12007
|
$286.00 |
$286.00 |
$286.00 |
$589.80
|
|
Ghs simple repair over 30 cm - 12018
|
$409.00 |
$409.00 |
$409.00 |
$537.60
|
|
Ghs somatosensory testing upper & lower limbs
|
$898.50 |
$898.50 |
$898.50 |
$1,405.20
|
|
Ghs speech-gen aug dev eval iii, st
|
$35.50 |
$35.50 |
$35.50 |
$152.55
|
|
Ghs strapping shoulder - 29240
|
$274.50 |
$274.50 |
$274.50 |
$213.20
|
|
Ghs st - re-eval for alt comm
|
$191.50 |
$191.50 |
$238.74 |
$298.00
|
|
Ghs superficial wnd dehiscence simp12020
|
$398.00 |
$398.00 |
$398.00 |
$890.40
|
|
Ghs superficial wnd dehis w packing12021
|
$305.50 |
$305.50 |
$305.50 |
$696.68
|
|
Ghs tracheostomy emergency - transtracheal
|
$819.72 |
$819.72 |
$891.00 |
$1,752.89
|
|
Ghs tx distal phalangeal fx with manipulation
|
$173.50 |
$173.50 |
$173.50 |
$526.35
|
|
Ghs urine, porphyrins quant
|
$39.50 |
$39.50 |
$39.50 |
$75.00
|
|
Ghs vaginal delivery only
|
$1,638.52 |
$1,638.52 |
$1,781.00 |
$3,142.35
|
|
Ghs veeg 12-26 hr intmt mont
|
$413.54 |
$413.54 |
$421.00 |
$1,932.00
|
|
Gi inhouse confirmation
|
$29.90 |
$29.90 |
$128.00 |
$84.60
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$1,636.00 |
$1,636.00 |
$1,636.00 |
$2,096.00
|
|
Gi trc img intral colon i&r
|
$1,415.50 |
$1,415.50 |
$1,415.50 |
$1,959.88
|
|
Gi trc img intral esophagus
|
$921.38 |
$921.38 |
$921.38 |
$1,897.82
|
|
Glassia injection
|
$0.29 |
$0.29 |
$0.31 |
$20.32
|
|
Glucagon 1 mg solution for injection
|
$117.81 |
$117.81 |
$128.05 |
$601.79
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$90.46 |
$90.46 |
$98.32 |
$491.67
|
|
Glucose 1 hr post dose
|
$5.52 |
$5.52 |
$64.00 |
$50.40
|
|
Glucose-6-phosphate dhydrogenase screen
|
$78.00 |
$78.00 |
$78.00 |
$55.50
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$24.84 |
$24.84 |
$42.00 |
$24.00
|
|
Glucose blood quantitative
|
$28.52 |
$28.52 |
$39.00 |
$41.40
|
|
Glucose body fluid
|
$22.08 |
$22.08 |
$61.00 |
$51.00
|
|
Glucose tolerance test (gtt) 3 specimens
|
$59.80 |
$59.80 |
$282.50 |
$100.16
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$17.02 |
$17.02 |
$80.00 |
$35.70
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$221.75 |
$221.75 |
$241.04 |
$4,846.65
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$38.18 |
$38.18 |
$129.00 |
$117.00
|
|
Gonadotropin luteinizing hormone (lh)
|
$67.16 |
$67.16 |
$143.00 |
$130.65
|
|
Goserelin 10.8 mg subcutaneous implant
|
$1,343.21 |
$1,343.21 |
$1,460.01 |
$4,653.16
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$67.45 |
$67.45 |
$67.45 |
$465.83
|
|
Graft axiofill 1000mg
|
$897.00 |
$897.00 |
$975.00 |
$5,125.68
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$441.14 |
$441.14 |
$8,100.00 |
$660.00
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$19,986.02 |
$19,986.02 |
$21,723.93 |
$23,288.44
|
|
Graft nerve adv 3-4x70mm
|
$2,944.58 |
$2,944.58 |
$3,200.63 |
$19,800.00
|
|
Graft patch felt ptfe 2x2
|
$16,232.83 |
$16,232.83 |
$17,644.38 |
$27,435.60
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$2,990.00 |
$2,990.00 |
$3,250.00 |
$1,111.05
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$1,788.48 |
$1,788.48 |
$1,944.00 |
$1,219.88
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$3,220.00 |
$3,220.00 |
$3,500.00 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$1,392.08 |
$1,392.08 |
$1,513.13 |
$427.89
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$21,437.50 |
$21,437.50 |
$23,301.63 |
$28,666.90
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$4,074.32 |
$4,074.32 |
$4,428.60 |
$1,132.47
|
|
Graft xenmtrx sft rect 15x20cm
|
$14,261.38 |
$14,261.38 |
$15,501.50 |
$30,392.04
|
|
Graft xenmtrx sft rect 19x28cm
|
$1,675.19 |
$1,675.19 |
$1,820.85 |
$3,089.48
|
|
Granisetron hcl injection
|
$6.99 |
$6.99 |
$7.59 |
$45.03
|
|
Great toe with reduction 28495
|
$304.50 |
$304.50 |
$304.50 |
$502.00
|
|
G-tube reposition
|
$371.50 |
$371.50 |
$371.50 |
$771.36
|
|
Gu dilat ureter/urethra s&i
|
$1,115.50 |
$1,115.50 |
$1,115.50 |
$2,148.90
|
|
Guided cath fluid drainage 10030
|
$2,127.00 |
$2,127.00 |
$2,127.00 |
$1,372.15
|
|
Guide endoanchr sg-64 aaa 62cm
|
$4,283.08 |
$4,283.08 |
$4,655.52 |
$7,743.36
|
|
Guide wire threaded 1.4x150mm
|
$1,971.68 |
$1,971.68 |
$2,143.13 |
$3,531.94
|
|
Guide worley csg 9fx50cm std
|
$1,172.66 |
$1,172.66 |
$1,274.63 |
$1,117.40
|
|
Guid loc target vol rad tx
|
$521.00 |
$521.00 |
$521.00 |
$536.00
|
|
Gw stiffened micro access kit
|
$7,320.00 |
$7,320.00 |
$8,651.68 |
$6,500.00
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$72.67 |
$72.67 |
$78.99 |
$89.32
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$1.08 |
$1.08 |
$1.17 |
$24.41
|
|
Hand X-ray
|
$146.28 |
$146.28 |
$249.00 |
$356.80
|
|
Haptoglobin quantitative
|
$44.16 |
$44.16 |
$104.50 |
$91.14
|
|
Hbot, full body chamber, 30m
|
$210.00 |
$210.00 |
$210.00 |
$526.90
|
|
Hc fl sm bowel enteroclss tube w kub double contrast
|
$357.00 |
$357.00 |
$357.00 |
$759.72
|
|
Hcg qualitative
|
$48.30 |
$48.30 |
$140.00 |
$90.10
|
|
Hcg quantitative
|
$15.18 |
$15.18 |
$101.50 |
$139.46
|
|
Hc i-131 sodium iodide cap dx per mci
|
$50.00 |
$50.00 |
$50.00 |
$106.60
|
|
Hc nm kidney imaging with flow
|
$486.00 |
$486.00 |
$486.00 |
$865.60
|
|
Hdr rdncl ntrstl/icav brchtx
|
$1,460.00 |
$1,460.00 |
$1,460.00 |
$2,668.85
|
|
Hdr rdncl ntrstl/icav brchtx
|
$1,460.00 |
$1,460.00 |
$1,460.00 |
$2,960.63
|
|
Hdr rdncl ntrstl/icav brchtx
|
$1,460.00 |
$1,460.00 |
$1,460.00 |
$3,735.73
|
