|
Ghs moderate sedation < 5 yr, 30 min
|
$232.18 |
$242.31 |
$338.06 |
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$232.18 |
$242.31 |
$338.06 |
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$242.31 |
$268.32 |
$338.06 |
|
|
Ghs moderate sedation ea addtl 15 min
|
$117.78 |
$121.16 |
$169.03 |
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$117.78 |
$121.16 |
$169.03 |
|
|
Ghs nerve blk intercostal, ea addtl level
|
$705.61 |
$730.80 |
$984.42 |
|
|
Ghs nerve blk intercostal, single level
|
$351.60 |
$542.43 |
$756.76 |
|
|
Ghs nerve block brachial plexus
|
$606.60 |
$606.60 |
$671.70 |
|
|
Ghs nerve block celiac plexus
|
$371.46 |
$371.46 |
$518.24 |
|
|
Ghs nerve block sciatic nerve
|
$486.26 |
$486.26 |
$538.45 |
|
|
Ghs ng placement w fluoro guidance
|
$109.17 |
$151.70 |
$211.64 |
|
|
Ghs o2 uptake rest & indirect
|
$128.34 |
$128.34 |
$128.34 |
|
|
Ghs opcc repair cvp without subq port
|
$917.38 |
$917.38 |
$917.38 |
|
|
Ghs opcc repair cvp w subq port
|
$673.43 |
$673.43 |
$673.43 |
|
|
Ghs ot group caregiver training
|
$52.29 |
$52.29 |
$52.29 |
|
|
Ghs ot prosthetic training/15 min
|
$52.89 |
$60.80 |
$73.79 |
|
|
Ghs ot sensory integrative tech/15min
|
$32.39 |
$32.39 |
$45.19 |
|
|
Ghs pacing - transcutaneous
|
$383.20 |
$444.85 |
$620.62 |
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$336.24 |
$336.24 |
$336.24 |
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$393.09 |
$393.09 |
$393.09 |
|
|
Ghs phenylketonurid
|
$8.19 |
$20.71 |
$22.93 |
|
|
Ghs picc line insert < 5
|
$729.83 |
$1,494.45 |
$1,654.83 |
|
|
Ghs polysom <6 yrs 4/> parameters
|
$4,338.07 |
$4,338.07 |
$4,338.07 |
|
|
Ghs ppd (tb intradermal)
|
$13.12 |
$14.53 |
$30.53 |
|
|
Ghs prostatic acid phosphatase (mayo)
|
$28.92 |
$28.92 |
$28.92 |
|
|
Ghs protoporphyrins fract
|
$21.32 |
$23.61 |
$53.50 |
|
|
Ghs pr without cont pulse ox
|
$137.49 |
$137.49 |
$137.49 |
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$32.29 |
$32.29 |
$32.29 |
|
|
Ghs quinidine
|
$28.92 |
$28.92 |
$28.92 |
|
|
Ghs respiratory syncytical virus igg/m
|
$34.65 |
$38.37 |
$48.34 |
|
|
Ghs reticulocyte count
|
$6.27 |
$6.27 |
$6.27 |
|
|
Ghs rsv eia (respir synctial vrs)
|
$8.00 |
$8.86 |
$22.30 |
|
|
Ghs sedimentation rate
|
$6.27 |
$6.27 |
$6.27 |
|
|
Ghs sensitivity (per antimicro)
|
$12.21 |
$168.31 |
$234.81 |
|
|
Ghs sleep study unattended
|
$679.38 |
$679.38 |
$679.38 |
|
|
Ghs somatosensory testing lower extremit
|
$152.32 |
$168.67 |
$212.50 |
|
|
Ghs speech-gen aug dev eval iii, st
|
$107.42 |
$107.42 |
$149.87 |
|
|
Ghs sphenopalatine ganglion block
|
$168.92 |
$168.92 |
$168.92 |
|
|
Ghs sp train/fitting sp device - kx
|
$131.61 |
$145.74 |
$171.89 |
|
|
Ghs st - re-eval for alt comm
|
$163.39 |
$180.92 |
$227.95 |
|
|
Ghs superficial wnd dehiscence simp12020
|
$1,647.18 |
$1,647.18 |
$1,823.95 |
|
|
Ghs tracheostomy emergency - transtracheal
|
$848.70 |
$848.70 |
$939.78 |
|
|
Ghs urine, porphyrins quant
|
$14.15 |
$15.67 |
$29.88 |
|
|
Ghs veeg 12-26 hr intmt mont
|
$306.68 |
$348.22 |
$427.86 |
|
|
Giardia ag if
|
$32.39 |
$32.39 |
$32.39 |
|
|
Giardia lamblia antibody
|
$38.59 |
$38.59 |
$38.59 |
|
|
Gi inhouse confirmation
|
$33.45 |
$274.91 |
$383.53 |
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$726.73 |
$804.72 |
$1,013.87 |
|
|
Glucagon 1 mg solution for injection
|
$189.63 |
$199.63 |
$342.55 |
|
|
Glucagon plasma - sendout
|
$10.05 |
$11.13 |
$32.29 |
|
|
Glucose 1 hr post dose
|
$7.23 |
$70.73 |
$98.67 |
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$20.91 |
$23.16 |
$29.18 |
|
|
Glucose blood quantitative
|
$81.80 |
$90.58 |
$114.12 |
|
|
Glucose body fluid
|
$63.14 |
$88.15 |
$122.98 |
|
|
Glucose tolerance test (gtt) 3 specimens
|
$18.80 |
$62.73 |
$87.52 |
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$5.78 |
$62.73 |
$87.52 |
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$42.90 |
$63.35 |
$70.15 |
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$25.22 |
$27.93 |
$35.18 |
|
|
Gonadotropin luteinizing hormone (lh)
|
$27.96 |
$43.05 |
$60.06 |
|
|
Goserelin 10.8 mg subcutaneous implant
|
$920.45 |
$920.45 |
$1,019.23 |
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$1,356.08 |
$1,356.08 |
$1,501.61 |
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$1,763.41 |
$1,763.41 |
$1,952.66 |
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$17,915.77 |
$17,915.77 |
$19,838.44 |
|
|
Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm
|
$1,356.08 |
$1,356.08 |
$1,501.61 |
|
|
Graft nerve adv 3-4x70mm
|
$17,915.77 |
$19,838.44 |
$27,705.80 |
|
|
Graft patch felt ptfe 2x2
|
$5,409.12 |
$31,483.55 |
$38,656.97 |
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$2,293.13 |
$2,293.13 |
$2,539.23 |
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$6,553.44 |
$6,553.44 |
$7,256.74 |
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$1,615.90 |
$10,112.86 |
$11,198.14 |
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$2,981.93 |
$3,301.95 |
$4,160.16 |
|
|
Graft tis hmatrix dermis 10x5 -cost per sq cm
|
$8,519.80 |
$8,519.80 |
$9,434.12 |
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$21,677.11 |
$21,677.11 |
$24,003.44 |
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$1,454.60 |
$2,293.13 |
$2,539.23 |
|
|
Graft xenmtrx sft rect 15x20cm
|
$21,409.55 |
$26,229.14 |
$29,043.97 |
|
|
Graft xenmtrx sft rect 19x28cm
|
$1,158.25 |
$1,282.55 |
$3,089.48 |
|
|
Granisetron hcl injection
|
$11.07 |
$11.07 |
$12.26 |
|
|
Ground mileage
|
$11.74 |
$11.74 |
$11.74 |
|
|
G-tube reposition
|
$393.40 |
$393.40 |
$435.62 |
|
|
Gu dilat ureter/urethra s&i
|
$835.99 |
$835.99 |
$835.99 |
|
|
Guided cath fluid drainage 10030
|
$291.51 |
$322.80 |
$406.70 |
|
|
Guide wire threaded 1.4x150mm
|
$1,891.89 |
$2,293.13 |
$6,711.28 |
|
|
Guide worley csg 9fx50cm std
|
$1,356.08 |
$1,501.61 |
$1,736.87 |
|
|
Gw stiffened micro access kit
|
$1,615.90 |
$3,804.11 |
$4,293.26 |
|
|
Halo cervical into jckt vest
|
$2,981.93 |
$3,301.95 |
$4,160.16 |
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$23.99 |
$23.99 |
$26.56 |
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$6.77 |
$7.50 |
$9.44 |
|
|
Halo repl liner/interface
|
$362.24 |
$401.11 |
$505.37 |
|
|
Handpiece aquabeam hp2000
|
$3,877.17 |
$3,877.17 |
$4,293.26 |
|
|
Hands-On Manual Therapy (each 15 minutes)
|
$42.44 |
$46.99 |
$88.16 |
|
|
Hand X-ray
|
$227.26 |
$452.23 |
$630.92 |
|
|
Hand X-ray (2 views, both hands)
|
$185.99 |
$379.87 |
$529.96 |
|
|
Haptoglobin quantitative
|
$28.44 |
$28.50 |
$39.76 |
|
|
Harvest auto stem cells
|
$2,578.08 |
$2,854.76 |
$3,596.74 |
|
|
Hba1/hba2 full gene sequence
|
$369.00 |
$408.60 |
$874.80 |
|
|
Hba1/hba2 gene dup/del vrnts
|
$261.38 |
$289.43 |
$364.65 |
|
|
Hbb full gene sequence
|
$568.88 |
$629.93 |
$1,932.22 |
|
|
Hbb gene dup/del variants
|
$165.64 |
$183.42 |
$231.09 |
|
|
Hbot, full body chamber, 30m
|
$352.60 |
$352.60 |
$390.44 |
|
|
Hc fl sm bowel enteroclss tube w kub double contrast
|
$1,277.82 |
$1,587.32 |
$2,214.50 |
|
|
Hcg qualitative
|
$11.09 |
$77.08 |
$107.54 |
|
