|
Ghs layer closure 2.5 cm or less - 12041
|
$551.00 |
$551.00 |
$551.00 |
$574.80
|
|
Ghs layer closure 2.5cm or less - 12051
|
$551.00 |
$551.00 |
$551.00 |
$606.60
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$551.00 |
$551.00 |
$551.00 |
$675.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$700.33 |
$700.33 |
$700.33 |
$703.20
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$389.50 |
$389.50 |
$389.50 |
$737.55
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$551.00 |
$551.00 |
$551.00 |
$779.35
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$857.00 |
$857.00 |
$857.00 |
$741.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$389.50 |
$389.50 |
$389.50 |
$737.55
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$323.00 |
$323.00 |
$323.00 |
$972.30
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$355.50 |
$355.50 |
$355.50 |
$782.46
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$708.00 |
$708.00 |
$708.00 |
$1,025.64
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$26.00 |
$26.00 |
$26.00 |
$246.40
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$101.00 |
$101.00 |
$101.00 |
$231.00
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$88.00 |
$88.00 |
$88.00 |
$242.31
|
|
Ghs moderate sedation ea addtl 15 min
|
$14.50 |
$14.50 |
$14.50 |
$151.50
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$67.00 |
$67.00 |
$67.00 |
$143.40
|
|
Ghs musc test done w/n test comp
|
$55.00 |
$55.00 |
$55.00 |
$331.20
|
|
Ghs musc tst done w/nerv tst lim
|
$22.00 |
$22.00 |
$22.00 |
$269.15
|
|
Ghs nailbed repair/nail removal
|
$845.00 |
$845.00 |
$845.00 |
$724.37
|
|
Ghs nerve blk intercostal, ea addtl level
|
$27.00 |
$27.00 |
$27.00 |
$1,560.00
|
|
Ghs nerve blk intercostal, single level
|
$64.00 |
$64.00 |
$64.00 |
$1,112.26
|
|
Ghs nerve block axillary nerve
|
$75.50 |
$75.50 |
$75.50 |
$1,605.00
|
|
Ghs nerve block brachial plexus
|
$81.50 |
$81.50 |
$81.50 |
$1,710.80
|
|
Ghs nerve block celiac plexus
|
$104.00 |
$104.00 |
$104.00 |
$1,556.40
|
|
Ghs nerve block interscaline
|
$84.50 |
$84.50 |
$84.50 |
$1,526.09
|
|
Ghs nerve block lumbar or thoracic symp
|
$93.00 |
$93.00 |
$93.00 |
$1,706.50
|
|
Ghs nerve block sciatic nerve
|
$1,051.50 |
$1,051.50 |
$1,051.50 |
$1,450.80
|
|
Ghs nerve block suprascapular
|
$694.50 |
$694.50 |
$694.50 |
$1,142.40
|
|
Ghs ng placement w fluoro guidance
|
$557.00 |
$557.00 |
$557.00 |
$485.00
|
|
Ghs opcc repair cvp w subq port
|
$207.50 |
$207.50 |
$207.50 |
$2,194.40
|
|
Ghs optokenetic
|
$195.50 |
$195.50 |
$195.50 |
$211.20
|
|
Ghs oscillating trac
|
$392.50 |
$392.50 |
$392.50 |
$344.68
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$28.00 |
$28.00 |
$28.00 |
$57.60
|
|
Ghs osteopathic manipulative tx, 3-4 regions
|
$42.50 |
$42.50 |
$42.50 |
$57.65
|
|
Ghs ot group caregiver training
|
$20.50 |
$20.50 |
$20.50 |
$37.20
|
|
Ghs ot sensory integrative tech/15min
|
$58.50 |
$58.50 |
$58.50 |
$96.20
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$63.00 |
$63.00 |
$63.00 |
$880.00
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$55.50 |
$55.50 |
$55.50 |
$962.00
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$29.00 |
$29.00 |
$29.00 |
$76.56
|
|
Ghs peritonsillar abscess i andd
|
$153.50 |
$153.50 |
$153.50 |
$544.44
|
|
Ghs phenylketonurid
|
$175.00 |
$175.00 |
$175.00 |
$53.76
|
|
Ghs plngl fx pm cl
|
$382.50 |
$382.50 |
$382.50 |
$579.15
|
|
Ghs protoporphyrins fract
|
$8.00 |
$8.00 |
$8.00 |
$64.28
|
|
Ghs pr without cont pulse ox
|
$87.00 |
$87.00 |
$87.00 |
$147.00
|
|
Ghs quinidine
|
$167.50 |
$167.50 |
$167.50 |
$85.00
|
|
Ghs refill of implantable pump
|
$316.50 |
$316.50 |
$316.50 |
$539.13
|
|
Ghs removal intranasal foreign body
|
$171.50 |
$171.50 |
$171.50 |
$294.45
|
|
Ghs removal pharyngeal foreign body
|
$141.00 |
$141.00 |
$141.00 |
$442.06
|
|
Ghs repair extensor tendon hand, ea tendon
|
$1,543.00 |
$1,543.00 |
$1,543.00 |
$2,211.05
|
|
Ghs repair tendon ext forearm/wrist ea
|
$564.00 |
$564.00 |
$564.00 |
$4,108.00
|
|
Ghs sensitivity (per antimicro)
|
$42.80 |
$42.80 |
$42.80 |
$59.90
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$116.50 |
$116.50 |
$116.50 |
$558.97
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$151.50 |
$151.50 |
$151.50 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$135.00 |
$135.00 |
$135.00 |
$575.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$190.50 |
$190.50 |
$190.50 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$266.50 |
$266.50 |
$266.50 |
$451.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$303.00 |
$303.00 |
$303.00 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$266.50 |
$266.50 |
$266.50 |
$492.80
|
|
Ghs simple repair over 30 cm - 12007
|
$165.50 |
$165.50 |
$165.50 |
$589.80
|
|
Ghs sleep study unattended
|
$47.50 |
$47.50 |
$47.50 |
$503.38
|
|
Ghs sphenopalatine ganglion block
|
$117.50 |
$117.50 |
$117.50 |
$616.08
|
|
Ghs sp train/fitting sp device - kx
|
$90.00 |
$90.00 |
$90.00 |
$250.50
|
|
Ghs st - eval for alt comm
|
$10.50 |
$10.50 |
$10.50 |
$93.60
|
|
Ghs st - re-eval for alt comm
|
$137.50 |
$137.50 |
$137.50 |
$309.00
|
|
Ghs superficial wnd dehiscence simp12020
|
$929.50 |
$929.50 |
$929.50 |
$883.50
|
|
Ghs superficial wnd dehis w packing12021
|
$389.50 |
$389.50 |
$389.50 |
$696.68
|
|
Ghs tx distal phalangeal fx with manipulation
|
$356.00 |
$356.00 |
$356.00 |
$526.35
|
|
Ghs vaginal delivery only
|
$892.00 |
$892.00 |
$892.00 |
$3,142.35
|
|
Gi inhouse confirmation
|
$46.50 |
$46.50 |
$46.50 |
$86.25
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$143.00 |
$143.00 |
$143.00 |
$2,096.00
|
|
Glucagon 1 mg solution for injection
|
$506.58 |
$506.58 |
$506.58 |
$601.79
|
|
Glucose 1 hr post dose
|
$39.50 |
$39.50 |
$39.50 |
$49.20
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$9.50 |
$9.50 |
$9.50 |
$24.60
|
|
Glucose blood quantitative
|
$35.00 |
$35.00 |
$35.00 |
$41.28
|
|
Glucose body fluid
|
$81.00 |
$81.00 |
$81.00 |
$52.20
|
|
Glucose tolerance test (gtt) 3 specimens
|
$62.50 |
$62.50 |
$62.50 |
$104.50
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$21.00 |
$21.00 |
$21.00 |
$35.10
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$70.00 |
$70.00 |
$70.00 |
$116.64
|
|
Gonadotropin luteinizing hormone (lh)
|
$91.00 |
$91.00 |
$91.00 |
$129.96
|
|
Gonioscopy
|
$20.00 |
$20.00 |
$20.00 |
$135.52
|
|
Goniotomy
|
$2,926.34 |
$2,926.34 |
$2,926.34 |
$4,452.74
|
|
Goserelin 10.8 mg subcutaneous implant
|
$1,686.00 |
$1,686.00 |
$1,686.00 |
$4,665.26
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$159.99
|
|
Graft axiofill 1000mg
|
$10.00 |
$10.00 |
$10.00 |
$6,300.79
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$684.60
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$23,801.51
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$1,625.46
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$1,233.60
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$427.89
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$1,132.47
|
|
Graft xenmtrx sft rect 15x20cm
|
$648.72 |
$648.72 |
$648.72 |
$29,738.57
|
|
Great toe with reduction 28495
|
$183.00 |
$183.00 |
$183.00 |
$495.00
|
|
Gstrct prtl dstl w/roux-en-y rcnstj 43633
|
$2,176.50 |
$2,176.50 |
$2,176.50 |
$3,604.20
|
|
Gstrst open wo constj tube
|
$820.50 |
$820.50 |
$820.50 |
$2,756.00
|
|
Guided cath fluid drainage 10030
|
$146.00 |
$146.00 |
$146.00 |
$1,372.15
|
|
Gynecomastia (males) 19300
|
$510.00 |
$510.00 |
$510.00 |
$3,735.20
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$1.50 |
$1.50 |
$1.50 |
$24.00
|
|
Handle/convey/speciman/office-lab 99000
|
$12.50 |
$12.50 |
$12.50 |
$23.30
|
|
Hand X-ray
|
$197.00 |
$197.00 |
$197.00 |
$364.81
|
