|
Ghs moderate sedation < 5 yr, 30 min
|
$259.20 |
$259.20 |
$259.20 |
$242.31
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$171.60 |
$171.60 |
$171.60 |
$228.45
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$196.20 |
$196.20 |
$196.20 |
$230.00
|
|
Ghs moderate sedation ea addtl 15 min
|
$186.60 |
$186.60 |
$186.60 |
$151.50
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$196.20 |
$196.20 |
$196.20 |
$147.75
|
|
Ghs nailbed repair/nail removal
|
$1,297.20 |
$1,297.20 |
$1,297.20 |
$724.37
|
|
Ghs nerve blk intercostal, ea addtl level
|
$3,972.60 |
$3,972.60 |
$3,972.60 |
$1,546.50
|
|
Ghs nerve blk intercostal, single level
|
$1,301.40 |
$1,301.40 |
$1,301.40 |
$1,107.00
|
|
Ghs nerve block axillary nerve
|
$2,967.60 |
$2,967.60 |
$2,967.60 |
$1,549.80
|
|
Ghs nerve block brachial plexus
|
$2,919.00 |
$2,919.00 |
$2,919.00 |
$1,689.00
|
|
Ghs nerve block sciatic nerve
|
$2,867.40 |
$2,867.40 |
$2,867.40 |
$1,450.80
|
|
Ghs nerve block suprascapular
|
$2,094.00 |
$2,094.00 |
$2,094.00 |
$1,141.36
|
|
Ghs ng placement w fluoro guidance
|
$299.40 |
$299.40 |
$299.40 |
$478.50
|
|
Ghs o2 saturation
|
$72.00 |
$72.00 |
$72.00 |
$70.80
|
|
Ghs ob unlisted IV or art inj or infusion
|
$97.80 |
$97.80 |
$97.80 |
$75.00
|
|
Ghs opcc repair cvp without subq port
|
$1,500.60 |
$1,500.60 |
$1,500.60 |
$1,229.24
|
|
Ghs opcc repair cvp w subq port
|
$1,500.60 |
$1,500.60 |
$1,500.60 |
$2,194.40
|
|
Ghs ot group caregiver training
|
$30.60 |
$30.60 |
$30.60 |
$34.92
|
|
Ghs ot prosthetic training/15 min
|
$78.60 |
$78.60 |
$78.60 |
$90.50
|
|
Ghs ot sensory integrative tech/15min
|
$135.60 |
$135.60 |
$135.60 |
$94.80
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$4,975.80 |
$4,975.80 |
$4,975.80 |
$851.04
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$2,689.20 |
$2,689.20 |
$2,689.20 |
$962.00
|
|
Ghs picc line insert < 5
|
$2,598.60 |
$2,598.60 |
$2,598.60 |
$2,019.50
|
|
Ghs plngl fx pm cl
|
$587.40 |
$587.40 |
$587.40 |
$564.80
|
|
Ghs ppd (tb intradermal)
|
$16.20 |
$16.20 |
$16.20 |
$37.70
|
|
Ghs prostatic acid phosphatase (mayo)
|
$21.60 |
$21.60 |
$21.60 |
$43.55
|
|
Ghs protein, misc fluid
|
$10.20 |
$10.20 |
$10.20 |
$24.60
|
|
Ghs protoporphyrins fract
|
$45.60 |
$45.60 |
$45.60 |
$64.28
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$26.40 |
$26.40 |
$26.40 |
$50.05
|
|
Ghs quinidine
|
$70.80 |
$70.80 |
$70.80 |
$85.00
|
|
Ghs repair extensor tendon hand, ea tendon
|
$3,619.80 |
$3,619.80 |
$3,619.80 |
$2,161.50
|
|
Ghs repair tendon ext forearm/wrist ea
|
$5,304.60 |
$5,304.60 |
$5,304.60 |
$4,041.79
|
|
Ghs sedimentation rate
|
$35.40 |
$35.40 |
$35.40 |
$45.50
|
|
Ghs semen analysis fert
|
$288.00 |
$288.00 |
$288.00 |
$129.00
|
|
Ghs sensitivity (per antimicro)
|
$36.60 |
$36.60 |
$36.60 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$837.00 |
$837.00 |
$837.00 |
$553.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$725.40 |
$725.40 |
$725.40 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$837.00 |
$837.00 |
$837.00 |
$575.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$725.40 |
$725.40 |
$725.40 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$465.00 |
$465.00 |
$465.00 |
$448.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$460.80 |
$460.80 |
$460.80 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$462.60 |
$462.60 |
$462.60 |
$484.80
|
|
Ghs simple repair over 30 cm - 12007
|
$408.00 |
$408.00 |
$408.00 |
$582.00
|
|
Ghs simple repair over 30 cm - 12018
|
$408.00 |
$408.00 |
$408.00 |
$537.60
|
|
Ghs sp train/fitting sp device - kx
|
$243.60 |
$243.60 |
$243.60 |
$250.50
|
|
Ghs superficial wnd dehiscence simp12020
|
$1,305.60 |
$1,305.60 |
$1,305.60 |
$861.75
|
|
Ghs superficial wnd dehis w packing12021
|
$725.40 |
$725.40 |
$725.40 |
$661.50
|
|
Ghs tx distal phalangeal fx with manipulation
|
$604.80 |
$604.80 |
$604.80 |
$523.00
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$520.80 |
$520.80 |
$520.80 |
$486.35
|
|
Ghs urine, porphyrins quant
|
$73.80 |
$73.80 |
$73.80 |
$75.00
|
|
Giardia lamblia antibody
|
$71.40 |
$71.40 |
$71.40 |
$83.44
|
|
Gi inhouse confirmation
|
$31.80 |
$31.80 |
$31.80 |
$83.70
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$10,689.19 |
$10,689.19 |
$10,689.19 |
$2,098.85
|
|
Gi trc img intral esophagus
|
$6,963.54 |
$6,963.54 |
$6,963.54 |
$1,897.82
|
|
Glove finger flexion right lg xl
|
$226.87 |
$226.87 |
$226.87 |
$100.48
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$1,140.12 |
$1,140.12 |
$1,140.12 |
$491.67
|
|
Glucagon plasma - sendout
|
$32.40 |
$32.40 |
$32.40 |
$63.00
|
|
Glucose 1 hr post dose
|
$45.00 |
$45.00 |
$45.00 |
$47.20
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$2.40 |
$2.40 |
$2.40 |
$23.86
|
|
Glucose blood quantitative
|
$34.80 |
$34.80 |
$34.80 |
$40.00
|
|
Glucose body fluid
|
$52.20 |
$52.20 |
$52.20 |
$52.20
|
|
Glucose tolerance test (gtt) 3 specimens
|
$67.20 |
$67.20 |
$67.20 |
$100.16
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$37.80 |
$37.80 |
$37.80 |
$35.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$29.34 |
$29.34 |
$29.34 |
$37.04
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$135.60 |
$135.60 |
$135.60 |
$115.05
|
|
Gonadotropin luteinizing hormone (lh)
|
$159.60 |
$159.60 |
$159.60 |
$129.00
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$4,471.67 |
$4,471.67 |
$4,471.67 |
$672.50
|
|
Graft axiofill 1000mg
|
$11,021.22 |
$11,021.22 |
$11,021.22 |
$5,125.68
|
|
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
|
|
Granisetron 1 mg tab
|
$30.00 |
$30.00 |
$30.00 |
$53.15
|
|
Granulocyte pheresis ea unit
|
$2,309.40 |
$2,309.40 |
$2,309.40 |
$2,309.40
|
|
Growth stimulation gene 2
|
$132.60 |
$132.60 |
$132.60 |
$170.04
|
|
G-tube reposition
|
$459.00 |
$459.00 |
$459.00 |
$759.36
|
|
Gu dilat ureter/urethra s&i
|
$1,545.00 |
$1,545.00 |
$1,545.00 |
$1,923.60
|
|
Guided cath fluid drainage 10030
|
$5,061.60 |
$5,061.60 |
$5,061.60 |
$1,372.15
|
|
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
|
$301.79 |
$301.79 |
$301.79 |
$102.37
|
|
Halo cervical into jckt vest
|
$17,713.49 |
$17,713.49 |
$17,713.49 |
$5,015.12
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$63.36 |
$63.36 |
$63.36 |
$90.14
|
|
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
|
$285.00 |
$285.00 |
$285.00 |
$356.00
|
