|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$540.15 |
$540.15 |
$540.15 |
$741.00
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$379.60 |
$379.60 |
$379.60 |
$261.80
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$379.60 |
$379.60 |
$379.60 |
$252.50
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$379.60 |
$379.60 |
$379.60 |
$239.20
|
|
Ghs moderate sedation ea addtl 15 min
|
$379.60 |
$379.60 |
$379.60 |
$145.60
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$379.60 |
$379.60 |
$379.60 |
$140.00
|
|
Ghs musc test done w/n test comp
|
$242.45 |
$242.45 |
$242.45 |
$349.80
|
|
Ghs musc tst done w/nerv tst lim
|
$242.45 |
$242.45 |
$242.45 |
$269.15
|
|
Ghs myocardial strain img spckl track
|
$241.80 |
$241.80 |
$241.80 |
$503.85
|
|
Ghs nailbed repair/nail removal
|
$406.25 |
$406.25 |
$406.25 |
$808.80
|
|
Ghs nerve blk intercostal, ea addtl level
|
$2,596.10 |
$2,596.10 |
$2,596.10 |
$1,618.50
|
|
Ghs nerve blk intercostal, single level
|
$1,522.30 |
$1,522.30 |
$1,522.30 |
$1,230.80
|
|
Ghs nerve block axillary nerve
|
$6,754.80 |
$6,754.80 |
$6,754.80 |
$1,541.40
|
|
Ghs nerve block brachial plexus
|
$3,867.50 |
$3,867.50 |
$3,867.50 |
$1,768.00
|
|
Ghs nerve block celiac plexus
|
$3,482.70 |
$3,482.70 |
$3,482.70 |
$1,712.00
|
|
Ghs nerve block interscaline
|
$6,448.00 |
$6,448.00 |
$6,448.00 |
$1,607.45
|
|
Ghs nerve block lumbar or thoracic symp
|
$6,260.80 |
$6,260.80 |
$6,260.80 |
$2,042.60
|
|
Ghs nerve block sciatic nerve
|
$7,789.60 |
$7,789.60 |
$7,789.60 |
$1,636.80
|
|
Ghs nerve block suprascapular
|
$5,935.80 |
$5,935.80 |
$5,935.80 |
$1,223.00
|
|
Ghs ng placement w fluoro guidance
|
$1,339.00 |
$1,339.00 |
$1,339.00 |
$468.75
|
|
Ghs o2 saturation
|
$72.15 |
$72.15 |
$72.15 |
$72.45
|
|
Ghs o2 uptake rest & indirect
|
$388.70 |
$388.70 |
$388.70 |
$195.00
|
|
Ghs opcc repair cvp without subq port
|
$2,860.65 |
$2,860.65 |
$2,860.65 |
$1,302.54
|
|
Ghs opcc repair cvp w subq port
|
$3,465.15 |
$3,465.15 |
$3,465.15 |
$2,430.56
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$380.90 |
$380.90 |
$380.90 |
$55.77
|
|
Ghs osteopathic manipulative tx, 3-4 regions
|
$380.90 |
$380.90 |
$380.90 |
$57.65
|
|
Ghs ot group caregiver training
|
$53.95 |
$53.95 |
$53.95 |
$43.20
|
|
Ghs ot prosthetic training/15 min
|
$124.80 |
$124.80 |
$124.80 |
$92.35
|
|
Ghs ot sensory integrative tech/15min
|
$124.80 |
$124.80 |
$124.80 |
$101.05
|
|
Ghs ot work hardening-additional hours
|
$89.05 |
$89.05 |
$89.05 |
$121.54
|
|
Ghs pacing - transcutaneous
|
$596.70 |
$596.70 |
$596.70 |
$868.68
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$1,650.35 |
$1,650.35 |
$1,650.35 |
$855.60
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$1,591.85 |
$1,591.85 |
$1,591.85 |
$1,003.00
|
|
Ghs peritonsillar abscess i andd
|
$618.15 |
$618.15 |
$618.15 |
$694.20
|
|
Ghs phenylketonurid
|
$49.40 |
$49.40 |
$49.40 |
$51.58
|
|
Ghs plt ct-manual
|
$42.90 |
$42.90 |
$42.90 |
$39.20
|
|
Ghs pos nystagmus
|
$204.75 |
$204.75 |
$204.75 |
$211.90
|
|
Ghs ppd (tb intradermal)
|
$45.50 |
$45.50 |
$45.50 |
$43.45
|
|
Ghs prostatic acid phosphatase (mayo)
|
$24.05 |
$24.05 |
$24.05 |
$40.56
|
|
Ghs protoporphyrins fract
|
$158.60 |
$158.60 |
$158.60 |
$64.35
|
|
Ghs pr without cont pulse ox
|
$143.00 |
$143.00 |
$143.00 |
$156.70
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$55.90 |
$55.90 |
$55.90 |
$45.05
|
|
Ghs pt - work hardening/int 2hrs
|
$181.35 |
$181.35 |
$181.35 |
$255.60
|
|
Ghs quinidine
|
$68.25 |
$68.25 |
$68.25 |
$68.40
|
|
Ghs refill of implantable pump
|
$1,352.65 |
$1,352.65 |
$1,352.65 |
$539.13
|
|
Ghs removal intranasal foreign body
|
$295.75 |
$295.75 |
$295.75 |
$324.35
|
|
Ghs rsv eia (respir synctial vrs)
|
$44.85 |
$44.85 |
$44.85 |
$101.15
|
|
Ghs semen analysis fert
|
$65.00 |
$65.00 |
$65.00 |
$123.20
|
|
Ghs sleep study unattended
|
$969.80 |
$969.80 |
$969.80 |
$503.38
|
|
Ghs somatosensory testing lower extremit
|
$1,253.85 |
$1,253.85 |
$1,253.85 |
$947.48
|
|
Ghs somatosensory testing upper & lower limbs
|
$2,557.75 |
$2,557.75 |
$2,557.75 |
$1,435.00
|
|
Ghs speech-gen aug dev eval iii, st
|
$111.80 |
$111.80 |
$111.80 |
$124.80
|
|
Ghs sphenopalatine ganglion block
|
$514.80 |
$514.80 |
$514.80 |
$706.56
|
|
Ghs spont nystagmus
|
$204.75 |
$204.75 |
$204.75 |
$217.57
|
|
Ghs sp train/fitting sp device - kx
|
$289.90 |
$289.90 |
$289.90 |
$261.95
|
|
Ghs st - re-eval for alt comm
|
$214.50 |
$214.50 |
$214.50 |
$309.00
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$301.60 |
$301.60 |
$301.60 |
$351.45
|
|
Ghs superficial wnd dehiscence simp12020
|
$399.75 |
$399.75 |
$399.75 |
$976.98
|
|
Ghs urine, porphyrins quant
|
$70.20 |
$70.20 |
$70.20 |
$70.20
|
|
Ghs veeg 12-26 hr intmt mont
|
$8,496.15 |
$8,496.15 |
$8,496.15 |
$1,843.00
|
|
Giardia lamblia antibody
|
$76.05 |
$76.05 |
$76.05 |
$81.60
|
|
Gi inhouse confirmation
|
$146.90 |
$146.90 |
$146.90 |
$87.00
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$2,896.40 |
$2,896.40 |
$2,896.40 |
$2,382.90
|
|
Gi trc img intral colon i&r
|
$2,896.40 |
$2,896.40 |
$2,896.40 |
$2,124.80
|
|
Gjb2 gene full sequence
|
$677.30 |
$677.30 |
$677.30 |
$386.10
|
|
Gjb2 gene known fam variants
|
$820.30 |
$820.30 |
$820.30 |
$67.67
|
|
Gjb6 gene com variants
|
$836.55 |
$836.55 |
$836.55 |
$38.50
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$395.67 |
$395.67 |
$395.67 |
$509.06
|
|
Glucagon plasma - sendout
|
$90.35 |
$90.35 |
$90.35 |
$58.56
|
|
Glucose 1 hr post dose
|
$9.75 |
$9.75 |
$9.75 |
$46.28
|
|
Glucose blood quantitative
|
$6.50 |
$6.50 |
$6.50 |
$44.76
|
|
Glucose body fluid
|
$35.75 |
$35.75 |
$35.75 |
$50.70
|
|
Glucose tolerance test (gtt) 3 specimens
|
$18.20 |
$18.20 |
$18.20 |
$100.10
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$18.20 |
$18.20 |
$18.20 |
$34.45
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$24.93 |
$24.93 |
$24.93 |
$56.70
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$6,354.72 |
$6,354.72 |
$6,354.72 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$20.80 |
$20.80 |
$20.80 |
$110.04
|
|
Gonadotropin luteinizing hormone (lh)
|
$175.50 |
$175.50 |
$175.50 |
$123.75
|
|
Goserelin 10.8 mg subcutaneous implant
|
$3,099.30 |
$3,099.30 |
$3,099.30 |
$2,802.00
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$60.99 |
$60.99 |
$60.99 |
$2,648.81
|
|
Graft axiofill 1000mg
|
$7,317.21 |
$7,317.21 |
$7,317.21 |
$5,278.73
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$1,846.08 |
$1,846.08 |
$1,846.08 |
$1,679.75
|
|
Graft nerve adv 3-4x70mm
|
$5,958.96 |
$5,958.96 |
$5,958.96 |
$27,495.00
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$599.64 |
$599.64 |
$599.64 |
$1,560.21
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$658.88 |
$658.88 |
$658.88 |
$2,369.10
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$349.41 |
$349.41 |
$349.41 |
$336.78
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$658.88 |
$658.88 |
$658.88 |
$3,070.00
|
|
Graft xenmtrx sft rect 15x20cm
|
$796.88 |
$796.88 |
$796.88 |
$43,312.93
|
|
Granulocyte pheresis ea unit
|
$11,899.55 |
$11,899.55 |
$11,899.55 |
$2,950.30
|
|
G-tube reposition
|
$910.00 |
$910.00 |
$910.00 |
$741.00
|
|
Gu dilat ureter/urethra s&i
|
$4,092.40 |
$4,092.40 |
$4,092.40 |
$1,793.00
|
|
Guided cath fluid drainage 10030
|
$708.50 |
$708.50 |
$708.50 |
$1,461.15
|
|
Guide wire threaded 1.4x150mm
|
$536.25 |
$536.25 |
$536.25 |
$3,474.86
|
|
Guid loc target vol rad tx
|
$681.85 |
$681.85 |
$681.85 |
$503.80
|
|
Gw stiffened micro access kit
|
$1,219.26 |
$1,219.26 |
$1,219.26 |
$6,285.56
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$58.60 |
$58.60 |
$58.60 |
$112.36
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$22.85 |
$22.85 |
$22.85 |
$35.40
|
|
Hand X-ray
|
$460.20 |
$460.20 |
$460.20 |
$338.58
|
|
Haptoglobin quantitative
|
$31.20 |
$31.20 |
$31.20 |
$89.95
|
|
Harvest stem cell concentrte
|
$866.45 |
$866.45 |
$866.45 |
$1,287.78
|
