|
Ghs moderate sedation < 5 yr, 30 min
|
$702.60 |
$702.60 |
$702.60 |
$242.31
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$702.60 |
$702.60 |
$702.60 |
$228.45
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$702.60 |
$702.60 |
$702.60 |
$230.00
|
|
Ghs moderate sedation ea addtl 15 min
|
$714.60 |
$714.60 |
$714.60 |
$151.50
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$714.60 |
$714.60 |
$714.60 |
$147.75
|
|
Ghs myocardial strain img spckl track
|
$959.40 |
$959.40 |
$959.40 |
$457.80
|
|
Ghs nailbed repair/nail removal
|
$1,008.60 |
$1,008.60 |
$1,008.60 |
$724.37
|
|
Ghs nerve block axillary nerve
|
$2,475.00 |
$2,475.00 |
$2,475.00 |
$1,549.80
|
|
Ghs nerve block brachial plexus
|
$4,585.20 |
$4,585.20 |
$4,585.20 |
$1,689.00
|
|
Ghs nerve block sciatic nerve
|
$3,645.00 |
$3,645.00 |
$3,645.00 |
$1,450.80
|
|
Ghs nerve block suprascapular
|
$1,564.80 |
$1,564.80 |
$1,564.80 |
$1,141.36
|
|
Ghs o2 saturation
|
$174.60 |
$174.60 |
$174.60 |
$70.80
|
|
Ghs opcc repair cvp without subq port
|
$1,267.80 |
$1,267.80 |
$1,267.80 |
$1,229.24
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$30.00 |
$30.00 |
$30.00 |
$55.77
|
|
Ghs ot prosthetic training/15 min
|
$115.20 |
$115.20 |
$115.20 |
$90.50
|
|
Ghs ot sensory integrative tech/15min
|
$74.40 |
$74.40 |
$74.40 |
$94.80
|
|
Ghs ot work hardening-additional hours
|
$120.00 |
$120.00 |
$120.00 |
$127.80
|
|
Ghs pacing - transcutaneous
|
$802.20 |
$802.20 |
$802.20 |
$815.20
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$4,042.92 |
$4,042.92 |
$4,042.92 |
$962.00
|
|
Ghs peritonsillar abscess i andd
|
$616.20 |
$616.20 |
$616.20 |
$546.36
|
|
Ghs plngl fx pm cl
|
$537.00 |
$537.00 |
$537.00 |
$564.80
|
|
Ghs plt ct-manual
|
$10.80 |
$10.80 |
$10.80 |
$37.96
|
|
Ghs prostatic acid phosphatase (mayo)
|
$136.80 |
$136.80 |
$136.80 |
$43.55
|
|
Ghs protoporphyrins fract
|
$247.80 |
$247.80 |
$247.80 |
$64.28
|
|
Ghs pr without cont pulse ox
|
$251.40 |
$251.40 |
$251.40 |
$146.86
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$78.60 |
$78.60 |
$78.60 |
$50.05
|
|
Ghs pt - work hardening/int 2hrs
|
$238.80 |
$238.80 |
$238.80 |
$275.60
|
|
Ghs quinidine
|
$202.80 |
$202.80 |
$202.80 |
$85.00
|
|
Ghs removal intranasal foreign body
|
$171.60 |
$171.60 |
$171.60 |
$287.50
|
|
Ghs removal pharyngeal foreign body
|
$565.80 |
$565.80 |
$565.80 |
$459.90
|
|
Ghs repair tendon ext forearm/wrist ea
|
$5,274.60 |
$5,274.60 |
$5,274.60 |
$4,041.79
|
|
Ghs respiratory syncytical virus igg/m
|
$83.40 |
$83.40 |
$83.40 |
$71.20
|
|
Ghs sedimentation rate
|
$47.40 |
$47.40 |
$47.40 |
$45.50
|
|
Ghs semen analysis fert
|
$369.60 |
$369.60 |
$369.60 |
$129.00
|
|
Ghs sensitivity (per antimicro)
|
$102.00 |
$102.00 |
$102.00 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$648.00 |
$648.00 |
$648.00 |
$553.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$648.00 |
$648.00 |
$648.00 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$648.00 |
$648.00 |
$648.00 |
$575.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$648.00 |
$648.00 |
$648.00 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$156.60 |
$156.60 |
$156.60 |
$448.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$156.60 |
$156.60 |
$156.60 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$164.40 |
$164.40 |
$164.40 |
$484.80
|
|
Ghs simple repair over 30 cm - 12007
|
$181.20 |
$181.20 |
$181.20 |
$582.00
|
|
Ghs simple repair over 30 cm - 12018
|
$323.40 |
$323.40 |
$323.40 |
$537.60
|
|
Ghs speech-gen aug dev eval iii, st
|
$44.40 |
$44.40 |
$44.40 |
$146.40
|
|
Ghs sphenopalatine ganglion block
|
$500.40 |
$500.40 |
$500.40 |
$637.92
|
|
Ghs sp train/fitting sp device - kx
|
$96.00 |
$96.00 |
$96.00 |
$250.50
|
|
Ghs strapping shoulder - 29240
|
$218.40 |
$218.40 |
$218.40 |
$213.20
|
|
Ghs st - re-eval for alt comm
|
$288.60 |
$288.60 |
$288.60 |
$309.00
|
|
Ghs superficial wnd dehiscence simp12020
|
$1,008.60 |
$1,008.60 |
$1,008.60 |
$861.75
|
|
Ghs tracheostomy emergency - transtracheal
|
$2,700.60 |
$2,700.60 |
$2,700.60 |
$1,752.89
|
|
Ghs tx distal phalangeal fx with manipulation
|
$537.00 |
$537.00 |
$537.00 |
$523.00
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$394.20 |
$394.20 |
$394.20 |
$486.35
|
|
Ghs urine, hydroxproline total
|
$222.60 |
$222.60 |
$222.60 |
$109.60
|
|
Ghs urine, porphyrins quant
|
$196.80 |
$196.80 |
$196.80 |
$75.00
|
|
Ghs vaginal delivery only
|
$4,986.60 |
$4,986.60 |
$4,986.60 |
$3,152.00
|
|
Giardia lamblia antibody
|
$115.80 |
$115.80 |
$115.80 |
$83.44
|
|
Gi inhouse confirmation
|
$108.60 |
$108.60 |
$108.60 |
$83.70
|
|
Gjb2 gene full sequence
|
$528.00 |
$528.00 |
$528.00 |
$502.80
|
|
Gjb6 gene com variants
|
$528.00 |
$528.00 |
$528.00 |
$106.40
|
|
Glove finger flexion right lg xl
|
$405.35 |
$405.35 |
$405.35 |
$100.48
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$947.58 |
$947.58 |
$947.58 |
$491.67
|
|
Glucagon plasma - sendout
|
$202.20 |
$202.20 |
$202.20 |
$63.00
|
|
Glucose 1 hr post dose
|
$52.20 |
$52.20 |
$52.20 |
$47.20
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$16.80 |
$16.80 |
$16.80 |
$23.86
|
|
Glucose blood quantitative
|
$64.20 |
$64.20 |
$64.20 |
$40.00
|
|
Glucose body fluid
|
$66.00 |
$66.00 |
$66.00 |
$52.20
|
|
Glucose monitoring continual min 72hr pt
|
$108.00 |
$108.00 |
$108.00 |
$118.39
|
|
Glucose tolerance test (gtt) 3 specimens
|
$160.80 |
$160.80 |
$160.80 |
$100.16
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$44.40 |
$44.40 |
$44.40 |
$35.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$24.42 |
$24.42 |
$24.42 |
$37.04
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$212.40 |
$212.40 |
$212.40 |
$115.05
|
|
Gonadotropin luteinizing hormone (lh)
|
$180.00 |
$180.00 |
$180.00 |
$129.00
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$4,506.13 |
$4,506.13 |
$4,506.13 |
$672.50
|
|
Graft axiofill 1000mg
|
$7,653.60 |
$7,653.60 |
$7,653.60 |
$5,125.68
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$60,729.56 |
$60,729.56 |
$60,729.56 |
$584.99
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$43,773.41 |
$43,773.41 |
$43,773.41 |
$24,469.57
|
|
Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm
|
$3,931.70 |
$3,931.70 |
$3,931.70 |
$3,432.00
|
|
Graft nerve adv 3-4x70mm
|
$111,833.37 |
$111,833.37 |
$111,833.37 |
$19,620.00
|
|
Graft patch felt ptfe 2x2
|
$84,622.08 |
$84,622.08 |
$84,622.08 |
$27,300.00
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$37,022.16 |
$37,022.16 |
$37,022.16 |
$1,455.76
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$13,565.98 |
$13,565.98 |
$13,565.98 |
$1,181.41
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$23,006.63 |
$23,006.63 |
$23,006.63 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$8,936.36 |
$8,936.36 |
$8,936.36 |
$373.00
|
|
Graft tis hmatrix dermis 10x5 -cost per sq cm
|
$3,966.66 |
$3,966.66 |
$3,966.66 |
$3,822.00
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$83,389.77 |
$83,389.77 |
$83,389.77 |
$27,367.40
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$7,007.77 |
$7,007.77 |
$7,007.77 |
$1,132.47
|
|
Graft xenmtrx sft rect 15x20cm
|
$83,537.86 |
$83,537.86 |
$83,537.86 |
$30,392.04
|
|
Graft xenmtrx sft rect 19x28cm
|
$39,567.43 |
$39,567.43 |
$39,567.43 |
$2,701.58
|
|
Great toe with reduction 28495
|
$537.00 |
$537.00 |
$537.00 |
$482.40
|
|
Growth hormone antibody
|
$222.60 |
$222.60 |
$222.60 |
$72.60
|
|
Guide endoanchr sg-64 aaa 62cm
|
$13,708.78 |
$13,708.78 |
$13,708.78 |
$7,728.17
|
|
Guide wire threaded 1.4x150mm
|
$21,102.63 |
$21,102.63 |
$21,102.63 |
$3,284.50
|
|
Guide worley csg 9fx50cm std
|
$1,851.11 |
$1,851.11 |
$1,851.11 |
$1,105.00
|
|
Gw stiffened micro access kit
|
$18,050.95 |
$18,050.95 |
$18,050.95 |
$6,696.00
|
|
Hallus-valgus nt dyn pre ots
|
$195.55 |
$195.55 |
$195.55 |
$102.37
|
|
Halo cervical into jckt vest
|
$17,849.97 |
$17,849.97 |
$17,849.97 |
$5,015.12
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$52.68 |
$52.68 |
$52.68 |
$90.14
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$9.00 |
$9.00 |
$9.00 |
$23.06
|
|
Halo repl liner/interface
|
$3,025.24 |
$3,025.24 |
$3,025.24 |
$1,931.10
|
