|
Ghs inj neurolytic other perph nerve
|
$3,099.20 |
$3,099.20 |
$3,099.20 |
$1,838.37
|
|
Ghs inj tendon origin/insertion
|
$449.80 |
$449.80 |
$449.80 |
$412.50
|
|
Ghs inj transforaminal cerv ea add bil
|
$1,634.10 |
$1,634.10 |
$1,634.10 |
$1,126.23
|
|
Ghs inj transforaminal cerv single bil
|
$2,600.65 |
$2,600.65 |
$2,600.65 |
$1,706.32
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$6,681.00 |
$6,681.00 |
$6,681.00 |
$876.00
|
|
Ghs intermed repair 20.1 - 30.0 cm-12036
|
$12,649.93 |
$12,649.93 |
$12,649.93 |
$1,046.70
|
|
Ghs intermed repair over 30 cm - 12037
|
$9,533.65 |
$9,533.65 |
$9,533.65 |
$2,026.46
|
|
Ghs intro needle/intracath vein - 36000
|
$6,766.98 |
$6,766.98 |
$6,766.98 |
$213.75
|
|
Ghs IV inf sq injection, on-body injector
|
$98.80 |
$98.80 |
$98.80 |
$117.42
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$5,201.02 |
$5,201.02 |
$5,201.02 |
$558.97
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$4,989.00 |
$4,989.00 |
$4,989.00 |
$573.60
|
|
Ghs layer closure 2.5cm or less - 12051
|
$4,823.88 |
$4,823.88 |
$4,823.88 |
$610.40
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$5,284.73 |
$5,284.73 |
$5,284.73 |
$675.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$4,980.74 |
$4,980.74 |
$4,980.74 |
$738.40
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$8,004.70 |
$8,004.70 |
$8,004.70 |
$741.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$4,970.24 |
$4,970.24 |
$4,970.24 |
$795.20
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$7,914.12 |
$7,914.12 |
$7,914.12 |
$993.00
|
|
Ghs mbp
|
$61.75 |
$61.75 |
$61.75 |
$97.20
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$948.35 |
$948.35 |
$948.35 |
$240.00
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$602.55 |
$602.55 |
$602.55 |
$219.95
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$598.00 |
$598.00 |
$598.00 |
$216.00
|
|
Ghs moderate sedation ea addtl 15 min
|
$145.60 |
$145.60 |
$145.60 |
$125.34
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$475.80 |
$475.80 |
$475.80 |
$123.30
|
|
Ghs musc test done w/n test comp
|
$394.55 |
$394.55 |
$394.55 |
$352.97
|
|
Ghs musc tst done w/nerv tst lim
|
$233.35 |
$233.35 |
$233.35 |
$277.25
|
|
Ghs musc tst done w/n tst non ext
|
$211.25 |
$211.25 |
$211.25 |
$219.05
|
|
Ghs myocardial strain img spckl track
|
$583.05 |
$583.05 |
$583.05 |
$503.85
|
|
Ghs nerve blk intercostal, ea addtl level
|
$5,167.10 |
$5,167.10 |
$5,167.10 |
$1,546.50
|
|
Ghs nerve blk intercostal, single level
|
$5,167.10 |
$5,167.10 |
$5,167.10 |
$1,232.23
|
|
Ghs nerve block axillary nerve
|
$8,481.48 |
$8,481.48 |
$8,481.48 |
$1,271.25
|
|
Ghs nerve block brachial plexus
|
$11,048.50 |
$11,048.50 |
$11,048.50 |
$1,789.51
|
|
Ghs nerve block celiac plexus
|
$2,835.90 |
$2,835.90 |
$2,835.90 |
$1,681.24
|
|
Ghs nerve block interscaline
|
$2,677.30 |
$2,677.30 |
$2,677.30 |
$1,574.21
|
|
Ghs nerve block lumbar or thoracic symp
|
$2,719.03 |
$2,719.03 |
$2,719.03 |
$2,079.21
|
|
Ghs nerve block sciatic nerve
|
$14,955.43 |
$14,955.43 |
$14,955.43 |
$1,745.25
|
|
Ghs nerve block suprascapular
|
$2,018.25 |
$2,018.25 |
$2,018.25 |
$1,220.00
|
|
Ghs ng placement w fluoro guidance
|
$282.10 |
$282.10 |
$282.10 |
$423.76
|
|
Ghs opcc repair cvp without subq port
|
$627.90 |
$627.90 |
$627.90 |
$1,289.00
|
|
Ghs opcc repair cvp w subq port
|
$11,681.86 |
$11,681.86 |
$11,681.86 |
$2,449.60
|
|
Ghs ot dds rom
|
$282.75 |
$282.75 |
$282.75 |
$53.01
|
|
Ghs ot group caregiver training
|
$37.70 |
$37.70 |
$37.70 |
$34.77
|
|
Ghs ot prosthetic training/15 min
|
$85.80 |
$85.80 |
$85.80 |
$92.35
|
|
Ghs ot sensory integrative tech/15min
|
$130.65 |
$130.65 |
$130.65 |
$89.73
|
|
Ghs ot work hardening-additional hours
|
$244.40 |
$244.40 |
$244.40 |
$113.35
|
|
Ghs pacing - transcutaneous
|
$930.80 |
$930.80 |
$930.80 |
$872.95
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$3,232.90 |
$3,232.90 |
$3,232.90 |
$880.00
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$3,702.85 |
$3,702.85 |
$3,702.85 |
$849.47
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$81.25 |
$81.25 |
$81.25 |
$82.80
|
|
Ghs phenylketonurid
|
$120.25 |
$120.25 |
$120.25 |
$61.20
|
|
Ghs picc line insert < 5
|
$1,483.95 |
$1,483.95 |
$1,483.95 |
$1,990.40
|
|
Ghs polysom <6 yrs 4/> parameters
|
$6,689.80 |
$6,689.80 |
$6,689.80 |
$3,557.58
|
|
Ghs ppd (tb intradermal)
|
$90.35 |
$90.35 |
$90.35 |
$39.77
|
|
Ghs prostatic acid phosphatase (mayo)
|
$102.70 |
$102.70 |
$102.70 |
$49.77
|
|
Ghs protein, misc fluid
|
$33.15 |
$33.15 |
$33.15 |
$24.60
|
|
Ghs protoporphyrins fract
|
$140.40 |
$140.40 |
$140.40 |
$68.38
|
|
Ghs pr without cont pulse ox
|
$244.40 |
$244.40 |
$244.40 |
$165.60
|
|
Ghs pt - work hardening/int 2hrs
|
$353.60 |
$353.60 |
$353.60 |
$230.40
|
|
Ghs quinidine
|
$105.30 |
$105.30 |
$105.30 |
$70.85
|
|
Ghs reticulocyte count
|
$139.10 |
$139.10 |
$139.10 |
$33.57
|
|
Ghs rsv eia (respir synctial vrs)
|
$472.55 |
$472.55 |
$472.55 |
$117.60
|
|
Ghs sedimentation rate
|
$61.10 |
$61.10 |
$61.10 |
$36.57
|
|
Ghs semen analysis fert
|
$106.60 |
$106.60 |
$106.60 |
$129.00
|
|
Ghs sensitivity (per antimicro)
|
$63.70 |
$63.70 |
$63.70 |
$55.12
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$4,811.62 |
$4,811.62 |
$4,811.62 |
$399.20
|
|
Ghs sleep study unattended
|
$519.35 |
$519.35 |
$519.35 |
$503.38
|
|
Ghs somatosensory testing lower extremit
|
$949.00 |
$949.00 |
$949.00 |
$917.80
|
|
Ghs somatosensory testing upper & lower limbs
|
$1,051.70 |
$1,051.70 |
$1,051.70 |
$1,506.58
|
|
Ghs speech-gen aug dev eval iii, st
|
$107.25 |
$107.25 |
$107.25 |
$134.50
|
|
Ghs sphenopalatine ganglion block
|
$237.25 |
$237.25 |
$237.25 |
$762.91
|
|
Ghs sp train/fitting sp device - kx
|
$352.95 |
$352.95 |
$352.95 |
$240.80
|
|
Ghs st - re-eval for alt comm
|
$559.65 |
$559.65 |
$559.65 |
$321.00
|
|
Ghs superficial wnd dehiscence simp12020
|
$6,129.36 |
$6,129.36 |
$6,129.36 |
$1,016.25
|
|
Ghs urine, porphyrins quant
|
$101.40 |
$101.40 |
$101.40 |
$85.15
|
|
Ghs vaginal delivery only
|
$1,624.35 |
$1,624.35 |
$1,624.35 |
$3,341.93
|
|
Gi inhouse confirmation
|
$103.35 |
$103.35 |
$103.35 |
$79.50
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$2,959.45 |
$2,959.45 |
$2,959.45 |
$2,418.92
|
|
Glassia injection
|
$2,930.91 |
$2,930.91 |
$2,930.91 |
$2,551.28
|
|
Glucagon 1 mg solution for injection
|
$1,224.86 |
$1,224.86 |
$1,224.86 |
$351.53
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$1,105.35 |
$1,105.35 |
$1,105.35 |
$509.06
|
|
Glucagon plasma - sendout
|
$280.15 |
$280.15 |
$280.15 |
$67.50
|
|
Glucose 1 hr post dose
|
$30.55 |
$30.55 |
$30.55 |
$40.00
|
|
Glucose-6-phosphate dhydrogenase screen
|
$176.15 |
$176.15 |
$176.15 |
$55.50
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$88.40 |
$88.40 |
$88.40 |
$20.00
|
|
Glucose blood quantitative
|
$75.40 |
$75.40 |
$75.40 |
$40.80
|
|
Glucose body fluid
|
$14.30 |
$14.30 |
$14.30 |
$47.70
|
|
Glucose monitoring continual min 72hr pt
|
$144.30 |
$144.30 |
$144.30 |
$154.70
|
|
Glucose tolerance test (gtt) 3 specimens
|
$103.35 |
$103.35 |
$103.35 |
$92.75
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$29.25 |
$29.25 |
$29.25 |
$33.15
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$13.12 |
$13.12 |
$13.12 |
$11.60
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$7,338.80 |
$7,338.80 |
$7,338.80 |
$61.21
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$66.30 |
$66.30 |
$66.30 |
$115.05
|
|
Gonadotropin luteinizing hormone (lh)
|
$217.10 |
$217.10 |
$217.10 |
$117.65
|
|
Goserelin 10.8 mg subcutaneous implant
|
$11,772.51 |
$11,772.51 |
$11,772.51 |
$1,598.97
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$75.40 |
$75.40 |
$75.40 |
$56.71
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$1,963.00 |
$1,963.00 |
$1,963.00 |
$9,693.72
|
|
Graft nerve adv 3-4x70mm
|
$19,500.00 |
$19,500.00 |
$19,500.00 |
$25,226.40
|
|
Graft patch felt ptfe 2x2
|
$15,722.85 |
$15,722.85 |
$15,722.85 |
$19,883.36
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$126.10 |
$126.10 |
$126.10 |
$3,735.34
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$288.60 |
$288.60 |
$288.60 |
$486.45
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$682.50 |
$682.50 |
$682.50 |
$1,123.34
|
