|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$1,758.65 |
$1,758.65 |
$1,758.65 |
$964.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$1,116.90 |
$1,116.90 |
$1,116.90 |
$790.40
|
|
Ghs leukocyte alkaline phos (mayo)
|
$35.70 |
$35.70 |
$35.70 |
$76.20
|
|
Ghs low level laser therapy
|
$36.55 |
$36.55 |
$36.55 |
$77.70
|
|
Ghs mbp
|
$69.70 |
$69.70 |
$69.70 |
$77.35
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$185.30 |
$185.30 |
$185.30 |
$242.31
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$185.30 |
$185.30 |
$185.30 |
$228.45
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$185.30 |
$185.30 |
$185.30 |
$230.00
|
|
Ghs moderate sedation ea addtl 15 min
|
$149.60 |
$149.60 |
$149.60 |
$151.50
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$117.30 |
$117.30 |
$117.30 |
$147.75
|
|
Ghs musc test done w/n test comp
|
$257.55 |
$257.55 |
$257.55 |
$318.75
|
|
Ghs musc tst done w/nerv tst lim
|
$352.75 |
$352.75 |
$352.75 |
$266.59
|
|
Ghs myocardial strain img spckl track
|
$29.75 |
$29.75 |
$29.75 |
$457.80
|
|
Ghs nailbed repair/nail removal
|
$1,758.65 |
$1,758.65 |
$1,758.65 |
$724.37
|
|
Ghs nerve blk intercostal, ea addtl level
|
$2,552.55 |
$2,552.55 |
$2,552.55 |
$1,546.50
|
|
Ghs nerve blk intercostal, single level
|
$1,936.30 |
$1,936.30 |
$1,936.30 |
$1,107.00
|
|
Ghs nerve block axillary nerve
|
$2,552.55 |
$2,552.55 |
$2,552.55 |
$1,549.80
|
|
Ghs nerve block brachial plexus
|
$2,552.55 |
$2,552.55 |
$2,552.55 |
$1,689.00
|
|
Ghs nerve block interscaline
|
$2,552.55 |
$2,552.55 |
$2,552.55 |
$1,526.09
|
|
Ghs nerve block lumbar or thoracic symp
|
$2,552.55 |
$2,552.55 |
$2,552.55 |
$1,710.80
|
|
Ghs nerve block sciatic nerve
|
$1,936.30 |
$1,936.30 |
$1,936.30 |
$1,450.80
|
|
Ghs nerve block suprascapular
|
$1,936.30 |
$1,936.30 |
$1,936.30 |
$1,141.36
|
|
Ghs ng placement w fluoro guidance
|
$937.55 |
$937.55 |
$937.55 |
$478.50
|
|
Ghs o2 saturation
|
$39.10 |
$39.10 |
$39.10 |
$70.80
|
|
Ghs opcc repair cvp without subq port
|
$1,759.50 |
$1,759.50 |
$1,759.50 |
$1,229.24
|
|
Ghs opcc repair cvp w subq port
|
$3,928.70 |
$3,928.70 |
$3,928.70 |
$2,194.40
|
|
Ghs ot prosthetic training/15 min
|
$102.00 |
$102.00 |
$102.00 |
$90.50
|
|
Ghs ot sensory integrative tech/15min
|
$155.55 |
$155.55 |
$155.55 |
$94.80
|
|
Ghs pacing - transcutaneous
|
$1,769.70 |
$1,769.70 |
$1,769.70 |
$815.20
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$113.90 |
$113.90 |
$113.90 |
$76.56
|
|
Ghs peritonsillar abscess i andd
|
$683.40 |
$683.40 |
$683.40 |
$546.36
|
|
Ghs phenylketonurid
|
$22.95 |
$22.95 |
$22.95 |
$53.76
|
|
Ghs plngl fx pm cl
|
$852.55 |
$852.55 |
$852.55 |
$564.80
|
|
Ghs ppd (tb intradermal)
|
$42.50 |
$42.50 |
$42.50 |
$37.70
|
|
Ghs protoporphyrins fract
|
$58.65 |
$58.65 |
$58.65 |
$64.28
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$50.15 |
$50.15 |
$50.15 |
$50.05
|
|
Ghs pt - work hardening/int 2hrs
|
$386.75 |
$386.75 |
$386.75 |
$275.60
|
|
Ghs quinidine
|
$60.35 |
$60.35 |
$60.35 |
$85.00
|
|
Ghs removal intranasal foreign body
|
$339.15 |
$339.15 |
$339.15 |
$287.50
|
|
Ghs removal pharyngeal foreign body
|
$977.50 |
$977.50 |
$977.50 |
$459.90
|
|
Ghs repair extensor tendon hand, ea tendon
|
$3,941.45 |
$3,941.45 |
$3,941.45 |
$2,161.50
|
|
Ghs reticulocyte count
|
$17.85 |
$17.85 |
$17.85 |
$34.45
|
|
Ghs rsv eia (respir synctial vrs)
|
$56.95 |
$56.95 |
$56.95 |
$96.60
|
|
Ghs sedimentation rate
|
$17.85 |
$17.85 |
$17.85 |
$45.50
|
|
Ghs semen analysis, post-vas
|
$40.80 |
$40.80 |
$40.80 |
$32.37
|
|
Ghs sensitivity (per antimicro)
|
$31.45 |
$31.45 |
$31.45 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$977.50 |
$977.50 |
$977.50 |
$553.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$977.50 |
$977.50 |
$977.50 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$977.50 |
$977.50 |
$977.50 |
$575.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$977.50 |
$977.50 |
$977.50 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$491.30 |
$491.30 |
$491.30 |
$448.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$491.30 |
$491.30 |
$491.30 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$491.30 |
$491.30 |
$491.30 |
$484.80
|
|
Ghs simple repair over 30 cm - 12007
|
$560.15 |
$560.15 |
$560.15 |
$582.00
|
|
Ghs speech-gen aug dev eval iii, st
|
$226.10 |
$226.10 |
$226.10 |
$146.40
|
|
Ghs sphenopalatine ganglion block
|
$828.75 |
$828.75 |
$828.75 |
$637.92
|
|
Ghs sp train/fitting sp device - kx
|
$479.40 |
$479.40 |
$479.40 |
$250.50
|
|
Ghs strapping shoulder - 29240
|
$313.65 |
$313.65 |
$313.65 |
$213.20
|
|
Ghs st - re-eval for alt comm
|
$334.90 |
$334.90 |
$334.90 |
$309.00
|
|
Ghs superficial wnd dehiscence simp12020
|
$1,758.65 |
$1,758.65 |
$1,758.65 |
$861.75
|
|
Ghs superficial wnd dehis w packing12021
|
$1,116.90 |
$1,116.90 |
$1,116.90 |
$661.50
|
|
Ghs tracheostomy emergency - transtracheal
|
$3,740.85 |
$3,740.85 |
$3,740.85 |
$1,752.89
|
|
Ghs tx distal phalangeal fx with manipulation
|
$765.00 |
$765.00 |
$765.00 |
$523.00
|
|
Ghs urine, hydroxproline total
|
$98.60 |
$98.60 |
$98.60 |
$109.60
|
|
Ghs urine, porphyrins quant
|
$60.35 |
$60.35 |
$60.35 |
$75.00
|
|
Ghs veeg 12-26 hr intmt mont
|
$2,154.75 |
$2,154.75 |
$2,154.75 |
$1,910.25
|
|
Giardia lamblia antibody
|
$60.35 |
$60.35 |
$60.35 |
$83.44
|
|
Gi inhouse confirmation
|
$39.10 |
$39.10 |
$39.10 |
$83.70
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$2,465.00 |
$2,465.00 |
$2,465.00 |
$2,098.85
|
|
Gi trc img intral colon i&r
|
$2,485.40 |
$2,485.40 |
$2,485.40 |
$1,959.88
|
|
Gi wireless capsule measure
|
$2,591.65 |
$2,591.65 |
$2,591.65 |
$1,579.30
|
|
Gjb2 gene full sequence
|
$55.25 |
$55.25 |
$55.25 |
$502.80
|
|
Gjb6 gene com variants
|
$55.25 |
$55.25 |
$55.25 |
$106.40
|
|
Glassia injection
|
$2.10 |
$2.10 |
$2.10 |
$20.32
|
|
Glucagon 1 mg solution for injection
|
$459.34 |
$459.34 |
$459.34 |
$601.79
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$293.90 |
$293.90 |
$293.90 |
$491.67
|
|
Glucagon plasma - sendout
|
$58.65 |
$58.65 |
$58.65 |
$63.00
|
|
Glucose 1 hr post dose
|
$19.55 |
$19.55 |
$19.55 |
$47.20
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$13.60 |
$13.60 |
$13.60 |
$23.86
|
|
Glucose blood quantitative
|
$16.15 |
$16.15 |
$16.15 |
$40.00
|
|
Glucose body fluid
|
$16.15 |
$16.15 |
$16.15 |
$52.20
|
|
Glucose tolerance test (gtt) 3 specimens
|
$51.85 |
$51.85 |
$51.85 |
$100.16
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$16.15 |
$16.15 |
$16.15 |
$35.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$24.20 |
$24.20 |
$24.20 |
$37.04
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$19,359.00 |
$19,359.00 |
$19,359.00 |
$4,977.60
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$74.80 |
$74.80 |
$74.80 |
$115.05
|
|
Gonadotropin luteinizing hormone (lh)
|
$74.80 |
$74.80 |
$74.80 |
$129.00
|
|
Goserelin 10.8 mg subcutaneous implant
|
$8,558.89 |
$8,558.89 |
$8,558.89 |
$4,652.18
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$2,059.04 |
$2,059.04 |
$2,059.04 |
$672.50
|
|
Graft axiofill 1000mg
|
$24,552.48 |
$24,552.48 |
$24,552.48 |
$5,125.68
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$12,246.80 |
$12,246.80 |
$12,246.80 |
$24,469.57
|
|
Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm
|
$2,992.00 |
$2,992.00 |
$2,992.00 |
$3,432.00
|
|
Graft nerve adv 3-4x70mm
|
$21,548.57 |
$21,548.57 |
$21,548.57 |
$19,620.00
|
|
Graft patch felt ptfe 2x2
|
$19,098.44 |
$19,098.44 |
$19,098.44 |
$27,300.00
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$1,111.05 |
$1,111.05 |
$1,111.05 |
$1,455.76
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$4,556.00 |
$4,556.00 |
$4,556.00 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$2,899.25 |
$2,899.25 |
$2,899.25 |
$373.00
|
|
Graft tis hmatrix dermis 10x5 -cost per sq cm
|
$1,700.00 |
$1,700.00 |
$1,700.00 |
$3,822.00
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$24,591.57 |
$24,591.57 |
$24,591.57 |
$27,367.40
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$3,604.00 |
$3,604.00 |
$3,604.00 |
$1,132.47
|
