|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$925.80 |
$925.80 |
$925.80 |
$672.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$910.20 |
$910.20 |
$910.20 |
$700.33
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$1,084.80 |
$1,084.80 |
$1,084.80 |
$741.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$1,693.20 |
$1,693.20 |
$1,693.20 |
$779.35
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$1,693.20 |
$1,693.20 |
$1,693.20 |
$760.20
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$1,693.20 |
$1,693.20 |
$1,693.20 |
$740.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$1,693.20 |
$1,693.20 |
$1,693.20 |
$969.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$1,693.20 |
$1,693.20 |
$1,693.20 |
$784.80
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$1,693.20 |
$1,693.20 |
$1,693.20 |
$1,016.25
|
|
Ghs layered repair 20.1 - 30.0 cm -12056
|
$1,693.20 |
$1,693.20 |
$1,693.20 |
$913.90
|
|
Ghs layered repair over 30.0 cm -12047
|
$1,720.20 |
$1,720.20 |
$1,720.20 |
$1,930.50
|
|
Ghs layered repair over 3.0 cm -12057
|
$1,717.80 |
$1,717.80 |
$1,717.80 |
$1,064.98
|
|
Ghs leukocyte alkaline phos (mayo)
|
$84.00 |
$84.00 |
$84.00 |
$75.00
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$35.40 |
$35.40 |
$35.40 |
$246.33
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$118.80 |
$118.80 |
$118.80 |
$233.28
|
|
Ghs moderate sedation ea addtl 15 min
|
$18.60 |
$18.60 |
$18.60 |
$150.00
|
|
Ghs musc test done w/n test comp
|
$104.40 |
$104.40 |
$104.40 |
$331.20
|
|
Ghs musc tst done w/nerv tst lim
|
$86.40 |
$86.40 |
$86.40 |
$272.48
|
|
Ghs musc tst done w/n tst non ext
|
$90.00 |
$90.00 |
$90.00 |
$184.80
|
|
Ghs nailbed repair/nail removal
|
$1,266.00 |
$1,266.00 |
$1,266.00 |
$724.37
|
|
Ghs nerve blk intercostal, ea addtl level
|
$1,266.00 |
$1,266.00 |
$1,266.00 |
$1,556.24
|
|
Ghs nerve blk intercostal, single level
|
$105.00 |
$105.00 |
$105.00 |
$1,160.00
|
|
Ghs nerve block axillary nerve
|
$102.60 |
$102.60 |
$102.60 |
$1,563.66
|
|
Ghs nerve block brachial plexus
|
$180.60 |
$180.60 |
$180.60 |
$1,710.80
|
|
Ghs nerve block interscaline
|
$132.60 |
$132.60 |
$132.60 |
$1,540.61
|
|
Ghs nerve block lumbar or thoracic symp
|
$255.00 |
$255.00 |
$255.00 |
$1,704.63
|
|
Ghs nerve block suprascapular
|
$166.80 |
$166.80 |
$166.80 |
$1,198.62
|
|
Ghs ng placement w fluoro guidance
|
$146.40 |
$146.40 |
$146.40 |
$485.00
|
|
Ghs opcc repair cvp w subq port
|
$457.20 |
$457.20 |
$457.20 |
$2,194.40
|
|
Ghs optokenetic
|
$65.40 |
$65.40 |
$65.40 |
$214.00
|
|
Ghs oscillating trac
|
$60.00 |
$60.00 |
$60.00 |
$325.00
|
|
Ghs ot prosthetic training/15 min
|
$99.00 |
$99.00 |
$99.00 |
$93.00
|
|
Ghs ot work hardening-additional hours
|
$127.20 |
$127.20 |
$127.20 |
$126.40
|
|
Ghs pacing - transcutaneous
|
$676.20 |
$676.20 |
$676.20 |
$830.53
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$147.00 |
$147.00 |
$147.00 |
$853.65
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$126.00 |
$126.00 |
$126.00 |
$962.00
|
|
Ghs peritonsillar abscess i andd
|
$1,266.00 |
$1,266.00 |
$1,266.00 |
$555.00
|
|
Ghs phenylketonurid
|
$55.80 |
$55.80 |
$55.80 |
$53.76
|
|
Ghs plngl fx pm cl
|
$1,061.40 |
$1,061.40 |
$1,061.40 |
$564.80
|
|
Ghs pos nystagmus
|
$80.40 |
$80.40 |
$80.40 |
$241.80
|
|
Ghs ppd (tb intradermal)
|
$29.40 |
$29.40 |
$29.40 |
$37.44
|
|
Ghs prostatic acid phosphatase (mayo)
|
$70.20 |
$70.20 |
$70.20 |
$43.55
|
|
Ghs protoporphyrins fract
|
$138.00 |
$138.00 |
$138.00 |
$60.75
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$105.00 |
$105.00 |
$105.00 |
$47.55
|
|
Ghs pt - work hardening/int 2hrs
|
$248.40 |
$248.40 |
$248.40 |
$285.60
|
|
Ghs quinidine
|
$100.80 |
$100.80 |
$100.80 |
$85.00
|
|
Ghs refill of implantable pump
|
$77.40 |
$77.40 |
$77.40 |
$539.13
|
|
Ghs removal intranasal foreign body
|
$657.60 |
$657.60 |
$657.60 |
$283.24
|
|
Ghs removal pharyngeal foreign body
|
$604.80 |
$604.80 |
$604.80 |
$441.68
|
|
Ghs repair extensor tendon hand, ea tendon
|
$1,941.60 |
$1,941.60 |
$1,941.60 |
$2,517.00
|
|
Ghs repair tendon ext forearm/wrist ea
|
$943.80 |
$943.80 |
$943.80 |
$4,150.20
|
|
Ghs reticulocyte count
|
$34.20 |
$34.20 |
$34.20 |
$34.50
|
|
Ghs rsv eia (respir synctial vrs)
|
$111.60 |
$111.60 |
$111.60 |
$99.00
|
|
Ghs semen analysis fert
|
$82.80 |
$82.80 |
$82.80 |
$124.80
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$1,693.20 |
$1,693.20 |
$1,693.20 |
$570.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$1,693.20 |
$1,693.20 |
$1,693.20 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$1,693.20 |
$1,693.20 |
$1,693.20 |
$586.50
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$1,693.20 |
$1,693.20 |
$1,693.20 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$609.60 |
$609.60 |
$609.60 |
$449.15
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$554.40 |
$554.40 |
$554.40 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$765.00 |
$765.00 |
$765.00 |
$489.72
|
|
Ghs simple repair over 30 cm - 12007
|
$1,693.20 |
$1,693.20 |
$1,693.20 |
$590.88
|
|
Ghs simple repair over 30 cm - 12018
|
$1,693.20 |
$1,693.20 |
$1,693.20 |
$537.60
|
|
Ghs speech-gen aug dev eval iii, st
|
$131.40 |
$131.40 |
$131.40 |
$157.50
|
|
Ghs sphenopalatine ganglion block
|
$106.80 |
$106.80 |
$106.80 |
$630.24
|
|
Ghs spont nystagmus
|
$79.80 |
$79.80 |
$79.80 |
$246.50
|
|
Ghs sp train/fitting sp device - kx
|
$249.60 |
$249.60 |
$249.60 |
$252.75
|
|
Ghs strapping shoulder - 29240
|
$220.20 |
$220.20 |
$220.20 |
$217.60
|
|
Ghs st - re-eval for alt comm
|
$321.00 |
$321.00 |
$321.00 |
$309.60
|
|
Ghs superficial wnd dehiscence simp12020
|
$1,266.00 |
$1,266.00 |
$1,266.00 |
$953.27
|
|
Ghs tracheostomy emergency - transtracheal
|
$1,941.60 |
$1,941.60 |
$1,941.60 |
$1,867.84
|
|
Ghs tx distal phalangeal fx with manipulation
|
$988.80 |
$988.80 |
$988.80 |
$529.65
|
|
Ghs urine, porphyrins quant
|
$81.60 |
$81.60 |
$81.60 |
$73.80
|
|
Ghs vaginal delivery only
|
$3,411.00 |
$3,411.00 |
$3,411.00 |
$3,341.93
|
|
Ghs windowing of cast
|
$220.20 |
$220.20 |
$220.20 |
$212.55
|
|
Gi inhouse confirmation
|
$67.80 |
$67.80 |
$67.80 |
$87.75
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$1,944.60 |
$1,944.60 |
$1,944.60 |
$2,215.20
|
|
Gi trc img intral esophagus
|
$1,794.60 |
$1,794.60 |
$1,794.60 |
$1,897.82
|
|
Glove finger flexion right lg xl
|
$429.60 |
$429.60 |
$429.60 |
$110.62
|
|
Glucagon 1 mg solution for injection
|
$121.80 |
$121.80 |
$121.80 |
$613.79
|
|
Glucose 1 hr post dose
|
$37.80 |
$37.80 |
$37.80 |
$49.00
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$16.80 |
$16.80 |
$16.80 |
$23.12
|
|
Glucose blood quantitative
|
$30.60 |
$30.60 |
$30.60 |
$42.25
|
|
Glucose body fluid
|
$41.40 |
$41.40 |
$41.40 |
$51.30
|
|
Glucose monitoring continual min 72hr pt
|
$178.20 |
$178.20 |
$178.20 |
$130.00
|
|
Glucose tolerance test (gtt) 3 specimens
|
$90.00 |
$90.00 |
$90.00 |
$105.60
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$20.40 |
$20.40 |
$20.40 |
$36.00
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$4,977.60 |
$4,977.60 |
$4,977.60 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$127.20 |
$127.20 |
$127.20 |
$116.64
|
|
Gonadotropin luteinizing hormone (lh)
|
$126.00 |
$126.00 |
$126.00 |
$129.03
|
|
Goserelin 10.8 mg subcutaneous implant
|
$3,877.80 |
$3,877.80 |
$3,877.80 |
$4,417.13
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$2,605.20 |
$2,605.20 |
$2,605.20 |
$73.83
|
|
Graft axiofill 1000mg
|
$46,342.20 |
$46,342.20 |
$46,342.20 |
$5,125.68
|
|
Graft nerve adv 3-4x70mm
|
$4,795.20 |
$4,795.20 |
$4,795.20 |
$20,782.10
|
|
Graft patch felt ptfe 2x2
|
$1,327.80 |
$1,327.80 |
$1,327.80 |
$29,293.39
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$1,835.40 |
$1,835.40 |
$1,835.40 |
$1,111.05
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$204.00 |
$204.00 |
$204.00 |
$886.17
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$385.20 |
$385.20 |
$385.20 |
$1,132.47
|
|
Graft xenmtrx sft rect 15x20cm
|
$3,100.80 |
$3,100.80 |
$3,100.80 |
$29,676.26
|
|
Graft xenmtrx sft rect 19x28cm
|
$984.60 |
$984.60 |
$984.60 |
$2,905.40
|
