|
Ghs IV thrombolytics - cerebral
|
$513.60 |
$513.60 |
$513.60 |
$663.00
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$471.00 |
$471.00 |
$471.00 |
$489.67
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$825.60 |
$825.60 |
$825.60 |
$591.00
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$825.60 |
$825.60 |
$825.60 |
$583.10
|
|
Ghs layer closure 2.5cm or less - 12051
|
$825.60 |
$825.60 |
$825.60 |
$603.20
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$825.60 |
$825.60 |
$825.60 |
$672.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$825.60 |
$825.60 |
$825.60 |
$700.33
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$825.60 |
$825.60 |
$825.60 |
$741.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$825.60 |
$825.60 |
$825.60 |
$779.35
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$825.60 |
$825.60 |
$825.60 |
$760.20
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$825.60 |
$825.60 |
$825.60 |
$740.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$825.60 |
$825.60 |
$825.60 |
$784.80
|
|
Ghs mbp
|
$209.40 |
$209.40 |
$209.40 |
$76.00
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$147.00 |
$147.00 |
$147.00 |
$246.33
|
|
Ghs moderate sedation ea addtl 15 min
|
$154.20 |
$154.20 |
$154.20 |
$150.00
|
|
Ghs myocardial strain img spckl track
|
$792.60 |
$792.60 |
$792.60 |
$457.80
|
|
Ghs nailbed repair/nail removal
|
$825.60 |
$825.60 |
$825.60 |
$724.37
|
|
Ghs nerve blk intercostal, ea addtl level
|
$2,249.40 |
$2,249.40 |
$2,249.40 |
$1,556.24
|
|
Ghs nerve blk intercostal, single level
|
$3,217.20 |
$3,217.20 |
$3,217.20 |
$1,160.00
|
|
Ghs nerve block axillary nerve
|
$2,285.40 |
$2,285.40 |
$2,285.40 |
$1,563.66
|
|
Ghs nerve block brachial plexus
|
$2,285.40 |
$2,285.40 |
$2,285.40 |
$1,710.80
|
|
Ghs nerve block celiac plexus
|
$2,569.20 |
$2,569.20 |
$2,569.20 |
$1,661.40
|
|
Ghs nerve block interscaline
|
$3,548.40 |
$3,548.40 |
$3,548.40 |
$1,540.61
|
|
Ghs nerve block lumbar or thoracic symp
|
$1,499.40 |
$1,499.40 |
$1,499.40 |
$1,704.63
|
|
Ghs nerve block sciatic nerve
|
$2,399.40 |
$2,399.40 |
$2,399.40 |
$1,450.80
|
|
Ghs nerve block suprascapular
|
$2,285.40 |
$2,285.40 |
$2,285.40 |
$1,198.62
|
|
Ghs ng placement w fluoro guidance
|
$2,568.60 |
$2,568.60 |
$2,568.60 |
$485.00
|
|
Ghs o2 saturation
|
$54.00 |
$54.00 |
$54.00 |
$69.50
|
|
Ghs opcc repair cvp w subq port
|
$5,034.60 |
$5,034.60 |
$5,034.60 |
$2,194.40
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$39.60 |
$39.60 |
$39.60 |
$58.00
|
|
Ghs osteopathic manipulative tx, 3-4 regions
|
$19.20 |
$19.20 |
$19.20 |
$64.50
|
|
Ghs ot group caregiver training
|
$43.20 |
$43.20 |
$43.20 |
$34.80
|
|
Ghs ot prosthetic training/15 min
|
$124.20 |
$124.20 |
$124.20 |
$93.00
|
|
Ghs ot sensory integrative tech/15min
|
$130.20 |
$130.20 |
$130.20 |
$96.20
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$2,157.60 |
$2,157.60 |
$2,157.60 |
$853.65
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$2,481.60 |
$2,481.60 |
$2,481.60 |
$962.00
|
|
Ghs peritonsillar abscess i andd
|
$825.60 |
$825.60 |
$825.60 |
$555.00
|
|
Ghs plngl fx pm cl
|
$825.60 |
$825.60 |
$825.60 |
$564.80
|
|
Ghs ppd (tb intradermal)
|
$18.60 |
$18.60 |
$18.60 |
$37.44
|
|
Ghs prostatic acid phosphatase (mayo)
|
$237.60 |
$237.60 |
$237.60 |
$43.55
|
|
Ghs protoporphyrins fract
|
$139.80 |
$139.80 |
$139.80 |
$60.75
|
|
Ghs pr without cont pulse ox
|
$347.40 |
$347.40 |
$347.40 |
$147.00
|
|
Ghs removal intranasal foreign body
|
$247.20 |
$247.20 |
$247.20 |
$283.24
|
|
Ghs repair tendon ext forearm/wrist ea
|
$6,497.40 |
$6,497.40 |
$6,497.40 |
$4,150.20
|
|
Ghs rsv eia (respir synctial vrs)
|
$286.20 |
$286.20 |
$286.20 |
$99.00
|
|
Ghs sedimentation rate
|
$62.40 |
$62.40 |
$62.40 |
$45.50
|
|
Ghs semen analysis fert
|
$195.60 |
$195.60 |
$195.60 |
$124.80
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$589.80 |
$589.80 |
$589.80 |
$570.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$589.80 |
$589.80 |
$589.80 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$781.80 |
$781.80 |
$781.80 |
$586.50
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$589.80 |
$589.80 |
$589.80 |
$449.15
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$589.80 |
$589.80 |
$589.80 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$589.80 |
$589.80 |
$589.80 |
$489.72
|
|
Ghs simple repair over 30 cm - 12007
|
$589.80 |
$589.80 |
$589.80 |
$590.88
|
|
Ghs sleep study unattended
|
$90.00 |
$90.00 |
$90.00 |
$503.38
|
|
Ghs somatosensory testing upper & lower limbs
|
$687.00 |
$687.00 |
$687.00 |
$1,416.80
|
|
Ghs sphenopalatine ganglion block
|
$568.20 |
$568.20 |
$568.20 |
$630.24
|
|
Ghs sp train/fitting sp device - kx
|
$366.60 |
$366.60 |
$366.60 |
$252.75
|
|
Ghs st - eval for alt comm
|
$27.00 |
$27.00 |
$27.00 |
$96.40
|
|
Ghs strapping shoulder - 29240
|
$471.00 |
$471.00 |
$471.00 |
$217.60
|
|
Ghs st - re-eval for alt comm
|
$249.60 |
$249.60 |
$249.60 |
$309.60
|
|
Ghs superficial wnd dehiscence simp12020
|
$3,384.00 |
$3,384.00 |
$3,384.00 |
$953.27
|
|
Ghs tx distal phalangeal fx with manipulation
|
$825.60 |
$825.60 |
$825.60 |
$529.65
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$499.80 |
$499.80 |
$499.80 |
$513.80
|
|
Ghs urine, porphyrins quant
|
$518.40 |
$518.40 |
$518.40 |
$73.80
|
|
Ghs vaginal delivery only
|
$9,063.60 |
$9,063.60 |
$9,063.60 |
$3,341.93
|
|
Gi inhouse confirmation
|
$86.40 |
$86.40 |
$86.40 |
$87.75
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$1,353.00 |
$1,353.00 |
$1,353.00 |
$2,215.20
|
|
Glucagon 1 mg solution for injection
|
$1,053.60 |
$1,053.60 |
$1,053.60 |
$613.79
|
|
Glucagon plasma - sendout
|
$202.20 |
$202.20 |
$202.20 |
$64.35
|
|
Glucose 1 hr post dose
|
$37.20 |
$37.20 |
$37.20 |
$49.00
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$29.40 |
$29.40 |
$29.40 |
$23.12
|
|
Glucose blood quantitative
|
$52.20 |
$52.20 |
$52.20 |
$42.25
|
|
Glucose body fluid
|
$52.20 |
$52.20 |
$52.20 |
$51.30
|
|
Glucose monitoring continual min 72hr pt
|
$95.40 |
$95.40 |
$95.40 |
$130.00
|
|
Glucose tolerance test (gtt) 3 specimens
|
$199.80 |
$199.80 |
$199.80 |
$105.60
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$42.60 |
$42.60 |
$42.60 |
$36.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$35.40 |
$35.40 |
$35.40 |
$37.40
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$104.80 |
$104.80 |
$104.80 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$280.80 |
$280.80 |
$280.80 |
$116.64
|
|
Gonadotropin luteinizing hormone (lh)
|
$255.60 |
$255.60 |
$255.60 |
$129.03
|
|
Goserelin 10.8 mg subcutaneous implant
|
$2,802.00 |
$2,802.00 |
$2,802.00 |
$4,417.13
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$62.40 |
$62.40 |
$62.40 |
$73.83
|
|
Graft axiofill 1000mg
|
$15,289.20 |
$15,289.20 |
$15,289.20 |
$5,125.68
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$256.80 |
$256.80 |
$256.80 |
$605.00
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$28,077.00 |
$28,077.00 |
$28,077.00 |
$23,233.80
|
|
Graft nerve adv 3-4x70mm
|
$28,969.20 |
$28,969.20 |
$28,969.20 |
$20,782.10
|
|
Graft patch felt ptfe 2x2
|
$16,977.00 |
$16,977.00 |
$16,977.00 |
$29,293.39
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$1,233.60 |
$1,233.60 |
$1,233.60 |
$886.17
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$410.40 |
$410.40 |
$410.40 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$6,183.00 |
$6,183.00 |
$6,183.00 |
$349.41
|
|
Graft xenmtrx sft rect 15x20cm
|
$25,379.40 |
$25,379.40 |
$25,379.40 |
$29,676.26
|
|
Graft xenmtrx sft rect 19x28cm
|
$2,112.60 |
$2,112.60 |
$2,112.60 |
$2,905.40
|
|
Granisetron hcl injection
|
$27.00 |
$27.00 |
$27.00 |
$45.03
|
|
Great toe with reduction 28495
|
$825.60 |
$825.60 |
$825.60 |
$495.00
|
|
Growth stimulation gene 2
|
$234.00 |
$234.00 |
$234.00 |
$180.50
|
|
G-tube reposition
|
$721.20 |
$721.20 |
$721.20 |
$771.36
|
|
Guided cath fluid drainage 10030
|
$2,183.40 |
$2,183.40 |
$2,183.40 |
$1,372.15
|
|
Guide endoanchr sg-64 aaa 62cm
|
$9,511.20 |
$9,511.20 |
$9,511.20 |
$7,743.36
|
|
Guide wire threaded 1.4x150mm
|
$2,825.40 |
$2,825.40 |
$2,825.40 |
$3,284.36
|
