|
Ghs nerve blk intercostal, single level
|
$2,108.00 |
$2,108.00 |
$2,108.00 |
$1,160.00
|
|
Ghs nerve block brachial plexus
|
$1,498.40 |
$1,498.40 |
$1,498.40 |
$1,710.80
|
|
Ghs nerve block sciatic nerve
|
$1,771.20 |
$1,771.20 |
$1,771.20 |
$1,450.80
|
|
Ghs nerve block suprascapular
|
$1,297.60 |
$1,297.60 |
$1,297.60 |
$1,198.62
|
|
Ghs ng placement w fluoro guidance
|
$535.20 |
$535.20 |
$535.20 |
$485.00
|
|
Ghs ob unlisted IV or art inj or infusion
|
$118.40 |
$118.40 |
$118.40 |
$82.62
|
|
Ghs opcc repair cvp without subq port
|
$1,389.60 |
$1,389.60 |
$1,389.60 |
$1,236.67
|
|
Ghs opcc repair cvp w subq port
|
$2,449.60 |
$2,449.60 |
$2,449.60 |
$2,194.40
|
|
Ghs ot group caregiver training
|
$51.20 |
$51.20 |
$51.20 |
$34.80
|
|
Ghs ot prosthetic training/15 min
|
$263.20 |
$263.20 |
$263.20 |
$93.00
|
|
Ghs ot sensory integrative tech/15min
|
$120.00 |
$120.00 |
$120.00 |
$96.20
|
|
Ghs pacing - transcutaneous
|
$751.20 |
$751.20 |
$751.20 |
$830.53
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$924.00 |
$924.00 |
$924.00 |
$853.65
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$944.80 |
$944.80 |
$944.80 |
$962.00
|
|
Ghs peritonsillar abscess i andd
|
$520.80 |
$520.80 |
$520.80 |
$555.00
|
|
Ghs picc line insert < 5
|
$2,061.60 |
$2,061.60 |
$2,061.60 |
$2,019.50
|
|
Ghs plngl fx pm cl
|
$482.40 |
$482.40 |
$482.40 |
$564.80
|
|
Ghs pr without cont pulse ox
|
$206.40 |
$206.40 |
$206.40 |
$147.00
|
|
Ghs removal intranasal foreign body
|
$230.40 |
$230.40 |
$230.40 |
$283.24
|
|
Ghs removal pharyngeal foreign body
|
$474.40 |
$474.40 |
$474.40 |
$441.68
|
|
Ghs repair extensor tendon hand, ea tendon
|
$3,128.80 |
$3,128.80 |
$3,128.80 |
$2,517.00
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$493.60 |
$493.60 |
$493.60 |
$570.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$492.00 |
$492.00 |
$492.00 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$528.80 |
$528.80 |
$528.80 |
$586.50
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$620.80 |
$620.80 |
$620.80 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$416.00 |
$416.00 |
$416.00 |
$449.15
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$384.00 |
$384.00 |
$384.00 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$457.60 |
$457.60 |
$457.60 |
$489.72
|
|
Ghs simple repair over 30 cm - 12007
|
$520.80 |
$520.80 |
$520.80 |
$590.88
|
|
Ghs simple repair over 30 cm - 12018
|
$478.40 |
$478.40 |
$478.40 |
$537.60
|
|
Ghs strapping shoulder - 29240
|
$199.20 |
$199.20 |
$199.20 |
$217.60
|
|
Ghs st - re-eval for alt comm
|
$308.80 |
$308.80 |
$308.80 |
$309.60
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$90.40 |
$90.40 |
$90.40 |
$99.98
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$357.60 |
$357.60 |
$357.60 |
$360.80
|
|
Ghs superficial wnd dehiscence simp12020
|
$1,319.20 |
$1,319.20 |
$1,319.20 |
$953.27
|
|
Ghs superficial wnd dehis w packing12021
|
$599.20 |
$599.20 |
$599.20 |
$695.93
|
|
Ghs tracheostomy emergency - transtracheal
|
$2,387.20 |
$2,387.20 |
$2,387.20 |
$1,867.84
|
|
Ghs tx distal phalangeal fx with manipulation
|
$488.00 |
$488.00 |
$488.00 |
$529.65
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$467.20 |
$467.20 |
$467.20 |
$513.80
|
|
Ghs vaginal delivery only
|
$3,455.20 |
$3,455.20 |
$3,455.20 |
$3,341.93
|
|
Ghs windowing of cast
|
$204.00 |
$204.00 |
$204.00 |
$212.55
|
|
Glucose monitoring continual min 72hr pt
|
$172.80 |
$172.80 |
$172.80 |
$130.00
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$122.40 |
$122.40 |
$122.40 |
$23,233.80
|
|
Graft nerve adv 3-4x70mm
|
$8,140.00 |
$8,140.00 |
$8,140.00 |
$20,782.10
|
|
Graft patch felt ptfe 2x2
|
$9,956.52 |
$9,956.52 |
$9,956.52 |
$29,293.39
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$172.00 |
$172.00 |
$172.00 |
$1,111.05
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$469.71 |
$469.71 |
$469.71 |
$886.17
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$792.00 |
$792.00 |
$792.00 |
$1,132.47
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$844.80 |
$844.80 |
$844.80 |
$1,103.05
|
|
Graft xenmtrx sft rect 15x20cm
|
$38,500.00 |
$38,500.00 |
$38,500.00 |
$29,676.26
|
|
Graft xenmtrx sft rect 19x28cm
|
$2,493.12 |
$2,493.12 |
$2,493.12 |
$2,905.40
|
|
Great toe with reduction 28495
|
$482.40 |
$482.40 |
$482.40 |
$495.00
|
|
Group train without patient
|
$51.20 |
$51.20 |
$51.20 |
$47.60
|
|
G-tube reposition
|
$1,130.40 |
$1,130.40 |
$1,130.40 |
$771.36
|
|
Gu dilat ureter/urethra s&i
|
$961.60 |
$961.60 |
$961.60 |
$2,000.16
|
|
Guide wire threaded 1.4x150mm
|
$2,156.00 |
$2,156.00 |
$2,156.00 |
$3,284.36
|
|
Guide worley csg 9fx50cm std
|
$323.20 |
$323.20 |
$323.20 |
$1,117.40
|
|
Gw stiffened micro access kit
|
$1,411.20 |
$1,411.20 |
$1,411.20 |
$6,893.38
|
|
Hands-On Manual Therapy (each 15 minutes)
|
$120.00 |
$120.00 |
$120.00 |
$105.30
|
|
Hand X-ray
|
$252.00 |
$252.00 |
$252.00 |
$350.35
|
|
Hand X-ray (2 views, both hands)
|
$253.60 |
$253.60 |
$253.60 |
$294.90
|
|
Hc fl sm bowel enteroclss tube w kub double contrast
|
$1,455.20 |
$1,455.20 |
$1,455.20 |
$726.00
|
|
Hc pet myocardial imaging metabolic eval single study
|
$5,828.00 |
$5,828.00 |
$5,828.00 |
$3,958.50
|
|
Head CT scan (with and without contrast)
|
$2,427.20 |
$2,427.20 |
$2,427.20 |
$1,818.96
|
|
Head CT scan (with contrast)
|
$2,151.20 |
$2,151.20 |
$2,151.20 |
$1,527.60
|
|
Head CT scan (without contrast)
|
$1,977.60 |
$1,977.60 |
$1,977.60 |
$1,268.90
|
|
Heart first pass add-on
|
$429.60 |
$429.60 |
$429.60 |
$485.27
|
|
Heart first pass multiple
|
$1,802.40 |
$1,802.40 |
$1,802.40 |
$1,422.05
|
|
Heart infarct image
|
$1,059.20 |
$1,059.20 |
$1,059.20 |
$942.29
|
|
Heel (Calcaneus) X-ray (both feet)
|
$306.40 |
$306.40 |
$306.40 |
$276.00
|
|
Hemorrhoidectomy intrnl lig rbbr band ligations
|
$1,230.40 |
$1,230.40 |
$1,230.40 |
$1,178.02
|
|
Hip and Pelvis X-ray (3 to 4 views, both hips)
|
$494.40 |
$494.40 |
$494.40 |
$424.80
|
|
Hip and Pelvis X-ray (single view, left side)
|
$281.60 |
$281.60 |
$281.60 |
$233.50
|
|
Hip X-ray
|
$339.20 |
$339.20 |
$339.20 |
$294.75
|
|
Home sleep test/type 3 porta
|
$680.00 |
$680.00 |
$680.00 |
$570.00
|
|
Hysterosalpingography s&i
|
$680.80 |
$680.80 |
$680.80 |
$669.12
|
|
I-123 iobenguane diag
|
$5,632.80 |
$5,632.80 |
$5,632.80 |
$5,170.70
|
|
I-123 sod iodide diag per 100 uci
|
$224.80 |
$224.80 |
$224.80 |
$147.46
|
|
I125 iothalamate, dx
|
$2,307.20 |
$2,307.20 |
$2,307.20 |
$634.90
|
|
I131 iodide cap, rx
|
$140.00 |
$140.00 |
$140.00 |
$71.70
|
|
Icd cobalt xt dr MRI is1 df1
|
$23,789.60 |
$23,789.60 |
$23,789.60 |
$34,093.09
|
|
Icd crtd cobalt hf MRI is1 df1
|
$35,654.40 |
$35,654.40 |
$35,654.40 |
$39,070.50
|
|
Icd crtp serena MRI
|
$14,430.40 |
$14,430.40 |
$14,430.40 |
$14,360.25
|
|
Icd reliance df4 ib 64cm
|
$6,286.40 |
$6,286.40 |
$6,286.40 |
$9,264.83
|
|
I&d lacrimal sac
|
$1,768.80 |
$1,768.80 |
$1,768.80 |
$2,760.73
|
|
I&d upper arm/elbow deep abscess/hematoma
|
$3,908.00 |
$3,908.00 |
$3,908.00 |
$3,371.02
|
|
Ihc/icc per specimen each additional single antibody stain
|
$159.20 |
$159.20 |
$159.20 |
$191.52
|
|
Ihc/icc per specimen each multiplex antibody stain
|
$558.40 |
$558.40 |
$558.40 |
$331.20
|
|
Ihc/icc per specimen initial single antibody stain
|
$281.60 |
$281.60 |
$281.60 |
$277.90
|
|
Iliac/fem angio cath insert
|
$2,324.80 |
$2,324.80 |
$2,324.80 |
$1,856.01
|
|
Immobilizer shldr cntor adlt
|
$236.00 |
$236.00 |
$236.00 |
$175.60
|
|
Immobilizer shldr dlx str 24-36in med
|
$70.40 |
$70.40 |
$70.40 |
$118.43
|
|
Implant ureth bulk agent
|
$2,760.00 |
$2,760.00 |
$2,760.00 |
$2,168.00
|
|
In-111 oxyquinolin per 0.5 mci
|
$4,940.80 |
$4,940.80 |
$4,940.80 |
$2,753.23
|
|
In-111 pentetate dtpa / 0.5 mci
|
$5,174.40 |
$5,174.40 |
$5,174.40 |
$2,598.17
|
|
In-111 pentetreotide
|
$8,008.00 |
$8,008.00 |
$8,008.00 |
$5,294.90
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$3,157.60 |
$3,157.60 |
$3,157.60 |
$2,086.70
|
|
Incision of breast lesion
|
$3,630.40 |
$3,630.40 |
$3,630.40 |
$2,577.85
|
|
Incision of eardrum
|
$281.60 |
$281.60 |
$281.60 |
$552.75
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$330.40 |
$330.40 |
$330.40 |
$296.00
|
