|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$882.40 |
$882.40 |
$882.40 |
$760.20
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$679.20 |
$679.20 |
$679.20 |
$740.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$882.40 |
$882.40 |
$882.40 |
$969.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$581.60 |
$581.60 |
$581.60 |
$784.80
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$508.00 |
$508.00 |
$508.00 |
$1,016.25
|
|
Ghs layered repair 20.1 - 30.0 cm -12056
|
$538.40 |
$538.40 |
$538.40 |
$913.90
|
|
Ghs layered repair over 30.0 cm -12047
|
$1,882.40 |
$1,882.40 |
$1,882.40 |
$1,930.50
|
|
Ghs layered repair over 3.0 cm -12057
|
$403.20 |
$403.20 |
$403.20 |
$1,064.98
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$277.60 |
$277.60 |
$277.60 |
$246.33
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$251.20 |
$251.20 |
$251.20 |
$228.45
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$256.00 |
$256.00 |
$256.00 |
$233.28
|
|
Ghs moderate sedation ea addtl 15 min
|
$208.80 |
$208.80 |
$208.80 |
$150.00
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$194.40 |
$194.40 |
$194.40 |
$142.40
|
|
Ghs musc tst done w/nerv tst lim
|
$257.60 |
$257.60 |
$257.60 |
$272.48
|
|
Ghs myocardial strain img spckl track
|
$572.00 |
$572.00 |
$572.00 |
$457.80
|
|
Ghs nailbed repair/nail removal
|
$872.80 |
$872.80 |
$872.80 |
$724.37
|
|
Ghs nerve blk intercostal, ea addtl level
|
$1,563.20 |
$1,563.20 |
$1,563.20 |
$1,556.24
|
|
Ghs nerve blk intercostal, single level
|
$1,540.80 |
$1,540.80 |
$1,540.80 |
$1,160.00
|
|
Ghs nerve block axillary nerve
|
$1,601.60 |
$1,601.60 |
$1,601.60 |
$1,563.66
|
|
Ghs nerve block brachial plexus
|
$2,064.80 |
$2,064.80 |
$2,064.80 |
$1,710.80
|
|
Ghs nerve block celiac plexus
|
$2,145.60 |
$2,145.60 |
$2,145.60 |
$1,661.40
|
|
Ghs nerve block interscaline
|
$1,845.60 |
$1,845.60 |
$1,845.60 |
$1,540.61
|
|
Ghs nerve block lumbar or thoracic symp
|
$1,902.40 |
$1,902.40 |
$1,902.40 |
$1,704.63
|
|
Ghs nerve block suprascapular
|
$1,440.00 |
$1,440.00 |
$1,440.00 |
$1,198.62
|
|
Ghs ng placement w fluoro guidance
|
$604.00 |
$604.00 |
$604.00 |
$485.00
|
|
Ghs ob unlisted IV or art inj or infusion
|
$148.80 |
$148.80 |
$148.80 |
$82.62
|
|
Ghs opcc repair cvp without subq port
|
$1,500.00 |
$1,500.00 |
$1,500.00 |
$1,236.67
|
|
Ghs opcc repair cvp w subq port
|
$3,056.00 |
$3,056.00 |
$3,056.00 |
$2,194.40
|
|
Ghs ot group caregiver training
|
$52.80 |
$52.80 |
$52.80 |
$34.80
|
|
Ghs ot prosthetic training/15 min
|
$122.40 |
$122.40 |
$122.40 |
$93.00
|
|
Ghs ot sensory integrative tech/15min
|
$130.40 |
$130.40 |
$130.40 |
$96.20
|
|
Ghs pacing - transcutaneous
|
$872.00 |
$872.00 |
$872.00 |
$830.53
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$1,850.40 |
$1,850.40 |
$1,850.40 |
$853.65
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$1,088.00 |
$1,088.00 |
$1,088.00 |
$962.00
|
|
Ghs peritonsillar abscess i andd
|
$693.60 |
$693.60 |
$693.60 |
$555.00
|
|
Ghs picc line insert < 5
|
$2,508.80 |
$2,508.80 |
$2,508.80 |
$2,019.50
|
|
Ghs plngl fx pm cl
|
$623.20 |
$623.20 |
$623.20 |
$564.80
|
|
Ghs polysom <6 yrs 4/> parameters
|
$5,356.80 |
$5,356.80 |
$5,356.80 |
$3,557.58
|
|
Ghs pr without cont pulse ox
|
$214.40 |
$214.40 |
$214.40 |
$147.00
|
|
Ghs refill of implantable pump
|
$685.60 |
$685.60 |
$685.60 |
$539.13
|
|
Ghs removal intranasal foreign body
|
$423.20 |
$423.20 |
$423.20 |
$283.24
|
|
Ghs removal pharyngeal foreign body
|
$512.80 |
$512.80 |
$512.80 |
$441.68
|
|
Ghs repair extensor tendon hand, ea tendon
|
$3,446.40 |
$3,446.40 |
$3,446.40 |
$2,517.00
|
|
Ghs repair tendon ext forearm/wrist ea
|
$4,585.60 |
$4,585.60 |
$4,585.60 |
$4,150.20
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$664.80 |
$664.80 |
$664.80 |
$570.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$613.60 |
$613.60 |
$613.60 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$625.60 |
$625.60 |
$625.60 |
$586.50
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$538.40 |
$538.40 |
$538.40 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$580.80 |
$580.80 |
$580.80 |
$449.15
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$534.40 |
$534.40 |
$534.40 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$624.80 |
$624.80 |
$624.80 |
$489.72
|
|
Ghs simple repair over 30 cm - 12007
|
$616.00 |
$616.00 |
$616.00 |
$590.88
|
|
Ghs simple repair over 30 cm - 12018
|
$523.20 |
$523.20 |
$523.20 |
$537.60
|
|
Ghs sleep study unattended
|
$650.40 |
$650.40 |
$650.40 |
$503.38
|
|
Ghs somatosensory testing lower extremit
|
$1,670.40 |
$1,670.40 |
$1,670.40 |
$925.91
|
|
Ghs somatosensory testing upper & lower limbs
|
$2,952.00 |
$2,952.00 |
$2,952.00 |
$1,416.80
|
|
Ghs speech-gen aug dev eval iii, st
|
$74.40 |
$74.40 |
$74.40 |
$157.50
|
|
Ghs sphenopalatine ganglion block
|
$804.80 |
$804.80 |
$804.80 |
$630.24
|
|
Ghs sp train/fitting sp device - kx
|
$148.80 |
$148.80 |
$148.80 |
$252.75
|
|
Ghs st - eval for alt comm
|
$77.60 |
$77.60 |
$77.60 |
$96.40
|
|
Ghs strapping shoulder - 29240
|
$292.00 |
$292.00 |
$292.00 |
$217.60
|
|
Ghs st - re-eval for alt comm
|
$514.40 |
$514.40 |
$514.40 |
$309.60
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$127.20 |
$127.20 |
$127.20 |
$99.98
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$524.80 |
$524.80 |
$524.80 |
$360.80
|
|
Ghs superficial wnd dehiscence simp12020
|
$951.20 |
$951.20 |
$951.20 |
$953.27
|
|
Ghs superficial wnd dehis w packing12021
|
$866.40 |
$866.40 |
$866.40 |
$695.93
|
|
Ghs tracheostomy emergency - transtracheal
|
$2,482.40 |
$2,482.40 |
$2,482.40 |
$1,867.84
|
|
Ghs tx distal phalangeal fx with manipulation
|
$647.20 |
$647.20 |
$647.20 |
$529.65
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$334.40 |
$334.40 |
$334.40 |
$513.80
|
|
Ghs vaginal delivery only
|
$3,518.40 |
$3,518.40 |
$3,518.40 |
$3,341.93
|
|
Ghs veeg 12-26 hr intmt mont
|
$5,656.80 |
$5,656.80 |
$5,656.80 |
$1,932.00
|
|
Ghs windowing of cast
|
$241.60 |
$241.60 |
$241.60 |
$212.55
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$2,714.40 |
$2,714.40 |
$2,714.40 |
$2,215.20
|
|
Glassia injection
|
$9,746.24 |
$9,746.24 |
$9,746.24 |
$20.32
|
|
Glove finger flexion right lg xl
|
$115.20 |
$115.20 |
$115.20 |
$110.62
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$678.52 |
$678.52 |
$678.52 |
$491.67
|
|
Glucose monitoring continual min 72hr pt
|
$196.00 |
$196.00 |
$196.00 |
$130.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$313.88 |
$313.88 |
$313.88 |
$37.40
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$5,575.08 |
$5,575.08 |
$5,575.08 |
$5,009.45
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$407.20 |
$407.20 |
$407.20 |
$73.83
|
|
Graft axiofill 1000mg
|
$5,288.11 |
$5,288.11 |
$5,288.11 |
$5,125.68
|
|
Graft bone flex 2.5cm x 5cm grafton-cost per sq cm
|
$712.80 |
$712.80 |
$712.80 |
$1.00
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$1,760.00 |
$1,760.00 |
$1,760.00 |
$605.00
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$492.80 |
$492.80 |
$492.80 |
$23,233.80
|
|
Graft nerve adv 3-4x70mm
|
$22,080.00 |
$22,080.00 |
$22,080.00 |
$20,782.10
|
|
Graft patch felt ptfe 2x2
|
$52,725.60 |
$52,725.60 |
$52,725.60 |
$29,293.39
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$298.08 |
$298.08 |
$298.08 |
$1,111.05
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$1,440.00 |
$1,440.00 |
$1,440.00 |
$886.17
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$1,589.60 |
$1,589.60 |
$1,589.60 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$130.40 |
$130.40 |
$130.40 |
$349.41
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$101.60 |
$101.60 |
$101.60 |
$28,894.71
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$1,689.60 |
$1,689.60 |
$1,689.60 |
$1,103.05
|
|
Graft xenmtrx sft rect 15x20cm
|
$64,400.00 |
$64,400.00 |
$64,400.00 |
$29,676.26
|
|
Graft xenmtrx sft rect 19x28cm
|
$4,273.60 |
$4,273.60 |
$4,273.60 |
$2,905.40
|
|
Granisetron 1 mg tab
|
$1.98 |
$1.98 |
$1.98 |
$53.15
|
|
Granisetron hcl injection
|
$323.54 |
$323.54 |
$323.54 |
$45.03
|
|
Great toe with reduction 28495
|
$477.60 |
$477.60 |
$477.60 |
$495.00
|
|
Ground mileage
|
$28.00 |
$28.00 |
$28.00 |
$17.60
|
|
Group train without patient
|
$52.80 |
$52.80 |
$52.80 |
$47.60
|
|
G-tube reposition
|
$1,227.20 |
$1,227.20 |
$1,227.20 |
$771.36
|
