|
Ghs layered repair 20.1 - 30.0 cm -12056
|
$538.40 |
$671.20 |
$672.80 |
|
|
Ghs layered repair over 30.0 cm -12047
|
$1,866.40 |
$1,866.40 |
$1,882.40 |
|
|
Ghs layered repair over 3.0 cm -12057
|
$403.20 |
$403.20 |
$943.20 |
|
|
Ghs mbp
|
$57.60 |
$57.60 |
$71.20 |
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$277.60 |
$277.60 |
$277.60 |
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$251.20 |
$251.20 |
$251.20 |
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$239.20 |
$256.00 |
$263.20 |
|
|
Ghs moderate sedation ea addtl 15 min
|
$156.00 |
$180.00 |
$208.80 |
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$160.00 |
$160.00 |
$194.40 |
|
|
Ghs musc tst done w/nerv tst lim
|
$257.60 |
$257.60 |
$257.60 |
|
|
Ghs myocardial strain img spckl track
|
$536.00 |
$566.40 |
$591.20 |
|
|
Ghs nailbed repair/nail removal
|
$771.20 |
$808.80 |
$1,150.40 |
|
|
Ghs nerve blk intercostal, ea addtl level
|
$1,212.80 |
$1,212.80 |
$1,563.20 |
|
|
Ghs nerve blk intercostal, single level
|
$1,540.80 |
$1,540.80 |
$2,108.00 |
|
|
Ghs nerve block axillary nerve
|
$1,601.60 |
$1,601.60 |
$1,601.60 |
|
|
Ghs nerve block brachial plexus
|
$1,498.40 |
$1,498.40 |
$2,064.80 |
|
|
Ghs nerve block celiac plexus
|
$2,145.60 |
$2,145.60 |
$2,145.60 |
|
|
Ghs nerve block interscaline
|
$1,845.60 |
$1,845.60 |
$1,845.60 |
|
|
Ghs nerve block lumbar or thoracic symp
|
$1,902.40 |
$1,902.40 |
$1,902.40 |
|
|
Ghs nerve block sciatic nerve
|
$1,771.20 |
$1,771.20 |
$1,771.20 |
|
|
Ghs nerve block suprascapular
|
$1,297.60 |
$1,297.60 |
$1,440.00 |
|
|
Ghs ng placement w fluoro guidance
|
$535.20 |
$544.00 |
$604.00 |
|
|
Ghs ob unlisted IV or art inj or infusion
|
$118.40 |
$118.40 |
$148.80 |
|
|
Ghs opcc repair cvp without subq port
|
$1,389.60 |
$1,389.60 |
$1,500.00 |
|
|
Ghs opcc repair cvp w subq port
|
$2,449.60 |
$2,449.60 |
$3,056.00 |
|
|
Ghs ot group caregiver training
|
$51.20 |
$52.00 |
$54.40 |
|
|
Ghs ot prosthetic training/15 min
|
$119.20 |
$122.40 |
$263.20 |
|
|
Ghs ot sensory integrative tech/15min
|
$115.20 |
$124.80 |
$130.40 |
|
|
Ghs pacing - transcutaneous
|
$751.20 |
$775.20 |
$872.00 |
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$924.00 |
$924.00 |
$1,850.40 |
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$944.80 |
$944.80 |
$1,088.00 |
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$111.20 |
$111.20 |
$111.20 |
|
|
Ghs peritonsillar abscess i andd
|
$440.80 |
$500.80 |
$693.60 |
|
|
Ghs phenylketonurid
|
$20.80 |
$20.80 |
$70.40 |
|
|
Ghs picc line insert < 5
|
$2,061.60 |
$2,061.60 |
$2,508.80 |
|
|
Ghs plngl fx pm cl
|
$464.80 |
$488.00 |
$659.20 |
|
|
Ghs polysom <6 yrs 4/> parameters
|
$5,356.80 |
$5,356.80 |
$5,356.80 |
|
|
Ghs ppd (tb intradermal)
|
$26.40 |
$28.80 |
$34.40 |
|
|
Ghs prostatic acid phosphatase (mayo)
|
$48.80 |
$63.20 |
$121.60 |
|
|
Ghs pr without cont pulse ox
|
$188.00 |
$206.40 |
$214.40 |
|
|
Ghs refill of implantable pump
|
$685.60 |
$685.60 |
$685.60 |
|
|
Ghs removal intranasal foreign body
|
$222.40 |
$336.00 |
$423.20 |
|
|
Ghs removal pharyngeal foreign body
|
$456.00 |
$474.40 |
$512.80 |
|
|
Ghs repair extensor tendon hand, ea tendon
|
$3,128.80 |
$3,128.80 |
$3,446.40 |
|
|
Ghs repair tendon ext forearm/wrist ea
|
$4,585.60 |
$4,585.60 |
$4,585.60 |
|
|
Ghs reticulocyte count
|
$31.20 |
$31.20 |
$31.20 |
|
|
Ghs rsv eia (respir synctial vrs)
|
$85.60 |
$105.60 |
$153.60 |
|
|
Ghs sedimentation rate
|
$24.00 |
$25.60 |
$78.40 |
|
|
Ghs sensitivity (per antimicro)
|
$40.80 |
$54.40 |
$110.40 |
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$436.00 |
$499.20 |
$664.80 |
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$474.40 |
$497.60 |
$708.00 |
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$509.60 |
$529.60 |
$625.60 |
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$538.40 |
$597.60 |
$620.80 |
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$400.80 |
$504.00 |
$592.80 |
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$370.40 |
$500.00 |
$534.40 |
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$440.80 |
$457.60 |
$624.80 |
|
|
Ghs simple repair over 30 cm - 12007
|
$500.80 |
$520.80 |
$752.00 |
|
|
Ghs simple repair over 30 cm - 12018
|
$452.80 |
$478.40 |
$523.20 |
|
|
Ghs sleep study unattended
|
$608.00 |
$608.00 |
$650.40 |
|
|
Ghs somatosensory testing lower extremit
|
$1,670.40 |
$1,670.40 |
$1,670.40 |
|
|
Ghs somatosensory testing upper & lower limbs
|
$2,952.00 |
$2,952.00 |
$2,952.00 |
|
|
Ghs speech-gen aug dev eval iii, st
|
$74.40 |
$214.40 |
$223.20 |
|
|
Ghs sphenopalatine ganglion block
|
$804.80 |
$804.80 |
$804.80 |
|
|
Ghs sp train/fitting sp device - kx
|
$148.80 |
$280.00 |
$334.40 |
|
|
Ghs st - eval for alt comm
|
$77.60 |
$77.60 |
$77.60 |
|
|
Ghs strapping shoulder - 29240
|
$188.80 |
$192.80 |
$292.00 |
|
|
Ghs st - re-eval for alt comm
|
$308.80 |
$504.00 |
$514.40 |
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$90.40 |
$90.40 |
$127.20 |
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$357.60 |
$357.60 |
$524.80 |
|
|
Ghs superficial wnd dehiscence simp12020
|
$951.20 |
$1,120.00 |
$1,319.20 |
|
|
Ghs superficial wnd dehis w packing12021
|
$599.20 |
$599.20 |
$866.40 |
|
|
Ghs tracheostomy emergency - transtracheal
|
$2,299.20 |
$2,387.20 |
$2,482.40 |
|
|
Ghs tx distal phalangeal fx with manipulation
|
$469.60 |
$488.00 |
$647.20 |
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$334.40 |
$334.40 |
$467.20 |
|
|
Ghs urine, porphyrins quant
|
$43.20 |
$50.40 |
$50.40 |
|
|
Ghs vaginal delivery only
|
$3,371.20 |
$3,455.20 |
$3,518.40 |
|
|
Ghs veeg 12-26 hr intmt mont
|
$5,656.80 |
$5,656.80 |
$5,656.80 |
|
|
Ghs windowing of cast
|
$204.00 |
$204.00 |
$241.60 |
|
|
Gi inhouse confirmation
|
$44.80 |
$66.40 |
$76.00 |
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$2,714.40 |
$2,714.40 |
$2,714.40 |
|
|
Glassia injection
|
$9,746.24 |
$9,746.24 |
$9,746.24 |
|
|
Glove finger flexion right lg xl
|
$96.80 |
$96.80 |
$115.20 |
|
|
Glucagon 1 mg solution for injection
|
$315.01 |
$315.01 |
$414.34 |
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$243.14 |
$247.06 |
$678.52 |
|
|
Glucagon plasma - sendout
|
$48.80 |
$48.80 |
$48.80 |
|
|
Glucose 1 hr post dose
|
$30.40 |
$50.40 |
$80.80 |
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$24.80 |
$28.80 |
$41.60 |
|
|
Glucose blood quantitative
|
$40.00 |
$48.00 |
$66.40 |
|
|
Glucose body fluid
|
$29.60 |
$56.80 |
$61.60 |
|
|
Glucose monitoring continual min 72hr pt
|
$153.60 |
$172.80 |
$196.00 |
|
|
Glucose tolerance test (gtt) 3 specimens
|
$64.80 |
$105.60 |
$201.60 |
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$28.00 |
$29.60 |
$61.60 |
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$60.34 |
$62.56 |
$313.88 |
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$2,446.18 |
$3,034.40 |
$5,575.08 |
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$84.00 |
$128.80 |
$148.00 |
|
|
Gonadotropin luteinizing hormone (lh)
|
$84.00 |
$131.20 |
$156.00 |
|
|
Goserelin 10.8 mg subcutaneous implant
|
$1,107.28 |
$1,131.85 |
$1,238.49 |
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$407.20 |
$407.20 |
$407.20 |
|
|
Graft axiofill 1000mg
|
$2,352.85 |
$2,870.75 |
$5,288.11 |
|
|
Graft bone flex 2.5cm x 5cm grafton-cost per sq cm
|
$712.80 |
$712.80 |
$712.80 |
|
