|
Ghs ob unlisted IV or art inj or infusion
|
$292.70 |
$292.70 |
$292.70 |
$82.62
|
|
Ghs opcc repair cvp without subq port
|
$1,008.30 |
$1,008.30 |
$1,229.24 |
$1,236.67
|
|
Ghs opcc repair cvp w subq port
|
$1,070.85 |
$1,070.85 |
$2,672.42 |
$2,194.40
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$102.06 |
$102.06 |
$102.06 |
$58.00
|
|
Ghs ot dds rom
|
$109.65 |
$109.65 |
$109.65 |
$69.00
|
|
Ghs ot group caregiver training
|
$13.88 |
$13.88 |
$46.35 |
$34.80
|
|
Ghs ot prosthetic training/15 min
|
$107.70 |
$109.65 |
$214.79 |
$93.00
|
|
Ghs ot sensory integrative tech/15min
|
$114.90 |
$134.70 |
$134.70 |
$96.20
|
|
Ghs ot work hardening-additional hours
|
$352.50 |
$352.50 |
$352.50 |
$126.40
|
|
Ghs pacing - transcutaneous
|
$878.70 |
$913.95 |
$1,102.70 |
$830.53
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$741.45 |
$741.45 |
$1,210.58 |
$853.65
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$741.45 |
$741.45 |
$843.23 |
$962.00
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$92.44 |
$92.44 |
$92.44 |
$74.10
|
|
Ghs peritonsillar abscess i andd
|
$283.05 |
$283.05 |
$1,453.82 |
$555.00
|
|
Ghs phenylketonurid
|
$86.44 |
$86.44 |
$86.44 |
$53.76
|
|
Ghs picc line insert < 5
|
$2,630.88 |
$2,780.70 |
$2,780.70 |
$2,019.50
|
|
Ghs plngl fx pm cl
|
$211.95 |
$211.95 |
$713.14 |
$564.80
|
|
Ghs plt ct-manual
|
$64.46 |
$64.46 |
$64.46 |
$37.96
|
|
Ghs polysom <6 yrs 4/> parameters
|
$2,902.39 |
$2,902.39 |
$2,902.39 |
$3,557.58
|
|
Ghs ppd (tb intradermal)
|
$20.81 |
$20.81 |
$60.68 |
$37.44
|
|
Ghs prostatic acid phosphatase (mayo)
|
$67.83 |
$67.83 |
$87.00 |
$43.55
|
|
Ghs protein, misc fluid
|
$24.60 |
$25.65 |
$25.65 |
$24.60
|
|
Ghs protoporphyrins fract
|
$88.90 |
$88.90 |
$88.90 |
$60.75
|
|
Ghs pr without cont pulse ox
|
$147.00 |
$147.00 |
$197.83 |
$147.00
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$47.55 |
$47.55 |
$61.85 |
$47.55
|
|
Ghs pt - work hardening/int 2hrs
|
$407.55 |
$407.55 |
$407.55 |
$285.60
|
|
Ghs quinidine
|
$475.50 |
$475.50 |
$475.50 |
$85.00
|
|
Ghs refill of implantable pump
|
$566.55 |
$566.55 |
$566.55 |
$539.13
|
|
Ghs removal intranasal foreign body
|
$217.20 |
$217.20 |
$301.22 |
$283.24
|
|
Ghs removal pharyngeal foreign body
|
$407.10 |
$407.10 |
$460.00 |
$441.68
|
|
Ghs repair extensor tendon hand, ea tendon
|
$2,923.60 |
$2,923.60 |
$2,923.60 |
$2,517.00
|
|
Ghs respiratory syncytical virus igg/m
|
$525.00 |
$525.00 |
$525.00 |
$74.82
|
|
Ghs reticulocyte count
|
$58.09 |
$58.09 |
$117.48 |
$34.50
|
|
Ghs rsv eia (respir synctial vrs)
|
$139.81 |
$193.05 |
$193.05 |
$99.00
|
|
Ghs sedimentation rate
|
$80.08 |
$84.00 |
$84.00 |
$45.50
|
|
Ghs semen analysis fert
|
$129.00 |
$129.00 |
$129.00 |
$124.80
|
|
Ghs sensitivity (per antimicro)
|
$79.31 |
$97.65 |
$97.65 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$449.25 |
$449.25 |
$744.69 |
$570.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$607.35 |
$607.35 |
$875.44 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$449.25 |
$449.25 |
$974.17 |
$586.50
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$564.61 |
$607.35 |
$607.35 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$312.90 |
$312.90 |
$644.19 |
$449.15
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$235.35 |
$235.35 |
$569.06 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$312.90 |
$312.90 |
$593.27 |
$489.72
|
|
Ghs simple repair over 30 cm - 12007
|
$235.35 |
$235.35 |
$980.75 |
$590.88
|
|
Ghs simple repair over 30 cm - 12018
|
$589.18 |
$589.18 |
$589.18 |
$537.60
|
|
Ghs sleep study unattended
|
$503.38 |
$503.38 |
$503.38 |
$503.38
|
|
Ghs somatosensory testing lower extremit
|
$812.40 |
$812.40 |
$885.81 |
$925.91
|
|
Ghs somatosensory testing upper & lower limbs
|
$471.30 |
$471.30 |
$1,765.32 |
$1,416.80
|
|
Ghs speech-gen aug dev eval iii, st
|
$162.65 |
$162.65 |
$286.35 |
$157.50
|
|
Ghs sphenopalatine ganglion block
|
$456.60 |
$456.60 |
$762.91 |
$630.24
|
|
Ghs sp train/fitting sp device - kx
|
$281.16 |
$281.16 |
$281.16 |
$252.75
|
|
Ghs strapping shoulder - 29240
|
$205.20 |
$205.20 |
$262.91 |
$217.60
|
|
Ghs st - re-eval for alt comm
|
$407.74 |
$407.74 |
$567.15 |
$309.60
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$99.98 |
$99.98 |
$99.98 |
$99.98
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$393.99 |
$393.99 |
$393.99 |
$360.80
|
|
Ghs superficial wnd dehiscence simp12020
|
$695.40 |
$695.40 |
$1,665.04 |
$953.27
|
|
Ghs superficial wnd dehis w packing12021
|
$431.85 |
$431.85 |
$901.36 |
$695.93
|
|
Ghs tracheostomy emergency - transtracheal
|
$1,529.85 |
$1,529.85 |
$2,634.36 |
$1,867.84
|
|
Ghs trypsin (fecal)
|
$79.83 |
$79.83 |
$79.83 |
$55.59
|
|
Ghs tx distal phalangeal fx with manipulation
|
$211.95 |
$211.95 |
$705.76 |
$529.65
|
|
Ghs urine, porphyrins quant
|
$87.00 |
$87.00 |
$127.80 |
$73.80
|
|
Ghs vaginal delivery only
|
$1,907.85 |
$1,907.85 |
$3,142.35 |
$3,341.93
|
|
Ghs veeg 12-26 hr intmt mont
|
$1,063.95 |
$1,063.95 |
$3,915.55 |
$1,932.00
|
|
Ghs windowing of cast
|
$235.37 |
$235.37 |
$235.37 |
$212.55
|
|
Giardia lamblia antibody
|
$105.75 |
$105.75 |
$105.75 |
$83.44
|
|
Gi inhouse confirmation
|
$153.28 |
$190.95 |
$190.95 |
$87.75
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$1,842.15 |
$1,842.15 |
$2,418.92 |
$2,215.20
|
|
Gi trc img intral esophagus
|
$1,897.82 |
$1,897.82 |
$1,897.82 |
$1,897.82
|
|
Gjb2 gene full sequence
|
$628.20 |
$628.20 |
$900.00 |
$502.80
|
|
Glassia injection
|
$33,840.00 |
$33,840.00 |
$33,840.00 |
$20.32
|
|
Glove finger flexion right lg xl
|
$54.62 |
$54.62 |
$54.62 |
$110.62
|
|
Glucagon 1 mg solution for injection
|
$370.66 |
$370.66 |
$682.24 |
$613.79
|
|
Glucagon plasma - sendout
|
$93.45 |
$117.00 |
$117.00 |
$64.35
|
|
Glucose 1 hr post dose
|
$68.98 |
$205.20 |
$205.20 |
$49.00
|
|
Glucose-6-phosphate dhydrogenase screen
|
$67.13 |
$67.13 |
$67.13 |
$55.50
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$28.35 |
$29.55 |
$33.96 |
$23.12
|
|
Glucose blood quantitative
|
$59.87 |
$80.70 |
$114.20 |
$42.25
|
|
Glucose body fluid
|
$76.34 |
$80.70 |
$80.70 |
$51.30
|
|
Glucose tolerance test (gtt) 3 specimens
|
$135.45 |
$135.45 |
$151.93 |
$105.60
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$45.82 |
$101.40 |
$101.40 |
$36.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$49.20 |
$49.20 |
$49.20 |
$37.40
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$3,598.55 |
$3,958.40 |
$3,958.40 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$160.05 |
$160.05 |
$162.51 |
$116.64
|
|
Gonadotropin luteinizing hormone (lh)
|
$151.20 |
$151.20 |
$316.50 |
$129.03
|
|
Goniotomy
|
$3,945.62 |
$3,945.62 |
$3,945.62 |
$4,396.50
|
|
Goserelin 10.8 mg subcutaneous implant
|
$5,010.53 |
$5,254.13 |
$5,254.13 |
$4,417.13
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$72.40 |
$72.40 |
$4,733.71 |
$73.83
|
|
Graft axiofill 1000mg
|
$3,456.79 |
$12,003.00 |
$12,003.00 |
$5,125.68
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$388.13 |
$424.77 |
$424.77 |
$605.00
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$199.26 |
$199.26 |
$27,603.28 |
$23,233.80
|
|
Graft nerve adv 3-4x70mm
|
$20,782.10 |
$30,006.00 |
$30,006.00 |
$20,782.10
|
|
Graft patch felt ptfe 2x2
|
$50,985.00 |
$94,500.00 |
$94,500.00 |
$29,293.39
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$203.91 |
$203.91 |
$203.91 |
$1,111.05
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$1,315.71 |
$2,784.00 |
$2,784.00 |
$886.17
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$765.06 |
$1,132.47 |
$1,132.47 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$430.75 |
$430.75 |
$7,021.66 |
$349.41
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$4,742.40 |
$4,742.40 |
$4,742.40 |
$28,894.71
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$800.41 |
$1,132.47 |
$1,132.47 |
$1,103.05
|
|
Graft xenmtrx sft rect 15x20cm
|
$44,712.17 |
$44,712.17 |
$50,985.00 |
$29,676.26
|
