|
Ghs layered repair 20.1 - 30.0 cm -12056
|
$276.30 |
$276.30 |
$276.30 |
$907.50
|
|
Ghs layered repair over 30.0 cm -12047
|
$1,365.90 |
$1,365.90 |
$1,365.90 |
$1,930.50
|
|
Ghs layered repair over 3.0 cm -12057
|
$1,420.65 |
$1,420.65 |
$1,420.65 |
$1,064.98
|
|
Ghs leukocyte alkaline phos (mayo)
|
$147.60 |
$147.60 |
$147.60 |
$76.20
|
|
Ghs low level laser therapy
|
$103.50 |
$103.50 |
$103.50 |
$77.70
|
|
Ghs mbp
|
$71.85 |
$71.85 |
$71.85 |
$77.35
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$228.45 |
$228.45 |
$228.45 |
$242.31
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$228.45 |
$228.45 |
$228.45 |
$228.45
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$228.45 |
$228.45 |
$228.45 |
$230.00
|
|
Ghs moderate sedation ea addtl 15 min
|
$228.45 |
$228.45 |
$228.45 |
$151.50
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$228.45 |
$228.45 |
$228.45 |
$147.75
|
|
Ghs myocardial strain img spckl track
|
$457.80 |
$457.80 |
$457.80 |
$457.80
|
|
Ghs nailbed repair/nail removal
|
$373.50 |
$373.50 |
$373.50 |
$724.37
|
|
Ghs nerve blk intercostal, ea addtl level
|
$1,382.70 |
$1,382.70 |
$1,382.70 |
$1,546.50
|
|
Ghs nerve blk intercostal, single level
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$1,107.00
|
|
Ghs nerve block brachial plexus
|
$1,382.70 |
$1,382.70 |
$1,382.70 |
$1,689.00
|
|
Ghs nerve block celiac plexus
|
$1,382.70 |
$1,382.70 |
$1,382.70 |
$1,661.40
|
|
Ghs nerve block interscaline
|
$1,382.70 |
$1,382.70 |
$1,382.70 |
$1,526.09
|
|
Ghs nerve block lumbar or thoracic symp
|
$1,354.95 |
$1,354.95 |
$1,354.95 |
$1,710.80
|
|
Ghs nerve block sciatic nerve
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$1,450.80
|
|
Ghs nerve block suprascapular
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$1,141.36
|
|
Ghs ng placement w fluoro guidance
|
$510.45 |
$510.45 |
$510.45 |
$478.50
|
|
Ghs opcc repair cvp w subq port
|
$1,070.85 |
$1,070.85 |
$1,070.85 |
$2,194.40
|
|
Ghs ot dds rom
|
$109.65 |
$109.65 |
$109.65 |
$62.28
|
|
Ghs ot sensory integrative tech/15min
|
$134.70 |
$134.70 |
$134.70 |
$94.80
|
|
Ghs ot work hardening-additional hours
|
$352.50 |
$352.50 |
$352.50 |
$127.80
|
|
Ghs pacing - transcutaneous
|
$878.70 |
$878.70 |
$878.70 |
$815.20
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$741.45 |
$741.45 |
$741.45 |
$851.04
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$741.45 |
$741.45 |
$741.45 |
$962.00
|
|
Ghs peritonsillar abscess i andd
|
$283.05 |
$283.05 |
$283.05 |
$546.36
|
|
Ghs plngl fx pm cl
|
$211.95 |
$211.95 |
$211.95 |
$564.80
|
|
Ghs ppd (tb intradermal)
|
$20.81 |
$20.81 |
$20.81 |
$37.70
|
|
Ghs prostatic acid phosphatase (mayo)
|
$87.00 |
$87.00 |
$87.00 |
$43.55
|
|
Ghs protein, misc fluid
|
$25.65 |
$25.65 |
$25.65 |
$24.60
|
|
Ghs pt - work hardening/int 2hrs
|
$407.55 |
$407.55 |
$407.55 |
$275.60
|
|
Ghs removal intranasal foreign body
|
$217.20 |
$217.20 |
$217.20 |
$287.50
|
|
Ghs removal pharyngeal foreign body
|
$407.10 |
$407.10 |
$407.10 |
$459.90
|
|
Ghs reticulocyte count
|
$105.00 |
$105.00 |
$105.00 |
$34.45
|
|
Ghs rsv eia (respir synctial vrs)
|
$193.05 |
$193.05 |
$193.05 |
$96.60
|
|
Ghs sedimentation rate
|
$84.00 |
$84.00 |
$84.00 |
$45.50
|
|
Ghs sensitivity (per antimicro)
|
$97.65 |
$97.65 |
$97.65 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$449.25 |
$449.25 |
$449.25 |
$553.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$607.35 |
$607.35 |
$607.35 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$449.25 |
$449.25 |
$449.25 |
$575.00
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$312.90 |
$312.90 |
$312.90 |
$448.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$235.35 |
$235.35 |
$235.35 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$312.90 |
$312.90 |
$312.90 |
$484.80
|
|
Ghs simple repair over 30 cm - 12007
|
$235.35 |
$235.35 |
$235.35 |
$582.00
|
|
Ghs somatosensory testing lower extremit
|
$781.05 |
$781.05 |
$781.05 |
$922.35
|
|
Ghs speech-gen aug dev eval iii, st
|
$286.35 |
$286.35 |
$286.35 |
$146.40
|
|
Ghs sphenopalatine ganglion block
|
$456.60 |
$456.60 |
$456.60 |
$637.92
|
|
Ghs sp train/fitting sp device - kx
|
$252.75 |
$252.75 |
$252.75 |
$250.50
|
|
Ghs strapping shoulder - 29240
|
$205.20 |
$205.20 |
$205.20 |
$213.20
|
|
Ghs superficial wnd dehiscence simp12020
|
$695.40 |
$695.40 |
$695.40 |
$861.75
|
|
Ghs tracheostomy emergency - transtracheal
|
$1,529.85 |
$1,529.85 |
$1,529.85 |
$1,752.89
|
|
Ghs tx distal phalangeal fx with manipulation
|
$211.95 |
$211.95 |
$211.95 |
$523.00
|
|
Ghs urine, porphyrins quant
|
$87.00 |
$87.00 |
$87.00 |
$75.00
|
|
Ghs vaginal delivery only
|
$1,907.85 |
$1,907.85 |
$1,907.85 |
$3,152.00
|
|
Ghs veeg 12-26 hr intmt mont
|
$1,063.95 |
$1,063.95 |
$1,063.95 |
$1,910.25
|
|
Gi inhouse confirmation
|
$190.95 |
$190.95 |
$190.95 |
$83.70
|
|
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 |
$100.48
|
|
Glucagon 1 mg solution for injection
|
$370.66 |
$370.66 |
$370.66 |
$601.79
|
|
Glucagon plasma - sendout
|
$117.00 |
$117.00 |
$117.00 |
$63.00
|
|
Glucose 1 hr post dose
|
$168.45 |
$168.45 |
$168.45 |
$47.20
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$28.35 |
$28.35 |
$28.35 |
$23.86
|
|
Glucose blood quantitative
|
$80.70 |
$80.70 |
$80.70 |
$40.00
|
|
Glucose body fluid
|
$80.70 |
$80.70 |
$80.70 |
$52.20
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$101.40 |
$101.40 |
$101.40 |
$35.00
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$3,958.40 |
$3,958.40 |
$3,958.40 |
$4,977.60
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$160.05 |
$160.05 |
$160.05 |
$115.05
|
|
Gonadotropin luteinizing hormone (lh)
|
$151.20 |
$151.20 |
$151.20 |
$129.00
|
|
Goserelin 10.8 mg subcutaneous implant
|
$5,254.13 |
$5,254.13 |
$5,254.13 |
$4,652.18
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$72.40 |
$72.40 |
$72.40 |
$672.50
|
|
Graft axiofill 1000mg
|
$12,003.00 |
$12,003.00 |
$12,003.00 |
$5,125.68
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$424.77 |
$424.77 |
$424.77 |
$584.99
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$199.26 |
$199.26 |
$199.26 |
$24,469.57
|
|
Graft nerve adv 3-4x70mm
|
$30,006.00 |
$30,006.00 |
$30,006.00 |
$19,620.00
|
|
Graft patch felt ptfe 2x2
|
$94,500.00 |
$94,500.00 |
$94,500.00 |
$27,300.00
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$203.91 |
$203.91 |
$203.91 |
$1,455.76
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$2,784.00 |
$2,784.00 |
$2,784.00 |
$1,181.41
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$1,132.47 |
$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 |
$430.75 |
$373.00
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$1,132.47 |
$1,132.47 |
$1,132.47 |
$1,132.47
|
|
Graft xenmtrx sft rect 15x20cm
|
$44,712.17 |
$44,712.17 |
$44,712.17 |
$30,392.04
|
|
Graft xenmtrx sft rect 19x28cm
|
$3,220.32 |
$3,220.32 |
$3,220.32 |
$2,701.58
|
|
Granisetron 1 mg tab
|
$53.15 |
$53.15 |
$53.15 |
$53.15
|
|
Granisetron hcl injection
|
$24.63 |
$24.63 |
$24.63 |
$45.03
|
|
Great toe with reduction 28495
|
$211.95 |
$211.95 |
$211.95 |
$482.40
|
|
G-tube reposition
|
$730.95 |
$730.95 |
$730.95 |
$759.36
|
|
Gu dilat ureter/urethra s&i
|
$3,009.45 |
$3,009.45 |
$3,009.45 |
$1,923.60
|
|
Guided cath fluid drainage 10030
|
$631.80 |
$631.80 |
$631.80 |
$1,372.15
|
|
Guide endoanchr sg-64 aaa 62cm
|
$6,492.00 |
$6,492.00 |
$6,492.00 |
$7,728.17
|
|
Guide wire threaded 1.4x150mm
|
$7,980.00 |
$7,980.00 |
$7,980.00 |
$3,284.50
|
|
Guide worley csg 9fx50cm std
|
$4,336.80 |
$4,336.80 |
$4,336.80 |
$1,105.00
|
|
Gw stiffened micro access kit
|
$12,003.00 |
$12,003.00 |
$12,003.00 |
$6,696.00
|
|
Halo cervical into jckt vest
|
$5,015.12 |
$5,015.12 |
$5,015.12 |
$5,015.12
|
|
Halo cerv into milwaukee typ
|
$6,758.24 |
$6,758.24 |
$6,758.24 |
$5,529.64
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$70.77 |
$70.77 |
$70.77 |
$90.14
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$8.20 |
$8.20 |
$8.20 |
$23.06
|
