|
Ghs mbp
|
$101.15 |
$101.15 |
$101.15 |
$74.19
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$1,096.20 |
$1,096.20 |
$1,096.20 |
$261.80
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$370.65 |
$370.65 |
$370.65 |
$252.50
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$228.90 |
$228.90 |
$228.90 |
$239.20
|
|
Ghs moderate sedation ea addtl 15 min
|
$197.40 |
$197.40 |
$197.40 |
$145.60
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$189.35 |
$189.35 |
$189.35 |
$140.00
|
|
Ghs musc test done w/n test comp
|
$527.80 |
$527.80 |
$527.80 |
$349.80
|
|
Ghs musc tst done w/nerv tst lim
|
$253.40 |
$253.40 |
$253.40 |
$269.15
|
|
Ghs musc tst done w/n tst non ext
|
$290.50 |
$290.50 |
$290.50 |
$222.60
|
|
Ghs myocardial strain img spckl track
|
$560.00 |
$560.00 |
$560.00 |
$503.85
|
|
Ghs nailbed repair/nail removal
|
$219.80 |
$219.80 |
$219.80 |
$808.80
|
|
Ghs nerve blk intercostal, single level
|
$583.80 |
$583.80 |
$583.80 |
$1,230.80
|
|
Ghs nerve block axillary nerve
|
$780.15 |
$780.15 |
$780.15 |
$1,541.40
|
|
Ghs nerve block brachial plexus
|
$428.40 |
$428.40 |
$428.40 |
$1,768.00
|
|
Ghs nerve block celiac plexus
|
$440.30 |
$440.30 |
$440.30 |
$1,712.00
|
|
Ghs nerve block sciatic nerve
|
$606.90 |
$606.90 |
$606.90 |
$1,636.80
|
|
Ghs ng placement w fluoro guidance
|
$210.70 |
$210.70 |
$210.70 |
$468.75
|
|
Ghs o2 saturation
|
$72.45 |
$72.45 |
$72.45 |
$72.45
|
|
Ghs o2 uptake rest & exercise
|
$990.85 |
$990.85 |
$990.85 |
$185.15
|
|
Ghs o2 uptake rest & indirect
|
$138.95 |
$138.95 |
$138.95 |
$195.00
|
|
Ghs opcc repair cvp without subq port
|
$255.85 |
$255.85 |
$255.85 |
$1,302.54
|
|
Ghs opcc repair cvp w subq port
|
$628.25 |
$628.25 |
$628.25 |
$2,430.56
|
|
Ghs ot group caregiver training
|
$31.50 |
$31.50 |
$31.50 |
$43.20
|
|
Ghs ot sensory integrative tech/15min
|
$52.15 |
$52.15 |
$52.15 |
$101.05
|
|
Ghs pacing - transcutaneous
|
$444.15 |
$444.15 |
$444.15 |
$868.68
|
|
Ghs peritonsillar abscess i andd
|
$202.30 |
$202.30 |
$202.30 |
$694.20
|
|
Ghs picc line insert < 5
|
$2,286.90 |
$2,286.90 |
$2,286.90 |
$2,060.40
|
|
Ghs plngl fx pm cl
|
$100.45 |
$100.45 |
$100.45 |
$662.20
|
|
Ghs plt ct-manual
|
$39.20 |
$39.20 |
$39.20 |
$39.20
|
|
Ghs polysom <6 yrs 4/> parameters
|
$3,705.80 |
$3,705.80 |
$3,705.80 |
$3,705.80
|
|
Ghs ppd (tb intradermal)
|
$25.90 |
$25.90 |
$25.90 |
$43.45
|
|
Ghs prostatic acid phosphatase (mayo)
|
$13.65 |
$13.65 |
$13.65 |
$40.56
|
|
Ghs pr without cont pulse ox
|
$62.30 |
$62.30 |
$62.30 |
$156.70
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$50.05 |
$50.05 |
$50.05 |
$45.05
|
|
Ghs removal intranasal foreign body
|
$75.95 |
$75.95 |
$75.95 |
$324.35
|
|
Ghs removal pharyngeal foreign body
|
$288.05 |
$288.05 |
$288.05 |
$460.00
|
|
Ghs rsv eia (respir synctial vrs)
|
$101.15 |
$101.15 |
$101.15 |
$101.15
|
|
Ghs sedimentation rate
|
$45.50 |
$45.50 |
$45.50 |
$45.50
|
|
Ghs sensitivity (per antimicro)
|
$54.95 |
$54.95 |
$54.95 |
$59.90
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$760.90 |
$760.90 |
$760.90 |
$590.40
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$894.60 |
$894.60 |
$894.60 |
$705.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$931.00 |
$931.00 |
$931.00 |
$670.08
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$523.60 |
$523.60 |
$523.60 |
$487.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$594.30 |
$594.30 |
$594.30 |
$470.47
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$660.45 |
$660.45 |
$660.45 |
$538.64
|
|
Ghs simple repair over 30 cm - 12007
|
$1,159.20 |
$1,159.20 |
$1,159.20 |
$660.00
|
|
Ghs sleep study unattended
|
$285.25 |
$285.25 |
$285.25 |
$503.38
|
|
Ghs somatosensory testing lower extremit
|
$484.05 |
$484.05 |
$484.05 |
$947.48
|
|
Ghs somatosensory testing upper & lower limbs
|
$889.00 |
$889.00 |
$889.00 |
$1,435.00
|
|
Ghs speech-gen aug dev eval iii, st
|
$73.15 |
$73.15 |
$73.15 |
$124.80
|
|
Ghs sphenopalatine ganglion block
|
$158.55 |
$158.55 |
$158.55 |
$706.56
|
|
Ghs sp train/fitting sp device - kx
|
$81.20 |
$81.20 |
$81.20 |
$261.95
|
|
Ghs st - re-eval for alt comm
|
$197.75 |
$197.75 |
$197.75 |
$309.00
|
|
Ghs superficial wnd dehiscence simp12020
|
$235.20 |
$235.20 |
$235.20 |
$976.98
|
|
Ghs superficial wnd dehis w packing12021
|
$155.75 |
$155.75 |
$155.75 |
$761.28
|
|
Ghs tracheostomy emergency - transtracheal
|
$2,970.45 |
$2,970.45 |
$2,970.45 |
$2,225.73
|
|
Ghs tx distal phalangeal fx with manipulation
|
$104.30 |
$104.30 |
$104.30 |
$591.00
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$217.35 |
$217.35 |
$217.35 |
$540.00
|
|
Ghs urine, porphyrins quant
|
$66.15 |
$66.15 |
$66.15 |
$70.20
|
|
Ghs vaginal delivery only
|
$1,286.95 |
$1,286.95 |
$1,286.95 |
$3,525.06
|
|
Ghs veeg 12-26 hr intmt mont
|
$2,014.60 |
$2,014.60 |
$2,014.60 |
$1,843.00
|
|
Gi inhouse confirmation
|
$98.70 |
$98.70 |
$98.70 |
$87.00
|
|
Glucagon 1 mg solution for injection
|
$433.98 |
$433.98 |
$433.98 |
$613.00
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$309.00 |
$309.00 |
$309.00 |
$509.06
|
|
Glucagon plasma - sendout
|
$47.25 |
$47.25 |
$47.25 |
$58.56
|
|
Glucose 1 hr post dose
|
$60.55 |
$60.55 |
$60.55 |
$46.28
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$12.60 |
$12.60 |
$12.60 |
$22.00
|
|
Glucose blood quantitative
|
$67.90 |
$67.90 |
$67.90 |
$44.76
|
|
Glucose body fluid
|
$94.50 |
$94.50 |
$94.50 |
$50.70
|
|
Glucose tolerance test (gtt) 3 specimens
|
$135.45 |
$135.45 |
$135.45 |
$100.10
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$17.15 |
$17.15 |
$17.15 |
$34.45
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$5,009.45 |
$5,009.45 |
$5,009.45 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$117.95 |
$117.95 |
$117.95 |
$110.04
|
|
Gonadotropin luteinizing hormone (lh)
|
$139.65 |
$139.65 |
$139.65 |
$123.75
|
|
Goserelin 10.8 mg subcutaneous implant
|
$5,516.35 |
$5,516.35 |
$5,516.35 |
$2,802.00
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$61.60 |
$61.60 |
$61.60 |
$2,648.81
|
|
Graft axiofill 1000mg
|
$7,884.72 |
$7,884.72 |
$7,884.72 |
$5,278.73
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$40,917.45 |
$40,917.45 |
$40,917.45 |
$25,762.70
|
|
Graft nerve adv 3-4x70mm
|
$31,237.50 |
$31,237.50 |
$31,237.50 |
$27,495.00
|
|
Graft patch felt ptfe 2x2
|
$88,841.55 |
$88,841.55 |
$88,841.55 |
$25,728.84
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$75.25 |
$75.25 |
$75.25 |
$10,989.38
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$545.30 |
$545.30 |
$545.30 |
$1,560.21
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$59.15 |
$59.15 |
$59.15 |
$336.78
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$40,756.80 |
$40,756.80 |
$40,756.80 |
$35,824.13
|
|
Graft xenmtrx sft rect 15x20cm
|
$86,498.48 |
$86,498.48 |
$86,498.48 |
$43,312.93
|
|
Graft xenmtrx sft rect 19x28cm
|
$12,380.20 |
$12,380.20 |
$12,380.20 |
$2,653.10
|
|
Granisetron 1 mg tab
|
$1.87 |
$1.87 |
$1.87 |
$10.04
|
|
Granisetron hcl injection
|
$30.41 |
$30.41 |
$30.41 |
$41.65
|
|
Great toe with reduction 28495
|
$301.00 |
$301.00 |
$301.00 |
$577.03
|
|
G-tube reposition
|
$116.20 |
$116.20 |
$116.20 |
$741.00
|
|
Gu dilat ureter/urethra s&i
|
$1,679.30 |
$1,679.30 |
$1,679.30 |
$1,793.00
|
|
Guided cath fluid drainage 10030
|
$586.95 |
$586.95 |
$586.95 |
$1,461.15
|
|
Guide wire threaded 1.4x150mm
|
$6,634.11 |
$6,634.11 |
$6,634.11 |
$3,474.86
|
|
Guide worley csg 9fx50cm std
|
$2,229.99 |
$2,229.99 |
$2,229.99 |
$2,229.99
|
|
Guid loc target vol rad tx
|
$395.15 |
$395.15 |
$395.15 |
$503.80
|
|
Gw stiffened micro access kit
|
$27,486.80 |
$27,486.80 |
$27,486.80 |
$6,285.56
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$32.39 |
$32.39 |
$32.39 |
$112.36
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$24.66 |
$24.66 |
$24.66 |
$35.40
|
|
Hand X-ray
|
$505.75 |
$505.75 |
$505.75 |
$338.58
|
|
Haptoglobin quantitative
|
$145.60 |
$145.60 |
$145.60 |
$89.95
|
