|
Ghs mbp
|
$56.00 |
$56.00 |
$56.00 |
$75.50
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$164.00 |
$164.00 |
$164.00 |
$242.64
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$253.50 |
$253.50 |
$253.50 |
$230.55
|
|
Ghs moderate sedation ea addtl 15 min
|
$187.50 |
$187.50 |
$187.50 |
$150.00
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$120.00 |
$120.00 |
$120.00 |
$141.00
|
|
Ghs musc test done w/n test comp
|
$487.50 |
$487.50 |
$487.50 |
$324.80
|
|
Ghs musc tst done w/nerv tst lim
|
$487.50 |
$487.50 |
$487.50 |
$272.25
|
|
Ghs myocardial strain img spckl track
|
$150.00 |
$150.00 |
$150.00 |
$444.60
|
|
Ghs nailbed repair/nail removal
|
$1,011.00 |
$1,011.00 |
$1,011.00 |
$724.37
|
|
Ghs nerve blk intercostal, single level
|
$1,459.50 |
$1,459.50 |
$1,459.50 |
$1,121.00
|
|
Ghs nerve block axillary nerve
|
$1,535.00 |
$1,535.00 |
$1,535.00 |
$1,540.00
|
|
Ghs nerve block brachial plexus
|
$6,235.33 |
$6,235.33 |
$6,235.33 |
$1,695.24
|
|
Ghs nerve block interscaline
|
$110.00 |
$110.00 |
$110.00 |
$1,526.09
|
|
Ghs nerve block lumbar or thoracic symp
|
$455.50 |
$455.50 |
$455.50 |
$1,671.75
|
|
Ghs nerve block sciatic nerve
|
$1,108.50 |
$1,108.50 |
$1,108.50 |
$1,450.80
|
|
Ghs nerve block suprascapular
|
$1,183.50 |
$1,183.50 |
$1,183.50 |
$1,183.50
|
|
Ghs ng placement w fluoro guidance
|
$728.00 |
$728.00 |
$728.00 |
$478.50
|
|
Ghs o2 saturation
|
$41.00 |
$41.00 |
$41.00 |
$69.50
|
|
Ghs opcc repair cvp w subq port
|
$5,777.00 |
$5,777.00 |
$5,777.00 |
$2,194.40
|
|
Ghs optokenetic
|
$204.50 |
$204.50 |
$204.50 |
$211.20
|
|
Ghs oscillating trac
|
$390.50 |
$390.50 |
$390.50 |
$291.75
|
|
Ghs ot dds rom
|
$75.00 |
$75.00 |
$75.00 |
$69.00
|
|
Ghs ot group caregiver training
|
$26.50 |
$26.50 |
$26.50 |
$34.80
|
|
Ghs ot prosthetic training/15 min
|
$82.50 |
$82.50 |
$82.50 |
$92.35
|
|
Ghs ot sensory integrative tech/15min
|
$89.00 |
$89.00 |
$89.00 |
$96.00
|
|
Ghs pacing - transcutaneous
|
$1,353.50 |
$1,353.50 |
$1,353.50 |
$822.00
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$508.50 |
$508.50 |
$508.50 |
$962.00
|
|
Ghs peritonsillar abscess i andd
|
$446.00 |
$446.00 |
$446.00 |
$545.40
|
|
Ghs phenylketonurid
|
$175.00 |
$175.00 |
$175.00 |
$53.76
|
|
Ghs plngl fx pm cl
|
$547.00 |
$547.00 |
$547.00 |
$564.50
|
|
Ghs ppd (tb intradermal)
|
$39.50 |
$39.50 |
$39.50 |
$37.44
|
|
Ghs prostatic acid phosphatase (mayo)
|
$7.00 |
$7.00 |
$7.00 |
$43.55
|
|
Ghs protoporphyrins fract
|
$14.50 |
$14.50 |
$14.50 |
$60.75
|
|
Ghs pr without cont pulse ox
|
$109.50 |
$109.50 |
$109.50 |
$146.86
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$8.00 |
$8.00 |
$8.00 |
$47.55
|
|
Ghs quinidine
|
$167.50 |
$167.50 |
$167.50 |
$83.20
|
|
Ghs refill of implantable pump
|
$409.50 |
$409.50 |
$409.50 |
$539.13
|
|
Ghs removal intranasal foreign body
|
$212.50 |
$212.50 |
$212.50 |
$283.51
|
|
Ghs repair extensor tendon hand, ea tendon
|
$2,116.50 |
$2,116.50 |
$2,116.50 |
$2,408.00
|
|
Ghs sedimentation rate
|
$38.00 |
$38.00 |
$38.00 |
$45.50
|
|
Ghs semen analysis fert
|
$116.50 |
$116.50 |
$116.50 |
$124.80
|
|
Ghs sensitivity (per antimicro)
|
$85.00 |
$85.00 |
$85.00 |
$56.40
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$719.50 |
$719.50 |
$719.50 |
$563.75
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$610.00 |
$610.00 |
$610.00 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$719.50 |
$719.50 |
$719.50 |
$575.00
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$347.50 |
$347.50 |
$347.50 |
$451.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$443.00 |
$443.00 |
$443.00 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$347.50 |
$347.50 |
$347.50 |
$492.00
|
|
Ghs sleep study unattended
|
$212.00 |
$212.00 |
$212.00 |
$503.38
|
|
Ghs somatosensory testing lower extremit
|
$159.00 |
$159.00 |
$159.00 |
$917.80
|
|
Ghs sphenopalatine ganglion block
|
$610.00 |
$610.00 |
$610.00 |
$616.00
|
|
Ghs st - eval for alt comm
|
$77.00 |
$77.00 |
$77.00 |
$94.60
|
|
Ghs strapping shoulder - 29240
|
$121.50 |
$121.50 |
$121.50 |
$217.60
|
|
Ghs st - re-eval for alt comm
|
$68.00 |
$68.00 |
$68.00 |
$309.00
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$95.50 |
$95.50 |
$95.50 |
$99.98
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$491.50 |
$491.50 |
$491.50 |
$354.00
|
|
Ghs superficial wnd dehiscence simp12020
|
$1,118.50 |
$1,118.50 |
$1,118.50 |
$909.00
|
|
Ghs superficial wnd dehis w packing12021
|
$588.00 |
$588.00 |
$588.00 |
$692.80
|
|
Ghs tx distal phalangeal fx with manipulation
|
$437.00 |
$437.00 |
$437.00 |
$525.60
|
|
Ghs urine, porphyrins quant
|
$15.00 |
$15.00 |
$15.00 |
$73.80
|
|
Ghs vaginal delivery only
|
$3,739.50 |
$3,739.50 |
$3,739.50 |
$3,338.40
|
|
Gi inhouse confirmation
|
$64.50 |
$64.50 |
$64.50 |
$86.40
|
|
Gi wireless capsule measure
|
$1,020.50 |
$1,020.50 |
$1,020.50 |
$1,579.30
|
|
Glassia injection
|
$3,253.80 |
$3,253.80 |
$3,253.80 |
$20.32
|
|
Glucagon 1 mg solution for injection
|
$613.79 |
$613.79 |
$613.79 |
$601.79
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$306.90 |
$306.90 |
$306.90 |
$491.67
|
|
Glucagon plasma - sendout
|
$31.00 |
$31.00 |
$31.00 |
$63.20
|
|
Glucose 1 hr post dose
|
$64.50 |
$64.50 |
$64.50 |
$48.25
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$22.00 |
$22.00 |
$22.00 |
$22.75
|
|
Glucose blood quantitative
|
$39.00 |
$39.00 |
$39.00 |
$41.40
|
|
Glucose body fluid
|
$81.00 |
$81.00 |
$81.00 |
$51.30
|
|
Glucose tolerance test (gtt) 3 specimens
|
$58.50 |
$58.50 |
$58.50 |
$104.50
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$17.00 |
$17.00 |
$17.00 |
$36.00
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$11,569.51 |
$11,569.51 |
$11,569.51 |
$4,977.60
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$33.00 |
$33.00 |
$33.00 |
$115.80
|
|
Gonadotropin luteinizing hormone (lh)
|
$22.00 |
$22.00 |
$22.00 |
$129.00
|
|
Gonioscopy
|
$155.50 |
$155.50 |
$155.50 |
$135.52
|
|
Goserelin 10.8 mg subcutaneous implant
|
$2,529.00 |
$2,529.00 |
$2,529.00 |
$4,496.37
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$2,024.00 |
$2,024.00 |
$2,024.00 |
$143.50
|
|
Graft axiofill 1000mg
|
$14.50 |
$14.50 |
$14.50 |
$5,125.68
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$143.50 |
$143.50 |
$143.50 |
$601.50
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$143.50 |
$143.50 |
$143.50 |
$23,288.44
|
|
Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm
|
$2,866.00 |
$2,866.00 |
$2,866.00 |
$3,432.00
|
|
Graft nerve adv 3-4x70mm
|
$2,338.50 |
$2,338.50 |
$2,338.50 |
$20,782.10
|
|
Graft patch felt ptfe 2x2
|
$1,856.00 |
$1,856.00 |
$1,856.00 |
$29,995.44
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$143.50 |
$143.50 |
$143.50 |
$1,455.76
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$143.50 |
$143.50 |
$143.50 |
$892.38
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$3,363.02 |
$3,363.02 |
$3,363.02 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$143.50 |
$143.50 |
$143.50 |
$427.89
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$45.50 |
$45.50 |
$45.50 |
$29,056.92
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$143.50 |
$143.50 |
$143.50 |
$1,132.47
|
|
Graft xenmtrx sft rect 15x20cm
|
$1,762.50 |
$1,762.50 |
$1,762.50 |
$31,191.20
|
|
Graft xenmtrx sft rect 19x28cm
|
$916.50 |
$916.50 |
$916.50 |
$3,076.20
|
|
Great toe with reduction 28495
|
$199.00 |
$199.00 |
$199.00 |
$495.00
|
|
Grfg autol soft tiss dir exc
|
$803.33 |
$803.33 |
$803.33 |
$4,332.25
|
|
Group health education
|
$11.00 |
$11.00 |
$11.00 |
$61.92
|
|
Group mnt 2 or more 30 mins
|
$55.50 |
$55.50 |
$55.50 |
$40.14
|
|
Guided cath fluid drainage 10030
|
$963.00 |
$963.00 |
$963.00 |
$1,327.76
|
|
Guide wire threaded 1.4x150mm
|
$519.50 |
$519.50 |
$519.50 |
$3,401.81
|
|
Guide worley csg 9fx50cm std
|
$87.63 |
$87.63 |
$87.63 |
$1,117.40
|
