|
Ghs mbp
|
$89.00 |
$89.00 |
$89.00 |
$75.50
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$84.00 |
$84.00 |
$84.00 |
$249.48
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$78.50 |
$78.50 |
$78.50 |
$243.36
|
|
Ghs moderate sedation ea addtl 15 min
|
$146.00 |
$146.00 |
$146.00 |
$151.50
|
|
Ghs myocardial strain img spckl track
|
$129.00 |
$129.00 |
$129.00 |
$457.80
|
|
Ghs nailbed repair/nail removal
|
$1,023.50 |
$1,023.50 |
$1,023.50 |
$724.37
|
|
Ghs nerve blk intercostal, single level
|
$779.00 |
$779.00 |
$779.00 |
$1,119.68
|
|
Ghs nerve block axillary nerve
|
$1,461.50 |
$1,461.50 |
$1,461.50 |
$1,541.40
|
|
Ghs nerve block brachial plexus
|
$1,437.50 |
$1,437.50 |
$1,437.50 |
$1,710.80
|
|
Ghs nerve block celiac plexus
|
$1,001.50 |
$1,001.50 |
$1,001.50 |
$1,556.40
|
|
Ghs nerve block interscaline
|
$1,001.50 |
$1,001.50 |
$1,001.50 |
$1,540.61
|
|
Ghs nerve block lumbar or thoracic symp
|
$1,001.50 |
$1,001.50 |
$1,001.50 |
$1,709.95
|
|
Ghs nerve block sciatic nerve
|
$779.00 |
$779.00 |
$779.00 |
$1,450.80
|
|
Ghs nerve block suprascapular
|
$779.00 |
$779.00 |
$779.00 |
$1,190.15
|
|
Ghs ng placement w fluoro guidance
|
$513.50 |
$513.50 |
$513.50 |
$485.00
|
|
Ghs opcc repair cvp without subq port
|
$1,149.00 |
$1,149.00 |
$1,149.00 |
$1,229.24
|
|
Ghs opcc repair cvp w subq port
|
$2,208.50 |
$2,208.50 |
$2,208.50 |
$2,194.40
|
|
Ghs optokenetic
|
$212.00 |
$212.00 |
$212.00 |
$203.50
|
|
Ghs oscillating trac
|
$426.50 |
$426.50 |
$426.50 |
$325.00
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$28.50 |
$28.50 |
$28.50 |
$58.00
|
|
Ghs osteopathic manipulative tx, 3-4 regions
|
$34.00 |
$34.00 |
$34.00 |
$60.03
|
|
Ghs ot group caregiver training
|
$25.00 |
$25.00 |
$25.00 |
$36.65
|
|
Ghs ot sensory integrative tech/15min
|
$108.50 |
$108.50 |
$108.50 |
$96.00
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$604.50 |
$604.50 |
$604.50 |
$851.04
|
|
Ghs peritonsillar abscess i andd
|
$3,131.00 |
$3,131.00 |
$3,131.00 |
$544.44
|
|
Ghs phenylketonurid
|
$175.00 |
$175.00 |
$175.00 |
$53.76
|
|
Ghs picc line insert < 5
|
$2,450.50 |
$2,450.50 |
$2,450.50 |
$1,999.46
|
|
Ghs plngl fx pm cl
|
$365.50 |
$365.50 |
$365.50 |
$580.32
|
|
Ghs polysom <6 yrs 4/> parameters
|
$3,253.50 |
$3,253.50 |
$3,253.50 |
$3,557.58
|
|
Ghs ppd (tb intradermal)
|
$30.00 |
$30.00 |
$30.00 |
$37.70
|
|
Ghs protoporphyrins fract
|
$8.00 |
$8.00 |
$8.00 |
$64.28
|
|
Ghs pr without cont pulse ox
|
$177.00 |
$177.00 |
$177.00 |
$147.95
|
|
Ghs quinidine
|
$167.50 |
$167.50 |
$167.50 |
$85.00
|
|
Ghs refill of implantable pump
|
$369.50 |
$369.50 |
$369.50 |
$550.00
|
|
Ghs removal intranasal foreign body
|
$178.00 |
$178.00 |
$178.00 |
$287.50
|
|
Ghs removal pharyngeal foreign body
|
$622.50 |
$622.50 |
$622.50 |
$441.68
|
|
Ghs repair extensor tendon hand, ea tendon
|
$2,161.50 |
$2,161.50 |
$2,161.50 |
$2,211.05
|
|
Ghs semen analysis fert
|
$62.50 |
$62.50 |
$62.50 |
$129.00
|
|
Ghs sensitivity (per antimicro)
|
$36.00 |
$36.00 |
$36.00 |
$58.95
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$4,336.50 |
$4,336.50 |
$4,336.50 |
$558.97
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$517.00 |
$517.00 |
$517.00 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$658.00 |
$658.00 |
$658.00 |
$575.00
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$318.00 |
$318.00 |
$318.00 |
$451.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$318.00 |
$318.00 |
$318.00 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$318.00 |
$318.00 |
$318.00 |
$492.80
|
|
Ghs simple repair over 30 cm - 12007
|
$257.50 |
$257.50 |
$257.50 |
$589.80
|
|
Ghs sphenopalatine ganglion block
|
$332.00 |
$332.00 |
$332.00 |
$637.92
|
|
Ghs sp train/fitting sp device - kx
|
$222.00 |
$222.00 |
$222.00 |
$242.00
|
|
Ghs st - eval for alt comm
|
$49.00 |
$49.00 |
$49.00 |
$94.60
|
|
Ghs superficial wnd dehiscence simp12020
|
$4,803.00 |
$4,803.00 |
$4,803.00 |
$890.40
|
|
Ghs tx distal phalangeal fx with manipulation
|
$365.50 |
$365.50 |
$365.50 |
$526.35
|
|
Ghs urine, porphyrins quant
|
$76.00 |
$76.00 |
$76.00 |
$75.00
|
|
Ghs veeg 12-26 hr intmt mont
|
$728.00 |
$728.00 |
$728.00 |
$1,932.00
|
|
Giardia lamblia antibody
|
$48.00 |
$48.00 |
$48.00 |
$83.44
|
|
Gi inhouse confirmation
|
$49.00 |
$49.00 |
$49.00 |
$84.60
|
|
Gi wireless capsule measure
|
$1,042.50 |
$1,042.50 |
$1,042.50 |
$1,579.30
|
|
Glassia injection
|
$3,189.38 |
$3,189.38 |
$3,189.38 |
$20.32
|
|
Glucagon 1 mg solution for injection
|
$1,534.84 |
$1,534.84 |
$1,534.84 |
$601.79
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$613.80 |
$613.80 |
$613.80 |
$491.67
|
|
Glucagon plasma - sendout
|
$74.00 |
$74.00 |
$74.00 |
$63.00
|
|
Glucose 1 hr post dose
|
$23.50 |
$23.50 |
$23.50 |
$50.40
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$12.50 |
$12.50 |
$12.50 |
$24.00
|
|
Glucose blood quantitative
|
$20.50 |
$20.50 |
$20.50 |
$41.40
|
|
Glucose body fluid
|
$81.00 |
$81.00 |
$81.00 |
$51.00
|
|
Glucose tolerance test (gtt) 3 specimens
|
$65.00 |
$65.00 |
$65.00 |
$100.16
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$20.50 |
$20.50 |
$20.50 |
$35.70
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$10,846.42 |
$10,846.42 |
$10,846.42 |
$4,846.65
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$94.50 |
$94.50 |
$94.50 |
$117.00
|
|
Gonadotropin luteinizing hormone (lh)
|
$93.50 |
$93.50 |
$93.50 |
$130.65
|
|
Goserelin 10.8 mg subcutaneous implant
|
$2,529.00 |
$2,529.00 |
$2,529.00 |
$4,653.16
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$1,926.88 |
$1,926.88 |
$1,926.88 |
$465.83
|
|
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 |
$660.00
|
|
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
|
$2,866.50 |
$2,866.50 |
$2,866.50 |
$3,432.00
|
|
Graft nerve adv 3-4x70mm
|
$3,432.49 |
$3,432.49 |
$3,432.49 |
$19,800.00
|
|
Graft patch felt ptfe 2x2
|
$1,589.50 |
$1,589.50 |
$1,589.50 |
$27,435.60
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$143.50 |
$143.50 |
$143.50 |
$1,111.05
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$1,968.50 |
$1,968.50 |
$1,968.50 |
$1,219.88
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$143.50 |
$143.50 |
$143.50 |
$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 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
|
$1,661.37 |
$1,661.37 |
$1,661.37 |
$30,392.04
|
|
Graft xenmtrx sft rect 19x28cm
|
$273.48 |
$273.48 |
$273.48 |
$3,089.48
|
|
Grfg autol soft tiss dir exc
|
$1,550.75 |
$1,550.75 |
$1,550.75 |
$4,332.25
|
|
Guided cath fluid drainage 10030
|
$2,515.00 |
$2,515.00 |
$2,515.00 |
$1,372.15
|
|
Guide wire threaded 1.4x150mm
|
$1,195.00 |
$1,195.00 |
$1,195.00 |
$3,531.94
|
|
Guide worley csg 9fx50cm std
|
$170.15 |
$170.15 |
$170.15 |
$1,117.40
|
|
Guid loc target vol rad tx
|
$584.00 |
$584.00 |
$584.00 |
$536.00
|
|
Gw stiffened micro access kit
|
$343.42 |
$343.42 |
$343.42 |
$6,500.00
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$2.00 |
$2.00 |
$2.00 |
$24.41
|
|
Handle/convey/speciman/office-lab 99000
|
$16.00 |
$16.00 |
$16.00 |
$23.30
|
|
Hand X-ray
|
$388.00 |
$388.00 |
$388.00 |
$356.80
|
|
Haptoglobin quantitative
|
$64.50 |
$64.50 |
$64.50 |
$91.14
|
|
Harvest allogeneic stem cell
|
$3,967.50 |
$3,967.50 |
$3,967.50 |
$3,067.50
|
|
Harvest auto stem cells
|
$2,083.50 |
$2,083.50 |
$2,083.50 |
$3,379.00
|
|
Hba1/hba2 full gene sequence
|
$827.50 |
$827.50 |
$827.50 |
$769.95
|
|
Hba1/hba2 gene dup/del vrnts
|
$300.50 |
$300.50 |
$300.50 |
$404.80
|
|
Hbb full gene sequence
|
$707.00 |
$707.00 |
$707.00 |
$633.25
|
|
Hbb gene dup/del variants
|
$675.00 |
$675.00 |
$675.00 |
$442.00
|
