|
Ghs i and d pilonidal cyst simple
|
$1,028.00 |
$1,028.00 |
$1,028.00 |
$703.15
|
|
Ghs incision thrombosed ext hemorrhoid
|
$346.00 |
$346.00 |
$346.00 |
$523.73
|
|
Ghs init tx 1st degree burn
|
$49.50 |
$49.50 |
$49.50 |
$275.50
|
|
Ghs inj neurolytic intercostal nerve
|
$847.50 |
$847.50 |
$847.50 |
$1,932.00
|
|
Ghs inj neurolytic other perph nerve
|
$847.50 |
$847.50 |
$847.50 |
$1,702.20
|
|
Ghs inj tendon origin/insertion
|
$294.00 |
$294.00 |
$294.00 |
$431.07
|
|
Ghs inj transforaminal cerv ea add bil
|
$438.50 |
$438.50 |
$438.50 |
$1,110.90
|
|
Ghs inj transforaminal cerv single bil
|
$847.50 |
$847.50 |
$847.50 |
$1,727.25
|
|
Ghs insertion of needle - bone
|
$550.50 |
$550.50 |
$550.50 |
$422.40
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$591.00 |
$591.00 |
$591.00 |
$863.28
|
|
Ghs intermed repair 20.1 - 30.0 cm-12036
|
$309.00 |
$309.00 |
$309.00 |
$1,035.60
|
|
Ghs intermed repair over 30 cm - 12037
|
$354.00 |
$354.00 |
$354.00 |
$2,164.64
|
|
Ghs intro needle/intracath vein - 36000
|
$92.50 |
$92.50 |
$92.50 |
$213.75
|
|
Ghs irrigate corpora cavernosa for priapism
|
$150.00 |
$150.00 |
$150.00 |
$544.80
|
|
Ghs IV thrombolytics - cerebral
|
$533.50 |
$533.50 |
$533.50 |
$663.00
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$184.50 |
$184.50 |
$184.50 |
$492.00
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$591.00 |
$591.00 |
$591.00 |
$584.00
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$591.00 |
$591.00 |
$591.00 |
$563.75
|
|
Ghs layer closure 2.5cm or less - 12051
|
$591.00 |
$591.00 |
$591.00 |
$593.00
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$591.00 |
$591.00 |
$591.00 |
$675.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$591.00 |
$591.00 |
$591.00 |
$689.04
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$210.00 |
$210.00 |
$210.00 |
$741.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$591.00 |
$591.00 |
$591.00 |
$770.22
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$700.00 |
$700.00 |
$700.00 |
$750.12
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$591.00 |
$591.00 |
$591.00 |
$740.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$301.00 |
$301.00 |
$301.00 |
$964.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$591.00 |
$591.00 |
$591.00 |
$790.40
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$357.00 |
$357.00 |
$357.00 |
$1,126.40
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$24.00 |
$24.00 |
$24.00 |
$242.31
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$96.00 |
$96.00 |
$96.00 |
$228.45
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$83.00 |
$83.00 |
$83.00 |
$230.00
|
|
Ghs moderate sedation ea addtl 15 min
|
$104.00 |
$104.00 |
$104.00 |
$151.50
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$104.00 |
$104.00 |
$104.00 |
$147.75
|
|
Ghs musc test done w/n test comp
|
$50.00 |
$50.00 |
$50.00 |
$318.75
|
|
Ghs musc tst done w/nerv tst lim
|
$20.00 |
$20.00 |
$20.00 |
$266.59
|
|
Ghs nailbed repair/nail removal
|
$889.50 |
$889.50 |
$889.50 |
$724.37
|
|
Ghs nerve blk intercostal, ea addtl level
|
$847.50 |
$847.50 |
$847.50 |
$1,546.50
|
|
Ghs nerve blk intercostal, single level
|
$676.50 |
$676.50 |
$676.50 |
$1,107.00
|
|
Ghs nerve block axillary nerve
|
$847.50 |
$847.50 |
$847.50 |
$1,549.80
|
|
Ghs nerve block brachial plexus
|
$1,593.00 |
$1,593.00 |
$1,593.00 |
$1,689.00
|
|
Ghs nerve block celiac plexus
|
$847.50 |
$847.50 |
$847.50 |
$1,661.40
|
|
Ghs nerve block interscaline
|
$847.50 |
$847.50 |
$847.50 |
$1,526.09
|
|
Ghs nerve block lumbar or thoracic symp
|
$847.50 |
$847.50 |
$847.50 |
$1,710.80
|
|
Ghs nerve block sciatic nerve
|
$676.50 |
$676.50 |
$676.50 |
$1,450.80
|
|
Ghs nerve block suprascapular
|
$676.50 |
$676.50 |
$676.50 |
$1,141.36
|
|
Ghs ng placement w fluoro guidance
|
$598.00 |
$598.00 |
$598.00 |
$478.50
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$22.50 |
$22.50 |
$22.50 |
$55.77
|
|
Ghs osteopathic manipulative tx, 3-4 regions
|
$34.00 |
$34.00 |
$34.00 |
$57.65
|
|
Ghs ot group caregiver training
|
$20.50 |
$20.50 |
$20.50 |
$34.92
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$438.50 |
$438.50 |
$438.50 |
$851.04
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$438.50 |
$438.50 |
$438.50 |
$962.00
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$25.50 |
$25.50 |
$25.50 |
$76.56
|
|
Ghs peritonsillar abscess i andd
|
$330.00 |
$330.00 |
$330.00 |
$546.36
|
|
Ghs phenylketonurid
|
$175.00 |
$175.00 |
$175.00 |
$53.76
|
|
Ghs plngl fx pm cl
|
$353.00 |
$353.00 |
$353.00 |
$564.80
|
|
Ghs ppd (tb intradermal)
|
$31.00 |
$31.00 |
$31.00 |
$37.70
|
|
Ghs protoporphyrins fract
|
$8.00 |
$8.00 |
$8.00 |
$64.28
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$8.00 |
$8.00 |
$8.00 |
$50.05
|
|
Ghs quinidine
|
$167.50 |
$167.50 |
$167.50 |
$85.00
|
|
Ghs removal intranasal foreign body
|
$184.00 |
$184.00 |
$184.00 |
$287.50
|
|
Ghs repair extensor tendon hand, ea tendon
|
$638.50 |
$638.50 |
$638.50 |
$2,161.50
|
|
Ghs sedimentation rate
|
$24.00 |
$24.00 |
$24.00 |
$45.50
|
|
Ghs sensitivity (per antimicro)
|
$43.00 |
$43.00 |
$43.00 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$591.00 |
$591.00 |
$591.00 |
$553.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$551.00 |
$551.00 |
$551.00 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$591.00 |
$591.00 |
$591.00 |
$575.00
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$286.00 |
$286.00 |
$286.00 |
$448.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$342.00 |
$342.00 |
$342.00 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$286.00 |
$286.00 |
$286.00 |
$484.80
|
|
Ghs sleep study unattended
|
$207.00 |
$207.00 |
$207.00 |
$495.00
|
|
Ghs sphenopalatine ganglion block
|
$294.00 |
$294.00 |
$294.00 |
$637.92
|
|
Ghs st - eval for alt comm
|
$10.00 |
$10.00 |
$10.00 |
$93.60
|
|
Ghs superficial wnd dehiscence simp12020
|
$200.00 |
$200.00 |
$200.00 |
$861.75
|
|
Ghs superficial wnd dehis w packing12021
|
$150.00 |
$150.00 |
$150.00 |
$661.50
|
|
Ghs tx distal phalangeal fx with manipulation
|
$328.50 |
$328.50 |
$328.50 |
$523.00
|
|
Ghs urine, porphyrins quant
|
$15.00 |
$15.00 |
$15.00 |
$75.00
|
|
Ghs vaginal delivery only
|
$876.50 |
$876.50 |
$876.50 |
$3,152.00
|
|
Gi inhouse confirmation
|
$81.50 |
$81.50 |
$81.50 |
$83.70
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$130.00 |
$130.00 |
$130.00 |
$2,098.85
|
|
Glucagon 1 mg solution for injection
|
$205.00 |
$205.00 |
$205.00 |
$601.79
|
|
Glucose 1 hr post dose
|
$29.50 |
$29.50 |
$29.50 |
$47.20
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$10.00 |
$10.00 |
$10.00 |
$23.86
|
|
Glucose blood quantitative
|
$23.50 |
$23.50 |
$23.50 |
$40.00
|
|
Glucose body fluid
|
$81.00 |
$81.00 |
$81.00 |
$52.20
|
|
Glucose tolerance test (gtt) 3 specimens
|
$80.50 |
$80.50 |
$80.50 |
$100.16
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$79.00 |
$79.00 |
$79.00 |
$115.05
|
|
Gonadotropin luteinizing hormone (lh)
|
$67.00 |
$67.00 |
$67.00 |
$129.00
|
|
Gonioscopy
|
$18.50 |
$18.50 |
$18.50 |
$135.52
|
|
Goserelin 10.8 mg subcutaneous implant
|
$1,686.00 |
$1,686.00 |
$1,686.00 |
$4,652.18
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$672.50
|
|
Graft axiofill 1000mg
|
$10.00 |
$10.00 |
$10.00 |
$5,125.68
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$584.99
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$24,469.57
|
|
Graft nerve adv 3-4x70mm
|
$2,037.50 |
$2,037.50 |
$2,037.50 |
$19,620.00
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$1,455.76
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$1,181.41
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$373.00
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$1,132.47
|
|
Graft xenmtrx sft rect 15x20cm
|
$1,800.00 |
$1,800.00 |
$1,800.00 |
$30,392.04
|
