|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$606.50 |
$606.50 |
$606.50 |
$737.10
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$853.00 |
$853.00 |
$853.00 |
$967.20
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$606.50 |
$606.50 |
$606.50 |
$779.35
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$708.00 |
$708.00 |
$708.00 |
$1,016.25
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$24.50 |
$24.50 |
$24.50 |
$242.64
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$87.50 |
$87.50 |
$87.50 |
$228.45
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$77.50 |
$77.50 |
$77.50 |
$230.55
|
|
Ghs moderate sedation ea addtl 15 min
|
$23.50 |
$23.50 |
$23.50 |
$150.00
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$60.50 |
$60.50 |
$60.50 |
$141.00
|
|
Ghs musc test done w/n test comp
|
$218.00 |
$218.00 |
$218.00 |
$324.80
|
|
Ghs musc tst done w/nerv tst lim
|
$189.00 |
$189.00 |
$189.00 |
$272.25
|
|
Ghs nailbed repair/nail removal
|
$719.00 |
$719.00 |
$719.00 |
$724.37
|
|
Ghs nerve blk intercostal, ea addtl level
|
$2,334.00 |
$2,334.00 |
$2,334.00 |
$1,545.05
|
|
Ghs nerve blk intercostal, single level
|
$1,396.00 |
$1,396.00 |
$1,396.00 |
$1,121.00
|
|
Ghs nerve block axillary nerve
|
$67.50 |
$67.50 |
$67.50 |
$1,540.00
|
|
Ghs nerve block brachial plexus
|
$6,715.50 |
$6,715.50 |
$6,715.50 |
$1,695.24
|
|
Ghs nerve block celiac plexus
|
$97.50 |
$97.50 |
$97.50 |
$1,556.40
|
|
Ghs nerve block interscaline
|
$78.50 |
$78.50 |
$78.50 |
$1,526.09
|
|
Ghs nerve block lumbar or thoracic symp
|
$87.00 |
$87.00 |
$87.00 |
$1,671.75
|
|
Ghs nerve block sciatic nerve
|
$4,060.00 |
$4,060.00 |
$4,060.00 |
$1,450.80
|
|
Ghs nerve block suprascapular
|
$871.50 |
$871.50 |
$871.50 |
$1,183.50
|
|
Ghs ng placement w fluoro guidance
|
$507.50 |
$507.50 |
$507.50 |
$478.50
|
|
Ghs opcc repair cvp w subq port
|
$191.00 |
$191.00 |
$191.00 |
$2,194.40
|
|
Ghs optokenetic
|
$123.50 |
$123.50 |
$123.50 |
$211.20
|
|
Ghs oscillating trac
|
$207.00 |
$207.00 |
$207.00 |
$291.75
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$46.50 |
$46.50 |
$46.50 |
$58.00
|
|
Ghs osteopathic manipulative tx, 3-4 regions
|
$53.50 |
$53.50 |
$53.50 |
$64.50
|
|
Ghs ot dds rom
|
$47.00 |
$47.00 |
$47.00 |
$69.00
|
|
Ghs ot group caregiver training
|
$22.00 |
$22.00 |
$22.00 |
$34.80
|
|
Ghs ot prosthetic training/15 min
|
$65.00 |
$65.00 |
$65.00 |
$92.35
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$62.50 |
$62.50 |
$62.50 |
$809.67
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$53.00 |
$53.00 |
$53.00 |
$962.00
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$25.00 |
$25.00 |
$25.00 |
$75.00
|
|
Ghs peritonsillar abscess i andd
|
$279.50 |
$279.50 |
$279.50 |
$545.40
|
|
Ghs phenylketonurid
|
$175.00 |
$175.00 |
$175.00 |
$53.76
|
|
Ghs plngl fx pm cl
|
$341.00 |
$341.00 |
$341.00 |
$564.50
|
|
Ghs ppd (tb intradermal)
|
$25.00 |
$25.00 |
$25.00 |
$37.44
|
|
Ghs protoporphyrins fract
|
$8.00 |
$8.00 |
$8.00 |
$60.75
|
|
Ghs pr without cont pulse ox
|
$96.00 |
$96.00 |
$96.00 |
$146.86
|
|
Ghs quinidine
|
$167.50 |
$167.50 |
$167.50 |
$83.20
|
|
Ghs refill of implantable pump
|
$325.50 |
$325.50 |
$325.50 |
$539.13
|
|
Ghs removal intranasal foreign body
|
$156.00 |
$156.00 |
$156.00 |
$283.51
|
|
Ghs removal pharyngeal foreign body
|
$131.50 |
$131.50 |
$131.50 |
$436.10
|
|
Ghs repair extensor tendon hand, ea tendon
|
$1,621.00 |
$1,621.00 |
$1,621.00 |
$2,408.00
|
|
Ghs repair tendon ext forearm/wrist ea
|
$522.50 |
$522.50 |
$522.50 |
$4,108.00
|
|
Ghs sedimentation rate
|
$40.50 |
$40.50 |
$40.50 |
$45.50
|
|
Ghs semen analysis fert
|
$82.50 |
$82.50 |
$82.50 |
$124.80
|
|
Ghs sensitivity (per antimicro)
|
$61.00 |
$61.00 |
$61.00 |
$56.40
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$501.50 |
$501.50 |
$501.50 |
$563.75
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$138.50 |
$138.50 |
$138.50 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$501.50 |
$501.50 |
$501.50 |
$575.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$167.00 |
$167.00 |
$167.00 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$276.00 |
$276.00 |
$276.00 |
$451.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$276.00 |
$276.00 |
$276.00 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$242.50 |
$242.50 |
$242.50 |
$492.00
|
|
Ghs simple repair over 30 cm - 12007
|
$156.50 |
$156.50 |
$156.50 |
$584.00
|
|
Ghs sleep study unattended
|
$39.50 |
$39.50 |
$39.50 |
$503.38
|
|
Ghs sphenopalatine ganglion block
|
$299.00 |
$299.00 |
$299.00 |
$616.00
|
|
Ghs st - eval for alt comm
|
$11.00 |
$11.00 |
$11.00 |
$94.60
|
|
Ghs st - re-eval for alt comm
|
$39.50 |
$39.50 |
$39.50 |
$309.00
|
|
Ghs superficial wnd dehiscence simp12020
|
$740.00 |
$740.00 |
$740.00 |
$909.00
|
|
Ghs superficial wnd dehis w packing12021
|
$501.50 |
$501.50 |
$501.50 |
$692.80
|
|
Ghs tx distal phalangeal fx with manipulation
|
$377.50 |
$377.50 |
$377.50 |
$525.60
|
|
Ghs urine, porphyrins quant
|
$13.50 |
$13.50 |
$13.50 |
$73.80
|
|
Ghs vaginal delivery only
|
$3,152.00 |
$3,152.00 |
$3,152.00 |
$3,338.40
|
|
Ghs veeg 12-26 hr intmt mont
|
$502.50 |
$502.50 |
$502.50 |
$1,932.00
|
|
Gi inhouse confirmation
|
$173.50 |
$173.50 |
$173.50 |
$86.40
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$112.50 |
$112.50 |
$112.50 |
$2,195.76
|
|
Glucagon 1 mg solution for injection
|
$409.29 |
$409.29 |
$409.29 |
$601.79
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$204.60 |
$204.60 |
$204.60 |
$491.67
|
|
Glucose 1 hr post dose
|
$30.50 |
$30.50 |
$30.50 |
$48.25
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$10.50 |
$10.50 |
$10.50 |
$22.75
|
|
Glucose blood quantitative
|
$38.00 |
$38.00 |
$38.00 |
$41.40
|
|
Glucose body fluid
|
$81.00 |
$81.00 |
$81.00 |
$51.30
|
|
Glucose monitoring continual min 72hr pt
|
$56.50 |
$56.50 |
$56.50 |
$126.80
|
|
Glucose tolerance test (gtt) 3 specimens
|
$54.50 |
$54.50 |
$54.50 |
$104.50
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$37.00 |
$37.00 |
$37.00 |
$36.00
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$8,677.14 |
$8,677.14 |
$8,677.14 |
$4,977.60
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$89.50 |
$89.50 |
$89.50 |
$115.80
|
|
Gonadotropin luteinizing hormone (lh)
|
$102.50 |
$102.50 |
$102.50 |
$129.00
|
|
Gonioscopy
|
$20.50 |
$20.50 |
$20.50 |
$135.52
|
|
Goniotomy
|
$806.00 |
$806.00 |
$806.00 |
$4,456.60
|
|
Goserelin 10.8 mg subcutaneous implant
|
$1,686.00 |
$1,686.00 |
$1,686.00 |
$4,496.37
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$143.50
|
|
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 |
$601.50
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$119.50 |
$119.50 |
$119.50 |
$23,288.44
|
|
Graft nerve adv 3-4x70mm
|
$2,358.51 |
$2,358.51 |
$2,358.51 |
$20,782.10
|
|
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
|
$238.50 |
$238.50 |
$238.50 |
$892.38
|
|
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 |
$427.89
|
|
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
|
$1,256.00 |
$1,256.00 |
$1,256.00 |
$31,191.20
|
|
Great toe with reduction 28495
|
$156.50 |
$156.50 |
$156.50 |
$495.00
|
|
Group health education
|
$5.00 |
$5.00 |
$5.00 |
$61.92
|
|
Gstrct prtl dstl w/roux-en-y rcnstj 43633
|
$2,076.50 |
$2,076.50 |
$2,076.50 |
$3,604.20
|
|
Gstrst open wo constj tube
|
$752.00 |
$752.00 |
$752.00 |
$2,756.00
|
|
Guided cath fluid drainage 10030
|
$140.00 |
$140.00 |
$140.00 |
$1,327.76
|
|
Guide wire threaded 1.4x150mm
|
$632.46 |
$632.46 |
$632.46 |
$3,401.81
|
