|
Ghs layer closure 2.5 cm or less - 12041
|
$130.92 |
$130.92 |
$130.92 |
$619.20
|
|
Ghs layer closure 2.5cm or less - 12051
|
$228.53 |
$228.53 |
$228.53 |
$648.00
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$228.53 |
$228.53 |
$228.53 |
$741.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$251.41 |
$251.41 |
$251.41 |
$741.00
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$228.53 |
$228.53 |
$228.53 |
$779.35
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$281.91 |
$281.91 |
$281.91 |
$810.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$251.41 |
$251.41 |
$251.41 |
$795.20
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$118.97 |
$118.97 |
$118.97 |
$779.35
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$251.41 |
$251.41 |
$251.41 |
$995.20
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$228.53 |
$228.53 |
$228.53 |
$879.60
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$251.41 |
$251.41 |
$251.41 |
$1,188.80
|
|
Ghs leukocyte alkaline phos (mayo)
|
$28.48 |
$28.48 |
$28.48 |
$59.40
|
|
Ghs mbp
|
$68.64 |
$68.64 |
$68.64 |
$74.19
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$107.28 |
$107.28 |
$107.28 |
$261.80
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$110.84 |
$110.84 |
$110.84 |
$239.20
|
|
Ghs moderate sedation ea addtl 15 min
|
$117.95 |
$117.95 |
$117.95 |
$145.60
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$117.95 |
$117.95 |
$117.95 |
$140.00
|
|
Ghs myocardial strain img spckl track
|
$213.28 |
$213.28 |
$213.28 |
$503.85
|
|
Ghs nailbed repair/nail removal
|
$181.00 |
$181.00 |
$181.00 |
$808.80
|
|
Ghs nerve blk intercostal, ea addtl level
|
$538.15 |
$538.15 |
$538.15 |
$1,618.50
|
|
Ghs nerve blk intercostal, single level
|
$427.06 |
$427.06 |
$427.06 |
$1,230.80
|
|
Ghs nerve block axillary nerve
|
$615.42 |
$615.42 |
$615.42 |
$1,541.40
|
|
Ghs nerve block brachial plexus
|
$470.53 |
$470.53 |
$470.53 |
$1,768.00
|
|
Ghs nerve block interscaline
|
$577.80 |
$577.80 |
$577.80 |
$1,607.45
|
|
Ghs nerve block lumbar or thoracic symp
|
$530.52 |
$530.52 |
$530.52 |
$2,042.60
|
|
Ghs nerve block sciatic nerve
|
$427.06 |
$427.06 |
$427.06 |
$1,636.80
|
|
Ghs nerve block suprascapular
|
$427.06 |
$427.06 |
$427.06 |
$1,223.00
|
|
Ghs ng placement w fluoro guidance
|
$154.81 |
$154.81 |
$154.81 |
$468.75
|
|
Ghs opcc repair cvp without subq port
|
$428.84 |
$428.84 |
$428.84 |
$1,302.54
|
|
Ghs opcc repair cvp w subq port
|
$896.82 |
$896.82 |
$896.82 |
$2,430.56
|
|
Ghs pacing - transcutaneous
|
$209.97 |
$209.97 |
$209.97 |
$868.68
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$277.08 |
$277.08 |
$277.08 |
$855.60
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$306.57 |
$306.57 |
$306.57 |
$1,003.00
|
|
Ghs peritonsillar abscess i andd
|
$156.85 |
$156.85 |
$156.85 |
$694.20
|
|
Ghs phenylketonurid
|
$18.05 |
$18.05 |
$18.05 |
$51.58
|
|
Ghs picc line insert < 5
|
$730.83 |
$730.83 |
$730.83 |
$2,060.40
|
|
Ghs plngl fx pm cl
|
$154.56 |
$154.56 |
$154.56 |
$662.20
|
|
Ghs ppd (tb intradermal)
|
$29.75 |
$29.75 |
$29.75 |
$43.45
|
|
Ghs prostatic acid phosphatase (mayo)
|
$32.03 |
$32.03 |
$32.03 |
$40.56
|
|
Ghs quinidine
|
$48.05 |
$48.05 |
$48.05 |
$68.40
|
|
Ghs refill of implantable pump
|
$145.15 |
$145.15 |
$145.15 |
$539.13
|
|
Ghs removal intranasal foreign body
|
$60.76 |
$60.76 |
$60.76 |
$324.35
|
|
Ghs removal pharyngeal foreign body
|
$53.64 |
$53.64 |
$53.64 |
$460.00
|
|
Ghs repair extensor tendon hand, ea tendon
|
$1,238.47 |
$1,238.47 |
$1,238.47 |
$2,211.05
|
|
Ghs repair tendon ext forearm/wrist ea
|
$2,035.13 |
$2,035.13 |
$2,035.13 |
$4,150.20
|
|
Ghs reticulocyte count
|
$14.49 |
$14.49 |
$14.49 |
$33.57
|
|
Ghs rsv eia (respir synctial vrs)
|
$32.80 |
$32.80 |
$32.80 |
$101.15
|
|
Ghs sedimentation rate
|
$15.77 |
$15.77 |
$15.77 |
$45.50
|
|
Ghs semen analysis fert
|
$39.91 |
$39.91 |
$39.91 |
$123.20
|
|
Ghs semen analysis, post-vas
|
$29.49 |
$29.49 |
$29.49 |
$32.37
|
|
Ghs sensitivity (per antimicro)
|
$22.88 |
$22.88 |
$22.88 |
$59.90
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$161.42 |
$161.42 |
$161.42 |
$590.40
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$164.47 |
$164.47 |
$164.47 |
$705.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$161.42 |
$161.42 |
$161.42 |
$670.08
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$164.47 |
$164.47 |
$164.47 |
$585.90
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$164.47 |
$164.47 |
$164.47 |
$487.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$161.42 |
$161.42 |
$161.42 |
$470.47
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$164.47 |
$164.47 |
$164.47 |
$538.64
|
|
Ghs simple repair over 30 cm - 12007
|
$254.97 |
$254.97 |
$254.97 |
$660.00
|
|
Ghs somatosensory testing lower extremit
|
$186.59 |
$186.59 |
$186.59 |
$947.48
|
|
Ghs sphenopalatine ganglion block
|
$183.03 |
$183.03 |
$183.03 |
$706.56
|
|
Ghs strapping shoulder - 29240
|
$101.94 |
$101.94 |
$101.94 |
$243.07
|
|
Ghs superficial wnd dehiscence simp12020
|
$381.30 |
$381.30 |
$381.30 |
$976.98
|
|
Ghs tracheostomy emergency - transtracheal
|
$705.92 |
$705.92 |
$705.92 |
$2,225.73
|
|
Ghs tx distal phalangeal fx with manipulation
|
$154.56 |
$154.56 |
$154.56 |
$591.00
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$205.14 |
$205.14 |
$205.14 |
$540.00
|
|
Ghs urine, porphyrins quant
|
$44.49 |
$44.49 |
$44.49 |
$70.20
|
|
Ghs vaginal delivery only
|
$586.95 |
$586.95 |
$586.95 |
$3,525.06
|
|
Ghs veeg 12-26 hr intmt mont
|
$384.86 |
$384.86 |
$384.86 |
$1,843.00
|
|
Gi inhouse confirmation
|
$37.88 |
$37.88 |
$37.88 |
$87.00
|
|
Glucagon plasma - sendout
|
$47.29 |
$47.29 |
$47.29 |
$58.56
|
|
Glucose 1 hr post dose
|
$16.02 |
$16.02 |
$16.02 |
$46.28
|
|
Glucose-6-phosphate dhydrogenase screen
|
$20.34 |
$20.34 |
$20.34 |
$45.34
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$13.99 |
$13.99 |
$13.99 |
$22.00
|
|
Glucose blood quantitative
|
$25.17 |
$25.17 |
$25.17 |
$44.76
|
|
Glucose body fluid
|
$19.83 |
$19.83 |
$19.83 |
$50.70
|
|
Glucose tolerance test (gtt) 3 specimens
|
$42.20 |
$42.20 |
$42.20 |
$100.10
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$13.22 |
$13.22 |
$13.22 |
$34.45
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$10.90 |
$10.90 |
$10.90 |
$49.20
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$59.23 |
$59.23 |
$59.23 |
$110.04
|
|
Gonadotropin luteinizing hormone (lh)
|
$59.23 |
$59.23 |
$59.23 |
$123.75
|
|
Goserelin 10.8 mg subcutaneous implant
|
$1,854.58 |
$1,854.58 |
$1,854.58 |
$3,358.00
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$9,310.84 |
$9,310.84 |
$9,310.84 |
$27,279.40
|
|
Graft nerve adv 3-4x70mm
|
$11,849.79 |
$11,849.79 |
$11,849.79 |
$20,782.10
|
|
Graft patch felt ptfe 2x2
|
$17,361.83 |
$17,361.83 |
$17,361.83 |
$25,515.36
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$580.80 |
$580.80 |
$580.80 |
$1,366.45
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$14,490.02 |
$14,490.02 |
$14,490.02 |
$28,799.96
|
|
Graft xenmtrx sft rect 15x20cm
|
$11,966.72 |
$11,966.72 |
$11,966.72 |
$33,720.69
|
|
Graft xenmtrx sft rect 19x28cm
|
$18,160.05 |
$18,160.05 |
$18,160.05 |
$2,677.50
|
|
Granulocyte pheresis ea unit
|
$3,315.79 |
$3,315.79 |
$3,315.79 |
$3,660.00
|
|
Great toe with reduction 28495
|
$205.14 |
$205.14 |
$205.14 |
$577.03
|
|
Growth hormone antibody
|
$9.92 |
$9.92 |
$9.92 |
$40.00
|
|
Gstrst open wo constj tube
|
$1,708.74 |
$1,708.74 |
$1,708.74 |
$2,749.01
|
|
G-tube reposition
|
$606.27 |
$606.27 |
$606.27 |
$741.00
|
|
Gu dilat ureter/urethra s&i
|
$492.14 |
$492.14 |
$492.14 |
$1,793.00
|
|
Guided cath fluid drainage 10030
|
$698.04 |
$698.04 |
$698.04 |
$1,461.15
|
|
Guide wire threaded 1.4x150mm
|
$1,452.85 |
$1,452.85 |
$1,452.85 |
$3,401.81
|
|
Guide worley csg 9fx50cm std
|
$498.46 |
$498.46 |
$498.46 |
$986.55
|
|
Guid loc target vol rad tx
|
$122.78 |
$122.78 |
$122.78 |
$503.80
|
|
Gw stiffened micro access kit
|
$2,745.36 |
$2,745.36 |
$2,745.36 |
$6,500.00
|
