|
Ghs layer closure 2.5 cm or less - 12031
|
$2,092.66 |
$2,092.66 |
$2,092.66 |
$617.60
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$2,092.66 |
$2,092.66 |
$2,092.66 |
$619.20
|
|
Ghs layer closure 2.5cm or less - 12051
|
$2,092.66 |
$2,092.66 |
$2,092.66 |
$648.00
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$2,092.66 |
$2,092.66 |
$2,092.66 |
$741.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$2,092.66 |
$2,092.66 |
$2,092.66 |
$741.00
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$2,092.66 |
$2,092.66 |
$2,092.66 |
$779.35
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$2,092.66 |
$2,092.66 |
$2,092.66 |
$810.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$2,092.66 |
$2,092.66 |
$2,092.66 |
$795.20
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$2,092.66 |
$2,092.66 |
$2,092.66 |
$779.35
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$2,092.66 |
$2,092.66 |
$2,092.66 |
$995.20
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$2,092.66 |
$2,092.66 |
$2,092.66 |
$879.60
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$2,092.66 |
$2,092.66 |
$2,092.66 |
$1,188.80
|
|
Ghs layered repair 20.1 - 30.0 cm -12056
|
$2,092.66 |
$2,092.66 |
$2,092.66 |
$1,030.80
|
|
Ghs layered repair over 30.0 cm -12047
|
$6,154.89 |
$6,154.89 |
$6,154.89 |
$2,024.70
|
|
Ghs layered repair over 3.0 cm -12057
|
$2,092.66 |
$2,092.66 |
$2,092.66 |
$1,064.98
|
|
Ghs leukocyte alkaline phos (mayo)
|
$30.10 |
$30.10 |
$30.10 |
$59.40
|
|
Ghs mbp
|
$126.79 |
$126.79 |
$126.79 |
$74.19
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$543.14 |
$543.14 |
$543.14 |
$261.80
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$512.40 |
$512.40 |
$512.40 |
$252.50
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$543.14 |
$543.14 |
$543.14 |
$239.20
|
|
Ghs moderate sedation ea addtl 15 min
|
$609.22 |
$609.22 |
$609.22 |
$145.60
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$512.40 |
$512.40 |
$512.40 |
$140.00
|
|
Ghs myocardial strain img spckl track
|
$278.25 |
$278.25 |
$278.25 |
$503.85
|
|
Ghs nailbed repair/nail removal
|
$2,092.66 |
$2,092.66 |
$2,092.66 |
$808.80
|
|
Ghs nerve block axillary nerve
|
$2,759.79 |
$2,759.79 |
$2,759.79 |
$1,541.40
|
|
Ghs nerve block brachial plexus
|
$2,092.66 |
$2,092.66 |
$2,092.66 |
$1,768.00
|
|
Ghs nerve block sciatic nerve
|
$1,671.61 |
$1,671.61 |
$1,671.61 |
$1,636.80
|
|
Ghs ng placement w fluoro guidance
|
$2,099.48 |
$2,099.48 |
$2,099.48 |
$468.75
|
|
Ghs o2 saturation
|
$65.67 |
$65.67 |
$65.67 |
$72.45
|
|
Ghs o2 uptake rest & indirect
|
$164.72 |
$164.72 |
$164.72 |
$195.00
|
|
Ghs ot dds rom
|
$363.95 |
$363.95 |
$363.95 |
$56.55
|
|
Ghs ot group caregiver training
|
$155.19 |
$155.19 |
$155.19 |
$43.20
|
|
Ghs ot prosthetic training/15 min
|
$404.02 |
$404.02 |
$404.02 |
$92.35
|
|
Ghs ot sensory integrative tech/15min
|
$417.38 |
$417.38 |
$417.38 |
$101.05
|
|
Ghs pacing - transcutaneous
|
$2,492.52 |
$2,492.52 |
$2,492.52 |
$868.68
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$90.15 |
$90.15 |
$90.15 |
$90.15
|
|
Ghs peritonsillar abscess i andd
|
$2,553.81 |
$2,553.81 |
$2,553.81 |
$694.20
|
|
Ghs phenylketonurid
|
$19.25 |
$19.25 |
$19.25 |
$51.58
|
|
Ghs plt ct-manual
|
$28.94 |
$28.94 |
$28.94 |
$39.20
|
|
Ghs ppd (tb intradermal)
|
$7,829.45 |
$7,829.45 |
$7,829.45 |
$43.45
|
|
Ghs prostatic acid phosphatase (mayo)
|
$64.55 |
$64.55 |
$64.55 |
$40.56
|
|
Ghs protoporphyrins fract
|
$50.23 |
$50.23 |
$50.23 |
$64.35
|
|
Ghs pr without cont pulse ox
|
$423.28 |
$423.28 |
$423.28 |
$156.70
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$42.88 |
$42.88 |
$42.88 |
$45.05
|
|
Ghs removal intranasal foreign body
|
$1,252.04 |
$1,252.04 |
$1,252.04 |
$324.35
|
|
Ghs reticulocyte count
|
$28.94 |
$28.94 |
$28.94 |
$33.57
|
|
Ghs rsv eia (respir synctial vrs)
|
$92.38 |
$92.38 |
$92.38 |
$101.15
|
|
Ghs sedimentation rate
|
$32.01 |
$32.01 |
$32.01 |
$45.50
|
|
Ghs sensitivity (per antimicro)
|
$50.09 |
$50.09 |
$50.09 |
$59.90
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$2,092.66 |
$2,092.66 |
$2,092.66 |
$590.40
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$2,092.66 |
$2,092.66 |
$2,092.66 |
$670.08
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$1,638.44 |
$1,638.44 |
$1,638.44 |
$487.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$1,230.98 |
$1,230.98 |
$1,230.98 |
$470.47
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$2,092.66 |
$2,092.66 |
$2,092.66 |
$538.64
|
|
Ghs simple repair over 30 cm - 12007
|
$1,230.98 |
$1,230.98 |
$1,230.98 |
$660.00
|
|
Ghs somatosensory testing lower extremit
|
$1,194.22 |
$1,194.22 |
$1,194.22 |
$947.48
|
|
Ghs somatosensory testing upper & lower limbs
|
$2,202.19 |
$2,202.19 |
$2,202.19 |
$1,435.00
|
|
Ghs sp train/fitting sp device - kx
|
$643.31 |
$643.31 |
$643.31 |
$261.95
|
|
Ghs strapping shoulder - 29240
|
$498.62 |
$498.62 |
$498.62 |
$243.07
|
|
Ghs st - re-eval for alt comm
|
$533.81 |
$533.81 |
$533.81 |
$309.00
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$178.08 |
$178.08 |
$178.08 |
$93.75
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$905.98 |
$905.98 |
$905.98 |
$351.45
|
|
Ghs superficial wnd dehiscence simp12020
|
$2,092.66 |
$2,092.66 |
$2,092.66 |
$976.98
|
|
Ghs urine, porphyrins quant
|
$97.94 |
$97.94 |
$97.94 |
$70.20
|
|
Ghs vaginal delivery only
|
$24,402.57 |
$24,402.57 |
$24,402.57 |
$3,525.06
|
|
Giardia lamblia antibody
|
$51.52 |
$51.52 |
$51.52 |
$81.60
|
|
Gi inhouse confirmation
|
$70.16 |
$70.16 |
$70.16 |
$87.00
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$4,042.31 |
$4,042.31 |
$4,042.31 |
$2,382.90
|
|
Glucagon plasma - sendout
|
$50.02 |
$50.02 |
$50.02 |
$58.56
|
|
Glucose 1 hr post dose
|
$35.70 |
$35.70 |
$35.70 |
$46.28
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$24.62 |
$24.62 |
$24.62 |
$22.00
|
|
Glucose blood quantitative
|
$29.54 |
$29.54 |
$29.54 |
$44.76
|
|
Glucose body fluid
|
$29.54 |
$29.54 |
$29.54 |
$50.70
|
|
Glucose tolerance test (gtt) 3 specimens
|
$94.78 |
$94.78 |
$94.78 |
$100.10
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$29.54 |
$29.54 |
$29.54 |
$34.45
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$390.81 |
$390.81 |
$390.81 |
$56.70
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$9,150.24 |
$9,150.24 |
$9,150.24 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$136.64 |
$136.64 |
$136.64 |
$110.04
|
|
Gonadotropin luteinizing hormone (lh)
|
$136.64 |
$136.64 |
$136.64 |
$123.75
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$285.18 |
$285.18 |
$285.18 |
$2,648.81
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$1,332.38 |
$1,332.38 |
$1,332.38 |
$1,679.75
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$2,061.55 |
$2,061.55 |
$2,061.55 |
$2,369.10
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$1,624.72 |
$1,624.72 |
$1,624.72 |
$336.78
|
|
Gu dilat ureter/urethra s&i
|
$5,359.10 |
$5,359.10 |
$5,359.10 |
$1,793.00
|
|
Guided cath fluid drainage 10030
|
$6,619.01 |
$6,619.01 |
$6,619.01 |
$1,461.15
|
|
Guid loc target vol rad tx
|
$993.91 |
$993.91 |
$993.91 |
$503.80
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$334.31 |
$334.31 |
$334.31 |
$35.40
|
|
Hand X-ray
|
$1,874.68 |
$1,874.68 |
$1,874.68 |
$338.58
|
|
Haptoglobin quantitative
|
$92.33 |
$92.33 |
$92.33 |
$89.95
|
|
Hba1/hba2 full gene sequence
|
$2,100.00 |
$2,100.00 |
$2,100.00 |
$777.60
|
|
Hba1/hba2 gene dup/del vrnts
|
$708.40 |
$708.40 |
$708.40 |
$406.25
|
|
Hbb full gene sequence
|
$1,136.03 |
$1,136.03 |
$1,136.03 |
$633.25
|
|
Hc fl sm bowel enteroclss tube w kub double contrast
|
$794.68 |
$794.68 |
$794.68 |
$759.72
|
|
Hcg qualitative
|
$55.40 |
$55.40 |
$55.40 |
$77.50
|
|
Hcg quantitative
|
$110.79 |
$110.79 |
$110.79 |
$124.80
|
|
Hc nm cardiac blood pool planar 1 stdy wal motn eject fract
|
$4,267.24 |
$4,267.24 |
$4,267.24 |
$839.65
|
|
Hc nm kidney imaging with flow
|
$2,952.79 |
$2,952.79 |
$2,952.79 |
$1,008.39
|
|
Head CT scan (with and without contrast)
|
$9,698.88 |
$9,698.88 |
$9,698.88 |
$1,878.75
|
|
Head CT scan (with contrast)
|
$8,109.68 |
$8,109.68 |
$8,109.68 |
$1,520.45
|
|
Head CT scan (without contrast)
|
$8,449.43 |
$8,449.43 |
$8,449.43 |
$1,268.90
|