|
Ghs layer closure 2.5cm or less - 12051
|
$336.00 |
$336.00 |
$336.00 |
$593.00
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$516.80 |
$516.80 |
$516.80 |
$675.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$536.80 |
$536.80 |
$536.80 |
$689.04
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$556.00 |
$556.00 |
$556.00 |
$741.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$514.40 |
$514.40 |
$514.40 |
$750.12
|
|
Ghs leukocyte alkaline phos (mayo)
|
$107.20 |
$107.20 |
$107.20 |
$76.20
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$915.20 |
$915.20 |
$915.20 |
$242.31
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$915.20 |
$915.20 |
$915.20 |
$228.45
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$915.20 |
$915.20 |
$915.20 |
$230.00
|
|
Ghs moderate sedation ea addtl 15 min
|
$915.20 |
$915.20 |
$915.20 |
$151.50
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$915.20 |
$915.20 |
$915.20 |
$147.75
|
|
Ghs myocardial strain img spckl track
|
$0.80 |
$0.80 |
$0.80 |
$457.80
|
|
Ghs nailbed repair/nail removal
|
$508.00 |
$508.00 |
$508.00 |
$724.37
|
|
Ghs nerve blk intercostal, ea addtl level
|
$2,338.40 |
$2,338.40 |
$2,338.40 |
$1,546.50
|
|
Ghs nerve blk intercostal, single level
|
$2,338.40 |
$2,338.40 |
$2,338.40 |
$1,107.00
|
|
Ghs nerve block axillary nerve
|
$2,338.40 |
$2,338.40 |
$2,338.40 |
$1,549.80
|
|
Ghs nerve block brachial plexus
|
$2,338.40 |
$2,338.40 |
$2,338.40 |
$1,689.00
|
|
Ghs nerve block interscaline
|
$1,557.60 |
$1,557.60 |
$1,557.60 |
$1,526.09
|
|
Ghs nerve block lumbar or thoracic symp
|
$1,557.60 |
$1,557.60 |
$1,557.60 |
$1,710.80
|
|
Ghs nerve block sciatic nerve
|
$2,338.40 |
$2,338.40 |
$2,338.40 |
$1,450.80
|
|
Ghs nerve block suprascapular
|
$2,338.40 |
$2,338.40 |
$2,338.40 |
$1,141.36
|
|
Ghs o2 saturation
|
$148.00 |
$148.00 |
$148.00 |
$70.80
|
|
Ghs ot group caregiver training
|
$46.40 |
$46.40 |
$46.40 |
$34.92
|
|
Ghs ot prosthetic training/15 min
|
$164.00 |
$164.00 |
$164.00 |
$90.50
|
|
Ghs ot sensory integrative tech/15min
|
$144.00 |
$144.00 |
$144.00 |
$94.80
|
|
Ghs ot work hardening-additional hours
|
$170.40 |
$170.40 |
$170.40 |
$127.80
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$2,338.40 |
$2,338.40 |
$2,338.40 |
$851.04
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$2,338.40 |
$2,338.40 |
$2,338.40 |
$962.00
|
|
Ghs phenylketonurid
|
$60.80 |
$60.80 |
$60.80 |
$53.76
|
|
Ghs picc line insert < 5
|
$1,230.40 |
$1,230.40 |
$1,230.40 |
$2,019.50
|
|
Ghs plngl fx pm cl
|
$300.00 |
$300.00 |
$300.00 |
$564.80
|
|
Ghs ppd (tb intradermal)
|
$48.00 |
$48.00 |
$48.00 |
$37.70
|
|
Ghs prostatic acid phosphatase (mayo)
|
$62.40 |
$62.40 |
$62.40 |
$43.55
|
|
Ghs pr without cont pulse ox
|
$224.80 |
$224.80 |
$224.80 |
$146.86
|
|
Ghs pt - work hardening/int 2hrs
|
$481.60 |
$481.60 |
$481.60 |
$275.60
|
|
Ghs removal intranasal foreign body
|
$280.80 |
$280.80 |
$280.80 |
$287.50
|
|
Ghs removal pharyngeal foreign body
|
$335.20 |
$335.20 |
$335.20 |
$459.90
|
|
Ghs sensitivity (per antimicro)
|
$21.60 |
$21.60 |
$21.60 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$477.60 |
$477.60 |
$477.60 |
$553.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$632.00 |
$632.00 |
$632.00 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$436.00 |
$436.00 |
$436.00 |
$575.00
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$407.20 |
$407.20 |
$407.20 |
$448.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$445.60 |
$445.60 |
$445.60 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$448.00 |
$448.00 |
$448.00 |
$484.80
|
|
Ghs simple repair over 30 cm - 12007
|
$584.00 |
$584.00 |
$584.00 |
$582.00
|
|
Ghs superficial wnd dehiscence simp12020
|
$514.40 |
$514.40 |
$514.40 |
$861.75
|
|
Ghs tracheostomy emergency - transtracheal
|
$1,244.00 |
$1,244.00 |
$1,244.00 |
$1,752.89
|
|
Ghs urine, porphyrins quant
|
$95.20 |
$95.20 |
$95.20 |
$75.00
|
|
Ghs vaginal delivery only
|
$3,890.40 |
$3,890.40 |
$3,890.40 |
$3,152.00
|
|
Gi inhouse confirmation
|
$162.40 |
$162.40 |
$162.40 |
$83.70
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$1,704.00 |
$1,704.00 |
$1,704.00 |
$2,098.85
|
|
Glucose 1 hr post dose
|
$92.80 |
$92.80 |
$92.80 |
$47.20
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$62.40 |
$62.40 |
$62.40 |
$23.86
|
|
Glucose blood quantitative
|
$93.60 |
$93.60 |
$93.60 |
$40.00
|
|
Glucose body fluid
|
$92.00 |
$92.00 |
$92.00 |
$52.20
|
|
Glucose tolerance test (gtt) 3 specimens
|
$280.00 |
$280.00 |
$280.00 |
$100.16
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$56.00 |
$56.00 |
$56.00 |
$35.00
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$225.60 |
$225.60 |
$225.60 |
$115.05
|
|
Gonadotropin luteinizing hormone (lh)
|
$188.80 |
$188.80 |
$188.80 |
$129.00
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$402.40 |
$402.40 |
$402.40 |
$1,181.41
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$80.00 |
$80.00 |
$80.00 |
$373.00
|
|
Great toe with reduction 28495
|
$333.60 |
$333.60 |
$333.60 |
$482.40
|
|
Guided cath fluid drainage 10030
|
$909.60 |
$909.60 |
$909.60 |
$1,372.15
|
|
Hand X-ray
|
$744.00 |
$744.00 |
$744.00 |
$356.00
|
|
Haptoglobin quantitative
|
$152.80 |
$152.80 |
$152.80 |
$91.14
|
|
Hba1/hba2 gene dup/del vrnts
|
$896.80 |
$896.80 |
$896.80 |
$404.80
|
|
Hcg qualitative
|
$216.00 |
$216.00 |
$216.00 |
$89.70
|
|
Hcg quantitative
|
$236.00 |
$236.00 |
$236.00 |
$139.20
|
|
Hc nm cardiac blood pool planar 1 stdy wal motn eject fract
|
$1,648.80 |
$1,648.80 |
$1,648.80 |
$1,160.64
|
|
Hc nm kidney imaging with flow
|
$1,285.60 |
$1,285.60 |
$1,285.60 |
$822.60
|
|
Hc pet myocardial imaging metabolic eval single study
|
$4,958.40 |
$4,958.40 |
$4,958.40 |
$3,931.12
|
|
Head CT scan (with and without contrast)
|
$2,549.60 |
$2,549.60 |
$2,549.60 |
$1,849.90
|
|
Head CT scan (with contrast)
|
$2,171.20 |
$2,171.20 |
$2,171.20 |
$1,545.60
|
|
Head CT scan (without contrast)
|
$2,005.60 |
$2,005.60 |
$2,005.60 |
$1,268.90
|
|
Heart infarct image
|
$972.80 |
$972.80 |
$972.80 |
$940.55
|
|
Hematocrit
|
$82.40 |
$82.40 |
$82.40 |
$33.57
|
|
Hemoglobin
|
$82.40 |
$82.40 |
$82.40 |
$31.80
|
|
Hemoglobin plasma
|
$89.60 |
$89.60 |
$89.60 |
$41.25
|
|
Hemophilus influenza antibdy
|
$56.80 |
$56.80 |
$56.80 |
$62.70
|
|
Heparin assay
|
$636.00 |
$636.00 |
$636.00 |
$140.10
|
|
Hepatitis a antibody igm
|
$186.40 |
$186.40 |
$186.40 |
$87.75
|
|
Hepatitis b core antibody igm
|
$75.20 |
$75.20 |
$75.20 |
$87.98
|
|
Hepatitis b core antibody total
|
$152.00 |
$152.00 |
$152.00 |
$77.50
|
|
Hepatitis b surface antibody
|
$140.00 |
$140.00 |
$140.00 |
$82.05
|
|
Hepatitis c antibody
|
$202.40 |
$202.40 |
$202.40 |
$108.00
|
|
Hepatitis d quantification
|
$1,960.80 |
$1,960.80 |
$1,960.80 |
$91.28
|
|
Hepatobiliary system imaging
|
$1,724.00 |
$1,724.00 |
$1,724.00 |
$1,438.58
|
|
Hereditary colon ca dsordrs
|
$4,903.20 |
$4,903.20 |
$4,903.20 |
$1,799.45
|
|
Herpes simplex type 1 antibody igg
|
$75.20 |
$75.20 |
$75.20 |
$70.00
|
|
Herpes simplex type 2 antibody igg
|
$75.20 |
$75.20 |
$75.20 |
$87.10
|
|
Heterophile antibodies screening
|
$175.20 |
$175.20 |
$175.20 |
$74.00
|
|
Hfo nontorsion jnts pre cst
|
$72.00 |
$72.00 |
$72.00 |
$110.88
|
|
Hhv-6 dna quant
|
$700.80 |
$700.80 |
$700.80 |
$246.35
|
|
Hip X-ray
|
$373.60 |
$373.60 |
$373.60 |
$292.05
|
|
Histamine
|
$420.80 |
$420.80 |
$420.80 |
$115.00
|
|
Hla i typing high res 1 allele grp ea
|
$1,104.00 |
$1,104.00 |
$1,104.00 |
$293.15
|
|
Home sleep test/type 3 porta
|
$730.40 |
$730.40 |
$730.40 |
$579.26
|
|
Homocysteine
|
$194.40 |
$194.40 |
$194.40 |
$121.92
|
|
Homogenization tissue
|
$64.00 |
$64.00 |
$64.00 |
$39.20
|
|
Hpv combo assay ca screen
|
$196.80 |
$196.80 |
$196.80 |
$70.40
|
