|
Ghs layered repair over 3.0 cm -12057
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$1,064.98
|
|
Ghs leukocyte alkaline phos (mayo)
|
$9.46 |
$9.46 |
$9.46 |
$59.40
|
|
Ghs mbp
|
$18.92 |
$18.92 |
$18.92 |
$74.19
|
|
Ghs musc test done w/n test comp
|
$124.56 |
$124.56 |
$124.56 |
$349.80
|
|
Ghs musc tst done w/nerv tst lim
|
$92.78 |
$92.78 |
$92.78 |
$269.15
|
|
Ghs musc tst done w/n tst non ext
|
$65.48 |
$65.48 |
$65.48 |
$222.60
|
|
Ghs myocardial strain img spckl track
|
$304.80 |
$304.80 |
$304.80 |
$503.85
|
|
Ghs nailbed repair/nail removal
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$808.80
|
|
Ghs nerve blk intercostal, ea addtl level
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$1,618.50
|
|
Ghs nerve blk intercostal, single level
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$1,230.80
|
|
Ghs nerve block axillary nerve
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$1,541.40
|
|
Ghs nerve block brachial plexus
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$1,768.00
|
|
Ghs nerve block celiac plexus
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$1,712.00
|
|
Ghs nerve block interscaline
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$1,607.45
|
|
Ghs nerve block lumbar or thoracic symp
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,042.60
|
|
Ghs nerve block sciatic nerve
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$1,636.80
|
|
Ghs nerve block suprascapular
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$1,223.00
|
|
Ghs ng placement w fluoro guidance
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$468.75
|
|
Ghs o2 saturation
|
$10.75 |
$10.75 |
$10.75 |
$72.45
|
|
Ghs ob unlisted IV or art inj or infusion
|
$30.28 |
$30.28 |
$30.28 |
$86.19
|
|
Ghs opcc repair cvp without subq port
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$1,302.54
|
|
Ghs opcc repair cvp w subq port
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,430.56
|
|
Ghs optokenetic
|
$69.96 |
$69.96 |
$69.96 |
$196.66
|
|
Ghs oscillating trac
|
$86.17 |
$86.17 |
$86.17 |
$267.15
|
|
Ghs peritonsillar abscess i andd
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$694.20
|
|
Ghs phenylketonurid
|
$6.05 |
$6.05 |
$6.05 |
$51.58
|
|
Ghs picc line insert < 5
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,060.40
|
|
Ghs plngl fx pm cl
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$662.20
|
|
Ghs plt ct-manual
|
$4.74 |
$4.74 |
$4.74 |
$39.20
|
|
Ghs ppd (tb intradermal)
|
$10.45 |
$10.45 |
$10.45 |
$43.45
|
|
Ghs prostatic acid phosphatase (mayo)
|
$10.63 |
$10.63 |
$10.63 |
$40.56
|
|
Ghs protein, misc fluid
|
$6.17 |
$6.17 |
$6.17 |
$24.60
|
|
Ghs protoporphyrins fract
|
$15.79 |
$15.79 |
$15.79 |
$64.35
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$13.48 |
$13.48 |
$13.48 |
$45.05
|
|
Ghs quinidine
|
$16.06 |
$16.06 |
$16.06 |
$68.40
|
|
Ghs removal intranasal foreign body
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$324.35
|
|
Ghs removal pharyngeal foreign body
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$460.00
|
|
Ghs repair extensor tendon hand, ea tendon
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,211.05
|
|
Ghs repair tendon ext forearm/wrist ea
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$4,150.20
|
|
Ghs respiratory syncytical virus igg/m
|
$17.48 |
$17.48 |
$17.48 |
$42.40
|
|
Ghs reticulocyte count
|
$4.74 |
$4.74 |
$4.74 |
$33.57
|
|
Ghs rsv eia (respir synctial vrs)
|
$15.30 |
$15.30 |
$15.30 |
$101.15
|
|
Ghs sedimentation rate
|
$4.70 |
$4.70 |
$4.70 |
$45.50
|
|
Ghs semen analysis fert
|
$13.54 |
$13.54 |
$13.54 |
$123.20
|
|
Ghs semen analysis, post-vas
|
$10.82 |
$10.82 |
$10.82 |
$32.37
|
|
Ghs sensitivity (per antimicro)
|
$8.23 |
$8.23 |
$8.23 |
$59.90
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$590.40
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$705.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$670.08
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$585.90
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$487.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$470.47
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$538.64
|
|
Ghs simple repair over 30 cm - 12007
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$660.00
|
|
Ghs simple repair over 30 cm - 12018
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$589.18
|
|
Ghs somatosensory testing lower extremit
|
$366.02 |
$366.02 |
$366.02 |
$947.48
|
|
Ghs somatosensory testing upper & lower limbs
|
$442.17 |
$442.17 |
$442.17 |
$1,435.00
|
|
Ghs sphenopalatine ganglion block
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$706.56
|
|
Ghs spont nystagmus
|
$110.06 |
$110.06 |
$110.06 |
$217.57
|
|
Ghs st - eval for alt comm
|
$48.63 |
$48.63 |
$48.63 |
$99.75
|
|
Ghs strapping shoulder - 29240
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$243.07
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$30.50 |
$30.50 |
$30.50 |
$93.75
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$99.82 |
$99.82 |
$99.82 |
$351.45
|
|
Ghs superficial wnd dehiscence simp12020
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$976.98
|
|
Ghs superficial wnd dehis w packing12021
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$761.28
|
|
Ghs tracheostomy emergency - transtracheal
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$2,225.73
|
|
Ghs trypsin (fecal)
|
$8.03 |
$8.03 |
$8.03 |
$21.84
|
|
Ghs tx distal phalangeal fx with manipulation
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$591.00
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$540.00
|
|
Ghs urine, hydroxproline total
|
$26.73 |
$26.73 |
$26.73 |
$61.60
|
|
Ghs urine, porphyrins quant
|
$16.18 |
$16.18 |
$16.18 |
$70.20
|
|
Ghs vaginal delivery only
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$3,525.06
|
|
Ghs veeg 12-26 hr intmt mont
|
$1,449.37 |
$1,449.37 |
$1,449.37 |
$1,843.00
|
|
Ghs windowing of cast
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$204.00
|
|
Giardia lamblia antibody
|
$16.19 |
$16.19 |
$16.19 |
$81.60
|
|
Gi inhouse confirmation
|
$10.38 |
$10.38 |
$10.38 |
$87.00
|
|
Gingivoplasty each quadrant
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$3,592.74
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$910.79 |
$910.79 |
$910.79 |
$2,382.90
|
|
Gi trc img intral esophagus
|
$712.42 |
$712.42 |
$712.42 |
$1,844.80
|
|
Gjb2 gene full sequence
|
$111.23 |
$111.23 |
$111.23 |
$386.10
|
|
Gjb2 gene known fam variants
|
$67.67 |
$67.67 |
$67.67 |
$67.67
|
|
Gjb6 gene com variants
|
$38.50 |
$38.50 |
$38.50 |
$38.50
|
|
Glaucoma surgery
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$4,737.56
|
|
Glaucoma surgery
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$4,737.56
|
|
Glaucoma surgery
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$3,895.82
|
|
Glaucoma surgery
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$4,188.22
|
|
Glucagon plasma - sendout
|
$15.72 |
$15.72 |
$15.72 |
$58.56
|
|
Glucose 1 hr post dose
|
$5.23 |
$5.23 |
$5.23 |
$46.28
|
|
Glucose-6-phosphate dhydrogenase screen
|
$6.66 |
$6.66 |
$6.66 |
$45.34
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$3.61 |
$3.61 |
$3.61 |
$22.00
|
|
Glucose blood quantitative
|
$4.32 |
$4.32 |
$4.32 |
$44.76
|
|
Glucose body fluid
|
$4.32 |
$4.32 |
$4.32 |
$50.70
|
|
Glucose tolerance test (gtt) 3 specimens
|
$14.16 |
$14.16 |
$14.16 |
$100.10
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$4.31 |
$4.31 |
$4.31 |
$34.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$20.44 |
$20.44 |
$20.44 |
$110.04
|
|
Gonadotropin luteinizing hormone (lh)
|
$20.37 |
$20.37 |
$20.37 |
$123.75
|
|
Goniotomy
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$4,627.00
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$34.11 |
$34.11 |
$34.11 |
$2,648.81
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$1,185.97 |
$1,185.97 |
$1,185.97 |
$1,679.75
|
|
Graft hand or finger tendon
|
$5,741.00 |
$5,741.00 |
$5,741.00 |
$3,786.00
|
