|
Ghs layer closure 2.5 cm or less - 12031
|
$1,245.00 |
$1,245.00 |
$1,245.00 |
$617.60
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$1,271.00 |
$1,271.00 |
$1,271.00 |
$619.20
|
|
Ghs layer closure 2.5cm or less - 12051
|
$1,277.00 |
$1,277.00 |
$1,277.00 |
$648.00
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$1,277.00 |
$1,277.00 |
$1,277.00 |
$741.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$1,271.00 |
$1,271.00 |
$1,271.00 |
$741.00
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$1,277.00 |
$1,277.00 |
$1,277.00 |
$779.35
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$1,245.00 |
$1,245.00 |
$1,245.00 |
$810.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$1,925.00 |
$1,925.00 |
$1,925.00 |
$795.20
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$1,277.00 |
$1,277.00 |
$1,277.00 |
$779.35
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$1,977.00 |
$1,977.00 |
$1,977.00 |
$995.20
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$1,277.00 |
$1,277.00 |
$1,277.00 |
$879.60
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$1,977.00 |
$1,977.00 |
$1,977.00 |
$1,188.80
|
|
Ghs layered repair 20.1 - 30.0 cm -12056
|
$1,277.00 |
$1,277.00 |
$1,277.00 |
$1,030.80
|
|
Ghs layered repair over 30.0 cm -12047
|
$6,465.00 |
$6,465.00 |
$6,465.00 |
$2,024.70
|
|
Ghs layered repair over 3.0 cm -12057
|
$1,277.00 |
$1,277.00 |
$1,277.00 |
$1,064.98
|
|
Ghs leukocyte alkaline phos (mayo)
|
$11.88 |
$11.95 |
$250.00 |
$59.40
|
|
Ghs mbp
|
$15.63 |
$15.70 |
$107.00 |
$74.19
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$436.00 |
$436.00 |
$436.00 |
$261.80
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$397.00 |
$397.00 |
$397.00 |
$252.50
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$439.00 |
$439.00 |
$439.00 |
$239.20
|
|
Ghs moderate sedation ea addtl 15 min
|
$436.00 |
$436.00 |
$436.00 |
$145.60
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$115.00 |
$115.00 |
$115.00 |
$140.00
|
|
Ghs musc test done w/n test comp
|
$495.00 |
$495.00 |
$514.60 |
$349.80
|
|
Ghs musc tst done w/nerv tst lim
|
$328.05 |
$328.05 |
$355.00 |
$269.15
|
|
Ghs musc tst done w/n tst non ext
|
$391.00 |
$391.00 |
$448.80 |
$222.60
|
|
Ghs myocardial strain img spckl track
|
$1,532.00 |
$2,207.21 |
$2,359.50 |
$503.85
|
|
Ghs nailbed repair/nail removal
|
$1,977.00 |
$1,977.00 |
$1,977.00 |
$808.80
|
|
Ghs nerve blk intercostal, ea addtl level
|
$3,343.00 |
$3,343.00 |
$3,343.00 |
$1,618.50
|
|
Ghs nerve blk intercostal, single level
|
$2,632.00 |
$2,632.00 |
$2,632.00 |
$1,230.80
|
|
Ghs nerve block axillary nerve
|
$3,107.00 |
$3,107.00 |
$3,107.00 |
$1,541.40
|
|
Ghs nerve block brachial plexus
|
$3,107.00 |
$3,107.00 |
$3,107.00 |
$1,768.00
|
|
Ghs nerve block celiac plexus
|
$3,343.00 |
$3,343.00 |
$3,343.00 |
$1,712.00
|
|
Ghs nerve block interscaline
|
$3,343.00 |
$3,343.00 |
$3,343.00 |
$1,607.45
|
|
Ghs nerve block lumbar or thoracic symp
|
$3,343.00 |
$3,343.00 |
$3,343.00 |
$2,042.60
|
|
Ghs nerve block sciatic nerve
|
$2,632.00 |
$2,632.00 |
$2,632.00 |
$1,636.80
|
|
Ghs nerve block suprascapular
|
$2,956.00 |
$2,956.00 |
$2,956.00 |
$1,223.00
|
|
Ghs ng placement w fluoro guidance
|
$686.00 |
$686.00 |
$686.00 |
$468.75
|
|
Ghs o2 saturation
|
$118.40 |
$331.00 |
$347.56 |
$72.45
|
|
Ghs o2 uptake rest & indirect
|
$151.00 |
$151.00 |
$1,409.55 |
$195.00
|
|
Ghs ob unlisted IV or art inj or infusion
|
$56.00 |
$56.00 |
$56.00 |
$86.19
|
|
Ghs opcc repair cvp without subq port
|
$2,040.00 |
$2,040.00 |
$2,040.00 |
$1,302.54
|
|
Ghs opcc repair cvp w subq port
|
$5,307.00 |
$5,307.00 |
$5,307.00 |
$2,430.56
|
|
Ghs optokenetic
|
$511.00 |
$511.00 |
$511.00 |
$196.66
|
|
Ghs oscillating trac
|
$451.00 |
$451.00 |
$451.00 |
$267.15
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$94.00 |
$94.00 |
$94.00 |
$55.77
|
|
Ghs osteopathic manipulative tx, 3-4 regions
|
$94.00 |
$94.00 |
$94.00 |
$57.65
|
|
Ghs ot dds rom
|
$151.00 |
$151.00 |
$151.00 |
$56.55
|
|
Ghs ot group caregiver training
|
$156.00 |
$156.00 |
$156.00 |
$43.20
|
|
Ghs ot prosthetic training/15 min
|
$923.80 |
$923.80 |
$923.80 |
$92.35
|
|
Ghs ot sensory integrative tech/15min
|
$162.00 |
$162.00 |
$162.00 |
$101.05
|
|
Ghs ot work hardening-additional hours
|
$227.00 |
$227.00 |
$227.00 |
$121.54
|
|
Ghs pacing - transcutaneous
|
$5,069.00 |
$5,069.00 |
$5,069.00 |
$868.68
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$3,343.00 |
$3,343.00 |
$3,343.00 |
$855.60
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$3,343.00 |
$3,343.00 |
$3,343.00 |
$1,003.00
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$35.00 |
$35.00 |
$35.00 |
$90.15
|
|
Ghs peritonsillar abscess i andd
|
$1,383.00 |
$1,383.00 |
$1,383.00 |
$694.20
|
|
Ghs phenylketonurid
|
$23.80 |
$24.20 |
$35.00 |
$51.58
|
|
Ghs picc line insert < 5
|
$5,307.00 |
$5,307.00 |
$5,307.00 |
$2,060.40
|
|
Ghs plngl fx pm cl
|
$1,586.00 |
$1,586.00 |
$1,586.00 |
$662.20
|
|
Ghs plt ct-manual
|
$23.00 |
$23.00 |
$23.00 |
$39.20
|
|
Ghs polysom <6 yrs 4/> parameters
|
$8,093.00 |
$8,093.00 |
$8,093.00 |
$3,705.80
|
|
Ghs ppd (tb intradermal)
|
$49.12 |
$50.80 |
$260.71 |
$43.45
|
|
Ghs prostatic acid phosphatase (mayo)
|
$7.93 |
$8.00 |
$95.00 |
$40.56
|
|
Ghs protein, misc fluid
|
$28.00 |
$28.00 |
$28.00 |
$24.60
|
|
Ghs protoporphyrins fract
|
$68.19 |
$68.19 |
$253.00 |
$64.35
|
|
Ghs pr without cont pulse ox
|
$372.00 |
$372.00 |
$372.00 |
$156.70
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$13.85 |
$13.85 |
$70.00 |
$45.05
|
|
Ghs pt - work hardening/int 2hrs
|
$430.00 |
$430.00 |
$430.00 |
$255.60
|
|
Ghs quinidine
|
$11.75 |
$11.75 |
$11.75 |
$68.40
|
|
Ghs refill of implantable pump
|
$2,551.00 |
$2,551.00 |
$2,551.00 |
$539.13
|
|
Ghs removal intranasal foreign body
|
$416.00 |
$416.00 |
$416.00 |
$324.35
|
|
Ghs removal pharyngeal foreign body
|
$1,024.00 |
$1,024.00 |
$1,024.00 |
$460.00
|
|
Ghs repair tendon ext forearm/wrist ea
|
$10,690.00 |
$10,690.00 |
$10,690.00 |
$4,150.20
|
|
Ghs respiratory syncytical virus igg/m
|
$11.04 |
$11.04 |
$11.04 |
$42.40
|
|
Ghs reticulocyte count
|
$216.00 |
$216.00 |
$771.40 |
$33.57
|
|
Ghs rsv eia (respir synctial vrs)
|
$326.15 |
$326.15 |
$371.00 |
$101.15
|
|
Ghs sedimentation rate
|
$236.00 |
$236.00 |
$886.90 |
$45.50
|
|
Ghs sensitivity (per antimicro)
|
$313.00 |
$766.90 |
$783.60 |
$59.90
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$1,652.00 |
$1,652.00 |
$1,652.00 |
$590.40
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$1,551.00 |
$1,551.00 |
$1,551.00 |
$705.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$1,652.00 |
$1,652.00 |
$1,652.00 |
$670.08
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$1,551.00 |
$1,551.00 |
$1,551.00 |
$585.90
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$751.00 |
$751.00 |
$751.00 |
$487.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$800.00 |
$800.00 |
$800.00 |
$470.47
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$751.00 |
$751.00 |
$751.00 |
$538.64
|
|
Ghs simple repair over 30 cm - 12007
|
$800.00 |
$800.00 |
$800.00 |
$660.00
|
|
Ghs simple repair over 30 cm - 12018
|
$751.00 |
$751.00 |
$751.00 |
$589.18
|
|
Ghs sleep study unattended
|
$4,308.00 |
$4,308.00 |
$4,308.00 |
$503.38
|
|
Ghs somatosensory testing lower extremit
|
$2,810.00 |
$2,810.00 |
$5,634.30 |
$947.48
|
|
Ghs somatosensory testing upper & lower limbs
|
$5,204.00 |
$5,204.00 |
$5,634.30 |
$1,435.00
|
|
Ghs speech-gen aug dev eval iii, st
|
$306.95 |
$306.95 |
$306.95 |
$124.80
|
|
Ghs sphenopalatine ganglion block
|
$1,222.00 |
$1,222.00 |
$1,222.00 |
$706.56
|
|
Ghs spont nystagmus
|
$511.00 |
$511.00 |
$511.00 |
$217.57
|
|
Ghs sp train/fitting sp device - kx
|
$1,530.00 |
$1,530.00 |
$1,530.00 |
$261.95
|
|
Ghs st - eval for alt comm
|
$224.00 |
$224.00 |
$224.00 |
$99.75
|
|
Ghs strapping shoulder - 29240
|
$311.00 |
$311.00 |
$311.00 |
$243.07
|
|
Ghs st - re-eval for alt comm
|
$900.00 |
$900.00 |
$959.00 |
$309.00
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$406.00 |
$406.00 |
$406.00 |
$93.75
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$978.00 |
$978.00 |
$978.00 |
$351.45
|
|
Ghs superficial wnd dehiscence simp12020
|
$4,034.00 |
$4,034.00 |
$4,034.00 |
$976.98
|
