|
Ghs layer closure 2.5 cm or less - 12031
|
$160.00 |
$160.00 |
$1,059.00 |
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$153.60 |
$153.60 |
$746.25 |
|
|
Ghs layer closure 2.5cm or less - 12051
|
$160.00 |
$160.00 |
$1,019.25 |
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$917.25 |
$917.25 |
$917.25 |
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$160.32 |
$160.32 |
$1,059.00 |
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$1,059.00 |
$1,059.00 |
$1,059.00 |
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$176.32 |
$176.32 |
$1,059.00 |
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$173.76 |
$173.76 |
$1,407.75 |
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$1,053.75 |
$1,053.75 |
$1,053.75 |
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$254.40 |
$254.40 |
$254.40 |
|
|
Ghs leukocyte alkaline phos (mayo)
|
$52.50 |
$52.50 |
$52.50 |
|
|
Ghs low level laser therapy
|
$40.64 |
$40.64 |
$40.64 |
|
|
Ghs mbp
|
$96.64 |
$96.64 |
$108.00 |
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$181.50 |
$181.50 |
$246.08 |
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$246.08 |
$246.08 |
$246.08 |
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$193.50 |
$193.50 |
$246.08 |
|
|
Ghs moderate sedation ea addtl 15 min
|
$34.50 |
$34.50 |
$148.16 |
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$49.28 |
$49.28 |
$49.28 |
|
|
Ghs musc test done w/n test comp
|
$76.48 |
$76.48 |
$237.00 |
|
|
Ghs musc tst done w/nerv tst lim
|
$76.48 |
$76.48 |
$172.50 |
|
|
Ghs musc tst done w/n tst non ext
|
$255.00 |
$255.00 |
$255.00 |
|
|
Ghs myocardial strain img spckl track
|
$119.25 |
$119.25 |
$119.25 |
|
|
Ghs nailbed repair/nail removal
|
$922.50 |
$922.50 |
$922.50 |
|
|
Ghs nerve blk intercostal, ea addtl level
|
$1,082.25 |
$1,082.25 |
$1,082.25 |
|
|
Ghs nerve blk intercostal, single level
|
$819.00 |
$819.00 |
$819.00 |
|
|
Ghs nerve block axillary nerve
|
$605.25 |
$605.25 |
$605.25 |
|
|
Ghs nerve block brachial plexus
|
$1,082.25 |
$1,082.25 |
$1,082.25 |
|
|
Ghs nerve block celiac plexus
|
$1,150.50 |
$1,150.50 |
$1,150.50 |
|
|
Ghs nerve block interscaline
|
$2,506.50 |
$2,506.50 |
$2,506.50 |
|
|
Ghs nerve block lumbar or thoracic symp
|
$2,506.50 |
$2,506.50 |
$2,506.50 |
|
|
Ghs nerve block sciatic nerve
|
$1,872.75 |
$1,872.75 |
$1,872.75 |
|
|
Ghs ng placement w fluoro guidance
|
$266.88 |
$266.88 |
$1,141.50 |
|
|
Ghs o2 saturation
|
$11.52 |
$11.52 |
$53.25 |
|
|
Ghs o2 uptake rest & exercise
|
$189.00 |
$189.00 |
$189.00 |
|
|
Ghs o2 uptake rest & indirect
|
$183.00 |
$183.00 |
$183.00 |
|
|
Ghs opcc repair cvp without subq port
|
$1,556.25 |
$1,556.25 |
$1,556.25 |
|
|
Ghs optokenetic
|
$417.00 |
$417.00 |
$417.00 |
|
|
Ghs oscillating trac
|
$723.75 |
$723.75 |
$723.75 |
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$13.44 |
$13.44 |
$13.44 |
|
|
Ghs osteopathic manipulative tx, 3-4 regions
|
$13.44 |
$13.44 |
$13.44 |
|
|
Ghs ot prosthetic training/15 min
|
$47.36 |
$47.36 |
$47.36 |
|
|
Ghs ot sensory integrative tech/15min
|
$40.64 |
$40.64 |
$169.50 |
|
|
Ghs ot work hardening-additional hours
|
$110.40 |
$110.40 |
$110.40 |
|
|
Ghs pacing - transcutaneous
|
$250.88 |
$250.88 |
$1,728.75 |
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$181.50 |
$181.50 |
$181.50 |
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$131.25 |
$131.25 |
$131.25 |
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$27.20 |
$27.20 |
$108.75 |
|
|
Ghs peritonsillar abscess i andd
|
$113.60 |
$113.60 |
$648.75 |
|
|
Ghs phenylketonurid
|
$33.75 |
$33.75 |
$33.75 |
|
|
Ghs picc line insert < 5
|
$2,458.50 |
$2,458.50 |
$2,458.50 |
|
|
Ghs plngl fx pm cl
|
$772.50 |
$772.50 |
$772.50 |
|
|
Ghs plt ct-manual
|
$27.00 |
$27.00 |
$27.00 |
|
|
Ghs polysom <6 yrs 4/> parameters
|
$3,343.50 |
$3,343.50 |
$3,343.50 |
|
|
Ghs pos nystagmus
|
$86.25 |
$86.25 |
$86.25 |
|
|
Ghs ppd (tb intradermal)
|
$13.44 |
$13.44 |
$29.25 |
|
|
Ghs prostatic acid phosphatase (mayo)
|
$8.64 |
$8.64 |
$58.50 |
|
|
Ghs protein, misc fluid
|
$3.52 |
$3.52 |
$25.50 |
|
|
Ghs protoporphyrins fract
|
$74.24 |
$74.24 |
$90.75 |
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$74.25 |
$74.25 |
$74.25 |
|
|
Ghs pt - work hardening/int 2hrs
|
$220.48 |
$220.48 |
$220.48 |
|
|
Ghs quinidine
|
$89.25 |
$89.25 |
$89.25 |
|
|
Ghs removal intranasal foreign body
|
$485.25 |
$485.25 |
$485.25 |
|
|
Ghs removal pharyngeal foreign body
|
$1,188.00 |
$1,188.00 |
$1,188.00 |
|
|
Ghs repair extensor tendon hand, ea tendon
|
$439.68 |
$439.68 |
$4,853.25 |
|
|
Ghs repair tendon ext forearm/wrist ea
|
$413.76 |
$413.76 |
$413.76 |
|
|
Ghs respiratory syncytical virus igg/m
|
$39.36 |
$39.36 |
$78.75 |
|
|
Ghs reticulocyte count
|
$27.00 |
$27.00 |
$27.00 |
|
|
Ghs rsv eia (respir synctial vrs)
|
$43.84 |
$43.84 |
$72.75 |
|
|
Ghs sedimentation rate
|
$25.60 |
$25.60 |
$30.00 |
|
|
Ghs semen analysis fert
|
$45.00 |
$45.00 |
$45.00 |
|
|
Ghs semen analysis, post-vas
|
$30.75 |
$30.75 |
$30.75 |
|
|
Ghs sensitivity (per antimicro)
|
$41.92 |
$41.92 |
$54.75 |
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$176.64 |
$176.64 |
$675.75 |
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$153.60 |
$153.60 |
$531.00 |
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$743.25 |
$743.25 |
$743.25 |
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$129.28 |
$129.28 |
$390.00 |
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$102.72 |
$102.72 |
$399.75 |
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$140.80 |
$140.80 |
$424.50 |
|
|
Ghs sleep study unattended
|
$465.00 |
$465.00 |
$465.00 |
|
|
Ghs somatosensory testing lower extremit
|
$292.48 |
$292.48 |
$830.25 |
|
|
Ghs somatosensory testing upper & lower limbs
|
$220.48 |
$220.48 |
$1,441.50 |
|
|
Ghs speech-gen aug dev eval iii, st
|
$59.52 |
$59.52 |
$144.75 |
|
|
Ghs sphenopalatine ganglion block
|
$2,517.00 |
$2,517.00 |
$2,517.00 |
|
|
Ghs spont nystagmus
|
$86.25 |
$86.25 |
$86.25 |
|
|
Ghs sp train/fitting sp device - kx
|
$100.80 |
$100.80 |
$305.25 |
|
|
Ghs st - eval for alt comm
|
$17.60 |
$17.60 |
$84.75 |
|
|
Ghs strapping shoulder - 29240
|
$135.68 |
$135.68 |
$135.68 |
|
|
Ghs st - re-eval for alt comm
|
$169.60 |
$169.60 |
$238.50 |
|
|
Ghs superficial wnd dehiscence simp12020
|
$1,100.25 |
$1,100.25 |
$1,100.25 |
|
|
Ghs superficial wnd dehis w packing12021
|
$115.84 |
$115.84 |
$1,118.25 |
|
|
Ghs tracheostomy emergency - transtracheal
|
$243.52 |
$243.52 |
$243.52 |
|
|
Ghs trypsin (fecal)
|
$7.36 |
$7.36 |
$45.00 |
|
|
Ghs tx distal phalangeal fx with manipulation
|
$772.50 |
$772.50 |
$772.50 |
|
|
Ghs urine, hydroxproline total
|
$148.50 |
$148.50 |
$148.50 |
|
|
Ghs urine, porphyrins quant
|
$89.60 |
$89.60 |
$92.25 |
|
|
Ghs vaginal delivery only
|
$606.40 |
$606.40 |
$2,419.50 |
|
|
Giardia ag if
|
$25.60 |
$25.60 |
$72.75 |
|
|
Giardia lamblia antibody
|
$13.44 |
$13.44 |
$92.25 |
|
|
Gi endoscopic ultrasound
|
$740.25 |
$740.25 |
$740.25 |
|
|
Gi inhouse confirmation
|
$36.80 |
$36.80 |
$59.25 |
|