|
Ghs i and d abscess/hematoma scrotum
|
$2,596.20 |
$2,596.20 |
$2,596.20 |
$3,320.80
|
|
Ghs i and d perirectal abscess 46040
|
$7,122.60 |
$7,122.60 |
$7,122.60 |
$2,637.00
|
|
Ghs i and d pilonidal cyst complex
|
$868.20 |
$868.20 |
$868.20 |
$1,402.80
|
|
Ghs i and d pilonidal cyst simple
|
$543.60 |
$543.60 |
$543.60 |
$696.80
|
|
Ghs incision thrombosed ext hemorrhoid
|
$868.80 |
$868.80 |
$868.80 |
$525.60
|
|
Ghs indirect laryngoscopy/w fb removal
|
$271.80 |
$271.80 |
$271.80 |
$350.90
|
|
Ghs inhibitor screen
|
$916.20 |
$916.20 |
$916.20 |
$191.88
|
|
Ghs init tx 1st degree burn
|
$255.60 |
$255.60 |
$255.60 |
$275.80
|
|
Ghs inj neurolytic other perph nerve
|
$5,204.40 |
$5,204.40 |
$5,204.40 |
$1,710.80
|
|
Ghs inj tendon origin/insertion
|
$184.20 |
$184.20 |
$184.20 |
$434.12
|
|
Ghs inj transforaminal cerv ea add bil
|
$1,688.40 |
$1,688.40 |
$1,688.40 |
$1,105.65
|
|
Ghs inj transforaminal cerv single bil
|
$1,688.40 |
$1,688.40 |
$1,688.40 |
$1,814.80
|
|
Ghs insertion of needle - bone
|
$366.00 |
$366.00 |
$366.00 |
$421.00
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$709.20 |
$709.20 |
$709.20 |
$876.00
|
|
Ghs intermed repair 20.1 - 30.0 cm-12036
|
$676.80 |
$676.80 |
$676.80 |
$1,051.20
|
|
Ghs irrigate corpora cavernosa for priapism
|
$555.60 |
$555.60 |
$555.60 |
$551.20
|
|
Ghs IV inf sq injection, on-body injector
|
$73.80 |
$73.80 |
$73.80 |
$108.00
|
|
Ghs IV infusion bamlanivimab/etesevimab
|
$563.40 |
$563.40 |
$563.40 |
$553.80
|
|
Ghs IV infusion casirivimab/imdevimab
|
$563.40 |
$563.40 |
$563.40 |
$573.86
|
|
Ghs IV infusion sotrovimab
|
$563.40 |
$563.40 |
$563.40 |
$563.40
|
|
Ghs IV thrombolytics - cerebral
|
$541.20 |
$541.20 |
$541.20 |
$663.00
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$917.40 |
$917.40 |
$917.40 |
$505.45
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$560.40 |
$560.40 |
$560.40 |
$602.70
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$560.40 |
$560.40 |
$560.40 |
$579.20
|
|
Ghs layer closure 2.5cm or less - 12051
|
$560.40 |
$560.40 |
$560.40 |
$614.00
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$592.80 |
$592.80 |
$592.80 |
$675.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$605.40 |
$605.40 |
$605.40 |
$703.20
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$605.40 |
$605.40 |
$605.40 |
$737.55
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$605.40 |
$605.40 |
$605.40 |
$779.35
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$382.20 |
$382.20 |
$382.20 |
$755.08
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$605.40 |
$605.40 |
$605.40 |
$737.55
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$819.00 |
$819.00 |
$819.00 |
$1,033.85
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$407.40 |
$407.40 |
$407.40 |
$246.33
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$324.00 |
$324.00 |
$324.00 |
$242.31
|
|
Ghs moderate sedation ea addtl 15 min
|
$220.80 |
$220.80 |
$220.80 |
$151.50
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$243.00 |
$243.00 |
$243.00 |
$142.40
|
|
Ghs myocardial strain img spckl track
|
$0.60 |
$0.60 |
$0.60 |
$457.80
|
|
Ghs nailbed repair/nail removal
|
$382.20 |
$382.20 |
$382.20 |
$726.86
|
|
Ghs nerve blk intercostal, ea addtl level
|
$1,726.80 |
$1,726.80 |
$1,726.80 |
$1,556.24
|
|
Ghs nerve blk intercostal, single level
|
$1,726.80 |
$1,726.80 |
$1,726.80 |
$1,121.00
|
|
Ghs nerve block axillary nerve
|
$1,688.40 |
$1,688.40 |
$1,688.40 |
$1,554.60
|
|
Ghs nerve block brachial plexus
|
$1,388.40 |
$1,388.40 |
$1,388.40 |
$1,710.80
|
|
Ghs nerve block interscaline
|
$2,578.20 |
$2,578.20 |
$2,578.20 |
$1,540.61
|
|
Ghs nerve block lumbar or thoracic symp
|
$1,726.80 |
$1,726.80 |
$1,726.80 |
$1,709.95
|
|
Ghs nerve block sciatic nerve
|
$1,688.40 |
$1,688.40 |
$1,688.40 |
$1,450.80
|
|
Ghs nerve block suprascapular
|
$1,688.40 |
$1,688.40 |
$1,688.40 |
$1,159.80
|
|
Ghs ng placement w fluoro guidance
|
$501.60 |
$501.60 |
$501.60 |
$485.00
|
|
Ghs o2 saturation
|
$148.20 |
$148.20 |
$148.20 |
$72.45
|
|
Ghs ot group caregiver training
|
$34.80 |
$34.80 |
$34.80 |
$34.92
|
|
Ghs ot prosthetic training/15 min
|
$123.00 |
$123.00 |
$123.00 |
$91.50
|
|
Ghs ot sensory integrative tech/15min
|
$108.00 |
$108.00 |
$108.00 |
$96.00
|
|
Ghs ot work hardening-additional hours
|
$127.80 |
$127.80 |
$127.80 |
$127.80
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$1,656.60 |
$1,656.60 |
$1,656.60 |
$851.04
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$1,647.60 |
$1,647.60 |
$1,647.60 |
$930.00
|
|
Ghs peritonsillar abscess i andd
|
$301.80 |
$301.80 |
$301.80 |
$546.36
|
|
Ghs phenylketonurid
|
$295.80 |
$295.80 |
$295.80 |
$53.30
|
|
Ghs picc line insert < 5
|
$1,058.40 |
$1,058.40 |
$1,058.40 |
$2,005.58
|
|
Ghs plngl fx pm cl
|
$598.80 |
$598.80 |
$598.80 |
$586.00
|
|
Ghs ppd (tb intradermal)
|
$49.20 |
$49.20 |
$49.20 |
$37.70
|
|
Ghs prostatic acid phosphatase (mayo)
|
$108.00 |
$108.00 |
$108.00 |
$43.55
|
|
Ghs protoporphyrins fract
|
$333.00 |
$333.00 |
$333.00 |
$63.90
|
|
Ghs pr without cont pulse ox
|
$340.80 |
$340.80 |
$340.80 |
$147.69
|
|
Ghs pt - work hardening/int 2hrs
|
$361.20 |
$361.20 |
$361.20 |
$285.60
|
|
Ghs removal intranasal foreign body
|
$192.00 |
$192.00 |
$192.00 |
$287.50
|
|
Ghs removal pharyngeal foreign body
|
$249.00 |
$249.00 |
$249.00 |
$445.45
|
|
Ghs sedimentation rate
|
$76.80 |
$76.80 |
$76.80 |
$44.85
|
|
Ghs sensitivity (per antimicro)
|
$102.60 |
$102.60 |
$102.60 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$421.20 |
$421.20 |
$421.20 |
$563.75
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$557.40 |
$557.40 |
$557.40 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$384.60 |
$384.60 |
$384.60 |
$575.00
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$358.80 |
$358.80 |
$358.80 |
$449.15
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$393.60 |
$393.60 |
$393.60 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$395.40 |
$395.40 |
$395.40 |
$492.00
|
|
Ghs simple repair over 30 cm - 12007
|
$514.80 |
$514.80 |
$514.80 |
$584.00
|
|
Ghs sleep study unattended
|
$686.40 |
$686.40 |
$686.40 |
$503.38
|
|
Ghs sphenopalatine ganglion block
|
$2,247.00 |
$2,247.00 |
$2,247.00 |
$628.16
|
|
Ghs sp train/fitting sp device - kx
|
$286.80 |
$286.80 |
$286.80 |
$243.60
|
|
Ghs superficial wnd dehiscence simp12020
|
$691.80 |
$691.80 |
$691.80 |
$897.96
|
|
Ghs tracheostomy emergency - transtracheal
|
$2,510.40 |
$2,510.40 |
$2,510.40 |
$1,752.89
|
|
Ghs tx distal phalangeal fx with manipulation
|
$683.40 |
$683.40 |
$683.40 |
$535.60
|
|
Ghs urine, porphyrins quant
|
$159.60 |
$159.60 |
$159.60 |
$74.20
|
|
Ghs vaginal delivery only
|
$3,719.40 |
$3,719.40 |
$3,719.40 |
$3,225.60
|
|
Gi inhouse confirmation
|
$176.40 |
$176.40 |
$176.40 |
$83.70
|
|
Glucose 1 hr post dose
|
$84.00 |
$84.00 |
$84.00 |
$49.20
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$52.20 |
$52.20 |
$52.20 |
$23.68
|
|
Glucose blood quantitative
|
$75.00 |
$75.00 |
$75.00 |
$41.40
|
|
Glucose body fluid
|
$94.80 |
$94.80 |
$94.80 |
$50.82
|
|
Glucose tolerance test (gtt) 3 specimens
|
$347.40 |
$347.40 |
$347.40 |
$100.10
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$75.00 |
$75.00 |
$75.00 |
$35.70
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$210.60 |
$210.60 |
$210.60 |
$116.64
|
|
Gonadotropin luteinizing hormone (lh)
|
$377.40 |
$377.40 |
$377.40 |
$129.89
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$129.00 |
$129.00 |
$129.00 |
$143.50
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$89.40 |
$89.40 |
$89.40 |
$23,253.65
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$168.00 |
$168.00 |
$168.00 |
$1,111.05
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$301.80 |
$301.80 |
$301.80 |
$1,181.41
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$569.40 |
$569.40 |
$569.40 |
$1,132.47
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$70.80 |
$70.80 |
$70.80 |
$28,666.90
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$284.40 |
$284.40 |
$284.40 |
$1,132.47
|
|
Great toe with reduction 28495
|
$322.20 |
$322.20 |
$322.20 |
$513.36
|
|
G-tube reposition
|
$3,010.20 |
$3,010.20 |
$3,010.20 |
$748.86
|
