|
Ghs moderate sedation < 5 yr, 30 min, other
|
$138.00 |
$138.00 |
$145.20 |
$228.45
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$120.00 |
$120.00 |
$130.20 |
$239.20
|
|
Ghs moderate sedation ea addtl 15 min
|
$39.00 |
$39.00 |
$47.40 |
$151.20
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$86.40 |
$86.40 |
$90.60 |
$142.40
|
|
Ghs musc test done w/n test comp
|
$315.00 |
$315.00 |
$331.20 |
$331.20
|
|
Ghs musc tst done w/nerv tst lim
|
$263.40 |
$263.40 |
$276.60 |
$272.48
|
|
Ghs musc tst done w/n tst non ext
|
$72.60 |
$72.60 |
$81.00 |
$184.80
|
|
Ghs myocardial strain img spckl track
|
$210.60 |
$210.60 |
$220.80 |
$457.80
|
|
Ghs nailbed repair/nail removal
|
$409.20 |
$409.20 |
$429.60 |
$726.86
|
|
Ghs nerve blk intercostal, ea addtl level
|
$906.00 |
$906.00 |
$1,047.00 |
$1,556.24
|
|
Ghs nerve blk intercostal, single level
|
$528.60 |
$528.60 |
$610.80 |
$1,160.00
|
|
Ghs nerve block axillary nerve
|
$528.60 |
$528.60 |
$610.80 |
$1,601.60
|
|
Ghs nerve block brachial plexus
|
$528.60 |
$528.60 |
$610.80 |
$1,710.80
|
|
Ghs nerve block celiac plexus
|
$690.60 |
$690.60 |
$798.00 |
$1,668.80
|
|
Ghs nerve block interscaline
|
$983.40 |
$983.40 |
$1,136.40 |
$1,541.40
|
|
Ghs nerve block lumbar or thoracic symp
|
$690.60 |
$690.60 |
$798.00 |
$1,706.50
|
|
Ghs nerve block sciatic nerve
|
$468.00 |
$468.00 |
$540.60 |
$1,450.80
|
|
Ghs nerve block suprascapular
|
$553.80 |
$553.80 |
$639.60 |
$1,198.62
|
|
Ghs ng placement w fluoro guidance
|
$349.20 |
$349.20 |
$366.60 |
$485.00
|
|
Ghs o2 saturation
|
$101.40 |
$101.40 |
$106.80 |
$69.50
|
|
Ghs o2 uptake rest & exercise
|
$298.80 |
$298.80 |
$333.00 |
$239.05
|
|
Ghs o2 uptake rest & indirect
|
$105.60 |
$105.60 |
$118.20 |
$173.50
|
|
Ghs ob unlisted IV or art inj or infusion
|
$118.80 |
$118.80 |
$132.60 |
$82.62
|
|
Ghs opcc repair cvp without subq port
|
$327.60 |
$327.60 |
$379.20 |
$1,236.96
|
|
Ghs opcc repair cvp w subq port
|
$1,027.80 |
$1,027.80 |
$1,187.40 |
$2,194.40
|
|
Ghs optokenetic
|
$141.00 |
$141.00 |
$157.20 |
$214.00
|
|
Ghs oscillating trac
|
$141.00 |
$141.00 |
$157.20 |
$296.91
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$58.80 |
$58.80 |
$61.80 |
$58.00
|
|
Ghs osteopathic manipulative tx, 3-4 regions
|
$83.40 |
$83.40 |
$87.60 |
$61.11
|
|
Ghs ot dds rom
|
$66.00 |
$66.00 |
$76.80 |
$66.95
|
|
Ghs ot group caregiver training
|
$31.20 |
$31.20 |
$33.00 |
$34.80
|
|
Ghs ot prosthetic training/15 min
|
$59.40 |
$59.40 |
$66.60 |
$93.50
|
|
Ghs ot sensory integrative tech/15min
|
$57.60 |
$57.60 |
$64.80 |
$96.60
|
|
Ghs ot work hardening-additional hours
|
$54.00 |
$54.00 |
$59.40 |
$126.40
|
|
Ghs pacing - transcutaneous
|
$400.80 |
$400.80 |
$484.20 |
$839.65
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$1,076.40 |
$1,076.40 |
$1,088.40 |
$880.00
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$1,076.40 |
$1,076.40 |
$1,212.60 |
$962.00
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$27.60 |
$27.60 |
$31.20 |
$72.80
|
|
Ghs peritonsillar abscess i andd
|
$373.80 |
$373.80 |
$451.20 |
$560.53
|
|
Ghs phenylketonurid
|
$108.00 |
$108.00 |
$120.60 |
$53.76
|
|
Ghs picc line insert < 5
|
$794.40 |
$794.40 |
$960.00 |
$2,019.50
|
|
Ghs plngl fx pm cl
|
$606.00 |
$606.00 |
$636.60 |
$578.00
|
|
Ghs plt ct-manual
|
$34.80 |
$34.80 |
$39.00 |
$37.96
|
|
Ghs polysom <6 yrs 4/> parameters
|
$2,840.40 |
$2,840.40 |
$3,161.40 |
$3,557.58
|
|
Ghs pos nystagmus
|
$141.00 |
$141.00 |
$157.20 |
$232.70
|
|
Ghs ppd (tb intradermal)
|
$28.80 |
$28.80 |
$31.80 |
$37.44
|
|
Ghs prostatic acid phosphatase (mayo)
|
$92.40 |
$92.40 |
$103.20 |
$43.55
|
|
Ghs protein, misc fluid
|
$28.20 |
$28.20 |
$31.80 |
$24.60
|
|
Ghs protoporphyrins fract
|
$85.20 |
$85.20 |
$95.40 |
$60.75
|
|
Ghs pr without cont pulse ox
|
$106.80 |
$106.80 |
$119.40 |
$147.00
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$72.00 |
$72.00 |
$80.40 |
$47.55
|
|
Ghs pt - work hardening/int 2hrs
|
$129.60 |
$129.60 |
$144.60 |
$285.60
|
|
Ghs quinidine
|
$118.20 |
$118.20 |
$124.20 |
$85.00
|
|
Ghs refill of implantable pump
|
$237.00 |
$237.00 |
$311.40 |
$539.13
|
|
Ghs removal intranasal foreign body
|
$424.80 |
$424.80 |
$445.80 |
$283.51
|
|
Ghs removal pharyngeal foreign body
|
$320.40 |
$320.40 |
$336.60 |
$441.68
|
|
Ghs repair extensor tendon hand, ea tendon
|
$1,011.60 |
$1,011.60 |
$1,062.00 |
$2,517.00
|
|
Ghs repair tendon ext forearm/wrist ea
|
$1,093.80 |
$1,093.80 |
$1,148.40 |
$4,150.20
|
|
Ghs respiratory syncytical virus igg/m
|
$174.00 |
$174.00 |
$193.80 |
$73.50
|
|
Ghs reticulocyte count
|
$37.80 |
$37.80 |
$42.60 |
$34.45
|
|
Ghs rsv eia (respir synctial vrs)
|
$143.40 |
$143.40 |
$159.60 |
$99.00
|
|
Ghs sedimentation rate
|
$24.60 |
$24.60 |
$27.60 |
$45.50
|
|
Ghs semen analysis fert
|
$112.20 |
$112.20 |
$124.80 |
$124.15
|
|
Ghs semen analysis, post-vas
|
$58.80 |
$58.80 |
$66.00 |
$32.37
|
|
Ghs sensitivity (per antimicro)
|
$63.60 |
$63.60 |
$70.80 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$309.00 |
$309.00 |
$341.40 |
$572.00
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$399.00 |
$399.00 |
$418.80 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$372.00 |
$372.00 |
$390.60 |
$590.40
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$550.80 |
$550.80 |
$578.40 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$270.00 |
$270.00 |
$326.40 |
$449.15
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$268.80 |
$268.80 |
$324.60 |
$437.60
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$322.20 |
$322.20 |
$343.20 |
$491.30
|
|
Ghs simple repair over 30 cm - 12007
|
$431.40 |
$431.40 |
$453.00 |
$592.20
|
|
Ghs simple repair over 30 cm - 12018
|
$313.20 |
$313.20 |
$378.00 |
$537.60
|
|
Ghs sleep study unattended
|
$799.20 |
$799.20 |
$889.80 |
$503.38
|
|
Ghs somatosensory testing lower extremit
|
$346.80 |
$346.80 |
$386.40 |
$925.91
|
|
Ghs somatosensory testing upper & lower limbs
|
$676.80 |
$676.80 |
$753.60 |
$1,416.80
|
|
Ghs speech-gen aug dev eval iii, st
|
$154.80 |
$154.80 |
$172.20 |
$157.50
|
|
Ghs sphenopalatine ganglion block
|
$442.80 |
$442.80 |
$511.80 |
$637.92
|
|
Ghs spont nystagmus
|
$129.00 |
$129.00 |
$144.00 |
$242.00
|
|
Ghs sp train/fitting sp device - kx
|
$164.40 |
$164.40 |
$183.00 |
$254.15
|
|
Ghs st - eval for alt comm
|
$119.40 |
$119.40 |
$133.20 |
$96.40
|
|
Ghs strapping shoulder - 29240
|
$129.00 |
$129.00 |
$156.00 |
$217.60
|
|
Ghs st - re-eval for alt comm
|
$125.40 |
$125.40 |
$140.40 |
$309.60
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$37.80 |
$37.80 |
$69.00 |
$99.98
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$315.60 |
$315.60 |
$351.60 |
$360.80
|
|
Ghs superficial wnd dehiscence simp12020
|
$495.60 |
$495.60 |
$520.20 |
$955.80
|
|
Ghs superficial wnd dehis w packing12021
|
$300.00 |
$300.00 |
$315.00 |
$696.68
|
|
Ghs tracheostomy emergency - transtracheal
|
$998.40 |
$998.40 |
$1,206.00 |
$1,867.84
|
|
Ghs trypsin (fecal)
|
$97.20 |
$97.20 |
$108.60 |
$50.93
|
|
Ghs tx distal phalangeal fx with manipulation
|
$562.80 |
$562.80 |
$591.00 |
$535.60
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$453.00 |
$453.00 |
$475.80 |
$513.80
|
|
Ghs urine, hydroxproline total
|
$201.60 |
$201.60 |
$224.40 |
$109.20
|
|
Ghs urine, porphyrins quant
|
$152.40 |
$152.40 |
$160.20 |
$73.80
|
|
Ghs vaginal delivery only
|
$2,042.40 |
$2,042.40 |
$2,466.60 |
$3,341.93
|
|
Ghs veeg 12-26 hr intmt mont
|
$1,416.00 |
$1,416.00 |
$1,576.80 |
$1,932.00
|
|
Ghs windowing of cast
|
$125.40 |
$125.40 |
$151.20 |
$212.55
|
|
Gi inhouse confirmation
|
$78.00 |
$78.00 |
$87.00 |
$87.20
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$1,281.60 |
$1,281.60 |
$1,345.80 |
$2,222.40
|
|
Gi trc img intral esophagus
|
$72.60 |
$72.60 |
$76.20 |
$1,897.82
|
