|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$1,657.60 |
$1,657.60 |
$1,657.60 |
$886.07
|
|
Ghs intermed repair 20.1 - 30.0 cm-12036
|
$2,137.60 |
$2,137.60 |
$2,137.60 |
$1,051.20
|
|
Ghs intermed repair over 30 cm - 12037
|
$2,111.20 |
$2,111.20 |
$2,111.20 |
$2,164.64
|
|
Ghs irrigate corpora cavernosa for priapism
|
$339.20 |
$339.20 |
$339.20 |
$551.20
|
|
Ghs IV inf sq injection, on-body injector
|
$86.40 |
$86.40 |
$86.40 |
$110.00
|
|
Ghs IV infusion bamlanivimab/etesevimab
|
$752.00 |
$752.00 |
$752.00 |
$553.80
|
|
Ghs IV infusion casirivimab/imdevimab
|
$752.00 |
$752.00 |
$752.00 |
$576.40
|
|
Ghs IV infusion sotrovimab
|
$752.00 |
$752.00 |
$752.00 |
$566.87
|
|
Ghs IV thrombolytics - cerebral
|
$632.00 |
$632.00 |
$632.00 |
$663.00
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$446.40 |
$446.40 |
$446.40 |
$489.67
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$660.80 |
$660.80 |
$660.80 |
$591.00
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$812.00 |
$812.00 |
$812.00 |
$583.10
|
|
Ghs layer closure 2.5cm or less - 12051
|
$1,012.00 |
$1,012.00 |
$1,012.00 |
$603.20
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$1,239.20 |
$1,239.20 |
$1,239.20 |
$672.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$1,196.00 |
$1,196.00 |
$1,196.00 |
$700.33
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$1,964.80 |
$1,964.80 |
$1,964.80 |
$741.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$1,344.80 |
$1,344.80 |
$1,344.80 |
$779.35
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$1,196.00 |
$1,196.00 |
$1,196.00 |
$760.20
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$2,332.00 |
$2,332.00 |
$2,332.00 |
$740.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$2,029.60 |
$2,029.60 |
$2,029.60 |
$969.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$2,908.00 |
$2,908.00 |
$2,908.00 |
$784.80
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$2,330.40 |
$2,330.40 |
$2,330.40 |
$1,016.25
|
|
Ghs layered repair 20.1 - 30.0 cm -12056
|
$3,696.80 |
$3,696.80 |
$3,696.80 |
$913.90
|
|
Ghs layered repair over 30.0 cm -12047
|
$2,230.40 |
$2,230.40 |
$2,230.40 |
$1,930.50
|
|
Ghs layered repair over 3.0 cm -12057
|
$4,013.60 |
$4,013.60 |
$4,013.60 |
$1,064.98
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$807.20 |
$807.20 |
$807.20 |
$246.33
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$919.20 |
$919.20 |
$919.20 |
$228.45
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$919.20 |
$919.20 |
$919.20 |
$233.28
|
|
Ghs moderate sedation ea addtl 15 min
|
$406.40 |
$406.40 |
$406.40 |
$150.00
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$406.40 |
$406.40 |
$406.40 |
$142.40
|
|
Ghs musc test done w/n test comp
|
$324.80 |
$324.80 |
$324.80 |
$331.20
|
|
Ghs musc tst done w/nerv tst lim
|
$324.80 |
$324.80 |
$324.80 |
$272.48
|
|
Ghs nailbed repair/nail removal
|
$495.20 |
$495.20 |
$495.20 |
$724.37
|
|
Ghs nerve blk intercostal, ea addtl level
|
$1,953.60 |
$1,953.60 |
$1,953.60 |
$1,556.24
|
|
Ghs nerve blk intercostal, single level
|
$1,525.60 |
$1,525.60 |
$1,525.60 |
$1,160.00
|
|
Ghs nerve block axillary nerve
|
$2,301.60 |
$2,301.60 |
$2,301.60 |
$1,563.66
|
|
Ghs nerve block brachial plexus
|
$1,607.20 |
$1,607.20 |
$1,607.20 |
$1,710.80
|
|
Ghs nerve block celiac plexus
|
$2,853.60 |
$2,853.60 |
$2,853.60 |
$1,661.40
|
|
Ghs o2 saturation
|
$170.40 |
$170.40 |
$170.40 |
$69.50
|
|
Ghs o2 uptake rest & indirect
|
$459.20 |
$459.20 |
$459.20 |
$173.50
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$148.00 |
$148.00 |
$148.00 |
$58.00
|
|
Ghs ot group caregiver training
|
$46.40 |
$46.40 |
$46.40 |
$34.80
|
|
Ghs ot prosthetic training/15 min
|
$164.00 |
$164.00 |
$164.00 |
$93.00
|
|
Ghs ot sensory integrative tech/15min
|
$152.00 |
$152.00 |
$152.00 |
$96.20
|
|
Ghs ot work hardening-additional hours
|
$170.40 |
$170.40 |
$170.40 |
$126.40
|
|
Ghs pacing - transcutaneous
|
$852.80 |
$852.80 |
$852.80 |
$830.53
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$2,824.80 |
$2,824.80 |
$2,824.80 |
$962.00
|
|
Ghs peritonsillar abscess i andd
|
$1,258.40 |
$1,258.40 |
$1,258.40 |
$555.00
|
|
Ghs phenylketonurid
|
$348.80 |
$348.80 |
$348.80 |
$53.76
|
|
Ghs picc line insert < 5
|
$1,311.20 |
$1,311.20 |
$1,311.20 |
$2,019.50
|
|
Ghs plngl fx pm cl
|
$974.40 |
$974.40 |
$974.40 |
$564.80
|
|
Ghs polysom <6 yrs 4/> parameters
|
$5,770.40 |
$5,770.40 |
$5,770.40 |
$3,557.58
|
|
Ghs ppd (tb intradermal)
|
$52.00 |
$52.00 |
$52.00 |
$37.44
|
|
Ghs prostatic acid phosphatase (mayo)
|
$154.40 |
$154.40 |
$154.40 |
$43.55
|
|
Ghs protoporphyrins fract
|
$449.60 |
$449.60 |
$449.60 |
$60.75
|
|
Ghs pr without cont pulse ox
|
$281.60 |
$281.60 |
$281.60 |
$147.00
|
|
Ghs pt - work hardening/int 2hrs
|
$481.60 |
$481.60 |
$481.60 |
$285.60
|
|
Ghs removal intranasal foreign body
|
$442.40 |
$442.40 |
$442.40 |
$283.24
|
|
Ghs removal pharyngeal foreign body
|
$898.40 |
$898.40 |
$898.40 |
$441.68
|
|
Ghs sedimentation rate
|
$80.80 |
$80.80 |
$80.80 |
$45.50
|
|
Ghs semen analysis fert
|
$396.80 |
$396.80 |
$396.80 |
$124.80
|
|
Ghs sensitivity (per antimicro)
|
$124.80 |
$124.80 |
$124.80 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$477.60 |
$477.60 |
$477.60 |
$570.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$632.00 |
$632.00 |
$632.00 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$436.00 |
$436.00 |
$436.00 |
$586.50
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$3,332.80 |
$3,332.80 |
$3,332.80 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$407.20 |
$407.20 |
$407.20 |
$449.15
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$445.60 |
$445.60 |
$445.60 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$448.00 |
$448.00 |
$448.00 |
$489.72
|
|
Ghs simple repair over 30 cm - 12007
|
$584.00 |
$584.00 |
$584.00 |
$590.88
|
|
Ghs simple repair over 30 cm - 12018
|
$3,747.20 |
$3,747.20 |
$3,747.20 |
$537.60
|
|
Ghs somatosensory testing lower extremit
|
$1,091.20 |
$1,091.20 |
$1,091.20 |
$925.91
|
|
Ghs sp train/fitting sp device - kx
|
$382.40 |
$382.40 |
$382.40 |
$252.75
|
|
Ghs strapping shoulder - 29240
|
$217.60 |
$217.60 |
$217.60 |
$217.60
|
|
Ghs superficial wnd dehiscence simp12020
|
$3,320.00 |
$3,320.00 |
$3,320.00 |
$953.27
|
|
Ghs tracheostomy emergency - transtracheal
|
$2,689.60 |
$2,689.60 |
$2,689.60 |
$1,867.84
|
|
Ghs tx distal phalangeal fx with manipulation
|
$1,196.00 |
$1,196.00 |
$1,196.00 |
$529.65
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$1,941.60 |
$1,941.60 |
$1,941.60 |
$513.80
|
|
Ghs urine, porphyrins quant
|
$215.20 |
$215.20 |
$215.20 |
$73.80
|
|
Ghs vaginal delivery only
|
$4,535.20 |
$4,535.20 |
$4,535.20 |
$3,341.93
|
|
Gi endoscopic ultrasound
|
$744.80 |
$744.80 |
$744.80 |
$582.31
|
|
Gi inhouse confirmation
|
$179.20 |
$179.20 |
$179.20 |
$87.75
|
|
Glucose 1 hr post dose
|
$118.40 |
$118.40 |
$118.40 |
$49.00
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$83.20 |
$83.20 |
$83.20 |
$23.12
|
|
Glucose blood quantitative
|
$72.80 |
$72.80 |
$72.80 |
$42.25
|
|
Glucose body fluid
|
$119.20 |
$119.20 |
$119.20 |
$51.30
|
|
Glucose tolerance test (gtt) 3 specimens
|
$235.20 |
$235.20 |
$235.20 |
$105.60
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$86.40 |
$86.40 |
$86.40 |
$36.00
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$243.20 |
$243.20 |
$243.20 |
$116.64
|
|
Gonadotropin luteinizing hormone (lh)
|
$537.60 |
$537.60 |
$537.60 |
$129.03
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$170.40 |
$170.40 |
$170.40 |
$73.83
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$1,920.00 |
$1,920.00 |
$1,920.00 |
$605.00
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$118.40 |
$118.40 |
$118.40 |
$23,233.80
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$222.40 |
$222.40 |
$222.40 |
$1,111.05
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$406.40 |
$406.40 |
$406.40 |
$886.17
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$766.40 |
$766.40 |
$766.40 |
$1,132.47
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$94.40 |
$94.40 |
$94.40 |
$28,894.71
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$382.40 |
$382.40 |
$382.40 |
$1,103.05
|
|
Great toe with reduction 28495
|
$907.20 |
$907.20 |
$907.20 |
$495.00
|
|
G-tube reposition
|
$2,052.00 |
$2,052.00 |
$2,052.00 |
$771.36
|
