|
Ghs layered repair over 3.0 cm -12057
|
$1,507.22 |
$1,507.22 |
$3,003.00 |
$1,064.98
|
|
Ghs leukocyte alkaline phos (mayo)
|
$203.50 |
$203.50 |
$203.50 |
$59.40
|
|
Ghs low level laser therapy
|
$315.15 |
$315.15 |
$315.15 |
$106.00
|
|
Ghs mbp
|
$212.85 |
$212.85 |
$240.90 |
$74.19
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$152.35 |
$152.35 |
$200.92 |
$261.80
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$200.92 |
$200.92 |
$224.40 |
$252.50
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$192.50 |
$192.50 |
$245.24 |
$239.20
|
|
Ghs moderate sedation ea addtl 15 min
|
$118.69 |
$118.69 |
$135.85 |
$145.60
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$111.54 |
$111.54 |
$152.35 |
$140.00
|
|
Ghs musc test done w/n test comp
|
$293.15 |
$293.15 |
$476.19 |
$349.80
|
|
Ghs musc tst done w/nerv tst lim
|
$243.10 |
$243.10 |
$476.19 |
$269.15
|
|
Ghs musc tst done w/n tst non ext
|
$150.70 |
$150.70 |
$150.70 |
$222.60
|
|
Ghs myocardial strain img spckl track
|
$621.34 |
$621.34 |
$963.05 |
$503.85
|
|
Ghs nailbed repair/nail removal
|
$1,425.00 |
$1,425.00 |
$1,453.10 |
$808.80
|
|
Ghs nerve blk intercostal, ea addtl level
|
$2,339.70 |
$2,339.70 |
$2,496.78 |
$1,618.50
|
|
Ghs nerve blk intercostal, single level
|
$1,559.42 |
$1,559.42 |
$1,789.15 |
$1,230.80
|
|
Ghs nerve block axillary nerve
|
$2,677.40 |
$2,677.40 |
$2,677.40 |
$1,541.40
|
|
Ghs nerve block brachial plexus
|
$3,587.65 |
$3,587.65 |
$3,587.65 |
$1,768.00
|
|
Ghs nerve block celiac plexus
|
$1,560.13 |
$1,560.13 |
$1,808.40 |
$1,712.00
|
|
Ghs nerve block interscaline
|
$1,555.40 |
$1,555.40 |
$1,555.40 |
$1,607.45
|
|
Ghs nerve block lumbar or thoracic symp
|
$1,789.64 |
$1,789.64 |
$2,033.90 |
$2,042.60
|
|
Ghs nerve block sciatic nerve
|
$4,305.95 |
$4,305.95 |
$4,305.95 |
$1,636.80
|
|
Ghs ng placement w fluoro guidance
|
$735.02 |
$735.02 |
$2,339.70 |
$468.75
|
|
Ghs o2 saturation
|
$152.35 |
$152.35 |
$152.35 |
$72.45
|
|
Ghs o2 uptake rest & indirect
|
$198.06 |
$198.06 |
$343.75 |
$195.00
|
|
Ghs opcc repair cvp without subq port
|
$2,033.90 |
$2,033.90 |
$3,255.40 |
$1,302.54
|
|
Ghs opcc repair cvp w subq port
|
$2,712.05 |
$2,712.05 |
$3,010.86 |
$2,430.56
|
|
Ghs ot group caregiver training
|
$36.85 |
$36.85 |
$38.12 |
$43.20
|
|
Ghs ot prosthetic training/15 min
|
$118.25 |
$118.25 |
$118.25 |
$92.35
|
|
Ghs ot sensory integrative tech/15min
|
$114.43 |
$114.43 |
$114.43 |
$101.05
|
|
Ghs ot work hardening-additional hours
|
$69.30 |
$69.30 |
$69.30 |
$121.54
|
|
Ghs pacing - transcutaneous
|
$658.35 |
$658.35 |
$1,556.56 |
$868.68
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$311.02 |
$311.02 |
$450.45 |
$855.60
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$388.24 |
$388.24 |
$1,646.70 |
$1,003.00
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$33.00 |
$33.00 |
$44.00 |
$90.15
|
|
Ghs peritonsillar abscess i andd
|
$1,687.95 |
$1,687.95 |
$1,688.12 |
$694.20
|
|
Ghs phenylketonurid
|
$6.05 |
$6.05 |
$6.60 |
$51.58
|
|
Ghs picc line insert < 5
|
$1,549.35 |
$1,549.35 |
$3,355.50 |
$2,060.40
|
|
Ghs plngl fx pm cl
|
$659.23 |
$659.23 |
$1,113.75 |
$662.20
|
|
Ghs plt ct-manual
|
$30.25 |
$30.25 |
$30.25 |
$39.20
|
|
Ghs polysom <6 yrs 4/> parameters
|
$4,114.60 |
$4,114.60 |
$4,114.60 |
$3,705.80
|
|
Ghs ppd (tb intradermal)
|
$20.00 |
$20.00 |
$29.70 |
$43.45
|
|
Ghs prostatic acid phosphatase (mayo)
|
$139.15 |
$139.15 |
$139.15 |
$40.56
|
|
Ghs protein, misc fluid
|
$133.65 |
$133.65 |
$133.65 |
$24.60
|
|
Ghs protoporphyrins fract
|
$113.30 |
$113.30 |
$140.80 |
$64.35
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$31.90 |
$31.90 |
$31.90 |
$45.05
|
|
Ghs pt - work hardening/int 2hrs
|
$184.25 |
$184.25 |
$184.25 |
$255.60
|
|
Ghs quinidine
|
$141.35 |
$141.35 |
$159.50 |
$68.40
|
|
Ghs refill of implantable pump
|
$345.59 |
$345.59 |
$345.59 |
$539.13
|
|
Ghs removal intranasal foreign body
|
$300.30 |
$300.30 |
$813.45 |
$324.35
|
|
Ghs removal pharyngeal foreign body
|
$1,059.63 |
$1,059.63 |
$1,977.80 |
$460.00
|
|
Ghs repair extensor tendon hand, ea tendon
|
$3,028.02 |
$3,028.02 |
$6,489.45 |
$2,211.05
|
|
Ghs repair tendon ext forearm/wrist ea
|
$3,151.00 |
$3,151.00 |
$6,392.65 |
$4,150.20
|
|
Ghs respiratory syncytical virus igg/m
|
$26.40 |
$26.40 |
$26.40 |
$42.40
|
|
Ghs rsv eia (respir synctial vrs)
|
$89.10 |
$89.10 |
$89.10 |
$101.15
|
|
Ghs sensitivity (per antimicro)
|
$31.35 |
$31.35 |
$77.00 |
$59.90
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$539.82 |
$539.82 |
$1,549.35 |
$590.40
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$738.60 |
$738.60 |
$1,549.35 |
$705.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$632.78 |
$632.78 |
$1,646.70 |
$670.08
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$1,646.70 |
$1,646.70 |
$1,646.70 |
$585.90
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$526.96 |
$526.96 |
$1,355.75 |
$487.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$501.93 |
$501.93 |
$1,258.95 |
$470.47
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$632.78 |
$632.78 |
$1,453.10 |
$538.64
|
|
Ghs simple repair over 30 cm - 12007
|
$925.92 |
$925.92 |
$1,742.95 |
$660.00
|
|
Ghs somatosensory testing lower extremit
|
$845.84 |
$845.84 |
$1,760.55 |
$947.48
|
|
Ghs somatosensory testing upper & lower limbs
|
$980.26 |
$980.26 |
$3,017.85 |
$1,435.00
|
|
Ghs speech-gen aug dev eval iii, st
|
$42.90 |
$42.90 |
$42.90 |
$124.80
|
|
Ghs sphenopalatine ganglion block
|
$341.55 |
$341.55 |
$341.55 |
$706.56
|
|
Ghs sp train/fitting sp device - kx
|
$114.84 |
$114.84 |
$114.84 |
$261.95
|
|
Ghs st - eval for alt comm
|
$34.98 |
$34.98 |
$72.60 |
$99.75
|
|
Ghs strapping shoulder - 29240
|
$308.16 |
$308.16 |
$308.16 |
$243.07
|
|
Ghs st - re-eval for alt comm
|
$258.50 |
$258.50 |
$314.10 |
$309.00
|
|
Ghs superficial wnd dehiscence simp12020
|
$1,583.01 |
$1,583.01 |
$3,007.40 |
$976.98
|
|
Ghs superficial wnd dehis w packing12021
|
$755.15 |
$755.15 |
$2,321.60 |
$761.28
|
|
Ghs tracheostomy emergency - transtracheal
|
$2,969.45 |
$2,969.45 |
$2,969.45 |
$2,225.73
|
|
Ghs tx distal phalangeal fx with manipulation
|
$632.78 |
$632.78 |
$1,113.75 |
$591.00
|
|
Ghs urine, porphyrins quant
|
$107.80 |
$107.80 |
$145.75 |
$70.20
|
|
Ghs vaginal delivery only
|
$2,795.65 |
$2,795.65 |
$2,795.65 |
$3,525.06
|
|
Ghs veeg 12-26 hr intmt mont
|
$898.70 |
$898.70 |
$3,467.20 |
$1,843.00
|
|
Ghs windowing of cast
|
$301.73 |
$301.73 |
$301.73 |
$204.00
|
|
Gi inhouse confirmation
|
$57.75 |
$57.75 |
$66.00 |
$87.00
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$2,526.70 |
$2,526.70 |
$3,286.25 |
$2,382.90
|
|
Gi trc img intral esophagus
|
$2,526.70 |
$2,526.70 |
$3,043.15 |
$1,844.80
|
|
Gi wireless capsule measure
|
$2,580.60 |
$2,580.60 |
$2,580.60 |
$1,247.13
|
|
Gjb2 gene known fam variants
|
$894.30 |
$894.30 |
$894.30 |
$67.67
|
|
Glucagon plasma - sendout
|
$132.00 |
$132.00 |
$132.00 |
$58.56
|
|
Glucose 1 hr post dose
|
$41.80 |
$41.80 |
$45.65 |
$46.28
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$22.00 |
$22.00 |
$89.10 |
$22.00
|
|
Glucose blood quantitative
|
$30.80 |
$30.80 |
$49.50 |
$44.76
|
|
Glucose body fluid
|
$21.45 |
$21.45 |
$44.00 |
$50.70
|
|
Glucose monitoring continual min 72hr pt
|
$56.63 |
$56.63 |
$56.63 |
$139.10
|
|
Glucose tolerance test (gtt) 3 specimens
|
$88.00 |
$88.00 |
$107.80 |
$100.10
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$21.45 |
$21.45 |
$50.05 |
$34.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$86.90 |
$86.90 |
$204.60 |
$110.04
|
|
Gonadotropin luteinizing hormone (lh)
|
$136.40 |
$136.40 |
$253.55 |
$123.75
|
|
Gonioscopy
|
$35.80 |
$35.80 |
$126.25 |
$145.86
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$15,958.26 |
$15,958.26 |
$15,958.26 |
$1,679.75
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$920.16 |
$920.16 |
$16,443.74 |
$25,762.70
|
|
Graft nerve adv 3-4x70mm
|
$3,444.83 |
$3,444.83 |
$4,459.81 |
$27,495.00
|
|
Graft patch felt ptfe 2x2
|
$2,174.78 |
$2,174.78 |
$2,604.93 |
$25,728.84
|
