|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$590.20 |
$8,599.49 |
$15,877.10 |
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$366.00 |
$597.35 |
$21,494.52 |
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$657.80 |
$776.10 |
$829.40 |
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$617.50 |
$635.05 |
$692.25 |
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$762.45 |
$762.45 |
$926.90 |
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$596.05 |
$596.05 |
$681.20 |
|
|
Ghs layered repair 20.1 - 30.0 cm -12056
|
$913.90 |
$913.90 |
$1,080.95 |
|
|
Ghs layered repair over 30.0 cm -12047
|
$911.30 |
$911.30 |
$924.30 |
|
|
Ghs layered repair over 3.0 cm -12057
|
$939.90 |
$939.90 |
$1,155.05 |
|
|
Ghs leukocyte alkaline phos (mayo)
|
$20.25 |
$20.25 |
$20.25 |
|
|
Ghs mbp
|
$18.20 |
$140.40 |
$215.15 |
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$124.15 |
$159.90 |
$223.60 |
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$95.55 |
$95.55 |
$146.90 |
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$159.25 |
$169.00 |
$184.60 |
|
|
Ghs moderate sedation ea addtl 15 min
|
$21.00 |
$55.25 |
$273.00 |
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$35.75 |
$121.55 |
$131.30 |
|
|
Ghs musc test done w/n test comp
|
$301.60 |
$441.35 |
$628.55 |
|
|
Ghs musc tst done w/nerv tst lim
|
$209.30 |
$287.30 |
$332.80 |
|
|
Ghs musc tst done w/n tst non ext
|
$135.20 |
$224.25 |
$382.85 |
|
|
Ghs myocardial strain img spckl track
|
$465.40 |
$465.40 |
$465.40 |
|
|
Ghs nailbed repair/nail removal
|
$453.70 |
$563.55 |
$1,038.05 |
|
|
Ghs nerve blk intercostal, ea addtl level
|
$432.75 |
$921.05 |
$3,275.82 |
|
|
Ghs nerve blk intercostal, single level
|
$588.90 |
$2,142.61 |
$22,936.17 |
|
|
Ghs nerve block axillary nerve
|
$631.15 |
$1,322.88 |
$18,931.32 |
|
|
Ghs nerve block brachial plexus
|
$14,405.22 |
$19,631.57 |
$35,853.41 |
|
|
Ghs nerve block celiac plexus
|
$722.80 |
$722.80 |
$3,457.01 |
|
|
Ghs nerve block interscaline
|
$1,188.20 |
$2,408.03 |
$3,031.96 |
|
|
Ghs nerve block lumbar or thoracic symp
|
$1,135.55 |
$2,216.38 |
$2,466.85 |
|
|
Ghs nerve block sciatic nerve
|
$17,333.10 |
$19,886.72 |
$33,211.72 |
|
|
Ghs nerve block suprascapular
|
$425.75 |
$1,322.88 |
$2,233.40 |
|
|
Ghs ng placement w fluoro guidance
|
$190.45 |
$234.65 |
$400.40 |
|
|
Ghs o2 saturation
|
$18.20 |
$18.20 |
$92.95 |
|
|
Ghs opcc repair cvp without subq port
|
$3,443.70 |
$3,443.70 |
$3,443.70 |
|
|
Ghs opcc repair cvp w subq port
|
$604.50 |
$604.50 |
$1,179.10 |
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$50.70 |
$61.10 |
$105.75 |
|
|
Ghs osteopathic manipulative tx, 3-4 regions
|
$52.65 |
$56.55 |
$146.25 |
|
|
Ghs ot dds rom
|
$61.10 |
$87.75 |
$104.65 |
|
|
Ghs ot prosthetic training/15 min
|
$61.75 |
$82.55 |
$102.05 |
|
|
Ghs ot sensory integrative tech/15min
|
$70.20 |
$74.75 |
$82.55 |
|
|
Ghs ot work hardening-additional hours
|
$72.80 |
$72.80 |
$73.45 |
|
|
Ghs pacing - transcutaneous
|
$416.65 |
$687.05 |
$872.95 |
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$324.35 |
$324.35 |
$3,481.96 |
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$67.50 |
$1,500.20 |
$5,154.50 |
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$57.20 |
$57.20 |
$64.35 |
|
|
Ghs peritonsillar abscess i andd
|
$337.35 |
$360.10 |
$5,902.43 |
|
|
Ghs phenylketonurid
|
$35.75 |
$66.30 |
$98.80 |
|
|
Ghs picc line insert < 5
|
$536.90 |
$1,154.40 |
$1,721.85 |
|
|
Ghs plngl fx pm cl
|
$593.45 |
$687.05 |
$742.30 |
|
|
Ghs polysom <6 yrs 4/> parameters
|
$4,799.60 |
$5,074.55 |
$6,115.85 |
|
|
Ghs ppd (tb intradermal)
|
$20.15 |
$32.50 |
$85.80 |
|
|
Ghs prostatic acid phosphatase (mayo)
|
$31.85 |
$65.65 |
$161.85 |
|
|
Ghs protein, misc fluid
|
$17.25 |
$17.25 |
$20.15 |
|
|
Ghs protoporphyrins fract
|
$42.90 |
$78.65 |
$104.65 |
|
|
Ghs pr without cont pulse ox
|
$206.05 |
$261.30 |
$283.40 |
|
|
Ghs pt - work hardening/int 2hrs
|
$204.10 |
$204.10 |
$208.65 |
|
|
Ghs quinidine
|
$67.60 |
$70.85 |
$121.55 |
|
|
Ghs removal intranasal foreign body
|
$274.50 |
$294.45 |
$7,347.78 |
|
|
Ghs removal pharyngeal foreign body
|
$362.05 |
$362.05 |
$362.05 |
|
|
Ghs repair extensor tendon hand, ea tendon
|
$2,648.75 |
$2,648.75 |
$2,648.75 |
|
|
Ghs repair tendon ext forearm/wrist ea
|
$2,368.60 |
$2,368.60 |
$2,368.60 |
|
|
Ghs respiratory syncytical virus igg/m
|
$31.50 |
$31.50 |
$31.50 |
|
|
Ghs reticulocyte count
|
$19.50 |
$63.05 |
$93.60 |
|
|
Ghs rsv eia (respir synctial vrs)
|
$49.50 |
$131.30 |
$166.40 |
|
|
Ghs sedimentation rate
|
$23.25 |
$29.25 |
$81.90 |
|
|
Ghs semen analysis fert
|
$133.90 |
$133.90 |
$152.10 |
|
|
Ghs semen analysis, post-vas
|
$42.75 |
$42.75 |
$42.75 |
|
|
Ghs sensitivity (per antimicro)
|
$24.00 |
$65.65 |
$91.65 |
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$202.50 |
$474.50 |
$535.60 |
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$499.20 |
$529.75 |
$579.15 |
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$488.15 |
$572.65 |
$626.60 |
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$518.70 |
$518.70 |
$518.70 |
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$348.00 |
$454.35 |
$1,156.35 |
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$159.75 |
$426.40 |
$648.09 |
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$166.50 |
$509.60 |
$601.25 |
|
|
Ghs simple repair over 30 cm - 12007
|
$570.70 |
$648.70 |
$664.95 |
|
|
Ghs simple repair over 30 cm - 12018
|
$657.15 |
$657.15 |
$657.15 |
|
|
Ghs sleep study unattended
|
$581.75 |
$611.65 |
$720.85 |
|
|
Ghs somatosensory testing lower extremit
|
$527.80 |
$527.80 |
$922.35 |
|
|
Ghs somatosensory testing upper & lower limbs
|
$949.00 |
$949.00 |
$2,092.35 |
|
|
Ghs speech-gen aug dev eval iii, st
|
$81.25 |
$99.45 |
$196.30 |
|
|
Ghs sphenopalatine ganglion block
|
$241.15 |
$241.15 |
$286.00 |
|
|
Ghs sp train/fitting sp device - kx
|
$234.65 |
$261.95 |
$328.25 |
|
|
Ghs st - eval for alt comm
|
$34.50 |
$55.90 |
$106.60 |
|
|
Ghs strapping shoulder - 29240
|
$137.15 |
$137.15 |
$196.95 |
|
|
Ghs st - re-eval for alt comm
|
$358.80 |
$393.90 |
$414.05 |
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$354.25 |
$354.25 |
$354.25 |
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$446.55 |
$446.55 |
$446.55 |
|
|
Ghs superficial wnd dehiscence simp12020
|
$473.20 |
$551.85 |
$20,162.61 |
|
|
Ghs superficial wnd dehis w packing12021
|
$326.30 |
$326.30 |
$326.95 |
|
|
Ghs tracheostomy emergency - transtracheal
|
$698.10 |
$841.10 |
$876.20 |
|
|
Ghs tx distal phalangeal fx with manipulation
|
$432.25 |
$443.95 |
$519.35 |
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$849.55 |
$849.55 |
$849.55 |
|
|
Ghs urine, porphyrins quant
|
$93.60 |
$121.50 |
$387.40 |
|
|
Ghs vaginal delivery only
|
$166.40 |
$1,911.00 |
$4,919.20 |
|
|
Ghs veeg 12-26 hr intmt mont
|
$2,930.85 |
$2,930.85 |
$2,930.85 |
|
|
Ghs windowing of cast
|
$120.90 |
$120.90 |
$120.90 |
|
|
Gi inhouse confirmation
|
$43.50 |
$96.20 |
$159.90 |
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$1,375.40 |
$1,375.40 |
$2,657.20 |
|
|
Gi trc img intral colon i&r
|
$2,018.90 |
$2,018.90 |
$2,018.90 |
|
|
Glassia injection
|
$2,025.07 |
$2,025.07 |
$2,830.75 |
|