|
Ghs i and d pilonidal cyst simple
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$794.82
|
|
Ghs immun0electrophoresis
|
$32.91 |
$32.91 |
$32.91 |
$110.00
|
|
Ghs incision thrombosed ext hemorrhoid
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$543.21
|
|
Ghs indirect laryngoscopy/w fb removal
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$293.58
|
|
Ghs inf midline insertion
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,228.50
|
|
Ghs inhibitor screen
|
$14.16 |
$14.16 |
$14.16 |
$152.10
|
|
Ghs init tx 1st degree burn
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$298.10
|
|
Ghs inj neurolytic intercostal nerve
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,037.10
|
|
Ghs inj neurolytic other perph nerve
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,972.69
|
|
Ghs inj tendon origin/insertion
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$431.07
|
|
Ghs inj transforaminal cerv single bil
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,855.36
|
|
Ghs insertion of needle - bone
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$460.65
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$943.20
|
|
Ghs intermed repair 20.1 - 30.0 cm-12036
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,160.00
|
|
Ghs intermed repair over 30 cm - 12037
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,164.64
|
|
Ghs irrigate corpora cavernosa for priapism
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$633.05
|
|
Ghs IV inf sq injection, on-body injector
|
$79.98 |
$79.98 |
$79.98 |
$117.00
|
|
Ghs IV thrombolytics - cerebral
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$657.15
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$542.40
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$617.60
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$619.20
|
|
Ghs layer closure 2.5cm or less - 12051
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$648.00
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$741.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$741.00
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$779.35
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$810.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$782.40
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$776.10
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$995.20
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$879.60
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,158.40
|
|
Ghs layered repair 20.1 - 30.0 cm -12056
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,030.80
|
|
Ghs layered repair over 30.0 cm -12047
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,024.70
|
|
Ghs layered repair over 3.0 cm -12057
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,064.98
|
|
Ghs leukocyte alkaline phos (mayo)
|
$9.46 |
$9.46 |
$9.46 |
$59.40
|
|
Ghs mbp
|
$18.92 |
$18.92 |
$18.92 |
$74.19
|
|
Ghs myocardial strain img spckl track
|
$297.66 |
$297.66 |
$297.66 |
$503.85
|
|
Ghs nailbed repair/nail removal
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$800.00
|
|
Ghs nerve blk intercostal, ea addtl level
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,577.79
|
|
Ghs nerve blk intercostal, single level
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,230.80
|
|
Ghs nerve block axillary nerve
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,540.00
|
|
Ghs nerve block brachial plexus
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,768.00
|
|
Ghs nerve block celiac plexus
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,712.00
|
|
Ghs nerve block interscaline
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,580.60
|
|
Ghs nerve block lumbar or thoracic symp
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,033.90
|
|
Ghs nerve block sciatic nerve
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,636.80
|
|
Ghs nerve block suprascapular
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,223.00
|
|
Ghs ng placement w fluoro guidance
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$468.75
|
|
Ghs o2 saturation
|
$10.75 |
$10.75 |
$10.75 |
$72.45
|
|
Ghs opcc repair cvp without subq port
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,289.00
|
|
Ghs opcc repair cvp w subq port
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,401.85
|
|
Ghs optokenetic
|
$68.32 |
$68.32 |
$68.32 |
$196.66
|
|
Ghs oscillating trac
|
$84.15 |
$84.15 |
$84.15 |
$267.15
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$1,003.00
|
|
Ghs peritonsillar abscess i andd
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$694.20
|
|
Ghs phenylketonurid
|
$6.05 |
$6.05 |
$6.05 |
$53.30
|
|
Ghs picc line insert < 5
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,060.40
|
|
Ghs plngl fx pm cl
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$662.20
|
|
Ghs plt ct-manual
|
$4.74 |
$4.74 |
$4.74 |
$39.20
|
|
Ghs polysom <6 yrs 4/> parameters
|
$1,697.43 |
$1,697.43 |
$1,697.43 |
$3,705.80
|
|
Ghs pos nystagmus
|
$111.23 |
$111.23 |
$111.23 |
$211.90
|
|
Ghs ppd (tb intradermal)
|
$10.20 |
$10.20 |
$10.20 |
$43.45
|
|
Ghs prostatic acid phosphatase (mayo)
|
$10.63 |
$10.63 |
$10.63 |
$40.56
|
|
Ghs protein, misc fluid
|
$6.17 |
$6.17 |
$6.17 |
$24.60
|
|
Ghs protoporphyrins fract
|
$15.79 |
$15.79 |
$15.79 |
$64.35
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$13.48 |
$13.48 |
$13.48 |
$45.05
|
|
Ghs quinidine
|
$16.06 |
$16.06 |
$16.06 |
$68.40
|
|
Ghs removal intranasal foreign body
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$321.75
|
|
Ghs removal pharyngeal foreign body
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$460.00
|
|
Ghs repair extensor tendon hand, ea tendon
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,211.05
|
|
Ghs repair tendon ext forearm/wrist ea
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$4,108.00
|
|
Ghs respiratory syncytical virus igg/m
|
$17.48 |
$17.48 |
$17.48 |
$42.40
|
|
Ghs reticulocyte count
|
$4.74 |
$4.74 |
$4.74 |
$33.57
|
|
Ghs rsv eia (respir synctial vrs)
|
$15.30 |
$15.30 |
$15.30 |
$103.95
|
|
Ghs sedimentation rate
|
$4.70 |
$4.70 |
$4.70 |
$46.62
|
|
Ghs semen analysis fert
|
$13.54 |
$13.54 |
$13.54 |
$124.80
|
|
Ghs semen analysis, post-vas
|
$10.82 |
$10.82 |
$10.82 |
$32.37
|
|
Ghs sensitivity (per antimicro)
|
$8.23 |
$8.23 |
$8.23 |
$59.90
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$589.80
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$705.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$667.16
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$585.90
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$487.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$470.47
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$533.00
|
|
Ghs simple repair over 30 cm - 12007
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$654.08
|
|
Ghs simple repair over 30 cm - 12018
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$589.18
|
|
Ghs sleep study unattended
|
$382.64 |
$382.64 |
$382.64 |
$503.38
|
|
Ghs sphenopalatine ganglion block
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$700.70
|
|
Ghs spont nystagmus
|
$107.48 |
$107.48 |
$107.48 |
$217.57
|
|
Ghs st - eval for alt comm
|
$47.49 |
$47.49 |
$47.49 |
$99.75
|
|
Ghs strapping shoulder - 29240
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$243.07
|
|
Ghs superficial wnd dehiscence simp12020
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$972.40
|
|
Ghs superficial wnd dehis w packing12021
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$755.82
|
|
Ghs tracheostomy emergency - transtracheal
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$2,224.80
|
|
Ghs trypsin (fecal)
|
$8.03 |
$8.03 |
$8.03 |
$21.84
|
|
Ghs tx distal phalangeal fx with manipulation
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$578.00
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$4,881.00 |
$4,881.00 |
$4,881.00 |
$545.05
|
|
Ghs urine, hydroxproline total
|
$26.73 |
$26.73 |
$26.73 |
$61.60
|
|
Ghs urine, porphyrins quant
|
$16.18 |
$16.18 |
$16.18 |
$67.60
|
