|
Ghs layer closure 2.5cm or less - 12051
|
$592.80 |
$616.80 |
$863.20 |
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$656.00 |
$846.40 |
$888.00 |
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$764.00 |
$782.40 |
$888.80 |
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$686.40 |
$876.00 |
$914.40 |
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$655.20 |
$655.20 |
$967.20 |
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$862.40 |
$862.40 |
$967.20 |
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$736.80 |
$862.40 |
$967.20 |
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$862.40 |
$862.40 |
$967.20 |
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$768.80 |
$967.20 |
$970.40 |
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$920.80 |
$1,126.40 |
$1,126.40 |
|
|
Ghs layered repair 20.1 - 30.0 cm -12056
|
$824.80 |
$1,248.00 |
$1,248.00 |
|
|
Ghs layered repair over 30.0 cm -12047
|
$1,821.60 |
$1,821.60 |
$2,638.40 |
|
|
Ghs layered repair over 3.0 cm -12057
|
$1,231.20 |
$1,231.20 |
$1,231.20 |
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$156.00 |
$156.00 |
$265.60 |
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$156.00 |
$156.00 |
$248.80 |
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$156.00 |
$156.00 |
$248.80 |
|
|
Ghs moderate sedation ea addtl 15 min
|
$156.00 |
$156.00 |
$166.40 |
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$137.60 |
$137.60 |
$156.00 |
|
|
Ghs myocardial strain img spckl track
|
$545.60 |
$545.60 |
$561.60 |
|
|
Ghs nailbed repair/nail removal
|
$712.80 |
$910.40 |
$952.80 |
|
|
Ghs nerve blk intercostal, ea addtl level
|
$1,476.80 |
$1,476.80 |
$1,692.00 |
|
|
Ghs nerve blk intercostal, single level
|
$1,379.20 |
$1,379.20 |
$1,548.80 |
|
|
Ghs nerve block axillary nerve
|
$1,501.60 |
$1,501.60 |
$1,725.60 |
|
|
Ghs nerve block brachial plexus
|
$1,453.60 |
$1,453.60 |
$1,941.60 |
|
|
Ghs nerve block celiac plexus
|
$1,668.80 |
$1,668.80 |
$1,974.40 |
|
|
Ghs nerve block interscaline
|
$1,834.40 |
$1,834.40 |
$1,876.00 |
|
|
Ghs nerve block lumbar or thoracic symp
|
$1,608.00 |
$1,608.00 |
$1,812.00 |
|
|
Ghs nerve block sciatic nerve
|
$1,448.00 |
$1,448.00 |
$1,790.40 |
|
|
Ghs nerve block suprascapular
|
$1,290.40 |
$1,290.40 |
$1,366.40 |
|
|
Ghs ng placement w fluoro guidance
|
$623.20 |
$623.20 |
$649.60 |
|
|
Ghs o2 uptake rest & indirect
|
$267.20 |
$267.20 |
$267.20 |
|
|
Ghs ob unlisted IV or art inj or infusion
|
$134.40 |
$134.40 |
$142.40 |
|
|
Ghs opcc repair cvp without subq port
|
$1,316.80 |
$1,316.80 |
$1,541.60 |
|
|
Ghs opcc repair cvp w subq port
|
$2,130.40 |
$2,130.40 |
$2,130.40 |
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$48.80 |
$48.80 |
$48.80 |
|
|
Ghs ot dds rom
|
$102.40 |
$102.40 |
$115.20 |
|
|
Ghs ot group caregiver training
|
$49.60 |
$55.20 |
$56.80 |
|
|
Ghs ot prosthetic training/15 min
|
$116.00 |
$118.40 |
$128.00 |
|
|
Ghs ot sensory integrative tech/15min
|
$80.80 |
$80.80 |
$124.80 |
|
|
Ghs ot work hardening-additional hours
|
$144.80 |
$144.80 |
$144.80 |
|
|
Ghs pacing - transcutaneous
|
$940.80 |
$940.80 |
$948.80 |
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$628.00 |
$628.00 |
$1,317.60 |
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$592.00 |
$592.00 |
$1,195.20 |
|
|
Ghs peritonsillar abscess i andd
|
$396.00 |
$396.00 |
$752.80 |
|
|
Ghs phenylketonurid
|
$71.20 |
$71.20 |
$71.20 |
|
|
Ghs picc line insert < 5
|
$1,990.40 |
$1,990.40 |
$2,072.00 |
|
|
Ghs plngl fx pm cl
|
$394.40 |
$949.60 |
$1,008.00 |
|
|
Ghs polysom <6 yrs 4/> parameters
|
$3,501.60 |
$3,501.60 |
$5,041.60 |
|
|
Ghs ppd (tb intradermal)
|
$24.00 |
$24.00 |
$24.00 |
|
|
Ghs pr without cont pulse ox
|
$198.40 |
$198.40 |
$254.40 |
|
|
Ghs pt - work hardening/int 2hrs
|
$253.60 |
$253.60 |
$269.60 |
|
|
Ghs refill of implantable pump
|
$517.60 |
$517.60 |
$596.80 |
|
|
Ghs removal intranasal foreign body
|
$200.00 |
$276.00 |
$507.20 |
|
|
Ghs removal pharyngeal foreign body
|
$370.40 |
$370.40 |
$578.40 |
|
|
Ghs repair extensor tendon hand, ea tendon
|
$3,835.20 |
$3,835.20 |
$3,864.00 |
|
|
Ghs repair tendon ext forearm/wrist ea
|
$4,370.40 |
$4,370.40 |
$4,370.40 |
|
|
Ghs reticulocyte count
|
$33.60 |
$33.60 |
$33.60 |
|
|
Ghs sedimentation rate
|
$22.40 |
$22.40 |
$22.40 |
|
|
Ghs semen analysis fert
|
$100.00 |
$100.00 |
$100.00 |
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$460.00 |
$460.00 |
$684.00 |
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$612.80 |
$652.80 |
$691.20 |
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$584.00 |
$757.60 |
$780.80 |
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$664.80 |
$664.80 |
$745.60 |
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$408.80 |
$448.80 |
$628.00 |
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$441.60 |
$441.60 |
$609.60 |
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$454.40 |
$504.80 |
$628.00 |
|
|
Ghs simple repair over 30 cm - 12007
|
$614.40 |
$743.20 |
$759.20 |
|
|
Ghs simple repair over 30 cm - 12018
|
$667.20 |
$667.20 |
$667.20 |
|
|
Ghs sleep study unattended
|
$589.60 |
$589.60 |
$731.20 |
|
|
Ghs somatosensory testing lower extremit
|
$410.40 |
$410.40 |
$620.80 |
|
|
Ghs somatosensory testing upper & lower limbs
|
$896.00 |
$896.00 |
$1,480.80 |
|
|
Ghs speech-gen aug dev eval iii, st
|
$146.40 |
$146.40 |
$182.40 |
|
|
Ghs sphenopalatine ganglion block
|
$640.80 |
$640.80 |
$1,160.00 |
|
|
Ghs sp train/fitting sp device - kx
|
$309.60 |
$326.40 |
$370.40 |
|
|
Ghs st - eval for alt comm
|
$93.60 |
$93.60 |
$148.80 |
|
|
Ghs strapping shoulder - 29240
|
$206.40 |
$206.40 |
$228.80 |
|
|
Ghs st - re-eval for alt comm
|
$244.80 |
$244.80 |
$432.80 |
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$108.00 |
$108.00 |
$157.60 |
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$360.80 |
$360.80 |
$588.00 |
|
|
Ghs superficial wnd dehiscence simp12020
|
$1,040.80 |
$1,399.20 |
$1,570.40 |
|
|
Ghs superficial wnd dehis w packing12021
|
$692.80 |
$768.80 |
$1,299.20 |
|
|
Ghs tracheostomy emergency - transtracheal
|
$2,224.80 |
$2,224.80 |
$2,224.80 |
|
|
Ghs tx distal phalangeal fx with manipulation
|
$388.00 |
$624.00 |
$660.80 |
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$388.00 |
$388.00 |
$388.00 |
|
|
Ghs urine, porphyrins quant
|
$50.40 |
$50.40 |
$50.40 |
|
|
Ghs vaginal delivery only
|
$3,338.40 |
$3,338.40 |
$3,338.40 |
|
|
Ghs veeg 12-26 hr intmt mont
|
$3,534.40 |
$3,534.40 |
$3,534.40 |
|
|
Ghs windowing of cast
|
$238.40 |
$299.20 |
$299.20 |
|
|
Giardia lamblia antibody
|
$72.80 |
$72.80 |
$72.80 |
|
|
Gi inhouse confirmation
|
$69.60 |
$69.60 |
$69.60 |
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$2,222.40 |
$2,222.40 |
$2,829.60 |
|
|
Glassia injection
|
$767.51 |
$767.51 |
$767.51 |
|
|
Glove finger flexion right lg xl
|
$119.20 |
$119.20 |
$119.20 |
|
|
Glucagon 1 mg solution for injection
|
$302.72 |
$302.72 |
$302.72 |
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$187.48 |
$289.36 |
$316.01 |
|
|
Glucose 1 hr post dose
|
$37.60 |
$37.60 |
$37.60 |
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$28.80 |
$28.80 |
$28.80 |
|
|
Glucose blood quantitative
|
$35.20 |
$35.20 |
$35.20 |
|
|
Glucose body fluid
|
$60.80 |
$60.80 |
$60.80 |
|
|
Glucose tolerance test (gtt) 3 specimens
|
$85.60 |
$85.60 |
$85.60 |
|
