|
Ghs gastric intub aspiration lavage
|
$262.00 |
$262.00 |
$262.00 |
$365.40
|
|
Ghs hgb stability-thal
|
$69.00 |
$69.00 |
$69.00 |
$89.91
|
|
Ghs histoplasma antigen
|
$114.00 |
$114.00 |
$114.00 |
$141.00
|
|
Ghs HIV antibody
|
$72.50 |
$72.50 |
$72.50 |
$90.00
|
|
Ghs i and d abscess/hematoma scrotum
|
$3,771.50 |
$3,771.50 |
$3,771.50 |
$3,245.90
|
|
Ghs i and d perirectal abscess 46040
|
$3,628.00 |
$3,628.00 |
$3,628.00 |
$2,766.00
|
|
Ghs i and d pilonidal cyst complex
|
$1,977.50 |
$1,977.50 |
$1,977.50 |
$1,402.80
|
|
Ghs i and d pilonidal cyst simple
|
$336.00 |
$336.00 |
$336.00 |
$696.80
|
|
Ghs incision thrombosed ext hemorrhoid
|
$455.00 |
$455.00 |
$455.00 |
$520.80
|
|
Ghs indirect laryngoscopy/w fb removal
|
$295.00 |
$295.00 |
$295.00 |
$350.90
|
|
Ghs inf midline insertion
|
$1,140.50 |
$1,140.50 |
$1,140.50 |
$1,219.20
|
|
Ghs inhibitor screen
|
$481.50 |
$481.50 |
$481.50 |
$191.88
|
|
Ghs init tx 1st degree burn
|
$187.00 |
$187.00 |
$187.00 |
$275.50
|
|
Ghs insertion of needle - bone
|
$333.50 |
$333.50 |
$333.50 |
$422.40
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$645.00 |
$645.00 |
$645.00 |
$865.60
|
|
Ghs intermed repair 20.1 - 30.0 cm-12036
|
$665.50 |
$665.50 |
$665.50 |
$1,051.20
|
|
Ghs intermed repair over 30 cm - 12037
|
$853.00 |
$853.00 |
$853.00 |
$2,164.64
|
|
Ghs intro needle/intracath vein - 36000
|
$155.00 |
$155.00 |
$155.00 |
$202.47
|
|
Ghs irrigate corpora cavernosa for priapism
|
$353.00 |
$353.00 |
$353.00 |
$551.20
|
|
Ghs IV inf sq injection, on-body injector
|
$26.50 |
$26.50 |
$26.50 |
$108.00
|
|
Ghs IV infusion bamlanivimab/etesevimab
|
$677.50 |
$677.50 |
$677.50 |
$553.80
|
|
Ghs IV infusion casirivimab/imdevimab
|
$677.50 |
$677.50 |
$677.50 |
$569.28
|
|
Ghs IV infusion sotrovimab
|
$677.50 |
$677.50 |
$677.50 |
$553.80
|
|
Ghs IV thrombolytics - cerebral
|
$273.50 |
$273.50 |
$273.50 |
$663.00
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$348.00 |
$348.00 |
$348.00 |
$492.00
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$326.00 |
$326.00 |
$326.00 |
$591.00
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$390.50 |
$390.50 |
$390.50 |
$576.19
|
|
Ghs layer closure 2.5cm or less - 12051
|
$455.50 |
$455.50 |
$455.50 |
$602.00
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$476.50 |
$476.50 |
$476.50 |
$670.40
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$497.00 |
$497.00 |
$497.00 |
$690.36
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$507.50 |
$507.50 |
$507.50 |
$733.20
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$593.00 |
$593.00 |
$593.00 |
$770.40
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$551.50 |
$551.50 |
$551.50 |
$750.12
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$685.50 |
$685.50 |
$685.50 |
$737.10
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$592.50 |
$592.50 |
$592.50 |
$967.20
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$722.00 |
$722.00 |
$722.00 |
$779.35
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$629.50 |
$629.50 |
$629.50 |
$1,016.25
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$50.50 |
$50.50 |
$50.50 |
$242.64
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$50.50 |
$50.50 |
$50.50 |
$228.45
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$50.50 |
$50.50 |
$50.50 |
$230.55
|
|
Ghs moderate sedation ea addtl 15 min
|
$40.00 |
$40.00 |
$40.00 |
$150.00
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$40.00 |
$40.00 |
$40.00 |
$141.00
|
|
Ghs myocardial strain img spckl track
|
$370.50 |
$370.50 |
$370.50 |
$444.60
|
|
Ghs nailbed repair/nail removal
|
$363.00 |
$363.00 |
$363.00 |
$724.37
|
|
Ghs ng placement w fluoro guidance
|
$233.00 |
$233.00 |
$233.00 |
$478.50
|
|
Ghs o2 saturation
|
$36.50 |
$36.50 |
$36.50 |
$69.50
|
|
Ghs ob unlisted IV or art inj or infusion
|
$230.50 |
$230.50 |
$230.50 |
$83.04
|
|
Ghs ot group caregiver training
|
$10.00 |
$10.00 |
$10.00 |
$34.80
|
|
Ghs ot prosthetic training/15 min
|
$78.00 |
$78.00 |
$78.00 |
$92.35
|
|
Ghs ot sensory integrative tech/15min
|
$56.00 |
$56.00 |
$56.00 |
$96.00
|
|
Ghs pacing - transcutaneous
|
$532.50 |
$532.50 |
$532.50 |
$822.00
|
|
Ghs peritonsillar abscess i andd
|
$587.00 |
$587.00 |
$587.00 |
$545.40
|
|
Ghs picc line insert < 5
|
$1,865.50 |
$1,865.50 |
$1,865.50 |
$1,996.00
|
|
Ghs plngl fx pm cl
|
$399.00 |
$399.00 |
$399.00 |
$564.50
|
|
Ghs polysom <6 yrs 4/> parameters
|
$1,937.50 |
$1,937.50 |
$1,937.50 |
$3,557.58
|
|
Ghs ppd (tb intradermal)
|
$28.50 |
$28.50 |
$28.50 |
$37.44
|
|
Ghs prostatic acid phosphatase (mayo)
|
$78.00 |
$78.00 |
$78.00 |
$43.55
|
|
Ghs protoporphyrins fract
|
$86.00 |
$86.00 |
$86.00 |
$60.75
|
|
Ghs pr without cont pulse ox
|
$79.00 |
$79.00 |
$79.00 |
$146.86
|
|
Ghs removal intranasal foreign body
|
$135.50 |
$135.50 |
$135.50 |
$283.51
|
|
Ghs removal pharyngeal foreign body
|
$245.00 |
$245.00 |
$245.00 |
$436.10
|
|
Ghs repair extensor tendon hand, ea tendon
|
$2,556.50 |
$2,556.50 |
$2,556.50 |
$2,408.00
|
|
Ghs sedimentation rate
|
$23.50 |
$23.50 |
$23.50 |
$45.50
|
|
Ghs sensitivity (per antimicro)
|
$92.00 |
$92.00 |
$92.00 |
$56.40
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$369.00 |
$369.00 |
$369.00 |
$563.75
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$375.00 |
$375.00 |
$375.00 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$380.00 |
$380.00 |
$380.00 |
$575.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$382.00 |
$382.00 |
$382.00 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$344.50 |
$344.50 |
$344.50 |
$451.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$342.50 |
$342.50 |
$342.50 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$369.00 |
$369.00 |
$369.00 |
$492.00
|
|
Ghs simple repair over 30 cm - 12007
|
$415.50 |
$415.50 |
$415.50 |
$584.00
|
|
Ghs sleep study unattended
|
$474.00 |
$474.00 |
$474.00 |
$503.38
|
|
Ghs st - re-eval for alt comm
|
$202.50 |
$202.50 |
$202.50 |
$309.00
|
|
Ghs superficial wnd dehiscence simp12020
|
$671.50 |
$671.50 |
$671.50 |
$909.00
|
|
Ghs superficial wnd dehis w packing12021
|
$631.00 |
$631.00 |
$631.00 |
$692.80
|
|
Ghs tx distal phalangeal fx with manipulation
|
$396.00 |
$396.00 |
$396.00 |
$525.60
|
|
Ghs urine, porphyrins quant
|
$109.00 |
$109.00 |
$109.00 |
$73.80
|
|
Ghs vaginal delivery only
|
$3,212.00 |
$3,212.00 |
$3,212.00 |
$3,338.40
|
|
Gi inhouse confirmation
|
$173.00 |
$173.00 |
$173.00 |
$86.40
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$2,181.00 |
$2,181.00 |
$2,181.00 |
$2,195.76
|
|
Gi wireless capsule measure
|
$654.50 |
$654.50 |
$654.50 |
$1,579.30
|
|
Glucagon plasma - sendout
|
$133.00 |
$133.00 |
$133.00 |
$63.20
|
|
Glucose 1 hr post dose
|
$36.50 |
$36.50 |
$36.50 |
$48.25
|
|
Glucose blood quantitative
|
$63.00 |
$63.00 |
$63.00 |
$41.40
|
|
Glucose body fluid
|
$76.00 |
$76.00 |
$76.00 |
$51.30
|
|
Glucose tolerance test (gtt) 3 specimens
|
$120.00 |
$120.00 |
$120.00 |
$104.50
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$40.50 |
$40.50 |
$40.50 |
$36.00
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$136.50 |
$136.50 |
$136.50 |
$115.80
|
|
Gonadotropin luteinizing hormone (lh)
|
$132.50 |
$132.50 |
$132.50 |
$129.00
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$72.00 |
$72.00 |
$72.00 |
$143.50
|
|
Graft axiofill 1000mg
|
$2,160.50 |
$2,160.50 |
$2,160.50 |
$5,125.68
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$622.00 |
$622.00 |
$622.00 |
$601.50
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$144.00 |
$144.00 |
$144.00 |
$23,288.44
|
|
Graft nerve adv 3-4x70mm
|
$32,190.00 |
$32,190.00 |
$32,190.00 |
$20,782.10
|
|
Graft patch felt ptfe 2x2
|
$36,600.00 |
$36,600.00 |
$36,600.00 |
$29,995.44
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$11,575.00 |
$11,575.00 |
$11,575.00 |
$1,455.76
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$559.50 |
$559.50 |
$559.50 |
$892.38
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$656.50 |
$656.50 |
$656.50 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$741.50 |
$741.50 |
$741.50 |
$427.89
|
