|
Full thick gft/scalp/arm/leg/20sqcm or< 15220
|
$2,123.50 |
$2,123.50 |
$2,123.50 |
$2,469.00
|
|
Full thick gft/scalp/arm/leg/add 20sqcm 15221
|
$389.00 |
$389.00 |
$389.00 |
$1,021.00
|
|
Full thick gft w/close donor fccmnaghf <=20sqcm 15240
|
$2,123.50 |
$2,123.50 |
$2,123.50 |
$2,706.60
|
|
Functional brain mapping
|
$291.50 |
$291.50 |
$291.50 |
$514.80
|
|
Fundus photography with i&r 92250
|
$116.50 |
$116.50 |
$116.50 |
$178.20
|
|
Furnsh initial orthosis only
|
$3,326.00 |
$3,326.00 |
$3,326.00 |
$3,034.95
|
|
Gammaglobulin iga
|
$91.50 |
$91.50 |
$91.50 |
$69.42
|
|
Gammaglobulin ige
|
$81.00 |
$81.00 |
$81.00 |
$83.40
|
|
Gamma glutamyltransferase
|
$49.50 |
$49.50 |
$49.50 |
$57.54
|
|
Gastric emptying imag study
|
$1,131.00 |
$1,131.00 |
$1,131.00 |
$1,364.00
|
|
Gastric emptying imag study
|
$1,198.00 |
$1,198.00 |
$1,198.00 |
$1,665.50
|
|
Gastric motility studies
|
$628.00 |
$628.00 |
$628.00 |
$972.00
|
|
Gastroesophageal reflux study
|
$837.50 |
$837.50 |
$837.50 |
$1,031.60
|
|
Gastroesophageal reflux test
|
$1,931.00 |
$1,931.00 |
$1,931.00 |
$1,352.00
|
|
Gastro/jejuno tube, std
|
$221.00 |
$221.00 |
$221.00 |
$337.96
|
|
General health panel
|
$109.00 |
$109.00 |
$109.00 |
$262.44
|
|
Generator barostim neo2 2014
|
$60,500.00 |
$60,500.00 |
$60,500.00 |
$49,450.20
|
|
Generator emblem MRI sicd subq
|
$38,360.00 |
$38,360.00 |
$38,360.00 |
$36,771.84
|
|
Generator stim baroreceptor neo legacy implant pulse
|
$54,137.00 |
$54,137.00 |
$54,137.00 |
$66,636.36
|
|
Genetic counseling 30 min
|
$75.00 |
$75.00 |
$75.00 |
$193.00
|
|
Gentamicin peak therapeutic drug level
|
$114.50 |
$114.50 |
$114.50 |
$123.84
|
|
Ghs abscess perianal iandd
|
$634.00 |
$634.00 |
$634.00 |
$1,452.00
|
|
Ghs abscess postoperative iandd complex
|
$2,012.00 |
$2,012.00 |
$2,012.00 |
$3,515.40
|
|
Ghs acetylcholinesterase, rbc
|
$68.00 |
$68.00 |
$68.00 |
$43.06
|
|
Ghs analysis neurostim without reprogramming
|
$324.00 |
$324.00 |
$324.00 |
$247.06
|
|
Ghs antibodies (torch) igm
|
$95.00 |
$95.00 |
$95.00 |
$69.12
|
|
Ghs aspiration bladder - needle
|
$388.50 |
$388.50 |
$388.50 |
$570.00
|
|
Ghs bladder cath - complex-foley
|
$180.00 |
$180.00 |
$180.00 |
$343.68
|
|
Ghs block ilioinguinal/gentitofemoral
|
$510.00 |
$510.00 |
$510.00 |
$1,045.65
|
|
Ghs central line insert < age 5, failed
|
$1,466.50 |
$1,466.50 |
$1,466.50 |
$2,499.90
|
|
Ghs change cysto/gastrost
|
$364.50 |
$364.50 |
$364.50 |
$594.55
|
|
Ghs chemo >8 hrs
|
$220.50 |
$220.50 |
$220.50 |
$714.87
|
|
Ghs chemo IV push, ea addtl
|
$90.00 |
$90.00 |
$90.00 |
$276.02
|
|
Ghs chlamydia pneumoniae by pcr (arup) (306630)
|
$35.50 |
$35.50 |
$35.50 |
$133.00
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$302.00 |
$302.00 |
$302.00 |
$510.40
|
|
Ghs closed reduction ankle dislocation
|
$428.50 |
$428.50 |
$428.50 |
$677.25
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$1,028.50 |
$1,028.50 |
$1,028.50 |
$1,554.70
|
|
Ghs closed tx tibial fracture w/manip
|
$1,255.00 |
$1,255.00 |
$1,255.00 |
$2,187.20
|
|
Ghs closure surg wound/dehiscence-13160
|
$4,353.00 |
$4,353.00 |
$4,353.00 |
$3,448.80
|
|
Ghs clsd red med malleolus fx without manip
|
$351.00 |
$351.00 |
$351.00 |
$494.40
|
|
Ghs clsd red med malleolus fx w manip
|
$2,631.00 |
$2,631.00 |
$2,631.00 |
$2,184.00
|
|
Ghs clsd tx frac distal tibia w/manipulation
|
$1,618.00 |
$1,618.00 |
$1,618.00 |
$2,319.00
|
|
Ghs cl tx knee disl; wo anesth
|
$486.00 |
$486.00 |
$486.00 |
$578.00
|
|
Ghs cl tx metacarpophal disloc without anes
|
$486.00 |
$486.00 |
$486.00 |
$497.53
|
|
Ghs community re-entry 15 minutes
|
$61.50 |
$61.50 |
$61.50 |
$89.00
|
|
Ghs conjunctiva foreign body-embed bil
|
$286.50 |
$286.50 |
$286.50 |
$424.90
|
|
Ghs conjunctiva foreign body-superf bil
|
$112.50 |
$112.50 |
$112.50 |
$287.40
|
|
Ghs corneal fb without slit lamp bilat
|
$299.00 |
$299.00 |
$299.00 |
$422.25
|
|
Ghs corneal fb with slit lamp bilat
|
$333.50 |
$333.50 |
$333.50 |
$339.60
|
|
Ghs cricothyroidotomy
|
$1,315.50 |
$1,315.50 |
$1,315.50 |
$1,103.75
|
|
Ghs dislocation elbow closed treatment
|
$302.00 |
$302.00 |
$302.00 |
$583.80
|
|
Ghs ed peritoneal lavage w guidance if performed
|
$845.50 |
$845.50 |
$845.50 |
$1,109.47
|
|
Ghs ed rmvl or bivalving cast
|
$207.00 |
$207.00 |
$207.00 |
$335.08
|
|
Ghs ed therapeutic lp, drain csf w fluoro
|
$956.50 |
$956.50 |
$956.50 |
$1,381.60
|
|
Ghs eeg cont rec w/video by tec min 8 chnls
|
$447.50 |
$447.50 |
$447.50 |
$560.00
|
|
Ghs electrostagmgraphy
|
$259.00 |
$259.00 |
$259.00 |
$295.50
|
|
Ghs elect torsion swing
|
$236.50 |
$236.50 |
$236.50 |
$253.00
|
|
Ghs elect vertical elct
|
$82.50 |
$82.50 |
$82.50 |
$116.00
|
|
Ghs epidermal shaving diameter >2.0 cm
|
$270.50 |
$270.50 |
$270.50 |
$467.00
|
|
Ghs excision ingrown nail
|
$460.00 |
$460.00 |
$460.00 |
$442.61
|
|
Ghs eye exam
|
$74.00 |
$74.00 |
$74.00 |
$162.24
|
|
Ghs eyelid foreign body-embedded - bil
|
$238.00 |
$238.00 |
$238.00 |
$501.04
|
|
Ghs fb removal foot - deep - left
|
$3,303.00 |
$3,303.00 |
$3,303.00 |
$2,723.00
|
|
Ghs fb removal - incisional
|
$1,413.50 |
$1,413.50 |
$1,413.50 |
$2,289.60
|
|
Ghs fb removal - non-incisional
|
$1,465.00 |
$1,465.00 |
$1,465.00 |
$1,706.20
|
|
Ghs fish cytogen
|
$474.50 |
$474.50 |
$474.50 |
$173.40
|
|
Ghs fish hybrid in situ 100-300
|
$540.00 |
$540.00 |
$540.00 |
$225.00
|
|
Ghs gastric intub aspiration lavage
|
$300.00 |
$300.00 |
$300.00 |
$365.40
|
|
Ghs hgb stability-thal
|
$57.00 |
$57.00 |
$57.00 |
$89.91
|
|
Ghs histoplasma antigen
|
$358.00 |
$358.00 |
$358.00 |
$141.00
|
|
Ghs HIV antibody
|
$67.50 |
$67.50 |
$67.50 |
$90.00
|
|
Ghs i and d abscess/hematoma scrotum
|
$3,066.50 |
$3,066.50 |
$3,066.50 |
$3,245.90
|
|
Ghs i and d perirectal abscess 46040
|
$3,383.50 |
$3,383.50 |
$3,383.50 |
$2,766.00
|
|
Ghs i and d pilonidal cyst complex
|
$1,969.50 |
$1,969.50 |
$1,969.50 |
$1,402.80
|
|
Ghs i and d pilonidal cyst simple
|
$494.00 |
$494.00 |
$494.00 |
$696.80
|
|
Ghs incision thrombosed ext hemorrhoid
|
$317.50 |
$317.50 |
$317.50 |
$520.80
|
|
Ghs indirect laryngoscopy/w fb removal
|
$209.00 |
$209.00 |
$209.00 |
$350.90
|
|
Ghs inf midline insertion
|
$1,062.50 |
$1,062.50 |
$1,062.50 |
$1,219.20
|
|
Ghs inhibitor screen
|
$453.50 |
$453.50 |
$453.50 |
$191.88
|
|
Ghs init tx 1st degree burn
|
$218.00 |
$218.00 |
$218.00 |
$275.50
|
|
Ghs inj neurolytic intercostal nerve
|
$1,550.50 |
$1,550.50 |
$1,550.50 |
$2,047.92
|
|
Ghs inj neurolytic other perph nerve
|
$864.00 |
$864.00 |
$864.00 |
$1,710.80
|
|
Ghs inj tendon origin/insertion
|
$338.00 |
$338.00 |
$338.00 |
$434.12
|
|
Ghs inj transforaminal cerv ea add bil
|
$746.00 |
$746.00 |
$746.00 |
$1,118.00
|
|
Ghs inj transforaminal cerv single bil
|
$864.00 |
$864.00 |
$864.00 |
$1,814.80
|
|
Ghs insertion of needle - bone
|
$298.50 |
$298.50 |
$298.50 |
$422.40
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$697.00 |
$697.00 |
$697.00 |
$865.60
|
|
Ghs intermed repair 20.1 - 30.0 cm-12036
|
$835.50 |
$835.50 |
$835.50 |
$1,051.20
|
|
Ghs intermed repair over 30 cm - 12037
|
$2,875.00 |
$2,875.00 |
$2,875.00 |
$2,164.64
|
|
Ghs intro needle/intracath vein - 36000
|
$175.50 |
$175.50 |
$175.50 |
$202.47
|
|
Ghs irrigate corpora cavernosa for priapism
|
$519.00 |
$519.00 |
$519.00 |
$551.20
|
|
Ghs IV inf sq injection, on-body injector
|
$25.50 |
$25.50 |
$25.50 |
$108.00
|
|
Ghs IV infusion bamlanivimab/etesevimab
|
$433.50 |
$433.50 |
$433.50 |
$553.80
|
|
Ghs IV infusion casirivimab/imdevimab
|
$433.50 |
$433.50 |
$433.50 |
$569.28
|
|
Ghs IV infusion sotrovimab
|
$433.50 |
$433.50 |
$433.50 |
$553.80
|
|
Ghs IV thrombolytics - cerebral
|
$232.00 |
$232.00 |
$232.00 |
$663.00
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$208.00 |
$208.00 |
$208.00 |
$492.00
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$410.50 |
$410.50 |
$410.50 |
$591.00
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$410.50 |
$410.50 |
$410.50 |
$576.19
|
|
Ghs layer closure 2.5cm or less - 12051
|
$410.50 |
$410.50 |
$410.50 |
$602.00
|
