|
Ghs IV infusion bamlanivimab/etesevimab
|
$521.40 |
$521.40 |
$521.40 |
$553.80
|
|
Ghs IV infusion casirivimab/imdevimab
|
$521.40 |
$521.40 |
$521.40 |
$569.28
|
|
Ghs IV infusion sotrovimab
|
$521.40 |
$521.40 |
$521.40 |
$553.80
|
|
Ghs IV thrombolytics - cerebral
|
$923.40 |
$923.40 |
$923.40 |
$663.00
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$347.40 |
$347.40 |
$347.40 |
$492.00
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$1,005.60 |
$1,005.60 |
$1,005.60 |
$591.00
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$529.80 |
$529.80 |
$529.80 |
$576.19
|
|
Ghs layer closure 2.5cm or less - 12051
|
$529.80 |
$529.80 |
$529.80 |
$602.00
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$583.20 |
$583.20 |
$583.20 |
$670.40
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$627.60 |
$627.60 |
$627.60 |
$690.36
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$627.60 |
$627.60 |
$627.60 |
$733.20
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$1,287.60 |
$1,287.60 |
$1,287.60 |
$770.40
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$529.80 |
$529.80 |
$529.80 |
$750.12
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$627.60 |
$627.60 |
$627.60 |
$737.10
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$627.60 |
$627.60 |
$627.60 |
$967.20
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$627.60 |
$627.60 |
$627.60 |
$779.35
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$627.60 |
$627.60 |
$627.60 |
$1,016.25
|
|
Ghs layered repair 20.1 - 30.0 cm -12056
|
$627.60 |
$627.60 |
$627.60 |
$907.50
|
|
Ghs layered repair over 30.0 cm -12047
|
$1,102.80 |
$1,102.80 |
$1,102.80 |
$1,897.70
|
|
Ghs layered repair over 3.0 cm -12057
|
$627.60 |
$627.60 |
$627.60 |
$1,064.98
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$615.00 |
$615.00 |
$615.00 |
$242.64
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$564.60 |
$564.60 |
$564.60 |
$228.45
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$564.60 |
$564.60 |
$564.60 |
$230.55
|
|
Ghs moderate sedation ea addtl 15 min
|
$569.40 |
$569.40 |
$569.40 |
$150.00
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$566.40 |
$566.40 |
$566.40 |
$141.00
|
|
Ghs musc test done w/n test comp
|
$276.60 |
$276.60 |
$276.60 |
$324.80
|
|
Ghs musc tst done w/nerv tst lim
|
$276.60 |
$276.60 |
$276.60 |
$272.25
|
|
Ghs musc tst done w/n tst non ext
|
$145.20 |
$145.20 |
$145.20 |
$184.80
|
|
Ghs myocardial strain img spckl track
|
$0.60 |
$0.60 |
$0.60 |
$444.60
|
|
Ghs nailbed repair/nail removal
|
$385.80 |
$385.80 |
$385.80 |
$724.37
|
|
Ghs nerve blk intercostal, ea addtl level
|
$2,046.60 |
$2,046.60 |
$2,046.60 |
$1,545.05
|
|
Ghs nerve blk intercostal, single level
|
$1,464.60 |
$1,464.60 |
$1,464.60 |
$1,121.00
|
|
Ghs nerve block axillary nerve
|
$1,554.60 |
$1,554.60 |
$1,554.60 |
$1,540.00
|
|
Ghs nerve block brachial plexus
|
$3,430.20 |
$3,430.20 |
$3,430.20 |
$1,695.24
|
|
Ghs nerve block celiac plexus
|
$2,298.00 |
$2,298.00 |
$2,298.00 |
$1,556.40
|
|
Ghs nerve block interscaline
|
$1,810.20 |
$1,810.20 |
$1,810.20 |
$1,526.09
|
|
Ghs nerve block lumbar or thoracic symp
|
$1,839.00 |
$1,839.00 |
$1,839.00 |
$1,671.75
|
|
Ghs nerve block sciatic nerve
|
$1,839.00 |
$1,839.00 |
$1,839.00 |
$1,450.80
|
|
Ghs ng placement w fluoro guidance
|
$543.00 |
$543.00 |
$543.00 |
$478.50
|
|
Ghs o2 saturation
|
$156.60 |
$156.60 |
$156.60 |
$69.50
|
|
Ghs o2 uptake rest & indirect
|
$427.20 |
$427.20 |
$427.20 |
$173.50
|
|
Ghs opcc repair cvp without subq port
|
$1,659.60 |
$1,659.60 |
$1,659.60 |
$1,229.24
|
|
Ghs opcc repair cvp w subq port
|
$2,903.40 |
$2,903.40 |
$2,903.40 |
$2,194.40
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$126.00 |
$126.00 |
$126.00 |
$58.00
|
|
Ghs ot group caregiver training
|
$34.80 |
$34.80 |
$34.80 |
$34.80
|
|
Ghs ot prosthetic training/15 min
|
$123.00 |
$123.00 |
$123.00 |
$92.35
|
|
Ghs ot sensory integrative tech/15min
|
$108.00 |
$108.00 |
$108.00 |
$96.00
|
|
Ghs ot work hardening-additional hours
|
$127.80 |
$127.80 |
$127.80 |
$126.40
|
|
Ghs pacing - transcutaneous
|
$751.20 |
$751.20 |
$751.20 |
$822.00
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$1,320.60 |
$1,320.60 |
$1,320.60 |
$809.67
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$1,857.00 |
$1,857.00 |
$1,857.00 |
$962.00
|
|
Ghs peritonsillar abscess i andd
|
$592.80 |
$592.80 |
$592.80 |
$545.40
|
|
Ghs phenylketonurid
|
$310.80 |
$310.80 |
$310.80 |
$53.76
|
|
Ghs picc line insert < 5
|
$5,440.80 |
$5,440.80 |
$5,440.80 |
$1,996.00
|
|
Ghs plngl fx pm cl
|
$739.20 |
$739.20 |
$739.20 |
$564.50
|
|
Ghs ppd (tb intradermal)
|
$46.20 |
$46.20 |
$46.20 |
$37.44
|
|
Ghs prostatic acid phosphatase (mayo)
|
$116.40 |
$116.40 |
$116.40 |
$43.55
|
|
Ghs protoporphyrins fract
|
$351.00 |
$351.00 |
$351.00 |
$60.75
|
|
Ghs pr without cont pulse ox
|
$171.60 |
$171.60 |
$171.60 |
$146.86
|
|
Ghs pt - work hardening/int 2hrs
|
$361.20 |
$361.20 |
$361.20 |
$285.60
|
|
Ghs refill of implantable pump
|
$598.80 |
$598.80 |
$598.80 |
$539.13
|
|
Ghs removal intranasal foreign body
|
$210.00 |
$210.00 |
$210.00 |
$283.51
|
|
Ghs removal pharyngeal foreign body
|
$351.00 |
$351.00 |
$351.00 |
$436.10
|
|
Ghs repair extensor tendon hand, ea tendon
|
$769.80 |
$769.80 |
$769.80 |
$2,408.00
|
|
Ghs repair tendon ext forearm/wrist ea
|
$1,077.60 |
$1,077.60 |
$1,077.60 |
$4,108.00
|
|
Ghs sensitivity (per antimicro)
|
$114.60 |
$114.60 |
$114.60 |
$56.40
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$485.40 |
$485.40 |
$485.40 |
$563.75
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$640.80 |
$640.80 |
$640.80 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$576.60 |
$576.60 |
$576.60 |
$575.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$627.60 |
$627.60 |
$627.60 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$414.00 |
$414.00 |
$414.00 |
$451.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$452.40 |
$452.40 |
$452.40 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$454.80 |
$454.80 |
$454.80 |
$492.00
|
|
Ghs simple repair over 30 cm - 12007
|
$592.20 |
$592.20 |
$592.20 |
$584.00
|
|
Ghs simple repair over 30 cm - 12018
|
$627.60 |
$627.60 |
$627.60 |
$537.60
|
|
Ghs somatosensory testing lower extremit
|
$1,141.20 |
$1,141.20 |
$1,141.20 |
$917.80
|
|
Ghs somatosensory testing upper & lower limbs
|
$3,182.40 |
$3,182.40 |
$3,182.40 |
$1,405.20
|
|
Ghs speech-gen aug dev eval iii, st
|
$183.00 |
$183.00 |
$183.00 |
$161.76
|
|
Ghs sphenopalatine ganglion block
|
$567.60 |
$567.60 |
$567.60 |
$616.00
|
|
Ghs sp train/fitting sp device - kx
|
$286.80 |
$286.80 |
$286.80 |
$249.60
|
|
Ghs strapping shoulder - 29240
|
$303.00 |
$303.00 |
$303.00 |
$217.60
|
|
Ghs st - re-eval for alt comm
|
$402.00 |
$402.00 |
$402.00 |
$309.00
|
|
Ghs superficial wnd dehiscence simp12020
|
$1,568.40 |
$1,568.40 |
$1,568.40 |
$909.00
|
|
Ghs superficial wnd dehis w packing12021
|
$852.60 |
$852.60 |
$852.60 |
$692.80
|
|
Ghs tracheostomy emergency - transtracheal
|
$933.00 |
$933.00 |
$933.00 |
$1,752.89
|
|
Ghs tx distal phalangeal fx with manipulation
|
$550.80 |
$550.80 |
$550.80 |
$525.60
|
|
Ghs urine, porphyrins quant
|
$169.80 |
$169.80 |
$169.80 |
$73.80
|
|
Ghs vaginal delivery only
|
$3,563.40 |
$3,563.40 |
$3,563.40 |
$3,338.40
|
|
Ghs veeg 12-26 hr intmt mont
|
$5,038.20 |
$5,038.20 |
$5,038.20 |
$1,932.00
|
|
Gi endoscopic ultrasound
|
$1,366.80 |
$1,366.80 |
$1,366.80 |
$582.31
|
|
Gi inhouse confirmation
|
$198.60 |
$198.60 |
$198.60 |
$86.40
|
|
Glucose 1 hr post dose
|
$89.40 |
$89.40 |
$89.40 |
$48.25
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$57.60 |
$57.60 |
$57.60 |
$22.75
|
|
Glucose blood quantitative
|
$78.60 |
$78.60 |
$78.60 |
$41.40
|
|
Glucose body fluid
|
$99.00 |
$99.00 |
$99.00 |
$51.30
|
|
Glucose tolerance test (gtt) 3 specimens
|
$366.00 |
$366.00 |
$366.00 |
$104.50
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$82.80 |
$82.80 |
$82.80 |
$36.00
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$249.00 |
$249.00 |
$249.00 |
$115.80
|
|
Gonadotropin luteinizing hormone (lh)
|
$402.60 |
$402.60 |
$402.60 |
$129.00
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$136.80 |
$136.80 |
$136.80 |
$143.50
|
