|
Ghs IV inf sq injection, on-body injector
|
$31.08 |
$31.08 |
$31.08 |
$108.00
|
|
Ghs IV infusion bamlanivimab/etesevimab
|
$276.78 |
$276.78 |
$276.78 |
$553.80
|
|
Ghs IV infusion casirivimab/imdevimab
|
$230.16 |
$230.16 |
$230.16 |
$573.86
|
|
Ghs IV infusion sotrovimab
|
$276.78 |
$276.78 |
$276.78 |
$563.40
|
|
Ghs IV thrombolytics - cerebral
|
$219.66 |
$219.66 |
$219.66 |
$663.00
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$231.84 |
$231.84 |
$231.84 |
$505.45
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$308.70 |
$308.70 |
$308.70 |
$602.70
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$292.32 |
$292.32 |
$292.32 |
$583.10
|
|
Ghs layer closure 2.5cm or less - 12051
|
$318.36 |
$318.36 |
$318.36 |
$614.00
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$441.84 |
$441.84 |
$441.84 |
$675.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$369.60 |
$369.60 |
$369.60 |
$703.20
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$477.12 |
$477.12 |
$477.12 |
$737.55
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$454.02 |
$454.02 |
$454.02 |
$779.35
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$913.08 |
$913.08 |
$913.08 |
$755.08
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$490.56 |
$490.56 |
$490.56 |
$737.55
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$972.30 |
$972.30 |
$972.30 |
$972.30
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$428.82 |
$428.82 |
$428.82 |
$784.80
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$1,319.64 |
$1,319.64 |
$1,319.64 |
$1,033.85
|
|
Ghs layered repair 20.1 - 30.0 cm -12056
|
$1,131.06 |
$1,131.06 |
$1,131.06 |
$929.50
|
|
Ghs layered repair over 30.0 cm -12047
|
$1,530.48 |
$1,530.48 |
$1,530.48 |
$1,930.50
|
|
Ghs layered repair over 3.0 cm -12057
|
$1,630.02 |
$1,630.02 |
$1,630.02 |
$1,064.98
|
|
Ghs leukocyte alkaline phos (mayo)
|
$125.58 |
$125.58 |
$125.58 |
$75.00
|
|
Ghs low level laser therapy
|
$43.68 |
$43.68 |
$43.68 |
$80.85
|
|
Ghs mbp
|
$86.10 |
$86.10 |
$86.10 |
$74.40
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$44.94 |
$44.94 |
$44.94 |
$246.40
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$44.94 |
$44.94 |
$44.94 |
$228.45
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$44.94 |
$44.94 |
$44.94 |
$242.31
|
|
Ghs moderate sedation ea addtl 15 min
|
$48.72 |
$48.72 |
$48.72 |
$151.50
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$44.94 |
$44.94 |
$44.94 |
$142.40
|
|
Ghs musc test done w/n test comp
|
$379.26 |
$379.26 |
$379.26 |
$318.75
|
|
Ghs musc tst done w/nerv tst lim
|
$314.58 |
$314.58 |
$314.58 |
$266.59
|
|
Ghs musc tst done w/n tst non ext
|
$98.70 |
$98.70 |
$98.70 |
$184.80
|
|
Ghs myocardial strain img spckl track
|
$340.62 |
$340.62 |
$340.62 |
$457.80
|
|
Ghs nailbed repair/nail removal
|
$442.26 |
$442.26 |
$442.26 |
$726.86
|
|
Ghs nerve blk intercostal, ea addtl level
|
$630.84 |
$630.84 |
$630.84 |
$1,556.24
|
|
Ghs nerve blk intercostal, single level
|
$307.02 |
$307.02 |
$307.02 |
$1,132.80
|
|
Ghs nerve block axillary nerve
|
$561.12 |
$561.12 |
$561.12 |
$1,579.20
|
|
Ghs nerve block celiac plexus
|
$784.56 |
$784.56 |
$784.56 |
$1,560.13
|
|
Ghs nerve block interscaline
|
$547.26 |
$547.26 |
$547.26 |
$1,541.40
|
|
Ghs nerve block sciatic nerve
|
$614.88 |
$614.88 |
$614.88 |
$1,450.80
|
|
Ghs nerve block suprascapular
|
$453.60 |
$453.60 |
$453.60 |
$1,173.60
|
|
Ghs ng placement w fluoro guidance
|
$207.06 |
$207.06 |
$207.06 |
$485.00
|
|
Ghs o2 saturation
|
$57.54 |
$57.54 |
$57.54 |
$72.45
|
|
Ghs o2 uptake rest & exercise
|
$102.06 |
$102.06 |
$102.06 |
$230.01
|
|
Ghs o2 uptake rest & indirect
|
$89.46 |
$89.46 |
$89.46 |
$173.50
|
|
Ghs opcc repair cvp without subq port
|
$981.12 |
$981.12 |
$981.12 |
$1,236.67
|
|
Ghs opcc repair cvp w subq port
|
$981.12 |
$981.12 |
$981.12 |
$2,194.40
|
|
Ghs ot dds rom
|
$118.44 |
$118.44 |
$118.44 |
$66.95
|
|
Ghs ot prosthetic training/15 min
|
$16.38 |
$16.38 |
$16.38 |
$91.65
|
|
Ghs ot sensory integrative tech/15min
|
$17.64 |
$17.64 |
$17.64 |
$96.00
|
|
Ghs ot work hardening-additional hours
|
$44.52 |
$44.52 |
$44.52 |
$127.80
|
|
Ghs pacing - transcutaneous
|
$149.10 |
$149.10 |
$149.10 |
$822.00
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$548.94 |
$548.94 |
$548.94 |
$853.65
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$429.66 |
$429.66 |
$429.66 |
$944.80
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$98.28 |
$98.28 |
$98.28 |
$84.60
|
|
Ghs peritonsillar abscess i andd
|
$238.56 |
$238.56 |
$238.56 |
$546.36
|
|
Ghs phenylketonurid
|
$51.66 |
$51.66 |
$51.66 |
$53.30
|
|
Ghs picc line insert < 5
|
$1,306.20 |
$1,306.20 |
$1,306.20 |
$2,005.58
|
|
Ghs plngl fx pm cl
|
$370.86 |
$370.86 |
$370.86 |
$586.00
|
|
Ghs plt ct-manual
|
$39.48 |
$39.48 |
$39.48 |
$37.96
|
|
Ghs polysom <6 yrs 4/> parameters
|
$817.32 |
$817.32 |
$817.32 |
$3,557.58
|
|
Ghs ppd (tb intradermal)
|
$869.22 |
$869.22 |
$869.22 |
$37.70
|
|
Ghs prostatic acid phosphatase (mayo)
|
$64.26 |
$64.26 |
$64.26 |
$43.55
|
|
Ghs protoporphyrins fract
|
$71.40 |
$71.40 |
$71.40 |
$64.00
|
|
Ghs pr without cont pulse ox
|
$166.32 |
$166.32 |
$166.32 |
$147.69
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$139.86 |
$139.86 |
$139.86 |
$47.55
|
|
Ghs pt - work hardening/int 2hrs
|
$144.06 |
$144.06 |
$144.06 |
$285.60
|
|
Ghs quinidine
|
$112.98 |
$112.98 |
$112.98 |
$85.00
|
|
Ghs removal intranasal foreign body
|
$162.54 |
$162.54 |
$162.54 |
$287.50
|
|
Ghs removal pharyngeal foreign body
|
$174.72 |
$174.72 |
$174.72 |
$445.45
|
|
Ghs repair extensor tendon hand, ea tendon
|
$1,252.02 |
$1,252.02 |
$1,252.02 |
$2,408.00
|
|
Ghs repair tendon ext forearm/wrist ea
|
$3,932.88 |
$3,932.88 |
$3,932.88 |
$4,108.00
|
|
Ghs respiratory syncytical virus igg/m
|
$112.14 |
$112.14 |
$112.14 |
$71.20
|
|
Ghs reticulocyte count
|
$33.60 |
$33.60 |
$33.60 |
$34.50
|
|
Ghs rsv eia (respir synctial vrs)
|
$42.00 |
$42.00 |
$42.00 |
$98.40
|
|
Ghs sedimentation rate
|
$55.44 |
$55.44 |
$55.44 |
$44.85
|
|
Ghs semen analysis fert
|
$251.16 |
$251.16 |
$251.16 |
$129.00
|
|
Ghs sensitivity (per antimicro)
|
$49.56 |
$49.56 |
$49.56 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$240.66 |
$240.66 |
$240.66 |
$563.75
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$244.02 |
$244.02 |
$244.02 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$356.58 |
$356.58 |
$356.58 |
$575.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$419.16 |
$419.16 |
$419.16 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$185.64 |
$185.64 |
$185.64 |
$451.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$195.72 |
$195.72 |
$195.72 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$203.70 |
$203.70 |
$203.70 |
$492.80
|
|
Ghs simple repair over 30 cm - 12007
|
$419.16 |
$419.16 |
$419.16 |
$584.21
|
|
Ghs simple repair over 30 cm - 12018
|
$435.54 |
$435.54 |
$435.54 |
$537.60
|
|
Ghs sleep study unattended
|
$291.48 |
$291.48 |
$291.48 |
$503.38
|
|
Ghs somatosensory testing upper & lower limbs
|
$347.76 |
$347.76 |
$347.76 |
$1,405.20
|
|
Ghs speech-gen aug dev eval iii, st
|
$71.40 |
$71.40 |
$71.40 |
$154.80
|
|
Ghs sphenopalatine ganglion block
|
$268.80 |
$268.80 |
$268.80 |
$630.24
|
|
Ghs sp train/fitting sp device - kx
|
$78.12 |
$78.12 |
$78.12 |
$243.60
|
|
Ghs strapping shoulder - 29240
|
$189.42 |
$189.42 |
$189.42 |
$213.20
|
|
Ghs st - re-eval for alt comm
|
$139.44 |
$139.44 |
$139.44 |
$298.00
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$54.18 |
$54.18 |
$54.18 |
$99.98
|
|
Ghs superficial wnd dehiscence simp12020
|
$328.44 |
$328.44 |
$328.44 |
$906.24
|
|
Ghs superficial wnd dehis w packing12021
|
$178.50 |
$178.50 |
$178.50 |
$696.68
|
|
Ghs tracheostomy emergency - transtracheal
|
$1,033.20 |
$1,033.20 |
$1,033.20 |
$1,752.89
|
|
Ghs tx distal phalangeal fx with manipulation
|
$283.08 |
$283.08 |
$283.08 |
$535.60
|
|
Ghs urine, porphyrins quant
|
$165.06 |
$165.06 |
$165.06 |
$75.00
|
