|
Ghs IV infusion bamlanivimab/etesevimab
|
$1,360.00 |
$1,360.00 |
$1,360.00 |
$553.80
|
|
Ghs IV infusion casirivimab/imdevimab
|
$1,360.00 |
$1,360.00 |
$1,360.00 |
$576.40
|
|
Ghs IV infusion sotrovimab
|
$1,360.00 |
$1,360.00 |
$1,360.00 |
$566.87
|
|
Ghs IV thrombolytics - cerebral
|
$620.80 |
$620.80 |
$620.80 |
$663.00
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$569.60 |
$569.60 |
$569.60 |
$489.67
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$998.40 |
$998.40 |
$998.40 |
$591.00
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$998.40 |
$998.40 |
$998.40 |
$583.10
|
|
Ghs layer closure 2.5cm or less - 12051
|
$998.40 |
$998.40 |
$998.40 |
$603.20
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$998.40 |
$998.40 |
$998.40 |
$672.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$998.40 |
$998.40 |
$998.40 |
$700.33
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$998.40 |
$998.40 |
$998.40 |
$741.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$998.40 |
$998.40 |
$998.40 |
$779.35
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$998.40 |
$998.40 |
$998.40 |
$760.20
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$998.40 |
$998.40 |
$998.40 |
$740.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$1,372.00 |
$1,372.00 |
$1,372.00 |
$969.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$998.40 |
$998.40 |
$998.40 |
$784.80
|
|
Ghs leukocyte alkaline phos (mayo)
|
$352.80 |
$352.80 |
$352.80 |
$75.00
|
|
Ghs mbp
|
$252.80 |
$252.80 |
$252.80 |
$76.00
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$177.60 |
$177.60 |
$177.60 |
$246.33
|
|
Ghs moderate sedation ea addtl 15 min
|
$177.60 |
$177.60 |
$177.60 |
$150.00
|
|
Ghs myocardial strain img spckl track
|
$958.40 |
$958.40 |
$958.40 |
$457.80
|
|
Ghs nailbed repair/nail removal
|
$998.40 |
$998.40 |
$998.40 |
$724.37
|
|
Ghs nerve blk intercostal, ea addtl level
|
$1,886.40 |
$1,886.40 |
$1,886.40 |
$1,556.24
|
|
Ghs nerve block axillary nerve
|
$2,764.00 |
$2,764.00 |
$2,764.00 |
$1,563.66
|
|
Ghs nerve block brachial plexus
|
$2,764.00 |
$2,764.00 |
$2,764.00 |
$1,710.80
|
|
Ghs nerve block sciatic nerve
|
$2,902.40 |
$2,902.40 |
$2,902.40 |
$1,450.80
|
|
Ghs ng placement w fluoro guidance
|
$712.80 |
$712.80 |
$712.80 |
$485.00
|
|
Ghs o2 saturation
|
$128.80 |
$128.80 |
$128.80 |
$69.50
|
|
Ghs o2 uptake rest & exercise
|
$799.20 |
$799.20 |
$799.20 |
$230.01
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$47.80 |
$47.80 |
$47.80 |
$58.00
|
|
Ghs ot prosthetic training/15 min
|
$157.60 |
$157.60 |
$157.60 |
$93.00
|
|
Ghs ot sensory integrative tech/15min
|
$157.60 |
$157.60 |
$157.60 |
$96.20
|
|
Ghs pacing - transcutaneous
|
$1,735.20 |
$1,735.20 |
$1,735.20 |
$830.53
|
|
Ghs peritonsillar abscess i andd
|
$998.40 |
$998.40 |
$998.40 |
$555.00
|
|
Ghs phenylketonurid
|
$123.20 |
$123.20 |
$123.20 |
$53.76
|
|
Ghs plngl fx pm cl
|
$998.40 |
$998.40 |
$998.40 |
$564.80
|
|
Ghs plt ct-manual
|
$84.80 |
$84.80 |
$84.80 |
$37.96
|
|
Ghs polysom <6 yrs 4/> parameters
|
$4,187.20 |
$4,187.20 |
$4,187.20 |
$3,557.58
|
|
Ghs ppd (tb intradermal)
|
$26.20 |
$26.20 |
$26.20 |
$37.44
|
|
Ghs prostatic acid phosphatase (mayo)
|
$287.20 |
$287.20 |
$287.20 |
$43.55
|
|
Ghs protoporphyrins fract
|
$168.80 |
$168.80 |
$168.80 |
$60.75
|
|
Ghs removal intranasal foreign body
|
$298.40 |
$298.40 |
$298.40 |
$283.24
|
|
Ghs removal pharyngeal foreign body
|
$852.00 |
$852.00 |
$852.00 |
$441.68
|
|
Ghs reticulocyte count
|
$42.80 |
$42.80 |
$42.80 |
$34.50
|
|
Ghs rsv eia (respir synctial vrs)
|
$345.60 |
$345.60 |
$345.60 |
$99.00
|
|
Ghs sedimentation rate
|
$73.60 |
$73.60 |
$73.60 |
$45.50
|
|
Ghs semen analysis fert
|
$236.00 |
$236.00 |
$236.00 |
$124.80
|
|
Ghs sensitivity (per antimicro)
|
$135.20 |
$135.20 |
$135.20 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$712.80 |
$712.80 |
$712.80 |
$570.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$712.80 |
$712.80 |
$712.80 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$945.60 |
$945.60 |
$945.60 |
$586.50
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$712.80 |
$712.80 |
$712.80 |
$449.15
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$712.80 |
$712.80 |
$712.80 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$712.80 |
$712.80 |
$712.80 |
$489.72
|
|
Ghs simple repair over 30 cm - 12007
|
$712.80 |
$712.80 |
$712.80 |
$590.88
|
|
Ghs sleep study unattended
|
$752.80 |
$752.80 |
$752.80 |
$503.38
|
|
Ghs speech-gen aug dev eval iii, st
|
$188.80 |
$188.80 |
$188.80 |
$157.50
|
|
Ghs sphenopalatine ganglion block
|
$687.20 |
$687.20 |
$687.20 |
$630.24
|
|
Ghs sp train/fitting sp device - kx
|
$216.80 |
$216.80 |
$216.80 |
$252.75
|
|
Ghs strapping shoulder - 29240
|
$569.60 |
$569.60 |
$569.60 |
$217.60
|
|
Ghs st - re-eval for alt comm
|
$301.60 |
$301.60 |
$301.60 |
$309.60
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$558.40 |
$558.40 |
$558.40 |
$360.80
|
|
Ghs superficial wnd dehiscence simp12020
|
$2,181.60 |
$2,181.60 |
$2,181.60 |
$953.27
|
|
Ghs superficial wnd dehis w packing12021
|
$945.60 |
$945.60 |
$945.60 |
$695.93
|
|
Ghs tx distal phalangeal fx with manipulation
|
$998.40 |
$998.40 |
$998.40 |
$529.65
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$604.00 |
$604.00 |
$604.00 |
$513.80
|
|
Ghs vaginal delivery only
|
$1,224.80 |
$1,224.80 |
$1,224.80 |
$3,341.93
|
|
Gi inhouse confirmation
|
$104.00 |
$104.00 |
$104.00 |
$87.75
|
|
Glassia injection
|
$34.80 |
$34.80 |
$34.80 |
$20.32
|
|
Glucagon 1 mg solution for injection
|
$1,053.60 |
$1,053.60 |
$1,053.60 |
$613.79
|
|
Glucagon plasma - sendout
|
$244.80 |
$244.80 |
$244.80 |
$64.35
|
|
Glucose 1 hr post dose
|
$45.00 |
$45.00 |
$45.00 |
$49.00
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$37.80 |
$37.80 |
$37.80 |
$23.12
|
|
Glucose blood quantitative
|
$63.20 |
$63.20 |
$63.20 |
$42.25
|
|
Glucose body fluid
|
$63.20 |
$63.20 |
$63.20 |
$51.30
|
|
Glucose tolerance test (gtt) 3 specimens
|
$241.60 |
$241.60 |
$241.60 |
$105.60
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$52.00 |
$52.00 |
$52.00 |
$36.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$35.40 |
$35.40 |
$35.40 |
$37.40
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$104.80 |
$104.80 |
$104.80 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$340.00 |
$340.00 |
$340.00 |
$116.64
|
|
Gonadotropin luteinizing hormone (lh)
|
$309.60 |
$309.60 |
$309.60 |
$129.03
|
|
Goserelin 10.8 mg subcutaneous implant
|
$4,524.00 |
$4,524.00 |
$4,524.00 |
$4,417.13
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$3,426.40 |
$3,426.40 |
$3,426.40 |
$73.83
|
|
Graft axiofill 1000mg
|
$8,212.20 |
$8,212.20 |
$8,212.20 |
$5,125.68
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$15,834.40 |
$15,834.40 |
$15,834.40 |
$23,233.80
|
|
Graft nerve adv 3-4x70mm
|
$25,992.80 |
$25,992.80 |
$25,992.80 |
$20,782.10
|
|
Graft patch felt ptfe 2x2
|
$5,246.40 |
$5,246.40 |
$5,246.40 |
$29,293.39
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$3,241.60 |
$3,241.60 |
$3,241.60 |
$886.17
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$7,673.60 |
$7,673.60 |
$7,673.60 |
$349.41
|
|
Graft xenmtrx sft rect 15x20cm
|
$4,445.60 |
$4,445.60 |
$4,445.60 |
$29,676.26
|
|
Graft xenmtrx sft rect 19x28cm
|
$2,112.60 |
$2,112.60 |
$2,112.60 |
$2,905.40
|
|
Granisetron hcl injection
|
$27.00 |
$27.00 |
$27.00 |
$45.03
|
|
Great toe with reduction 28495
|
$998.40 |
$998.40 |
$998.40 |
$495.00
|
|
G-tube reposition
|
$2,128.00 |
$2,128.00 |
$2,128.00 |
$771.36
|
|
Guided cath fluid drainage 10030
|
$2,640.80 |
$2,640.80 |
$2,640.80 |
$1,372.15
|
|
Guide endoanchr sg-64 aaa 62cm
|
$9,038.40 |
$9,038.40 |
$9,038.40 |
$7,743.36
|
|
Guide wire threaded 1.4x150mm
|
$1,221.60 |
$1,221.60 |
$1,221.60 |
$3,284.36
|
|
Guide worley csg 9fx50cm std
|
$228.00 |
$228.00 |
$228.00 |
$1,117.40
|
|
Gw stiffened micro access kit
|
$1,028.80 |
$1,028.80 |
$1,028.80 |
$6,893.38
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$160.00 |
$160.00 |
$160.00 |
$91.09
|
