|
Ghs IV infusion bamlanivimab/etesevimab
|
$357.50 |
$357.50 |
$357.50 |
$553.80
|
|
Ghs IV infusion casirivimab/imdevimab
|
$357.50 |
$357.50 |
$357.50 |
$569.28
|
|
Ghs IV infusion sotrovimab
|
$357.50 |
$357.50 |
$357.50 |
$553.80
|
|
Ghs IV thrombolytics - cerebral
|
$188.00 |
$188.00 |
$188.00 |
$663.00
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$150.50 |
$150.50 |
$150.50 |
$492.00
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$297.00 |
$297.00 |
$297.00 |
$591.00
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$297.00 |
$297.00 |
$297.00 |
$576.19
|
|
Ghs layer closure 2.5cm or less - 12051
|
$297.00 |
$297.00 |
$297.00 |
$602.00
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$297.00 |
$297.00 |
$297.00 |
$670.40
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$297.00 |
$297.00 |
$297.00 |
$690.36
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$366.50 |
$366.50 |
$366.50 |
$733.20
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$421.00 |
$421.00 |
$421.00 |
$770.40
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$449.50 |
$449.50 |
$449.50 |
$750.12
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$370.00 |
$370.00 |
$370.00 |
$737.10
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$449.50 |
$449.50 |
$449.50 |
$967.20
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$432.00 |
$432.00 |
$432.00 |
$779.35
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$449.50 |
$449.50 |
$449.50 |
$1,016.25
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$52.50 |
$52.50 |
$52.50 |
$242.64
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$52.50 |
$52.50 |
$52.50 |
$228.45
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$52.50 |
$52.50 |
$52.50 |
$230.55
|
|
Ghs moderate sedation ea addtl 15 min
|
$42.50 |
$42.50 |
$42.50 |
$150.00
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$42.50 |
$42.50 |
$42.50 |
$141.00
|
|
Ghs musc test done w/n test comp
|
$139.00 |
$139.00 |
$139.00 |
$324.80
|
|
Ghs musc tst done w/nerv tst lim
|
$139.00 |
$139.00 |
$139.00 |
$272.25
|
|
Ghs musc tst done w/n tst non ext
|
$74.00 |
$74.00 |
$74.00 |
$184.80
|
|
Ghs myocardial strain img spckl track
|
$524.50 |
$524.50 |
$524.50 |
$444.60
|
|
Ghs nailbed repair/nail removal
|
$449.50 |
$449.50 |
$449.50 |
$724.37
|
|
Ghs nerve blk intercostal, ea addtl level
|
$512.50 |
$512.50 |
$512.50 |
$1,545.05
|
|
Ghs nerve blk intercostal, single level
|
$420.00 |
$420.00 |
$420.00 |
$1,121.00
|
|
Ghs nerve block axillary nerve
|
$849.50 |
$849.50 |
$849.50 |
$1,540.00
|
|
Ghs nerve block brachial plexus
|
$470.00 |
$470.00 |
$470.00 |
$1,695.24
|
|
Ghs nerve block celiac plexus
|
$512.50 |
$512.50 |
$512.50 |
$1,556.40
|
|
Ghs nerve block interscaline
|
$512.50 |
$512.50 |
$512.50 |
$1,526.09
|
|
Ghs nerve block lumbar or thoracic symp
|
$512.50 |
$512.50 |
$512.50 |
$1,671.75
|
|
Ghs nerve block sciatic nerve
|
$512.50 |
$512.50 |
$512.50 |
$1,450.80
|
|
Ghs nerve block suprascapular
|
$718.00 |
$718.00 |
$718.00 |
$1,183.50
|
|
Ghs ng placement w fluoro guidance
|
$216.00 |
$216.00 |
$216.00 |
$478.50
|
|
Ghs o2 saturation
|
$26.00 |
$26.00 |
$26.00 |
$69.50
|
|
Ghs o2 uptake rest & indirect
|
$357.00 |
$357.00 |
$357.00 |
$173.50
|
|
Ghs ob unlisted IV or art inj or infusion
|
$21.00 |
$21.00 |
$21.00 |
$83.04
|
|
Ghs opcc repair cvp without subq port
|
$743.50 |
$743.50 |
$743.50 |
$1,229.24
|
|
Ghs opcc repair cvp w subq port
|
$1,501.50 |
$1,501.50 |
$1,501.50 |
$2,194.40
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$64.50 |
$64.50 |
$64.50 |
$58.00
|
|
Ghs osteopathic manipulative tx, 3-4 regions
|
$55.00 |
$55.00 |
$55.00 |
$64.50
|
|
Ghs ot dds rom
|
$29.50 |
$29.50 |
$29.50 |
$69.00
|
|
Ghs ot group caregiver training
|
$9.00 |
$9.00 |
$9.00 |
$34.80
|
|
Ghs ot prosthetic training/15 min
|
$31.00 |
$31.00 |
$31.00 |
$92.35
|
|
Ghs ot sensory integrative tech/15min
|
$59.50 |
$59.50 |
$59.50 |
$96.00
|
|
Ghs ot work hardening-additional hours
|
$92.00 |
$92.00 |
$92.00 |
$126.40
|
|
Ghs pacing - transcutaneous
|
$359.00 |
$359.00 |
$359.00 |
$822.00
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$338.00 |
$338.00 |
$338.00 |
$809.67
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$292.00 |
$292.00 |
$292.00 |
$962.00
|
|
Ghs peritonsillar abscess i andd
|
$277.50 |
$277.50 |
$277.50 |
$545.40
|
|
Ghs phenylketonurid
|
$18.50 |
$18.50 |
$18.50 |
$53.76
|
|
Ghs picc line insert < 5
|
$1,002.50 |
$1,002.50 |
$1,002.50 |
$1,996.00
|
|
Ghs plngl fx pm cl
|
$218.00 |
$218.00 |
$218.00 |
$564.50
|
|
Ghs polysom <6 yrs 4/> parameters
|
$1,901.00 |
$1,901.00 |
$1,901.00 |
$3,557.58
|
|
Ghs ppd (tb intradermal)
|
$29.00 |
$29.00 |
$29.00 |
$37.44
|
|
Ghs prostatic acid phosphatase (mayo)
|
$42.50 |
$42.50 |
$42.50 |
$43.55
|
|
Ghs protoporphyrins fract
|
$36.50 |
$36.50 |
$36.50 |
$60.75
|
|
Ghs pr without cont pulse ox
|
$53.50 |
$53.50 |
$53.50 |
$146.86
|
|
Ghs pt - work hardening/int 2hrs
|
$137.50 |
$137.50 |
$137.50 |
$285.60
|
|
Ghs refill of implantable pump
|
$96.50 |
$96.50 |
$96.50 |
$539.13
|
|
Ghs removal intranasal foreign body
|
$183.00 |
$183.00 |
$183.00 |
$283.51
|
|
Ghs removal pharyngeal foreign body
|
$261.50 |
$261.50 |
$261.50 |
$436.10
|
|
Ghs repair extensor tendon hand, ea tendon
|
$2,143.50 |
$2,143.50 |
$2,143.50 |
$2,408.00
|
|
Ghs sedimentation rate
|
$28.50 |
$28.50 |
$28.50 |
$45.50
|
|
Ghs semen analysis fert
|
$79.00 |
$79.00 |
$79.00 |
$124.80
|
|
Ghs sensitivity (per antimicro)
|
$73.00 |
$73.00 |
$73.00 |
$56.40
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$400.00 |
$400.00 |
$400.00 |
$563.75
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$240.00 |
$240.00 |
$240.00 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$424.00 |
$424.00 |
$424.00 |
$575.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$299.00 |
$299.00 |
$299.00 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$224.50 |
$224.50 |
$224.50 |
$451.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$356.50 |
$356.50 |
$356.50 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$230.50 |
$230.50 |
$230.50 |
$492.00
|
|
Ghs simple repair over 30 cm - 12007
|
$444.50 |
$444.50 |
$444.50 |
$584.00
|
|
Ghs sleep study unattended
|
$712.50 |
$712.50 |
$712.50 |
$503.38
|
|
Ghs somatosensory testing lower extremit
|
$681.50 |
$681.50 |
$681.50 |
$917.80
|
|
Ghs somatosensory testing upper & lower limbs
|
$1,361.00 |
$1,361.00 |
$1,361.00 |
$1,405.20
|
|
Ghs speech-gen aug dev eval iii, st
|
$107.00 |
$107.00 |
$107.00 |
$161.76
|
|
Ghs sphenopalatine ganglion block
|
$301.50 |
$301.50 |
$301.50 |
$616.00
|
|
Ghs sp train/fitting sp device - kx
|
$91.00 |
$91.00 |
$91.00 |
$249.60
|
|
Ghs strapping shoulder - 29240
|
$161.50 |
$161.50 |
$161.50 |
$217.60
|
|
Ghs st - re-eval for alt comm
|
$204.00 |
$204.00 |
$204.00 |
$309.00
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$47.00 |
$47.00 |
$47.00 |
$99.98
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$54.50 |
$54.50 |
$54.50 |
$354.00
|
|
Ghs superficial wnd dehiscence simp12020
|
$328.00 |
$328.00 |
$328.00 |
$909.00
|
|
Ghs superficial wnd dehis w packing12021
|
$288.00 |
$288.00 |
$288.00 |
$692.80
|
|
Ghs tx distal phalangeal fx with manipulation
|
$353.00 |
$353.00 |
$353.00 |
$525.60
|
|
Ghs urine, porphyrins quant
|
$70.50 |
$70.50 |
$70.50 |
$73.80
|
|
Ghs vaginal delivery only
|
$1,420.50 |
$1,420.50 |
$1,420.50 |
$3,338.40
|
|
Ghs veeg 12-26 hr intmt mont
|
$2,077.50 |
$2,077.50 |
$2,077.50 |
$1,932.00
|
|
Ghs windowing of cast
|
$98.50 |
$98.50 |
$98.50 |
$212.55
|
|
Gi endoscopic ultrasound
|
$280.00 |
$280.00 |
$280.00 |
$582.31
|
|
Gi inhouse confirmation
|
$91.50 |
$91.50 |
$91.50 |
$86.40
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$608.00 |
$608.00 |
$608.00 |
$2,195.76
|
|
Gi wireless capsule measure
|
$374.50 |
$374.50 |
$374.50 |
$1,579.30
|
|
Glaucoma surgery
|
$2,011.00 |
$2,011.00 |
$2,011.00 |
$4,672.80
|
|
Glove finger flexion right lg xl
|
$36.50 |
$36.50 |
$36.50 |
$110.62
|
