|
Ghs IV infusion bamlanivimab/etesevimab
|
$475.00 |
$475.00 |
$475.00 |
$553.80
|
|
Ghs IV infusion casirivimab/imdevimab
|
$475.00 |
$475.00 |
$475.00 |
$569.28
|
|
Ghs IV infusion sotrovimab
|
$475.00 |
$475.00 |
$475.00 |
$553.80
|
|
Ghs IV thrombolytics - cerebral
|
$315.00 |
$315.00 |
$315.00 |
$663.00
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$319.50 |
$319.50 |
$319.50 |
$492.00
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$518.00 |
$518.00 |
$518.00 |
$591.00
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$518.00 |
$518.00 |
$518.00 |
$576.19
|
|
Ghs layer closure 2.5cm or less - 12051
|
$518.00 |
$518.00 |
$518.00 |
$602.00
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$564.00 |
$564.00 |
$564.00 |
$670.40
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$569.00 |
$569.00 |
$569.00 |
$690.36
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$779.00 |
$779.00 |
$779.00 |
$733.20
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$893.50 |
$893.50 |
$893.50 |
$770.40
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$632.50 |
$632.50 |
$632.50 |
$750.12
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$879.50 |
$879.50 |
$879.50 |
$737.10
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$687.50 |
$687.50 |
$687.50 |
$967.20
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$103.00 |
$103.00 |
$103.00 |
$242.64
|
|
Ghs moderate sedation ea addtl 15 min
|
$69.00 |
$69.00 |
$69.00 |
$150.00
|
|
Ghs myocardial strain img spckl track
|
$315.00 |
$315.00 |
$315.00 |
$444.60
|
|
Ghs nailbed repair/nail removal
|
$558.00 |
$558.00 |
$558.00 |
$724.37
|
|
Ghs nerve blk intercostal, ea addtl level
|
$1,089.50 |
$1,089.50 |
$1,089.50 |
$1,545.05
|
|
Ghs nerve blk intercostal, single level
|
$892.50 |
$892.50 |
$892.50 |
$1,121.00
|
|
Ghs nerve block brachial plexus
|
$999.00 |
$999.00 |
$999.00 |
$1,695.24
|
|
Ghs nerve block interscaline
|
$567.00 |
$567.00 |
$567.00 |
$1,526.09
|
|
Ghs nerve block lumbar or thoracic symp
|
$1,089.50 |
$1,089.50 |
$1,089.50 |
$1,671.75
|
|
Ghs nerve block sciatic nerve
|
$1,089.50 |
$1,089.50 |
$1,089.50 |
$1,450.80
|
|
Ghs nerve block suprascapular
|
$1,524.50 |
$1,524.50 |
$1,524.50 |
$1,183.50
|
|
Ghs ng placement w fluoro guidance
|
$459.50 |
$459.50 |
$459.50 |
$478.50
|
|
Ghs o2 saturation
|
$69.50 |
$69.50 |
$69.50 |
$69.50
|
|
Ghs ot dds rom
|
$104.50 |
$104.50 |
$104.50 |
$69.00
|
|
Ghs ot group caregiver training
|
$10.00 |
$10.00 |
$10.00 |
$34.80
|
|
Ghs ot prosthetic training/15 min
|
$216.00 |
$216.00 |
$216.00 |
$92.35
|
|
Ghs ot sensory integrative tech/15min
|
$260.00 |
$260.00 |
$260.00 |
$96.00
|
|
Ghs ot work hardening-additional hours
|
$96.00 |
$96.00 |
$96.00 |
$126.40
|
|
Ghs pacing - transcutaneous
|
$376.50 |
$376.50 |
$376.50 |
$822.00
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$656.50 |
$656.50 |
$656.50 |
$809.67
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$620.00 |
$620.00 |
$620.00 |
$962.00
|
|
Ghs peritonsillar abscess i andd
|
$589.00 |
$589.00 |
$589.00 |
$545.40
|
|
Ghs plngl fx pm cl
|
$486.00 |
$486.00 |
$486.00 |
$564.50
|
|
Ghs polysom <6 yrs 4/> parameters
|
$5,515.50 |
$5,515.50 |
$5,515.50 |
$3,557.58
|
|
Ghs ppd (tb intradermal)
|
$37.00 |
$37.00 |
$37.00 |
$37.44
|
|
Ghs prostatic acid phosphatase (mayo)
|
$338.00 |
$338.00 |
$338.00 |
$43.55
|
|
Ghs pt - work hardening/int 2hrs
|
$144.50 |
$144.50 |
$144.50 |
$285.60
|
|
Ghs removal intranasal foreign body
|
$388.50 |
$388.50 |
$388.50 |
$283.51
|
|
Ghs removal pharyngeal foreign body
|
$364.00 |
$364.00 |
$364.00 |
$436.10
|
|
Ghs rsv eia (respir synctial vrs)
|
$441.50 |
$441.50 |
$441.50 |
$99.00
|
|
Ghs sedimentation rate
|
$214.50 |
$214.50 |
$214.50 |
$45.50
|
|
Ghs sensitivity (per antimicro)
|
$175.50 |
$175.50 |
$175.50 |
$56.40
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$850.00 |
$850.00 |
$850.00 |
$563.75
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$901.00 |
$901.00 |
$901.00 |
$575.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$904.00 |
$904.00 |
$904.00 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$890.50 |
$890.50 |
$890.50 |
$451.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$795.50 |
$795.50 |
$795.50 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$897.50 |
$897.50 |
$897.50 |
$492.00
|
|
Ghs sphenopalatine ganglion block
|
$374.50 |
$374.50 |
$374.50 |
$616.00
|
|
Ghs sp train/fitting sp device - kx
|
$113.00 |
$113.00 |
$113.00 |
$249.60
|
|
Ghs st - re-eval for alt comm
|
$388.00 |
$388.00 |
$388.00 |
$309.00
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$187.50 |
$187.50 |
$187.50 |
$99.98
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$375.00 |
$375.00 |
$375.00 |
$354.00
|
|
Ghs tx distal phalangeal fx with manipulation
|
$749.50 |
$749.50 |
$749.50 |
$525.60
|
|
Ghs urine, porphyrins quant
|
$93.50 |
$93.50 |
$93.50 |
$73.80
|
|
Ghs veeg 12-26 hr intmt mont
|
$471.50 |
$471.50 |
$471.50 |
$1,932.00
|
|
Gi inhouse confirmation
|
$111.50 |
$111.50 |
$111.50 |
$86.40
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$1,187.00 |
$1,187.00 |
$1,187.00 |
$2,195.76
|
|
Gi wireless capsule measure
|
$971.50 |
$971.50 |
$971.50 |
$1,579.30
|
|
Glucagon plasma - sendout
|
$138.50 |
$138.50 |
$138.50 |
$63.20
|
|
Glucose 1 hr post dose
|
$263.50 |
$263.50 |
$263.50 |
$48.25
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$99.00 |
$99.00 |
$99.00 |
$22.75
|
|
Glucose blood quantitative
|
$216.00 |
$216.00 |
$216.00 |
$41.40
|
|
Glucose body fluid
|
$216.00 |
$216.00 |
$216.00 |
$51.30
|
|
Glucose tolerance test (gtt) 3 specimens
|
$528.50 |
$528.50 |
$528.50 |
$104.50
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$168.50 |
$168.50 |
$168.50 |
$36.00
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$529.50 |
$529.50 |
$529.50 |
$115.80
|
|
Gonadotropin luteinizing hormone (lh)
|
$524.50 |
$524.50 |
$524.50 |
$129.00
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$63.00 |
$63.00 |
$63.00 |
$143.50
|
|
Graft axiofill 1000mg
|
$2,091.00 |
$2,091.00 |
$2,091.00 |
$5,125.68
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$601.50 |
$601.50 |
$601.50 |
$601.50
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$139.50 |
$139.50 |
$139.50 |
$23,288.44
|
|
Graft nerve adv 3-4x70mm
|
$20,483.50 |
$20,483.50 |
$20,483.50 |
$20,782.10
|
|
Graft patch felt ptfe 2x2
|
$27,093.00 |
$27,093.00 |
$27,093.00 |
$29,995.44
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$8,300.00 |
$8,300.00 |
$8,300.00 |
$1,455.76
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$541.00 |
$541.00 |
$541.00 |
$892.38
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$635.50 |
$635.50 |
$635.50 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$718.00 |
$718.00 |
$718.00 |
$427.89
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$52.00 |
$52.00 |
$52.00 |
$29,056.92
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$416.00 |
$416.00 |
$416.00 |
$1,132.47
|
|
Graft xenmtrx sft rect 15x20cm
|
$45,489.50 |
$45,489.50 |
$45,489.50 |
$31,191.20
|
|
Graft xenmtrx sft rect 19x28cm
|
$2,458.50 |
$2,458.50 |
$2,458.50 |
$3,076.20
|
|
Growth hormone panel
|
$531.00 |
$531.00 |
$531.00 |
$173.00
|
|
G-tube reposition
|
$704.50 |
$704.50 |
$704.50 |
$745.80
|
|
Gu dilat ureter/urethra s&i
|
$1,150.00 |
$1,150.00 |
$1,150.00 |
$1,980.66
|
|
Guided cath fluid drainage 10030
|
$1,402.50 |
$1,402.50 |
$1,402.50 |
$1,327.76
|
|
Guide endoanchr sg-64 aaa 62cm
|
$22,766.50 |
$22,766.50 |
$22,766.50 |
$7,743.36
|
|
Guide wire threaded 1.4x150mm
|
$7,855.50 |
$7,855.50 |
$7,855.50 |
$3,401.81
|
|
Guide worley csg 9fx50cm std
|
$1,283.50 |
$1,283.50 |
$1,283.50 |
$1,117.40
|
|
Gw stiffened micro access kit
|
$13,902.50 |
$13,902.50 |
$13,902.50 |
$6,600.00
|
|
Halo cervical into jckt vest
|
$7,863.50 |
$7,863.50 |
$7,863.50 |
$5,015.12
|
|
Hand X-ray
|
$1,107.00 |
$1,107.00 |
$1,107.00 |
$345.87
|
|
Haptoglobin quantitative
|
$413.50 |
$413.50 |
$413.50 |
$91.80
|
|
Hba1/hba2 full gene sequence
|
$408.50 |
$408.50 |
$408.50 |
$769.95
|
|
Hbot, full body chamber, 30m
|
$303.50 |
$303.50 |
$303.50 |
$526.90
|
