|
Ghs picc line insert < 5
|
$1,010.75 |
$1,010.75 |
$1,010.75 |
$2,019.50
|
|
Ghs polysom <6 yrs 4/> parameters
|
$4,228.25 |
$4,228.25 |
$4,228.25 |
$3,557.58
|
|
Ghs ppd (tb intradermal)
|
$48.10 |
$48.10 |
$48.10 |
$37.44
|
|
Ghs prostatic acid phosphatase (mayo)
|
$20.15 |
$20.15 |
$20.15 |
$43.55
|
|
Ghs protoporphyrins fract
|
$20.15 |
$20.15 |
$20.15 |
$60.75
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$22.10 |
$22.10 |
$22.10 |
$47.55
|
|
Ghs pt - work hardening/int 2hrs
|
$512.20 |
$512.20 |
$512.20 |
$285.60
|
|
Ghs semen analysis fert
|
$305.50 |
$305.50 |
$305.50 |
$124.80
|
|
Ghs sensitivity (per antimicro)
|
$74.10 |
$74.10 |
$74.10 |
$57.60
|
|
Ghs sleep study unattended
|
$616.85 |
$616.85 |
$616.85 |
$503.38
|
|
Ghs somatosensory testing lower extremit
|
$1,101.10 |
$1,101.10 |
$1,101.10 |
$925.91
|
|
Ghs somatosensory testing upper & lower limbs
|
$1,810.90 |
$1,810.90 |
$1,810.90 |
$1,416.80
|
|
Ghs speech-gen aug dev eval iii, st
|
$256.75 |
$256.75 |
$256.75 |
$157.50
|
|
Ghs sp train/fitting sp device - kx
|
$1,043.25 |
$1,043.25 |
$1,043.25 |
$252.75
|
|
Ghs st - re-eval for alt comm
|
$1,344.85 |
$1,344.85 |
$1,344.85 |
$309.60
|
|
Ghs urine, hydroxproline total
|
$44.85 |
$44.85 |
$44.85 |
$109.60
|
|
Ghs urine, porphyrins quant
|
$47.45 |
$47.45 |
$47.45 |
$73.80
|
|
Ghs veeg 12-26 hr intmt mont
|
$3,835.65 |
$3,835.65 |
$3,835.65 |
$1,932.00
|
|
Gi inhouse confirmation
|
$321.10 |
$321.10 |
$321.10 |
$87.75
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$2,484.95 |
$2,484.95 |
$2,484.95 |
$2,215.20
|
|
Gi trc img intral colon i&r
|
$2,644.85 |
$2,644.85 |
$2,644.85 |
$1,959.88
|
|
Gi wireless capsule measure
|
$2,484.95 |
$2,484.95 |
$2,484.95 |
$1,579.30
|
|
Glucagon 1 mg solution for injection
|
$1,435.20 |
$1,435.20 |
$1,435.20 |
$613.79
|
|
Glucagon plasma - sendout
|
$15.60 |
$15.60 |
$15.60 |
$64.35
|
|
Glucose 1 hr post dose
|
$149.50 |
$149.50 |
$149.50 |
$49.00
|
|
Glucose blood quantitative
|
$54.60 |
$54.60 |
$54.60 |
$42.25
|
|
Glucose body fluid
|
$104.00 |
$104.00 |
$104.00 |
$51.30
|
|
Glucose tolerance test (gtt) 3 specimens
|
$406.25 |
$406.25 |
$406.25 |
$105.60
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$107.90 |
$107.90 |
$107.90 |
$36.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$50.70 |
$50.70 |
$50.70 |
$37.40
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$188.50 |
$188.50 |
$188.50 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$195.65 |
$195.65 |
$195.65 |
$116.64
|
|
Gonadotropin luteinizing hormone (lh)
|
$196.95 |
$196.95 |
$196.95 |
$129.03
|
|
Goserelin 10.8 mg subcutaneous implant
|
$6,871.80 |
$6,871.80 |
$6,871.80 |
$4,417.13
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$5,831.15 |
$5,831.15 |
$5,831.15 |
$73.83
|
|
Graft axiofill 1000mg
|
$12,404.60 |
$12,404.60 |
$12,404.60 |
$5,125.68
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$62,838.10 |
$62,838.10 |
$62,838.10 |
$23,233.80
|
|
Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm
|
$8,082.75 |
$8,082.75 |
$8,082.75 |
$3,432.00
|
|
Graft nerve adv 3-4x70mm
|
$71,091.15 |
$71,091.15 |
$71,091.15 |
$20,782.10
|
|
Graft patch felt ptfe 2x2
|
$58,299.80 |
$58,299.80 |
$58,299.80 |
$29,293.39
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$17,290.00 |
$17,290.00 |
$17,290.00 |
$1,111.05
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$26,745.55 |
$26,745.55 |
$26,745.55 |
$886.17
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$48,627.80 |
$48,627.80 |
$48,627.80 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$13,333.45 |
$13,333.45 |
$13,333.45 |
$349.41
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$160,260.75 |
$160,260.75 |
$160,260.75 |
$28,894.71
|
|
Graft xenmtrx sft rect 15x20cm
|
$98,429.50 |
$98,429.50 |
$98,429.50 |
$29,676.26
|
|
Graft xenmtrx sft rect 19x28cm
|
$9,266.40 |
$9,266.40 |
$9,266.40 |
$2,905.40
|
|
Granisetron hcl injection
|
$17.55 |
$17.55 |
$17.55 |
$45.03
|
|
Granulocyte pheresis ea unit
|
$1,494.35 |
$1,494.35 |
$1,494.35 |
$2,698.02
|
|
Growth hormone antibody
|
$44.20 |
$44.20 |
$44.20 |
$73.10
|
|
G-tube reposition
|
$827.45 |
$827.45 |
$827.45 |
$771.36
|
|
Gu dilat ureter/urethra s&i
|
$3,803.80 |
$3,803.80 |
$3,803.80 |
$2,000.16
|
|
Guided cath fluid drainage 10030
|
$1,942.85 |
$1,942.85 |
$1,942.85 |
$1,372.15
|
|
Guide wire threaded 1.4x150mm
|
$21,453.25 |
$21,453.25 |
$21,453.25 |
$3,284.36
|
|
Guide worley csg 9fx50cm std
|
$2,645.50 |
$2,645.50 |
$2,645.50 |
$1,117.40
|
|
Gw stiffened micro access kit
|
$18,552.30 |
$18,552.30 |
$18,552.30 |
$6,893.38
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$9.75 |
$9.75 |
$9.75 |
$24.30
|
|
Hands-On Manual Therapy (each 15 minutes)
|
$188.50 |
$188.50 |
$188.50 |
$105.30
|
|
Hand X-ray
|
$580.45 |
$580.45 |
$580.45 |
$350.35
|
|
Hand X-ray (2 views, both hands)
|
$404.95 |
$404.95 |
$404.95 |
$294.90
|
|
Haptoglobin quantitative
|
$338.00 |
$338.00 |
$338.00 |
$92.80
|
|
Hast w/i&r phys/qhp
|
$349.70 |
$349.70 |
$349.70 |
$301.95
|
|
Hast w/oxygen titrate
|
$357.50 |
$357.50 |
$357.50 |
$347.20
|
|
Hc fl sm bowel enteroclss tube w kub double contrast
|
$1,199.25 |
$1,199.25 |
$1,199.25 |
$726.00
|
|
Hcg qualitative
|
$135.20 |
$135.20 |
$135.20 |
$90.10
|
|
Hcg quantitative
|
$191.75 |
$191.75 |
$191.75 |
$139.20
|
|
Hc i-131 sodium iodide cap dx per mci
|
$302.90 |
$302.90 |
$302.90 |
$113.12
|
|
Hc nm cardiac blood pool planar 1 stdy wal motn eject fract
|
$1,648.40 |
$1,648.40 |
$1,648.40 |
$1,070.00
|
|
Hc nm kidney imaging with flow
|
$1,344.20 |
$1,344.20 |
$1,344.20 |
$849.00
|
|
Hc nm myocard infarct avid plnr tomo spect w/wo quant
|
$1,682.85 |
$1,682.85 |
$1,682.85 |
$1,327.95
|
|
Head CT scan (with and without contrast)
|
$4,335.50 |
$4,335.50 |
$4,335.50 |
$1,818.96
|
|
Head CT scan (with contrast)
|
$3,426.80 |
$3,426.80 |
$3,426.80 |
$1,527.60
|
|
Head CT scan (without contrast)
|
$3,054.35 |
$3,054.35 |
$3,054.35 |
$1,268.90
|
|
Heart first pass add-on
|
$3,630.90 |
$3,630.90 |
$3,630.90 |
$485.27
|
|
Heart first pass multiple
|
$3,541.85 |
$3,541.85 |
$3,541.85 |
$1,422.05
|
|
Heart image spect
|
$2,303.60 |
$2,303.60 |
$2,303.60 |
$1,135.68
|
|
Heart infarct image
|
$940.55 |
$940.55 |
$940.55 |
$942.29
|
|
Heart infarct image (ef)
|
$1,238.90 |
$1,238.90 |
$1,238.90 |
$865.98
|
|
Heavy metal qual any number
|
$23.40 |
$23.40 |
$23.40 |
$72.50
|
|
Heel (Calcaneus) X-ray (both feet)
|
$492.70 |
$492.70 |
$492.70 |
$276.00
|
|
Helicobacter pylori antibody igm
|
$259.35 |
$259.35 |
$259.35 |
$92.00
|
|
Hematocrit
|
$62.40 |
$62.40 |
$62.40 |
$33.80
|
|
Hematopoietic nuclear tx
|
$342.55 |
$342.55 |
$342.55 |
$928.98
|
|
Hemin 350 mg intravenous powder for solution
|
$140.40 |
$140.40 |
$140.40 |
$20,618.46
|
|
Hemodialysis one evaluation
|
$2,858.70 |
$2,858.70 |
$2,858.70 |
$1,364.27
|
|
Hemoglobin
|
$62.40 |
$62.40 |
$62.40 |
$33.54
|
|
Hemoglobin fetal qualitative
|
$335.40 |
$335.40 |
$335.40 |
$51.75
|
|
Hemoglobin plasma
|
$23.40 |
$23.40 |
$23.40 |
$41.40
|
|
Hemolysins/agglutinins auto
|
$66.95 |
$66.95 |
$66.95 |
$62.48
|
|
Hemoperfusion
|
$4,594.20 |
$4,594.20 |
$4,594.20 |
$202.40
|
|
Hepagam b im injection
|
$721.50 |
$721.50 |
$721.50 |
$1,118.05
|
|
Heparin assay
|
$414.70 |
$414.70 |
$414.70 |
$139.15
|
|
Heparin bolus from bag
|
$1,001.65 |
$1,001.65 |
$1,001.65 |
$66.06
|
|
Heparin neutralization
|
$56.55 |
$56.55 |
$56.55 |
$37.10
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$5.20 |
$5.20 |
$5.20 |
$12.00
|
|
Hepatitis a antibody igm
|
$332.15 |
$332.15 |
$332.15 |
$89.44
|
|
Hepatitis b core antibody igm
|
$332.15 |
$332.15 |
$332.15 |
$89.60
|
|
Hepatitis b core antibody total
|
$332.15 |
$332.15 |
$332.15 |
$77.50
|
|
Hepatitis b immune globulin greater than 1,560 units/5 ml im solution
|
$4,545.45 |
$4,545.45 |
$4,545.45 |
$1,154.13
|
|
Hepatitis b surface antibody
|
$332.15 |
$332.15 |
$332.15 |
$82.32
|
