|
Gi inhouse confirmation
|
$321.10 |
$321.10 |
$1,779.00 |
$87.75
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$2,484.95 |
$2,484.95 |
$7,385.00 |
$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 |
$839.00 |
$49.00
|
|
Glucose-6-phosphate dhydrogenase screen
|
$33.00 |
$33.00 |
$33.00 |
$55.50
|
|
Glucose blood quantitative
|
$54.60 |
$54.60 |
$743.00 |
$42.25
|
|
Glucose body fluid
|
$104.00 |
$104.00 |
$104.00 |
$51.30
|
|
Glucose monitoring continual min 72hr pt
|
$182.65 |
$182.65 |
$182.65 |
$130.00
|
|
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 |
$1,480.00 |
$116.64
|
|
Gonadotropin luteinizing hormone (lh)
|
$196.95 |
$196.95 |
$1,506.00 |
$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 bone flex 2.5cm x 5cm grafton-cost per sq cm
|
$1.00 |
$1.00 |
$1.00 |
$1.00
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$1.00 |
$1.00 |
$1.00 |
$605.00
|
|
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
|
$1.00 |
$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 tis hmatrix dermis 10x5 -cost per sq cm
|
$1.00 |
$1.00 |
$1.00 |
$3,822.00
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$1.00 |
$160,260.75 |
$160,260.75 |
$28,894.71
|
|
Graft viashield 2layer amnion patch 2x2cm-cost per sq cm
|
$1.00 |
$1.00 |
$1.00 |
$1.00
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$1.00 |
$1.00 |
$1.00 |
$1,103.05
|
|
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
|
|
Grfg autol fat lipo 25 cc/<
|
$5,825.30 |
$5,825.30 |
$5,825.30 |
$5,419.00
|
|
Grfg autol fat lipo 50 cc/<
|
$10,687.95 |
$10,687.95 |
$10,687.95 |
$5,102.99
|
|
Grfg autol fat lipo ea addl
|
$10,687.95 |
$10,687.95 |
$10,687.95 |
$4,026.40
|
|
Grfg autol soft tiss dir exc
|
$10,687.95 |
$10,687.95 |
$10,687.95 |
$4,627.00
|
|
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 |
$9,299.00 |
$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
|
|
Guid loc target vol rad tx
|
$536.00 |
$536.00 |
$1,014.65 |
$535.60
|
|
Gw stiffened micro access kit
|
$18,552.30 |
$18,552.30 |
$18,552.30 |
$6,893.38
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$704.00 |
$704.00 |
$704.00 |
$91.09
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$9.75 |
$9.75 |
$181.00 |
$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 |
$483.60 |
$294.90
|
|
Haptoglobin quantitative
|
$338.00 |
$338.00 |
$652.00 |
$92.80
|
|
Harvest allogeneic stem cell
|
$15,023.45 |
$15,023.45 |
$15,023.45 |
$3,766.50
|
|
Harvest auto stem cells
|
$15,023.45 |
$15,023.45 |
$15,023.45 |
$3,624.31
|
|
Harvest stem cell concentrte
|
$1,282.45 |
$1,282.45 |
$1,282.45 |
$1,355.25
|
|
Harvest vein for bypass 35500
|
$20,878.65 |
$20,878.65 |
$20,878.65 |
$780.00
|
|
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
|
|
Hbot, full body chamber, 30m
|
$1,593.00 |
$1,593.00 |
$1,593.00 |
$526.90
|
|
Hc fl sm bowel enteroclss tube w kub double contrast
|
$1,199.25 |
$1,199.25 |
$2,111.00 |
$726.00
|
|
Hcg qualitative
|
$135.20 |
$135.20 |
$1,170.00 |
$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 |
$1,610.00 |
$113.12
|
|
Hc mohs micrographic h/n/h/f/g 1st stage 5 blocks
|
$1,746.55 |
$1,746.55 |
$1,746.55 |
$1,223.03
|
|
Hc mohs micrographic h/n/h/f/g each addl stage
|
$1,047.15 |
$1,047.15 |
$1,047.15 |
$858.00
|
|
Hc mohs trunk/arm/leg 1st stage 5 blocks
|
$1,746.55 |
$1,746.55 |
$1,746.55 |
$1,221.12
|
|
Hc mohs trunk/arm/leg ea addl block any stage
|
$1,047.15 |
$1,047.15 |
$1,047.15 |
$564.00
|
|
Hc mohs trunk/arm/leg ea stage after 1st stage
|
$1,047.15 |
$1,047.15 |
$1,047.15 |
$845.60
|
|
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 |
$4,097.00 |
$849.00
|
|
Hc nm myocard infarct avid plnr tomo spect w/wo quant
|
$1,682.85 |
$1,682.85 |
$3,084.00 |
$1,327.95
|
|
Hc pet myocardial imaging metabolic eval single study
|
$5,897.45 |
$5,897.45 |
$5,897.45 |
$3,958.50
|
|
Hc transcatheter placement and sbsq removal cepd perq
|
$7,499.70 |
$7,499.70 |
$7,499.70 |
$3,780.00
|
|
Hdr rdncl ntrstl/icav brchtx
|
$10,513.75 |
$10,513.75 |
$10,513.75 |
$2,725.00
|
|
Hdr rdncl ntrstl/icav brchtx
|
$13,698.75 |
$13,698.75 |
$13,698.75 |
$2,960.63
|
|
Hdr rdncl ntrstl/icav brchtx
|
$18,732.35 |
$18,732.35 |
$18,732.35 |
$3,706.29
|
|
Hdr rdncl skn surf brachytx
|
$724.75 |
$724.75 |
$724.75 |
$911.04
|
|
Hdr rdncl skn surf brachytx
|
$724.75 |
$724.75 |
$724.75 |
$1,179.75
|
|
Head CT scan (with and without contrast)
|
$4,335.50 |
$4,335.50 |
$4,621.50 |
$1,818.96
|
|
Head CT scan (with contrast)
|
$3,426.80 |
$3,426.80 |
$3,653.00 |
$1,527.60
|
|
Head CT scan (without contrast)
|
$3,054.35 |
$3,054.35 |
$3,257.15 |
$1,268.90
|
|
Heart first pass add-on
|
$3,084.00 |
$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 |
$4,897.00 |
$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 |
$344.00 |
$72.50
|
|
Heel (Calcaneus) X-ray (both feet)
|
$492.70 |
$492.70 |
$492.70 |
$276.00
|
|
Heinz bodies direct
|
$417.00 |
$417.00 |
$417.00 |
$43.15
|
|
Helicobacter pylori antibody igm
|
$259.35 |
$259.35 |
$259.35 |
$92.00
|
|
Helicoll, per square cm
|
$1.00 |
$1.00 |
$1.00 |
$1.00
|
|
Hematocrit
|
$62.40 |
$62.40 |
$237.00 |
$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 |
$4,897.00 |
$1,364.27
|
|
Hemoglobin
|
$62.40 |
$62.40 |
$201.00 |
$33.54
|
