|
Ghs moderate sedation < 5 yr, 30 min
|
$1,512.15 |
$1,512.15 |
$1,512.15 |
$261.80
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$955.76 |
$955.76 |
$955.76 |
$252.50
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$1,444.33 |
$1,444.33 |
$1,444.33 |
$239.20
|
|
Ghs moderate sedation ea addtl 15 min
|
$405.80 |
$405.80 |
$405.80 |
$145.60
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$498.41 |
$498.41 |
$498.41 |
$140.00
|
|
Ghs musc test done w/n test comp
|
$511.94 |
$511.94 |
$511.94 |
$349.80
|
|
Ghs musc tst done w/nerv tst lim
|
$419.91 |
$419.91 |
$419.91 |
$269.15
|
|
Ghs musc tst done w/n tst non ext
|
$442.64 |
$442.64 |
$442.64 |
$222.60
|
|
Ghs myocardial strain img spckl track
|
$663.26 |
$663.26 |
$663.26 |
$503.85
|
|
Ghs nailbed repair/nail removal
|
$1,978.81 |
$1,978.81 |
$1,978.81 |
$808.80
|
|
Ghs nerve block brachial plexus
|
$2,882.49 |
$2,882.49 |
$2,882.49 |
$1,768.00
|
|
Ghs nerve block sciatic nerve
|
$1,876.88 |
$1,876.88 |
$1,876.88 |
$1,636.80
|
|
Ghs ng placement w fluoro guidance
|
$1,061.91 |
$1,061.91 |
$1,061.91 |
$468.75
|
|
Ghs o2 saturation
|
$150.80 |
$150.80 |
$150.80 |
$72.45
|
|
Ghs ot sensory integrative tech/15min
|
$248.29 |
$248.29 |
$248.29 |
$101.05
|
|
Ghs pacing - transcutaneous
|
$2,623.71 |
$2,623.71 |
$2,623.71 |
$868.68
|
|
Ghs plngl fx pm cl
|
$2,536.71 |
$2,536.71 |
$2,536.71 |
$662.20
|
|
Ghs ppd (tb intradermal)
|
$301.03 |
$301.03 |
$301.03 |
$43.45
|
|
Ghs prostatic acid phosphatase (mayo)
|
$149.10 |
$149.10 |
$149.10 |
$40.56
|
|
Ghs protoporphyrins fract
|
$221.50 |
$221.50 |
$221.50 |
$64.35
|
|
Ghs removal intranasal foreign body
|
$1,252.04 |
$1,252.04 |
$1,252.04 |
$324.35
|
|
Ghs removal pharyngeal foreign body
|
$1,061.91 |
$1,061.91 |
$1,061.91 |
$460.00
|
|
Ghs reticulocyte count
|
$66.53 |
$66.53 |
$66.53 |
$33.57
|
|
Ghs rsv eia (respir synctial vrs)
|
$505.17 |
$505.17 |
$505.17 |
$101.15
|
|
Ghs sensitivity (per antimicro)
|
$129.71 |
$129.71 |
$129.71 |
$59.90
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$2,827.66 |
$2,827.66 |
$2,827.66 |
$590.40
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$3,457.14 |
$3,457.14 |
$3,457.14 |
$670.08
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$2,801.99 |
$2,801.99 |
$2,801.99 |
$487.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$2,198.18 |
$2,198.18 |
$2,198.18 |
$470.47
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$3,514.99 |
$3,514.99 |
$3,514.99 |
$538.64
|
|
Ghs simple repair over 30 cm - 12007
|
$4,296.44 |
$4,296.44 |
$4,296.44 |
$660.00
|
|
Ghs somatosensory testing upper & lower limbs
|
$5,921.18 |
$5,921.18 |
$5,921.18 |
$1,435.00
|
|
Ghs sphenopalatine ganglion block
|
$432.38 |
$432.38 |
$432.38 |
$706.56
|
|
Ghs sp train/fitting sp device - kx
|
$432.87 |
$432.87 |
$432.87 |
$261.95
|
|
Ghs strapping shoulder - 29240
|
$1,252.04 |
$1,252.04 |
$1,252.04 |
$243.07
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$329.02 |
$329.02 |
$329.02 |
$351.45
|
|
Ghs tx distal phalangeal fx with manipulation
|
$2,536.71 |
$2,536.71 |
$2,536.71 |
$591.00
|
|
Ghs vaginal delivery only
|
$10,282.01 |
$10,282.01 |
$10,282.01 |
$3,525.06
|
|
Gi inhouse confirmation
|
$297.14 |
$297.14 |
$297.14 |
$87.00
|
|
Glucagon plasma - sendout
|
$220.56 |
$220.56 |
$220.56 |
$58.56
|
|
Glucose 1 hr post dose
|
$73.32 |
$73.32 |
$73.32 |
$46.28
|
|
Glucose blood quantitative
|
$66.62 |
$66.62 |
$66.62 |
$44.76
|
|
Glucose body fluid
|
$278.39 |
$278.39 |
$278.39 |
$50.70
|
|
Glucose tolerance test (gtt) 3 specimens
|
$198.65 |
$198.65 |
$198.65 |
$100.10
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$60.50 |
$60.50 |
$60.50 |
$34.45
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$156.10 |
$156.10 |
$156.10 |
$56.70
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$7,395.06 |
$7,395.06 |
$7,395.06 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$93.35 |
$93.35 |
$93.35 |
$110.04
|
|
Gonadotropin luteinizing hormone (lh)
|
$142.05 |
$142.05 |
$142.05 |
$123.75
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$380.36 |
$380.36 |
$380.36 |
$1,679.75
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$2,071.56 |
$2,071.56 |
$2,071.56 |
$2,369.10
|
|
Great toe with reduction 28495
|
$2,536.71 |
$2,536.71 |
$2,536.71 |
$577.03
|
|
Guided cath fluid drainage 10030
|
$5,322.16 |
$5,322.16 |
$5,322.16 |
$1,461.15
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$268.63 |
$268.63 |
$268.63 |
$112.36
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$37.16 |
$37.16 |
$37.16 |
$35.40
|
|
Hand X-ray
|
$1,231.66 |
$1,231.66 |
$1,231.66 |
$338.58
|
|
Haptoglobin quantitative
|
$194.18 |
$194.18 |
$194.18 |
$89.95
|
|
Hcg qualitative
|
$400.94 |
$400.94 |
$400.94 |
$77.50
|
|
Hcg quantitative
|
$367.62 |
$367.62 |
$367.62 |
$124.80
|
|
Head CT scan (with and without contrast)
|
$9,524.76 |
$9,524.76 |
$9,524.76 |
$1,878.75
|
|
Head CT scan (with contrast)
|
$8,189.96 |
$8,189.96 |
$8,189.96 |
$1,520.45
|
|
Head CT scan (without contrast)
|
$7,113.12 |
$7,113.12 |
$7,113.12 |
$1,268.90
|
|
Hematocrit
|
$117.82 |
$117.82 |
$117.82 |
$33.57
|
|
Hemodialysis one evaluation
|
$2,063.03 |
$2,063.03 |
$2,063.03 |
$1,329.90
|
|
Hemoglobin
|
$94.17 |
$94.17 |
$94.17 |
$31.75
|
|
Hemoglobin methemoglobin quantitative
|
$126.57 |
$126.57 |
$126.57 |
$49.40
|
|
Hemoglobin urine
|
$60.97 |
$60.97 |
$60.97 |
$23.31
|
|
Heparin assay
|
$295.39 |
$295.39 |
$295.39 |
$130.20
|
|
Heparin bolus from bag
|
$321.89 |
$321.89 |
$321.89 |
$79.04
|
|
Heparin neutralization
|
$182.75 |
$182.75 |
$182.75 |
$47.45
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$57.45 |
$57.45 |
$57.45 |
$32.27
|
|
Hepatitis a antibody igm
|
$282.88 |
$282.88 |
$282.88 |
$85.15
|
|
Hepatitis b core antibody igm
|
$289.85 |
$289.85 |
$289.85 |
$87.98
|
|
Hepatitis b core antibody total
|
$186.00 |
$186.00 |
$186.00 |
$83.29
|
|
Hepatitis b surface antibody
|
$551.51 |
$551.51 |
$551.51 |
$83.79
|
|
Hepatitis c antibody
|
$220.26 |
$220.26 |
$220.26 |
$108.00
|
|
Hepatobiliary system imaging
|
$1,891.53 |
$1,891.53 |
$1,891.53 |
$1,521.10
|
|
Hernia Repair (Inguinal)
|
$32,065.11 |
$32,065.11 |
$32,065.11 |
$5,870.15
|
|
Herpes simplex type 1 antibody igg
|
$203.58 |
$203.58 |
$203.58 |
$70.00
|
|
Herpes simplex type 2 antibody igg
|
$96.08 |
$96.08 |
$96.08 |
$87.10
|
|
Herpes simplex virus isolation
|
$124.44 |
$124.44 |
$124.44 |
$93.32
|
|
Heterophile antibodies screening
|
$370.82 |
$370.82 |
$370.82 |
$73.60
|
|
Hip X-ray
|
$2,240.42 |
$2,240.42 |
$2,240.42 |
$292.05
|
|
Hla i low res one antigen equiv ea
|
$1,147.28 |
$1,147.28 |
$1,147.28 |
$164.00
|
|
Hla i typing 1 locus hr
|
$2,735.86 |
$2,735.86 |
$2,735.86 |
$398.40
|
|
Hla i typing complete lr
|
$6,229.41 |
$6,229.41 |
$6,229.41 |
$588.55
|
|
Hocm 350-399mg/ml iodine,1ml
|
$68.86 |
$68.86 |
$68.86 |
$68.86
|
|
Homocysteine
|
$276.59 |
$276.59 |
$276.59 |
$113.10
|
|
Homogenization tissue
|
$67.46 |
$67.46 |
$67.46 |
$39.00
|
|
H pylori (c-13) breath
|
$990.19 |
$990.19 |
$990.19 |
$219.05
|
|
H pylori drug admin
|
$27.51 |
$27.51 |
$27.51 |
$31.99
|
|
Human epididymis protein 4 (he4)
|
$280.52 |
$280.52 |
$280.52 |
$131.84
|
|
Hyaluronidase 150 unit/ml injection solution
|
$374.89 |
$374.89 |
$374.89 |
$152.81
|
|
Hydralazine 20 mg/ml injection solution
|
$264.32 |
$264.32 |
$264.32 |
$57.02
|
|
Hydration IV infusion each additional hour
|
$303.16 |
$303.16 |
$303.16 |
$134.53
|
|
Hydration IV infusion initial 31minutes - 1 hour
|
$782.35 |
$782.35 |
$782.35 |
$394.40
|
|
Hydromorphone 0.2 mg/ml in 0.9% nacl IV pca opioid naive - 4 hr dose limit (wrapper)
|
$1,048.92 |
$1,048.92 |
$1,048.92 |
$112.22
|
|
Hydroxyzine hcl 50 mg/ml intramuscular solution
|
$480.69 |
$480.69 |
$480.69 |
$86.47
|
|
Hyoscyamine sulfate inj
|
$1,804.84 |
$1,804.84 |
$1,804.84 |
$215.75
|
|
Hysteroscopy biopsy
|
$30,377.57 |
$30,377.57 |
$30,377.57 |
$4,753.18
|