|
Ghs inj tendon origin/insertion
|
$1,331.57 |
$1,331.57 |
$1,331.57 |
$431.07
|
|
Ghs inj transforaminal cerv ea add bil
|
$1,095.54 |
$1,095.54 |
$1,095.54 |
$1,126.23
|
|
Ghs inj transforaminal cerv single bil
|
$2,553.34 |
$2,553.34 |
$2,553.34 |
$1,861.60
|
|
Ghs insertion of needle - bone
|
$1,175.90 |
$1,175.90 |
$1,175.90 |
$461.58
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$2,296.87 |
$2,296.87 |
$2,296.87 |
$943.80
|
|
Ghs intermed repair 20.1 - 30.0 cm-12036
|
$3,816.03 |
$3,816.03 |
$3,816.03 |
$1,160.28
|
|
Ghs irrigate corpora cavernosa for priapism
|
$1,341.78 |
$1,341.78 |
$1,341.78 |
$637.92
|
|
Ghs IV inf sq injection, on-body injector
|
$649.26 |
$649.26 |
$649.26 |
$117.00
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$1,998.80 |
$1,998.80 |
$1,998.80 |
$547.95
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$6,029.39 |
$6,029.39 |
$6,029.39 |
$617.60
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$2,452.06 |
$2,452.06 |
$2,452.06 |
$619.20
|
|
Ghs layer closure 2.5cm or less - 12051
|
$2,487.54 |
$2,487.54 |
$2,487.54 |
$648.00
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$2,296.87 |
$2,296.87 |
$2,296.87 |
$741.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$2,280.02 |
$2,280.02 |
$2,280.02 |
$741.00
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$2,296.87 |
$2,296.87 |
$2,296.87 |
$779.35
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$2,296.87 |
$2,296.87 |
$2,296.87 |
$810.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$3,399.74 |
$3,399.74 |
$3,399.74 |
$795.20
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$2,296.87 |
$2,296.87 |
$2,296.87 |
$779.35
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$3,425.58 |
$3,425.58 |
$3,425.58 |
$995.20
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$3,425.58 |
$3,425.58 |
$3,425.58 |
$1,188.80
|
|
Ghs mbp
|
$455.35 |
$455.35 |
$455.35 |
$74.19
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$1,870.43 |
$1,870.43 |
$1,870.43 |
$261.80
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$1,870.43 |
$1,870.43 |
$1,870.43 |
$252.50
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$1,870.43 |
$1,870.43 |
$1,870.43 |
$239.20
|
|
Ghs moderate sedation ea addtl 15 min
|
$424.84 |
$424.84 |
$424.84 |
$145.60
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$235.20 |
$235.20 |
$235.20 |
$140.00
|
|
Ghs myocardial strain img spckl track
|
$773.68 |
$773.68 |
$773.68 |
$503.85
|
|
Ghs nailbed repair/nail removal
|
$1,715.99 |
$1,715.99 |
$1,715.99 |
$808.80
|
|
Ghs nerve blk intercostal, ea addtl level
|
$2,432.44 |
$2,432.44 |
$2,432.44 |
$1,618.50
|
|
Ghs nerve blk intercostal, single level
|
$2,245.22 |
$2,245.22 |
$2,245.22 |
$1,230.80
|
|
Ghs nerve block brachial plexus
|
$2,988.99 |
$2,988.99 |
$2,988.99 |
$1,768.00
|
|
Ghs nerve block celiac plexus
|
$1,346.09 |
$1,346.09 |
$1,346.09 |
$1,712.00
|
|
Ghs nerve block lumbar or thoracic symp
|
$2,400.57 |
$2,400.57 |
$2,400.57 |
$2,042.60
|
|
Ghs ng placement w fluoro guidance
|
$922.62 |
$922.62 |
$922.62 |
$468.75
|
|
Ghs o2 saturation
|
$3,623.61 |
$3,623.61 |
$3,623.61 |
$72.45
|
|
Ghs opcc repair cvp without subq port
|
$2,880.14 |
$2,880.14 |
$2,880.14 |
$1,302.54
|
|
Ghs ot group caregiver training
|
$59.63 |
$59.63 |
$59.63 |
$43.20
|
|
Ghs ot sensory integrative tech/15min
|
$187.11 |
$187.11 |
$187.11 |
$101.05
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$1,672.25 |
$1,672.25 |
$1,672.25 |
$855.60
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$1,308.11 |
$1,308.11 |
$1,308.11 |
$1,003.00
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$192.69 |
$192.69 |
$192.69 |
$90.15
|
|
Ghs peritonsillar abscess i andd
|
$1,678.03 |
$1,678.03 |
$1,678.03 |
$694.20
|
|
Ghs phenylketonurid
|
$188.90 |
$188.90 |
$188.90 |
$51.58
|
|
Ghs picc line insert < 5
|
$7,675.04 |
$7,675.04 |
$7,675.04 |
$2,060.40
|
|
Ghs plngl fx pm cl
|
$1,771.38 |
$1,771.38 |
$1,771.38 |
$662.20
|
|
Ghs ppd (tb intradermal)
|
$333.29 |
$333.29 |
$333.29 |
$43.45
|
|
Ghs prostatic acid phosphatase (mayo)
|
$263.84 |
$263.84 |
$263.84 |
$40.56
|
|
Ghs protoporphyrins fract
|
$314.92 |
$314.92 |
$314.92 |
$64.35
|
|
Ghs removal intranasal foreign body
|
$808.56 |
$808.56 |
$808.56 |
$324.35
|
|
Ghs rsv eia (respir synctial vrs)
|
$196.82 |
$196.82 |
$196.82 |
$101.15
|
|
Ghs sensitivity (per antimicro)
|
$123.55 |
$123.55 |
$123.55 |
$59.90
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$2,316.53 |
$2,316.53 |
$2,316.53 |
$590.40
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$1,390.11 |
$1,390.11 |
$1,390.11 |
$487.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$1,164.26 |
$1,164.26 |
$1,164.26 |
$470.47
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$1,539.54 |
$1,539.54 |
$1,539.54 |
$538.64
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$621.22 |
$621.22 |
$621.22 |
$351.45
|
|
Ghs superficial wnd dehiscence simp12020
|
$3,991.03 |
$3,991.03 |
$3,991.03 |
$976.98
|
|
Ghs tx distal phalangeal fx with manipulation
|
$1,472.70 |
$1,472.70 |
$1,472.70 |
$591.00
|
|
Ghs urine, porphyrins quant
|
$136.18 |
$136.18 |
$136.18 |
$70.20
|
|
Ghs vaginal delivery only
|
$12,010.12 |
$12,010.12 |
$12,010.12 |
$3,525.06
|
|
Gi inhouse confirmation
|
$277.25 |
$277.25 |
$277.25 |
$87.00
|
|
Glucagon plasma - sendout
|
$50.50 |
$50.50 |
$50.50 |
$58.56
|
|
Glucose 1 hr post dose
|
$81.94 |
$81.94 |
$81.94 |
$46.28
|
|
Glucose blood quantitative
|
$108.94 |
$108.94 |
$108.94 |
$44.76
|
|
Glucose body fluid
|
$118.57 |
$118.57 |
$118.57 |
$50.70
|
|
Glucose tolerance test (gtt) 3 specimens
|
$221.97 |
$221.97 |
$221.97 |
$100.10
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$154.29 |
$154.29 |
$154.29 |
$34.45
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$169.66 |
$169.66 |
$169.66 |
$56.70
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$6,953.70 |
$6,953.70 |
$6,953.70 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$61.47 |
$61.47 |
$61.47 |
$110.04
|
|
Gonadotropin luteinizing hormone (lh)
|
$89.65 |
$89.65 |
$89.65 |
$123.75
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$334.46 |
$334.46 |
$334.46 |
$2,648.81
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$1,297.48 |
$1,297.48 |
$1,297.48 |
$1,560.21
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$13,133.38 |
$13,133.38 |
$13,133.38 |
$2,369.10
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$1,401.29 |
$1,401.29 |
$1,401.29 |
$336.78
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$2,820.96 |
$2,820.96 |
$2,820.96 |
$3,070.00
|
|
Great toe with reduction 28495
|
$1,371.94 |
$1,371.94 |
$1,371.94 |
$577.03
|
|
Guided cath fluid drainage 10030
|
$670.04 |
$670.04 |
$670.04 |
$1,461.15
|
|
Guid loc target vol rad tx
|
$409.66 |
$409.66 |
$409.66 |
$503.80
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$297.35 |
$297.35 |
$297.35 |
$112.36
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$40.31 |
$40.31 |
$40.31 |
$35.40
|
|
Hand X-ray
|
$681.92 |
$681.92 |
$681.92 |
$338.58
|
|
Haptoglobin quantitative
|
$157.26 |
$157.26 |
$157.26 |
$89.95
|
|
Hba1/hba2 full gene sequence
|
$4,601.14 |
$4,601.14 |
$4,601.14 |
$777.60
|
|
Hba1/hba2 gene dup/del vrnts
|
$2,319.13 |
$2,319.13 |
$2,319.13 |
$406.25
|
|
Hcg qualitative
|
$323.49 |
$323.49 |
$323.49 |
$77.50
|
|
Hcg quantitative
|
$267.46 |
$267.46 |
$267.46 |
$124.80
|
|
Head CT scan (with and without contrast)
|
$3,976.57 |
$3,976.57 |
$3,976.57 |
$1,878.75
|
|
Head CT scan (with contrast)
|
$4,893.42 |
$4,893.42 |
$4,893.42 |
$1,520.45
|
|
Head CT scan (without contrast)
|
$2,777.12 |
$2,777.12 |
$2,777.12 |
$1,268.90
|
|
Hematocrit
|
$119.26 |
$119.26 |
$119.26 |
$33.57
|
|
Hemoglobin
|
$82.32 |
$82.32 |
$82.32 |
$31.75
|
|
Hemoglobin methemoglobin quantitative
|
$102.50 |
$102.50 |
$102.50 |
$49.40
|
|
Heparin assay
|
$316.26 |
$316.26 |
$316.26 |
$130.20
|
|
Heparin bolus from bag
|
$356.41 |
$356.41 |
$356.41 |
$79.04
|
|
Heparin neutralization
|
$180.90 |
$180.90 |
$180.90 |
$47.45
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$62.40 |
$62.40 |
$62.40 |
$32.27
|
|
Hepatitis a antibody igm
|
$89.03 |
$89.03 |
$89.03 |
$85.15
|
|
Hepatitis b core antibody igm
|
$69.27 |
$69.27 |
$69.27 |
$87.98
|
|
Hepatitis b core antibody total
|
$150.63 |
$150.63 |
$150.63 |
$83.29
|
