|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$1,397.20 |
$1,397.20 |
$1,397.20 |
$964.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$911.40 |
$911.40 |
$911.40 |
$790.40
|
|
Ghs mbp
|
$114.80 |
$114.80 |
$114.80 |
$77.35
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$347.20 |
$347.20 |
$347.20 |
$242.31
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$469.00 |
$469.00 |
$469.00 |
$228.45
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$457.80 |
$457.80 |
$457.80 |
$230.00
|
|
Ghs moderate sedation ea addtl 15 min
|
$63.00 |
$63.00 |
$63.00 |
$151.50
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$355.60 |
$355.60 |
$355.60 |
$147.75
|
|
Ghs nailbed repair/nail removal
|
$1,397.20 |
$1,397.20 |
$1,397.20 |
$724.37
|
|
Ghs nerve blk intercostal, single level
|
$1,580.60 |
$1,580.60 |
$1,580.60 |
$1,107.00
|
|
Ghs nerve block brachial plexus
|
$1,869.70 |
$1,869.70 |
$1,869.70 |
$1,689.00
|
|
Ghs nerve block interscaline
|
$1,869.70 |
$1,869.70 |
$1,869.70 |
$1,526.09
|
|
Ghs nerve block lumbar or thoracic symp
|
$1,869.70 |
$1,869.70 |
$1,869.70 |
$1,710.80
|
|
Ghs ot prosthetic training/15 min
|
$192.50 |
$192.50 |
$192.50 |
$90.50
|
|
Ghs ot sensory integrative tech/15min
|
$228.90 |
$228.90 |
$228.90 |
$94.80
|
|
Ghs ot work hardening-additional hours
|
$135.10 |
$135.10 |
$135.10 |
$127.80
|
|
Ghs pacing - transcutaneous
|
$1,493.10 |
$1,493.10 |
$1,493.10 |
$815.20
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$191.80 |
$191.80 |
$191.80 |
$851.04
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$175.00 |
$175.00 |
$175.00 |
$962.00
|
|
Ghs peritonsillar abscess i andd
|
$529.90 |
$529.90 |
$529.90 |
$546.36
|
|
Ghs phenylketonurid
|
$125.30 |
$125.30 |
$125.30 |
$53.76
|
|
Ghs plngl fx pm cl
|
$547.40 |
$547.40 |
$547.40 |
$564.80
|
|
Ghs ppd (tb intradermal)
|
$16.10 |
$16.10 |
$16.10 |
$37.70
|
|
Ghs protoporphyrins fract
|
$231.00 |
$231.00 |
$231.00 |
$64.28
|
|
Ghs pr without cont pulse ox
|
$124.60 |
$124.60 |
$124.60 |
$146.86
|
|
Ghs pt - work hardening/int 2hrs
|
$293.30 |
$293.30 |
$293.30 |
$275.60
|
|
Ghs removal intranasal foreign body
|
$294.00 |
$294.00 |
$294.00 |
$287.50
|
|
Ghs removal pharyngeal foreign body
|
$910.70 |
$910.70 |
$910.70 |
$459.90
|
|
Ghs reticulocyte count
|
$36.40 |
$36.40 |
$36.40 |
$34.45
|
|
Ghs sensitivity (per antimicro)
|
$94.50 |
$94.50 |
$94.50 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$1,003.10 |
$1,003.10 |
$1,003.10 |
$553.60
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$1,003.10 |
$1,003.10 |
$1,003.10 |
$575.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$911.40 |
$911.40 |
$911.40 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$499.10 |
$499.10 |
$499.10 |
$448.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$453.60 |
$453.60 |
$453.60 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$499.10 |
$499.10 |
$499.10 |
$484.80
|
|
Ghs simple repair over 30 cm - 12007
|
$453.60 |
$453.60 |
$453.60 |
$582.00
|
|
Ghs sleep study unattended
|
$843.50 |
$843.50 |
$843.50 |
$495.00
|
|
Ghs speech-gen aug dev eval iii, st
|
$268.10 |
$268.10 |
$268.10 |
$146.40
|
|
Ghs sp train/fitting sp device - kx
|
$464.80 |
$464.80 |
$464.80 |
$250.50
|
|
Ghs st - eval for alt comm
|
$60.20 |
$60.20 |
$60.20 |
$93.60
|
|
Ghs strapping shoulder - 29240
|
$294.00 |
$294.00 |
$294.00 |
$213.20
|
|
Ghs st - re-eval for alt comm
|
$364.00 |
$364.00 |
$364.00 |
$309.00
|
|
Ghs superficial wnd dehiscence simp12020
|
$1,397.20 |
$1,397.20 |
$1,397.20 |
$861.75
|
|
Ghs superficial wnd dehis w packing12021
|
$1,092.00 |
$1,092.00 |
$1,092.00 |
$661.50
|
|
Ghs tracheostomy emergency - transtracheal
|
$3,380.30 |
$3,380.30 |
$3,380.30 |
$1,752.89
|
|
Ghs tx distal phalangeal fx with manipulation
|
$547.40 |
$547.40 |
$547.40 |
$523.00
|
|
Ghs urine, porphyrins quant
|
$168.00 |
$168.00 |
$168.00 |
$75.00
|
|
Ghs vaginal delivery only
|
$3,811.50 |
$3,811.50 |
$3,811.50 |
$3,152.00
|
|
Gi inhouse confirmation
|
$114.10 |
$114.10 |
$114.10 |
$83.70
|
|
Gjb2 gene full sequence
|
$849.10 |
$849.10 |
$849.10 |
$502.80
|
|
Glucose 1 hr post dose
|
$67.90 |
$67.90 |
$67.90 |
$47.20
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$41.30 |
$41.30 |
$41.30 |
$23.86
|
|
Glucose blood quantitative
|
$53.20 |
$53.20 |
$53.20 |
$40.00
|
|
Glucose body fluid
|
$53.20 |
$53.20 |
$53.20 |
$52.20
|
|
Glucose tolerance test (gtt) 3 specimens
|
$191.10 |
$191.10 |
$191.10 |
$100.16
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$51.80 |
$51.80 |
$51.80 |
$35.00
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$147.70 |
$147.70 |
$147.70 |
$115.05
|
|
Gonadotropin luteinizing hormone (lh)
|
$271.60 |
$271.60 |
$271.60 |
$129.00
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$63.00 |
$63.00 |
$63.00 |
$672.50
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$472.50 |
$472.50 |
$472.50 |
$1,181.41
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$520.80 |
$520.80 |
$520.80 |
$1,132.47
|
|
Granulocyte pheresis ea unit
|
$2,625.00 |
$2,625.00 |
$2,625.00 |
$2,309.40
|
|
Guided cath fluid drainage 10030
|
$8,372.70 |
$8,372.70 |
$8,372.70 |
$1,372.15
|
|
Hand X-ray
|
$400.40 |
$400.40 |
$400.40 |
$356.00
|
|
Haptoglobin quantitative
|
$143.50 |
$143.50 |
$143.50 |
$91.14
|
|
Hbot, full body chamber, 30m
|
$138.60 |
$138.60 |
$138.60 |
$526.90
|
|
Hcg qualitative
|
$105.00 |
$105.00 |
$105.00 |
$89.70
|
|
Hcg quantitative
|
$202.30 |
$202.30 |
$202.30 |
$139.20
|
|
Head CT scan (with and without contrast)
|
$2,569.00 |
$2,569.00 |
$2,569.00 |
$1,849.90
|
|
Head CT scan (with contrast)
|
$2,330.30 |
$2,330.30 |
$2,330.30 |
$1,545.60
|
|
Head CT scan (without contrast)
|
$1,265.60 |
$1,265.60 |
$1,265.60 |
$1,268.90
|
|
Helicobacter pylori antibody igm
|
$166.60 |
$166.60 |
$166.60 |
$91.98
|
|
Hematocrit
|
$42.00 |
$42.00 |
$42.00 |
$33.57
|
|
Hemodialysis one evaluation
|
$612.50 |
$612.50 |
$612.50 |
$1,319.44
|
|
Hemoglobin
|
$39.90 |
$39.90 |
$39.90 |
$31.80
|
|
Hemoglobin fetal qualitative
|
$99.40 |
$99.40 |
$99.40 |
$51.75
|
|
Hemophilus influenza antibdy
|
$45.50 |
$45.50 |
$45.50 |
$62.70
|
|
Heparin assay
|
$222.60 |
$222.60 |
$222.60 |
$140.10
|
|
Hepatitis a antibody igm
|
$144.90 |
$144.90 |
$144.90 |
$87.75
|
|
Hepatitis b core antibody igm
|
$155.40 |
$155.40 |
$155.40 |
$87.98
|
|
Hepatitis b core antibody total
|
$170.80 |
$170.80 |
$170.80 |
$77.50
|
|
Hepatitis b surface antibody
|
$140.00 |
$140.00 |
$140.00 |
$82.05
|
|
Hepatitis c antibody
|
$213.50 |
$213.50 |
$213.50 |
$108.00
|
|
Hepatobiliary system imaging
|
$1,336.30 |
$1,336.30 |
$1,336.30 |
$1,438.58
|
|
Herpes simplex type 1 antibody igg
|
$118.30 |
$118.30 |
$118.30 |
$70.00
|
|
Herpes simplex type 2 antibody igg
|
$145.60 |
$145.60 |
$145.60 |
$87.10
|
|
Herpes simplex virus isolation
|
$205.10 |
$205.10 |
$205.10 |
$104.10
|
|
Heterophile antibodies screening
|
$79.10 |
$79.10 |
$79.10 |
$74.00
|
|
Hip X-ray
|
$400.40 |
$400.40 |
$400.40 |
$292.05
|
|
Histochemical stains add-on
|
$436.80 |
$436.80 |
$436.80 |
$153.29
|
|
Hla i low res one antigen equiv ea
|
$686.70 |
$686.70 |
$686.70 |
$161.70
|
|
Hla i typing high res 1 allele grp ea
|
$1,036.70 |
$1,036.70 |
$1,036.70 |
$293.15
|
|
Home sleep test/type 3 porta
|
$766.50 |
$766.50 |
$766.50 |
$579.26
|
|
Homocysteine
|
$184.80 |
$184.80 |
$184.80 |
$121.92
|
|
Hpv types 16 & 18 only
|
$217.00 |
$217.00 |
$217.00 |
$110.70
|
|
H pylori (c-13) breath
|
$392.00 |
$392.00 |
$392.00 |
$213.00
|
|
Human epididymis protein 4 (he4)
|
$270.90 |
$270.90 |
$270.90 |
$157.32
|
|
Hydration IV infusion each additional hour
|
$145.60 |
$145.60 |
$145.60 |
$131.20
|
|
Hydration IV infusion initial 31minutes - 1 hour
|
$663.60 |
$663.60 |
$663.60 |
$383.00
|
