|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$660.96 |
$660.96 |
$660.96 |
$750.12
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$431.28 |
$431.28 |
$431.28 |
$740.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$660.96 |
$660.96 |
$660.96 |
$964.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$431.28 |
$431.28 |
$431.28 |
$790.40
|
|
Ghs layered repair 20.1 - 30.0 cm -12046
|
$660.96 |
$660.96 |
$660.96 |
$1,126.40
|
|
Ghs layered repair 20.1 - 30.0 cm -12056
|
$431.28 |
$431.28 |
$431.28 |
$907.50
|
|
Ghs layered repair over 30.0 cm -12047
|
$1,975.68 |
$1,975.68 |
$1,975.68 |
$1,930.50
|
|
Ghs layered repair over 3.0 cm -12057
|
$431.28 |
$431.28 |
$431.28 |
$1,064.98
|
|
Ghs leukocyte alkaline phos (mayo)
|
$88.56 |
$88.56 |
$88.56 |
$76.20
|
|
Ghs mbp
|
$44.64 |
$44.64 |
$44.64 |
$77.35
|
|
Ghs nailbed repair/nail removal
|
$660.96 |
$660.96 |
$660.96 |
$724.37
|
|
Ghs nerve blk intercostal, ea addtl level
|
$961.20 |
$961.20 |
$961.20 |
$1,546.50
|
|
Ghs nerve blk intercostal, single level
|
$748.08 |
$748.08 |
$748.08 |
$1,107.00
|
|
Ghs nerve block axillary nerve
|
$1,538.64 |
$1,538.64 |
$1,538.64 |
$1,549.80
|
|
Ghs nerve block brachial plexus
|
$2,162.88 |
$2,162.88 |
$2,162.88 |
$1,689.00
|
|
Ghs nerve block lumbar or thoracic symp
|
$1,593.36 |
$1,593.36 |
$1,593.36 |
$1,710.80
|
|
Ghs ng placement w fluoro guidance
|
$491.76 |
$491.76 |
$491.76 |
$478.50
|
|
Ghs o2 uptake rest & indirect
|
$148.32 |
$148.32 |
$148.32 |
$173.50
|
|
Ghs opcc repair cvp without subq port
|
$1,260.00 |
$1,260.00 |
$1,260.00 |
$1,229.24
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$62.64 |
$62.64 |
$62.64 |
$55.77
|
|
Ghs ot dds rom
|
$53.28 |
$53.28 |
$53.28 |
$62.28
|
|
Ghs ot prosthetic training/15 min
|
$75.60 |
$75.60 |
$75.60 |
$90.50
|
|
Ghs ot sensory integrative tech/15min
|
$75.60 |
$75.60 |
$75.60 |
$94.80
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$1,070.64 |
$1,070.64 |
$1,070.64 |
$851.04
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$868.32 |
$868.32 |
$868.32 |
$962.00
|
|
Ghs peritonsillar abscess i andd
|
$492.48 |
$492.48 |
$492.48 |
$546.36
|
|
Ghs picc line insert < 5
|
$1,677.60 |
$1,677.60 |
$1,677.60 |
$2,019.50
|
|
Ghs plngl fx pm cl
|
$259.20 |
$259.20 |
$259.20 |
$564.80
|
|
Ghs ppd (tb intradermal)
|
$252.00 |
$252.00 |
$252.00 |
$37.70
|
|
Ghs pr without cont pulse ox
|
$168.48 |
$168.48 |
$168.48 |
$146.86
|
|
Ghs quinidine
|
$94.32 |
$94.32 |
$94.32 |
$85.00
|
|
Ghs removal intranasal foreign body
|
$138.96 |
$138.96 |
$138.96 |
$287.50
|
|
Ghs removal pharyngeal foreign body
|
$672.48 |
$672.48 |
$672.48 |
$459.90
|
|
Ghs repair tendon ext forearm/wrist ea
|
$3,589.20 |
$3,589.20 |
$3,589.20 |
$4,041.79
|
|
Ghs semen analysis fert
|
$283.68 |
$283.68 |
$283.68 |
$129.00
|
|
Ghs sensitivity (per antimicro)
|
$97.92 |
$97.92 |
$97.92 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$431.28 |
$431.28 |
$431.28 |
$553.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$431.28 |
$431.28 |
$431.28 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$431.28 |
$431.28 |
$431.28 |
$575.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$431.28 |
$431.28 |
$431.28 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$246.96 |
$246.96 |
$246.96 |
$448.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$249.12 |
$249.12 |
$249.12 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$272.16 |
$272.16 |
$272.16 |
$484.80
|
|
Ghs simple repair over 30 cm - 12007
|
$331.92 |
$331.92 |
$331.92 |
$582.00
|
|
Ghs simple repair over 30 cm - 12018
|
$361.44 |
$361.44 |
$361.44 |
$537.60
|
|
Ghs sleep study unattended
|
$930.96 |
$930.96 |
$930.96 |
$495.00
|
|
Ghs strapping shoulder - 29240
|
$159.84 |
$159.84 |
$159.84 |
$213.20
|
|
Ghs tx distal phalangeal fx with manipulation
|
$259.20 |
$259.20 |
$259.20 |
$523.00
|
|
Ghs urine, porphyrins quant
|
$77.04 |
$77.04 |
$77.04 |
$75.00
|
|
Ghs vaginal delivery only
|
$3,433.68 |
$3,433.68 |
$3,433.68 |
$3,152.00
|
|
Gi inhouse confirmation
|
$105.12 |
$105.12 |
$105.12 |
$83.70
|
|
Glucagon 1 mg solution for injection
|
$967.68 |
$967.68 |
$967.68 |
$601.79
|
|
Glucose 1 hr post dose
|
$90.00 |
$90.00 |
$90.00 |
$47.20
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$26.64 |
$26.64 |
$26.64 |
$23.86
|
|
Glucose blood quantitative
|
$79.20 |
$79.20 |
$79.20 |
$40.00
|
|
Glucose body fluid
|
$235.44 |
$235.44 |
$235.44 |
$52.20
|
|
Glucose tolerance test (gtt) 3 specimens
|
$156.24 |
$156.24 |
$156.24 |
$100.16
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$48.24 |
$48.24 |
$48.24 |
$35.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$6.48 |
$6.48 |
$6.48 |
$37.04
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$293.04 |
$293.04 |
$293.04 |
$115.05
|
|
Gonadotropin luteinizing hormone (lh)
|
$119.52 |
$119.52 |
$119.52 |
$129.00
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$76.32 |
$76.32 |
$76.32 |
$672.50
|
|
Graft axiofill 1000mg
|
$261.94 |
$261.94 |
$261.94 |
$5,125.68
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$172.80 |
$172.80 |
$172.80 |
$584.99
|
|
Graft patch felt ptfe 2x2
|
$1,512.00 |
$1,512.00 |
$1,512.00 |
$27,300.00
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$102.96 |
$102.96 |
$102.96 |
$1,455.76
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$324.00 |
$324.00 |
$324.00 |
$1,181.41
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$187.92 |
$187.92 |
$187.92 |
$373.00
|
|
Graft xenmtrx sft rect 15x20cm
|
$7,128.00 |
$7,128.00 |
$7,128.00 |
$30,392.04
|
|
Graft xenmtrx sft rect 19x28cm
|
$378.00 |
$378.00 |
$378.00 |
$2,701.58
|
|
Great toe with reduction 28495
|
$259.20 |
$259.20 |
$259.20 |
$482.40
|
|
Guide wire threaded 1.4x150mm
|
$864.00 |
$864.00 |
$864.00 |
$3,284.50
|
|
Gw stiffened micro access kit
|
$378.00 |
$378.00 |
$378.00 |
$6,696.00
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$20.74 |
$20.74 |
$20.74 |
$23.06
|
|
Hand X-ray
|
$436.32 |
$436.32 |
$436.32 |
$356.00
|
|
Haptoglobin quantitative
|
$90.00 |
$90.00 |
$90.00 |
$91.14
|
|
Hbot, full body chamber, 30m
|
$167.04 |
$167.04 |
$167.04 |
$526.90
|
|
Hcg qualitative
|
$130.32 |
$130.32 |
$130.32 |
$89.70
|
|
Hcg quantitative
|
$167.76 |
$167.76 |
$167.76 |
$139.20
|
|
Hc pet myocardial imaging metabolic eval single study
|
$5,635.44 |
$5,635.44 |
$5,635.44 |
$3,931.12
|
|
Head CT scan (with and without contrast)
|
$2,587.68 |
$2,587.68 |
$2,587.68 |
$1,849.90
|
|
Head CT scan (with contrast)
|
$1,889.28 |
$1,889.28 |
$1,889.28 |
$1,545.60
|
|
Head CT scan (without contrast)
|
$1,834.56 |
$1,834.56 |
$1,834.56 |
$1,268.90
|
|
Helicobacter pylori antibody igm
|
$75.60 |
$75.60 |
$75.60 |
$91.98
|
|
Hematocrit
|
$313.20 |
$313.20 |
$313.20 |
$33.57
|
|
Hemoglobin
|
$374.40 |
$374.40 |
$374.40 |
$31.80
|
|
Hemoglobin methemoglobin quantitative
|
$80.64 |
$80.64 |
$80.64 |
$53.60
|
|
Hemoglobin plasma
|
$34.56 |
$34.56 |
$34.56 |
$41.25
|
|
Hemophilus influenza antibdy
|
$115.92 |
$115.92 |
$115.92 |
$62.70
|
|
Heparin assay
|
$185.76 |
$185.76 |
$185.76 |
$140.10
|
|
Heparin bolus from bag
|
$2.88 |
$2.88 |
$2.88 |
$66.47
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$0.09 |
$0.09 |
$0.09 |
$10.61
|
|
Hepatitis a antibody igm
|
$184.32 |
$184.32 |
$184.32 |
$87.75
|
|
Hepatitis b core antibody igm
|
$241.92 |
$241.92 |
$241.92 |
$87.98
|
|
Hepatitis b surface antibody
|
$90.72 |
$90.72 |
$90.72 |
$82.05
|
|
Hepatitis c antibody
|
$439.20 |
$439.20 |
$439.20 |
$108.00
|
|
Hepatobiliary system imaging
|
$2,253.60 |
$2,253.60 |
$2,253.60 |
$1,438.58
|
|
Herpes simplex type 1 antibody igg
|
$132.48 |
$132.48 |
$132.48 |
$70.00
|
|
Herpes simplex type 2 antibody igg
|
$82.08 |
$82.08 |
$82.08 |
$87.10
|
|
Herpes simplex virus isolation
|
$108.72 |
$108.72 |
$108.72 |
$104.10
|
