|
Ghs chemo >8 hrs
|
$1,543.20 |
$1,543.20 |
$1,543.20 |
$714.87
|
|
Ghs chemo IV push, ea addtl
|
$433.80 |
$433.80 |
$433.80 |
$292.80
|
|
Ghs community re-entry 15 minutes
|
$120.60 |
$120.60 |
$120.60 |
$85.00
|
|
Ghs diphtheria toxoid ab igg
|
$177.60 |
$177.60 |
$177.60 |
$91.80
|
|
Ghs ed therapeutic lp, drain csf w fluoro
|
$1,576.20 |
$1,576.20 |
$1,576.20 |
$1,360.20
|
|
Ghs electrostagmgraphy
|
$208.20 |
$208.20 |
$208.20 |
$247.20
|
|
Ghs elect vertical elct
|
$170.40 |
$170.40 |
$170.40 |
$116.00
|
|
Ghs fb removal - incisional
|
$5,637.00 |
$5,637.00 |
$5,637.00 |
$2,454.00
|
|
Ghs febrile agglutinns(mayo)
|
$154.80 |
$154.80 |
$154.80 |
$51.99
|
|
Ghs fish cytogen
|
$255.00 |
$255.00 |
$255.00 |
$173.40
|
|
Ghs fish hybrid in situ 100-300
|
$360.00 |
$360.00 |
$360.00 |
$229.45
|
|
Ghs gastric intub aspiration lavage
|
$437.40 |
$437.40 |
$437.40 |
$385.60
|
|
Ghs hcv amplificaiton
|
$743.40 |
$743.40 |
$743.40 |
$198.90
|
|
Ghs hepatitis c virus (hcv riba)
|
$525.60 |
$525.60 |
$525.60 |
$105.00
|
|
Ghs histoplasma antigen
|
$435.00 |
$435.00 |
$435.00 |
$157.30
|
|
Ghs HIV antibody
|
$223.80 |
$223.80 |
$223.80 |
$90.14
|
|
Ghs hla-dr/dq, multiple antigens
|
$1,951.20 |
$1,951.20 |
$1,951.20 |
$475.80
|
|
Ghs inhibitor screen
|
$308.40 |
$308.40 |
$308.40 |
$138.06
|
|
Ghs intro needle/intracath vein - 36000
|
$587.40 |
$587.40 |
$587.40 |
$213.75
|
|
Ghs IV inf sq injection, on-body injector
|
$464.40 |
$464.40 |
$464.40 |
$117.42
|
|
Ghs leukocyte alkaline phos (mayo)
|
$175.20 |
$175.20 |
$175.20 |
$62.28
|
|
Ghs mbp
|
$274.20 |
$274.20 |
$274.20 |
$97.20
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$293.40 |
$293.40 |
$293.40 |
$240.00
|
|
Ghs moderate sedation ea addtl 15 min
|
$292.80 |
$292.80 |
$292.80 |
$125.34
|
|
Ghs myocardial strain img spckl track
|
$568.80 |
$568.80 |
$568.80 |
$503.85
|
|
Ghs nerve block celiac plexus
|
$2,307.60 |
$2,307.60 |
$2,307.60 |
$1,681.24
|
|
Ghs ng placement w fluoro guidance
|
$321.00 |
$321.00 |
$321.00 |
$423.76
|
|
Ghs o2 saturation
|
$161.40 |
$161.40 |
$161.40 |
$55.90
|
|
Ghs opcc repair cvp without subq port
|
$2,071.80 |
$2,071.80 |
$2,071.80 |
$1,289.00
|
|
Ghs optokenetic
|
$211.20 |
$211.20 |
$211.20 |
$198.98
|
|
Ghs oscillating trac
|
$233.40 |
$233.40 |
$233.40 |
$256.50
|
|
Ghs ot prosthetic training/15 min
|
$75.60 |
$75.60 |
$75.60 |
$92.35
|
|
Ghs ot sensory integrative tech/15min
|
$79.80 |
$79.80 |
$79.80 |
$89.73
|
|
Ghs ot work hardening-additional hours
|
$181.80 |
$181.80 |
$181.80 |
$113.35
|
|
Ghs pacing - transcutaneous
|
$1,282.80 |
$1,282.80 |
$1,282.80 |
$872.95
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$100.20 |
$100.20 |
$100.20 |
$82.80
|
|
Ghs picc line insert < 5
|
$4,980.60 |
$4,980.60 |
$4,980.60 |
$1,990.40
|
|
Ghs plt ct-manual
|
$85.80 |
$85.80 |
$85.80 |
$40.80
|
|
Ghs polysom <6 yrs 4/> parameters
|
$5,539.20 |
$5,539.20 |
$5,539.20 |
$3,557.58
|
|
Ghs pos nystagmus
|
$289.20 |
$289.20 |
$289.20 |
$228.00
|
|
Ghs ppd (tb intradermal)
|
$57.00 |
$57.00 |
$57.00 |
$39.77
|
|
Ghs prostatic acid phosphatase (mayo)
|
$118.20 |
$118.20 |
$118.20 |
$49.77
|
|
Ghs protein, misc fluid
|
$19.80 |
$19.80 |
$19.80 |
$24.60
|
|
Ghs protoporphyrins fract
|
$129.60 |
$129.60 |
$129.60 |
$68.38
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$47.40 |
$47.40 |
$47.40 |
$55.25
|
|
Ghs pt - work hardening/int 2hrs
|
$315.60 |
$315.60 |
$315.60 |
$230.40
|
|
Ghs reticulocyte count
|
$105.60 |
$105.60 |
$105.60 |
$33.57
|
|
Ghs sensitivity (per antimicro)
|
$148.20 |
$148.20 |
$148.20 |
$55.12
|
|
Ghs somatosensory testing lower extremit
|
$1,046.40 |
$1,046.40 |
$1,046.40 |
$917.80
|
|
Ghs somatosensory testing upper & lower limbs
|
$1,959.60 |
$1,959.60 |
$1,959.60 |
$1,506.58
|
|
Ghs speech-gen aug dev eval iii, st
|
$108.00 |
$108.00 |
$108.00 |
$134.50
|
|
Ghs spont nystagmus
|
$300.60 |
$300.60 |
$300.60 |
$228.00
|
|
Ghs sp train/fitting sp device - kx
|
$270.00 |
$270.00 |
$270.00 |
$240.80
|
|
Ghs st - eval for alt comm
|
$138.00 |
$138.00 |
$138.00 |
$100.98
|
|
Ghs strapping shoulder - 29240
|
$207.60 |
$207.60 |
$207.60 |
$210.91
|
|
Ghs st - re-eval for alt comm
|
$329.40 |
$329.40 |
$329.40 |
$321.00
|
|
Ghs urine, porphyrins quant
|
$195.00 |
$195.00 |
$195.00 |
$85.15
|
|
Gi inhouse confirmation
|
$43.20 |
$43.20 |
$43.20 |
$79.50
|
|
Glucagon 1 mg solution for injection
|
$351.53 |
$351.53 |
$351.53 |
$351.53
|
|
Glucagon plasma - sendout
|
$162.00 |
$162.00 |
$162.00 |
$67.50
|
|
Glucose 1 hr post dose
|
$130.20 |
$130.20 |
$130.20 |
$40.00
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$68.40 |
$68.40 |
$68.40 |
$20.00
|
|
Glucose blood quantitative
|
$78.00 |
$78.00 |
$78.00 |
$40.80
|
|
Glucose body fluid
|
$102.00 |
$102.00 |
$102.00 |
$47.70
|
|
Glucose tolerance test (gtt) 3 specimens
|
$259.80 |
$259.80 |
$259.80 |
$92.75
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$14.40 |
$14.40 |
$14.40 |
$33.15
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$120.40 |
$120.40 |
$120.40 |
$11.60
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$61.21 |
$61.21 |
$61.21 |
$61.21
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$413.40 |
$413.40 |
$413.40 |
$115.05
|
|
Gonadotropin luteinizing hormone (lh)
|
$430.20 |
$430.20 |
$430.20 |
$117.65
|
|
Goserelin 10.8 mg subcutaneous implant
|
$3,231.51 |
$3,231.51 |
$3,231.51 |
$1,598.97
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$3,476.40 |
$3,476.40 |
$3,476.40 |
$56.71
|
|
Graft axiofill 1000mg
|
$2,890.20 |
$2,890.20 |
$2,890.20 |
$2,890.20
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$5,152.80 |
$5,152.80 |
$5,152.80 |
$9,693.72
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$23,233.80 |
$23,233.80 |
$23,233.80 |
$23,233.80
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$2,643.60 |
$2,643.60 |
$2,643.60 |
$3,735.34
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$6,651.60 |
$6,651.60 |
$6,651.60 |
$486.45
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$3,060.00 |
$3,060.00 |
$3,060.00 |
$5,533.20
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$3,132.60 |
$3,132.60 |
$3,132.60 |
$53,576.40
|
|
Granisetron 1 mg tab
|
$10.04 |
$10.04 |
$10.04 |
$40.18
|
|
Granisetron hcl injection
|
$41.81 |
$41.81 |
$41.81 |
$21.42
|
|
G-tube reposition
|
$1,395.00 |
$1,395.00 |
$1,395.00 |
$727.35
|
|
Guided cath fluid drainage 10030
|
$3,337.20 |
$3,337.20 |
$3,337.20 |
$1,451.40
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$130.49 |
$130.49 |
$130.49 |
$120.02
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$38.87 |
$38.87 |
$38.87 |
$11.25
|
|
Hand X-ray
|
$403.20 |
$403.20 |
$403.20 |
$317.78
|
|
Haptoglobin quantitative
|
$243.00 |
$243.00 |
$243.00 |
$75.00
|
|
Hc ea ha check monaural
|
$90.00 |
$90.00 |
$90.00 |
$57.00
|
|
Hc fl sm bowel enteroclss tube w kub double contrast
|
$258.00 |
$258.00 |
$258.00 |
$527.13
|
|
Hcg qualitative
|
$189.00 |
$189.00 |
$189.00 |
$72.50
|
|
Hcg quantitative
|
$315.60 |
$315.60 |
$315.60 |
$105.00
|
|
Hc hearing aid chck binaurl
|
$98.40 |
$98.40 |
$98.40 |
$75.00
|
|
Hc hearing aid chck monarl
|
$73.20 |
$73.20 |
$73.20 |
$48.00
|
|
Hc hearing aid exam both ears
|
$214.80 |
$214.80 |
$214.80 |
$175.20
|
|
Hc hearing aid exam one ear
|
$131.40 |
$131.40 |
$131.40 |
$150.00
|
|
Head CT scan (with and without contrast)
|
$542.40 |
$542.40 |
$542.40 |
$1,732.80
|
|
Head CT scan (with contrast)
|
$542.40 |
$542.40 |
$542.40 |
$1,496.25
|
|
Head CT scan (without contrast)
|
$542.40 |
$542.40 |
$542.40 |
$1,252.80
|
|
Helicobacter pylori antibody igm
|
$382.20 |
$382.20 |
$382.20 |
$84.80
|
|
Hematocrit
|
$61.20 |
$61.20 |
$61.20 |
$32.50
|
