|
Ghs inj neurolytic intercostal nerve
|
$2,460.00 |
$2,460.00 |
$2,460.00 |
$2,047.92
|
|
Ghs intro needle/intracath vein - 36000
|
$234.60 |
$234.60 |
$234.60 |
$200.20
|
|
Ghs IV inf sq injection, on-body injector
|
$462.00 |
$462.00 |
$462.00 |
$110.00
|
|
Ghs IV thrombolytics - cerebral
|
$799.80 |
$799.80 |
$799.80 |
$663.00
|
|
Ghs leukocyte alkaline phos (mayo)
|
$131.40 |
$131.40 |
$131.40 |
$75.00
|
|
Ghs mbp
|
$148.20 |
$148.20 |
$148.20 |
$76.00
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$674.40 |
$674.40 |
$674.40 |
$246.33
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$621.00 |
$621.00 |
$621.00 |
$228.45
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$565.20 |
$565.20 |
$565.20 |
$233.28
|
|
Ghs moderate sedation ea addtl 15 min
|
$102.60 |
$102.60 |
$102.60 |
$150.00
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$99.60 |
$99.60 |
$99.60 |
$142.40
|
|
Ghs musc test done w/n test comp
|
$312.00 |
$312.00 |
$312.00 |
$331.20
|
|
Ghs musc tst done w/nerv tst lim
|
$749.40 |
$749.40 |
$749.40 |
$272.48
|
|
Ghs myocardial strain img spckl track
|
$545.40 |
$545.40 |
$545.40 |
$457.80
|
|
Ghs nerve block celiac plexus
|
$2,175.60 |
$2,175.60 |
$2,175.60 |
$1,661.40
|
|
Ghs ng placement w fluoro guidance
|
$282.60 |
$282.60 |
$282.60 |
$485.00
|
|
Ghs o2 saturation
|
$119.40 |
$119.40 |
$119.40 |
$69.50
|
|
Ghs opcc repair cvp without subq port
|
$1,954.20 |
$1,954.20 |
$1,954.20 |
$1,236.67
|
|
Ghs opcc repair cvp w subq port
|
$2,815.20 |
$2,815.20 |
$2,815.20 |
$2,194.40
|
|
Ghs ot dds rom
|
$51.60 |
$51.60 |
$51.60 |
$69.00
|
|
Ghs ot prosthetic training/15 min
|
$85.80 |
$85.80 |
$85.80 |
$93.00
|
|
Ghs ot sensory integrative tech/15min
|
$62.40 |
$62.40 |
$62.40 |
$96.20
|
|
Ghs ot work hardening-additional hours
|
$126.60 |
$126.60 |
$126.60 |
$126.40
|
|
Ghs pacing - transcutaneous
|
$1,112.40 |
$1,112.40 |
$1,112.40 |
$830.53
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$82.80 |
$82.80 |
$82.80 |
$74.10
|
|
Ghs picc line insert < 5
|
$1,047.60 |
$1,047.60 |
$1,047.60 |
$2,019.50
|
|
Ghs plt ct-manual
|
$21.60 |
$21.60 |
$21.60 |
$37.96
|
|
Ghs polysom <6 yrs 4/> parameters
|
$3,401.40 |
$3,401.40 |
$3,401.40 |
$3,557.58
|
|
Ghs ppd (tb intradermal)
|
$50.40 |
$50.40 |
$50.40 |
$37.44
|
|
Ghs prostatic acid phosphatase (mayo)
|
$86.40 |
$86.40 |
$86.40 |
$43.55
|
|
Ghs protein, misc fluid
|
$27.60 |
$27.60 |
$27.60 |
$24.60
|
|
Ghs protoporphyrins fract
|
$58.80 |
$58.80 |
$58.80 |
$60.75
|
|
Ghs pr without cont pulse ox
|
$286.80 |
$286.80 |
$286.80 |
$147.00
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$66.60 |
$66.60 |
$66.60 |
$47.55
|
|
Ghs pt - work hardening/int 2hrs
|
$256.80 |
$256.80 |
$256.80 |
$285.60
|
|
Ghs reticulocyte count
|
$18.60 |
$18.60 |
$18.60 |
$34.50
|
|
Ghs sensitivity (per antimicro)
|
$56.40 |
$56.40 |
$56.40 |
$57.60
|
|
Ghs somatosensory testing lower extremit
|
$881.40 |
$881.40 |
$881.40 |
$925.91
|
|
Ghs somatosensory testing upper & lower limbs
|
$1,963.80 |
$1,963.80 |
$1,963.80 |
$1,416.80
|
|
Ghs speech-gen aug dev eval iii, st
|
$118.20 |
$118.20 |
$118.20 |
$157.50
|
|
Ghs sp train/fitting sp device - kx
|
$307.80 |
$307.80 |
$307.80 |
$252.75
|
|
Ghs strapping shoulder - 29240
|
$174.00 |
$174.00 |
$174.00 |
$217.60
|
|
Ghs st - re-eval for alt comm
|
$359.40 |
$359.40 |
$359.40 |
$309.60
|
|
Ghs urine, hydroxproline total
|
$119.40 |
$119.40 |
$119.40 |
$109.60
|
|
Ghs urine, porphyrins quant
|
$72.60 |
$72.60 |
$72.60 |
$73.80
|
|
Ghs veeg 12-26 hr intmt mont
|
$928.20 |
$928.20 |
$928.20 |
$1,932.00
|
|
Giardia ag if
|
$82.20 |
$82.20 |
$82.20 |
$38.58
|
|
Gi inhouse confirmation
|
$127.80 |
$127.80 |
$127.80 |
$87.75
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$2,991.00 |
$2,991.00 |
$2,991.00 |
$2,215.20
|
|
Glucagon 1 mg solution for injection
|
$351.53 |
$351.53 |
$351.53 |
$613.79
|
|
Glucagon plasma - sendout
|
$100.20 |
$100.20 |
$100.20 |
$64.35
|
|
Glucose 1 hr post dose
|
$73.20 |
$73.20 |
$73.20 |
$49.00
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$13.20 |
$13.20 |
$13.20 |
$23.12
|
|
Glucose blood quantitative
|
$44.40 |
$44.40 |
$44.40 |
$42.25
|
|
Glucose body fluid
|
$52.80 |
$52.80 |
$52.80 |
$51.30
|
|
Glucose tolerance test (gtt) 3 specimens
|
$67.20 |
$67.20 |
$67.20 |
$105.60
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$21.60 |
$21.60 |
$21.60 |
$36.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$120.40 |
$120.40 |
$120.40 |
$37.40
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$93.97 |
$93.97 |
$93.97 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$133.80 |
$133.80 |
$133.80 |
$116.64
|
|
Gonadotropin luteinizing hormone (lh)
|
$141.60 |
$141.60 |
$141.60 |
$129.03
|
|
Goserelin 10.8 mg subcutaneous implant
|
$1,577.10 |
$1,577.10 |
$1,577.10 |
$4,417.13
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$3,642.00 |
$3,642.00 |
$3,642.00 |
$73.83
|
|
Graft axiofill 1000mg
|
$2,890.20 |
$2,890.20 |
$2,890.20 |
$5,125.68
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$17,933.40 |
$17,933.40 |
$17,933.40 |
$605.00
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$18,096.60 |
$18,096.60 |
$18,096.60 |
$23,233.80
|
|
Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm
|
$5,002.20 |
$5,002.20 |
$5,002.20 |
$3,432.00
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$15,476.40 |
$15,476.40 |
$15,476.40 |
$1,111.05
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$10,983.60 |
$10,983.60 |
$10,983.60 |
$886.17
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$3,468.00 |
$3,468.00 |
$3,468.00 |
$1,132.47
|
|
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 |
$349.41
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$41,130.00 |
$41,130.00 |
$41,130.00 |
$28,894.71
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$2,754.00 |
$2,754.00 |
$2,754.00 |
$1,103.05
|
|
Ground mileage
|
$2.40 |
$2.40 |
$2.40 |
$17.60
|
|
G-tube reposition
|
$1,095.00 |
$1,095.00 |
$1,095.00 |
$771.36
|
|
Guided cath fluid drainage 10030
|
$1,765.20 |
$1,765.20 |
$1,765.20 |
$1,372.15
|
|
Guide endoanchr sg-64 aaa 62cm
|
$3,228.60 |
$3,228.60 |
$3,228.60 |
$7,743.36
|
|
Guid loc target vol rad tx
|
$370.80 |
$370.80 |
$370.80 |
$535.60
|
|
Halo cervical into jckt vest
|
$8,149.80 |
$8,149.80 |
$8,149.80 |
$5,015.12
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$51.04 |
$51.04 |
$51.04 |
$91.09
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$38.87 |
$38.87 |
$38.87 |
$24.30
|
|
Hands-On Manual Therapy (each 15 minutes)
|
$105.60 |
$105.60 |
$105.60 |
$105.30
|
|
Hand X-ray
|
$281.40 |
$281.40 |
$281.40 |
$350.35
|
|
Hand X-ray (2 views, both hands)
|
$281.40 |
$281.40 |
$281.40 |
$294.90
|
|
Haptoglobin quantitative
|
$174.00 |
$174.00 |
$174.00 |
$92.80
|
|
Hbot, full body chamber, 30m
|
$477.00 |
$477.00 |
$477.00 |
$526.90
|
|
Hc fl sm bowel enteroclss tube w kub double contrast
|
$273.60 |
$273.60 |
$273.60 |
$726.00
|
|
Hcg qualitative
|
$95.40 |
$95.40 |
$95.40 |
$90.10
|
|
Hcg quantitative
|
$216.60 |
$216.60 |
$216.60 |
$139.20
|
|
Hc nm fusion spect CT unlisted
|
$2,244.60 |
$2,244.60 |
$2,244.60 |
$463.68
|
|
Hdr rdncl ntrstl/icav brchtx
|
$4,171.80 |
$4,171.80 |
$4,171.80 |
$2,725.00
|
|
Hdr rdncl ntrstl/icav brchtx
|
$4,295.40 |
$4,295.40 |
$4,295.40 |
$2,960.63
|
|
Hdr rdncl ntrstl/icav brchtx
|
$4,662.60 |
$4,662.60 |
$4,662.60 |
$3,706.29
|
|
Head CT scan (with and without contrast)
|
$1,722.60 |
$1,722.60 |
$1,722.60 |
$1,818.96
|
|
Head CT scan (with contrast)
|
$1,707.60 |
$1,707.60 |
$1,707.60 |
$1,527.60
|
|
Head CT scan (without contrast)
|
$885.00 |
$885.00 |
$885.00 |
$1,268.90
|
|
Heart infarct image
|
$1,076.40 |
$1,076.40 |
$1,076.40 |
$942.29
|
|
Heel (Calcaneus) X-ray (both feet)
|
$310.80 |
$310.80 |
$310.80 |
$276.00
|
|
Helicobacter pylori antibody igm
|
$145.20 |
$145.20 |
$145.20 |
$92.00
|
|
Hematocrit
|
$18.00 |
$18.00 |
$18.00 |
$33.80
|
