|
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
|
$160.80 |
$160.80 |
$160.80 |
$210.91
|
|
Ghs st - re-eval for alt comm
|
$329.40 |
$329.40 |
$329.40 |
$321.00
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$354.00 |
$354.00 |
$354.00 |
$342.40
|
|
Ghs superficial wnd dehiscence simp12020
|
$340.80 |
$340.80 |
$340.80 |
$1,016.25
|
|
Ghs urine, hydroxproline total
|
$162.60 |
$162.60 |
$162.60 |
$119.40
|
|
Ghs urine, porphyrins quant
|
$195.00 |
$195.00 |
$195.00 |
$85.15
|
|
Ghs veeg 12-26 hr intmt mont
|
$1,191.00 |
$1,191.00 |
$1,191.00 |
$1,990.20
|
|
Gi inhouse confirmation
|
$227.40 |
$227.40 |
$227.40 |
$79.50
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$3,570.60 |
$3,570.60 |
$3,570.60 |
$2,418.92
|
|
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
|
$28.80 |
$28.80 |
$28.80 |
$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
|
$1,577.10 |
$1,577.10 |
$1,577.10 |
$1,598.97
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$3,642.00 |
$3,642.00 |
$3,642.00 |
$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
|
$10,096.80 |
$10,096.80 |
$10,096.80 |
$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
|
$4,177.80 |
$4,177.80 |
$4,177.80 |
$3,735.34
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$10,983.60 |
$10,983.60 |
$10,983.60 |
$486.45
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$5,781.00 |
$5,781.00 |
$5,781.00 |
$1,123.34
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$5,176.20 |
$5,176.20 |
$5,176.20 |
$5,533.20
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$19,062.00 |
$19,062.00 |
$19,062.00 |
$53,576.40
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$9,120.60 |
$9,120.60 |
$9,120.60 |
$543.12
|
|
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
|
|
Guide endoanchr sg-64 aaa 62cm
|
$5,511.60 |
$5,511.60 |
$5,511.60 |
$2,108.25
|
|
Guid loc target vol rad tx
|
$526.20 |
$526.20 |
$526.20 |
$620.91
|
|
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
|
|
Hbb gene known fam variant
|
$1,033.20 |
$1,033.20 |
$1,033.20 |
$751.20
|
|
Hbot, full body chamber, 30m
|
$490.80 |
$490.80 |
$490.80 |
$524.17
|
|
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
|
|
Hc i-131 sodium iodide cap dx per mci
|
$22.20 |
$22.20 |
$22.20 |
$184.20
|
|
Hc nm fusion spect CT unlisted
|
$6,829.80 |
$6,829.80 |
$6,829.80 |
$463.68
|
|
Hc transcatheter placement and sbsq removal cepd perq
|
$18,754.80 |
$18,754.80 |
$18,754.80 |
$3,046.80
|
|
Hdr rdncl ntrstl/icav brchtx
|
$7,490.40 |
$7,490.40 |
$7,490.40 |
$2,668.85
|
|
Hdr rdncl ntrstl/icav brchtx
|
$9,365.40 |
$9,365.40 |
$9,365.40 |
$2,960.63
|
|
Hdr rdncl ntrstl/icav brchtx
|
$9,830.40 |
$9,830.40 |
$9,830.40 |
$3,111.55
|
|
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
|
|
Hematopoietic nuclear tx
|
$2,815.80 |
$2,815.80 |
$2,815.80 |
$878.33
|
|
Hemin 350 mg intravenous powder for solution
|
$16,410.74 |
$16,410.74 |
$16,410.74 |
$37,212.55
|
|
Hemodialysis one evaluation
|
$1,697.40 |
$1,697.40 |
$1,697.40 |
$1,131.00
|
|
Hemoglobin
|
$63.60 |
$63.60 |
$63.60 |
$28.60
|
|
Hemoglobin fetal qualitative
|
$172.20 |
$172.20 |
$172.20 |
$54.60
|
|
Hemoglobin methemoglobin quantitative
|
$267.00 |
$267.00 |
$267.00 |
$43.01
|
|
Hemoglobin-oxygen affinity
|
$357.60 |
$357.60 |
$357.60 |
$59.94
|
|
Hemoglobin plasma
|
$237.60 |
$237.60 |
$237.60 |
$43.80
|
|
Hemolysin acid
|
$140.40 |
$140.40 |
$140.40 |
$65.19
|
|
Hemophilus influenza antibdy
|
$217.80 |
$217.80 |
$217.80 |
$56.80
|
|
Heparin assay
|
$576.00 |
$576.00 |
$576.00 |
$107.50
|
|
Heparin bolus from bag
|
$99.09 |
$99.09 |
$158.03 |
$50.95
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$44.37 |
$44.37 |
$99.30 |
$7.15
|
|
Hepatitis a antibody igm
|
$288.00 |
$288.00 |
$288.00 |
$80.60
|
|
Hepatitis b core antibody igm
|
$288.60 |
$288.60 |
$288.60 |
$85.80
|
|
Hepatitis b core antibody total
|
$223.80 |
$223.80 |
$223.80 |
$84.75
|
|
Hepatitis b immune globulin greater than 1,560 units/5 ml im solution
|
$1,580.54 |
$1,580.54 |
$1,580.54 |
$468.80
|
|
Hepatitis b surface antibody
|
$217.20 |
$217.20 |
$217.20 |
$81.12
|
|
Hepatitis c antibody
|
$316.20 |
$316.20 |
$316.20 |
$106.50
|
|
Hepatobiliary system imaging
|
$2,378.40 |
$2,378.40 |
$2,378.40 |
$1,438.58
|
|
Herpes simplex type 1 antibody igg
|
$172.20 |
$172.20 |
$172.20 |
$79.92
|
|
Herpes simplex type 2 antibody igg
|
$198.60 |
$198.60 |
$198.60 |
$96.20
|
|
Herpes simplex virus isolation
|
$259.80 |
$259.80 |
$259.80 |
$110.50
|
|
Heterophile antibodies screening
|
$162.60 |
$162.60 |
$162.60 |
$59.40
|
|
Hip X-ray
|
$274.80 |
$274.80 |
$274.80 |
$262.64
|
|
Histamine
|
$304.80 |
$304.80 |
$304.80 |
$132.60
|
|
Histochemical stains add-on
|
$433.80 |
$433.80 |
$433.80 |
$179.04
|
|
Hiv-1 ag ia
|
$51.60 |
$51.60 |
$51.60 |
$87.00
|
|
HIV prep, ftc/taf 200/25mg
|
$104.33 |
$104.33 |
$104.33 |
$104.33
|
|
HIV prep, ftc/tdf 200/300mg
|
$50.75 |
$50.75 |
$50.75 |
$50.75
|
|
Hla class i high defin qual
|
$532.20 |
$532.20 |
$532.20 |
$574.86
|
|
Hla class ii high defin qual
|
$493.20 |
$493.20 |
$493.20 |
$530.54
|
|
Hla class i&ii antibody qual
|
$241.20 |
$241.20 |
$241.20 |
$241.20
|
