|
Ghs vaginal delivery only
|
$2,731.68 |
$2,731.68 |
$2,731.68 |
$3,338.40
|
|
Ghs veeg 12-26 hr intmt mont
|
$2,713.20 |
$2,713.20 |
$2,713.20 |
$1,932.00
|
|
Ghs windowing of cast
|
$96.60 |
$96.60 |
$96.60 |
$212.55
|
|
Gi inhouse confirmation
|
$111.72 |
$111.72 |
$111.72 |
$86.40
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$1,646.40 |
$1,646.40 |
$1,646.40 |
$2,195.76
|
|
Gi trc img intral colon i&r
|
$585.06 |
$585.06 |
$585.06 |
$1,959.88
|
|
Gi trc img intral esophagus
|
$866.88 |
$866.88 |
$866.88 |
$1,897.82
|
|
Glassia injection
|
$41.79 |
$41.79 |
$41.79 |
$20.32
|
|
Glucagon 1 mg solution for injection
|
$537.79 |
$537.79 |
$537.79 |
$601.79
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$412.95 |
$412.95 |
$412.95 |
$491.67
|
|
Glucagon plasma - sendout
|
$101.64 |
$101.64 |
$101.64 |
$63.20
|
|
Glucose 1 hr post dose
|
$55.44 |
$55.44 |
$55.44 |
$48.25
|
|
Glucose-6-phosphate dhydrogenase screen
|
$71.40 |
$71.40 |
$71.40 |
$55.50
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$35.28 |
$35.28 |
$35.28 |
$22.75
|
|
Glucose blood quantitative
|
$36.96 |
$36.96 |
$36.96 |
$41.40
|
|
Glucose body fluid
|
$53.34 |
$53.34 |
$53.34 |
$51.30
|
|
Glucose monitoring continual min 72hr pt
|
$43.26 |
$43.26 |
$43.26 |
$126.80
|
|
Glucose tolerance test (gtt) 3 specimens
|
$261.24 |
$261.24 |
$261.24 |
$104.50
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$73.92 |
$73.92 |
$73.92 |
$36.00
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$4,049.33 |
$4,049.33 |
$4,049.33 |
$4,977.60
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$112.56 |
$112.56 |
$112.56 |
$115.80
|
|
Gonadotropin luteinizing hormone (lh)
|
$124.32 |
$124.32 |
$124.32 |
$129.00
|
|
Goserelin 10.8 mg subcutaneous implant
|
$6,132.05 |
$6,132.05 |
$6,132.05 |
$4,496.37
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$56.66 |
$56.66 |
$56.66 |
$143.50
|
|
Graft axiofill 1000mg
|
$5,125.68 |
$5,125.68 |
$5,125.68 |
$5,125.68
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$402.78 |
$402.78 |
$402.78 |
$601.50
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$18,248.11 |
$18,248.11 |
$18,248.11 |
$23,288.44
|
|
Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm
|
$887.04 |
$887.04 |
$887.04 |
$3,432.00
|
|
Graft nerve adv 3-4x70mm
|
$2,688.53 |
$2,688.53 |
$2,688.53 |
$20,782.10
|
|
Graft patch felt ptfe 2x2
|
$14,821.28 |
$14,821.28 |
$14,821.28 |
$29,995.44
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$2,730.00 |
$2,730.00 |
$2,730.00 |
$1,455.76
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$1,632.96 |
$1,632.96 |
$1,632.96 |
$892.38
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$2,940.00 |
$2,940.00 |
$2,940.00 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$1,271.03 |
$1,271.03 |
$1,271.03 |
$427.89
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$19,573.37 |
$19,573.37 |
$19,573.37 |
$29,056.92
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$3,720.03 |
$3,720.03 |
$3,720.03 |
$1,132.47
|
|
Graft xenmtrx sft rect 15x20cm
|
$13,021.26 |
$13,021.26 |
$13,021.26 |
$31,191.20
|
|
Graft xenmtrx sft rect 19x28cm
|
$1,529.52 |
$1,529.52 |
$1,529.52 |
$3,076.20
|
|
Granisetron hcl injection
|
$127.52 |
$127.52 |
$127.52 |
$47.04
|
|
Great toe with reduction 28495
|
$412.86 |
$412.86 |
$412.86 |
$495.00
|
|
Group mnt 2 or more 30 mins
|
$26.46 |
$26.46 |
$26.46 |
$40.14
|
|
G-tube reposition
|
$608.58 |
$608.58 |
$608.58 |
$745.80
|
|
Gu dilat ureter/urethra s&i
|
$699.72 |
$699.72 |
$699.72 |
$1,980.66
|
|
Guided cath fluid drainage 10030
|
$1,219.26 |
$1,219.26 |
$1,219.26 |
$1,327.76
|
|
Guide endoanchr sg-64 aaa 62cm
|
$3,910.64 |
$3,910.64 |
$3,910.64 |
$7,743.36
|
|
Guide wire threaded 1.4x150mm
|
$7,045.50 |
$7,045.50 |
$7,045.50 |
$3,401.81
|
|
Guide worley csg 9fx50cm std
|
$1,070.69 |
$1,070.69 |
$1,070.69 |
$1,117.40
|
|
Guid loc target vol rad tx
|
$678.72 |
$678.72 |
$678.72 |
$535.60
|
|
Gw stiffened micro access kit
|
$8,330.28 |
$8,330.28 |
$8,330.28 |
$6,600.00
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$331.75 |
$331.75 |
$331.75 |
$89.32
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$119.94 |
$119.94 |
$119.94 |
$24.41
|
|
Hand X-ray
|
$223.02 |
$223.02 |
$223.02 |
$345.87
|
|
Haptoglobin quantitative
|
$91.14 |
$91.14 |
$91.14 |
$91.80
|
|
Harvest auto stem cells
|
$1,563.66 |
$1,563.66 |
$1,563.66 |
$3,379.00
|
|
Hast w/i&r phys/qhp
|
$161.28 |
$161.28 |
$161.28 |
$301.95
|
|
Hast w/oxygen titrate
|
$161.28 |
$161.28 |
$161.28 |
$347.20
|
|
Hbot, full body chamber, 30m
|
$190.68 |
$190.68 |
$190.68 |
$526.90
|
|
Hcg free betachain test
|
$121.80 |
$121.80 |
$121.80 |
$68.90
|
|
Hcg qualitative
|
$122.22 |
$122.22 |
$122.22 |
$88.00
|
|
Hcg quantitative
|
$88.62 |
$88.62 |
$88.62 |
$137.15
|
|
Hc i-131 sodium iodide cap dx per mci
|
$24.36 |
$24.36 |
$24.36 |
$117.00
|
|
Hc nm kidney imaging with flow
|
$260.82 |
$260.82 |
$260.82 |
$849.00
|
|
Hc pet myocardial imaging metabolic eval single study
|
$2,070.18 |
$2,070.18 |
$2,070.18 |
$3,840.40
|
|
Hc transcatheter placement and sbsq removal cepd perq
|
$3,780.00 |
$3,780.00 |
$3,780.00 |
$3,228.40
|
|
Hdr rdncl ntrstl/icav brchtx
|
$2,244.90 |
$2,244.90 |
$2,244.90 |
$2,668.85
|
|
Hdr rdncl ntrstl/icav brchtx
|
$2,693.88 |
$2,693.88 |
$2,693.88 |
$2,960.63
|
|
Hdr rdncl ntrstl/icav brchtx
|
$4,152.96 |
$4,152.96 |
$4,152.96 |
$3,694.80
|
|
Head CT scan (with and without contrast)
|
$1,104.60 |
$1,104.60 |
$1,104.60 |
$1,818.96
|
|
Head CT scan (with contrast)
|
$916.02 |
$916.02 |
$916.02 |
$1,526.50
|
|
Head CT scan (without contrast)
|
$673.68 |
$673.68 |
$673.68 |
$1,268.90
|
|
Heart image spect
|
$511.56 |
$511.56 |
$511.56 |
$1,131.00
|
|
Heart revascularize (tmr)
|
$4,129.86 |
$4,129.86 |
$4,129.86 |
$4,129.86
|
|
Heinz bodies direct
|
$141.54 |
$141.54 |
$141.54 |
$43.15
|
|
Helicobacter pylori antibody igm
|
$73.92 |
$73.92 |
$73.92 |
$92.23
|
|
Hematocrit
|
$25.62 |
$25.62 |
$25.62 |
$33.57
|
|
Hematopoietic nuclear tx
|
$770.70 |
$770.70 |
$770.70 |
$928.98
|
|
Hemin 350 mg intravenous powder for solution
|
$22,975.03 |
$22,975.03 |
$22,975.03 |
$20,618.46
|
|
Hemoglobin
|
$29.40 |
$29.40 |
$29.40 |
$32.76
|
|
Hemoglobin fetal qualitative
|
$47.46 |
$47.46 |
$47.46 |
$51.75
|
|
Hemoglobin f (fetal) chemical
|
$36.54 |
$36.54 |
$36.54 |
$42.00
|
|
Hemoglobin methemoglobin quantitative
|
$124.32 |
$124.32 |
$124.32 |
$52.32
|
|
Hemoglobin plasma
|
$121.80 |
$121.80 |
$121.80 |
$41.25
|
|
Hemolysin acid
|
$91.14 |
$91.14 |
$91.14 |
$79.04
|
|
Hemolysins/agglutinins auto
|
$43.26 |
$43.26 |
$43.26 |
$57.28
|
|
Hemolysins and agglutinins incubated
|
$39.90 |
$39.90 |
$39.90 |
$59.80
|
|
Hemorrhoidectomy intrnl lig rbbr band ligations
|
$585.06 |
$585.06 |
$585.06 |
$1,170.54
|
|
Heparin assay
|
$201.60 |
$201.60 |
$201.60 |
$138.84
|
|
Heparin bolus from bag
|
$86.84 |
$86.84 |
$86.84 |
$68.00
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$478.26 |
$478.26 |
$478.26 |
$12.91
|
|
Hepatitis a antibody igm
|
$108.36 |
$108.36 |
$108.36 |
$88.92
|
|
Hepatitis b core antibody igm
|
$65.94 |
$65.94 |
$65.94 |
$88.80
|
|
Hepatitis b core antibody total
|
$86.52 |
$86.52 |
$86.52 |
$77.50
|
|
Hepatitis b immune globulin greater than 1,560 units/5 ml im solution
|
$1,525.40 |
$1,525.40 |
$1,525.40 |
$1,174.30
|
|
Hepatitis b surface antibody
|
$90.72 |
$90.72 |
$90.72 |
$81.12
|
|
Hepatitis c antibody
|
$91.56 |
$91.56 |
$91.56 |
$108.00
|
|
Hepatobiliary system imaging
|
$857.64 |
$857.64 |
$857.64 |
$1,438.99
|
|
Hepb vacc 3 dose immunsup im
|
$229.66 |
$229.66 |
$229.66 |
$319.52
|
|
Herpes simplex type 1 antibody igg
|
$140.28 |
$140.28 |
$140.28 |
$66.30
|
|
Herpes simplex type 2 antibody igg
|
$140.70 |
$140.70 |
$140.70 |
$87.10
|
|
Heterophile antibodies screening
|
$64.68 |
$64.68 |
$64.68 |
$72.00
|
