|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$402.40 |
$402.40 |
$402.40 |
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$527.60 |
$527.60 |
$527.60 |
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$540.40 |
$540.40 |
$540.40 |
|
|
Ghs leukocyte alkaline phos (mayo)
|
$66.00 |
$66.00 |
$66.00 |
|
|
Ghs low level laser therapy
|
$19.20 |
$19.20 |
$19.20 |
|
|
Ghs mbp
|
$79.60 |
$79.60 |
$79.60 |
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$423.80 |
$423.80 |
$423.80 |
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$352.30 |
$352.30 |
$352.30 |
|
|
Ghs moderate sedation ea addtl 15 min
|
$86.80 |
$86.80 |
$245.70 |
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$91.00 |
$91.00 |
$91.00 |
|
|
Ghs myocardial strain img spckl track
|
$260.00 |
$260.00 |
$466.05 |
|
|
Ghs nerve blk intercostal, ea addtl level
|
$693.60 |
$693.60 |
$728.40 |
|
|
Ghs nerve blk intercostal, single level
|
$693.60 |
$693.60 |
$764.40 |
|
|
Ghs nerve block axillary nerve
|
$19,362.25 |
$19,362.25 |
$19,362.25 |
|
|
Ghs nerve block brachial plexus
|
$21,220.48 |
$21,220.48 |
$21,220.48 |
|
|
Ghs nerve block interscaline
|
$714.80 |
$714.80 |
$750.40 |
|
|
Ghs nerve block lumbar or thoracic symp
|
$714.80 |
$714.80 |
$866.40 |
|
|
Ghs nerve block sciatic nerve
|
$714.80 |
$750.40 |
$18,591.70 |
|
|
Ghs nerve block suprascapular
|
$469.60 |
$469.60 |
$469.60 |
|
|
Ghs ng placement w fluoro guidance
|
$207.60 |
$207.60 |
$207.60 |
|
|
Ghs ot group caregiver training
|
$20.15 |
$20.15 |
$20.15 |
|
|
Ghs ot prosthetic training/15 min
|
$53.95 |
$62.00 |
$64.80 |
|
|
Ghs ot sensory integrative tech/15min
|
$59.80 |
$59.80 |
$79.60 |
|
|
Ghs ot work hardening-additional hours
|
$30.00 |
$93.60 |
$128.80 |
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$610.00 |
$610.00 |
$640.40 |
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$679.60 |
$679.60 |
$713.60 |
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$33.20 |
$33.20 |
$33.20 |
|
|
Ghs phenylketonurid
|
$25.20 |
$25.20 |
$25.20 |
|
|
Ghs picc line insert < 5
|
$1,920.10 |
$1,920.10 |
$1,920.10 |
|
|
Ghs plngl fx pm cl
|
$565.60 |
$565.60 |
$565.60 |
|
|
Ghs ppd (tb intradermal)
|
$16.80 |
$16.80 |
$16.80 |
|
|
Ghs protoporphyrins fract
|
$36.00 |
$36.00 |
$38.80 |
|
|
Ghs pr without cont pulse ox
|
$164.40 |
$164.40 |
$164.40 |
|
|
Ghs pt - work hardening/int 2hrs
|
$149.60 |
$162.40 |
$185.25 |
|
|
Ghs removal intranasal foreign body
|
$466.80 |
$466.80 |
$466.80 |
|
|
Ghs rsv eia (respir synctial vrs)
|
$70.40 |
$95.20 |
$270.40 |
|
|
Ghs sedimentation rate
|
$39.20 |
$39.20 |
$39.20 |
|
|
Ghs sensitivity (per antimicro)
|
$25.60 |
$25.60 |
$77.35 |
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$402.40 |
$402.40 |
$402.40 |
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$765.20 |
$765.20 |
$765.20 |
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$236.80 |
$236.80 |
$236.80 |
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$96.80 |
$96.80 |
$287.60 |
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$402.40 |
$402.40 |
$402.40 |
|
|
Ghs sleep study unattended
|
$945.10 |
$945.10 |
$945.10 |
|
|
Ghs speech-gen aug dev eval iii, st
|
$52.80 |
$52.80 |
$52.80 |
|
|
Ghs sp train/fitting sp device - kx
|
$114.80 |
$114.80 |
$304.85 |
|
|
Ghs urine, porphyrins quant
|
$49.20 |
$62.80 |
$122.20 |
|
|
Ghs vaginal delivery only
|
$156.65 |
$156.65 |
$1,778.00 |
|
|
Giardia lamblia antibody
|
$70.00 |
$70.00 |
$70.00 |
|
|
Gi inhouse confirmation
|
$34.80 |
$36.80 |
$107.25 |
|
|
Glucagon 1 mg solution for injection
|
$1,183.00 |
$1,183.00 |
$1,183.00 |
|
|
Glucagon plasma - sendout
|
$87.60 |
$87.60 |
$87.60 |
|
|
Glucose 1 hr post dose
|
$33.15 |
$47.20 |
$48.00 |
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$16.00 |
$16.00 |
$29.20 |
|
|
Glucose blood quantitative
|
$26.40 |
$36.40 |
$52.40 |
|
|
Glucose body fluid
|
$40.40 |
$42.80 |
$59.80 |
|
|
Glucose tolerance test (gtt) 3 specimens
|
$74.00 |
$124.80 |
$174.40 |
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$14.40 |
$16.00 |
$45.50 |
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$7.15 |
$7.15 |
$7.15 |
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$3,581.36 |
$3,581.36 |
$3,581.36 |
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$76.00 |
$86.80 |
$143.65 |
|
|
Gonadotropin luteinizing hormone (lh)
|
$89.20 |
$90.40 |
$159.90 |
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$73.45 |
$73.45 |
$73.45 |
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$169.00 |
$169.00 |
$169.00 |
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$403.65 |
$403.65 |
$403.65 |
|
|
Gstrst open wo constj tube
|
$16,103.00 |
$16,103.00 |
$16,103.00 |
|
|
Gu dilat ureter/urethra s&i
|
$1,129.20 |
$1,129.20 |
$1,129.20 |
|
|
Guided cath fluid drainage 10030
|
$437.60 |
$437.60 |
$437.60 |
|
|
Guid loc target vol rad tx
|
$319.15 |
$319.15 |
$319.15 |
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$7.15 |
$7.15 |
$7.15 |
|
|
Handle/convey/speciman/office-lab 99000
|
$20.80 |
$20.80 |
$33.80 |
|
|
Hand X-ray
|
$178.80 |
$226.00 |
$386.10 |
|
|
Haptoglobin quantitative
|
$45.20 |
$79.60 |
$112.45 |
|
|
Hbot, full body chamber, 30m
|
$208.65 |
$208.65 |
$208.65 |
|
|
Hcg qualitative
|
$82.80 |
$89.60 |
$102.05 |
|
|
Hcg quantitative
|
$113.60 |
$115.60 |
$167.05 |
|
|
Hc i-131 sodium iodide cap dx per mci
|
$220.35 |
$220.35 |
$220.35 |
|
|
Hc metata joint dislocation anes
|
$404.80 |
$404.80 |
$404.80 |
|
|
Hc nm kidney imaging with flow
|
$693.20 |
$693.20 |
$693.20 |
|
|
Hc pet myocardial imaging metabolic eval single study
|
$4,191.85 |
$4,191.85 |
$4,191.85 |
|
|
Head CT scan (with and without contrast)
|
$1,248.00 |
$1,344.40 |
$2,029.95 |
|
|
Head CT scan (with contrast)
|
$1,145.60 |
$1,162.80 |
$1,807.65 |
|
|
Head CT scan (without contrast)
|
$1,018.00 |
$1,061.20 |
$1,643.20 |
|
|
Helicobacter pylori antibody igm
|
$22.00 |
$27.20 |
$150.80 |
|
|
Hematocrit
|
$26.00 |
$26.80 |
$34.45 |
|
|
Hemodialysis one evaluation
|
$859.60 |
$859.60 |
$859.60 |
|
|
Hemoglobin
|
$23.20 |
$26.00 |
$26.00 |
|
|
Hemoglobin fetal qualitative
|
$66.30 |
$66.30 |
$66.30 |
|
|
Hemoglobin methemoglobin quantitative
|
$43.60 |
$43.60 |
$43.60 |
|
|
Hemoglobin plasma
|
$70.00 |
$70.00 |
$70.00 |
|
|
Hemophilus influenza antibdy
|
$49.20 |
$49.20 |
$49.20 |
|
|
Heparin assay
|
$49.20 |
$49.60 |
$74.75 |
|
|
Heparin bolus from bag
|
$69.71 |
$69.71 |
$69.71 |
|
|
Heparin neutralization
|
$105.95 |
$105.95 |
$105.95 |
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$7.15 |
$7.15 |
$7.15 |
|
|
Hepatitis a antibody igm
|
$44.00 |
$52.80 |
$128.05 |
|
|
Hepatitis b core antibody igm
|
$52.80 |
$85.20 |
$118.30 |
|
|
Hepatitis b core antibody total
|
$35.20 |
$35.20 |
$64.40 |
|
|
Hepatitis b immune globulin greater than 1,560 units/5 ml im solution
|
$187.52 |
$187.52 |
$187.52 |
|
|
Hepatitis b surface antibody
|
$74.80 |
$85.15 |
$102.00 |
|