|
Ghs paravert facet/nerve cerv ea add bil
|
$1,177.20 |
$1,177.20 |
$1,177.20 |
$851.04
|
|
Ghs plngl fx pm cl
|
$286.80 |
$286.80 |
$286.80 |
$564.80
|
|
Ghs polysom <6 yrs 4/> parameters
|
$349.80 |
$349.80 |
$349.80 |
$3,557.58
|
|
Ghs ppd (tb intradermal)
|
$46.80 |
$46.80 |
$46.80 |
$37.70
|
|
Ghs protoporphyrins fract
|
$174.00 |
$174.00 |
$174.00 |
$64.28
|
|
Ghs pr without cont pulse ox
|
$141.00 |
$141.00 |
$141.00 |
$146.86
|
|
Ghs removal intranasal foreign body
|
$209.40 |
$209.40 |
$209.40 |
$287.50
|
|
Ghs repair extensor tendon hand, ea tendon
|
$2,082.00 |
$2,082.00 |
$2,082.00 |
$2,161.50
|
|
Ghs rsv eia (respir synctial vrs)
|
$20.40 |
$20.40 |
$20.40 |
$96.60
|
|
Ghs sensitivity (per antimicro)
|
$132.60 |
$132.60 |
$132.60 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$327.00 |
$327.00 |
$327.00 |
$553.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$327.00 |
$327.00 |
$327.00 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$327.00 |
$327.00 |
$327.00 |
$575.00
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$327.00 |
$327.00 |
$327.00 |
$448.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$327.00 |
$327.00 |
$327.00 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$327.00 |
$327.00 |
$327.00 |
$484.80
|
|
Ghs simple repair over 30 cm - 12007
|
$327.00 |
$327.00 |
$327.00 |
$582.00
|
|
Ghs sleep study unattended
|
$122.40 |
$122.40 |
$122.40 |
$495.00
|
|
Ghs st - re-eval for alt comm
|
$838.80 |
$838.80 |
$838.80 |
$309.00
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$80.40 |
$80.40 |
$80.40 |
$98.00
|
|
Ghs superficial wnd dehiscence simp12020
|
$787.80 |
$787.80 |
$787.80 |
$861.75
|
|
Ghs superficial wnd dehis w packing12021
|
$327.00 |
$327.00 |
$327.00 |
$661.50
|
|
Ghs tx distal phalangeal fx with manipulation
|
$286.80 |
$286.80 |
$286.80 |
$523.00
|
|
Ghs urine, porphyrins quant
|
$72.00 |
$72.00 |
$72.00 |
$75.00
|
|
Ghs vaginal delivery only
|
$3,753.00 |
$3,753.00 |
$3,753.00 |
$3,152.00
|
|
Ghs windowing of cast
|
$203.40 |
$203.40 |
$203.40 |
$212.55
|
|
Gi inhouse confirmation
|
$30.60 |
$30.60 |
$30.60 |
$83.70
|
|
Glassia injection
|
$3.60 |
$3.60 |
$3.60 |
$20.32
|
|
Glucagon 1 mg solution for injection
|
$1,080.00 |
$1,080.00 |
$1,080.00 |
$601.79
|
|
Glucagon plasma - sendout
|
$316.20 |
$316.20 |
$316.20 |
$63.00
|
|
Glucose 1 hr post dose
|
$127.20 |
$127.20 |
$127.20 |
$47.20
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$13.80 |
$13.80 |
$13.80 |
$23.86
|
|
Glucose blood quantitative
|
$122.40 |
$122.40 |
$122.40 |
$40.00
|
|
Glucose body fluid
|
$134.40 |
$134.40 |
$134.40 |
$52.20
|
|
Glucose tolerance test (gtt) 3 specimens
|
$185.40 |
$185.40 |
$185.40 |
$100.16
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$120.60 |
$120.60 |
$120.60 |
$35.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$10.20 |
$10.20 |
$10.20 |
$37.04
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$5,780.40 |
$5,780.40 |
$5,780.40 |
$4,977.60
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$280.20 |
$280.20 |
$280.20 |
$115.05
|
|
Gonadotropin luteinizing hormone (lh)
|
$280.20 |
$280.20 |
$280.20 |
$129.00
|
|
Goserelin 10.8 mg subcutaneous implant
|
$2,017.80 |
$2,017.80 |
$2,017.80 |
$4,652.18
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$5,087.40 |
$5,087.40 |
$5,087.40 |
$672.50
|
|
Graft axiofill 1000mg
|
$133.20 |
$133.20 |
$133.20 |
$5,125.68
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$70.67 |
$70.67 |
$70.67 |
$24,469.57
|
|
Graft patch felt ptfe 2x2
|
$3,482.14 |
$3,482.14 |
$3,482.14 |
$27,300.00
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$94.08 |
$94.08 |
$94.08 |
$1,455.76
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$22,192.80 |
$22,192.80 |
$22,192.80 |
$1,181.41
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$10,595.70 |
$10,595.70 |
$10,595.70 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$526.26 |
$526.26 |
$526.26 |
$373.00
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$517.44 |
$517.44 |
$517.44 |
$1,132.47
|
|
Graft xenmtrx sft rect 15x20cm
|
$18,140.09 |
$18,140.09 |
$18,140.09 |
$30,392.04
|
|
Graft xenmtrx sft rect 19x28cm
|
$329.87 |
$329.87 |
$329.87 |
$2,701.58
|
|
Great toe with reduction 28495
|
$286.80 |
$286.80 |
$286.80 |
$482.40
|
|
G-tube reposition
|
$1,612.80 |
$1,612.80 |
$1,612.80 |
$759.36
|
|
Guided cath fluid drainage 10030
|
$1,806.00 |
$1,806.00 |
$1,806.00 |
$1,372.15
|
|
Guide wire threaded 1.4x150mm
|
$1,675.80 |
$1,675.80 |
$1,675.80 |
$3,284.50
|
|
Guide worley csg 9fx50cm std
|
$174.64 |
$174.64 |
$174.64 |
$1,105.00
|
|
Guid loc target vol rad tx
|
$343.80 |
$343.80 |
$343.80 |
$536.00
|
|
Gw stiffened micro access kit
|
$350.40 |
$350.40 |
$350.40 |
$6,696.00
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$172.20 |
$172.20 |
$172.20 |
$90.14
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$4.80 |
$4.80 |
$4.80 |
$23.06
|
|
Handle/convey/speciman/office-lab 99000
|
$21.00 |
$21.00 |
$21.00 |
$23.40
|
|
Hand X-ray
|
$487.80 |
$487.80 |
$487.80 |
$356.00
|
|
Haptoglobin quantitative
|
$151.20 |
$151.20 |
$151.20 |
$91.14
|
|
Hbot, full body chamber, 30m
|
$892.20 |
$892.20 |
$892.20 |
$526.90
|
|
Hcg qualitative
|
$118.20 |
$118.20 |
$118.20 |
$89.70
|
|
Hcg quantitative
|
$185.40 |
$185.40 |
$185.40 |
$139.20
|
|
Head CT scan (with and without contrast)
|
$2,428.20 |
$2,428.20 |
$2,428.20 |
$1,849.90
|
|
Head CT scan (with contrast)
|
$1,710.00 |
$1,710.00 |
$1,710.00 |
$1,545.60
|
|
Head CT scan (without contrast)
|
$1,561.80 |
$1,561.80 |
$1,561.80 |
$1,268.90
|
|
Hematocrit
|
$60.00 |
$60.00 |
$60.00 |
$33.57
|
|
Hemodialysis one evaluation
|
$1,500.00 |
$1,500.00 |
$1,500.00 |
$1,319.44
|
|
Hemoglobin
|
$58.20 |
$58.20 |
$58.20 |
$31.80
|
|
Hemophilus influenza antibdy
|
$114.00 |
$114.00 |
$114.00 |
$62.70
|
|
Heparin assay
|
$42.00 |
$42.00 |
$42.00 |
$140.10
|
|
Heparin bolus from bag
|
$33.00 |
$33.00 |
$33.00 |
$66.47
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$6.00 |
$6.00 |
$6.00 |
$10.61
|
|
Hepatitis a antibody igm
|
$157.80 |
$157.80 |
$157.80 |
$87.75
|
|
Hepatitis b core antibody igm
|
$163.20 |
$163.20 |
$163.20 |
$87.98
|
|
Hepatitis b core antibody total
|
$152.40 |
$152.40 |
$152.40 |
$77.50
|
|
Hepatitis b surface antibody
|
$213.00 |
$213.00 |
$213.00 |
$82.05
|
|
Hepatitis c antibody
|
$147.00 |
$147.00 |
$147.00 |
$108.00
|
|
Hepatobiliary system imaging
|
$688.80 |
$688.80 |
$688.80 |
$1,438.58
|
|
Herpes simplex type 1 antibody igg
|
$133.80 |
$133.80 |
$133.80 |
$70.00
|
|
Herpes simplex type 2 antibody igg
|
$109.80 |
$109.80 |
$109.80 |
$87.10
|
|
Herpes simplex virus isolation
|
$25.80 |
$25.80 |
$25.80 |
$104.10
|
|
Heterophile antibodies screening
|
$102.00 |
$102.00 |
$102.00 |
$74.00
|
|
Hib-hepb vaccine im
|
$55.20 |
$55.20 |
$55.20 |
$85.80
|
|
Hip X-ray
|
$239.40 |
$239.40 |
$239.40 |
$292.05
|
|
Histamine
|
$253.20 |
$253.20 |
$253.20 |
$115.00
|
|
Hla i low res one antigen equiv ea
|
$109.80 |
$109.80 |
$109.80 |
$161.70
|
|
Hocm 350-399mg/ml iodine,1ml
|
$296.40 |
$296.40 |
$296.40 |
$79.78
|
|
Home sleep test/type 3 porta
|
$102.00 |
$102.00 |
$102.00 |
$579.26
|
|
Homocysteine
|
$252.60 |
$252.60 |
$252.60 |
$121.92
|
|
Hpv types 16 & 18 only
|
$87.00 |
$87.00 |
$87.00 |
$110.70
|
|
H pylori (c-13) breath
|
$394.80 |
$394.80 |
$394.80 |
$213.00
|
|
Htt gene detc abnor alleles
|
$447.60 |
$447.60 |
$447.60 |
$250.50
|
|
Hyaluronidase, human recombinant 150 unit/ml injection solution
|
$194.40 |
$194.40 |
$194.40 |
$142.40
|
|
Hydralazine 20 mg/ml injection solution
|
$42.60 |
$42.60 |
$42.60 |
$46.74
|
|
Hydration IV infusion each additional hour
|
$80.40 |
$80.40 |
$80.40 |
$131.20
|
