|
Ghs conjunctiva foreign body-superf bil
|
$262.80 |
$262.80 |
$262.80 |
$283.80
|
|
Ghs corneal fb without slit lamp bilat
|
$292.20 |
$292.20 |
$292.20 |
$419.65
|
|
Ghs corneal fb with slit lamp bilat
|
$292.20 |
$292.20 |
$292.20 |
$339.60
|
|
Ghs dislocation elbow closed treatment
|
$287.40 |
$287.40 |
$287.40 |
$578.00
|
|
Ghs ed peritoneal lavage w guidance if performed
|
$207.60 |
$207.60 |
$207.60 |
$1,109.47
|
|
Ghs fish cytogen
|
$101.40 |
$101.40 |
$101.40 |
$170.80
|
|
Ghs fish hybrid in situ 100-300
|
$222.60 |
$222.60 |
$222.60 |
$223.00
|
|
Ghs gastric intub aspiration lavage
|
$463.20 |
$463.20 |
$463.20 |
$368.50
|
|
Ghs histoplasma antigen
|
$325.20 |
$325.20 |
$325.20 |
$141.00
|
|
Ghs i and d perirectal abscess 46040
|
$1,378.80 |
$1,378.80 |
$1,378.80 |
$2,630.53
|
|
Ghs init tx 1st degree burn
|
$242.40 |
$242.40 |
$242.40 |
$275.50
|
|
Ghs insertion of needle - bone
|
$375.00 |
$375.00 |
$375.00 |
$422.40
|
|
Ghs IV thrombolytics - cerebral
|
$426.60 |
$426.60 |
$426.60 |
$663.00
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$301.20 |
$301.20 |
$301.20 |
$584.00
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$301.20 |
$301.20 |
$301.20 |
$563.75
|
|
Ghs layer closure 2.5cm or less - 12051
|
$301.20 |
$301.20 |
$301.20 |
$593.00
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$301.20 |
$301.20 |
$301.20 |
$675.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$301.20 |
$301.20 |
$301.20 |
$689.04
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$328.80 |
$328.80 |
$328.80 |
$770.22
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$294.00 |
$294.00 |
$294.00 |
$242.31
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$294.00 |
$294.00 |
$294.00 |
$228.45
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$294.00 |
$294.00 |
$294.00 |
$230.00
|
|
Ghs moderate sedation ea addtl 15 min
|
$148.20 |
$148.20 |
$148.20 |
$151.50
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$148.20 |
$148.20 |
$148.20 |
$147.75
|
|
Ghs nailbed repair/nail removal
|
$327.60 |
$327.60 |
$327.60 |
$724.37
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$67.20 |
$67.20 |
$67.20 |
$55.77
|
|
Ghs osteopathic manipulative tx, 3-4 regions
|
$70.80 |
$70.80 |
$70.80 |
$57.65
|
|
Ghs plngl fx pm cl
|
$287.40 |
$287.40 |
$287.40 |
$564.80
|
|
Ghs ppd (tb intradermal)
|
$43.20 |
$43.20 |
$43.20 |
$37.70
|
|
Ghs pr without cont pulse ox
|
$141.00 |
$141.00 |
$141.00 |
$146.86
|
|
Ghs removal intranasal foreign body
|
$315.60 |
$315.60 |
$315.60 |
$287.50
|
|
Ghs sensitivity (per antimicro)
|
$115.80 |
$115.80 |
$115.80 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$327.60 |
$327.60 |
$327.60 |
$553.60
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$327.60 |
$327.60 |
$327.60 |
$575.00
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$327.60 |
$327.60 |
$327.60 |
$448.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$327.60 |
$327.60 |
$327.60 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$327.60 |
$327.60 |
$327.60 |
$484.80
|
|
Ghs simple repair over 30 cm - 12007
|
$327.60 |
$327.60 |
$327.60 |
$582.00
|
|
Ghs st - re-eval for alt comm
|
$795.00 |
$795.00 |
$795.00 |
$309.00
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$72.00 |
$72.00 |
$72.00 |
$98.00
|
|
Ghs tx distal phalangeal fx with manipulation
|
$287.40 |
$287.40 |
$287.40 |
$523.00
|
|
Gi inhouse confirmation
|
$29.40 |
$29.40 |
$29.40 |
$83.70
|
|
Glucagon 1 mg solution for injection
|
$1,080.00 |
$1,080.00 |
$1,080.00 |
$601.79
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$690.60 |
$690.60 |
$690.60 |
$491.67
|
|
Glucose 1 hr post dose
|
$121.20 |
$121.20 |
$121.20 |
$47.20
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$13.80 |
$13.80 |
$13.80 |
$23.86
|
|
Glucose blood quantitative
|
$116.40 |
$116.40 |
$116.40 |
$40.00
|
|
Glucose body fluid
|
$130.20 |
$130.20 |
$130.20 |
$52.20
|
|
Glucose tolerance test (gtt) 3 specimens
|
$175.20 |
$175.20 |
$175.20 |
$100.16
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$118.20 |
$118.20 |
$118.20 |
$35.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$10.20 |
$10.20 |
$10.20 |
$37.04
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$266.40 |
$266.40 |
$266.40 |
$115.05
|
|
Gonadotropin luteinizing hormone (lh)
|
$266.40 |
$266.40 |
$266.40 |
$129.00
|
|
Goserelin 10.8 mg subcutaneous implant
|
$6,052.20 |
$6,052.20 |
$6,052.20 |
$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 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
|
$14,599.57 |
$14,599.57 |
$14,599.57 |
$30,392.04
|
|
Graft xenmtrx sft rect 19x28cm
|
$296.35 |
$296.35 |
$296.35 |
$2,701.58
|
|
Guided cath fluid drainage 10030
|
$1,703.40 |
$1,703.40 |
$1,703.40 |
$1,372.15
|
|
Guide wire threaded 1.4x150mm
|
$280.48 |
$280.48 |
$280.48 |
$3,284.50
|
|
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
|
|
Hand X-ray
|
$606.00 |
$606.00 |
$606.00 |
$356.00
|
|
Haptoglobin quantitative
|
$143.40 |
$143.40 |
$143.40 |
$91.14
|
|
Hbot, full body chamber, 30m
|
$1,083.60 |
$1,083.60 |
$1,083.60 |
$526.90
|
|
Hcg qualitative
|
$112.80 |
$112.80 |
$112.80 |
$89.70
|
|
Hcg quantitative
|
$175.20 |
$175.20 |
$175.20 |
$139.20
|
|
Head CT scan (with and without contrast)
|
$2,631.60 |
$2,631.60 |
$2,631.60 |
$1,849.90
|
|
Head CT scan (with contrast)
|
$1,852.80 |
$1,852.80 |
$1,852.80 |
$1,545.60
|
|
Head CT scan (without contrast)
|
$1,692.60 |
$1,692.60 |
$1,692.60 |
$1,268.90
|
|
Hematocrit
|
$52.80 |
$52.80 |
$52.80 |
$33.57
|
|
Hemodialysis one evaluation
|
$1,500.00 |
$1,500.00 |
$1,500.00 |
$1,319.44
|
|
Hemoglobin
|
$55.20 |
$55.20 |
$55.20 |
$31.80
|
|
Heparin assay
|
$42.00 |
$42.00 |
$42.00 |
$140.10
|
|
Heparin bolus from bag
|
$32.40 |
$32.40 |
$32.40 |
$66.47
|
|
Hepatitis a antibody igm
|
$151.20 |
$151.20 |
$151.20 |
$87.75
|
|
Hepatitis b core antibody igm
|
$154.80 |
$154.80 |
$154.80 |
$87.98
|
|
Hepatitis b core antibody total
|
$147.00 |
$147.00 |
$147.00 |
$77.50
|
|
Hepatitis b immune globulin greater than 1,560 units/5 ml im solution
|
$2,938.20 |
$2,938.20 |
$2,938.20 |
$1,116.61
|
|
Hepatitis b surface antibody
|
$203.40 |
$203.40 |
$203.40 |
$82.05
|
|
Hepatitis c antibody
|
$139.20 |
$139.20 |
$139.20 |
$108.00
|
|
Hepatobiliary system imaging
|
$706.20 |
$706.20 |
$706.20 |
$1,438.58
|
|
Herpes simplex type 1 antibody igg
|
$126.60 |
$126.60 |
$126.60 |
$70.00
|
|
Herpes simplex type 2 antibody igg
|
$109.80 |
$109.80 |
$109.80 |
$87.10
|
|
Heterophile antibodies screening
|
$98.40 |
$98.40 |
$98.40 |
$74.00
|
|
Hip X-ray
|
$294.60 |
$294.60 |
$294.60 |
$292.05
|
|
Histamine
|
$170.40 |
$170.40 |
$170.40 |
$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
|
$445.20 |
$445.20 |
$445.20 |
$579.26
|
|
Homocysteine
|
$220.80 |
$220.80 |
$220.80 |
$121.92
|
|
Homogenization tissue
|
$141.60 |
$141.60 |
$141.60 |
$39.20
|
|
Hpv types 16 & 18 only
|
$87.00 |
$87.00 |
$87.00 |
$110.70
|
|
H pylori (c-13) breath
|
$343.80 |
$343.80 |
$343.80 |
$213.00
|
