|
Ghs intermed repair over 30 cm - 12037
|
$648.00 |
$648.00 |
$648.00 |
$2,164.64
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$480.00 |
$480.00 |
$480.00 |
$584.00
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$289.80 |
$289.80 |
$289.80 |
$563.75
|
|
Ghs layer closure 2.5cm or less - 12051
|
$251.40 |
$251.40 |
$251.40 |
$593.00
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$289.80 |
$289.80 |
$289.80 |
$675.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$376.20 |
$376.20 |
$376.20 |
$689.04
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$501.00 |
$501.00 |
$501.00 |
$741.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$328.80 |
$328.80 |
$328.80 |
$770.22
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$289.80 |
$289.80 |
$289.80 |
$750.12
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$289.80 |
$289.80 |
$289.80 |
$740.00
|
|
Ghs layered repair 20.1 - 30.0 cm -12056
|
$717.00 |
$717.00 |
$717.00 |
$907.50
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$330.60 |
$330.60 |
$330.60 |
$242.31
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$330.60 |
$330.60 |
$330.60 |
$230.00
|
|
Ghs moderate sedation ea addtl 15 min
|
$164.40 |
$164.40 |
$164.40 |
$151.50
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$164.40 |
$164.40 |
$164.40 |
$147.75
|
|
Ghs myocardial strain img spckl track
|
$192.60 |
$192.60 |
$192.60 |
$457.80
|
|
Ghs nailbed repair/nail removal
|
$289.80 |
$289.80 |
$289.80 |
$724.37
|
|
Ghs ot sensory integrative tech/15min
|
$171.00 |
$171.00 |
$171.00 |
$94.80
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$90.60 |
$90.60 |
$90.60 |
$962.00
|
|
Ghs plngl fx pm cl
|
$258.60 |
$258.60 |
$258.60 |
$564.80
|
|
Ghs ppd (tb intradermal)
|
$43.20 |
$43.20 |
$43.20 |
$37.70
|
|
Ghs pr without cont pulse ox
|
$100.80 |
$100.80 |
$100.80 |
$146.86
|
|
Ghs removal intranasal foreign body
|
$193.20 |
$193.20 |
$193.20 |
$287.50
|
|
Ghs sensitivity (per antimicro)
|
$120.60 |
$120.60 |
$120.60 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$289.80 |
$289.80 |
$289.80 |
$553.60
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$289.80 |
$289.80 |
$289.80 |
$575.00
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$289.80 |
$289.80 |
$289.80 |
$448.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$289.80 |
$289.80 |
$289.80 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$289.80 |
$289.80 |
$289.80 |
$484.80
|
|
Ghs sp train/fitting sp device - kx
|
$281.40 |
$281.40 |
$281.40 |
$250.50
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$72.00 |
$72.00 |
$72.00 |
$98.00
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$300.00 |
$300.00 |
$300.00 |
$351.45
|
|
Ghs tx distal phalangeal fx with manipulation
|
$258.60 |
$258.60 |
$258.60 |
$523.00
|
|
Ghs urine, porphyrins quant
|
$63.00 |
$63.00 |
$63.00 |
$75.00
|
|
Gi inhouse confirmation
|
$128.40 |
$128.40 |
$128.40 |
$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
|
$288.00 |
$288.00 |
$288.00 |
$63.00
|
|
Glucose 1 hr post dose
|
$116.40 |
$116.40 |
$116.40 |
$47.20
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$13.80 |
$13.80 |
$13.80 |
$23.86
|
|
Glucose blood quantitative
|
$60.00 |
$60.00 |
$60.00 |
$40.00
|
|
Glucose body fluid
|
$44.40 |
$44.40 |
$44.40 |
$52.20
|
|
Glucose tolerance test (gtt) 3 specimens
|
$169.20 |
$169.20 |
$169.20 |
$100.16
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$107.40 |
$107.40 |
$107.40 |
$35.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$21.60 |
$21.60 |
$21.60 |
$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)
|
$255.00 |
$255.00 |
$255.00 |
$115.05
|
|
Gonadotropin luteinizing hormone (lh)
|
$255.00 |
$255.00 |
$255.00 |
$129.00
|
|
Graft axiofill 1000mg
|
$133.20 |
$133.20 |
$133.20 |
$5,125.68
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$13,693.80 |
$13,693.80 |
$13,693.80 |
$584.99
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$5,266.80 |
$5,266.80 |
$5,266.80 |
$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 xenmtrx sft rect 15x20cm
|
$4,678.13 |
$4,678.13 |
$4,678.13 |
$30,392.04
|
|
Guide wire threaded 1.4x150mm
|
$55.14 |
$55.14 |
$55.14 |
$3,284.50
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$4.80 |
$4.80 |
$4.80 |
$23.06
|
|
Hand X-ray
|
$477.60 |
$477.60 |
$477.60 |
$356.00
|
|
Haptoglobin quantitative
|
$139.20 |
$139.20 |
$139.20 |
$91.14
|
|
Hcg qualitative
|
$105.00 |
$105.00 |
$105.00 |
$89.70
|
|
Hcg quantitative
|
$169.20 |
$169.20 |
$169.20 |
$139.20
|
|
Head CT scan (with and without contrast)
|
$2,391.60 |
$2,391.60 |
$2,391.60 |
$1,849.90
|
|
Head CT scan (with contrast)
|
$1,683.60 |
$1,683.60 |
$1,683.60 |
$1,545.60
|
|
Head CT scan (without contrast)
|
$1,537.20 |
$1,537.20 |
$1,537.20 |
$1,268.90
|
|
Hematocrit
|
$55.20 |
$55.20 |
$55.20 |
$33.57
|
|
Hemoglobin
|
$54.60 |
$54.60 |
$54.60 |
$31.80
|
|
Hemolysins/agglutinins auto
|
$36.00 |
$36.00 |
$36.00 |
$57.14
|
|
Heparin assay
|
$42.00 |
$42.00 |
$42.00 |
$140.10
|
|
Heparin bolus from bag
|
$32.40 |
$32.40 |
$32.40 |
$66.47
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$6.00 |
$6.00 |
$6.00 |
$10.61
|
|
Hepatitis a antibody igm
|
$142.80 |
$142.80 |
$142.80 |
$87.75
|
|
Hepatitis b core antibody igm
|
$144.00 |
$144.00 |
$144.00 |
$87.98
|
|
Hepatitis b core antibody total
|
$42.60 |
$42.60 |
$42.60 |
$77.50
|
|
Hepatitis b immune globulin greater than 1,560 units/5 ml im solution
|
$355.80 |
$355.80 |
$355.80 |
$1,116.61
|
|
Hepatitis b surface antibody
|
$42.60 |
$42.60 |
$42.60 |
$82.05
|
|
Hepatitis c antibody
|
$44.40 |
$44.40 |
$44.40 |
$108.00
|
|
Hepatobiliary system imaging
|
$696.00 |
$696.00 |
$696.00 |
$1,438.58
|
|
Hernia Repair (Inguinal)
|
$995.40 |
$995.40 |
$995.40 |
$6,311.00
|
|
Herpes simplex type 1 antibody igg
|
$25.20 |
$25.20 |
$25.20 |
$70.00
|
|
Herpes simplex type 2 antibody igg
|
$109.80 |
$109.80 |
$109.80 |
$87.10
|
|
Heterophile antibodies screening
|
$80.40 |
$80.40 |
$80.40 |
$74.00
|
|
Hip X-ray
|
$235.80 |
$235.80 |
$235.80 |
$292.05
|
|
Histamine
|
$180.60 |
$180.60 |
$180.60 |
$115.00
|
|
Hla i low res one antigen equiv ea
|
$109.80 |
$109.80 |
$109.80 |
$161.70
|
|
Home sleep test/type 3 porta
|
$377.40 |
$377.40 |
$377.40 |
$579.26
|
|
Homocysteine
|
$44.40 |
$44.40 |
$44.40 |
$121.92
|
|
H pylori (c-13) breath
|
$358.20 |
$358.20 |
$358.20 |
$213.00
|
|
Hydralazine 20 mg/ml injection solution
|
$42.60 |
$42.60 |
$42.60 |
$46.74
|
|
Hydration IV infusion each additional hour
|
$77.40 |
$77.40 |
$77.40 |
$131.20
|
|
Hydration IV infusion initial 31minutes - 1 hour
|
$275.40 |
$275.40 |
$275.40 |
$383.00
|
|
Hydrocortisone in ns IV syringe 1 mg/ml (neo/ped) - cnr
|
$47.40 |
$47.40 |
$47.40 |
$154.78
|
|
Hydromorphone 0.2 mg/ml in 0.9% nacl IV pca opioid naive - 4 hr dose limit (wrapper)
|
$17.40 |
$17.40 |
$17.40 |
$131.47
|
|
Hydromorphone 20-0.9 mg/100ml-% soln 100 ml cartridge
|
$20.10 |
$20.10 |
$20.10 |
$294.92
|
|
Hydroxyzine hcl 50 mg/ml intramuscular solution
|
$12.60 |
$12.60 |
$12.60 |
$72.65
|
|
#hypersens-actinomyces ab
|
$16.80 |
$16.80 |
$16.80 |
$31.74
|
|
Hysterosalpingography s&i
|
$477.00 |
$477.00 |
$477.00 |
$651.85
|
|
I-123 sod iodide diag per 100 uci
|
$154.20 |
$154.20 |
$154.20 |
$139.20
|
|
Ibandronate 3 mg/3 ml intravenous syringe
|
$1,672.20 |
$1,672.20 |
$1,672.20 |
$635.44
|
|
Igh gene rearrange amp meth
|
$237.60 |
$237.60 |
$237.60 |
$456.54
|
|
Ihc/icc per specimen each additional single antibody stain
|
$143.40 |
$143.40 |
$143.40 |
$191.52
|
|
Ihc/icc per specimen initial single antibody stain
|
$399.60 |
$399.60 |
$399.60 |
$274.86
|
|
Immune globulin, gamma (igg) (10 %)-gly-iga over 50 mcg/ml injection solution
|
$15,268.20 |
$15,268.20 |
$15,268.20 |
$6,106.32
|
