|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$514.40 |
$514.40 |
$514.40 |
$586.50
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$602.40 |
$602.40 |
$602.40 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$404.80 |
$404.80 |
$404.80 |
$449.15
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$374.40 |
$374.40 |
$374.40 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$444.80 |
$444.80 |
$444.80 |
$489.72
|
|
Ghs simple repair over 30 cm - 12007
|
$505.60 |
$505.60 |
$505.60 |
$590.88
|
|
Ghs simple repair over 30 cm - 12018
|
$465.60 |
$465.60 |
$465.60 |
$537.60
|
|
Ghs sleep study unattended
|
$608.00 |
$608.00 |
$608.00 |
$503.38
|
|
Ghs speech-gen aug dev eval iii, st
|
$61.60 |
$61.60 |
$61.60 |
$157.50
|
|
Ghs sp train/fitting sp device - kx
|
$266.40 |
$266.40 |
$266.40 |
$252.75
|
|
Ghs st - eval for alt comm
|
$88.80 |
$88.80 |
$88.80 |
$96.40
|
|
Ghs st - re-eval for alt comm
|
$264.80 |
$264.80 |
$264.80 |
$309.60
|
|
Ghs superficial wnd dehiscence simp12020
|
$1,283.20 |
$1,283.20 |
$1,283.20 |
$953.27
|
|
Ghs tracheostomy emergency - transtracheal
|
$2,320.80 |
$2,320.80 |
$2,320.80 |
$1,867.84
|
|
Ghs tx distal phalangeal fx with manipulation
|
$474.40 |
$474.40 |
$474.40 |
$529.65
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$455.20 |
$455.20 |
$455.20 |
$513.80
|
|
Glassia injection
|
$940.00 |
$940.00 |
$940.00 |
$20.32
|
|
Glucagon 1 mg solution for injection
|
$525.04 |
$525.04 |
$525.04 |
$613.79
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$246.07 |
$246.07 |
$246.07 |
$491.67
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$60.33 |
$60.33 |
$60.33 |
$37.40
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$3,177.19 |
$3,177.19 |
$3,177.19 |
$5,009.45
|
|
Goserelin 10.8 mg subcutaneous implant
|
$2,542.77 |
$2,542.77 |
$2,542.77 |
$4,417.13
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$162.40 |
$162.40 |
$162.40 |
$73.83
|
|
Graft axiofill 1000mg
|
$5,988.40 |
$5,988.40 |
$5,988.40 |
$5,125.68
|
|
Graft nerve adv 3-4x70mm
|
$6,512.00 |
$6,512.00 |
$6,512.00 |
$20,782.10
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$562.40 |
$562.40 |
$562.40 |
$886.17
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$682.40 |
$682.40 |
$682.40 |
$1,132.47
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$88.00 |
$88.00 |
$88.00 |
$28,894.71
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$243.20 |
$243.20 |
$243.20 |
$1,103.05
|
|
Graft xenmtrx sft rect 15x20cm
|
$31,191.20 |
$31,191.20 |
$31,191.20 |
$29,676.26
|
|
Granisetron 1 mg tab
|
$1.20 |
$1.20 |
$1.20 |
$53.15
|
|
Granisetron hcl injection
|
$61.52 |
$61.52 |
$61.52 |
$45.03
|
|
Great toe with reduction 28495
|
$468.80 |
$468.80 |
$468.80 |
$495.00
|
|
Ground mileage
|
$24.00 |
$24.00 |
$24.00 |
$17.60
|
|
Group train without patient
|
$53.60 |
$53.60 |
$53.60 |
$47.60
|
|
Guided cath fluid drainage 10030
|
$1,984.00 |
$1,984.00 |
$1,984.00 |
$1,372.15
|
|
Guide wire threaded 1.4x150mm
|
$2,156.00 |
$2,156.00 |
$2,156.00 |
$3,284.36
|
|
Guid loc target vol rad tx
|
$758.40 |
$758.40 |
$758.40 |
$535.60
|
|
Gw stiffened micro access kit
|
$124.80 |
$124.80 |
$124.80 |
$6,893.38
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$60.58 |
$60.58 |
$60.58 |
$24.30
|
|
Hands-On Manual Therapy (each 15 minutes)
|
$120.96 |
$120.96 |
$120.96 |
$105.30
|
|
Hand X-ray
|
$330.40 |
$330.40 |
$330.40 |
$350.35
|
|
Hand X-ray (2 views, both hands)
|
$283.20 |
$283.20 |
$283.20 |
$294.90
|
|
Head CT scan (with and without contrast)
|
$2,056.80 |
$2,056.80 |
$2,056.80 |
$1,818.96
|
|
Head CT scan (with contrast)
|
$1,870.40 |
$1,870.40 |
$1,870.40 |
$1,527.60
|
|
Head CT scan (without contrast)
|
$1,795.20 |
$1,795.20 |
$1,795.20 |
$1,268.90
|
|
Heel (Calcaneus) X-ray (both feet)
|
$235.20 |
$235.20 |
$235.20 |
$276.00
|
|
Hemorrhoidectomy intrnl lig rbbr band ligations
|
$600.80 |
$600.80 |
$600.80 |
$1,178.02
|
|
Heparin bolus from bag
|
$134.02 |
$134.02 |
$134.02 |
$66.06
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$9.79 |
$9.79 |
$9.79 |
$12.00
|
|
Hepatitis b vaccine 40 mcg/ml inj-adult
|
$223.40 |
$223.40 |
$223.40 |
$210.40
|
|
Hip and Pelvis X-ray (2 views, both hips)
|
$420.80 |
$420.80 |
$420.80 |
$374.40
|
|
Hip and Pelvis X-ray (3 to 4 views, both hips)
|
$472.80 |
$472.80 |
$472.80 |
$424.80
|
|
Hip and Pelvis X-ray (single view, left side)
|
$236.80 |
$236.80 |
$236.80 |
$233.50
|
|
Hip X-ray
|
$290.40 |
$290.40 |
$290.40 |
$294.75
|
|
Home sleep test/type 3 porta
|
$684.00 |
$684.00 |
$684.00 |
$570.00
|
|
Hyaluronidase, human recombinant 150 unit/ml injection solution
|
$89.89 |
$89.89 |
$89.89 |
$142.40
|
|
Hydralazine 20 mg/ml injection solution
|
$62.52 |
$62.52 |
$62.52 |
$48.00
|
|
Hydrocortisone in ns IV syringe 1 mg/ml (neo/ped) - cnr
|
$95.08 |
$95.08 |
$95.08 |
$140.54
|
|
Hydromorphone 0.2 mg/ml in 0.9% nacl IV pca opioid naive - 4 hr dose limit (wrapper)
|
$60.56 |
$60.56 |
$60.56 |
$112.66
|
|
Hydromorphone 20-0.9 mg/100ml-% soln 100 ml cartridge
|
$148.16 |
$148.16 |
$148.16 |
$294.92
|
|
Hydroxyzine hcl 50 mg/ml intramuscular solution
|
$64.09 |
$64.09 |
$64.09 |
$72.65
|
|
Hysterosalpingography s&i
|
$976.00 |
$976.00 |
$976.00 |
$669.12
|
|
Hzv zoster vacc recombinant adjuvanted im inj
|
$379.32 |
$379.32 |
$379.32 |
$352.24
|
|
I-123 sod iodide diag per 100 uci
|
$224.80 |
$224.80 |
$224.80 |
$147.46
|
|
Ibandronate 3 mg/3 ml intravenous syringe
|
$843.75 |
$843.75 |
$843.75 |
$684.45
|
|
Ibutilide fumarate 0.1 mg/ml intravenous solution
|
$193.60 |
$193.60 |
$193.60 |
$980.94
|
|
Ifosfamide 1 gram intravenous solution
|
$358.92 |
$358.92 |
$358.92 |
$246.95
|
|
Ihc/icc per specimen each additional single antibody stain
|
$248.80 |
$248.80 |
$248.80 |
$191.52
|
|
Ihc/icc per specimen each multiplex antibody stain
|
$558.40 |
$558.40 |
$558.40 |
$331.20
|
|
Ihc/icc per specimen initial single antibody stain
|
$296.80 |
$296.80 |
$296.80 |
$277.90
|
|
Imetelstat 188 mg intravenous solution
|
$16,265.91 |
$16,265.91 |
$16,265.91 |
$20,373.55
|
|
Immobilizer shldr cntor adlt
|
$167.20 |
$167.20 |
$167.20 |
$175.60
|
|
Immobilizer shldr dlx str 24-36in med
|
$84.00 |
$84.00 |
$84.00 |
$118.43
|
|
Immune globulin, gamma (igg) (10 %)-gly-iga over 50 mcg/ml injection solution
|
$3,359.52 |
$3,359.52 |
$3,359.52 |
$6,106.32
|
|
Implant ureth bulk agent
|
$1,310.40 |
$1,310.40 |
$1,310.40 |
$2,168.00
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$2,628.80 |
$2,628.80 |
$2,628.80 |
$2,086.70
|
|
Infliximab 100 mg intravenous solution
|
$800.63 |
$800.63 |
$800.63 |
$2,047.13
|
|
Infliximab-dyyb 100 mg intravenous solution
|
$791.51 |
$791.51 |
$791.51 |
$1,537.84
|
|
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis
|
$348.00 |
$348.00 |
$348.00 |
$296.00
|
|
Inj, abilify maintena, 1 mg
|
$3,073.27 |
$3,073.27 |
$3,073.27 |
$5,355.30
|
|
Inj, acetaminophen (b braun)
|
$130.46 |
$130.46 |
$130.46 |
$32.79
|
|
Inj acetaminophen -fresenius
|
$130.50 |
$130.50 |
$130.50 |
$36.60
|
|
Inj alymsys 10 mg
|
$1,620.74 |
$1,620.74 |
$1,620.74 |
$1,280.74
|
|
Inj., benralizumab, 1 mg
|
$8,057.28 |
$8,057.28 |
$8,057.28 |
$11,310.00
|
|
Inj, bezlotoxumab, 10 mg
|
$6,108.64 |
$6,108.64 |
$6,108.64 |
$7,612.43
|
|
Inj, bupivacaine liposome
|
$60.00 |
$60.00 |
$60.00 |
$699.38
|
|
Inj cefazolin sodium, hikma
|
$63.90 |
$63.90 |
$63.90 |
$27.38
|
|
Inj, cefepime hcl (b braun)
|
$165.40 |
$165.40 |
$165.40 |
$69.85
|
|
Inj cyclophosphamd auromedic
|
$279.88 |
$279.88 |
$279.88 |
$249.68
|
|
Inj cyclophosphamd (ingenus)
|
$538.39 |
$538.39 |
$538.39 |
$742.72
|
|
Inj, daptomycin (hospira)
|
$84.36 |
$84.36 |
$84.36 |
$128.08
|
|
Inj, decitabine (sun pharma)
|
$487.00 |
$487.00 |
$487.00 |
$310.09
|
|
Inj dx for sinogram
|
$488.00 |
$488.00 |
$488.00 |
$436.00
|
|
Injection arthrography hip without anesthesia (both sides)
|
$784.80 |
$784.80 |
$784.80 |
$503.50
|
|
Injection, daratumumab 10 mg
|
$6,918.40 |
$6,918.40 |
$6,918.40 |
$5,324.34
|
|
Injection, doxercalciferol
|
$62.23 |
$62.23 |
$62.23 |
$23.86
|
|
Injection epidural blood patch or clot
|
$1,452.80 |
$1,452.80 |
$1,452.80 |
$1,182.33
|
|
Injection for bladder x-ray
|
$724.00 |
$724.00 |
$724.00 |
$459.20
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$424.80 |
$424.80 |
$424.80 |
$497.76
|