|
Ghs spont nystagmus
|
$69.72 |
$69.72 |
$69.72 |
$241.80
|
|
Ghs sp train/fitting sp device - kx
|
$2,403.24 |
$2,403.24 |
$2,403.24 |
$243.60
|
|
Ghs st - eval for alt comm
|
$1,870.68 |
$1,870.68 |
$1,870.68 |
$95.25
|
|
Ghs strapping shoulder - 29240
|
$248.64 |
$248.64 |
$248.64 |
$213.20
|
|
Ghs st - re-eval for alt comm
|
$1,069.32 |
$1,069.32 |
$1,069.32 |
$297.60
|
|
Ghs superficial wnd dehiscence simp12020
|
$708.12 |
$708.12 |
$708.12 |
$897.96
|
|
Ghs superficial wnd dehis w packing12021
|
$414.96 |
$414.96 |
$414.96 |
$696.68
|
|
Ghs tracheostomy emergency - transtracheal
|
$1,395.24 |
$1,395.24 |
$1,395.24 |
$1,752.89
|
|
Ghs tx distal phalangeal fx with manipulation
|
$751.80 |
$751.80 |
$751.80 |
$529.65
|
|
Ghs urine, porphyrins quant
|
$260.40 |
$260.40 |
$260.40 |
$74.20
|
|
Ghs vaginal delivery only
|
$1,775.76 |
$1,775.76 |
$1,775.76 |
$3,217.00
|
|
Ghs veeg 12-26 hr intmt mont
|
$617.40 |
$617.40 |
$617.40 |
$1,932.00
|
|
Ghs windowing of cast
|
$147.00 |
$147.00 |
$147.00 |
$216.80
|
|
Gi inhouse confirmation
|
$236.88 |
$236.88 |
$236.88 |
$83.70
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$2,303.28 |
$2,303.28 |
$2,303.28 |
$2,098.85
|
|
Gi trc img intral colon i&r
|
$994.56 |
$994.56 |
$994.56 |
$1,959.88
|
|
Glassia injection
|
$83.58 |
$83.58 |
$83.58 |
$20.32
|
|
Glucagon 1 mg solution for injection
|
$1,075.58 |
$1,075.58 |
$1,075.58 |
$601.79
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$825.89 |
$825.89 |
$825.89 |
$491.67
|
|
Glucagon plasma - sendout
|
$194.88 |
$194.88 |
$194.88 |
$63.00
|
|
Glucose 1 hr post dose
|
$120.96 |
$120.96 |
$120.96 |
$49.20
|
|
Glucose-6-phosphate dhydrogenase screen
|
$121.80 |
$121.80 |
$121.80 |
$53.95
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$68.88 |
$68.88 |
$68.88 |
$23.68
|
|
Glucose blood quantitative
|
$72.24 |
$72.24 |
$72.24 |
$41.40
|
|
Glucose body fluid
|
$116.76 |
$116.76 |
$116.76 |
$50.82
|
|
Glucose tolerance test (gtt) 3 specimens
|
$400.68 |
$400.68 |
$400.68 |
$100.10
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$117.60 |
$117.60 |
$117.60 |
$35.52
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$8,098.66 |
$8,098.66 |
$8,098.66 |
$4,846.65
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$221.76 |
$221.76 |
$221.76 |
$116.64
|
|
Gonadotropin luteinizing hormone (lh)
|
$228.48 |
$228.48 |
$228.48 |
$129.89
|
|
Goserelin 10.8 mg subcutaneous implant
|
$12,264.09 |
$12,264.09 |
$12,264.09 |
$4,612.00
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$2,998.80 |
$2,998.80 |
$2,998.80 |
$159.99
|
|
Graft axiofill 1000mg
|
$10,251.36 |
$10,251.36 |
$10,251.36 |
$5,125.68
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$805.56 |
$805.56 |
$805.56 |
$684.60
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$36,496.21 |
$36,496.21 |
$36,496.21 |
$23,288.44
|
|
Graft nerve adv 3-4x70mm
|
$5,377.05 |
$5,377.05 |
$5,377.05 |
$19,838.44
|
|
Graft patch felt ptfe 2x2
|
$29,642.55 |
$29,642.55 |
$29,642.55 |
$27,435.60
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$5,460.00 |
$5,460.00 |
$5,460.00 |
$1,111.05
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$3,265.92 |
$3,265.92 |
$3,265.92 |
$1,181.41
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$5,880.00 |
$5,880.00 |
$5,880.00 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$2,542.05 |
$2,542.05 |
$2,542.05 |
$408.01
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$39,146.74 |
$39,146.74 |
$39,146.74 |
$28,666.90
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$7,440.05 |
$7,440.05 |
$7,440.05 |
$1,132.47
|
|
Graft xenmtrx sft rect 15x20cm
|
$26,042.52 |
$26,042.52 |
$26,042.52 |
$29,738.57
|
|
Graft xenmtrx sft rect 19x28cm
|
$3,059.03 |
$3,059.03 |
$3,059.03 |
$3,089.48
|
|
Granisetron hcl injection
|
$255.03 |
$255.03 |
$255.03 |
$45.03
|
|
Great toe with reduction 28495
|
$422.52 |
$422.52 |
$422.52 |
$513.36
|
|
Grfg autol fat lipo 25 cc/<
|
$2,058.00 |
$2,058.00 |
$2,058.00 |
$4,627.00
|
|
Group mnt 2 or more 30 mins
|
$36.96 |
$36.96 |
$36.96 |
$43.12
|
|
Gstrst open wo constj tube
|
$1,598.52 |
$1,598.52 |
$1,598.52 |
$2,756.00
|
|
Gu dilat ureter/urethra s&i
|
$1,272.60 |
$1,272.60 |
$1,272.60 |
$2,193.75
|
|
Guided cath fluid drainage 10030
|
$1,584.24 |
$1,584.24 |
$1,584.24 |
$1,372.15
|
|
Guide endoanchr sg-64 aaa 62cm
|
$7,821.28 |
$7,821.28 |
$7,821.28 |
$7,743.36
|
|
Guide wire threaded 1.4x150mm
|
$3,600.45 |
$3,600.45 |
$3,600.45 |
$3,401.81
|
|
Guide worley csg 9fx50cm std
|
$2,141.37 |
$2,141.37 |
$2,141.37 |
$1,117.40
|
|
Gw stiffened micro access kit
|
$12,297.60 |
$12,297.60 |
$12,297.60 |
$6,500.00
|
|
Gynecomastia (males) 19300
|
$1,360.80 |
$1,360.80 |
$1,360.80 |
$3,735.20
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$663.50 |
$663.50 |
$663.50 |
$86.70
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$239.87 |
$239.87 |
$239.87 |
$24.41
|
|
Hand X-ray
|
$344.40 |
$344.40 |
$344.40 |
$352.00
|
|
Haptoglobin quantitative
|
$176.40 |
$176.40 |
$176.40 |
$91.14
|
|
Hc ea ha check monaural
|
$284.76 |
$284.76 |
$284.76 |
$57.00
|
|
Hc fl sm bowel enteroclss tube w kub double contrast
|
$514.08 |
$514.08 |
$514.08 |
$726.00
|
|
Hcg free betachain test
|
$193.20 |
$193.20 |
$193.20 |
$68.90
|
|
Hcg qualitative
|
$169.68 |
$169.68 |
$169.68 |
$89.60
|
|
Hcg quantitative
|
$178.92 |
$178.92 |
$178.92 |
$137.70
|
|
Hc hearing aid chck binaurl
|
$97.44 |
$97.44 |
$97.44 |
$75.60
|
|
Hc hearing aid chck monarl
|
$204.12 |
$204.12 |
$204.12 |
$48.00
|
|
Hc hearing aid exam both ears
|
$214.20 |
$214.20 |
$214.20 |
$175.20
|
|
Hc hearing aid exam one ear
|
$142.80 |
$142.80 |
$142.80 |
$144.50
|
|
Hc nm kidney imaging with flow
|
$1,359.12 |
$1,359.12 |
$1,359.12 |
$865.60
|
|
Hc pet myocardial imaging metabolic eval single study
|
$2,807.28 |
$2,807.28 |
$2,807.28 |
$3,959.20
|
|
Head CT scan (with and without contrast)
|
$3,203.76 |
$3,203.76 |
$3,203.76 |
$1,818.96
|
|
Head CT scan (with contrast)
|
$2,623.32 |
$2,623.32 |
$2,623.32 |
$1,526.50
|
|
Head CT scan (without contrast)
|
$2,150.40 |
$2,150.40 |
$2,150.40 |
$1,267.56
|
|
Heart image spect
|
$600.60 |
$600.60 |
$600.60 |
$1,067.57
|
|
Helicobacter pylori antibody igm
|
$94.08 |
$94.08 |
$94.08 |
$92.66
|
|
Hematocrit
|
$53.76 |
$53.76 |
$53.76 |
$33.57
|
|
Hemin 350 mg intravenous powder for solution
|
$45,950.06 |
$45,950.06 |
$45,950.06 |
$20,618.46
|
|
Hemoglobin
|
$40.32 |
$40.32 |
$40.32 |
$32.50
|
|
Hemoglobin fetal qualitative
|
$61.32 |
$61.32 |
$61.32 |
$52.50
|
|
Hemoglobin methemoglobin quantitative
|
$131.88 |
$131.88 |
$131.88 |
$53.60
|
|
Hemoglobin plasma
|
$133.56 |
$133.56 |
$133.56 |
$41.16
|
|
Hemolysin acid
|
$140.28 |
$140.28 |
$140.28 |
$79.04
|
|
Hemolysins/agglutinins auto
|
$74.76 |
$74.76 |
$74.76 |
$57.14
|
|
Hemorrhoidectomy intrnl lig rbbr band ligations
|
$680.40 |
$680.40 |
$680.40 |
$1,170.54
|
|
Heparin assay
|
$313.32 |
$313.32 |
$313.32 |
$137.10
|
|
Heparin bolus from bag
|
$173.67 |
$173.67 |
$173.67 |
$67.74
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$956.51 |
$956.51 |
$956.51 |
$11.77
|
|
Hepatitis a antibody igm
|
$25.20 |
$25.20 |
$25.20 |
$87.75
|
|
Hepatitis b core antibody igm
|
$78.12 |
$78.12 |
$78.12 |
$87.98
|
|
Hepatitis b core antibody total
|
$161.28 |
$161.28 |
$161.28 |
$77.50
|
|
Hepatitis b immune globulin greater than 1,560 units/5 ml im solution
|
$3,050.80 |
$3,050.80 |
$3,050.80 |
$1,154.13
|
|
Hepatitis b surface antibody
|
$162.96 |
$162.96 |
$162.96 |
$81.12
|
|
Hepatitis c antibody
|
$192.36 |
$192.36 |
$192.36 |
$107.10
|
|
Hepatobiliary system imaging
|
$2,296.56 |
$2,296.56 |
$2,296.56 |
$1,446.00
|
|
Hepb vacc 3 dose immunsup im
|
$459.32 |
$459.32 |
$459.32 |
$319.52
|
|
Hernia Repair (Inguinal)
|
$1,187.76 |
$1,187.76 |
$1,187.76 |
$6,707.58
|
|
Herpes simplex type 1 antibody igg
|
$231.00 |
$231.00 |
$231.00 |
$70.00
|
|
Herpes simplex type 2 antibody igg
|
$236.88 |
$236.88 |
$236.88 |
$87.10
|
