|
Ghs spont nystagmus
|
$70.55 |
$70.55 |
$70.55 |
$228.00
|
|
Ghs sp train/fitting sp device - kx
|
$2,431.85 |
$2,431.85 |
$2,431.85 |
$249.60
|
|
Ghs st - eval for alt comm
|
$1,892.95 |
$1,892.95 |
$1,892.95 |
$94.60
|
|
Ghs strapping shoulder - 29240
|
$251.60 |
$251.60 |
$251.60 |
$217.60
|
|
Ghs st - re-eval for alt comm
|
$1,082.05 |
$1,082.05 |
$1,082.05 |
$309.00
|
|
Ghs superficial wnd dehiscence simp12020
|
$716.55 |
$716.55 |
$716.55 |
$909.00
|
|
Ghs superficial wnd dehis w packing12021
|
$419.90 |
$419.90 |
$419.90 |
$692.80
|
|
Ghs tracheostomy emergency - transtracheal
|
$1,411.85 |
$1,411.85 |
$1,411.85 |
$1,752.89
|
|
Ghs tx distal phalangeal fx with manipulation
|
$760.75 |
$760.75 |
$760.75 |
$525.60
|
|
Ghs urine, porphyrins quant
|
$263.50 |
$263.50 |
$263.50 |
$73.80
|
|
Ghs vaginal delivery only
|
$1,796.90 |
$1,796.90 |
$1,796.90 |
$3,338.40
|
|
Ghs veeg 12-26 hr intmt mont
|
$624.75 |
$624.75 |
$624.75 |
$1,932.00
|
|
Ghs windowing of cast
|
$148.75 |
$148.75 |
$148.75 |
$212.55
|
|
Gi inhouse confirmation
|
$239.70 |
$239.70 |
$239.70 |
$86.40
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$2,330.70 |
$2,330.70 |
$2,330.70 |
$2,195.76
|
|
Gi trc img intral colon i&r
|
$1,006.40 |
$1,006.40 |
$1,006.40 |
$1,959.88
|
|
Glassia injection
|
$84.58 |
$84.58 |
$84.58 |
$20.32
|
|
Glucagon 1 mg solution for injection
|
$1,088.39 |
$1,088.39 |
$1,088.39 |
$601.79
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$835.72 |
$835.72 |
$835.72 |
$491.67
|
|
Glucagon plasma - sendout
|
$197.20 |
$197.20 |
$197.20 |
$63.20
|
|
Glucose 1 hr post dose
|
$122.40 |
$122.40 |
$122.40 |
$48.25
|
|
Glucose-6-phosphate dhydrogenase screen
|
$123.25 |
$123.25 |
$123.25 |
$55.50
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$69.70 |
$69.70 |
$69.70 |
$22.75
|
|
Glucose blood quantitative
|
$73.10 |
$73.10 |
$73.10 |
$41.40
|
|
Glucose body fluid
|
$118.15 |
$118.15 |
$118.15 |
$51.30
|
|
Glucose tolerance test (gtt) 3 specimens
|
$405.45 |
$405.45 |
$405.45 |
$104.50
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$119.00 |
$119.00 |
$119.00 |
$36.00
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$8,195.08 |
$8,195.08 |
$8,195.08 |
$4,977.60
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$224.40 |
$224.40 |
$224.40 |
$115.80
|
|
Gonadotropin luteinizing hormone (lh)
|
$231.20 |
$231.20 |
$231.20 |
$129.00
|
|
Goserelin 10.8 mg subcutaneous implant
|
$12,410.09 |
$12,410.09 |
$12,410.09 |
$4,496.37
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$3,034.50 |
$3,034.50 |
$3,034.50 |
$143.50
|
|
Graft axiofill 1000mg
|
$10,373.40 |
$10,373.40 |
$10,373.40 |
$5,125.68
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$815.15 |
$815.15 |
$815.15 |
$601.50
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$36,930.69 |
$36,930.69 |
$36,930.69 |
$23,288.44
|
|
Graft nerve adv 3-4x70mm
|
$5,441.07 |
$5,441.07 |
$5,441.07 |
$20,782.10
|
|
Graft patch felt ptfe 2x2
|
$29,995.44 |
$29,995.44 |
$29,995.44 |
$29,995.44
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$5,525.00 |
$5,525.00 |
$5,525.00 |
$1,455.76
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$3,304.80 |
$3,304.80 |
$3,304.80 |
$892.38
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$5,950.00 |
$5,950.00 |
$5,950.00 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$2,572.32 |
$2,572.32 |
$2,572.32 |
$427.89
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$39,612.78 |
$39,612.78 |
$39,612.78 |
$29,056.92
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$7,528.62 |
$7,528.62 |
$7,528.62 |
$1,132.47
|
|
Graft xenmtrx sft rect 15x20cm
|
$26,352.55 |
$26,352.55 |
$26,352.55 |
$31,191.20
|
|
Graft xenmtrx sft rect 19x28cm
|
$3,095.45 |
$3,095.45 |
$3,095.45 |
$3,076.20
|
|
Granisetron hcl injection
|
$258.06 |
$258.06 |
$258.06 |
$47.04
|
|
Great toe with reduction 28495
|
$427.55 |
$427.55 |
$427.55 |
$495.00
|
|
Grfg autol fat lipo 25 cc/<
|
$2,082.50 |
$2,082.50 |
$2,082.50 |
$4,627.00
|
|
Group mnt 2 or more 30 mins
|
$37.40 |
$37.40 |
$37.40 |
$40.14
|
|
Gstrst open wo constj tube
|
$1,617.55 |
$1,617.55 |
$1,617.55 |
$2,756.00
|
|
Gu dilat ureter/urethra s&i
|
$1,287.75 |
$1,287.75 |
$1,287.75 |
$1,980.66
|
|
Guided cath fluid drainage 10030
|
$1,603.10 |
$1,603.10 |
$1,603.10 |
$1,327.76
|
|
Guide endoanchr sg-64 aaa 62cm
|
$7,914.39 |
$7,914.39 |
$7,914.39 |
$7,743.36
|
|
Guide wire threaded 1.4x150mm
|
$3,643.32 |
$3,643.32 |
$3,643.32 |
$3,401.81
|
|
Guide worley csg 9fx50cm std
|
$2,166.87 |
$2,166.87 |
$2,166.87 |
$1,117.40
|
|
Gw stiffened micro access kit
|
$12,444.00 |
$12,444.00 |
$12,444.00 |
$6,600.00
|
|
Gynecomastia (males) 19300
|
$1,377.00 |
$1,377.00 |
$1,377.00 |
$3,735.20
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$671.40 |
$671.40 |
$671.40 |
$89.32
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$242.72 |
$242.72 |
$242.72 |
$24.41
|
|
Hand X-ray
|
$348.50 |
$348.50 |
$348.50 |
$345.87
|
|
Haptoglobin quantitative
|
$178.50 |
$178.50 |
$178.50 |
$91.80
|
|
Hc ea ha check monaural
|
$288.15 |
$288.15 |
$288.15 |
$57.00
|
|
Hc fl sm bowel enteroclss tube w kub double contrast
|
$520.20 |
$520.20 |
$520.20 |
$721.00
|
|
Hcg free betachain test
|
$195.50 |
$195.50 |
$195.50 |
$68.90
|
|
Hcg qualitative
|
$171.70 |
$171.70 |
$171.70 |
$88.00
|
|
Hcg quantitative
|
$181.05 |
$181.05 |
$181.05 |
$137.15
|
|
Hc hearing aid chck binaurl
|
$98.60 |
$98.60 |
$98.60 |
$78.40
|
|
Hc hearing aid chck monarl
|
$206.55 |
$206.55 |
$206.55 |
$48.75
|
|
Hc hearing aid exam both ears
|
$216.75 |
$216.75 |
$216.75 |
$175.20
|
|
Hc hearing aid exam one ear
|
$144.50 |
$144.50 |
$144.50 |
$150.00
|
|
Hc nm kidney imaging with flow
|
$1,375.30 |
$1,375.30 |
$1,375.30 |
$849.00
|
|
Hc pet myocardial imaging metabolic eval single study
|
$2,840.70 |
$2,840.70 |
$2,840.70 |
$3,840.40
|
|
Head CT scan (with and without contrast)
|
$3,241.90 |
$3,241.90 |
$3,241.90 |
$1,818.96
|
|
Head CT scan (with contrast)
|
$2,654.55 |
$2,654.55 |
$2,654.55 |
$1,526.50
|
|
Head CT scan (without contrast)
|
$2,176.00 |
$2,176.00 |
$2,176.00 |
$1,268.90
|
|
Heart image spect
|
$607.75 |
$607.75 |
$607.75 |
$1,131.00
|
|
Helicobacter pylori antibody igm
|
$95.20 |
$95.20 |
$95.20 |
$92.23
|
|
Hematocrit
|
$54.40 |
$54.40 |
$54.40 |
$33.57
|
|
Hemin 350 mg intravenous powder for solution
|
$46,497.09 |
$46,497.09 |
$46,497.09 |
$20,618.46
|
|
Hemoglobin
|
$40.80 |
$40.80 |
$40.80 |
$32.76
|
|
Hemoglobin fetal qualitative
|
$62.05 |
$62.05 |
$62.05 |
$51.75
|
|
Hemoglobin methemoglobin quantitative
|
$133.45 |
$133.45 |
$133.45 |
$52.32
|
|
Hemoglobin plasma
|
$135.15 |
$135.15 |
$135.15 |
$41.25
|
|
Hemolysin acid
|
$141.95 |
$141.95 |
$141.95 |
$79.04
|
|
Hemolysins/agglutinins auto
|
$75.65 |
$75.65 |
$75.65 |
$57.28
|
|
Hemorrhoidectomy intrnl lig rbbr band ligations
|
$688.50 |
$688.50 |
$688.50 |
$1,170.54
|
|
Heparin assay
|
$317.05 |
$317.05 |
$317.05 |
$138.84
|
|
Heparin bolus from bag
|
$175.74 |
$175.74 |
$175.74 |
$68.00
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$967.90 |
$967.90 |
$967.90 |
$12.91
|
|
Hepatitis a antibody igm
|
$25.50 |
$25.50 |
$25.50 |
$88.92
|
|
Hepatitis b core antibody igm
|
$79.05 |
$79.05 |
$79.05 |
$88.80
|
|
Hepatitis b core antibody total
|
$163.20 |
$163.20 |
$163.20 |
$77.50
|
|
Hepatitis b immune globulin greater than 1,560 units/5 ml im solution
|
$3,087.12 |
$3,087.12 |
$3,087.12 |
$1,174.30
|
|
Hepatitis b surface antibody
|
$164.90 |
$164.90 |
$164.90 |
$81.12
|
|
Hepatitis c antibody
|
$194.65 |
$194.65 |
$194.65 |
$108.00
|
|
Hepatobiliary system imaging
|
$2,323.90 |
$2,323.90 |
$2,323.90 |
$1,438.99
|
|
Hepb vacc 3 dose immunsup im
|
$464.78 |
$464.78 |
$464.78 |
$319.52
|
|
Hernia Repair (Inguinal)
|
$1,201.90 |
$1,201.90 |
$1,201.90 |
$6,739.98
|
|
Herpes simplex type 1 antibody igg
|
$233.75 |
$233.75 |
$233.75 |
$66.30
|
|
Herpes simplex type 2 antibody igg
|
$239.70 |
$239.70 |
$239.70 |
$87.10
|
