|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$526.70 |
$526.70 |
$526.70 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$686.80 |
$686.80 |
$686.80 |
$449.15
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$658.95 |
$658.95 |
$658.95 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$843.90 |
$843.90 |
$843.90 |
$489.72
|
|
Ghs simple repair over 30 cm - 12007
|
$497.75 |
$497.75 |
$497.75 |
$590.88
|
|
Ghs simple repair over 30 cm - 12018
|
$721.05 |
$721.05 |
$721.05 |
$537.60
|
|
Ghs somatosensory testing lower extremit
|
$1,662.55 |
$1,662.55 |
$1,662.55 |
$925.91
|
|
Ghs somatosensory testing upper & lower limbs
|
$1,662.55 |
$1,662.55 |
$1,662.55 |
$1,416.80
|
|
Ghs speech-gen aug dev eval iii, st
|
$162.50 |
$162.50 |
$162.50 |
$157.50
|
|
Ghs sphenopalatine ganglion block
|
$806.10 |
$806.10 |
$806.10 |
$630.24
|
|
Ghs sp train/fitting sp device - kx
|
$448.75 |
$448.75 |
$448.75 |
$252.75
|
|
Ghs strapping shoulder - 29240
|
$290.80 |
$290.80 |
$290.80 |
$217.60
|
|
Ghs st - re-eval for alt comm
|
$547.95 |
$547.95 |
$547.95 |
$309.60
|
|
Ghs superficial wnd dehiscence simp12020
|
$1,412.45 |
$1,412.45 |
$1,412.45 |
$953.27
|
|
Ghs superficial wnd dehis w packing12021
|
$634.25 |
$634.25 |
$634.25 |
$695.93
|
|
Ghs tracheostomy emergency - transtracheal
|
$805.95 |
$805.95 |
$805.95 |
$1,867.84
|
|
Ghs tx distal phalangeal fx with manipulation
|
$900.90 |
$900.90 |
$900.90 |
$529.65
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$1,561.45 |
$1,561.45 |
$1,561.45 |
$513.80
|
|
Ghs urine, porphyrins quant
|
$331.10 |
$331.10 |
$331.10 |
$73.80
|
|
Ghs vaginal delivery only
|
$2,186.00 |
$2,186.00 |
$2,186.00 |
$3,341.93
|
|
Ghs veeg 12-26 hr intmt mont
|
$967.10 |
$967.10 |
$967.10 |
$1,932.00
|
|
Gi inhouse confirmation
|
$198.45 |
$198.45 |
$198.45 |
$87.75
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$2,206.10 |
$2,206.10 |
$2,206.10 |
$2,215.20
|
|
Glucagon 1 mg solution for injection
|
$2,438.99 |
$2,438.99 |
$2,438.99 |
$613.79
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$2,572.14 |
$2,572.14 |
$2,572.14 |
$491.67
|
|
Glucagon plasma - sendout
|
$308.45 |
$308.45 |
$308.45 |
$64.35
|
|
Glucose 1 hr post dose
|
$115.75 |
$115.75 |
$115.75 |
$49.00
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$32.70 |
$32.70 |
$32.70 |
$23.12
|
|
Glucose blood quantitative
|
$102.90 |
$102.90 |
$102.90 |
$42.25
|
|
Glucose body fluid
|
$103.70 |
$103.70 |
$103.70 |
$51.30
|
|
Glucose tolerance test (gtt) 3 specimens
|
$288.60 |
$288.60 |
$288.60 |
$105.60
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$103.80 |
$103.80 |
$103.80 |
$36.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$37.16 |
$37.16 |
$37.16 |
$37.40
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$7,174.15 |
$7,174.15 |
$7,174.15 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$582.55 |
$582.55 |
$582.55 |
$116.64
|
|
Gonadotropin luteinizing hormone (lh)
|
$547.60 |
$547.60 |
$547.60 |
$129.03
|
|
Goserelin 10.8 mg subcutaneous implant
|
$10,478.50 |
$10,478.50 |
$10,478.50 |
$4,417.13
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$1,295.00 |
$1,295.00 |
$1,295.00 |
$73.83
|
|
Graft axiofill 1000mg
|
$757.80 |
$757.80 |
$757.80 |
$5,125.68
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$10,350.00 |
$10,350.00 |
$10,350.00 |
$605.00
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$12,349.00 |
$12,349.00 |
$12,349.00 |
$23,233.80
|
|
Graft nerve adv 3-4x70mm
|
$16,250.00 |
$16,250.00 |
$16,250.00 |
$20,782.10
|
|
Graft patch felt ptfe 2x2
|
$78,422.95 |
$78,422.95 |
$78,422.95 |
$29,293.39
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$13,181.23 |
$13,181.23 |
$13,181.23 |
$1,111.05
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$5,130.00 |
$5,130.00 |
$5,130.00 |
$886.17
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$3,350.00 |
$3,350.00 |
$3,350.00 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$1,295.00 |
$1,295.00 |
$1,295.00 |
$349.41
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$14,568.00 |
$14,568.00 |
$14,568.00 |
$28,894.71
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$894.63 |
$894.63 |
$894.63 |
$1,103.05
|
|
Graft xenmtrx sft rect 15x20cm
|
$17,080.00 |
$17,080.00 |
$17,080.00 |
$29,676.26
|
|
Graft xenmtrx sft rect 19x28cm
|
$4,400.00 |
$4,400.00 |
$4,400.00 |
$2,905.40
|
|
Great toe with reduction 28495
|
$471.00 |
$471.00 |
$471.00 |
$495.00
|
|
G-tube reposition
|
$1,659.40 |
$1,659.40 |
$1,659.40 |
$771.36
|
|
Gu dilat ureter/urethra s&i
|
$3,849.20 |
$3,849.20 |
$3,849.20 |
$2,000.16
|
|
Guided cath fluid drainage 10030
|
$1,179.95 |
$1,179.95 |
$1,179.95 |
$1,372.15
|
|
Guide endoanchr sg-64 aaa 62cm
|
$2,245.00 |
$2,245.00 |
$2,245.00 |
$7,743.36
|
|
Guide wire threaded 1.4x150mm
|
$10,303.95 |
$10,303.95 |
$10,303.95 |
$3,284.36
|
|
Guide worley csg 9fx50cm std
|
$2,110.00 |
$2,110.00 |
$2,110.00 |
$1,117.40
|
|
Guid loc target vol rad tx
|
$350.15 |
$350.15 |
$350.15 |
$535.60
|
|
Gw stiffened micro access kit
|
$23,737.80 |
$23,737.80 |
$23,737.80 |
$6,893.38
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$125.59 |
$125.59 |
$125.59 |
$91.09
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$23.22 |
$23.22 |
$23.22 |
$24.30
|
|
Hands-On Manual Therapy (each 15 minutes)
|
$220.25 |
$220.25 |
$220.25 |
$105.30
|
|
Hand X-ray
|
$293.05 |
$293.05 |
$293.05 |
$350.35
|
|
Hand X-ray (2 views, both hands)
|
$256.45 |
$256.45 |
$256.45 |
$294.90
|
|
Haptoglobin quantitative
|
$185.95 |
$185.95 |
$185.95 |
$92.80
|
|
Hast w/i&r phys/qhp
|
$187.15 |
$187.15 |
$187.15 |
$301.95
|
|
Hast w/oxygen titrate
|
$187.15 |
$187.15 |
$187.15 |
$347.20
|
|
Hba1/hba2 gene dup/del vrnts
|
$443.10 |
$443.10 |
$443.10 |
$403.25
|
|
Hbb gene com variants
|
$1,410.15 |
$1,410.15 |
$1,410.15 |
$345.95
|
|
Hbot, full body chamber, 30m
|
$841.20 |
$841.20 |
$841.20 |
$526.90
|
|
Hc fl sm bowel enteroclss tube w kub double contrast
|
$1,054.10 |
$1,054.10 |
$1,054.10 |
$726.00
|
|
Hcg qualitative
|
$106.10 |
$106.10 |
$106.10 |
$90.10
|
|
Hcg quantitative
|
$195.05 |
$195.05 |
$195.05 |
$139.20
|
|
Hc i-131 sodium iodide cap dx per mci
|
$73.50 |
$73.50 |
$73.50 |
$113.12
|
|
Hc nm myocard infarct avid plnr tomo spect w/wo quant
|
$2,631.20 |
$2,631.20 |
$2,631.20 |
$1,327.95
|
|
Hc pet myocardial imaging metabolic eval single study
|
$8,278.55 |
$8,278.55 |
$8,278.55 |
$3,958.50
|
|
Hdr rdncl ntrstl/icav brchtx
|
$4,513.95 |
$4,513.95 |
$4,513.95 |
$2,725.00
|
|
Hdr rdncl ntrstl/icav brchtx
|
$4,513.95 |
$4,513.95 |
$4,513.95 |
$2,960.63
|
|
Hdr rdncl ntrstl/icav brchtx
|
$4,513.95 |
$4,513.95 |
$4,513.95 |
$3,706.29
|
|
Head CT scan (with and without contrast)
|
$3,125.30 |
$3,125.30 |
$3,125.30 |
$1,818.96
|
|
Head CT scan (with contrast)
|
$2,262.10 |
$2,262.10 |
$2,262.10 |
$1,527.60
|
|
Head CT scan (without contrast)
|
$1,728.30 |
$1,728.30 |
$1,728.30 |
$1,268.90
|
|
Heart infarct image
|
$972.50 |
$972.50 |
$972.50 |
$942.29
|
|
Heel (Calcaneus) X-ray (both feet)
|
$365.75 |
$365.75 |
$365.75 |
$276.00
|
|
Helicobacter pylori antibody igm
|
$326.40 |
$326.40 |
$326.40 |
$92.00
|
|
Hematocrit
|
$46.75 |
$46.75 |
$46.75 |
$33.80
|
|
Hematopoietic nuclear tx
|
$1,151.30 |
$1,151.30 |
$1,151.30 |
$928.98
|
|
Hemin 350 mg intravenous powder for solution
|
$14,962.83 |
$14,962.83 |
$14,962.83 |
$20,618.46
|
|
Hemodialysis one evaluation
|
$3,758.00 |
$3,758.00 |
$3,758.00 |
$1,364.27
|
|
Hemoglobin
|
$46.50 |
$46.50 |
$46.50 |
$33.54
|
|
Hemoglobin methemoglobin quantitative
|
$236.75 |
$236.75 |
$236.75 |
$52.32
|
|
Hemoglobin-oxygen affinity
|
$403.75 |
$403.75 |
$403.75 |
$89.13
|
|
Hemophilus influenza antibdy
|
$98.40 |
$98.40 |
$98.40 |
$62.70
|
|
Hemorrhoidectomy intrnl lig rbbr band ligations
|
$1,335.55 |
$1,335.55 |
$1,335.55 |
$1,178.02
|
|
Hepagam b im injection
|
$2,069.99 |
$2,069.99 |
$2,069.99 |
$1,118.05
|
|
Heparin assay
|
$267.85 |
$267.85 |
$267.85 |
$139.15
|
|
Heparin bolus from bag
|
$250.86 |
$250.86 |
$250.86 |
$66.06
|
|
Hepatitis a antibody igm
|
$143.90 |
$143.90 |
$143.90 |
$89.44
|
|
Hepatitis b core antibody igm
|
$409.45 |
$409.45 |
$409.45 |
$89.60
|