|
Ghs sensitivity (per antimicro)
|
$8.23 |
$8.23 |
$8.23 |
$59.90
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$590.40
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$705.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$670.08
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$585.90
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$487.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$470.47
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$538.64
|
|
Ghs simple repair over 30 cm - 12007
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$660.00
|
|
Ghs simple repair over 30 cm - 12018
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$589.18
|
|
Ghs sleep study unattended
|
$375.49 |
$375.49 |
$375.49 |
$503.38
|
|
Ghs sphenopalatine ganglion block
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$706.56
|
|
Ghs st - eval for alt comm
|
$32.45 |
$32.45 |
$32.45 |
$99.75
|
|
Ghs strapping shoulder - 29240
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$243.07
|
|
Ghs superficial wnd dehiscence simp12020
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$976.98
|
|
Ghs superficial wnd dehis w packing12021
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$761.28
|
|
Ghs tracheostomy emergency - transtracheal
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,225.73
|
|
Ghs trypsin (fecal)
|
$8.03 |
$8.03 |
$8.03 |
$21.84
|
|
Ghs tx distal phalangeal fx with manipulation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$591.00
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$540.00
|
|
Ghs urine, hydroxproline total
|
$26.73 |
$26.73 |
$26.73 |
$61.60
|
|
Ghs urine, porphyrins quant
|
$16.18 |
$16.18 |
$16.18 |
$70.20
|
|
Ghs vaginal delivery only
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,525.06
|
|
Ghs veeg 12-26 hr intmt mont
|
$571.02 |
$571.02 |
$571.02 |
$1,843.00
|
|
Ghs windowing of cast
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$204.00
|
|
Giardia lamblia antibody
|
$16.19 |
$16.19 |
$16.19 |
$81.60
|
|
Gi inhouse confirmation
|
$10.38 |
$10.38 |
$10.38 |
$87.00
|
|
Gingivoplasty each quadrant
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,592.74
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$620.03 |
$620.03 |
$620.03 |
$2,382.90
|
|
Gi trc img intral esophagus
|
$590.20 |
$590.20 |
$590.20 |
$1,844.80
|
|
Gjb2 gene full sequence
|
$111.23 |
$111.23 |
$111.23 |
$386.10
|
|
Gjb2 gene known fam variants
|
$67.67 |
$67.67 |
$67.67 |
$67.67
|
|
Gjb6 gene com variants
|
$38.50 |
$38.50 |
$38.50 |
$38.50
|
|
Glaucoma surgery
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,737.56
|
|
Glaucoma surgery
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,737.56
|
|
Glaucoma surgery
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,895.82
|
|
Glaucoma surgery
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,188.22
|
|
Glucagon plasma - sendout
|
$15.72 |
$15.72 |
$15.72 |
$58.56
|
|
Glucose 1 hr post dose
|
$5.23 |
$5.23 |
$5.23 |
$46.28
|
|
Glucose-6-phosphate dhydrogenase screen
|
$6.66 |
$6.66 |
$6.66 |
$45.34
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$3.61 |
$3.61 |
$3.61 |
$22.00
|
|
Glucose blood quantitative
|
$4.32 |
$4.32 |
$4.32 |
$44.76
|
|
Glucose body fluid
|
$4.32 |
$4.32 |
$4.32 |
$50.70
|
|
Glucose tolerance test (gtt) 3 specimens
|
$14.16 |
$14.16 |
$14.16 |
$100.10
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$4.31 |
$4.31 |
$4.31 |
$34.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$20.44 |
$20.44 |
$20.44 |
$110.04
|
|
Gonadotropin luteinizing hormone (lh)
|
$20.37 |
$20.37 |
$20.37 |
$123.75
|
|
Goniotomy
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,627.00
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$26.21 |
$26.21 |
$26.21 |
$2,648.81
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$911.30 |
$911.30 |
$911.30 |
$1,679.75
|
|
Graft hand or finger tendon
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,786.00
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$247.10 |
$247.10 |
$247.10 |
$25,762.70
|
|
Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm
|
$504.81 |
$504.81 |
$504.81 |
$2,274.83
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$1,576.40 |
$1,576.40 |
$1,576.40 |
$10,989.38
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$307.33 |
$307.33 |
$307.33 |
$1,560.21
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$368.44 |
$368.44 |
$368.44 |
$2,369.10
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$427.89 |
$427.89 |
$427.89 |
$336.78
|
|
Great toe with reduction 28495
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$577.03
|
|
Grfg autol fat lipo 25 cc/<
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,164.64
|
|
Grfg autol fat lipo 50 cc/<
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,332.25
|
|
Grfg autol soft tiss dir exc
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,128.93
|
|
Growth hormone antibody
|
$17.31 |
$17.31 |
$17.31 |
$40.00
|
|
Growth stimulation gene 2
|
$83.16 |
$83.16 |
$83.16 |
$223.47
|
|
Gstrst open wo constj tube
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,749.01
|
|
G-tube reposition
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$741.00
|
|
Guided cath fluid drainage 10030
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,461.15
|
|
Guide endoanchr sg-64 aaa 62cm
|
$203.07 |
$203.07 |
$203.07 |
$7,133.49
|
|
Guide wire threaded 1.4x150mm
|
$131.03 |
$131.03 |
$131.03 |
$3,474.86
|
|
Guid loc target vol rad tx
|
$181.43 |
$181.43 |
$181.43 |
$503.80
|
|
Gum graft
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,133.48
|
|
Gynecomastia (males) 19300
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,238.48
|
|
Hair removal by electrolysis 17380
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$706.98
|
|
Hair trnspl 1-15 punch grfts
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$472.79
|
|
Hair trnspl >15 punch grafts
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$472.79
|
|
Hand tendon/muscle transfer
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,839.54
|
|
Hand tendon reconstruction
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,741.00
|
|
Hand tendon reconstruction
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,192.86
|
|
Haptoglobin quantitative
|
$13.84 |
$13.84 |
$13.84 |
$89.95
|
|
Harvest auto stem cells
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,914.00
|
|
Harvest cultured skin graft 15040
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,024.70
|
|
Harvest eye tissue alograft
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,760.73
|
|
Harvest stem cell concentrte
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,287.78
|
|
Hba1/hba2 full gene sequence
|
$660.00 |
$660.00 |
$660.00 |
$777.60
|
|
Hba1/hba2 gene dup/del vrnts
|
$222.64 |
$222.64 |
$222.64 |
$406.25
|
|
Hba1/hba2 gene fam vrnt
|
$412.78 |
$412.78 |
$412.78 |
$517.85
|
|
Hbb full gene sequence
|
$357.04 |
$357.04 |
$357.04 |
$633.25
|
|
Hbb gene com variants
|
$192.29 |
$192.29 |
$192.29 |
$228.54
|
|
Hbb gene dup/del variants
|
$222.64 |
$222.64 |
$222.64 |
$404.80
|
|
Hbb gene known fam variant
|
$412.78 |
$412.78 |
$412.78 |
$626.88
|
|
Hbot, full body chamber, 30m
|
$182.09 |
$182.09 |
$182.09 |
$494.40
|
|
Hcg free betachain test
|
$16.82 |
$16.82 |
$16.82 |
$54.59
|
|
Hcg qualitative
|
$8.27 |
$8.27 |
$8.27 |
$77.50
|
|
Hcg quantitative
|
$16.56 |
$16.56 |
$16.56 |
$124.80
|
|
Hc metata joint dislocation anes
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,423.85
|
|
Hc mohs micrographic h/n/h/f/g 1st stage 5 blocks
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,223.03
|
|
Hc mohs trunk/arm/leg 1st stage 5 blocks
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,107.48
|
|
Hc pet myocardial imaging metabolic eval single study
|
$797.53 |
$797.53 |
$797.53 |
$3,309.00
|
|
Head CT scan (with and without contrast)
|
$480.88 |
$480.88 |
$480.88 |
$1,878.75
|
|
Head CT scan (with contrast)
|
$377.78 |
$377.78 |
$377.78 |
$1,520.45
|
|
Head CT scan (without contrast)
|
$341.73 |
$341.73 |
$341.73 |
$1,268.90
|
