|
Ghs IV thrombolytics - cerebral
|
$495.17 |
$495.17 |
$495.17 |
$663.00
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$920.28 |
$920.28 |
$920.28 |
$591.00
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$1,037.28 |
$1,037.28 |
$1,037.28 |
$583.10
|
|
Ghs layer closure 2.5cm or less - 12051
|
$766.90 |
$766.90 |
$766.90 |
$603.20
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$611.10 |
$611.10 |
$611.10 |
$672.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$603.31 |
$603.31 |
$603.31 |
$700.33
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$597.64 |
$597.64 |
$597.64 |
$741.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$611.81 |
$611.81 |
$611.81 |
$779.35
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$1,281.19 |
$1,281.19 |
$1,281.19 |
$760.20
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$598.35 |
$598.35 |
$598.35 |
$740.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$690.79 |
$690.79 |
$690.79 |
$784.80
|
|
Ghs mbp
|
$36.54 |
$36.54 |
$36.54 |
$76.00
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$238.80 |
$238.80 |
$238.80 |
$246.33
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$257.87 |
$257.87 |
$257.87 |
$233.28
|
|
Ghs moderate sedation ea addtl 15 min
|
$269.26 |
$269.26 |
$269.26 |
$150.00
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$98.16 |
$98.16 |
$98.16 |
$142.40
|
|
Ghs musc test done w/n test comp
|
$442.77 |
$442.77 |
$442.77 |
$331.20
|
|
Ghs musc tst done w/nerv tst lim
|
$285.20 |
$285.20 |
$285.20 |
$272.48
|
|
Ghs musc tst done w/n tst non ext
|
$222.23 |
$222.23 |
$222.23 |
$184.80
|
|
Ghs myocardial strain img spckl track
|
$53.11 |
$53.11 |
$53.11 |
$457.80
|
|
Ghs nailbed repair/nail removal
|
$709.53 |
$709.53 |
$709.53 |
$724.37
|
|
Ghs nerve blk intercostal, ea addtl level
|
$1,159.18 |
$1,159.18 |
$1,159.18 |
$1,556.24
|
|
Ghs nerve blk intercostal, single level
|
$1,296.80 |
$1,296.80 |
$1,296.80 |
$1,160.00
|
|
Ghs ng placement w fluoro guidance
|
$442.60 |
$442.60 |
$442.60 |
$485.00
|
|
Ghs osteopathic manipulative tx, 1-2 regions
|
$66.57 |
$66.57 |
$66.57 |
$58.00
|
|
Ghs osteopathic manipulative tx, 3-4 regions
|
$67.89 |
$67.89 |
$67.89 |
$64.50
|
|
Ghs ot group caregiver training
|
$15.92 |
$15.92 |
$15.92 |
$34.80
|
|
Ghs ot prosthetic training/15 min
|
$130.62 |
$130.62 |
$130.62 |
$93.00
|
|
Ghs pacing - transcutaneous
|
$703.86 |
$703.86 |
$703.86 |
$830.53
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$121.01 |
$121.01 |
$121.01 |
$74.10
|
|
Ghs peritonsillar abscess i andd
|
$527.74 |
$527.74 |
$527.74 |
$555.00
|
|
Ghs phenylketonurid
|
$18.64 |
$18.64 |
$18.64 |
$53.76
|
|
Ghs plngl fx pm cl
|
$619.35 |
$619.35 |
$619.35 |
$564.80
|
|
Ghs ppd (tb intradermal)
|
$67.91 |
$67.91 |
$67.91 |
$37.44
|
|
Ghs protoporphyrins fract
|
$45.66 |
$45.66 |
$45.66 |
$60.75
|
|
Ghs removal intranasal foreign body
|
$270.50 |
$270.50 |
$270.50 |
$283.24
|
|
Ghs removal pharyngeal foreign body
|
$740.28 |
$740.28 |
$740.28 |
$441.68
|
|
Ghs repair extensor tendon hand, ea tendon
|
$1,953.78 |
$1,953.78 |
$1,953.78 |
$2,517.00
|
|
Ghs sensitivity (per antimicro)
|
$15.89 |
$15.89 |
$15.89 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$509.13 |
$509.13 |
$509.13 |
$570.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$534.66 |
$534.66 |
$534.66 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$743.37 |
$743.37 |
$743.37 |
$586.50
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$332.10 |
$332.10 |
$332.10 |
$449.15
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$597.57 |
$597.57 |
$597.57 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$344.14 |
$344.14 |
$344.14 |
$489.72
|
|
Ghs simple repair over 30 cm - 12007
|
$373.39 |
$373.39 |
$373.39 |
$590.88
|
|
Ghs speech-gen aug dev eval iii, st
|
$153.09 |
$153.09 |
$153.09 |
$157.50
|
|
Ghs strapping shoulder - 29240
|
$164.99 |
$164.99 |
$164.99 |
$217.60
|
|
Ghs superficial wnd dehiscence simp12020
|
$1,433.06 |
$1,433.06 |
$1,433.06 |
$953.27
|
|
Ghs tx distal phalangeal fx with manipulation
|
$618.89 |
$618.89 |
$618.89 |
$529.65
|
|
Ghs vaginal delivery only
|
$3,715.31 |
$3,715.31 |
$3,715.31 |
$3,341.93
|
|
Giardia ag if
|
$28.91 |
$28.91 |
$28.91 |
$38.58
|
|
Gi inhouse confirmation
|
$64.82 |
$64.82 |
$64.82 |
$87.75
|
|
Glucose 1 hr post dose
|
$40.51 |
$40.51 |
$40.51 |
$49.00
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$6.97 |
$6.97 |
$6.97 |
$23.12
|
|
Glucose blood quantitative
|
$54.88 |
$54.88 |
$54.88 |
$42.25
|
|
Glucose body fluid
|
$37.56 |
$37.56 |
$37.56 |
$51.30
|
|
Glucose tolerance test (gtt) 3 specimens
|
$64.82 |
$64.82 |
$64.82 |
$105.60
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$36.46 |
$36.46 |
$36.46 |
$36.00
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$66.02 |
$66.02 |
$66.02 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$152.10 |
$152.10 |
$152.10 |
$116.64
|
|
Gonadotropin luteinizing hormone (lh)
|
$180.07 |
$180.07 |
$180.07 |
$129.03
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$99.03 |
$99.03 |
$99.03 |
$73.83
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$731.25 |
$731.25 |
$731.25 |
$886.17
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$314.46 |
$314.46 |
$314.46 |
$349.41
|
|
G-tube reposition
|
$359.99 |
$359.99 |
$359.99 |
$771.36
|
|
Guid loc target vol rad tx
|
$190.18 |
$190.18 |
$190.18 |
$535.60
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$15.88 |
$15.88 |
$15.88 |
$91.09
|
|
Hands-On Manual Therapy (each 15 minutes)
|
$81.11 |
$81.11 |
$81.11 |
$105.30
|
|
Hand X-ray
|
$219.69 |
$219.69 |
$219.69 |
$350.35
|
|
Hand X-ray (2 views, both hands)
|
$277.91 |
$277.91 |
$277.91 |
$294.90
|
|
Haptoglobin quantitative
|
$120.41 |
$120.41 |
$120.41 |
$92.80
|
|
Hba1/hba2 gene dup/del vrnts
|
$394.68 |
$394.68 |
$394.68 |
$403.25
|
|
Hbot, full body chamber, 30m
|
$265.30 |
$265.30 |
$265.30 |
$526.90
|
|
Hcg qualitative
|
$68.12 |
$68.12 |
$68.12 |
$90.10
|
|
Hcg quantitative
|
$110.85 |
$110.85 |
$110.85 |
$139.20
|
|
Head CT scan (with and without contrast)
|
$1,899.65 |
$1,899.65 |
$1,899.65 |
$1,818.96
|
|
Head CT scan (with contrast)
|
$1,386.34 |
$1,386.34 |
$1,386.34 |
$1,527.60
|
|
Head CT scan (without contrast)
|
$1,078.52 |
$1,078.52 |
$1,078.52 |
$1,268.90
|
|
Heel (Calcaneus) X-ray (both feet)
|
$216.23 |
$216.23 |
$216.23 |
$276.00
|
|
Helicobacter pylori antibody igm
|
$127.43 |
$127.43 |
$127.43 |
$92.00
|
|
Hematocrit
|
$38.30 |
$38.30 |
$38.30 |
$33.80
|
|
Hemoglobin
|
$21.74 |
$21.74 |
$21.74 |
$33.54
|
|
Hemoglobin plasma
|
$14.25 |
$14.25 |
$14.25 |
$41.40
|
|
Heparin assay
|
$25.53 |
$25.53 |
$25.53 |
$139.15
|
|
Hepatitis a antibody igm
|
$31.69 |
$31.69 |
$31.69 |
$89.44
|
|
Hepatitis b core antibody igm
|
$144.35 |
$144.35 |
$144.35 |
$89.60
|
|
Hepatitis b core antibody total
|
$38.36 |
$38.36 |
$38.36 |
$77.50
|
|
Hepatitis b surface antibody
|
$34.18 |
$34.18 |
$34.18 |
$82.32
|
|
Hepatitis c antibody
|
$45.40 |
$45.40 |
$45.40 |
$108.25
|
|
Hepatitis d quantification
|
$92.52 |
$92.52 |
$92.52 |
$91.28
|
|
Herpes simplex type 1 antibody igg
|
$109.76 |
$109.76 |
$109.76 |
$69.12
|
|
Herpes simplex type 2 antibody igg
|
$117.48 |
$117.48 |
$117.48 |
$87.36
|
|
Herpes simplex virus isolation
|
$139.21 |
$139.21 |
$139.21 |
$110.00
|
|
Heterophile antibodies screening
|
$39.41 |
$39.41 |
$39.41 |
$73.87
|
|
Hip and Pelvis X-ray (2 views, both hips)
|
$492.87 |
$492.87 |
$492.87 |
$374.40
|
|
Hip and Pelvis X-ray (3 to 4 views, both hips)
|
$514.70 |
$514.70 |
$514.70 |
$424.80
|
|
Hip and Pelvis X-ray (single view, left side)
|
$200.99 |
$200.99 |
$200.99 |
$233.50
|
|
Hip X-ray
|
$357.54 |
$357.54 |
$357.54 |
$294.75
|
|
Hla class i high defin qual
|
$834.74 |
$834.74 |
$834.74 |
$631.15
|
