|
Ghs sensitivity (per antimicro)
|
$39.00 |
$39.00 |
$39.00 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$262.20 |
$262.20 |
$262.20 |
$553.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$262.20 |
$262.20 |
$262.20 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$262.20 |
$262.20 |
$262.20 |
$575.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$262.20 |
$262.20 |
$262.20 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$142.80 |
$142.80 |
$142.80 |
$448.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$142.80 |
$142.80 |
$142.80 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$142.80 |
$142.80 |
$142.80 |
$484.80
|
|
Ghs simple repair over 30 cm - 12007
|
$193.20 |
$193.20 |
$193.20 |
$582.00
|
|
Ghs simple repair over 30 cm - 12018
|
$349.80 |
$349.80 |
$349.80 |
$537.60
|
|
Ghs speech-gen aug dev eval iii, st
|
$54.00 |
$54.00 |
$54.00 |
$146.40
|
|
Ghs sphenopalatine ganglion block
|
$500.40 |
$500.40 |
$500.40 |
$637.92
|
|
Ghs sp train/fitting sp device - kx
|
$115.20 |
$115.20 |
$115.20 |
$250.50
|
|
Ghs st - eval for alt comm
|
$67.20 |
$67.20 |
$67.20 |
$93.60
|
|
Ghs strapping shoulder - 29240
|
$149.40 |
$149.40 |
$149.40 |
$213.20
|
|
Ghs st - re-eval for alt comm
|
$165.60 |
$165.60 |
$165.60 |
$309.00
|
|
Ghs superficial wnd dehiscence simp12020
|
$412.20 |
$412.20 |
$412.20 |
$861.75
|
|
Ghs tracheostomy emergency - transtracheal
|
$2,700.00 |
$2,700.00 |
$2,700.00 |
$1,752.89
|
|
Ghs tx distal phalangeal fx with manipulation
|
$463.80 |
$463.80 |
$463.80 |
$523.00
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$394.20 |
$394.20 |
$394.20 |
$486.35
|
|
Ghs urine, hydroxproline total
|
$192.60 |
$192.60 |
$192.60 |
$109.60
|
|
Ghs urine, porphyrins quant
|
$170.40 |
$170.40 |
$170.40 |
$75.00
|
|
Ghs vaginal delivery only
|
$4,984.80 |
$4,984.80 |
$4,984.80 |
$3,152.00
|
|
Giardia lamblia antibody
|
$127.80 |
$127.80 |
$127.80 |
$83.44
|
|
Gi inhouse confirmation
|
$67.80 |
$67.80 |
$67.80 |
$83.70
|
|
Gjb2 gene full sequence
|
$528.00 |
$528.00 |
$528.00 |
$502.80
|
|
Gjb6 gene com variants
|
$528.00 |
$528.00 |
$528.00 |
$106.40
|
|
Glove finger flexion right lg xl
|
$472.43 |
$472.43 |
$472.43 |
$100.48
|
|
Glucagon 1 mg solution for injection
|
$1,050.00 |
$1,050.00 |
$1,050.00 |
$601.79
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$1,049.28 |
$1,049.28 |
$1,049.28 |
$491.67
|
|
Glucagon plasma - sendout
|
$175.20 |
$175.20 |
$175.20 |
$63.00
|
|
Glucose 1 hr post dose
|
$45.60 |
$45.60 |
$45.60 |
$47.20
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$13.80 |
$13.80 |
$13.80 |
$23.86
|
|
Glucose blood quantitative
|
$25.80 |
$25.80 |
$25.80 |
$40.00
|
|
Glucose body fluid
|
$38.40 |
$38.40 |
$38.40 |
$52.20
|
|
Glucose tolerance test (gtt) 3 specimens
|
$97.20 |
$97.20 |
$97.20 |
$100.16
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$22.80 |
$22.80 |
$22.80 |
$35.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$24.42 |
$24.42 |
$24.42 |
$37.04
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$5,997.60 |
$5,997.60 |
$5,997.60 |
$4,977.60
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$113.40 |
$113.40 |
$113.40 |
$115.05
|
|
Gonadotropin luteinizing hormone (lh)
|
$133.20 |
$133.20 |
$133.20 |
$129.00
|
|
Goniotomy
|
$15,176.45 |
$15,176.45 |
$15,176.45 |
$4,452.74
|
|
Goserelin 10.8 mg subcutaneous implant
|
$9,592.32 |
$9,592.32 |
$9,592.32 |
$4,652.18
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$5,195.94 |
$5,195.94 |
$5,195.94 |
$672.50
|
|
Graft axiofill 1000mg
|
$7,653.60 |
$7,653.60 |
$7,653.60 |
$5,125.68
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$70,026.26 |
$70,026.26 |
$70,026.26 |
$584.99
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$50,474.40 |
$50,474.40 |
$50,474.40 |
$24,469.57
|
|
Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm
|
$4,533.58 |
$4,533.58 |
$4,533.58 |
$3,432.00
|
|
Graft nerve adv 3-4x70mm
|
$128,953.21 |
$128,953.21 |
$128,953.21 |
$19,620.00
|
|
Graft patch felt ptfe 2x2
|
$97,576.32 |
$97,576.32 |
$97,576.32 |
$27,300.00
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$42,689.64 |
$42,689.64 |
$42,689.64 |
$1,455.76
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$15,642.70 |
$15,642.70 |
$15,642.70 |
$1,181.41
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$26,528.56 |
$26,528.56 |
$26,528.56 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$10,304.36 |
$10,304.36 |
$10,304.36 |
$373.00
|
|
Graft tis hmatrix dermis 10x5 -cost per sq cm
|
$4,573.89 |
$4,573.89 |
$4,573.89 |
$3,822.00
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$96,155.36 |
$96,155.36 |
$96,155.36 |
$27,367.40
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$8,080.54 |
$8,080.54 |
$8,080.54 |
$1,132.47
|
|
Graft xenmtrx sft rect 15x20cm
|
$96,326.12 |
$96,326.12 |
$96,326.12 |
$30,392.04
|
|
Graft xenmtrx sft rect 19x28cm
|
$45,624.55 |
$45,624.55 |
$45,624.55 |
$2,701.58
|
|
Great toe with reduction 28495
|
$463.80 |
$463.80 |
$463.80 |
$482.40
|
|
Growth hormone antibody
|
$243.60 |
$243.60 |
$243.60 |
$72.60
|
|
Guided cath fluid drainage 10030
|
$1,306.80 |
$1,306.80 |
$1,306.80 |
$1,372.15
|
|
Guide endoanchr sg-64 aaa 62cm
|
$15,807.37 |
$15,807.37 |
$15,807.37 |
$7,728.17
|
|
Guide wire threaded 1.4x150mm
|
$24,333.10 |
$24,333.10 |
$24,333.10 |
$3,284.50
|
|
Guide worley csg 9fx50cm std
|
$2,134.48 |
$2,134.48 |
$2,134.48 |
$1,105.00
|
|
Gw stiffened micro access kit
|
$20,814.25 |
$20,814.25 |
$20,814.25 |
$6,696.00
|
|
Hallus-valgus nt dyn pre ots
|
$229.76 |
$229.76 |
$229.76 |
$102.37
|
|
Halo cervical into jckt vest
|
$20,582.51 |
$20,582.51 |
$20,582.51 |
$5,015.12
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$9.00 |
$9.00 |
$9.00 |
$23.06
|
|
Halo repl liner/interface
|
$3,488.35 |
$3,488.35 |
$3,488.35 |
$1,931.10
|
|
Hand orthosis metacarpal fracture orthosis prefa l3918
|
$473.53 |
$473.53 |
$473.53 |
$115.00
|
|
Handpiece aquabeam hp2000
|
$9,910.10 |
$9,910.10 |
$9,910.10 |
$6,628.05
|
|
Hand X-ray
|
$361.80 |
$361.80 |
$361.80 |
$356.00
|
|
Haptoglobin quantitative
|
$85.20 |
$85.20 |
$85.20 |
$91.14
|
|
Hba1/hba2 full gene sequence
|
$364.80 |
$364.80 |
$364.80 |
$769.95
|
|
Hba1/hba2 gene dup/del vrnts
|
$381.60 |
$381.60 |
$381.60 |
$404.80
|
|
Hbb full gene sequence
|
$399.60 |
$399.60 |
$399.60 |
$633.25
|
|
Hbb gene dup/del variants
|
$298.20 |
$298.20 |
$298.20 |
$455.00
|
|
Hcg qualitative
|
$36.60 |
$36.60 |
$36.60 |
$89.70
|
|
Hcg quantitative
|
$40.80 |
$40.80 |
$40.80 |
$139.20
|
|
Hc pet myocardial imaging metabolic eval single study
|
$6,705.00 |
$6,705.00 |
$6,705.00 |
$3,931.12
|
|
Head CT scan (with and without contrast)
|
$1,156.80 |
$1,156.80 |
$1,156.80 |
$1,849.90
|
|
Head CT scan (with contrast)
|
$1,435.80 |
$1,435.80 |
$1,435.80 |
$1,545.60
|
|
Head CT scan (without contrast)
|
$1,666.20 |
$1,666.20 |
$1,666.20 |
$1,268.90
|
|
Hearing loss dup/del analys
|
$544.80 |
$544.80 |
$544.80 |
$937.81
|
|
Hearing loss sequence analys
|
$2,712.00 |
$2,712.00 |
$2,712.00 |
$2,687.40
|
|
Heel leather reinforced
|
$375.98 |
$375.98 |
$375.98 |
$180.55
|
|
Heinz bodies direct
|
$69.60 |
$69.60 |
$69.60 |
$37.44
|
|
Heinz bodies induced
|
$84.00 |
$84.00 |
$84.00 |
$31.22
|
|
Helicobacter pylori antibody igm
|
$148.80 |
$148.80 |
$148.80 |
$91.98
|
|
Hematocrit
|
$19.80 |
$19.80 |
$19.80 |
$33.57
|
|
Hemoglobin
|
$18.00 |
$18.00 |
$18.00 |
$31.80
|
|
Hemoglobin fetal qualitative
|
$58.20 |
$58.20 |
$58.20 |
$51.75
|
|
Hemoglobin f (fetal) chemical
|
$142.20 |
$142.20 |
$142.20 |
$42.00
|
|
Hemoglobin methemoglobin quantitative
|
$36.00 |
$36.00 |
$36.00 |
$53.60
|
|
Hemoglobin-oxygen affinity
|
$171.60 |
$171.60 |
$171.60 |
$84.76
|
|
Hemoglobin plasma
|
$89.40 |
$89.40 |
$89.40 |
$41.25
|
|
Hemoglobin urine
|
$43.20 |
$43.20 |
$43.20 |
$22.00
|
|
Hemolysins/agglutinins auto
|
$53.40 |
$53.40 |
$53.40 |
$57.14
|
|
Hemolysins and agglutinins incubated
|
$67.20 |
$67.20 |
$67.20 |
$57.14
|
