|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$819.60 |
$819.60 |
$819.60 |
$489.72
|
|
Ghs simple repair over 30 cm - 12007
|
$1,305.00 |
$1,305.00 |
$1,305.00 |
$590.88
|
|
Ghs sleep study unattended
|
$1,899.00 |
$1,899.00 |
$1,899.00 |
$503.38
|
|
Ghs somatosensory testing lower extremit
|
$656.40 |
$656.40 |
$656.40 |
$925.91
|
|
Ghs somatosensory testing upper & lower limbs
|
$687.00 |
$687.00 |
$687.00 |
$1,416.80
|
|
Ghs speech-gen aug dev eval iii, st
|
$190.20 |
$190.20 |
$190.20 |
$157.50
|
|
Ghs sp train/fitting sp device - kx
|
$202.80 |
$202.80 |
$202.80 |
$252.75
|
|
Ghs superficial wnd dehiscence simp12020
|
$2,181.60 |
$2,181.60 |
$2,181.60 |
$953.27
|
|
Ghs superficial wnd dehis w packing12021
|
$2,183.40 |
$2,183.40 |
$2,183.40 |
$695.93
|
|
Ghs tx distal phalangeal fx with manipulation
|
$574.80 |
$574.80 |
$574.80 |
$529.65
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$3,535.80 |
$3,535.80 |
$3,535.80 |
$513.80
|
|
Ghs urine, porphyrins quant
|
$87.00 |
$87.00 |
$87.00 |
$73.80
|
|
Ghs vaginal delivery only
|
$8,247.60 |
$8,247.60 |
$8,247.60 |
$3,341.93
|
|
Ghs veeg 12-26 hr intmt mont
|
$1,992.60 |
$1,992.60 |
$1,992.60 |
$1,932.00
|
|
Gi inhouse confirmation
|
$172.80 |
$172.80 |
$172.80 |
$87.75
|
|
Glucagon 1 mg solution for injection
|
$528.00 |
$528.00 |
$528.00 |
$613.79
|
|
Glucagon plasma - sendout
|
$130.20 |
$130.20 |
$130.20 |
$64.35
|
|
Glucose 1 hr post dose
|
$58.20 |
$58.20 |
$58.20 |
$49.00
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$23.40 |
$23.40 |
$23.40 |
$23.12
|
|
Glucose blood quantitative
|
$46.80 |
$46.80 |
$46.80 |
$42.25
|
|
Glucose body fluid
|
$58.20 |
$58.20 |
$58.20 |
$51.30
|
|
Glucose tolerance test (gtt) 3 specimens
|
$136.80 |
$136.80 |
$136.80 |
$105.60
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$15.00 |
$15.00 |
$15.00 |
$36.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$21.40 |
$21.40 |
$21.40 |
$37.40
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$105.60 |
$105.60 |
$105.60 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$141.60 |
$141.60 |
$141.60 |
$116.64
|
|
Gonadotropin luteinizing hormone (lh)
|
$141.60 |
$141.60 |
$141.60 |
$129.03
|
|
Goserelin 10.8 mg subcutaneous implant
|
$1,663.80 |
$1,663.80 |
$1,663.80 |
$4,417.13
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$62.40 |
$62.40 |
$62.40 |
$73.83
|
|
Graft axiofill 1000mg
|
$15,289.20 |
$15,289.20 |
$15,289.20 |
$5,125.68
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$256.80 |
$256.80 |
$256.80 |
$605.00
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$26,740.20 |
$26,740.20 |
$26,740.20 |
$23,233.80
|
|
Graft nerve adv 3-4x70mm
|
$25,023.60 |
$25,023.60 |
$25,023.60 |
$20,782.10
|
|
Graft patch felt ptfe 2x2
|
$50,063.40 |
$50,063.40 |
$50,063.40 |
$29,293.39
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$319.20 |
$319.20 |
$319.20 |
$886.17
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$410.40 |
$410.40 |
$410.40 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$3,468.00 |
$3,468.00 |
$3,468.00 |
$349.41
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$19,818.60 |
$19,818.60 |
$19,818.60 |
$28,894.71
|
|
Graft xenmtrx sft rect 15x20cm
|
$44,226.00 |
$44,226.00 |
$44,226.00 |
$29,676.26
|
|
Graft xenmtrx sft rect 19x28cm
|
$1,559.40 |
$1,559.40 |
$1,559.40 |
$2,905.40
|
|
Granisetron 1 mg tab
|
$215.40 |
$215.40 |
$215.40 |
$53.15
|
|
Granisetron hcl injection
|
$172.80 |
$172.80 |
$172.80 |
$45.03
|
|
Great toe with reduction 28495
|
$3,184.80 |
$3,184.80 |
$3,184.80 |
$495.00
|
|
Growth stimulation gene 2
|
$234.00 |
$234.00 |
$234.00 |
$180.50
|
|
G-tube reposition
|
$1,710.60 |
$1,710.60 |
$1,710.60 |
$771.36
|
|
Guided cath fluid drainage 10030
|
$3,907.20 |
$3,907.20 |
$3,907.20 |
$1,372.15
|
|
Guide endoanchr sg-64 aaa 62cm
|
$10,920.00 |
$10,920.00 |
$10,920.00 |
$7,743.36
|
|
Guide wire threaded 1.4x150mm
|
$2,506.20 |
$2,506.20 |
$2,506.20 |
$3,284.36
|
|
Guide worley csg 9fx50cm std
|
$255.00 |
$255.00 |
$255.00 |
$1,117.40
|
|
Guid loc target vol rad tx
|
$1,093.80 |
$1,093.80 |
$1,093.80 |
$535.60
|
|
Gw stiffened micro access kit
|
$3,307.80 |
$3,307.80 |
$3,307.80 |
$6,893.38
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$391.20 |
$391.20 |
$391.20 |
$91.09
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$34.20 |
$34.20 |
$34.20 |
$24.30
|
|
Hand-held pefr meter a4614
|
$113.40 |
$113.40 |
$113.40 |
$26.40
|
|
Hand X-ray
|
$179.40 |
$179.40 |
$179.40 |
$350.35
|
|
Hand X-ray (2 views, both hands)
|
$172.80 |
$172.80 |
$172.80 |
$294.90
|
|
Haptoglobin quantitative
|
$73.80 |
$73.80 |
$73.80 |
$92.80
|
|
Hbot, full body chamber, 30m
|
$400.20 |
$400.20 |
$400.20 |
$526.90
|
|
Hcg qualitative
|
$124.80 |
$124.80 |
$124.80 |
$90.10
|
|
Hcg quantitative
|
$180.60 |
$180.60 |
$180.60 |
$139.20
|
|
Hc i-131 sodium iodide cap dx per mci
|
$603.00 |
$603.00 |
$603.00 |
$113.12
|
|
Hdr rdncl ntrstl/icav brchtx
|
$3,364.80 |
$3,364.80 |
$3,364.80 |
$2,725.00
|
|
Head CT scan (with and without contrast)
|
$1,420.20 |
$1,420.20 |
$1,420.20 |
$1,818.96
|
|
Head CT scan (with contrast)
|
$1,160.40 |
$1,160.40 |
$1,160.40 |
$1,527.60
|
|
Head CT scan (without contrast)
|
$961.20 |
$961.20 |
$961.20 |
$1,268.90
|
|
Heel (Calcaneus) X-ray (both feet)
|
$144.00 |
$144.00 |
$144.00 |
$276.00
|
|
Helicobacter pylori antibody igm
|
$163.20 |
$163.20 |
$163.20 |
$92.00
|
|
Hematocrit
|
$27.60 |
$27.60 |
$27.60 |
$33.80
|
|
Hemin 350 mg intravenous powder for solution
|
$87.20 |
$87.20 |
$87.20 |
$20,618.46
|
|
Hemodialysis one evaluation
|
$1,635.00 |
$1,635.00 |
$1,635.00 |
$1,364.27
|
|
Hemoglobin
|
$27.60 |
$27.60 |
$27.60 |
$33.54
|
|
Hemoglobin fetal qualitative
|
$72.00 |
$72.00 |
$72.00 |
$51.75
|
|
Hemoglobin methemoglobin quantitative
|
$40.20 |
$40.20 |
$40.20 |
$52.32
|
|
Hemoglobin-oxygen affinity
|
$45.60 |
$45.60 |
$45.60 |
$89.13
|
|
Hemoglobin plasma
|
$61.20 |
$61.20 |
$61.20 |
$41.40
|
|
Hemolysins and agglutinins incubated
|
$129.60 |
$129.60 |
$129.60 |
$61.79
|
|
Hemophilus influenza antibdy
|
$209.40 |
$209.40 |
$209.40 |
$62.70
|
|
Heparin assay
|
$28.80 |
$28.80 |
$28.80 |
$139.15
|
|
Heparin bolus from bag
|
$8.00 |
$8.00 |
$8.00 |
$66.06
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$3.20 |
$3.20 |
$3.20 |
$12.00
|
|
Hepatitis a antibody igm
|
$150.60 |
$150.60 |
$150.60 |
$89.44
|
|
Hepatitis b core antibody igm
|
$93.00 |
$93.00 |
$93.00 |
$89.60
|
|
Hepatitis b core antibody total
|
$106.20 |
$106.20 |
$106.20 |
$77.50
|
|
Hepatitis b immune globulin greater than 1,560 units/5 ml im solution
|
$1,206.00 |
$1,206.00 |
$1,206.00 |
$1,154.13
|
|
Hepatitis b surface antibody
|
$100.20 |
$100.20 |
$100.20 |
$82.32
|
|
Hepatitis c antibody
|
$130.20 |
$130.20 |
$130.20 |
$108.25
|
|
Hepatitis d quantification
|
$427.20 |
$427.20 |
$427.20 |
$91.28
|
|
Hepb vacc 3 dose immunsup im
|
$194.40 |
$194.40 |
$194.40 |
$319.52
|
|
Hereditary colon ca dsordrs
|
$13,579.80 |
$13,579.80 |
$13,579.80 |
$1,901.23
|
|
Herpes simplex type 1 antibody igg
|
$93.00 |
$93.00 |
$93.00 |
$69.12
|
|
Herpes simplex type 2 antibody igg
|
$108.60 |
$108.60 |
$108.60 |
$87.36
|
|
Herpes simplex virus isolation
|
$447.60 |
$447.60 |
$447.60 |
$110.00
|
|
Heterophile antibodies screening
|
$90.60 |
$90.60 |
$90.60 |
$73.87
|
|
Hexa gene
|
$1,336.80 |
$1,336.80 |
$1,336.80 |
$150.82
|
|
Hhv-6 dna quant
|
$499.80 |
$499.80 |
$499.80 |
$253.68
|
|
Hip and Pelvis X-ray (2 views, both hips)
|
$273.60 |
$273.60 |
$273.60 |
$374.40
|
|
Hip and Pelvis X-ray (3 to 4 views, both hips)
|
$219.00 |
$219.00 |
$219.00 |
$424.80
|
|
Hip and Pelvis X-ray (single view, left side)
|
$141.00 |
$141.00 |
$141.00 |
$233.50
|
|
Hip X-ray
|
$172.80 |
$172.80 |
$172.80 |
$294.75
|
|
Histamine
|
$351.60 |
$351.60 |
$351.60 |
$115.00
|
