|
Ghs init tx 1st degree burn
|
$691.20 |
$691.20 |
$691.20 |
$275.50
|
|
Ghs inj neurolytic intercostal nerve
|
$2,128.00 |
$2,128.00 |
$2,128.00 |
$2,047.92
|
|
Ghs inj neurolytic other perph nerve
|
$2,256.80 |
$2,256.80 |
$2,256.80 |
$1,710.80
|
|
Ghs insertion of needle - bone
|
$1,173.60 |
$1,173.60 |
$1,173.60 |
$422.40
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$1,440.80 |
$1,440.80 |
$1,440.80 |
$865.60
|
|
Ghs intermed repair 20.1 - 30.0 cm-12036
|
$1,560.00 |
$1,560.00 |
$1,560.00 |
$1,051.20
|
|
Ghs intro needle/intracath vein - 36000
|
$100.80 |
$100.80 |
$100.80 |
$202.47
|
|
Ghs irrigate corpora cavernosa for priapism
|
$1,212.00 |
$1,212.00 |
$1,212.00 |
$551.20
|
|
Ghs IV thrombolytics - cerebral
|
$804.00 |
$804.00 |
$804.00 |
$663.00
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$496.80 |
$496.80 |
$496.80 |
$492.00
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$1,152.00 |
$1,152.00 |
$1,152.00 |
$591.00
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$1,152.00 |
$1,152.00 |
$1,152.00 |
$576.19
|
|
Ghs layer closure 2.5cm or less - 12051
|
$1,152.00 |
$1,152.00 |
$1,152.00 |
$602.00
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$1,160.00 |
$1,160.00 |
$1,160.00 |
$670.40
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$1,160.00 |
$1,160.00 |
$1,160.00 |
$690.36
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$1,252.80 |
$1,252.80 |
$1,252.80 |
$733.20
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$1,315.20 |
$1,315.20 |
$1,315.20 |
$770.40
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$1,315.20 |
$1,315.20 |
$1,315.20 |
$750.12
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$1,314.40 |
$1,314.40 |
$1,314.40 |
$737.10
|
|
Ghs mbp
|
$71.20 |
$71.20 |
$71.20 |
$75.50
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$236.00 |
$236.00 |
$236.00 |
$242.64
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$236.00 |
$236.00 |
$236.00 |
$228.45
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$230.40 |
$230.40 |
$230.40 |
$230.55
|
|
Ghs moderate sedation ea addtl 15 min
|
$58.40 |
$58.40 |
$58.40 |
$150.00
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$58.40 |
$58.40 |
$58.40 |
$141.00
|
|
Ghs musc test done w/n test comp
|
$368.80 |
$368.80 |
$368.80 |
$324.80
|
|
Ghs musc tst done w/nerv tst lim
|
$368.80 |
$368.80 |
$368.80 |
$272.25
|
|
Ghs myocardial strain img spckl track
|
$888.00 |
$888.00 |
$888.00 |
$444.60
|
|
Ghs nailbed repair/nail removal
|
$1,268.00 |
$1,268.00 |
$1,268.00 |
$724.37
|
|
Ghs nerve blk intercostal, ea addtl level
|
$3,346.40 |
$3,346.40 |
$3,346.40 |
$1,545.05
|
|
Ghs nerve blk intercostal, single level
|
$1,108.00 |
$1,108.00 |
$1,108.00 |
$1,121.00
|
|
Ghs nerve block axillary nerve
|
$1,220.80 |
$1,220.80 |
$1,220.80 |
$1,540.00
|
|
Ghs nerve block celiac plexus
|
$1,292.80 |
$1,292.80 |
$1,292.80 |
$1,556.40
|
|
Ghs nerve block interscaline
|
$1,192.80 |
$1,192.80 |
$1,192.80 |
$1,526.09
|
|
Ghs nerve block lumbar or thoracic symp
|
$1,138.40 |
$1,138.40 |
$1,138.40 |
$1,671.75
|
|
Ghs nerve block sciatic nerve
|
$3,346.40 |
$3,346.40 |
$3,346.40 |
$1,450.80
|
|
Ghs nerve block suprascapular
|
$1,444.00 |
$1,444.00 |
$1,444.00 |
$1,183.50
|
|
Ghs ng placement w fluoro guidance
|
$576.00 |
$576.00 |
$576.00 |
$478.50
|
|
Ghs o2 saturation
|
$40.80 |
$40.80 |
$40.80 |
$69.50
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$1,594.40 |
$1,594.40 |
$1,594.40 |
$809.67
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$1,756.80 |
$1,756.80 |
$1,756.80 |
$962.00
|
|
Ghs peritonsillar abscess i andd
|
$1,325.60 |
$1,325.60 |
$1,325.60 |
$545.40
|
|
Ghs plngl fx pm cl
|
$452.00 |
$452.00 |
$452.00 |
$564.50
|
|
Ghs ppd (tb intradermal)
|
$104.80 |
$104.80 |
$104.80 |
$37.44
|
|
Ghs prostatic acid phosphatase (mayo)
|
$40.00 |
$40.00 |
$40.00 |
$43.55
|
|
Ghs protoporphyrins fract
|
$60.00 |
$60.00 |
$60.00 |
$60.75
|
|
Ghs pr without cont pulse ox
|
$284.00 |
$284.00 |
$284.00 |
$146.86
|
|
Ghs removal intranasal foreign body
|
$462.40 |
$462.40 |
$462.40 |
$283.51
|
|
Ghs semen analysis fert
|
$51.20 |
$51.20 |
$51.20 |
$124.80
|
|
Ghs sensitivity (per antimicro)
|
$30.40 |
$30.40 |
$30.40 |
$56.40
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$1,411.20 |
$1,411.20 |
$1,411.20 |
$563.75
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$1,204.00 |
$1,204.00 |
$1,204.00 |
$451.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$1,262.40 |
$1,262.40 |
$1,262.40 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$1,262.40 |
$1,262.40 |
$1,262.40 |
$492.00
|
|
Ghs sleep study unattended
|
$847.20 |
$847.20 |
$847.20 |
$503.38
|
|
Ghs sphenopalatine ganglion block
|
$1,124.00 |
$1,124.00 |
$1,124.00 |
$616.00
|
|
Ghs st - re-eval for alt comm
|
$737.60 |
$737.60 |
$737.60 |
$309.00
|
|
Ghs superficial wnd dehiscence simp12020
|
$1,033.60 |
$1,033.60 |
$1,033.60 |
$909.00
|
|
Ghs tx distal phalangeal fx with manipulation
|
$989.60 |
$989.60 |
$989.60 |
$525.60
|
|
Ghs urine, porphyrins quant
|
$61.60 |
$61.60 |
$61.60 |
$73.80
|
|
Gi inhouse confirmation
|
$39.20 |
$39.20 |
$39.20 |
$86.40
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$1,449.40 |
$1,449.40 |
$1,449.40 |
$491.67
|
|
Glucose 1 hr post dose
|
$20.00 |
$20.00 |
$20.00 |
$48.25
|
|
Glucose blood quantitative
|
$16.80 |
$16.80 |
$16.80 |
$41.40
|
|
Glucose body fluid
|
$16.80 |
$16.80 |
$16.80 |
$51.30
|
|
Glucose tolerance test (gtt) 3 specimens
|
$53.60 |
$53.60 |
$53.60 |
$104.50
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$16.80 |
$16.80 |
$16.80 |
$36.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$124.00 |
$124.00 |
$124.00 |
$37.16
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$77.60 |
$77.60 |
$77.60 |
$115.80
|
|
Gonadotropin luteinizing hormone (lh)
|
$77.60 |
$77.60 |
$77.60 |
$129.00
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$1,033.30 |
$1,033.30 |
$1,033.30 |
$23,288.44
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$4,721.60 |
$4,721.60 |
$4,721.60 |
$892.38
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$3,208.87 |
$3,208.87 |
$3,208.87 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$69.60 |
$69.60 |
$69.60 |
$427.89
|
|
Group mnt 2 or more 30 mins
|
$37.60 |
$37.60 |
$37.60 |
$40.14
|
|
Gu dilat ureter/urethra s&i
|
$5,041.60 |
$5,041.60 |
$5,041.60 |
$1,980.66
|
|
Guided cath fluid drainage 10030
|
$8,240.80 |
$8,240.80 |
$8,240.80 |
$1,327.76
|
|
Guid loc target vol rad tx
|
$1,804.80 |
$1,804.80 |
$1,804.80 |
$535.60
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$136.20 |
$136.20 |
$136.20 |
$89.32
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$26.60 |
$26.60 |
$26.60 |
$24.41
|
|
Hand X-ray
|
$369.60 |
$369.60 |
$369.60 |
$345.87
|
|
Haptoglobin quantitative
|
$45.00 |
$45.00 |
$45.00 |
$91.80
|
|
Hbb full gene sequence
|
$670.40 |
$670.40 |
$670.40 |
$633.25
|
|
Hbot, full body chamber, 30m
|
$742.40 |
$742.40 |
$742.40 |
$526.90
|
|
Hcg qualitative
|
$32.00 |
$32.00 |
$32.00 |
$88.00
|
|
Hcg quantitative
|
$55.00 |
$55.00 |
$55.00 |
$137.15
|
|
Head CT scan (with and without contrast)
|
$569.00 |
$569.00 |
$569.00 |
$1,818.96
|
|
Head CT scan (with contrast)
|
$478.00 |
$478.00 |
$478.00 |
$1,526.50
|
|
Head CT scan (without contrast)
|
$296.00 |
$296.00 |
$296.00 |
$1,268.90
|
|
Hematocrit
|
$18.40 |
$18.40 |
$18.40 |
$33.57
|
|
Hemodialysis one evaluation
|
$1,440.00 |
$1,440.00 |
$1,440.00 |
$1,338.00
|
|
Hemoglobin
|
$14.40 |
$14.40 |
$14.40 |
$32.76
|
|
Hemoglobin methemoglobin quantitative
|
$34.40 |
$34.40 |
$34.40 |
$52.32
|
|
Hemoglobin plasma
|
$30.40 |
$30.40 |
$30.40 |
$41.25
|
|
Hemophilus influenza antibdy
|
$65.60 |
$65.60 |
$65.60 |
$62.70
|
|
Heparin assay
|
$54.40 |
$54.40 |
$54.40 |
$138.84
|
|
Heparin bolus from bag
|
$135.80 |
$135.80 |
$135.80 |
$68.00
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$34.60 |
$34.60 |
$34.60 |
$12.91
|
|
Hepatitis a antibody igm
|
$46.40 |
$46.40 |
$46.40 |
$88.92
|
|
Hepatitis b core antibody igm
|
$48.80 |
$48.80 |
$48.80 |
$88.80
|
