|
Ghs inf midline insertion
|
$5,790.00 |
$5,790.00 |
$5,790.00 |
$1,238.25
|
|
Ghs inhibitor screen
|
$104.40 |
$104.40 |
$104.40 |
$191.88
|
|
Ghs init tx 1st degree burn
|
$212.40 |
$212.40 |
$212.40 |
$275.88
|
|
Ghs inj tendon origin/insertion
|
$360.60 |
$360.60 |
$360.60 |
$434.12
|
|
Ghs insertion of needle - bone
|
$721.20 |
$721.20 |
$721.20 |
$431.28
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$1,626.60 |
$1,626.60 |
$1,626.60 |
$886.07
|
|
Ghs intermed repair 20.1 - 30.0 cm-12036
|
$4,739.40 |
$4,739.40 |
$4,739.40 |
$1,051.20
|
|
Ghs irrigate corpora cavernosa for priapism
|
$3,207.60 |
$3,207.60 |
$3,207.60 |
$551.20
|
|
Ghs IV infusion bamlanivimab/etesevimab
|
$1,020.00 |
$1,020.00 |
$1,020.00 |
$553.80
|
|
Ghs IV infusion casirivimab/imdevimab
|
$1,020.00 |
$1,020.00 |
$1,020.00 |
$576.40
|
|
Ghs IV infusion sotrovimab
|
$1,020.00 |
$1,020.00 |
$1,020.00 |
$566.87
|
|
Ghs IV thrombolytics - cerebral
|
$3,883.80 |
$3,883.80 |
$3,883.80 |
$663.00
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$4,300.80 |
$4,300.80 |
$4,300.80 |
$489.67
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$289.20 |
$289.20 |
$289.20 |
$591.00
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$289.20 |
$289.20 |
$289.20 |
$583.10
|
|
Ghs layer closure 2.5cm or less - 12051
|
$873.00 |
$873.00 |
$873.00 |
$603.20
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$289.20 |
$289.20 |
$289.20 |
$672.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$454.20 |
$454.20 |
$454.20 |
$700.33
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$428.40 |
$428.40 |
$428.40 |
$741.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$1,626.60 |
$1,626.60 |
$1,626.60 |
$779.35
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$1,626.60 |
$1,626.60 |
$1,626.60 |
$760.20
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$4,057.20 |
$4,057.20 |
$4,057.20 |
$740.00
|
|
Ghs mbp
|
$103.20 |
$103.20 |
$103.20 |
$76.00
|
|
Ghs musc test done w/n test comp
|
$254.40 |
$254.40 |
$254.40 |
$331.20
|
|
Ghs nailbed repair/nail removal
|
$1,214.40 |
$1,214.40 |
$1,214.40 |
$724.37
|
|
Ghs nerve block sciatic nerve
|
$3,232.80 |
$3,232.80 |
$3,232.80 |
$1,450.80
|
|
Ghs ng placement w fluoro guidance
|
$474.00 |
$474.00 |
$474.00 |
$485.00
|
|
Ghs peritonsillar abscess i andd
|
$3,653.40 |
$3,653.40 |
$3,653.40 |
$555.00
|
|
Ghs plngl fx pm cl
|
$289.20 |
$289.20 |
$289.20 |
$564.80
|
|
Ghs prostatic acid phosphatase (mayo)
|
$121.20 |
$121.20 |
$121.20 |
$43.55
|
|
Ghs protoporphyrins fract
|
$86.40 |
$86.40 |
$86.40 |
$60.75
|
|
Ghs pr without cont pulse ox
|
$260.40 |
$260.40 |
$260.40 |
$147.00
|
|
Ghs removal intranasal foreign body
|
$210.00 |
$210.00 |
$210.00 |
$283.24
|
|
Ghs rsv eia (respir synctial vrs)
|
$91.20 |
$91.20 |
$91.20 |
$99.00
|
|
Ghs sensitivity (per antimicro)
|
$86.40 |
$86.40 |
$86.40 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$1,626.60 |
$1,626.60 |
$1,626.60 |
$570.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$1,851.60 |
$1,851.60 |
$1,851.60 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$4,942.80 |
$4,942.80 |
$4,942.80 |
$586.50
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$4,799.40 |
$4,799.40 |
$4,799.40 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$454.20 |
$454.20 |
$454.20 |
$449.15
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$454.20 |
$454.20 |
$454.20 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$454.20 |
$454.20 |
$454.20 |
$489.72
|
|
Ghs sleep study unattended
|
$90.00 |
$90.00 |
$90.00 |
$503.38
|
|
Ghs somatosensory testing upper & lower limbs
|
$2,029.20 |
$2,029.20 |
$2,029.20 |
$1,416.80
|
|
Ghs superficial wnd dehiscence simp12020
|
$1,145.40 |
$1,145.40 |
$1,145.40 |
$953.27
|
|
Ghs tx distal phalangeal fx with manipulation
|
$722.40 |
$722.40 |
$722.40 |
$529.65
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$3,561.60 |
$3,561.60 |
$3,561.60 |
$513.80
|
|
Ghs urine, porphyrins quant
|
$49.80 |
$49.80 |
$49.80 |
$73.80
|
|
Ghs vaginal delivery only
|
$10,399.20 |
$10,399.20 |
$10,399.20 |
$3,341.93
|
|
Gi inhouse confirmation
|
$58.80 |
$58.80 |
$58.80 |
$87.75
|
|
Glucagon 1 mg solution for injection
|
$396.00 |
$396.00 |
$396.00 |
$613.79
|
|
Glucagon plasma - sendout
|
$210.60 |
$210.60 |
$210.60 |
$64.35
|
|
Glucose 1 hr post dose
|
$30.00 |
$30.00 |
$30.00 |
$49.00
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$43.80 |
$43.80 |
$43.80 |
$23.12
|
|
Glucose blood quantitative
|
$30.00 |
$30.00 |
$30.00 |
$42.25
|
|
Glucose body fluid
|
$33.00 |
$33.00 |
$33.00 |
$51.30
|
|
Glucose tolerance test (gtt) 3 specimens
|
$66.60 |
$66.60 |
$66.60 |
$105.60
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$24.60 |
$24.60 |
$24.60 |
$36.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$11.00 |
$11.00 |
$11.00 |
$37.40
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$100.20 |
$100.20 |
$100.20 |
$116.64
|
|
Gonadotropin luteinizing hormone (lh)
|
$100.20 |
$100.20 |
$100.20 |
$129.03
|
|
Goserelin 10.8 mg subcutaneous implant
|
$392.40 |
$392.40 |
$392.40 |
$4,417.13
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$64.20 |
$64.20 |
$64.20 |
$73.83
|
|
Graft axiofill 1000mg
|
$15,879.60 |
$15,879.60 |
$15,879.60 |
$5,125.68
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$1,533.00 |
$1,533.00 |
$1,533.00 |
$605.00
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$328.80 |
$328.80 |
$328.80 |
$886.17
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$243.00 |
$243.00 |
$243.00 |
$349.41
|
|
Graft xenmtrx sft rect 15x20cm
|
$4,772.40 |
$4,772.40 |
$4,772.40 |
$29,676.26
|
|
Graft xenmtrx sft rect 19x28cm
|
$2,045.40 |
$2,045.40 |
$2,045.40 |
$2,905.40
|
|
Great toe with reduction 28495
|
$5,239.20 |
$5,239.20 |
$5,239.20 |
$495.00
|
|
Guide wire threaded 1.4x150mm
|
$677.40 |
$677.40 |
$677.40 |
$3,284.36
|
|
Gw stiffened micro access kit
|
$557.40 |
$557.40 |
$557.40 |
$6,893.38
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$113.60 |
$113.60 |
$113.60 |
$91.09
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$39.80 |
$39.80 |
$39.80 |
$24.30
|
|
Hands-On Manual Therapy (each 15 minutes)
|
$75.00 |
$75.00 |
$75.00 |
$105.30
|
|
Hand X-ray
|
$115.80 |
$115.80 |
$115.80 |
$350.35
|
|
Hand X-ray (2 views, both hands)
|
$100.20 |
$100.20 |
$100.20 |
$294.90
|
|
Haptoglobin quantitative
|
$66.60 |
$66.60 |
$66.60 |
$92.80
|
|
Hcg qualitative
|
$52.80 |
$52.80 |
$52.80 |
$90.10
|
|
Hcg quantitative
|
$91.20 |
$91.20 |
$91.20 |
$139.20
|
|
Head CT scan (with and without contrast)
|
$957.60 |
$957.60 |
$957.60 |
$1,818.96
|
|
Head CT scan (with contrast)
|
$873.60 |
$873.60 |
$873.60 |
$1,527.60
|
|
Head CT scan (without contrast)
|
$741.00 |
$741.00 |
$741.00 |
$1,268.90
|
|
Heel (Calcaneus) X-ray (both feet)
|
$100.20 |
$100.20 |
$100.20 |
$276.00
|
|
Hematocrit
|
$16.20 |
$16.20 |
$16.20 |
$33.80
|
|
Hemodialysis one evaluation
|
$817.20 |
$817.20 |
$817.20 |
$1,364.27
|
|
Hemoglobin
|
$16.20 |
$16.20 |
$16.20 |
$33.54
|
|
Hemoglobin fetal qualitative
|
$91.20 |
$91.20 |
$91.20 |
$51.75
|
|
Hemophilus influenza antibdy
|
$269.40 |
$269.40 |
$269.40 |
$62.70
|
|
Heparin assay
|
$88.20 |
$88.20 |
$88.20 |
$139.15
|
|
Heparin bolus from bag
|
$4.40 |
$4.40 |
$4.40 |
$66.06
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$3.00 |
$3.00 |
$3.00 |
$12.00
|
|
Hepatitis a antibody igm
|
$83.40 |
$83.40 |
$83.40 |
$89.44
|
|
Hepatitis b core antibody igm
|
$108.00 |
$108.00 |
$108.00 |
$89.60
|
|
Hepatitis b core antibody total
|
$83.40 |
$83.40 |
$83.40 |
$77.50
|
|
Hepatitis b immune globulin greater than 1,560 units/5 ml im solution
|
$1,758.00 |
$1,758.00 |
$1,758.00 |
$1,154.13
|
|
Hepatitis b surface antibody
|
$83.40 |
$83.40 |
$83.40 |
$82.32
|
|
Hepatitis c antibody
|
$100.20 |
$100.20 |
$100.20 |
$108.25
|
|
Hereditary colon ca dsordrs
|
$13,708.80 |
$13,708.80 |
$13,708.80 |
$1,901.23
|
|
Herpes simplex type 1 antibody igg
|
$79.80 |
$79.80 |
$79.80 |
$69.12
|
