|
Ghs vaginal delivery only
|
$4,096.68 |
$4,096.68 |
$4,096.68 |
$3,525.06
|
|
Ghs veeg 12-26 hr intmt mont
|
$1,260.00 |
$1,260.00 |
$1,260.00 |
$1,843.00
|
|
Ghs windowing of cast
|
$205.38 |
$205.38 |
$205.38 |
$204.00
|
|
Gi endoscopic ultrasound
|
$323.82 |
$323.82 |
$323.82 |
$328.08
|
|
Gi inhouse confirmation
|
$341.88 |
$341.88 |
$341.88 |
$87.00
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$5,201.70 |
$5,201.70 |
$5,201.70 |
$2,382.90
|
|
Gi wireless capsule measure
|
$4,001.34 |
$4,001.34 |
$4,001.34 |
$1,247.13
|
|
Glassia injection
|
$11,068.03 |
$11,068.03 |
$11,068.03 |
$1,023.81
|
|
Glucagon 1 mg solution for injection
|
$1,268.48 |
$2,048.46 |
$2,056.12 |
$613.00
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$904.99 |
$904.99 |
$904.99 |
$509.06
|
|
Glucose 1 hr post dose
|
$136.50 |
$136.50 |
$136.50 |
$46.28
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$35.28 |
$35.28 |
$35.28 |
$22.00
|
|
Glucose blood quantitative
|
$76.86 |
$76.86 |
$76.86 |
$44.76
|
|
Glucose body fluid
|
$98.70 |
$98.70 |
$98.70 |
$50.70
|
|
Glucose tolerance test (gtt) 3 specimens
|
$418.32 |
$418.32 |
$418.32 |
$100.10
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$85.26 |
$85.26 |
$85.26 |
$34.45
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$56.70 |
$56.70 |
$56.70 |
$56.70
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$12,077.17 |
$12,077.17 |
$12,077.17 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$268.38 |
$268.38 |
$268.38 |
$110.04
|
|
Gonadotropin luteinizing hormone (lh)
|
$296.10 |
$296.10 |
$296.10 |
$123.75
|
|
Goserelin 10.8 mg subcutaneous implant
|
$13,568.86 |
$13,568.86 |
$13,568.86 |
$2,802.00
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$3,202.29 |
$3,202.29 |
$3,202.29 |
$2,648.81
|
|
Graft axiofill 1000mg
|
$4,121.90 |
$4,121.90 |
$24,066.00 |
$5,278.73
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$20,895.93 |
$20,895.93 |
$20,895.93 |
$1,679.75
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$34,943.93 |
$34,943.93 |
$34,943.93 |
$25,762.70
|
|
Graft nerve adv 3-4x70mm
|
$44,940.00 |
$44,940.00 |
$44,940.00 |
$27,495.00
|
|
Graft patch felt ptfe 2x2
|
$40,989.02 |
$40,989.02 |
$40,989.02 |
$25,728.84
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$35,468.43 |
$35,468.43 |
$35,468.43 |
$10,989.38
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$9,889.61 |
$9,889.61 |
$9,889.61 |
$1,560.21
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$17,161.20 |
$17,161.20 |
$17,161.20 |
$2,369.10
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$43,599.44 |
$43,599.44 |
$43,599.44 |
$35,824.13
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$5,817.42 |
$5,817.42 |
$5,817.42 |
$3,070.00
|
|
Graft xenmtrx sft rect 15x20cm
|
$54,040.64 |
$54,040.64 |
$54,040.64 |
$43,312.93
|
|
Graft xenmtrx sft rect 19x28cm
|
$4,134.06 |
$4,134.06 |
$4,134.06 |
$2,653.10
|
|
Granisetron 1 mg tab
|
$84.21 |
$84.21 |
$84.21 |
$10.04
|
|
Granisetron hcl injection
|
$56.70 |
$56.70 |
$56.70 |
$41.65
|
|
Great toe with reduction 28495
|
$340.62 |
$340.62 |
$340.62 |
$577.03
|
|
G-tube reposition
|
$302.82 |
$302.82 |
$302.82 |
$741.00
|
|
Gu dilat ureter/urethra s&i
|
$4,246.20 |
$4,246.20 |
$4,246.20 |
$1,793.00
|
|
Guided cath fluid drainage 10030
|
$914.34 |
$914.34 |
$914.34 |
$1,461.15
|
|
Guide endoanchr sg-64 aaa 62cm
|
$8,568.87 |
$8,568.87 |
$8,568.87 |
$7,133.49
|
|
Guide wire threaded 1.4x150mm
|
$5,492.08 |
$5,492.08 |
$5,492.08 |
$3,474.86
|
|
Guide worley csg 9fx50cm std
|
$14,777.70 |
$14,777.70 |
$14,777.70 |
$2,229.99
|
|
Guid loc target vol rad tx
|
$619.08 |
$619.08 |
$619.08 |
$503.80
|
|
Gw stiffened micro access kit
|
$17,065.86 |
$17,065.86 |
$17,065.86 |
$6,285.56
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$60.92 |
$60.92 |
$70.77 |
$112.36
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$56.70 |
$56.70 |
$56.70 |
$35.40
|
|
Handpiece aquabeam hp2000
|
$6,661.20 |
$6,661.20 |
$6,661.20 |
$6,605.63
|
|
Hand tendon reconstruction
|
$4,192.86 |
$4,192.86 |
$4,192.86 |
$4,192.86
|
|
Hand X-ray
|
$596.82 |
$596.82 |
$596.82 |
$338.58
|
|
Haptoglobin quantitative
|
$208.74 |
$208.74 |
$208.74 |
$89.95
|
|
Harvest auto stem cells
|
$3,699.36 |
$3,699.36 |
$3,699.36 |
$3,914.00
|
|
Hbot, full body chamber, 30m
|
$1,209.18 |
$1,209.18 |
$1,209.18 |
$494.40
|
|
Hc fl sm bowel enteroclss tube w kub double contrast
|
$840.84 |
$840.84 |
$840.84 |
$759.72
|
|
Hcg qualitative
|
$203.28 |
$203.28 |
$203.28 |
$77.50
|
|
Hcg quantitative
|
$312.06 |
$312.06 |
$312.06 |
$124.80
|
|
Hc i-131 sodium iodide cap dx per mci
|
$42.00 |
$42.00 |
$42.00 |
$136.50
|
|
Hc metata joint dislocation anes
|
$2,021.04 |
$2,021.04 |
$2,021.04 |
$2,423.85
|
|
Hc nm kidney imaging with flow
|
$611.52 |
$611.58 |
$611.58 |
$1,008.39
|
|
Hdr rdncl ntrstl/icav brchtx
|
$11,047.68 |
$11,047.68 |
$11,047.68 |
$2,725.00
|
|
Hdr rdncl ntrstl/icav brchtx
|
$11,172.42 |
$11,172.42 |
$11,172.42 |
$3,111.55
|
|
Hdr rdncl ntrstl/icav brchtx
|
$12,083.82 |
$12,083.82 |
$12,083.82 |
$3,410.55
|
|
Head CT scan (with and without contrast)
|
$4,035.36 |
$4,035.36 |
$4,035.36 |
$1,878.75
|
|
Head CT scan (with contrast)
|
$3,228.54 |
$3,228.54 |
$3,228.54 |
$1,520.45
|
|
Head CT scan (without contrast)
|
$140.00 |
$140.00 |
$2,421.30 |
$1,268.90
|
|
Heart infarct image
|
$1,666.02 |
$1,666.02 |
$1,666.14 |
$840.74
|
|
Hematocrit
|
$88.62 |
$88.62 |
$88.62 |
$33.57
|
|
Hemin 350 mg intravenous powder for solution
|
$48,294.83 |
$48,294.83 |
$48,294.83 |
$23,025.73
|
|
Hemodialysis one evaluation
|
$3,821.16 |
$3,821.16 |
$3,821.16 |
$1,329.90
|
|
Hemoglobin
|
$88.62 |
$88.62 |
$88.62 |
$31.75
|
|
Hemoglobin methemoglobin quantitative
|
$140.28 |
$140.28 |
$140.28 |
$49.40
|
|
Hemoglobin plasma
|
$42.84 |
$42.84 |
$42.84 |
$40.56
|
|
Hemorrhoidectomy intrnl lig rbbr band ligations
|
$1,170.54 |
$1,170.54 |
$1,170.54 |
$1,141.40
|
|
Hemorrhoidopexy stapling 46947
|
$3,619.14 |
$3,619.14 |
$3,619.14 |
$3,316.74
|
|
Hepagam b intravenous, inj
|
$960.12 |
$960.12 |
$960.12 |
$569.70
|
|
Heparin assay
|
$230.16 |
$230.16 |
$230.16 |
$130.20
|
|
Heparin bolus from bag
|
$56.70 |
$61.24 |
$129.87 |
$79.04
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$56.70 |
$56.70 |
$56.70 |
$32.27
|
|
Hepatitis a antibody igm
|
$812.28 |
$812.28 |
$812.28 |
$85.15
|
|
Hepatitis b core antibody igm
|
$845.04 |
$845.04 |
$845.04 |
$87.98
|
|
Hepatitis b core antibody total
|
$870.24 |
$870.24 |
$870.24 |
$83.29
|
|
Hepatitis b immune globulin greater than 1,560 units/5 ml im solution
|
$1,145.74 |
$1,145.74 |
$1,336.08 |
$1,116.61
|
|
Hepatitis b surface antibody
|
$382.20 |
$382.20 |
$382.20 |
$83.79
|
|
Hepatitis c antibody
|
$1,557.78 |
$1,557.78 |
$1,557.78 |
$108.00
|
|
Hepatobiliary system imaging
|
$1,678.32 |
$1,678.50 |
$1,678.50 |
$1,521.10
|
|
Hernia Repair (Inguinal)
|
$4,989.18 |
$4,989.18 |
$4,989.18 |
$5,870.15
|
|
Heterophile antibodies screening
|
$824.46 |
$824.46 |
$824.46 |
$73.60
|
|
Hip X-ray
|
$905.52 |
$905.52 |
$905.52 |
$292.05
|
|
Hiv-1 ag ia
|
$186.48 |
$186.48 |
$186.48 |
$84.67
|
|
Hlth bhv assmt/reassessment
|
$49.14 |
$49.14 |
$49.14 |
$180.70
|
|
Hlth bhv ivntj fam 1st 30
|
$19.32 |
$19.32 |
$19.32 |
$151.00
|
|
Hlth bhv ivntj grp 1st 30
|
$19.32 |
$19.32 |
$19.32 |
$78.50
|
|
Hlth bhv ivntj indiv 1st 30
|
$49.14 |
$49.14 |
$49.14 |
$190.13
|
|
Hocm 250-299mg/ml iodine,1ml
|
$37.80 |
$37.80 |
$37.80 |
$33.91
|
|
Home sleep test/type 3 porta
|
$179.76 |
$179.76 |
$179.76 |
$632.40
|
|
Homocysteine
|
$272.58 |
$272.58 |
$272.58 |
$113.10
|
|
H pylori (c-13) breath
|
$393.12 |
$393.12 |
$393.12 |
$219.05
|
|
H pylori drug admin
|
$41.16 |
$46.20 |
$46.20 |
$31.99
|
|
Human prothrombin complex concentrate (pcc)-lans 500 unit (400-640 unit) IV solution
|
$11,209.80 |
$11,209.80 |
$11,209.80 |
$4,652.48
|
|
Hyaluronidase, human recombinant 150 unit/ml injection solution
|
$296.34 |
$296.34 |
$296.34 |
$198.97
|
