|
Ghs moderate sedation ea addtl 15 min
|
$87.00 |
$87.00 |
$87.00 |
$145.60
|
|
Ghs musc test done w/n test comp
|
$39.00 |
$39.00 |
$39.00 |
$349.80
|
|
Ghs musc tst done w/nerv tst lim
|
$39.00 |
$39.00 |
$39.00 |
$269.15
|
|
Ghs musc tst done w/n tst non ext
|
$25.95 |
$25.95 |
$25.95 |
$222.60
|
|
Ghs myocardial strain img spckl track
|
$239.10 |
$239.10 |
$239.10 |
$503.85
|
|
Ghs nailbed repair/nail removal
|
$301.57 |
$301.57 |
$301.57 |
$808.80
|
|
Ghs ng placement w fluoro guidance
|
$175.34 |
$175.34 |
$175.34 |
$468.75
|
|
Ghs ot prosthetic training/15 min
|
$29.85 |
$29.85 |
$29.85 |
$92.35
|
|
Ghs ot sensory integrative tech/15min
|
$35.85 |
$35.85 |
$35.85 |
$101.05
|
|
Ghs pacing - transcutaneous
|
$96.00 |
$96.00 |
$96.00 |
$868.68
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$105.75 |
$105.75 |
$105.75 |
$855.60
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$105.75 |
$105.75 |
$105.75 |
$1,003.00
|
|
Ghs peritonsillar abscess i andd
|
$126.90 |
$126.90 |
$126.90 |
$694.20
|
|
Ghs phenylketonurid
|
$17.40 |
$17.40 |
$17.40 |
$51.58
|
|
Ghs plngl fx pm cl
|
$133.73 |
$133.73 |
$133.73 |
$662.20
|
|
Ghs prostatic acid phosphatase (mayo)
|
$32.40 |
$32.40 |
$32.40 |
$40.56
|
|
Ghs protoporphyrins fract
|
$39.30 |
$39.30 |
$39.30 |
$64.35
|
|
Ghs removal intranasal foreign body
|
$64.13 |
$64.13 |
$64.13 |
$324.35
|
|
Ghs removal pharyngeal foreign body
|
$166.35 |
$166.35 |
$166.35 |
$460.00
|
|
Ghs respiratory syncytical virus igg/m
|
$62.40 |
$62.40 |
$62.40 |
$42.40
|
|
Ghs rsv eia (respir synctial vrs)
|
$67.48 |
$67.48 |
$67.48 |
$101.15
|
|
Ghs sensitivity (per antimicro)
|
$43.80 |
$43.80 |
$43.80 |
$59.90
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$445.80 |
$445.80 |
$445.80 |
$590.40
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$486.15 |
$486.15 |
$486.15 |
$705.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$545.55 |
$545.55 |
$545.55 |
$670.08
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$585.90 |
$585.90 |
$585.90 |
$585.90
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$284.55 |
$284.55 |
$284.55 |
$487.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$348.15 |
$348.15 |
$348.15 |
$470.47
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$358.80 |
$358.80 |
$358.80 |
$538.64
|
|
Ghs simple repair over 30 cm - 12007
|
$679.20 |
$679.20 |
$679.20 |
$660.00
|
|
Ghs somatosensory testing lower extremit
|
$89.85 |
$89.85 |
$89.85 |
$947.48
|
|
Ghs somatosensory testing upper & lower limbs
|
$159.75 |
$159.75 |
$159.75 |
$1,435.00
|
|
Ghs speech-gen aug dev eval iii, st
|
$38.55 |
$38.55 |
$38.55 |
$124.80
|
|
Ghs sphenopalatine ganglion block
|
$160.05 |
$160.05 |
$160.05 |
$706.56
|
|
Ghs sp train/fitting sp device - kx
|
$53.85 |
$53.85 |
$53.85 |
$261.95
|
|
Ghs superficial wnd dehiscence simp12020
|
$320.85 |
$320.85 |
$320.85 |
$976.98
|
|
Ghs tx distal phalangeal fx with manipulation
|
$131.10 |
$131.10 |
$131.10 |
$591.00
|
|
Ghs urine, porphyrins quant
|
$53.71 |
$53.71 |
$53.71 |
$70.20
|
|
Ghs vaginal delivery only
|
$1,126.95 |
$1,126.95 |
$1,126.95 |
$3,525.06
|
|
Giardia lamblia antibody
|
$32.31 |
$32.31 |
$32.31 |
$81.60
|
|
Gi inhouse confirmation
|
$83.70 |
$83.70 |
$83.70 |
$87.00
|
|
Glove finger flexion right lg xl
|
$68.83 |
$68.83 |
$68.83 |
$93.10
|
|
Glucagon 1 mg solution for injection
|
$972.28 |
$972.28 |
$972.28 |
$613.00
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$876.92 |
$876.92 |
$876.92 |
$509.06
|
|
Glucagon plasma - sendout
|
$60.75 |
$60.75 |
$60.75 |
$58.56
|
|
Glucose-6-phosphate dhydrogenase screen
|
$19.98 |
$19.98 |
$19.98 |
$45.34
|
|
Glucose blood quantitative
|
$25.95 |
$25.95 |
$25.95 |
$44.76
|
|
Glucose body fluid
|
$38.63 |
$38.63 |
$38.63 |
$50.70
|
|
Glucose monitoring continual min 72hr pt
|
$34.65 |
$34.65 |
$34.65 |
$139.10
|
|
Glucose tolerance test (gtt) 3 specimens
|
$46.71 |
$46.71 |
$46.71 |
$100.10
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$15.26 |
$15.26 |
$15.26 |
$34.45
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$159.06 |
$159.06 |
$159.06 |
$56.70
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$1,734.50 |
$1,734.50 |
$1,734.50 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$78.30 |
$78.30 |
$78.30 |
$110.04
|
|
Gonadotropin luteinizing hormone (lh)
|
$61.80 |
$61.80 |
$61.80 |
$123.75
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$22.92 |
$22.92 |
$22.92 |
$2,648.81
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$17,536.05 |
$17,536.05 |
$17,536.05 |
$25,762.70
|
|
Graft nerve adv 3-4x70mm
|
$21,477.18 |
$21,477.18 |
$21,477.18 |
$27,495.00
|
|
Graft patch felt ptfe 2x2
|
$17,112.38 |
$17,112.38 |
$17,112.38 |
$25,728.84
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$1,181.41 |
$1,181.41 |
$1,181.41 |
$1,560.21
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$115.44 |
$115.44 |
$115.44 |
$336.78
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$3,691.64 |
$3,691.64 |
$3,691.64 |
$35,824.13
|
|
Graft xenmtrx sft rect 15x20cm
|
$25,824.49 |
$25,824.49 |
$25,824.49 |
$43,312.93
|
|
Graft xenmtrx sft rect 19x28cm
|
$1,683.36 |
$1,683.36 |
$1,683.36 |
$2,653.10
|
|
Great toe with reduction 28495
|
$118.58 |
$118.58 |
$118.58 |
$577.03
|
|
Growth hormone antibody
|
$14.55 |
$14.55 |
$14.55 |
$40.00
|
|
G-tube reposition
|
$180.45 |
$180.45 |
$180.45 |
$741.00
|
|
Guided cath fluid drainage 10030
|
$564.60 |
$564.60 |
$564.60 |
$1,461.15
|
|
Guide endoanchr sg-64 aaa 62cm
|
$7,133.49 |
$7,133.49 |
$7,133.49 |
$7,133.49
|
|
Guide wire threaded 1.4x150mm
|
$567.79 |
$567.79 |
$567.79 |
$3,474.86
|
|
Guide worley csg 9fx50cm std
|
$986.55 |
$986.55 |
$986.55 |
$2,229.99
|
|
Guid loc target vol rad tx
|
$146.55 |
$146.55 |
$146.55 |
$503.80
|
|
Gw stiffened micro access kit
|
$1,231.02 |
$1,231.02 |
$1,231.02 |
$6,285.56
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$65.19 |
$65.19 |
$65.19 |
$35.40
|
|
Hand X-ray
|
$256.20 |
$256.20 |
$256.20 |
$338.58
|
|
Haptoglobin quantitative
|
$44.85 |
$44.85 |
$44.85 |
$89.95
|
|
Hbot, full body chamber, 30m
|
$215.40 |
$215.40 |
$215.40 |
$494.40
|
|
Hcg qualitative
|
$65.70 |
$65.70 |
$65.70 |
$77.50
|
|
Hcg quantitative
|
$75.15 |
$75.15 |
$75.15 |
$124.80
|
|
Hc nm fusion spect CT unlisted
|
$90.60 |
$90.60 |
$90.60 |
$463.68
|
|
Hc pet myocardial imaging metabolic eval single study
|
$1,022.85 |
$1,022.85 |
$1,022.85 |
$3,309.00
|
|
Head CT scan (with and without contrast)
|
$1,337.10 |
$1,337.10 |
$1,337.10 |
$1,878.75
|
|
Head CT scan (with contrast)
|
$1,141.50 |
$1,141.50 |
$1,141.50 |
$1,520.45
|
|
Head CT scan (without contrast)
|
$815.40 |
$815.40 |
$815.40 |
$1,268.90
|
|
Heart first pass add-on
|
$138.00 |
$138.00 |
$138.00 |
$445.54
|
|
Helicobacter pylori antibody igm
|
$52.35 |
$52.35 |
$52.35 |
$84.80
|
|
Hemodialysis one evaluation
|
$505.05 |
$505.05 |
$505.05 |
$1,329.90
|
|
Hemoglobin fetal qualitative
|
$6.58 |
$6.58 |
$6.58 |
$51.75
|
|
Hemoglobin methemoglobin quantitative
|
$8.54 |
$8.54 |
$8.54 |
$49.40
|
|
Hemoglobin plasma
|
$9.90 |
$9.90 |
$9.90 |
$40.56
|
|
Hemolysin acid
|
$24.68 |
$24.68 |
$24.68 |
$31.74
|
|
Hemolysins and agglutinins incubated
|
$38.25 |
$38.25 |
$38.25 |
$67.50
|
|
Hemophilus influenza antibdy
|
$13.96 |
$13.96 |
$13.96 |
$56.80
|
|
Heparin assay
|
$44.84 |
$44.84 |
$44.84 |
$130.20
|
|
Heparin bolus from bag
|
$180.47 |
$180.47 |
$180.47 |
$79.04
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$281.97 |
$281.97 |
$281.97 |
$32.27
|
|
Hepatitis a antibody igm
|
$40.80 |
$40.80 |
$40.80 |
$85.15
|
|
Hepatitis b core antibody igm
|
$36.57 |
$36.57 |
$36.57 |
$87.98
|
|
Hepatitis b core antibody total
|
$48.38 |
$48.38 |
$48.38 |
$83.29
|
|
Hepatitis b immune globulin greater than 1,560 units/5 ml im solution
|
$613.92 |
$613.92 |
$613.92 |
$1,116.61
|