|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$941.40 |
$941.40 |
$941.40 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$941.40 |
$941.40 |
$941.40 |
$451.50
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$941.40 |
$941.40 |
$941.40 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$941.40 |
$941.40 |
$941.40 |
$492.80
|
|
Ghs simple repair over 30 cm - 12007
|
$941.40 |
$941.40 |
$941.40 |
$589.80
|
|
Ghs simple repair over 30 cm - 12018
|
$941.40 |
$941.40 |
$941.40 |
$537.60
|
|
Ghs sphenopalatine ganglion block
|
$226.80 |
$226.80 |
$226.80 |
$616.08
|
|
Ghs strapping shoulder - 29240
|
$477.60 |
$477.60 |
$477.60 |
$220.20
|
|
Ghs st - re-eval for alt comm
|
$279.60 |
$279.60 |
$279.60 |
$309.00
|
|
Ghs superficial wnd dehiscence simp12020
|
$10,879.18 |
$10,879.18 |
$10,879.18 |
$883.50
|
|
Ghs superficial wnd dehis w packing12021
|
$795.00 |
$795.00 |
$795.00 |
$696.68
|
|
Ghs tracheostomy emergency - transtracheal
|
$1,156.80 |
$1,156.80 |
$1,156.80 |
$1,752.89
|
|
Ghs tx distal phalangeal fx with manipulation
|
$172.80 |
$172.80 |
$172.80 |
$526.35
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$172.80 |
$172.80 |
$172.80 |
$486.35
|
|
Ghs urine, porphyrins quant
|
$126.60 |
$126.60 |
$126.60 |
$75.00
|
|
Ghs vaginal delivery only
|
$4,052.40 |
$4,052.40 |
$4,052.40 |
$3,142.35
|
|
Ghs windowing of cast
|
$237.00 |
$237.00 |
$237.00 |
$212.55
|
|
Giardia lamblia antibody
|
$57.60 |
$57.60 |
$57.60 |
$83.44
|
|
Gi inhouse confirmation
|
$30.60 |
$30.60 |
$30.60 |
$86.25
|
|
Gi wireless capsule measure
|
$12,163.48 |
$12,163.48 |
$12,163.48 |
$1,579.30
|
|
Glove finger flexion right lg xl
|
$449.45 |
$449.45 |
$449.45 |
$114.00
|
|
Glucagon 1 mg solution for injection
|
$2,940.00 |
$2,940.00 |
$2,940.00 |
$601.79
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$2,937.90 |
$2,937.90 |
$2,937.90 |
$491.67
|
|
Glucagon plasma - sendout
|
$135.60 |
$135.60 |
$135.60 |
$63.00
|
|
Glucose 1 hr post dose
|
$49.20 |
$49.20 |
$49.20 |
$49.20
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$46.20 |
$46.20 |
$46.20 |
$24.60
|
|
Glucose blood quantitative
|
$39.60 |
$39.60 |
$39.60 |
$41.28
|
|
Glucose body fluid
|
$242.40 |
$242.40 |
$242.40 |
$52.20
|
|
Glucose tolerance test (gtt) 3 specimens
|
$69.60 |
$69.60 |
$69.60 |
$104.50
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$28.20 |
$28.20 |
$28.20 |
$35.10
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$48.00 |
$48.00 |
$48.00 |
$37.04
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$10,915.59 |
$10,915.59 |
$10,915.59 |
$4,943.84
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$142.80 |
$142.80 |
$142.80 |
$116.64
|
|
Gonadotropin luteinizing hormone (lh)
|
$134.40 |
$134.40 |
$134.40 |
$129.96
|
|
Goserelin 10.8 mg subcutaneous implant
|
$17,626.11 |
$17,626.11 |
$17,626.11 |
$4,665.26
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$8,859.10 |
$8,859.10 |
$8,859.10 |
$159.99
|
|
Graft axiofill 1000mg
|
$13,929.55 |
$13,929.55 |
$13,929.55 |
$6,300.79
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$119,395.04 |
$119,395.04 |
$119,395.04 |
$684.60
|
|
Graft hand or finger tendon
|
$18,324.64 |
$18,324.64 |
$18,324.64 |
$3,839.54
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$86,059.05 |
$86,059.05 |
$86,059.05 |
$23,801.51
|
|
Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm
|
$7,729.77 |
$7,729.77 |
$7,729.77 |
$3,432.00
|
|
Graft nerve adv 3-4x70mm
|
$219,865.71 |
$219,865.71 |
$219,865.71 |
$19,838.44
|
|
Graft patch felt ptfe 2x2
|
$166,368.00 |
$166,368.00 |
$166,368.00 |
$27,300.00
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$72,786.00 |
$72,786.00 |
$72,786.00 |
$1,625.46
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$26,670.87 |
$26,670.87 |
$26,670.87 |
$1,233.60
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$45,231.30 |
$45,231.30 |
$45,231.30 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$17,568.98 |
$17,568.98 |
$17,568.98 |
$427.89
|
|
Graft tis hmatrix dermis 10x5 -cost per sq cm
|
$7,798.50 |
$7,798.50 |
$7,798.50 |
$3,822.00
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$163,945.27 |
$163,945.27 |
$163,945.27 |
$28,502.41
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$13,777.35 |
$13,777.35 |
$13,777.35 |
$1,132.47
|
|
Graft xenmtrx sft rect 15x20cm
|
$164,236.41 |
$164,236.41 |
$164,236.41 |
$29,738.57
|
|
Graft xenmtrx sft rect 19x28cm
|
$77,790.04 |
$77,790.04 |
$77,790.04 |
$2,850.05
|
|
Granisetron hcl injection
|
$90.00 |
$90.00 |
$90.00 |
$45.03
|
|
Great toe with reduction 28495
|
$172.80 |
$172.80 |
$172.80 |
$495.00
|
|
Grfg autol fat lipo 25 cc/<
|
$27,577.07 |
$27,577.07 |
$27,577.07 |
$4,627.00
|
|
Grfg autol fat lipo 50 cc/<
|
$73,608.08 |
$73,608.08 |
$73,608.08 |
$5,102.99
|
|
Grfg autol fat lipo ea addl
|
$49,883.71 |
$49,883.71 |
$49,883.71 |
$4,026.40
|
|
Grfg autol soft tiss dir exc
|
$47,224.70 |
$47,224.70 |
$47,224.70 |
$4,332.25
|
|
Guided cath fluid drainage 10030
|
$2,856.60 |
$2,856.60 |
$2,856.60 |
$1,372.15
|
|
Guide endoanchr sg-64 aaa 62cm
|
$26,951.62 |
$26,951.62 |
$26,951.62 |
$7,728.17
|
|
Guide wire threaded 1.4x150mm
|
$41,488.02 |
$41,488.02 |
$41,488.02 |
$3,284.36
|
|
Guide worley csg 9fx50cm std
|
$3,639.30 |
$3,639.30 |
$3,639.30 |
$1,083.60
|
|
Gw stiffened micro access kit
|
$35,488.37 |
$35,488.37 |
$35,488.37 |
$6,500.00
|
|
Hallus-valgus nt dyn pre ots
|
$202.81 |
$202.81 |
$202.81 |
$102.37
|
|
Halo cervical into jckt vest
|
$35,093.25 |
$35,093.25 |
$35,093.25 |
$5,015.12
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$115.50 |
$115.50 |
$115.50 |
$91.09
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$48.00 |
$48.00 |
$48.00 |
$24.00
|
|
Halo repl liner/interface
|
$5,947.66 |
$5,947.66 |
$5,947.66 |
$1,931.10
|
|
Handle/convey/speciman/office-lab 99000
|
$27.60 |
$27.60 |
$27.60 |
$23.30
|
|
Hand orthosis metacarpal fracture orthosis prefa l3918
|
$450.49 |
$450.49 |
$450.49 |
$115.00
|
|
Handpiece aquabeam hp2000
|
$16,896.75 |
$16,896.75 |
$16,896.75 |
$6,628.05
|
|
Hand tendon reconstruction
|
$36,378.89 |
$36,378.89 |
$36,378.89 |
$5,023.20
|
|
Hand X-ray
|
$712.80 |
$712.80 |
$712.80 |
$364.81
|
|
Haptoglobin quantitative
|
$171.00 |
$171.00 |
$171.00 |
$91.80
|
|
Hbb full gene sequence
|
$1,074.00 |
$1,074.00 |
$1,074.00 |
$633.25
|
|
Hbot, full body chamber, 30m
|
$496.20 |
$496.20 |
$496.20 |
$543.84
|
|
Hcg qualitative
|
$186.60 |
$186.60 |
$186.60 |
$91.50
|
|
Hcg quantitative
|
$222.60 |
$222.60 |
$222.60 |
$141.83
|
|
Hc i-131 sodium iodide cap dx per mci
|
$218.40 |
$218.40 |
$218.40 |
$117.00
|
|
Head CT scan (with and without contrast)
|
$2,741.40 |
$2,741.40 |
$2,741.40 |
$1,834.20
|
|
Head CT scan (with contrast)
|
$2,964.00 |
$2,964.00 |
$2,964.00 |
$1,545.60
|
|
Head CT scan (without contrast)
|
$1,683.00 |
$1,683.00 |
$1,683.00 |
$1,268.90
|
|
Heel leather reinforced
|
$357.69 |
$357.69 |
$357.69 |
$180.55
|
|
Heinz bodies direct
|
$26.40 |
$26.40 |
$26.40 |
$37.50
|
|
Heinz bodies induced
|
$79.20 |
$79.20 |
$79.20 |
$31.22
|
|
Helicobacter pylori antibody igm
|
$89.40 |
$89.40 |
$89.40 |
$95.68
|
|
Hematocrit
|
$39.60 |
$39.60 |
$39.60 |
$33.57
|
|
Hemodialysis one evaluation
|
$1,338.00 |
$1,338.00 |
$1,338.00 |
$1,319.44
|
|
Hemoglobin
|
$57.60 |
$57.60 |
$57.60 |
$31.98
|
|
Hemoglobin methemoglobin quantitative
|
$93.00 |
$93.00 |
$93.00 |
$54.00
|
|
Hemoglobin plasma
|
$74.40 |
$74.40 |
$74.40 |
$41.25
|
|
Heparin assay
|
$264.00 |
$264.00 |
$264.00 |
$140.10
|
|
Heparin bolus from bag
|
$173.25 |
$173.25 |
$173.25 |
$68.93
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$48.00 |
$48.00 |
$48.00 |
$11.73
|
|
Hepatitis a antibody igm
|
$70.20 |
$70.20 |
$70.20 |
$90.40
|
|
Hepatitis b core antibody igm
|
$167.40 |
$167.40 |
$167.40 |
$88.80
|
|
Hepatitis b core antibody total
|
$50.40 |
$50.40 |
$50.40 |
$77.61
|
|
Hepatitis b immune globulin greater than 1,560 units/5 ml im solution
|
$2,897.62 |
$2,897.62 |
$2,897.62 |
$1,154.13
|
|
Hepatitis b surface antibody
|
$142.20 |
$142.20 |
$142.20 |
$83.50
|
|
Hepatitis c antibody
|
$178.80 |
$178.80 |
$178.80 |
$110.25
|