|
Ghs path - pap (papanicolau) smear - vagina
|
$31.80 |
$31.80 |
$31.80 |
$76.56
|
|
Ghs peritonsillar abscess i andd
|
$324.00 |
$324.00 |
$324.00 |
$546.36
|
|
Ghs pos nystagmus
|
$73.80 |
$73.80 |
$73.80 |
$228.00
|
|
Ghs pr without cont pulse ox
|
$141.00 |
$141.00 |
$141.00 |
$146.86
|
|
Ghs pt - work hardening/int 2hrs
|
$163.20 |
$163.20 |
$163.20 |
$275.60
|
|
Ghs refill of implantable pump
|
$441.00 |
$441.00 |
$441.00 |
$539.13
|
|
Ghs removal intranasal foreign body
|
$209.40 |
$209.40 |
$209.40 |
$287.50
|
|
Ghs rsv eia (respir synctial vrs)
|
$26.40 |
$26.40 |
$26.40 |
$96.60
|
|
Ghs sensitivity (per antimicro)
|
$132.60 |
$132.60 |
$132.60 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$327.00 |
$327.00 |
$327.00 |
$553.60
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$327.00 |
$327.00 |
$327.00 |
$575.00
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$327.00 |
$327.00 |
$327.00 |
$448.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$327.00 |
$327.00 |
$327.00 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$327.00 |
$327.00 |
$327.00 |
$484.80
|
|
Ghs simple repair over 30 cm - 12007
|
$136.20 |
$136.20 |
$136.20 |
$582.00
|
|
Ghs spont nystagmus
|
$78.00 |
$78.00 |
$78.00 |
$242.00
|
|
Ghs st - eval for alt comm
|
$25.20 |
$25.20 |
$25.20 |
$93.60
|
|
Ghs superficial wnd dehis w packing12021
|
$327.00 |
$327.00 |
$327.00 |
$661.50
|
|
Ghs tx distal phalangeal fx with manipulation
|
$286.80 |
$286.80 |
$286.80 |
$523.00
|
|
Gi inhouse confirmation
|
$30.60 |
$30.60 |
$30.60 |
$83.70
|
|
Glassia injection
|
$3.60 |
$3.60 |
$3.60 |
$20.32
|
|
Glucagon 1 mg solution for injection
|
$1,080.00 |
$1,080.00 |
$1,080.00 |
$601.79
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$690.60 |
$690.60 |
$690.60 |
$491.67
|
|
Glucagon plasma - sendout
|
$316.20 |
$316.20 |
$316.20 |
$63.00
|
|
Glucose 1 hr post dose
|
$127.20 |
$127.20 |
$127.20 |
$47.20
|
|
Glucose blood quantitative
|
$122.40 |
$122.40 |
$122.40 |
$40.00
|
|
Glucose body fluid
|
$134.40 |
$134.40 |
$134.40 |
$52.20
|
|
Glucose tolerance test (gtt) 3 specimens
|
$185.40 |
$185.40 |
$185.40 |
$100.16
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$120.60 |
$120.60 |
$120.60 |
$35.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$10.20 |
$10.20 |
$10.20 |
$37.04
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$5,780.40 |
$5,780.40 |
$5,780.40 |
$4,977.60
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$280.20 |
$280.20 |
$280.20 |
$115.05
|
|
Gonadotropin luteinizing hormone (lh)
|
$280.20 |
$280.20 |
$280.20 |
$129.00
|
|
Goserelin 10.8 mg subcutaneous implant
|
$2,017.80 |
$2,017.80 |
$2,017.80 |
$4,652.18
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$5,087.40 |
$5,087.40 |
$5,087.40 |
$672.50
|
|
Graft axiofill 1000mg
|
$133.20 |
$133.20 |
$133.20 |
$5,125.68
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$70.67 |
$70.67 |
$70.67 |
$24,469.57
|
|
Graft patch felt ptfe 2x2
|
$7,052.47 |
$7,052.47 |
$7,052.47 |
$27,300.00
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$94.08 |
$94.08 |
$94.08 |
$1,455.76
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$22,192.80 |
$22,192.80 |
$22,192.80 |
$1,181.41
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$10,595.70 |
$10,595.70 |
$10,595.70 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$526.26 |
$526.26 |
$526.26 |
$373.00
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$517.44 |
$517.44 |
$517.44 |
$1,132.47
|
|
Graft xenmtrx sft rect 15x20cm
|
$14,599.57 |
$14,599.57 |
$14,599.57 |
$30,392.04
|
|
Graft xenmtrx sft rect 19x28cm
|
$1,732.25 |
$1,732.25 |
$1,732.25 |
$2,701.58
|
|
Grfg autol soft tiss dir exc
|
$794.40 |
$794.40 |
$794.40 |
$4,332.25
|
|
Guide wire threaded 1.4x150mm
|
$1,234.80 |
$1,234.80 |
$1,234.80 |
$3,284.50
|
|
Gw stiffened micro access kit
|
$132.30 |
$132.30 |
$132.30 |
$6,696.00
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$172.20 |
$172.20 |
$172.20 |
$90.14
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$4.80 |
$4.80 |
$4.80 |
$23.06
|
|
Hand X-ray
|
$487.80 |
$487.80 |
$487.80 |
$356.00
|
|
Haptoglobin quantitative
|
$151.20 |
$151.20 |
$151.20 |
$91.14
|
|
Harvest femoropopliteal vein 35572
|
$543.60 |
$543.60 |
$543.60 |
$844.00
|
|
Hcg qualitative
|
$118.20 |
$118.20 |
$118.20 |
$89.70
|
|
Hcg quantitative
|
$185.40 |
$185.40 |
$185.40 |
$139.20
|
|
Hc metata joint dislocation anes
|
$2,823.00 |
$2,823.00 |
$2,823.00 |
$2,453.28
|
|
Head CT scan (with and without contrast)
|
$2,428.20 |
$2,428.20 |
$2,428.20 |
$1,849.90
|
|
Head CT scan (with contrast)
|
$1,710.00 |
$1,710.00 |
$1,710.00 |
$1,545.60
|
|
Head CT scan (without contrast)
|
$1,561.80 |
$1,561.80 |
$1,561.80 |
$1,268.90
|
|
Hematocrit
|
$60.00 |
$60.00 |
$60.00 |
$33.57
|
|
Hemodialysis one evaluation
|
$1,500.00 |
$1,500.00 |
$1,500.00 |
$1,319.44
|
|
Hemoglobin
|
$58.20 |
$58.20 |
$58.20 |
$31.80
|
|
Hemophilus influenza antibdy
|
$114.00 |
$114.00 |
$114.00 |
$62.70
|
|
Heparin bolus from bag
|
$33.00 |
$33.00 |
$33.00 |
$66.47
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$6.00 |
$6.00 |
$6.00 |
$10.61
|
|
Hepatitis a antibody igm
|
$157.80 |
$157.80 |
$157.80 |
$87.75
|
|
Hepatitis b core antibody igm
|
$163.20 |
$163.20 |
$163.20 |
$87.98
|
|
Hepatitis b core antibody total
|
$152.40 |
$152.40 |
$152.40 |
$77.50
|
|
Hepatitis b surface antibody
|
$213.00 |
$213.00 |
$213.00 |
$82.05
|
|
Hepatitis c antibody
|
$147.00 |
$147.00 |
$147.00 |
$108.00
|
|
Hepatobiliary system imaging
|
$688.80 |
$688.80 |
$688.80 |
$1,438.58
|
|
Herpes simplex type 1 antibody igg
|
$133.80 |
$133.80 |
$133.80 |
$70.00
|
|
Herpes simplex type 2 antibody igg
|
$109.80 |
$109.80 |
$109.80 |
$87.10
|
|
Heterophile antibodies screening
|
$102.00 |
$102.00 |
$102.00 |
$74.00
|
|
Hib-hepb vaccine im
|
$55.20 |
$55.20 |
$55.20 |
$85.80
|
|
Hip X-ray
|
$239.40 |
$239.40 |
$239.40 |
$292.05
|
|
Histamine
|
$253.20 |
$253.20 |
$253.20 |
$115.00
|
|
Hla i low res one antigen equiv ea
|
$109.80 |
$109.80 |
$109.80 |
$161.70
|
|
Hocm 350-399mg/ml iodine,1ml
|
$296.40 |
$296.40 |
$296.40 |
$79.78
|
|
Home sleep test/type 3 porta
|
$457.80 |
$457.80 |
$457.80 |
$579.26
|
|
Homocysteine
|
$252.60 |
$252.60 |
$252.60 |
$121.92
|
|
Hpv types 16 & 18 only
|
$87.00 |
$87.00 |
$87.00 |
$110.70
|
|
Hydralazine 20 mg/ml injection solution
|
$42.60 |
$42.60 |
$42.60 |
$46.74
|
|
Hydration IV infusion each additional hour
|
$80.40 |
$80.40 |
$80.40 |
$131.20
|
|
Hydration IV infusion initial 31minutes - 1 hour
|
$289.20 |
$289.20 |
$289.20 |
$383.00
|
|
Hydrocortisone in ns IV syringe 1 mg/ml (neo/ped) - cnr
|
$47.40 |
$47.40 |
$47.40 |
$154.78
|
|
Hydromorphone 0.2 mg/ml in 0.9% nacl IV pca opioid naive - 4 hr dose limit (wrapper)
|
$17.40 |
$17.40 |
$17.40 |
$131.47
|
|
Hydroxyzine hcl 50 mg/ml intramuscular solution
|
$72.00 |
$72.00 |
$72.00 |
$72.65
|
|
#hypersens-actinomyces ab
|
$16.80 |
$16.80 |
$16.80 |
$31.74
|
|
Hysteroscopy ablation
|
$1,642.20 |
$1,642.20 |
$1,642.20 |
$5,841.60
|
|
Hysteroscopy biopsy
|
$927.00 |
$927.00 |
$927.00 |
$5,110.50
|
|
Hysteroscopy lysis
|
$1,083.00 |
$1,083.00 |
$1,083.00 |
$5,468.70
|
|
I-123 sod iodide diag per 100 uci
|
$154.20 |
$154.20 |
$154.20 |
$139.20
|
|
Ibandronate 3 mg/3 ml intravenous syringe
|
$1,672.20 |
$1,672.20 |
$1,672.20 |
$635.44
|
|
Icd cobalt xt dr MRI is1 df1
|
$51,889.60 |
$51,889.60 |
$51,889.60 |
$34,234.20
|
|
Icd crtd cobalt hf MRI is1 df1
|
$34,274.52 |
$34,274.52 |
$34,274.52 |
$37,789.50
|
|
Icd reliance df4 ib 64cm
|
$1,441.19 |
$1,441.19 |
$1,441.19 |
$9,259.80
|
|
Ihc/icc per specimen each additional single antibody stain
|
$291.00 |
$291.00 |
$291.00 |
$191.52
|
|
Ihc/icc per specimen initial single antibody stain
|
$399.60 |
$399.60 |
$399.60 |
$274.86
|
|
Immobilizer shldr cntor adlt
|
$68.09 |
$68.09 |
$68.09 |
$171.43
|
