|
Floweramniopatch, per sq cm
|
$1.00 |
$1.00 |
$1.00 |
$269.00
|
|
Fluoroguide for spine inject 77003-26
|
$1,404.00 |
$1,404.00 |
$1,404.00 |
$495.00
|
|
Fluoroguide needle placement
|
$14,912.00 |
$14,912.00 |
$14,912.00 |
$497.92
|
|
Fluoroscopy (Live X-ray Guidance, up to 1 hour)
|
$3,670.00 |
$3,670.00 |
$3,670.00 |
$503.80
|
|
Folic acid
|
$688.00 |
$688.00 |
$688.00 |
$101.50
|
|
Folic acid 5 mg/ml injection solution
|
$8.82 |
$8.82 |
$8.82 |
$45.00
|
|
Formoterol fumarate, inh
|
$46.00 |
$46.00 |
$46.00 |
$59.40
|
|
Fructosamine glycated protein
|
$5.00 |
$5.00 |
$5.00 |
$63.50
|
|
Full Spine X-ray (Scoliosis Survey)
|
$2,111.00 |
$2,111.00 |
$2,111.00 |
$355.00
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$161.00 |
$161.00 |
$161.00 |
$108.40
|
|
Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution
|
$933.00 |
$933.00 |
$933.00 |
$177.52
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$530.00 |
$530.00 |
$530.00 |
$249.80
|
|
Gallbladder and Bile Duct Scan (HIDA Scan)
|
$23,760.00 |
$23,760.00 |
$23,760.00 |
$1,494.00
|
|
Gallbladder Function Scan (HIDA with Medication)
|
$21,786.00 |
$21,786.00 |
$21,786.00 |
$1,615.00
|
|
Gammaglobulin ige
|
$234.00 |
$234.00 |
$234.00 |
$83.85
|
|
Gamma glutamyltransferase
|
$478.00 |
$478.00 |
$478.00 |
$57.54
|
|
Gammagraft
|
$1.00 |
$1.00 |
$1.00 |
$1.00
|
|
Gamunex-c/gammaked
|
$5,429.72 |
$5,429.72 |
$5,429.72 |
$7,435.88
|
|
Gemcitabine 1 gram intravenous solution
|
$140.00 |
$140.00 |
$140.00 |
$207.51
|
|
Ghs HIV antibody
|
$55.00 |
$55.00 |
$55.00 |
$89.70
|
|
Ghs inhibitor screen
|
$63.00 |
$63.00 |
$63.00 |
$191.88
|
|
Ghs mbp
|
$46.06 |
$46.06 |
$46.06 |
$76.00
|
|
Ghs prostatic acid phosphatase (mayo)
|
$76.13 |
$76.13 |
$76.13 |
$43.55
|
|
Ghs sensitivity (per antimicro)
|
$816.00 |
$816.00 |
$816.00 |
$57.60
|
|
Ghs urine, porphyrins quant
|
$18.00 |
$18.00 |
$18.00 |
$73.80
|
|
Gi inhouse confirmation
|
$1,919.00 |
$1,919.00 |
$1,919.00 |
$87.75
|
|
Glucagon 1 mg solution for injection
|
$761.00 |
$761.00 |
$761.00 |
$613.79
|
|
Glucose blood quantitative
|
$724.00 |
$724.00 |
$724.00 |
$42.25
|
|
Glucose tolerance test (gtt) 3 specimens
|
$1,372.00 |
$1,372.00 |
$1,372.00 |
$105.60
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$460.00 |
$460.00 |
$460.00 |
$36.00
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$1,282.00 |
$1,282.00 |
$1,282.00 |
$116.64
|
|
Gonadotropin luteinizing hormone (lh)
|
$1,540.00 |
$1,540.00 |
$1,540.00 |
$129.03
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$1.00 |
$1.00 |
$1.00 |
$73.83
|
|
Graft bone flex 2.5cm x 5cm grafton-cost per sq cm
|
$1.00 |
$1.00 |
$1.00 |
$1.00
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$1.00 |
$1.00 |
$1.00 |
$605.00
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$1.00 |
$1.00 |
$1.00 |
$23,233.80
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$1.00 |
$1.00 |
$1.00 |
$1,111.05
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$1.00 |
$1.00 |
$1.00 |
$886.17
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$1.00 |
$1.00 |
$1.00 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$1.00 |
$1.00 |
$1.00 |
$349.41
|
|
Graft tis hmatrix dermis 10x5 -cost per sq cm
|
$1.00 |
$1.00 |
$1.00 |
$3,822.00
|
|
Graft viashield 2layer amnion patch 2x2cm-cost per sq cm
|
$1.00 |
$1.00 |
$1.00 |
$1.00
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$1.00 |
$1.00 |
$1.00 |
$1,103.05
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$132.00 |
$132.00 |
$132.00 |
$24.30
|
|
Haptoglobin quantitative
|
$569.00 |
$569.00 |
$569.00 |
$92.80
|
|
Hc fl sm bowel enteroclss tube w kub double contrast
|
$2,263.00 |
$2,263.00 |
$2,263.00 |
$726.00
|
|
Hcg quantitative
|
$1,631.00 |
$1,631.00 |
$1,631.00 |
$139.20
|
|
Heart infarct image
|
$10,241.00 |
$10,241.00 |
$10,241.00 |
$942.29
|
|
Helicobacter pylori antibody igm
|
$21.00 |
$21.00 |
$21.00 |
$92.00
|
|
Helicoll, per square cm
|
$1.00 |
$1.00 |
$1.00 |
$1.00
|
|
Hemoglobin
|
$437.00 |
$437.00 |
$437.00 |
$33.54
|
|
Hemoglobin methemoglobin quantitative
|
$27.00 |
$27.00 |
$27.00 |
$52.32
|
|
Hemolysins/agglutinins auto
|
$28.00 |
$28.00 |
$28.00 |
$62.48
|
|
Hemolysins and agglutinins incubated
|
$39.00 |
$39.00 |
$39.00 |
$61.79
|
|
Heparin assay
|
$42.00 |
$42.00 |
$42.00 |
$139.15
|
|
Hepatitis a antibody igm
|
$1,226.00 |
$1,226.00 |
$1,226.00 |
$89.44
|
|
Hepatitis b core antibody igm
|
$1,335.00 |
$1,335.00 |
$1,335.00 |
$89.60
|
|
Hepatitis b core antibody total
|
$1,335.00 |
$1,335.00 |
$1,335.00 |
$77.50
|
|
Hepatitis b surface antibody
|
$1,335.00 |
$1,335.00 |
$1,335.00 |
$82.32
|
|
Hepatitis c antibody
|
$923.00 |
$923.00 |
$923.00 |
$108.25
|
|
Herpes simplex type 1 antibody igg
|
$65.00 |
$65.00 |
$65.00 |
$69.12
|
|
Herpes simplex type 2 antibody igg
|
$65.00 |
$65.00 |
$65.00 |
$87.36
|
|
Herpes simplex virus isolation
|
$119.00 |
$119.00 |
$119.00 |
$110.00
|
|
Heterophile antibodies screening
|
$783.00 |
$783.00 |
$783.00 |
$73.87
|
|
Hiv-1 ag ia
|
$78.00 |
$78.00 |
$78.00 |
$107.90
|
|
Hla i low res one antigen equiv ea
|
$241.00 |
$241.00 |
$241.00 |
$164.00
|
|
Hla i typing high res 1 allele grp ea
|
$614.25 |
$614.25 |
$614.25 |
$304.20
|
|
Homocysteine
|
$240.00 |
$240.00 |
$240.00 |
$125.40
|
|
Homogenization tissue
|
$21.00 |
$21.00 |
$21.00 |
$41.30
|
|
H pylori (c-13) breath
|
$70.00 |
$70.00 |
$70.00 |
$212.25
|
|
H pylori drug admin
|
$91.88 |
$91.88 |
$91.88 |
$28.56
|
|
Hydralazine 20 mg/ml injection solution
|
$134.00 |
$134.00 |
$134.00 |
$48.00
|
|
Hysterosalpingography s&i
|
$5,057.00 |
$5,057.00 |
$5,057.00 |
$669.12
|
|
I-123 sod iodide diag per 100 uci
|
$748.00 |
$748.00 |
$748.00 |
$147.46
|
|
Ibandronate 3 mg/3 ml intravenous syringe
|
$4,524.00 |
$4,524.00 |
$4,524.00 |
$684.45
|
|
Ibutilide fumarate 0.1 mg/ml intravenous solution
|
$594.00 |
$594.00 |
$594.00 |
$980.94
|
|
Ihc/icc per specimen each additional single antibody stain
|
$462.00 |
$462.00 |
$462.00 |
$191.52
|
|
Ihc/icc per specimen each multiplex antibody stain
|
$688.00 |
$688.00 |
$688.00 |
$331.20
|
|
Ihc/icc per specimen initial single antibody stain
|
$462.00 |
$462.00 |
$462.00 |
$277.90
|
|
Immunoassay tumor antigen quantitative ca 125
|
$1,335.00 |
$1,335.00 |
$1,335.00 |
$132.00
|
|
Immunoassay tumor antigen quantitative ca 19-9
|
$288.00 |
$288.00 |
$288.00 |
$116.40
|
|
Immunodiff gel qual ea antigen/ab
|
$30.00 |
$30.00 |
$30.00 |
$48.57
|
|
Immunofixation electrophoresis serum
|
$724.00 |
$724.00 |
$724.00 |
$142.50
|
|
Implant ureth bulk agent
|
$1,241.00 |
$1,241.00 |
$1,241.00 |
$2,168.00
|
|
Indigotindisulfonate 8 mg/ml soln 5 ml ampule
|
$276.00 |
$276.00 |
$276.00 |
$766.66
|
|
Infect ag drug suscept pheno predict
|
$143.68 |
$143.68 |
$143.68 |
$325.00
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$283.92 |
$283.92 |
$283.92 |
$603.83
|
|
Infect ag if legionella pneumophila
|
$55.00 |
$55.00 |
$55.00 |
$73.45
|
|
Infect ag if pneumocystis carinii
|
$35.94 |
$35.94 |
$35.94 |
$66.06
|
|
Infect ag na orthopoxvirus amp prb each
|
$90.00 |
$90.00 |
$90.00 |
$100.00
|
|
Infect ag na resp virus 12-25 targets
|
$175.00 |
$175.00 |
$175.00 |
$854.70
|
|
Infect ag phenotype na hiv-1 1-10 drugs
|
$193.31 |
$193.31 |
$193.31 |
$954.00
|
|
Infect ag phenotype na hiv-1 ea addl drg
|
$193.31 |
$193.31 |
$193.31 |
$75.63
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$529.00 |
$529.00 |
$529.00 |
$83.60
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium
|
$178.00 |
$178.00 |
$178.00 |
$76.00
|
|
Infectious agent antigen immunoassay ql/sq multi step giardia
|
$129.00 |
$129.00 |
$129.00 |
$74.88
|
|
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool
|
$177.00 |
$177.00 |
$177.00 |
$103.40
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$1,335.00 |
$1,335.00 |
$1,335.00 |
$81.20
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$78.00 |
$78.00 |
$78.00 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$28.49 |
$28.49 |
$28.49 |
$98.58
|
