|
Ghs leukocyte alkaline phos (mayo)
|
$10.00 |
$10.00 |
$10.00 |
$59.40
|
|
Ghs mbp
|
$13.16 |
$13.16 |
$13.16 |
$74.19
|
|
Ghs o2 saturation
|
$611.85 |
$611.85 |
$611.85 |
$72.45
|
|
Ghs ob unlisted IV or art inj or infusion
|
$1,016.15 |
$1,016.15 |
$1,016.15 |
$86.19
|
|
Ghs pacing - transcutaneous
|
$7,924.62 |
$7,924.62 |
$7,924.62 |
$868.68
|
|
Ghs plt ct-manual
|
$934.26 |
$934.26 |
$934.26 |
$39.20
|
|
Ghs ppd (tb intradermal)
|
$20.00 |
$20.00 |
$20.00 |
$43.45
|
|
Ghs pseudocholinesterase,dibucain-inhibi
|
$12.50 |
$12.50 |
$12.50 |
$45.05
|
|
Ghs quinidine
|
$9.89 |
$9.89 |
$9.89 |
$68.40
|
|
Ghs reticulocyte count
|
$1,117.89 |
$1,117.89 |
$1,117.89 |
$33.57
|
|
Ghs rsv eia (respir synctial vrs)
|
$1,981.90 |
$1,981.90 |
$1,981.90 |
$101.15
|
|
Ghs sensitivity (per antimicro)
|
$775.08 |
$775.08 |
$775.08 |
$59.90
|
|
Ghs speech-gen aug dev eval iii, st
|
$239.11 |
$239.11 |
$239.11 |
$124.80
|
|
Ghs sp train/fitting sp device - kx
|
$523.95 |
$523.95 |
$523.95 |
$261.95
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$515.00 |
$515.00 |
$515.00 |
$93.75
|
|
Ghs subcutaneous infus. for therapy init 1 hr
|
$1,802.38 |
$1,802.38 |
$1,802.38 |
$351.45
|
|
Ghs urine, porphyrins quant
|
$16.00 |
$16.00 |
$16.00 |
$70.20
|
|
Gi endoscopic ultrasound
|
$16,869.26 |
$16,869.26 |
$16,869.26 |
$328.08
|
|
Gi inhouse confirmation
|
$1,750.07 |
$1,750.07 |
$1,750.07 |
$87.00
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$13,056.31 |
$13,056.31 |
$13,056.31 |
$2,382.90
|
|
Glucagon 1 mg solution for injection
|
$945.04 |
$945.04 |
$945.04 |
$613.00
|
|
Glucagon plasma - sendout
|
$17.10 |
$17.10 |
$17.10 |
$58.56
|
|
Glucose 1 hr post dose
|
$1,809.12 |
$1,809.12 |
$1,809.12 |
$46.28
|
|
Glucose blood quantitative
|
$977.46 |
$977.46 |
$977.46 |
$44.76
|
|
Glucose tolerance test (gtt) 3 specimens
|
$1,185.17 |
$1,185.17 |
$1,185.17 |
$100.10
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$985.99 |
$985.99 |
$985.99 |
$34.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$151.23 |
$151.23 |
$151.23 |
$110.04
|
|
Gonadotropin luteinizing hormone (lh)
|
$150.69 |
$150.69 |
$150.69 |
$123.75
|
|
Goserelin 10.8 mg subcutaneous implant
|
$10,776.45 |
$10,776.45 |
$10,776.45 |
$2,802.00
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$4,833.53 |
$4,833.53 |
$4,833.53 |
$2,648.81
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$4,640.18 |
$4,640.18 |
$4,640.18 |
$10,989.38
|
|
Granisetron 1 mg tab
|
$448.90 |
$448.90 |
$448.90 |
$10.04
|
|
Granisetron hcl injection
|
$1,334.72 |
$1,334.72 |
$1,334.72 |
$41.65
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$156.37 |
$156.37 |
$156.37 |
$35.40
|
|
Hbot, full body chamber, 30m
|
$3,479.04 |
$3,479.04 |
$3,479.04 |
$494.40
|
|
Hc fl sm bowel enteroclss tube w kub double contrast
|
$8,115.91 |
$8,115.91 |
$8,115.91 |
$759.72
|
|
Hcg qualitative
|
$1,949.54 |
$1,949.54 |
$1,949.54 |
$77.50
|
|
Hc nm cardiac blood pool planar 1 stdy wal motn eject fract
|
$10,748.19 |
$10,748.19 |
$10,748.19 |
$839.65
|
|
Hc nm myocard infarct avid plnr tomo spect w/wo quant
|
$14,392.21 |
$14,392.21 |
$14,392.21 |
$1,186.80
|
|
Head CT scan (with and without contrast)
|
$17,332.99 |
$17,332.99 |
$17,332.99 |
$1,878.75
|
|
Head CT scan (with contrast)
|
$16,608.88 |
$16,608.88 |
$16,608.88 |
$1,520.45
|
|
Head CT scan (without contrast)
|
$16,594.16 |
$16,594.16 |
$16,594.16 |
$1,268.90
|
|
Heart infarct image
|
$9,348.24 |
$9,348.24 |
$9,348.24 |
$840.74
|
|
Hematocrit
|
$691.19 |
$691.19 |
$691.19 |
$33.57
|
|
Hemin 350 mg intravenous powder for solution
|
$19,899.42 |
$19,899.42 |
$19,899.42 |
$23,025.73
|
|
Hemoglobin
|
$815.49 |
$815.49 |
$815.49 |
$31.75
|
|
Hemoglobin f (fetal) chemical
|
$9.16 |
$9.16 |
$9.16 |
$45.82
|
|
Hemoglobin methemoglobin quantitative
|
$167.33 |
$167.33 |
$167.33 |
$49.40
|
|
Hemoglobin plasma
|
$8.28 |
$8.28 |
$8.28 |
$40.56
|
|
Hemolysins/agglutinins auto
|
$9.00 |
$9.00 |
$9.00 |
$53.90
|
|
Hepatitis b core antibody total
|
$98.05 |
$98.05 |
$98.05 |
$83.29
|
|
Hepatitis b immune globulin greater than 1,560 units/5 ml im solution
|
$4,792.11 |
$4,792.11 |
$4,792.11 |
$1,116.61
|
|
Hepatobiliary system imaging
|
$9,945.90 |
$9,945.90 |
$9,945.90 |
$1,521.10
|
|
Heterophile antibodies screening
|
$1,050.07 |
$1,050.07 |
$1,050.07 |
$73.60
|
|
Hip X-ray
|
$2,808.52 |
$2,808.52 |
$2,808.52 |
$292.05
|
|
Histamine
|
$8.55 |
$8.55 |
$8.55 |
$125.40
|
|
Hla i typing high res 1 allele grp ea
|
$62.50 |
$62.50 |
$62.50 |
$307.53
|
|
Hla typing a b or c
|
$495.00 |
$495.00 |
$495.00 |
$309.40
|
|
Homogenization tissue
|
$169.73 |
$169.73 |
$169.73 |
$39.00
|
|
Homovanillic acid (hva)
|
$10.88 |
$10.88 |
$10.88 |
$56.00
|
|
Hyaluronidase, human recombinant 150 unit/ml injection solution
|
$367.98 |
$367.98 |
$367.98 |
$198.97
|
|
Hydralazine 20 mg/ml injection solution
|
$199.43 |
$199.43 |
$199.43 |
$57.02
|
|
Hydroxyzine pamoate 25 mg capsule
|
$16.47 |
$16.47 |
$16.47 |
$10.83
|
|
Hyperthermia gen intrcv prb
|
$1.48 |
$1.48 |
$1.48 |
$759.77
|
|
Hysterosalpingography s&i
|
$6,019.41 |
$6,019.41 |
$6,019.41 |
$629.46
|
|
I-123 iobenguane diag
|
$25,487.70 |
$25,487.70 |
$25,487.70 |
$5,730.40
|
|
I-123 sod iodide diag per 100 uci
|
$2,996.28 |
$2,996.28 |
$2,996.28 |
$158.05
|
|
I-131 iobenguane sulf diag mibg
|
$19,448.74 |
$19,448.74 |
$19,448.74 |
$5,062.20
|
|
I131 iodide cap, rx
|
$284.15 |
$284.15 |
$284.15 |
$91.83
|
|
I131 iodide sol, rx
|
$321.76 |
$321.76 |
$321.76 |
$42.01
|
|
Iaadi respiratory synctial virus
|
$132.74 |
$132.74 |
$132.74 |
$42.48
|
|
Ibutilide fumarate 0.1 mg/ml intravenous solution
|
$3,651.01 |
$3,651.01 |
$3,651.01 |
$891.89
|
|
Ihc/icc per specimen each multiplex antibody stain
|
$343.20 |
$343.20 |
$343.20 |
$339.73
|
|
Immobilizer shldr dlx str 24-36in med
|
$122.51 |
$122.51 |
$122.51 |
$80.00
|
|
Immobilizer shldr sling med
|
$44.85 |
$44.85 |
$44.85 |
$35.82
|
|
Immune globulin, gamma (igg) (10 %)-gly-iga over 50 mcg/ml injection solution
|
$4,567.24 |
$4,567.24 |
$4,567.24 |
$5,617.36
|
|
Immune globulin, gamma (igg) 10 gram-gly-gluc-iga 0 to 50 mcg/ml IV solution
|
$3,913.59 |
$3,913.59 |
$3,913.59 |
$2,568.72
|
|
Immunoassay tumor antigen quantitative ca 125
|
$166.06 |
$166.06 |
$166.06 |
$123.50
|
|
Immunodiffusion nes
|
$11.24 |
$11.24 |
$11.24 |
$53.76
|
|
Immunofixation electrophoresis serum
|
$181.90 |
$181.90 |
$181.90 |
$133.38
|
|
Immunoglobulin assay
|
$73.70 |
$73.70 |
$73.70 |
$74.00
|
|
In-111 autol wbc diag per dose
|
$9,606.23 |
$9,606.23 |
$9,606.23 |
$3,704.00
|
|
In-111 oxyquinolin per 0.5 mci
|
$16,455.41 |
$16,455.41 |
$16,455.41 |
$2,808.00
|
|
In-111 pentetate dtpa / 0.5 mci
|
$14,876.14 |
$14,876.14 |
$14,876.14 |
$2,135.29
|
|
In-111 pentetreotide
|
$23,972.15 |
$23,972.15 |
$23,972.15 |
$6,617.05
|
|
Infect ag drug suscept pheno predict
|
$109.72 |
$109.72 |
$109.72 |
$325.00
|
|
Infect ag genotype na hiv-1 other region
|
$109.76 |
$109.76 |
$109.76 |
$301.50
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$122.17 |
$122.17 |
$122.17 |
$574.60
|
|
Infect ag if hep delta agent
|
$93.00 |
$93.00 |
$93.00 |
$125.97
|
|
Infect ag if influenza a
|
$132.74 |
$132.74 |
$132.74 |
$40.61
|
|
Infect ag if influenza b
|
$132.74 |
$132.74 |
$132.74 |
$34.67
|
|
Infect ag if varicella zoster
|
$132.74 |
$132.74 |
$132.74 |
$66.00
|
|
Infect ag na orthopoxvirus amp prb each
|
$77.00 |
$77.00 |
$77.00 |
$102.00
|
|
Infect ag na resp virus 12-25 targets
|
$2,766.52 |
$2,766.52 |
$2,766.52 |
$859.44
|
|
Infect ag phenotype na hiv-1 1-10 drugs
|
$109.72 |
$109.72 |
$109.72 |
$714.67
|
|
Infect ag phenotype na hiv-1 ea addl drg
|
$109.72 |
$109.72 |
$109.72 |
$77.00
|
|
Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin
|
$98.38 |
$98.38 |
$98.38 |
$60.00
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$16.29 |
$16.29 |
$16.29 |
$178.00
|
|
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus
|
$253.39 |
$253.39 |
$253.39 |
$150.15
|
|
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis
|
$81.45 |
$81.45 |
$81.45 |
$210.00
|
