|
Ga-68 gallium 68 dotatate
|
$15,600.00 |
$15,600.00 |
$15,600.00 |
$140.35
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$591.40 |
$591.40 |
$591.40 |
$108.40
|
|
Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper)
|
$231.00 |
$231.00 |
$231.00 |
$120.00
|
|
Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution
|
$99.80 |
$99.80 |
$99.80 |
$177.52
|
|
Gamma globulin 1 cc inj
|
$463.20 |
$463.20 |
$463.20 |
$407.60
|
|
Gammaglobulin iga
|
$81.90 |
$81.90 |
$81.90 |
$69.60
|
|
Gammaglobulin ige
|
$83.85 |
$83.85 |
$83.85 |
$83.85
|
|
Gamma glutamyltransferase
|
$60.45 |
$60.45 |
$60.45 |
$57.54
|
|
Gamunex-c/gammaked
|
$14,238.00 |
$14,238.00 |
$14,238.00 |
$7,435.88
|
|
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr
|
$314.60 |
$314.60 |
$314.60 |
$197.40
|
|
Gemcitabine 1 gram intravenous solution
|
$540.20 |
$540.20 |
$540.20 |
$207.51
|
|
Gemtuzumab ozogamicin 4.5 mg (1 mg/ml initial concentration) IV soln
|
$31,504.65 |
$31,504.65 |
$31,504.65 |
$19,305.62
|
|
Generator barostim neo2 2014
|
$44,831.44 |
$44,831.44 |
$44,831.44 |
$52,020.00
|
|
Generator emblem MRI sicd subq
|
$22,347.00 |
$22,347.00 |
$22,347.00 |
$36,467.76
|
|
Generator stim baroreceptor neo legacy implant pulse
|
$37,570.90 |
$37,570.90 |
$37,570.90 |
$66,636.36
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$17.40 |
$17.40 |
$17.40 |
$52.54
|
|
Gentamicin peak therapeutic drug level
|
$97.50 |
$97.50 |
$97.50 |
$123.84
|
|
Ghs conjunctiva foreign body-superf bil
|
$197.42 |
$197.42 |
$197.42 |
$287.40
|
|
Ghs corneal fb without slit lamp bilat
|
$224.25 |
$224.25 |
$224.25 |
$422.25
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$547.95 |
$547.95 |
$547.95 |
$489.67
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$668.85 |
$668.85 |
$668.85 |
$700.33
|
|
Ghs nailbed repair/nail removal
|
$505.05 |
$505.05 |
$505.05 |
$724.37
|
|
Ghs path - pap (papanicolau) smear - vagina
|
$67.00 |
$67.00 |
$67.00 |
$74.10
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$485.00 |
$485.00 |
$485.00 |
$570.60
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$282.10 |
$282.10 |
$282.10 |
$436.80
|
|
Gi inhouse confirmation
|
$83.85 |
$83.85 |
$83.85 |
$87.75
|
|
Glove finger flexion right lg xl
|
$53.03 |
$53.03 |
$53.03 |
$110.62
|
|
Glucagon 1 mg solution for injection
|
$655.40 |
$655.40 |
$655.40 |
$613.79
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$567.40 |
$567.40 |
$567.40 |
$491.67
|
|
Glucose 1 hr post dose
|
$41.60 |
$41.60 |
$41.60 |
$49.00
|
|
Glucose blood quantitative
|
$36.40 |
$36.40 |
$36.40 |
$42.25
|
|
Glucose body fluid
|
$45.50 |
$45.50 |
$45.50 |
$51.30
|
|
Glucose tolerance test (gtt) 3 specimens
|
$92.30 |
$92.30 |
$92.30 |
$105.60
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$53.95 |
$53.95 |
$53.95 |
$36.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$7.00 |
$7.00 |
$7.00 |
$37.40
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$5,516.60 |
$5,516.60 |
$5,516.60 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$133.25 |
$133.25 |
$133.25 |
$116.64
|
|
Gonadotropin luteinizing hormone (lh)
|
$135.20 |
$135.20 |
$135.20 |
$129.03
|
|
Goserelin 10.8 mg subcutaneous implant
|
$16,064.55 |
$16,064.55 |
$16,064.55 |
$4,417.13
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$100.11 |
$100.11 |
$100.11 |
$73.83
|
|
Graft axiofill 1000mg
|
$6,300.79 |
$6,300.79 |
$6,300.79 |
$5,125.68
|
|
Graft bone flex 2.5cm x 5cm grafton-cost per sq cm
|
$1.41 |
$1.41 |
$1.41 |
$1.00
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$1,885.86 |
$1,885.86 |
$1,885.86 |
$605.00
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$4,970.86 |
$4,970.86 |
$4,970.86 |
$23,233.80
|
|
Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm
|
$1,548.87 |
$1,548.87 |
$1,548.87 |
$3,432.00
|
|
Graft nerve adv 3-4x70mm
|
$16,761.06 |
$16,761.06 |
$16,761.06 |
$20,782.10
|
|
Graft patch felt ptfe 2x2
|
$35,755.20 |
$35,755.20 |
$35,755.20 |
$29,293.39
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$304.44 |
$304.44 |
$304.44 |
$1,111.05
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$397.50 |
$397.50 |
$397.50 |
$886.17
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$414.05 |
$414.05 |
$414.05 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$476.79 |
$476.79 |
$476.79 |
$349.41
|
|
Graft tis hmatrix dermis 10x5 -cost per sq cm
|
$58.05 |
$58.05 |
$58.05 |
$3,822.00
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$1,705.66 |
$1,705.66 |
$1,705.66 |
$28,894.71
|
|
Graft viashield 2layer amnion patch 2x2cm-cost per sq cm
|
$593.61 |
$593.61 |
$593.61 |
$1.00
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$312.02 |
$312.02 |
$312.02 |
$1,103.05
|
|
Graft xenmtrx sft rect 15x20cm
|
$25,506.74 |
$25,506.74 |
$25,506.74 |
$29,676.26
|
|
Graft xenmtrx sft rect 19x28cm
|
$17,074.23 |
$17,074.23 |
$17,074.23 |
$2,905.40
|
|
Granisetron hcl injection
|
$92.00 |
$92.00 |
$92.00 |
$45.03
|
|
Guide endoanchr sg-64 aaa 62cm
|
$2,547.89 |
$2,547.89 |
$2,547.89 |
$7,743.36
|
|
Guide wire threaded 1.4x150mm
|
$4,925.86 |
$4,925.86 |
$4,925.86 |
$3,284.36
|
|
Guide worley csg 9fx50cm std
|
$747.95 |
$747.95 |
$747.95 |
$1,117.40
|
|
Gw stiffened micro access kit
|
$9,830.88 |
$9,830.88 |
$9,830.88 |
$6,893.38
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$124.20 |
$124.20 |
$124.20 |
$91.09
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$3.65 |
$3.65 |
$3.65 |
$24.30
|
|
Handpiece aquabeam hp2000
|
$14,876.30 |
$14,876.30 |
$14,876.30 |
$6,628.05
|
|
Hands-On Manual Therapy (each 15 minutes)
|
$128.70 |
$128.70 |
$128.70 |
$105.30
|
|
Hand X-ray
|
$305.50 |
$305.50 |
$305.50 |
$350.35
|
|
Hand X-ray (2 views, both hands)
|
$235.95 |
$235.95 |
$235.95 |
$294.90
|
|
Haptoglobin quantitative
|
$126.10 |
$126.10 |
$126.10 |
$92.80
|
|
Hcg qualitative
|
$85.15 |
$85.15 |
$85.15 |
$90.10
|
|
Hcg quantitative
|
$109.20 |
$109.20 |
$109.20 |
$139.20
|
|
Head CT scan (without contrast)
|
$1,368.25 |
$1,368.25 |
$1,368.25 |
$1,268.90
|
|
Heel (Calcaneus) X-ray (both feet)
|
$274.95 |
$274.95 |
$274.95 |
$276.00
|
|
Helicobacter pylori antibody igm
|
$79.95 |
$79.95 |
$79.95 |
$92.00
|
|
Hematocrit
|
$30.55 |
$30.55 |
$30.55 |
$33.80
|
|
Hemin 350 mg intravenous powder for solution
|
$34,281.50 |
$34,281.50 |
$34,281.50 |
$20,618.46
|
|
Hemoglobin
|
$538.85 |
$538.85 |
$538.85 |
$33.54
|
|
Hemoglobin fetal qualitative
|
$128.70 |
$128.70 |
$128.70 |
$51.75
|
|
Hemoglobin methemoglobin quantitative
|
$74.75 |
$74.75 |
$74.75 |
$52.32
|
|
Hemoglobin plasma
|
$83.85 |
$83.85 |
$83.85 |
$41.40
|
|
Heparin assay
|
$53.95 |
$53.95 |
$53.95 |
$139.15
|
|
Heparin bolus from bag
|
$80.00 |
$80.00 |
$80.00 |
$66.06
|
|
Heparin neutralization
|
$47.45 |
$47.45 |
$47.45 |
$37.10
|
|
Hepatitis a antibody igm
|
$100.10 |
$100.10 |
$100.10 |
$89.44
|
|
Hepatitis b core antibody igm
|
$118.95 |
$118.95 |
$118.95 |
$89.60
|
|
Hepatitis b core antibody total
|
$96.20 |
$96.20 |
$96.20 |
$77.50
|
|
Hepatitis b immune globulin greater than 1,560 units/5 ml im solution
|
$3,148.75 |
$3,148.75 |
$3,148.75 |
$1,154.13
|
|
Hepatitis b surface antibody
|
$107.90 |
$107.90 |
$107.90 |
$82.32
|
|
Hepatitis c antibody
|
$126.75 |
$126.75 |
$126.75 |
$108.25
|
|
Herpes simplex type 1 antibody igg
|
$85.80 |
$85.80 |
$85.80 |
$69.12
|
|
Herpes simplex type 2 antibody igg
|
$57.85 |
$57.85 |
$57.85 |
$87.36
|
|
Heterophile antibodies screening
|
$52.00 |
$52.00 |
$52.00 |
$73.87
|
|
Hip and Pelvis X-ray (2 views, both hips)
|
$312.65 |
$312.65 |
$312.65 |
$374.40
|
|
Hip and Pelvis X-ray (3 to 4 views, both hips)
|
$306.80 |
$306.80 |
$306.80 |
$424.80
|
|
Hip X-ray
|
$222.30 |
$222.30 |
$222.30 |
$294.75
|
|
Hldr trach tb tie ad
|
$1,057.54 |
$1,057.54 |
$1,057.54 |
$940.87
|
|
Holder tube cath-secure nonstrl lf disp
|
$0.78 |
$0.78 |
$0.78 |
$1.94
|
|
Homocysteine
|
$181.35 |
$181.35 |
$181.35 |
$125.40
|
|
Hopd mntl hlt, 15-29 min
|
$396.50 |
$396.50 |
$396.50 |
$60.00
|
|
Hopd mntl hlt, grp
|
$477.75 |
$477.75 |
$477.75 |
$57.85
|
