|
Glucose blood quantitative
|
$8.40 |
$8.40 |
$8.40 |
$40.80
|
|
Glucose body fluid
|
$7.98 |
$7.98 |
$7.98 |
$47.70
|
|
Glucose tolerance test (gtt) 3 specimens
|
$15.12 |
$15.12 |
$15.12 |
$92.75
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$26.67 |
$26.67 |
$26.67 |
$33.15
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$40.74 |
$40.74 |
$40.74 |
$115.05
|
|
Gonadotropin luteinizing hormone (lh)
|
$40.32 |
$40.32 |
$40.32 |
$117.65
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$36.96 |
$36.96 |
$36.96 |
$56.71
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$46.20 |
$46.20 |
$46.20 |
$23,233.80
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$236.46 |
$236.46 |
$236.46 |
$486.45
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$378.00 |
$378.00 |
$378.00 |
$1,123.34
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$98.70 |
$98.70 |
$98.70 |
$5,533.20
|
|
Guide endoanchr sg-64 aaa 62cm
|
$1,814.40 |
$1,814.40 |
$1,814.40 |
$2,108.25
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$1.31 |
$1.31 |
$1.31 |
$11.25
|
|
Hand X-ray
|
$124.32 |
$124.32 |
$124.32 |
$317.78
|
|
Haptoglobin quantitative
|
$27.72 |
$27.72 |
$27.72 |
$75.00
|
|
Hbot, full body chamber, 30m
|
$590.94 |
$590.94 |
$590.94 |
$524.17
|
|
Hcg qualitative
|
$10.50 |
$10.50 |
$10.50 |
$72.50
|
|
Hcg quantitative
|
$12.18 |
$12.18 |
$12.18 |
$105.00
|
|
Head CT scan (with and without contrast)
|
$997.50 |
$997.50 |
$997.50 |
$1,732.80
|
|
Head CT scan (with contrast)
|
$853.44 |
$853.44 |
$853.44 |
$1,496.25
|
|
Head CT scan (without contrast)
|
$736.68 |
$736.68 |
$736.68 |
$1,252.80
|
|
Heart infarct image
|
$527.94 |
$527.94 |
$527.94 |
$840.74
|
|
Hematocrit
|
$5.46 |
$5.46 |
$5.46 |
$32.50
|
|
Hemoglobin
|
$5.46 |
$5.46 |
$5.46 |
$28.60
|
|
Hemoglobin fetal qualitative
|
$6.30 |
$6.30 |
$6.30 |
$54.60
|
|
Hemoglobin methemoglobin quantitative
|
$37.38 |
$37.38 |
$37.38 |
$43.01
|
|
Hemoglobin plasma
|
$6.64 |
$6.64 |
$6.64 |
$43.80
|
|
Hemolysins and agglutinins incubated
|
$16.80 |
$16.80 |
$16.80 |
$67.50
|
|
Heparin bolus from bag
|
$1.88 |
$1.88 |
$1.88 |
$50.95
|
|
Hepatitis a antibody igm
|
$24.78 |
$24.78 |
$24.78 |
$80.60
|
|
Hepatitis b core antibody igm
|
$25.62 |
$25.62 |
$25.62 |
$85.80
|
|
Hepatitis b core antibody total
|
$2.99 |
$2.99 |
$2.99 |
$84.75
|
|
Hepatitis b surface antibody
|
$23.52 |
$23.52 |
$23.52 |
$81.12
|
|
Hepatitis c antibody
|
$27.72 |
$27.72 |
$27.72 |
$106.50
|
|
Herpes simplex 1 ag if
|
$28.88 |
$28.88 |
$28.88 |
$49.40
|
|
Heterophile antibodies screening
|
$10.92 |
$10.92 |
$10.92 |
$59.40
|
|
Heterophile antibody absrbj
|
$10.08 |
$10.08 |
$10.08 |
$19.20
|
|
Histamine
|
$11.07 |
$11.07 |
$11.07 |
$132.60
|
|
Hla ii typing 1 loc hr
|
$159.60 |
$159.60 |
$159.60 |
$342.60
|
|
Hla i typing high res 1 allele grp ea
|
$48.49 |
$48.49 |
$48.49 |
$340.00
|
|
Hla typing a b or c
|
$137.34 |
$137.34 |
$137.34 |
$379.20
|
|
Homocysteine
|
$36.54 |
$36.54 |
$36.54 |
$100.00
|
|
Homovanillic acid (hva)
|
$7.16 |
$7.16 |
$7.16 |
$66.60
|
|
Hpv types 16 & 18 only
|
$25.39 |
$25.39 |
$25.39 |
$114.33
|
|
Hyaluronidase 150 unit/ml injection solution
|
$122.34 |
$122.34 |
$122.34 |
$119.93
|
|
Hydralazine 20 mg/ml injection solution
|
$4.77 |
$4.77 |
$4.77 |
$46.01
|
|
Hydration IV infusion each additional hour
|
$83.16 |
$83.16 |
$83.16 |
$125.45
|
|
Hydration IV infusion initial 31minutes - 1 hour
|
$166.74 |
$166.74 |
$166.74 |
$388.70
|
|
Hydrocortisone in ns IV syringe 1 mg/ml (neo/ped) - cnr
|
$23.75 |
$23.75 |
$23.75 |
$63.24
|
|
Hydroxyzine hcl 50 mg/ml intramuscular solution
|
$0.84 |
$0.84 |
$0.84 |
$75.95
|
|
Hydrxycorticsterds 17- (17-ohcs)
|
$18.65 |
$18.65 |
$18.65 |
$86.45
|
|
Hysterosalpingography s&i
|
$414.54 |
$414.54 |
$414.54 |
$555.39
|
|
I-123 sod iodide diag per 100 uci
|
$94.50 |
$94.50 |
$94.50 |
$157.09
|
|
I-131 iobenguane sulf diag mibg
|
$825.72 |
$825.72 |
$825.72 |
$2,517.38
|
|
I131 iodide cap, rx
|
$45.78 |
$45.78 |
$45.78 |
$117.00
|
|
Ibutilide fumarate 0.1 mg/ml intravenous solution
|
$153.46 |
$153.46 |
$153.46 |
$614.95
|
|
Idarubicin hcl injection
|
$81.99 |
$81.99 |
$81.99 |
$249.51
|
|
I&d/bursa/foot 28001
|
$1,509.48 |
$1,509.48 |
$1,509.48 |
$1,814.47
|
|
Ihc/icc per specimen initial single antibody stain
|
$63.84 |
$63.84 |
$63.84 |
$274.86
|
|
Immob elbow child sm
|
$63.42 |
$63.42 |
$63.42 |
$63.42
|
|
Immobilizer shldr cntor adlt
|
$75.18 |
$75.18 |
$75.18 |
$89.70
|
|
Immobilizer shldr dlx str 24-36in med
|
$31.08 |
$31.08 |
$31.08 |
$72.60
|
|
Immobilizer shldr sling med
|
$68.04 |
$68.04 |
$68.04 |
$29.14
|
|
Immune complex assay
|
$20.41 |
$20.41 |
$20.41 |
$89.25
|
|
Immune globulin, gamma (igg) 10 gram-gly-gluc-iga 0 to 50 mcg/ml IV solution
|
$39.63 |
$39.63 |
$39.63 |
$107.10
|
|
Immunoassay tumor antigen quantitative ca 125
|
$44.52 |
$44.52 |
$44.52 |
$122.50
|
|
Immunoassay tumor antigen quantitative ca 19-9
|
$44.94 |
$44.94 |
$44.94 |
$117.00
|
|
Immunodiffusion nes
|
$58.07 |
$58.07 |
$58.07 |
$63.57
|
|
Immunofixation electrophoresis serum
|
$47.04 |
$47.04 |
$47.04 |
$133.38
|
|
Implant cochlear osia osi300
|
$4,050.48 |
$4,050.48 |
$4,050.48 |
$9,185.56
|
|
Implant ureth bulk agent
|
$915.60 |
$915.60 |
$915.60 |
$2,342.17
|
|
In-111 satumomab pend
|
$1,382.22 |
$1,382.22 |
$1,382.22 |
$3,524.25
|
|
Incision & drainage hematoma/seroma/fluid collection
|
$1,509.48 |
$1,509.48 |
$1,509.48 |
$2,056.93
|
|
Incision of toe tendons 28011
|
$2,250.36 |
$2,250.36 |
$2,250.36 |
$1,858.61
|
|
Infect ag eia chlamydia trachomatis
|
$27.72 |
$27.72 |
$27.72 |
$35.20
|
|
Infect ag na influenza r/amp 1st 2 types
|
$147.00 |
$147.00 |
$147.00 |
$248.80
|
|
Infect ag na resp virus 12-25 targets
|
$241.08 |
$241.08 |
$241.08 |
$878.20
|
|
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin
|
$26.04 |
$26.04 |
$26.04 |
$76.00
|
|
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans
|
$26.04 |
$26.04 |
$26.04 |
$74.10
|
|
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn
|
$22.68 |
$22.68 |
$22.68 |
$75.27
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$39.90 |
$39.90 |
$39.90 |
$107.90
|
|
Infectious agent antigen immunoassay ql/sq multi step legionella urine
|
$25.20 |
$25.20 |
$25.20 |
$132.60
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$15.12 |
$15.12 |
$15.12 |
$98.40
|
|
Infectious agent nucleic acid amplified probe hsv-1
|
$17.43 |
$17.43 |
$17.43 |
$181.35
|
|
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19
|
$39.90 |
$39.90 |
$39.90 |
$109.18
|
|
Infectious agent nucleic acid amplified probe trichomonas vaginalis
|
$27.34 |
$27.34 |
$27.34 |
$135.00
|
|
Infectious agent nucleic acid quantification hepatitis b
|
$35.18 |
$35.18 |
$35.18 |
$242.50
|
|
Infectious agent nucleic acid quantification hepatitis c
|
$24.78 |
$24.78 |
$24.78 |
$280.20
|
|
Infectious agent nucleic acid quantification hiv-1
|
$22.21 |
$22.21 |
$22.21 |
$381.55
|
|
Inj calcitriol per 0.1 mcg
|
$1.52 |
$1.52 |
$1.52 |
$11.21
|
|
Inj ceftolozane tazobactam
|
$10.51 |
$10.51 |
$10.51 |
$248.93
|
|
Inj cntr knee arthro incl ct/mri
|
$540.96 |
$540.96 |
$540.96 |
$505.20
|
|
Injection arthrography hip without anesthesia (both sides)
|
$582.54 |
$582.54 |
$582.54 |
$609.20
|
|
Injection for arthrography wrist (both sides)
|
$499.38 |
$499.38 |
$499.38 |
$521.18
|
|
Injection for bladder x-ray
|
$840.42 |
$840.42 |
$840.42 |
$585.00
|
|
Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides)
|
$374.64 |
$374.64 |
$374.64 |
$514.36
|
|
Injection, fulvestrant
|
$91.72 |
$91.72 |
$91.72 |
$166.25
|
|
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug
|
$110.88 |
$110.88 |
$110.88 |
$153.60
|
|
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug
|
$119.70 |
$119.70 |
$119.70 |
$303.60
|
|
Injection therapeutic/prophylactic/diagnostic subcutaneous/im
|
$66.36 |
$66.36 |
$66.36 |
$130.19
|
