|
Formoterol fumarate, inh
|
$3.70 |
$3.70 |
$3.70 |
$59.40
|
|
Fresh frozen plasma thawing ea un
|
$167.38 |
$167.38 |
$167.38 |
$130.98
|
|
Fructosamine glycated protein
|
$273.02 |
$273.02 |
$273.02 |
$61.75
|
|
Ga-67 gallium 0.1 mci
|
$367.60 |
$367.60 |
$367.60 |
$121.73
|
|
Ga-68 gallium 68 dotatate
|
$539.37 |
$539.37 |
$539.37 |
$139.70
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$118.37 |
$118.37 |
$118.37 |
$107.11
|
|
Galactose transferase test
|
$224.28 |
$224.28 |
$224.28 |
$32.00
|
|
Gammaglobulin ige
|
$402.55 |
$402.55 |
$402.55 |
$83.40
|
|
Gamma glutamyltransferase
|
$380.27 |
$380.27 |
$380.27 |
$57.54
|
|
Gastric emptying imag study
|
$3,226.06 |
$3,226.06 |
$3,226.06 |
$1,364.00
|
|
Gastric emptying imag study
|
$4,280.35 |
$4,280.35 |
$4,280.35 |
$1,665.50
|
|
General health panel
|
$756.44 |
$756.44 |
$756.44 |
$262.44
|
|
Gentamicin peak therapeutic drug level
|
$1,025.11 |
$1,025.11 |
$1,025.11 |
$123.84
|
|
G-esoph reflx tst w/electrod
|
$4,835.19 |
$4,835.19 |
$4,835.19 |
$1,500.00
|
|
Ghs acetylcholinesterase, rbc
|
$640.70 |
$640.70 |
$640.70 |
$43.06
|
|
Ghs alpha thalasemia, 7 deletions
|
$1,201.11 |
$1,201.11 |
$1,201.11 |
$403.38
|
|
Ghs analysis neurostim without reprogramming
|
$2,412.88 |
$2,412.88 |
$2,412.88 |
$247.06
|
|
Ghs bleeding time (ivy)
|
$604.45 |
$604.45 |
$604.45 |
$64.08
|
|
Ghs chemo >8 hrs
|
$2,675.09 |
$2,675.09 |
$2,675.09 |
$714.87
|
|
Ghs chlamydia pneumoniae by pcr (arup) (306630)
|
$416.39 |
$416.39 |
$416.39 |
$133.00
|
|
Ghs diphtheria toxoid ab igg
|
$1,117.03 |
$1,117.03 |
$1,117.03 |
$55.02
|
|
Ghs eeg cont rec w/video by tec min 8 chnls
|
$5,223.00 |
$5,223.00 |
$5,223.00 |
$560.00
|
|
Ghs fat & muscle
|
$444.33 |
$444.33 |
$444.33 |
$38.08
|
|
Ghs febrile agglutinns(mayo)
|
$210.32 |
$210.32 |
$210.32 |
$48.10
|
|
Ghs fish cytogen
|
$500.27 |
$500.27 |
$500.27 |
$173.40
|
|
Ghs fish hybrid in situ 100-300
|
$937.77 |
$937.77 |
$937.77 |
$225.00
|
|
Ghs hcv amplificaiton
|
$812.14 |
$812.14 |
$812.14 |
$203.45
|
|
Ghs hepatitis c virus (hcv riba)
|
$1,033.44 |
$1,033.44 |
$1,033.44 |
$144.60
|
|
Ghs histoplasma antigen
|
$905.39 |
$905.39 |
$905.39 |
$141.00
|
|
Ghs HIV antibody
|
$586.40 |
$586.40 |
$586.40 |
$90.00
|
|
Ghs hla-dr/dq, multiple antigens
|
$2,060.55 |
$2,060.55 |
$2,060.55 |
$507.65
|
|
Ghs leukocyte alkaline phos (mayo)
|
$664.42 |
$664.42 |
$664.42 |
$73.50
|
|
Ghs mbp
|
$1,128.16 |
$1,128.16 |
$1,128.16 |
$75.50
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$949.54 |
$949.54 |
$949.54 |
$228.45
|
|
Ghs musc test done w/n test comp
|
$1,385.55 |
$1,385.55 |
$1,385.55 |
$324.80
|
|
Ghs musc tst done w/nerv tst lim
|
$1,385.55 |
$1,385.55 |
$1,385.55 |
$272.25
|
|
Ghs musc tst done w/n tst non ext
|
$730.05 |
$730.05 |
$730.05 |
$184.80
|
|
Ghs o2 saturation
|
$747.00 |
$747.00 |
$747.00 |
$69.50
|
|
Ghs optokenetic
|
$692.57 |
$692.57 |
$692.57 |
$211.20
|
|
Ghs oscillating trac
|
$692.57 |
$692.57 |
$692.57 |
$291.75
|
|
Ghs phenylketonurid
|
$224.28 |
$224.28 |
$224.28 |
$53.76
|
|
Ghs pos nystagmus
|
$692.57 |
$692.57 |
$692.57 |
$229.10
|
|
Ghs ppd (tb intradermal)
|
$322.43 |
$322.43 |
$322.43 |
$37.44
|
|
Ghs protoporphyrins fract
|
$1,153.25 |
$1,153.25 |
$1,153.25 |
$60.75
|
|
Ghs pr without cont pulse ox
|
$1,211.53 |
$1,211.53 |
$1,211.53 |
$146.86
|
|
Ghs quinidine
|
$488.87 |
$488.87 |
$488.87 |
$83.20
|
|
Ghs respiratory syncytical virus igg/m
|
$1,011.17 |
$1,011.17 |
$1,011.17 |
$74.82
|
|
Ghs rsv eia (respir synctial vrs)
|
$801.92 |
$801.92 |
$801.92 |
$99.00
|
|
Ghs sedimentation rate
|
$724.27 |
$724.27 |
$724.27 |
$45.50
|
|
Ghs somatosensory testing lower extremit
|
$6,200.33 |
$6,200.33 |
$6,200.33 |
$917.80
|
|
Ghs somatosensory testing upper & lower limbs
|
$3,052.19 |
$3,052.19 |
$3,052.19 |
$1,405.20
|
|
Ghs speech-gen aug dev eval iii, st
|
$430.95 |
$430.95 |
$430.95 |
$161.76
|
|
Ghs spont nystagmus
|
$692.57 |
$692.57 |
$692.57 |
$228.00
|
|
Ghs sp train/fitting sp device - kx
|
$1,171.06 |
$1,171.06 |
$1,171.06 |
$249.60
|
|
Ghs st - re-eval for alt comm
|
$1,685.02 |
$1,685.02 |
$1,685.02 |
$309.00
|
|
Ghs trypsin (fecal)
|
$746.53 |
$746.53 |
$746.53 |
$55.59
|
|
Ghs urine, hydroxproline total
|
$809.27 |
$809.27 |
$809.27 |
$110.77
|
|
Ghs urine, porphyrins quant
|
$900.60 |
$900.60 |
$900.60 |
$73.80
|
|
Ghs veeg 12-26 hr intmt mont
|
$5,223.00 |
$5,223.00 |
$5,223.00 |
$1,932.00
|
|
Gi inhouse confirmation
|
$1,169.00 |
$1,169.00 |
$1,169.00 |
$86.40
|
|
Gi tract capsule endoscopy (pillcam) 91110
|
$7,272.83 |
$7,272.83 |
$7,272.83 |
$2,195.76
|
|
Glucagon 1 mg solution for injection
|
$266.75 |
$266.75 |
$266.75 |
$601.79
|
|
Glucagon plasma - sendout
|
$800.91 |
$800.91 |
$800.91 |
$63.20
|
|
Glucose-6-phosphate dhydrogenase screen
|
$567.64 |
$567.64 |
$567.64 |
$55.50
|
|
Glucose tolerance test (gtt) 3 specimens
|
$439.96 |
$439.96 |
$439.96 |
$104.50
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$91.53 |
$91.53 |
$91.53 |
$36.00
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$1,011.17 |
$1,011.17 |
$1,011.17 |
$115.80
|
|
Gonadotropin luteinizing hormone (lh)
|
$965.25 |
$965.25 |
$965.25 |
$129.00
|
|
Goserelin 10.8 mg subcutaneous implant
|
$2,742.64 |
$2,742.64 |
$2,742.64 |
$4,496.37
|
|
Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm
|
$2,333.76 |
$2,333.76 |
$2,333.76 |
$3,432.00
|
|
Guid loc target vol rad tx
|
$1,898.41 |
$1,898.41 |
$1,898.41 |
$535.60
|
|
Halo cervical into jckt vest
|
$10,587.00 |
$10,587.00 |
$10,587.00 |
$5,015.12
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$106.00 |
$106.00 |
$106.00 |
$24.41
|
|
Haptoglobin quantitative
|
$483.28 |
$483.28 |
$483.28 |
$91.80
|
|
Hbot, full body chamber, 30m
|
$1,022.45 |
$1,022.45 |
$1,022.45 |
$526.90
|
|
Hcg quantitative
|
$910.95 |
$910.95 |
$910.95 |
$137.15
|
|
Hc i-131 sodium iodide cap dx per mci
|
$548.39 |
$548.39 |
$548.39 |
$117.00
|
|
Hc nm kidney imaging with flow
|
$5,477.26 |
$5,477.26 |
$5,477.26 |
$849.00
|
|
Hc nm myocard infarct avid plnr tomo spect w/wo quant
|
$8,175.01 |
$8,175.01 |
$8,175.01 |
$1,327.95
|
|
Hemoglobin methemoglobin quantitative
|
$664.56 |
$664.56 |
$664.56 |
$52.32
|
|
Hemoglobin plasma
|
$1,055.74 |
$1,055.74 |
$1,055.74 |
$41.25
|
|
Hemolysins/agglutinins auto
|
$207.46 |
$207.46 |
$207.46 |
$57.28
|
|
Hemophilus influenza antibdy
|
$370.70 |
$370.70 |
$370.70 |
$62.70
|
|
Heparin assay
|
$752.82 |
$752.82 |
$752.82 |
$138.84
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$95.33 |
$95.33 |
$95.33 |
$12.91
|
|
Hepatitis a antibody igm
|
$674.18 |
$674.18 |
$674.18 |
$88.92
|
|
Hepatitis b core antibody igm
|
$877.46 |
$877.46 |
$877.46 |
$88.80
|
|
Hepatitis b core antibody total
|
$674.18 |
$674.18 |
$674.18 |
$77.50
|
|
Hepatitis b surface antibody
|
$394.13 |
$394.13 |
$394.13 |
$81.12
|
|
Hepatitis c antibody
|
$451.31 |
$451.31 |
$451.31 |
$108.00
|
|
Heterophile antibodies screening
|
$562.72 |
$562.72 |
$562.72 |
$72.00
|
|
Hhv-6 dna quant
|
$1,531.93 |
$1,531.93 |
$1,531.93 |
$250.80
|
|
Histamine
|
$792.52 |
$792.52 |
$792.52 |
$114.84
|
|
Histochemical stains add-on
|
$903.18 |
$903.18 |
$903.18 |
$152.75
|
|
Hla class i high defin qual
|
$1,179.64 |
$1,179.64 |
$1,179.64 |
$625.00
|
|
Hla class i/ii antibody qual
|
$1,179.64 |
$1,179.64 |
$1,179.64 |
$171.92
|
|
Hla i low res one antigen equiv ea
|
$367.82 |
$367.82 |
$367.82 |
$164.00
|
|
Hla i typing high res 1 allele grp ea
|
$1,214.26 |
$1,214.26 |
$1,214.26 |
$304.20
|
|
Hla typing a b or c
|
$1,911.36 |
$1,911.36 |
$1,911.36 |
$364.00
|
|
Homocysteine
|
$1,112.87 |
$1,112.87 |
$1,112.87 |
$125.00
|
