|
Golimumab 12.5 mg/ml intravenous solution
|
$109.60 |
$109.60 |
$109.60 |
$5,009.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$45.60 |
$45.60 |
$45.60 |
$116.64
|
|
Gonadotropin luteinizing hormone (lh)
|
$45.00 |
$45.00 |
$45.00 |
$129.03
|
|
Goserelin 10.8 mg subcutaneous implant
|
$1,807.80 |
$1,807.80 |
$1,807.80 |
$4,417.13
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$2,841.00 |
$2,841.00 |
$2,841.00 |
$73.83
|
|
Graft axiofill 1000mg
|
$14,980.80 |
$14,980.80 |
$14,980.80 |
$5,125.68
|
|
Graft nerve adv 3-4x70mm
|
$5,872.80 |
$5,872.80 |
$5,872.80 |
$20,782.10
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$6,744.00 |
$6,744.00 |
$6,744.00 |
$886.17
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$6,217.20 |
$6,217.20 |
$6,217.20 |
$349.41
|
|
Graft xenmtrx sft rect 15x20cm
|
$3,216.00 |
$3,216.00 |
$3,216.00 |
$29,676.26
|
|
Graft xenmtrx sft rect 19x28cm
|
$1,774.80 |
$1,774.80 |
$1,774.80 |
$2,905.40
|
|
Granisetron 1 mg tab
|
$3.00 |
$3.00 |
$3.00 |
$53.15
|
|
Granisetron hcl injection
|
$21.00 |
$21.00 |
$21.00 |
$45.03
|
|
Great toe with reduction 28495
|
$102.00 |
$102.00 |
$102.00 |
$495.00
|
|
G-tube reposition
|
$559.80 |
$559.80 |
$559.80 |
$771.36
|
|
Guided cath fluid drainage 10030
|
$1,172.40 |
$1,172.40 |
$1,172.40 |
$1,372.15
|
|
Guide endoanchr sg-64 aaa 62cm
|
$936.00 |
$936.00 |
$936.00 |
$7,743.36
|
|
Guide wire threaded 1.4x150mm
|
$1,680.60 |
$1,680.60 |
$1,680.60 |
$3,284.36
|
|
Guide worley csg 9fx50cm std
|
$147.00 |
$147.00 |
$147.00 |
$1,117.40
|
|
Gw stiffened micro access kit
|
$408.00 |
$408.00 |
$408.00 |
$6,893.38
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$441.60 |
$441.60 |
$441.60 |
$91.09
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$15.00 |
$15.00 |
$15.00 |
$24.30
|
|
Hands-On Manual Therapy (each 15 minutes)
|
$75.00 |
$75.00 |
$75.00 |
$105.30
|
|
Hand X-ray
|
$122.40 |
$122.40 |
$122.40 |
$350.35
|
|
Hand X-ray (2 views, both hands)
|
$52.20 |
$52.20 |
$52.20 |
$294.90
|
|
Haptoglobin quantitative
|
$30.60 |
$30.60 |
$30.60 |
$92.80
|
|
Hcg qualitative
|
$18.60 |
$18.60 |
$18.60 |
$90.10
|
|
Hcg quantitative
|
$36.60 |
$36.60 |
$36.60 |
$139.20
|
|
Hc hearing aid chck binaurl
|
$153.00 |
$153.00 |
$153.00 |
$78.40
|
|
Hc hearing aid chck monarl
|
$53.40 |
$53.40 |
$53.40 |
$48.75
|
|
Hc hearing aid exam both ears
|
$242.40 |
$242.40 |
$242.40 |
$175.20
|
|
Hc hearing aid exam one ear
|
$170.40 |
$170.40 |
$170.40 |
$150.00
|
|
Head CT scan (with and without contrast)
|
$753.00 |
$753.00 |
$753.00 |
$1,818.96
|
|
Head CT scan (with contrast)
|
$606.60 |
$606.60 |
$606.60 |
$1,527.60
|
|
Head CT scan (without contrast)
|
$495.00 |
$495.00 |
$495.00 |
$1,268.90
|
|
Heel (Calcaneus) X-ray (both feet)
|
$108.60 |
$108.60 |
$108.60 |
$276.00
|
|
Hematocrit
|
$5.40 |
$5.40 |
$5.40 |
$33.80
|
|
Hemin 350 mg intravenous powder for solution
|
$10,821.60 |
$10,821.60 |
$10,821.60 |
$20,618.46
|
|
Hemodialysis one evaluation
|
$406.20 |
$406.20 |
$406.20 |
$1,364.27
|
|
Hemoglobin
|
$5.40 |
$5.40 |
$5.40 |
$33.54
|
|
Hemoglobin fetal qualitative
|
$64.80 |
$64.80 |
$64.80 |
$51.75
|
|
Hemoglobin plasma
|
$66.00 |
$66.00 |
$66.00 |
$41.40
|
|
Hemolysins and agglutinins incubated
|
$144.60 |
$144.60 |
$144.60 |
$61.79
|
|
Hemophilus influenza antibdy
|
$150.60 |
$150.60 |
$150.60 |
$62.70
|
|
Heparin assay
|
$31.80 |
$31.80 |
$31.80 |
$139.15
|
|
Heparin bolus from bag
|
$4.80 |
$4.80 |
$4.80 |
$66.06
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$1.40 |
$1.40 |
$1.40 |
$12.00
|
|
Hepatitis a antibody igm
|
$27.60 |
$27.60 |
$27.60 |
$89.44
|
|
Hepatitis b core antibody igm
|
$28.80 |
$28.80 |
$28.80 |
$89.60
|
|
Hepatitis b core antibody total
|
$29.40 |
$29.40 |
$29.40 |
$77.50
|
|
Hepatitis b immune globulin greater than 1,560 units/5 ml im solution
|
$1,300.20 |
$1,300.20 |
$1,300.20 |
$1,154.13
|
|
Hepatitis b surface antibody
|
$25.80 |
$25.80 |
$25.80 |
$82.32
|
|
Hepatitis c antibody
|
$102.00 |
$102.00 |
$102.00 |
$108.25
|
|
Hereditary colon ca dsordrs
|
$3,394.80 |
$3,394.80 |
$3,394.80 |
$1,901.23
|
|
Hernia Repair (Inguinal)
|
$5,440.80 |
$5,440.80 |
$5,440.80 |
$6,906.90
|
|
Herpes simplex type 1 antibody igg
|
$58.80 |
$58.80 |
$58.80 |
$69.12
|
|
Herpes simplex type 2 antibody igg
|
$58.80 |
$58.80 |
$58.80 |
$87.36
|
|
Herpes simplex virus isolation
|
$83.40 |
$83.40 |
$83.40 |
$110.00
|
|
Heterophile antibodies screening
|
$12.60 |
$12.60 |
$12.60 |
$73.87
|
|
Hexa gene
|
$1,335.60 |
$1,335.60 |
$1,335.60 |
$150.82
|
|
Hhv-6 dna quant
|
$568.20 |
$568.20 |
$568.20 |
$253.68
|
|
Hip and Pelvis X-ray (2 views, both hips)
|
$136.20 |
$136.20 |
$136.20 |
$374.40
|
|
Hip and Pelvis X-ray (3 to 4 views, both hips)
|
$250.20 |
$250.20 |
$250.20 |
$424.80
|
|
Hip and Pelvis X-ray (single view, left side)
|
$75.60 |
$75.60 |
$75.60 |
$233.50
|
|
Hip X-ray
|
$130.80 |
$130.80 |
$130.80 |
$294.75
|
|
Histamine
|
$108.00 |
$108.00 |
$108.00 |
$115.00
|
|
Hla class i high defin qual
|
$388.20 |
$388.20 |
$388.20 |
$631.15
|
|
Hla class ii high defin qual
|
$388.20 |
$388.20 |
$388.20 |
$569.25
|
|
Hla i & ii typing lr
|
$3,155.40 |
$3,155.40 |
$3,155.40 |
$1,407.51
|
|
Hla i low res one antigen equiv ea
|
$790.20 |
$790.20 |
$790.20 |
$164.00
|
|
Hla i typing high res 1 allele grp ea
|
$518.40 |
$518.40 |
$518.40 |
$304.20
|
|
Hocm 350-399mg/ml iodine,1ml
|
$0.60 |
$0.60 |
$0.60 |
$79.78
|
|
Ho flex frejka w/cov pre cst
|
$34.80 |
$34.80 |
$34.80 |
$173.60
|
|
Home sleep test/type 2 porta
|
$1,159.80 |
$1,159.80 |
$1,159.80 |
$503.13
|
|
Homocysteine
|
$41.40 |
$41.40 |
$41.40 |
$125.40
|
|
Homovanillic acid (hva)
|
$111.60 |
$111.60 |
$111.60 |
$59.95
|
|
Hpv low-risk types
|
$115.80 |
$115.80 |
$115.80 |
$77.60
|
|
Hpv types 16 & 18 only
|
$96.00 |
$96.00 |
$96.00 |
$112.00
|
|
H pylori (c-13) breath
|
$242.40 |
$242.40 |
$242.40 |
$212.25
|
|
Htt gene detc abnor alleles
|
$1,333.80 |
$1,333.80 |
$1,333.80 |
$250.50
|
|
Human epididymis protein 4 (he4)
|
$265.20 |
$265.20 |
$265.20 |
$157.32
|
|
Hyaluronidase, human recombinant 150 unit/ml injection solution
|
$3.00 |
$3.00 |
$3.00 |
$142.40
|
|
Hydralazine 20 mg/ml injection solution
|
$12.80 |
$12.80 |
$12.80 |
$48.00
|
|
Hydrocolld drg <=16 without bdr
|
$3.60 |
$3.60 |
$3.60 |
$7.76
|
|
Hydrocortisone in ns IV syringe 1 mg/ml (neo/ped) - cnr
|
$28.20 |
$28.20 |
$28.20 |
$140.54
|
|
Hydromorphone 0.2 mg/ml in 0.9% nacl IV pca opioid naive - 4 hr dose limit (wrapper)
|
$2.00 |
$2.00 |
$2.00 |
$112.66
|
|
Hydromorphone 20-0.9 mg/100ml-% soln 100 ml cartridge
|
$1,166.40 |
$1,166.40 |
$1,166.40 |
$294.92
|
|
Hydroxyzine hcl 50 mg/ml intramuscular solution
|
$11.40 |
$11.40 |
$11.40 |
$72.65
|
|
Hysterosalpingography s&i
|
$369.60 |
$369.60 |
$369.60 |
$669.12
|
|
Hysterotomy abdominal 59100
|
$3,761.40 |
$3,761.40 |
$3,761.40 |
$5,110.00
|
|
I-123 sod iodide diag per 100 uci
|
$90.60 |
$90.60 |
$90.60 |
$147.46
|
|
Ibandronate 3 mg/3 ml intravenous syringe
|
$165.00 |
$165.00 |
$165.00 |
$684.45
|
|
Icatibant injection
|
$1,249.60 |
$1,249.60 |
$1,249.60 |
$8,695.05
|
|
Icd cobalt xt dr MRI is1 df1
|
$33,717.60 |
$33,717.60 |
$33,717.60 |
$34,093.09
|
|
Icd crtd cobalt hf MRI is1 df1
|
$42,449.40 |
$42,449.40 |
$42,449.40 |
$39,070.50
|
|
Icd crtp serena MRI
|
$35,393.40 |
$35,393.40 |
$35,393.40 |
$14,360.25
|
|
I&d frarm&/wrst deep absc/hematoma
|
$2,850.60 |
$2,850.60 |
$2,850.60 |
$3,839.54
|
|
I&d upper arm/elbow deep abscess/hematoma
|
$2,992.80 |
$2,992.80 |
$2,992.80 |
$3,371.02
|
|
Idursulfase injection
|
$7,538.40 |
$7,538.40 |
$7,538.40 |
$5,646.08
|
|
Igh@ var region somatic mutation analy
|
$1,313.40 |
$1,313.40 |
$1,313.40 |
$660.80
|
