|
Glucose tolerance test (gtt) >3 specimens each additional
|
$25.60 |
$25.60 |
$25.60 |
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$13.60 |
$25.99 |
$41.54 |
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$2,221.83 |
$2,699.10 |
$3,132.77 |
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$97.60 |
$97.60 |
$97.60 |
|
|
Gonadotropin luteinizing hormone (lh)
|
$103.20 |
$103.20 |
$103.20 |
|
|
Goserelin 10.8 mg subcutaneous implant
|
$3,414.56 |
$3,414.56 |
$3,414.56 |
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$179.00 |
$179.00 |
$211.55 |
|
|
Graft axiofill 1000mg
|
$2,741.25 |
$2,741.25 |
$3,970.05 |
|
|
Graft fish skin 16mm round marigen 2units-cost per sq cm
|
$605.00 |
$605.00 |
$792.00 |
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$231.00 |
$231.00 |
$277.20 |
|
|
Graft nerve adv 3-4x70mm
|
$11,707.35 |
$11,707.35 |
$23,040.00 |
|
|
Graft patch felt ptfe 2x2
|
$15,168.00 |
$15,168.00 |
$50,432.80 |
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$77.44 |
$77.44 |
$134.14 |
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$630.00 |
$630.00 |
$756.00 |
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$546.34 |
$546.34 |
$715.20 |
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$57.54 |
$57.54 |
$73.24 |
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$25.64 |
$25.64 |
$54.68 |
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$623.71 |
$623.71 |
$748.44 |
|
|
Graft xenmtrx sft rect 15x20cm
|
$53,592.00 |
$53,592.00 |
$58,464.00 |
|
|
Graft xenmtrx sft rect 19x28cm
|
$1,567.11 |
$1,567.11 |
$2,279.43 |
|
|
Granisetron 1 mg tab
|
$3.92 |
$3.92 |
$6.03 |
|
|
Granisetron hcl injection
|
$32.33 |
$32.33 |
$38.97 |
|
|
Granulocyte pheresis ea unit
|
$2,484.00 |
$2,484.00 |
$2,484.00 |
|
|
Great toe with reduction 28495
|
$388.00 |
$388.00 |
$632.00 |
|
|
Group train without patient
|
$49.60 |
$55.20 |
$56.80 |
|
|
G-tube reposition
|
$1,398.40 |
$1,398.40 |
$1,591.20 |
|
|
Gu dilat ureter/urethra s&i
|
$1,042.40 |
$1,042.40 |
$2,632.00 |
|
|
Guided cath fluid drainage 10030
|
$1,816.80 |
$1,816.80 |
$1,970.40 |
|
|
Guide wire threaded 1.4x150mm
|
$4,400.00 |
$4,400.00 |
$5,600.00 |
|
|
Guide worley csg 9fx50cm std
|
$1,988.80 |
$1,988.80 |
$2,531.20 |
|
|
Guid loc target vol rad tx
|
$295.20 |
$295.20 |
$873.60 |
|
|
Gw stiffened micro access kit
|
$1,967.68 |
$1,967.68 |
$8,430.35 |
|
|
Hallus-valgus nt dyn pre ots
|
$13.27 |
$13.27 |
$19.04 |
|
|
Halo cervical into jckt vest
|
$2,001.21 |
$2,001.21 |
$3,752.00 |
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$36.84 |
$69.36 |
$133.53 |
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$18.32 |
$27.79 |
$30.68 |
|
|
Handle/convey/speciman/office-lab 99000
|
$31.20 |
$31.20 |
$31.20 |
|
|
Hand orthosis metacarpal fracture orthosis prefa l3918
|
$132.80 |
$132.80 |
$132.80 |
|
|
Hands-On Manual Therapy (each 15 minutes)
|
$104.80 |
$104.80 |
$125.60 |
|
|
Hand X-ray
|
$193.60 |
$216.80 |
$415.20 |
|
|
Hand X-ray (2 views, both hands)
|
$168.80 |
$193.60 |
$419.20 |
|
|
Haptoglobin quantitative
|
$76.80 |
$76.80 |
$76.80 |
|
|
Harvest allogeneic stem cell
|
$4,389.60 |
$4,389.60 |
$4,389.60 |
|
|
Harvest auto stem cells
|
$4,849.60 |
$4,849.60 |
$4,849.60 |
|
|
Harvest stem cell concentrte
|
$3,390.40 |
$3,390.40 |
$3,390.40 |
|
|
Hast w/i&r phys/qhp
|
$265.60 |
$265.60 |
$265.60 |
|
|
Hast w/oxygen titrate
|
$310.40 |
$310.40 |
$310.40 |
|
|
Hbot, full body chamber, 30m
|
$473.60 |
$473.60 |
$473.60 |
|
|
Hc fl sm bowel enteroclss tube w kub double contrast
|
$1,164.80 |
$1,164.80 |
$1,164.80 |
|
|
Hcg qualitative
|
$49.60 |
$49.60 |
$49.60 |
|
|
Hcg quantitative
|
$72.80 |
$72.80 |
$72.80 |
|
|
Hc i-131 sodium iodide cap dx per mci
|
$200.80 |
$200.80 |
$204.00 |
|
|
Hc metata joint dislocation anes
|
$2,503.20 |
$2,503.20 |
$2,503.20 |
|
|
Hc nm kidney imaging with flow
|
$1,368.00 |
$1,368.00 |
$1,368.00 |
|
|
Hc pet myocardial imaging metabolic eval single study
|
$4,080.00 |
$4,080.00 |
$5,549.60 |
|
|
Hc transcatheter placement and sbsq removal cepd perq
|
$8,719.20 |
$8,719.20 |
$8,720.00 |
|
|
Hdr rdncl ntrstl/icav brchtx
|
$806.40 |
$806.40 |
$4,043.20 |
|
|
Hdr rdncl ntrstl/icav brchtx
|
$1,342.40 |
$1,342.40 |
$4,665.60 |
|
|
Hdr rdncl ntrstl/icav brchtx
|
$2,066.40 |
$2,066.40 |
$5,166.40 |
|
|
Hdr rdncl skn surf brachytx
|
$620.80 |
$620.80 |
$3,411.20 |
|
|
Hdr rdncl skn surf brachytx
|
$937.60 |
$937.60 |
$3,388.80 |
|
|
Head CT scan (with and without contrast)
|
$2,292.00 |
$2,292.00 |
$2,848.00 |
|
|
Head CT scan (with contrast)
|
$1,760.80 |
$1,760.80 |
$2,340.00 |
|
|
Head CT scan (without contrast)
|
$1,468.80 |
$1,468.80 |
$2,108.80 |
|
|
Heart infarct image
|
$845.60 |
$845.60 |
$845.60 |
|
|
Heel (Calcaneus) X-ray (both feet)
|
$160.80 |
$168.00 |
$327.20 |
|
|
Helicobacter pylori antibody igm
|
$84.80 |
$84.80 |
$84.80 |
|
|
Hematocrit
|
$16.80 |
$16.80 |
$16.80 |
|
|
Hematopoietic nuclear tx
|
$682.40 |
$682.40 |
$772.00 |
|
|
Hemodialysis one evaluation
|
$1,652.00 |
$1,652.00 |
$1,652.00 |
|
|
Hemoglobin
|
$21.60 |
$21.60 |
$21.60 |
|
|
Hemoglobin plasma
|
$28.80 |
$28.80 |
$28.80 |
|
|
Hemophilus influenza antibdy
|
$56.80 |
$56.80 |
$56.80 |
|
|
Hemorrhoidectomy intrnl lig rbbr band ligations
|
$1,396.80 |
$1,529.60 |
$1,683.20 |
|
|
Hepagam b intravenous, inj
|
$517.67 |
$517.67 |
$657.72 |
|
|
Heparin assay
|
$88.80 |
$88.80 |
$88.80 |
|
|
Heparin bolus from bag
|
$31.32 |
$71.20 |
$94.00 |
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$1.52 |
$7.60 |
$16.80 |
|
|
Hepatitis a antibody igm
|
$60.00 |
$60.00 |
$60.00 |
|
|
Hepatitis b core antibody igm
|
$67.20 |
$67.20 |
$67.20 |
|
|
Hepatitis b core antibody total
|
$66.40 |
$66.40 |
$66.40 |
|
|
Hepatitis b surface antibody
|
$63.20 |
$63.20 |
$63.20 |
|
|
Hepatitis b vaccine 40 mcg/ml inj-adult
|
$171.99 |
$171.99 |
$339.76 |
|
|
Hepatitis c antibody
|
$81.60 |
$81.60 |
$81.60 |
|
|
Herpes simplex type 1 antibody igg
|
$71.20 |
$71.20 |
$71.20 |
|
|
Herpes simplex type 2 antibody igg
|
$103.20 |
$103.20 |
$103.20 |
|
|
Heterophile antibodies screening
|
$43.20 |
$43.20 |
$43.20 |
|
|
Hfo nontorsion jnts pre cst
|
$98.40 |
$98.40 |
$98.40 |
|
|
Hfo nontorsion jnts pre ots
|
$98.40 |
$98.40 |
$98.40 |
|
|
Hinge extension/flex wrist/f
|
$909.25 |
$909.25 |
$909.25 |
|
|
Hip and Pelvis X-ray (2 views, both hips)
|
$228.00 |
$423.20 |
$424.00 |
|
|
Hip and Pelvis X-ray (3 to 4 views, both hips)
|
$237.60 |
$331.20 |
$488.00 |
|
|
Hip and Pelvis X-ray (single view, left side)
|
$144.80 |
$185.60 |
$457.60 |
|
|
Hip X-ray
|
$193.60 |
$248.00 |
$495.20 |
|
|
Histamine
|
$130.40 |
$130.40 |
$130.40 |
|
|
Histochemical stains add-on
|
$175.20 |
$182.40 |
$187.20 |
|
|
HIV prep, inj, cabotegravir
|
$6,011.04 |
$6,011.04 |
$6,011.04 |
|
|
Hizentra injection
|
$1,204.78 |
$1,204.78 |
$2,072.85 |
|
|
Hla class i high defin qual
|
$432.00 |
$449.60 |
$804.00 |
|
|
Hla class ii high defin qual
|
$414.40 |
$432.00 |
$808.80 |
|
