|
Glucose body fluid
|
$19.80 |
$19.80 |
$19.80 |
$51.30
|
|
Glucose tolerance test (gtt) 3 specimens
|
$29.04 |
$29.04 |
$29.04 |
$104.50
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$13.20 |
$13.20 |
$13.20 |
$36.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$35.54 |
$35.54 |
$35.54 |
$37.16
|
|
Golimumab 12.5 mg/ml intravenous solution
|
$2,248.37 |
$2,248.37 |
$2,248.37 |
$4,977.60
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$61.71 |
$61.71 |
$61.71 |
$115.80
|
|
Gonadotropin luteinizing hormone (lh)
|
$61.71 |
$61.71 |
$61.71 |
$129.00
|
|
Goserelin 10.8 mg subcutaneous implant
|
$1,264.04 |
$1,264.04 |
$1,264.04 |
$4,496.37
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$26,706.90 |
$26,706.90 |
$26,706.90 |
$23,288.44
|
|
Graft nerve adv 3-4x70mm
|
$3,550.78 |
$3,550.78 |
$3,550.78 |
$20,782.10
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$976.80 |
$976.80 |
$976.80 |
$892.38
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$4,900.50 |
$4,900.50 |
$4,900.50 |
$1,132.47
|
|
Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm
|
$33,877.80 |
$33,877.80 |
$33,877.80 |
$29,056.92
|
|
Graft xenmtrx sft rect 15x20cm
|
$19,965.00 |
$19,965.00 |
$19,965.00 |
$31,191.20
|
|
Graft xenmtrx sft rect 19x28cm
|
$1,958.55 |
$1,958.55 |
$1,958.55 |
$3,076.20
|
|
Granisetron 1 mg tab
|
$19.49 |
$19.49 |
$19.49 |
$53.15
|
|
Granisetron hcl injection
|
$115.80 |
$115.80 |
$115.80 |
$47.04
|
|
G-tube reposition
|
$134.64 |
$134.64 |
$134.64 |
$745.80
|
|
Guided cath fluid drainage 10030
|
$358.05 |
$358.05 |
$358.05 |
$1,327.76
|
|
Guide wire threaded 1.4x150mm
|
$1,214.40 |
$1,214.40 |
$1,214.40 |
$3,401.81
|
|
Gw stiffened micro access kit
|
$882.73 |
$882.73 |
$882.73 |
$6,600.00
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$84.33 |
$84.33 |
$84.33 |
$89.32
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$13.85 |
$13.85 |
$13.85 |
$24.41
|
|
Hand X-ray
|
$144.54 |
$144.54 |
$144.54 |
$345.87
|
|
Haptoglobin quantitative
|
$41.91 |
$41.91 |
$41.91 |
$91.80
|
|
Hba1/hba2 full gene sequence
|
$235.62 |
$235.62 |
$235.62 |
$769.95
|
|
Hba1/hba2 gene dup/del vrnts
|
$256.74 |
$256.74 |
$256.74 |
$403.25
|
|
Hbb full gene sequence
|
$235.62 |
$235.62 |
$235.62 |
$633.25
|
|
Hbb gene dup/del variants
|
$231.00 |
$231.00 |
$231.00 |
$404.80
|
|
Hcg qualitative
|
$25.08 |
$25.08 |
$25.08 |
$88.00
|
|
Hcg quantitative
|
$50.16 |
$50.16 |
$50.16 |
$137.15
|
|
Hc i-131 sodium iodide cap dx per mci
|
$21.50 |
$21.50 |
$21.50 |
$117.00
|
|
Hc nm kidney imaging with flow
|
$224.07 |
$224.07 |
$224.07 |
$849.00
|
|
Head CT scan (with and without contrast)
|
$635.91 |
$635.91 |
$635.91 |
$1,818.96
|
|
Head CT scan (with contrast)
|
$410.85 |
$410.85 |
$410.85 |
$1,526.50
|
|
Head CT scan (without contrast)
|
$410.85 |
$410.85 |
$410.85 |
$1,268.90
|
|
Helicobacter pylori antibody igm
|
$48.18 |
$48.18 |
$48.18 |
$92.23
|
|
Hematocrit
|
$7.92 |
$7.92 |
$7.92 |
$33.57
|
|
Hemin 350 mg intravenous powder for solution
|
$12,587.12 |
$12,587.12 |
$12,587.12 |
$20,618.46
|
|
Hemodialysis one evaluation
|
$654.72 |
$654.72 |
$654.72 |
$1,338.00
|
|
Hemoglobin
|
$7.92 |
$7.92 |
$7.92 |
$32.76
|
|
Hemoglobin methemoglobin quantitative
|
$23.43 |
$23.43 |
$23.43 |
$52.32
|
|
Hepagam b im injection
|
$228.70 |
$228.70 |
$228.70 |
$1,118.05
|
|
Heparin assay
|
$43.56 |
$43.56 |
$43.56 |
$138.84
|
|
Heparin bolus from bag
|
$17.58 |
$17.58 |
$17.58 |
$68.00
|
|
Hepatitis a antibody igm
|
$36.30 |
$36.30 |
$36.30 |
$88.92
|
|
Hepatitis b core antibody total
|
$11.22 |
$11.22 |
$11.22 |
$77.50
|
|
Hepatitis b immune globulin greater than 1,560 units/5 ml im solution
|
$742.09 |
$742.09 |
$742.09 |
$1,174.30
|
|
Hepatitis b surface antibody
|
$35.64 |
$35.64 |
$35.64 |
$81.12
|
|
Hepatitis c antibody
|
$47.52 |
$47.52 |
$47.52 |
$108.00
|
|
Hepatobiliary system imaging
|
$220.11 |
$220.11 |
$220.11 |
$1,438.99
|
|
Herpes simplex type 1 antibody igg
|
$44.88 |
$44.88 |
$44.88 |
$66.30
|
|
Herpes simplex type 2 antibody igg
|
$44.88 |
$44.88 |
$44.88 |
$87.10
|
|
Heterophile antibodies screening
|
$17.16 |
$17.16 |
$17.16 |
$72.00
|
|
Hip X-ray
|
$149.49 |
$149.49 |
$149.49 |
$296.05
|
|
Histamine
|
$85.80 |
$85.80 |
$85.80 |
$114.84
|
|
HIV prep, ftc/taf 200/25mg
|
$29.07 |
$29.07 |
$29.07 |
$88.39
|
|
HIV prep, ftc/tdf 200/300mg
|
$24.32 |
$24.32 |
$24.32 |
$31.80
|
|
Hla ii typing 1 loc hr
|
$81.51 |
$81.51 |
$81.51 |
$290.94
|
|
Hla i typing complete lr
|
$159.39 |
$159.39 |
$159.39 |
$719.20
|
|
Hla i typing high res 1 allele grp ea
|
$122.43 |
$122.43 |
$122.43 |
$304.20
|
|
Hocm 250-299mg/ml iodine,1ml
|
$35.41 |
$35.41 |
$35.41 |
$41.79
|
|
Hocm 350-399mg/ml iodine,1ml
|
$161.16 |
$161.16 |
$161.16 |
$79.78
|
|
Homocysteine
|
$13.20 |
$13.20 |
$13.20 |
$125.00
|
|
Homogenization tissue
|
$11.88 |
$11.88 |
$11.88 |
$41.00
|
|
Ho post-op hip abduction
|
$1,947.86 |
$1,947.86 |
$1,947.86 |
$1,837.50
|
|
Human epididymis protein 4 (he4)
|
$41.58 |
$41.58 |
$41.58 |
$156.65
|
|
Hyaluronidase 150 unit/ml injection solution
|
$106.95 |
$106.95 |
$106.95 |
$120.76
|
|
Hyaluronidase 200 units/ml inj
|
$135.88 |
$135.88 |
$135.88 |
$239.37
|
|
Hyaluronidase, human recombinant 150 unit/ml injection solution
|
$106.95 |
$106.95 |
$106.95 |
$142.40
|
|
Hydralazine 20 mg/ml injection solution
|
$32.66 |
$32.66 |
$32.66 |
$46.74
|
|
Hydration IV infusion each additional hour
|
$23.76 |
$23.76 |
$23.76 |
$133.11
|
|
Hydration IV infusion initial 31minutes - 1 hour
|
$107.58 |
$107.58 |
$107.58 |
$385.20
|
|
Hydrocortisone in ns IV syringe 1 mg/ml (neo/ped) - cnr
|
$196.62 |
$196.62 |
$196.62 |
$153.08
|
|
Hydromorphone 0.2 mg/ml in 0.9% nacl IV pca opioid naive - 4 hr dose limit (wrapper)
|
$149.61 |
$149.61 |
$149.61 |
$120.72
|
|
Hydroxocobalamin im 10mcg
|
$1.19 |
$1.19 |
$1.19 |
$4.86
|
|
Hydroxyzine hcl 50 mg/ml intramuscular solution
|
$58.59 |
$58.59 |
$58.59 |
$72.65
|
|
Hydroxyzine pamoate 25 mg capsule
|
$0.19 |
$0.19 |
$0.19 |
$1.28
|
|
Hysterosalpingography s&i
|
$120.78 |
$120.78 |
$120.78 |
$663.50
|
|
Hzv zoster vacc recombinant adjuvanted im inj
|
$272.91 |
$272.91 |
$272.91 |
$352.24
|
|
I-123 iobenguane diag
|
$2,909.11 |
$2,909.11 |
$2,909.11 |
$5,170.70
|
|
I-123 sod iodide diag per 100 uci
|
$54.78 |
$54.78 |
$54.78 |
$144.24
|
|
I131 iodide cap, rx
|
$21.50 |
$21.50 |
$21.50 |
$71.70
|
|
Iaadi respiratory synctial virus
|
$73.92 |
$73.92 |
$73.92 |
$54.98
|
|
Iadna legionella pneumophila amplified probe tq
|
$31.68 |
$31.68 |
$31.68 |
$109.00
|
|
Ibandronate 3 mg/3 ml intravenous syringe
|
$281.16 |
$281.16 |
$281.16 |
$684.45
|
|
Ibutilide fumarate 0.1 mg/ml intravenous solution
|
$1,073.00 |
$1,073.00 |
$1,073.00 |
$975.45
|
|
Icd cobalt xt dr MRI is1 df1
|
$17,490.00 |
$17,490.00 |
$17,490.00 |
$34,681.07
|
|
Idarubicin hcl injection
|
$206.58 |
$206.58 |
$206.58 |
$447.02
|
|
Ifosfamide 1 gram intravenous solution
|
$120.95 |
$120.95 |
$120.95 |
$246.95
|
|
Ihc/icc per specimen each additional single antibody stain
|
$66.99 |
$66.99 |
$66.99 |
$191.52
|
|
Ihc/icc per specimen each multiplex antibody stain
|
$137.94 |
$137.94 |
$137.94 |
$328.79
|
|
Ihc/icc per specimen initial single antibody stain
|
$73.26 |
$73.26 |
$73.26 |
$272.30
|
|
Imetelstat 188 mg intravenous solution
|
$11,707.03 |
$11,707.03 |
$11,707.03 |
$20,373.55
|
|
Immobilizer shldr cntor adlt
|
$153.19 |
$153.19 |
$153.19 |
$175.60
|
|
Immobilizer shldr dlx str 24-36in med
|
$71.28 |
$71.28 |
$71.28 |
$114.60
|
|
Immune globulin, gamma (igg) (10 %)-gly-iga over 50 mcg/ml injection solution
|
$10,039.94 |
$10,039.94 |
$10,039.94 |
$6,106.32
|
|
Immune globulin, gamma (igg) 10 gram-gly-gluc-iga 0 to 50 mcg/ml IV solution
|
$2,522.12 |
$2,522.12 |
$2,522.12 |
$2,900.11
|
|
Immune globulin, gamma (igg) (10 %)-malt-iga over 50 mcg/ml intravenous solution
|
$3,669.39 |
$3,669.39 |
$3,669.39 |
$3,846.15
|
|
Immunoassay tumor antigen quantitative ca 125
|
$70.29 |
$70.29 |
$70.29 |
$131.95
|
