|
Foscarnet sodium injection
|
$2,264.50 |
$2,264.50 |
$2,264.50 |
$714.25
|
|
Fracture assessment via dxa
|
$858.54 |
$858.54 |
$858.54 |
$136.07
|
|
Fresh frozen plasma thawing ea un
|
$151.94 |
$151.94 |
$151.94 |
$130.00
|
|
Furosemide in ns IV syringe 2 mg/ml (neo/ped) - cnr
|
$87.80 |
$87.80 |
$87.80 |
$26.40
|
|
Ga-67 gallium 0.1 mci
|
$3,003.21 |
$3,003.21 |
$3,003.21 |
$163.80
|
|
Ga-68 gallium 68 dotatate
|
$214.39 |
$214.39 |
$214.39 |
$119.90
|
|
Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper)
|
$54.89 |
$54.89 |
$54.89 |
$144.98
|
|
Gadoterate meglumine 0.5 mmol/ml (376.9 mg/ml) intravenous solution
|
$1,007.07 |
$1,007.07 |
$1,007.07 |
$86.54
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$1,435.15 |
$1,435.15 |
$1,435.15 |
$210.50
|
|
Gallium illuccix 1 millicure
|
$3,560.18 |
$3,560.18 |
$3,560.18 |
$1,395.27
|
|
Gamma globulin 1 cc inj
|
$2,821.18 |
$2,821.18 |
$2,821.18 |
$101.98
|
|
Gammaglobulin ige
|
$606.96 |
$606.96 |
$606.96 |
$85.00
|
|
Gamma glutamyltransferase
|
$975.65 |
$975.65 |
$975.65 |
$55.28
|
|
Gastric analy w/ph ea spec
|
$442.75 |
$442.75 |
$442.75 |
$23.01
|
|
Gastroesophageal reflux test
|
$4,372.86 |
$4,372.86 |
$4,372.86 |
$1,115.40
|
|
Gemcitabine 1 gram intravenous solution
|
$180.14 |
$180.14 |
$180.14 |
$240.65
|
|
General health panel
|
$1,952.91 |
$1,952.91 |
$1,952.91 |
$280.00
|
|
G-esoph reflx tst w/electrod
|
$6,335.64 |
$6,335.64 |
$6,335.64 |
$1,352.03
|
|
Ghs alcohol, methyl (methanol)-medtox
|
$397.66 |
$397.66 |
$397.66 |
$103.14
|
|
Ghs alpha thalasemia, 7 deletions
|
$940.22 |
$940.22 |
$940.22 |
$433.58
|
|
Ghs antibodies (torch) igm
|
$1,849.87 |
$1,849.87 |
$1,849.87 |
$77.60
|
|
Ghs chemo >8 hrs
|
$2,666.35 |
$2,666.35 |
$2,666.35 |
$710.00
|
|
Ghs chemo IV push, ea addtl
|
$1,119.67 |
$1,119.67 |
$1,119.67 |
$291.87
|
|
Ghs chlamydia pneumoniae by pcr (arup) (306630)
|
$1,362.04 |
$1,362.04 |
$1,362.04 |
$130.70
|
|
Ghs diphtheria toxoid ab igg
|
$701.95 |
$701.95 |
$701.95 |
$74.53
|
|
Ghs ed therapeutic lp, drain csf w fluoro
|
$2,077.00 |
$2,077.00 |
$2,077.00 |
$1,381.60
|
|
Ghs eeg cont rec w/video by tec min 8 chnls
|
$4,610.49 |
$4,610.49 |
$4,610.49 |
$547.20
|
|
Ghs febrile agglutinns(mayo)
|
$359.02 |
$359.02 |
$359.02 |
$48.57
|
|
Ghs fish cytogen
|
$662.10 |
$662.10 |
$662.10 |
$176.93
|
|
Ghs fish hybrid in situ 100-300
|
$1,215.54 |
$1,215.54 |
$1,215.54 |
$229.45
|
|
Ghs flow volume loop
|
$1,683.52 |
$1,683.52 |
$1,683.52 |
$308.69
|
|
Ghs hcv amplificaiton
|
$1,812.84 |
$1,812.84 |
$1,812.84 |
$195.60
|
|
Ghs hepatitis c virus (hcv riba)
|
$3,620.84 |
$3,620.84 |
$3,620.84 |
$105.00
|
|
Ghs histoplasma antigen
|
$758.30 |
$758.30 |
$758.30 |
$144.50
|
|
Ghs HIV antibody
|
$1,304.08 |
$1,304.08 |
$1,304.08 |
$93.00
|
|
Ghs immun0electrophoresis
|
$872.60 |
$872.60 |
$872.60 |
$102.70
|
|
Ghs mbp
|
$1,458.64 |
$1,458.64 |
$1,458.64 |
$77.35
|
|
Ghs ng placement w fluoro guidance
|
$2,602.91 |
$2,602.91 |
$2,602.91 |
$456.33
|
|
Ghs o2 saturation
|
$193.19 |
$193.19 |
$193.19 |
$72.45
|
|
Ghs o2 uptake rest & exercise
|
$1,880.13 |
$1,880.13 |
$1,880.13 |
$185.15
|
|
Ghs opcc repair cvp without subq port
|
$4,307.67 |
$4,307.67 |
$4,307.67 |
$1,325.50
|
|
Ghs phenylketonurid
|
$442.75 |
$442.75 |
$442.75 |
$55.53
|
|
Ghs polysom <6 yrs 4/> parameters
|
$11,051.88 |
$11,051.88 |
$11,051.88 |
$3,705.80
|
|
Ghs protein, misc fluid
|
$130.42 |
$130.42 |
$130.42 |
$24.60
|
|
Ghs protoporphyrins fract
|
$431.07 |
$431.07 |
$431.07 |
$64.35
|
|
Ghs pr without cont pulse ox
|
$461.16 |
$461.16 |
$461.16 |
$149.60
|
|
Ghs reticulocyte count
|
$394.44 |
$394.44 |
$394.44 |
$33.57
|
|
Ghs sedimentation rate
|
$669.75 |
$669.75 |
$669.75 |
$45.50
|
|
Ghs sensitivity (per antimicro)
|
$832.16 |
$832.16 |
$832.16 |
$59.90
|
|
Ghs sleep study unattended
|
$7,977.70 |
$7,977.70 |
$7,977.70 |
$503.38
|
|
Ghs speech-gen aug dev eval iii, st
|
$526.36 |
$526.36 |
$526.36 |
$118.20
|
|
Ghs sp train/fitting sp device - kx
|
$574.63 |
$574.63 |
$574.63 |
$249.60
|
|
Ghs urine, porphyrins quant
|
$609.79 |
$609.79 |
$609.79 |
$72.60
|
|
Gi endoscopic ultrasound
|
$1,911.34 |
$1,911.34 |
$1,911.34 |
$328.08
|
|
Gi inhouse confirmation
|
$1,345.94 |
$1,345.94 |
$1,345.94 |
$83.85
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$1,126.43 |
$1,126.43 |
$1,126.43 |
$509.06
|
|
Glucagon plasma - sendout
|
$606.96 |
$606.96 |
$606.96 |
$58.00
|
|
Glucose 1 hr post dose
|
$265.64 |
$265.64 |
$265.64 |
$45.00
|
|
Glucose blood quantitative
|
$276.91 |
$276.91 |
$276.91 |
$44.40
|
|
Glucose tolerance test (gtt) 3 specimens
|
$862.95 |
$862.95 |
$862.95 |
$97.50
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$373.88 |
$373.88 |
$373.88 |
$33.57
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$1,716.23 |
$1,716.23 |
$1,716.23 |
$107.55
|
|
Gonadotropin luteinizing hormone (lh)
|
$2,026.97 |
$2,026.97 |
$2,026.97 |
$124.00
|
|
Goserelin 10.8 mg subcutaneous implant
|
$4,675.87 |
$4,675.87 |
$4,675.87 |
$2,506.56
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$2,109.00 |
$2,109.00 |
$2,109.00 |
$17,915.77
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$2,152.00 |
$2,152.00 |
$2,152.00 |
$2,114.00
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$6,031.00 |
$6,031.00 |
$6,031.00 |
$886.89
|
|
Group mnt 2 or more 30 mins
|
$138.82 |
$138.82 |
$138.82 |
$35.20
|
|
Gu dilat ureter/urethra s&i
|
$305.63 |
$305.63 |
$305.63 |
$1,712.25
|
|
Guided cath fluid drainage 10030
|
$1,068.55 |
$1,068.55 |
$1,068.55 |
$1,454.66
|
|
Guid loc target vol rad tx
|
$1,206.77 |
$1,206.77 |
$1,206.77 |
$500.00
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$109.44 |
$109.44 |
$109.44 |
$120.02
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$285.38 |
$285.38 |
$285.38 |
$27.12
|
|
Hand-held pefr meter a4614
|
$212.00 |
$212.00 |
$212.00 |
$33.10
|
|
Haptoglobin quantitative
|
$487.82 |
$487.82 |
$487.82 |
$80.24
|
|
Hbb full gene sequence
|
$833.97 |
$833.97 |
$833.97 |
$633.25
|
|
Hc fl sm bowel enteroclss tube w kub double contrast
|
$5,637.39 |
$5,637.39 |
$5,637.39 |
$757.08
|
|
Hc i-131 sodium iodide cap dx per mci
|
$349.11 |
$349.11 |
$349.11 |
$142.49
|
|
Hc nm kidney imaging with flow
|
$9,660.21 |
$9,660.21 |
$9,660.21 |
$1,008.39
|
|
Hc nm myocard infarct avid plnr tomo spect w/wo quant
|
$8,783.93 |
$8,783.93 |
$8,783.93 |
$1,186.80
|
|
Hdr rdncl ntrstl/icav brchtx
|
$11,753.50 |
$11,753.50 |
$11,753.50 |
$2,668.85
|
|
Hdr rdncl ntrstl/icav brchtx
|
$12,469.96 |
$12,469.96 |
$12,469.96 |
$2,960.63
|
|
Helicobacter pylori antibody igm
|
$587.65 |
$587.65 |
$587.65 |
$82.50
|
|
Hemodialysis one evaluation
|
$5,206.33 |
$5,206.33 |
$5,206.33 |
$1,257.76
|
|
Hemoglobin
|
$412.15 |
$412.15 |
$412.15 |
$32.50
|
|
Hemoglobin fetal qualitative
|
$400.89 |
$400.89 |
$400.89 |
$51.75
|
|
Hemoglobin methemoglobin quantitative
|
$328.43 |
$328.43 |
$328.43 |
$47.49
|
|
Hemoglobin plasma
|
$1,175.28 |
$1,175.28 |
$1,175.28 |
$38.20
|
|
Hemoglobin urine
|
$347.76 |
$347.76 |
$347.76 |
$23.31
|
|
Hemolysins/agglutinins auto
|
$204.57 |
$204.57 |
$204.57 |
$53.96
|
|
Hemolysins and agglutinins incubated
|
$957.45 |
$957.45 |
$957.45 |
$67.50
|
|
Hepagam b intravenous, inj
|
$1,845.39 |
$1,845.39 |
$1,845.39 |
$386.40
|
|
Heparin, porcine (pf) 10 unit/ml flush (wrapper)
|
$61.74 |
$61.74 |
$61.74 |
$24.26
|
|
Hepatitis a antibody igm
|
$202.85 |
$202.85 |
$202.85 |
$83.91
|
|
Hepatitis b core antibody igm
|
$1,664.72 |
$1,664.72 |
$1,664.72 |
$83.91
|
|
Hepatitis b core antibody total
|
$1,278.32 |
$1,278.32 |
$1,278.32 |
$79.34
|
|
Hepatitis b surface antibody
|
$1,191.38 |
$1,191.38 |
$1,191.38 |
$81.12
|
|
Hepatitis c antibody
|
$621.45 |
$621.45 |
$621.45 |
$108.00
|
|
Hepatobiliary system imaging
|
$11,513.75 |
$11,513.75 |
$11,513.75 |
$1,521.10
|
|
Herpes simplex type 2 antibody igg
|
$1,849.87 |
$1,849.87 |
$1,849.87 |
$87.10
|
