|
Gamunex-c/gammaked
|
$8,343.60 |
$8,343.60 |
$8,343.60 |
$7,634.20
|
|
Gemcitabine 1 gram intravenous solution
|
$346.80 |
$346.80 |
$346.80 |
$207.51
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$4.20 |
$4.20 |
$4.20 |
$57.84
|
|
Gentamicin peak therapeutic drug level
|
$175.20 |
$175.20 |
$175.20 |
$126.00
|
|
Ghs bladder cath - complex-foley
|
$304.20 |
$304.20 |
$304.20 |
$344.00
|
|
Ghs block ilioinguinal/gentitofemoral
|
$112.80 |
$112.80 |
$112.80 |
$1,045.65
|
|
Ghs change cysto/gastrost
|
$378.00 |
$378.00 |
$378.00 |
$565.49
|
|
Ghs chemo >8 hrs
|
$443.40 |
$443.40 |
$443.40 |
$714.87
|
|
Ghs chemo IV push, ea addtl
|
$327.00 |
$327.00 |
$327.00 |
$286.00
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$267.60 |
$267.60 |
$267.60 |
$512.40
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$957.60 |
$957.60 |
$957.60 |
$1,592.00
|
|
Ghs closed tx tibial fracture w/manip
|
$3,543.60 |
$3,543.60 |
$3,543.60 |
$2,148.00
|
|
Ghs clsd red med malleolus fx w manip
|
$3,543.60 |
$3,543.60 |
$3,543.60 |
$2,184.00
|
|
Ghs clsd tx frac distal tibia w/manipulation
|
$3,543.60 |
$3,543.60 |
$3,543.60 |
$2,211.05
|
|
Ghs cl tx metacarpophal disloc without anes
|
$267.60 |
$267.60 |
$267.60 |
$495.55
|
|
Ghs corneal fb without slit lamp bilat
|
$255.00 |
$255.00 |
$255.00 |
$419.65
|
|
Ghs corneal fb with slit lamp bilat
|
$255.00 |
$255.00 |
$255.00 |
$339.60
|
|
Ghs dislocation elbow closed treatment
|
$267.60 |
$267.60 |
$267.60 |
$578.00
|
|
Ghs ed rmvl or bivalving cast
|
$45.60 |
$45.60 |
$45.60 |
$329.60
|
|
Ghs epidermal shaving diameter >2.0 cm
|
$109.20 |
$109.20 |
$109.20 |
$467.00
|
|
Ghs fish cytogen
|
$101.40 |
$101.40 |
$101.40 |
$170.80
|
|
Ghs fish hybrid in situ 100-300
|
$222.60 |
$222.60 |
$222.60 |
$223.00
|
|
Ghs gastric intub aspiration lavage
|
$405.00 |
$405.00 |
$405.00 |
$368.50
|
|
Ghs histoplasma antigen
|
$109.80 |
$109.80 |
$109.80 |
$141.00
|
|
Ghs inhibitor screen
|
$332.40 |
$332.40 |
$332.40 |
$187.32
|
|
Ghs init tx 1st degree burn
|
$171.00 |
$171.00 |
$171.00 |
$275.50
|
|
Ghs inj tendon origin/insertion
|
$49.80 |
$49.80 |
$49.80 |
$431.07
|
|
Ghs insertion of needle - bone
|
$397.80 |
$397.80 |
$397.80 |
$422.40
|
|
Ghs IV thrombolytics - cerebral
|
$398.40 |
$398.40 |
$398.40 |
$663.00
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$267.60 |
$267.60 |
$267.60 |
$584.00
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$267.60 |
$267.60 |
$267.60 |
$563.75
|
|
Ghs layer closure 2.5cm or less - 12051
|
$267.60 |
$267.60 |
$267.60 |
$593.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$267.60 |
$267.60 |
$267.60 |
$689.04
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$328.80 |
$328.80 |
$328.80 |
$770.22
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$287.40 |
$287.40 |
$287.40 |
$750.12
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$294.00 |
$294.00 |
$294.00 |
$242.31
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$294.00 |
$294.00 |
$294.00 |
$230.00
|
|
Ghs moderate sedation ea addtl 15 min
|
$148.20 |
$148.20 |
$148.20 |
$151.50
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$148.20 |
$148.20 |
$148.20 |
$147.75
|
|
Ghs ot prosthetic training/15 min
|
$126.00 |
$126.00 |
$126.00 |
$90.50
|
|
Ghs ot sensory integrative tech/15min
|
$126.00 |
$126.00 |
$126.00 |
$94.80
|
|
Ghs plngl fx pm cl
|
$267.60 |
$267.60 |
$267.60 |
$564.80
|
|
Ghs polysom <6 yrs 4/> parameters
|
$2,277.00 |
$2,277.00 |
$2,277.00 |
$3,557.58
|
|
Ghs quinidine
|
$102.00 |
$102.00 |
$102.00 |
$85.00
|
|
Ghs removal intranasal foreign body
|
$315.60 |
$315.60 |
$315.60 |
$287.50
|
|
Ghs sensitivity (per antimicro)
|
$112.80 |
$112.80 |
$112.80 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$287.40 |
$287.40 |
$287.40 |
$553.60
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$287.40 |
$287.40 |
$287.40 |
$448.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$287.40 |
$287.40 |
$287.40 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$287.40 |
$287.40 |
$287.40 |
$484.80
|
|
Ghs subcutaneous infus, for therapy ea. add. hr
|
$82.80 |
$82.80 |
$82.80 |
$98.00
|
|
Ghs superficial wnd dehiscence simp12020
|
$738.60 |
$738.60 |
$738.60 |
$861.75
|
|
Ghs tracheostomy emergency - transtracheal
|
$1,347.60 |
$1,347.60 |
$1,347.60 |
$1,752.89
|
|
Ghs urine, porphyrins quant
|
$63.00 |
$63.00 |
$63.00 |
$75.00
|
|
Gi inhouse confirmation
|
$27.00 |
$27.00 |
$27.00 |
$83.70
|
|
Glucagon 1 mg solution for injection
|
$1,080.00 |
$1,080.00 |
$1,080.00 |
$601.79
|
|
Glucagon hcl 1 mg/ml solution for injection
|
$690.60 |
$690.60 |
$690.60 |
$491.67
|
|
Glucagon plasma - sendout
|
$277.20 |
$277.20 |
$277.20 |
$63.00
|
|
Glucose 1 hr post dose
|
$108.60 |
$108.60 |
$108.60 |
$47.20
|
|
Glucose blood quantitative
|
$111.00 |
$111.00 |
$111.00 |
$40.00
|
|
Glucose body fluid
|
$127.80 |
$127.80 |
$127.80 |
$52.20
|
|
Glucose tolerance test (gtt) 3 specimens
|
$163.80 |
$163.80 |
$163.80 |
$100.16
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$103.20 |
$103.20 |
$103.20 |
$35.00
|
|
Glycopyrrolate 0.2 mg/ml injection solution
|
$10.20 |
$10.20 |
$10.20 |
$37.04
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$247.80 |
$247.80 |
$247.80 |
$115.05
|
|
Gonadotropin luteinizing hormone (lh)
|
$247.80 |
$247.80 |
$247.80 |
$129.00
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$5,087.40 |
$5,087.40 |
$5,087.40 |
$672.50
|
|
Graft axiofill 1000mg
|
$133.20 |
$133.20 |
$133.20 |
$5,125.68
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$70.67 |
$70.67 |
$70.67 |
$24,469.57
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$94.08 |
$94.08 |
$94.08 |
$1,455.76
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$22,192.80 |
$22,192.80 |
$22,192.80 |
$1,181.41
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$10,595.70 |
$10,595.70 |
$10,595.70 |
$1,132.47
|
|
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm
|
$526.26 |
$526.26 |
$526.26 |
$373.00
|
|
Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm
|
$517.44 |
$517.44 |
$517.44 |
$1,132.47
|
|
Graft xenmtrx sft rect 15x20cm
|
$4,018.57 |
$4,018.57 |
$4,018.57 |
$30,392.04
|
|
Graft xenmtrx sft rect 19x28cm
|
$353.77 |
$353.77 |
$353.77 |
$2,701.58
|
|
Guide wire threaded 1.4x150mm
|
$924.25 |
$924.25 |
$924.25 |
$3,284.50
|
|
Gw stiffened micro access kit
|
$19.40 |
$19.40 |
$19.40 |
$6,696.00
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$172.20 |
$172.20 |
$172.20 |
$90.14
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$4.80 |
$4.80 |
$4.80 |
$23.06
|
|
Hand X-ray
|
$462.60 |
$462.60 |
$462.60 |
$356.00
|
|
Haptoglobin quantitative
|
$136.20 |
$136.20 |
$136.20 |
$91.14
|
|
Hbot, full body chamber, 30m
|
$892.20 |
$892.20 |
$892.20 |
$526.90
|
|
Hcg qualitative
|
$102.00 |
$102.00 |
$102.00 |
$89.70
|
|
Hcg quantitative
|
$163.80 |
$163.80 |
$163.80 |
$139.20
|
|
Hc nm kidney imaging with flow
|
$898.80 |
$898.80 |
$898.80 |
$822.60
|
|
Head CT scan (with and without contrast)
|
$2,260.20 |
$2,260.20 |
$2,260.20 |
$1,849.90
|
|
Head CT scan (with contrast)
|
$1,590.60 |
$1,590.60 |
$1,590.60 |
$1,545.60
|
|
Head CT scan (without contrast)
|
$1,453.20 |
$1,453.20 |
$1,453.20 |
$1,268.90
|
|
Hematocrit
|
$55.20 |
$55.20 |
$55.20 |
$33.57
|
|
Hemodialysis one evaluation
|
$1,500.00 |
$1,500.00 |
$1,500.00 |
$1,319.44
|
|
Hemoglobin
|
$54.60 |
$54.60 |
$54.60 |
$31.80
|
|
Hemophilus influenza antibdy
|
$100.20 |
$100.20 |
$100.20 |
$62.70
|
|
Heparin bolus from bag
|
$33.00 |
$33.00 |
$33.00 |
$66.47
|
|
Hepatitis a antibody igm
|
$140.40 |
$140.40 |
$140.40 |
$87.75
|
|
Hepatitis b core antibody igm
|
$142.20 |
$142.20 |
$142.20 |
$87.98
|
|
Hepatitis b core antibody total
|
$136.80 |
$136.80 |
$136.80 |
$77.50
|
|
Hepatitis b immune globulin greater than 1,560 units/5 ml im solution
|
$2,938.20 |
$2,938.20 |
$2,938.20 |
$1,116.61
|
|
Hepatitis b surface antibody
|
$185.40 |
$185.40 |
$185.40 |
$82.05
|
|
Hepatitis c antibody
|
$130.80 |
$130.80 |
$130.80 |
$108.00
|
