|
Furosemide 10 mg/ml injection solution
|
$19.00 |
$26.02 |
$27.94 |
|
|
Ga-67 gallium 0.1 mci
|
$192.80 |
$192.80 |
$192.80 |
|
|
Ga-68 gallium 68 dotatate
|
$136.00 |
$136.00 |
$170.40 |
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$60.00 |
$102.00 |
$289.56 |
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$136.00 |
$208.00 |
$458.67 |
|
|
Galactose transferase test
|
$34.40 |
$34.40 |
$34.40 |
|
|
Gallbladder and Bile Duct Scan (HIDA Scan)
|
$1,564.80 |
$1,564.80 |
$2,038.40 |
|
|
Gallbladder Function Scan (HIDA with Medication)
|
$1,972.00 |
$1,983.20 |
$2,038.40 |
|
|
Gallium illuccix 1 millicure
|
$1,304.80 |
$1,304.80 |
$1,377.60 |
|
|
Gamma globulin 1 cc inj
|
$227.11 |
$227.11 |
$910.76 |
|
|
Gammaglobulin iga
|
$69.60 |
$69.60 |
$69.60 |
|
|
Gammaglobulin ige
|
$93.60 |
$93.60 |
$93.60 |
|
|
Gamma glutamyltransferase
|
$54.40 |
$54.40 |
$54.40 |
|
|
Gammagraft
|
$144.00 |
$144.00 |
$1,120.00 |
|
|
Gamunex-c/gammaked
|
$2,876.40 |
$4,550.40 |
$4,993.20 |
|
|
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr
|
$193.29 |
$193.29 |
$219.19 |
|
|
Gastroesophageal reflux study
|
$800.80 |
$800.80 |
$1,348.00 |
|
|
Gastroesophageal reflux test
|
$1,057.60 |
$1,057.60 |
$1,865.60 |
|
|
Gel cap for trach voice pros
|
$67.84 |
$67.84 |
$67.84 |
|
|
Gemcitabine 1 gram intravenous solution
|
$224.09 |
$224.09 |
$239.91 |
|
|
Gemtuzumab ozogamicin 4.5 mg (1 mg/ml initial concentration) IV soln
|
$9,179.38 |
$9,179.38 |
$15,595.40 |
|
|
General health panel
|
$221.60 |
$221.60 |
$221.60 |
|
|
Generator barostim neo2 2014
|
$66,916.68 |
$66,916.68 |
$73,000.02 |
|
|
Generator emblem MRI sicd subq
|
$62,726.40 |
$62,726.40 |
$68,428.80 |
|
|
Gen, neuro, clo loop, rechg
|
$35,200.00 |
$35,200.00 |
$38,400.00 |
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$27.55 |
$60.07 |
$72.12 |
|
|
Gentamicin peak therapeutic drug level
|
$85.60 |
$85.60 |
$85.60 |
|
|
G-esoph reflx tst w/electrod
|
$1,871.20 |
$1,871.20 |
$1,900.80 |
|
|
Ghs abscess perianal iandd
|
$1,421.60 |
$2,070.40 |
$2,135.20 |
|
|
Ghs abscess postoperative iandd complex
|
$3,235.20 |
$3,235.20 |
$4,176.80 |
|
|
Ghs analysis neurostim without reprogramming
|
$216.00 |
$216.00 |
$376.80 |
|
|
Ghs antibodies (torch) igm
|
$77.60 |
$77.60 |
$77.60 |
|
|
Ghs aspiration bladder - needle
|
$796.00 |
$796.00 |
$827.20 |
|
|
Ghs bladder cath - complex-foley
|
$332.00 |
$332.00 |
$552.80 |
|
|
Ghs block ilioinguinal/gentitofemoral
|
$1,270.40 |
$1,270.40 |
$1,340.00 |
|
|
Ghs central line insert < age 5, failed
|
$2,069.60 |
$2,069.60 |
$2,312.80 |
|
|
Ghs change cysto/gastrost
|
$552.00 |
$552.00 |
$964.80 |
|
|
Ghs chemo >8 hrs
|
$795.20 |
$795.20 |
$947.20 |
|
|
Ghs chemo IV push, ea addtl
|
$321.60 |
$321.60 |
$327.20 |
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$405.60 |
$587.20 |
$616.00 |
|
|
Ghs closed reduction ankle dislocation
|
$394.40 |
$680.80 |
$720.00 |
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$1,573.60 |
$1,573.60 |
$2,040.80 |
|
|
Ghs closed tx radiocarpal disloc w manip
|
$476.80 |
$476.80 |
$620.00 |
|
|
Ghs closed tx tibial fracture w/manip
|
$2,071.20 |
$2,071.20 |
$2,179.20 |
|
|
Ghs closure surg wound/dehiscence-13160
|
$3,219.20 |
$3,219.20 |
$3,780.00 |
|
|
Ghs clsd red med malleolus fx without manip
|
$388.00 |
$539.20 |
$565.60 |
|
|
Ghs clsd red med malleolus fx w manip
|
$1,841.60 |
$1,841.60 |
$2,053.60 |
|
|
Ghs clsd tx frac distal tibia w/manipulation
|
$2,304.00 |
$2,304.00 |
$2,375.20 |
|
|
Ghs cl tx knee disl; wo anesth
|
$388.00 |
$496.80 |
$555.20 |
|
|
Ghs cl tx metacarpophal disloc without anes
|
$376.00 |
$604.80 |
$616.80 |
|
|
Ghs community re-entry 15 minutes
|
$92.80 |
$92.80 |
$137.60 |
|
|
Ghs conjunctiva foreign body-embed bil
|
$496.80 |
$532.80 |
$548.80 |
|
|
Ghs conjunctiva foreign body-superf bil
|
$239.20 |
$341.60 |
$532.80 |
|
|
Ghs corneal fb without slit lamp bilat
|
$496.80 |
$565.60 |
$586.40 |
|
|
Ghs corneal fb with slit lamp bilat
|
$352.00 |
$352.00 |
$532.80 |
|
|
Ghs cricothyroidotomy
|
$820.80 |
$820.80 |
$1,562.40 |
|
|
Ghs cutdown placement under 1 yr
|
$163.20 |
$163.20 |
$163.20 |
|
|
Ghs dislocation elbow closed treatment
|
$394.40 |
$618.40 |
$731.20 |
|
|
Ghs ed peritoneal lavage w guidance if performed
|
$2,154.40 |
$2,154.40 |
$2,159.20 |
|
|
Ghs ed rmvl or bivalving cast
|
$363.20 |
$363.20 |
$368.00 |
|
|
Ghs ed therapeutic lp, drain csf w fluoro
|
$1,880.80 |
$1,880.80 |
$1,910.40 |
|
|
Ghs eeg cont rec w/video by tec min 8 chnls
|
$1,429.60 |
$1,429.60 |
$1,646.40 |
|
|
Ghs electrostagmgraphy
|
$695.20 |
$695.20 |
$695.20 |
|
|
Ghs elect vertical elct
|
$28.80 |
$28.80 |
$28.80 |
|
|
Ghs excision ingrown nail
|
$505.60 |
$505.60 |
$532.00 |
|
|
Ghs eyelid foreign body-embedded - bil
|
$605.60 |
$605.60 |
$645.60 |
|
|
Ghs fb removal foot - deep - left
|
$2,316.80 |
$2,316.80 |
$2,640.80 |
|
|
Ghs fb removal from muscle - complicated
|
$3,532.80 |
$3,532.80 |
$4,675.20 |
|
|
Ghs fb removal - incisional
|
$2,289.60 |
$2,289.60 |
$2,614.40 |
|
|
Ghs fb removal - non-incisional
|
$1,870.40 |
$1,870.40 |
$3,908.00 |
|
|
Ghs fish cytogen
|
$118.40 |
$118.40 |
$118.40 |
|
|
Ghs fish hybrid in situ 100-300
|
$124.80 |
$124.80 |
$124.80 |
|
|
Ghs gastric intub aspiration lavage
|
$385.60 |
$385.60 |
$668.00 |
|
|
Ghs hgb stability-thal
|
$120.80 |
$120.80 |
$120.80 |
|
|
Ghs HIV antibody
|
$67.20 |
$67.20 |
$67.20 |
|
|
Ghs hla-dr/dq, multiple antigens
|
$320.00 |
$320.00 |
$320.00 |
|
|
Ghs i and d abscess/hematoma scrotum
|
$3,076.00 |
$3,076.00 |
$3,320.80 |
|
|
Ghs i and d perirectal abscess 46040
|
$3,267.20 |
$3,267.20 |
$3,407.20 |
|
|
Ghs i and d pilonidal cyst complex
|
$1,142.40 |
$1,142.40 |
$1,807.20 |
|
|
Ghs i and d pilonidal cyst simple
|
$701.60 |
$701.60 |
$866.40 |
|
|
Ghs incision thrombosed ext hemorrhoid
|
$484.00 |
$565.60 |
$679.20 |
|
|
Ghs indirect laryngoscopy/w fb removal
|
$352.80 |
$696.80 |
$696.80 |
|
|
Ghs inf midline insertion
|
$1,706.40 |
$1,706.40 |
$2,041.60 |
|
|
Ghs init tx 1st degree burn
|
$248.00 |
$258.40 |
$329.60 |
|
|
Ghs inj neurolytic intercostal nerve
|
$2,546.40 |
$2,546.40 |
$2,785.60 |
|
|
Ghs inj neurolytic other perph nerve
|
$1,566.40 |
$1,566.40 |
$1,977.60 |
|
|
Ghs inj tendon origin/insertion
|
$504.00 |
$504.00 |
$908.80 |
|
|
Ghs inj transforaminal cerv ea add bil
|
$1,072.80 |
$1,072.80 |
$1,301.60 |
|
|
Ghs inj transforaminal cerv single bil
|
$1,647.20 |
$1,647.20 |
$1,861.60 |
|
|
Ghs insertion of needle - bone
|
$497.60 |
$556.00 |
$577.60 |
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$852.00 |
$862.40 |
$967.20 |
|
|
Ghs intermed repair 20.1 - 30.0 cm-12036
|
$967.20 |
$971.20 |
$986.40 |
|
|
Ghs intermed repair over 30 cm - 12037
|
$3,070.40 |
$3,070.40 |
$3,255.20 |
|
|
Ghs intro needle/intracath vein - 36000
|
$17.60 |
$17.60 |
$166.40 |
|
|
Ghs irrigate corpora cavernosa for priapism
|
$462.40 |
$462.40 |
$596.00 |
|
|
Ghs IV inf sq injection, on-body injector
|
$140.80 |
$140.80 |
$140.80 |
|
|
Ghs IV thrombolytics - cerebral
|
$585.60 |
$585.60 |
$864.00 |
|
|
Ghs lac repair mouth.ant tong 2.5cm/less
|
$505.60 |
$505.60 |
$526.40 |
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$716.80 |
$862.40 |
$967.20 |
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$525.60 |
$525.60 |
$815.20 |
|
