|
Furosemide in ns IV syringe 2 mg/ml (neo/ped) - cnr
|
$11.45 |
$11.45 |
$11.45 |
$27.08
|
|
Gadopentetate dimeglumine 469.01 mg/ml (46.9 %) intravenous (wrapper)
|
$73.80 |
$73.80 |
$73.80 |
$144.98
|
|
Gallium illuccix 1 millicure
|
$10,451.70 |
$10,451.70 |
$10,451.70 |
$1,395.27
|
|
Gammaglobulin iga
|
$221.85 |
$221.85 |
$221.85 |
$67.20
|
|
Gammaglobulin ige
|
$79.05 |
$79.05 |
$79.05 |
$83.85
|
|
Gamma glutamyltransferase
|
$161.85 |
$161.85 |
$161.85 |
$57.54
|
|
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr
|
$210.11 |
$210.11 |
$210.11 |
$197.40
|
|
Gauze >16<=48 no w/sal without b
|
$9.89 |
$9.89 |
$9.89 |
$5.00
|
|
Gauze <=16 in no w/sal without b
|
$17.01 |
$17.01 |
$17.01 |
$6.40
|
|
Gauze <= 16 sq in w/border
|
$26.06 |
$26.06 |
$26.06 |
$13.65
|
|
Gauze > 48 in no w/sal without b
|
$16.29 |
$16.29 |
$16.29 |
$7.08
|
|
Gel-one
|
$2,277.00 |
$2,277.00 |
$2,277.00 |
$1,341.67
|
|
Gemcitabine 1 gram intravenous solution
|
$195.71 |
$195.71 |
$195.71 |
$207.51
|
|
Gemtuzumab ozogamicin 4.5 mg (1 mg/ml initial concentration) IV soln
|
$19,305.62 |
$19,305.62 |
$19,305.62 |
$19,305.62
|
|
General health panel
|
$638.70 |
$638.70 |
$638.70 |
$275.00
|
|
Generator barostim neo2 2014
|
$48,147.60 |
$48,147.60 |
$48,147.60 |
$48,147.60
|
|
Generator emblem MRI sicd subq
|
$30,006.00 |
$30,006.00 |
$30,006.00 |
$36,467.76
|
|
Gentamicin 10 mg/ml liquid compound - enteral use only
|
$30.00 |
$30.00 |
$30.00 |
$57.84
|
|
Gentamicin peak therapeutic drug level
|
$302.10 |
$302.10 |
$302.10 |
$126.00
|
|
G-esoph reflx tst w/electrod
|
$1,551.45 |
$1,551.45 |
$1,551.45 |
$1,418.18
|
|
Ghs alcohol, methyl (methanol)-medtox
|
$57.75 |
$57.75 |
$57.75 |
$100.30
|
|
Ghs antibodies (torch) igm
|
$30.75 |
$30.75 |
$30.75 |
$69.30
|
|
Ghs bleeding time (ivy)
|
$153.90 |
$153.90 |
$153.90 |
$64.40
|
|
Ghs block ilioinguinal/gentitofemoral
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$1,045.65
|
|
Ghs chlamydia pneumoniae by pcr (arup) (306630)
|
$243.90 |
$243.90 |
$243.90 |
$132.00
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$211.95 |
$211.95 |
$211.95 |
$512.40
|
|
Ghs closure surg wound/dehiscence-13160
|
$2,105.40 |
$2,105.40 |
$2,105.40 |
$3,086.00
|
|
Ghs clsd tx frac distal tibia w/manipulation
|
$1,650.90 |
$1,650.90 |
$1,650.90 |
$2,211.05
|
|
Ghs community re-entry 15 minutes
|
$35.00 |
$35.00 |
$35.00 |
$88.50
|
|
Ghs conjunctiva foreign body-superf bil
|
$339.60 |
$339.60 |
$339.60 |
$283.80
|
|
Ghs dislocation elbow closed treatment
|
$279.90 |
$279.90 |
$279.90 |
$578.00
|
|
Ghs ed therapeutic lp, drain csf w fluoro
|
$2,776.65 |
$2,776.65 |
$2,776.65 |
$1,432.20
|
|
Ghs fish cytogen
|
$715.20 |
$715.20 |
$715.20 |
$170.80
|
|
Ghs fish hybrid in situ 100-300
|
$160.50 |
$160.50 |
$160.50 |
$223.00
|
|
Ghs HIV antibody
|
$123.60 |
$123.60 |
$123.60 |
$90.14
|
|
Ghs i and d perirectal abscess 46040
|
$1,915.20 |
$1,915.20 |
$1,915.20 |
$2,630.53
|
|
Ghs i and d pilonidal cyst simple
|
$526.50 |
$526.50 |
$526.50 |
$703.15
|
|
Ghs init tx 1st degree burn
|
$235.35 |
$235.35 |
$235.35 |
$275.50
|
|
Ghs inj neurolytic other perph nerve
|
$1,382.70 |
$1,382.70 |
$1,382.70 |
$1,702.20
|
|
Ghs inj transforaminal cerv ea add bil
|
$741.45 |
$741.45 |
$741.45 |
$1,110.90
|
|
Ghs inj transforaminal cerv single bil
|
$1,382.70 |
$1,382.70 |
$1,382.70 |
$1,727.25
|
|
Ghs intermed repair 12.6 - 20.0 cm-12035
|
$449.25 |
$449.25 |
$449.25 |
$863.28
|
|
Ghs intermed repair 20.1 - 30.0 cm-12036
|
$695.40 |
$695.40 |
$695.40 |
$1,035.60
|
|
Ghs intermed repair over 30 cm - 12037
|
$3,840.60 |
$3,840.60 |
$3,840.60 |
$2,164.64
|
|
Ghs layer closure 2.5 cm or less - 12031
|
$449.25 |
$449.25 |
$449.25 |
$584.00
|
|
Ghs layer closure 2.5 cm or less - 12041
|
$312.90 |
$312.90 |
$312.90 |
$563.75
|
|
Ghs layer closure 2.5cm or less - 12051
|
$312.90 |
$312.90 |
$312.90 |
$593.00
|
|
Ghs layer closure 2.6 - 5.0 cm - 12052
|
$312.90 |
$312.90 |
$312.90 |
$675.00
|
|
Ghs layer closure 2.6 - 7.5 cm - 12042
|
$312.90 |
$312.90 |
$312.90 |
$689.04
|
|
Ghs layer closure 5.1 - 7.5 cm - 12053
|
$312.90 |
$312.90 |
$312.90 |
$741.00
|
|
Ghs layer closure 7.6 - 12.5 cm - 12034
|
$449.25 |
$449.25 |
$449.25 |
$770.22
|
|
Ghs layer closure 7.6 - 12.5 cm - 12044
|
$373.50 |
$373.50 |
$373.50 |
$750.12
|
|
Ghs layer closure 7.6 - 12.5 cm - 12054
|
$312.90 |
$312.90 |
$312.90 |
$740.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12045
|
$373.50 |
$373.50 |
$373.50 |
$964.00
|
|
Ghs layered repair 12.6 - 20.0 cm -12055
|
$312.90 |
$312.90 |
$312.90 |
$790.40
|
|
Ghs layered repair 20.1 - 30.0 cm -12056
|
$276.30 |
$276.30 |
$276.30 |
$907.50
|
|
Ghs layered repair over 30.0 cm -12047
|
$1,365.90 |
$1,365.90 |
$1,365.90 |
$1,930.50
|
|
Ghs layered repair over 3.0 cm -12057
|
$1,420.65 |
$1,420.65 |
$1,420.65 |
$1,064.98
|
|
Ghs leukocyte alkaline phos (mayo)
|
$147.60 |
$147.60 |
$147.60 |
$76.20
|
|
Ghs low level laser therapy
|
$103.50 |
$103.50 |
$103.50 |
$77.70
|
|
Ghs mbp
|
$71.85 |
$71.85 |
$71.85 |
$77.35
|
|
Ghs moderate sedation < 5 yr, 30 min
|
$228.45 |
$228.45 |
$228.45 |
$242.31
|
|
Ghs moderate sedation < 5 yr, 30 min, other
|
$228.45 |
$228.45 |
$228.45 |
$228.45
|
|
Ghs moderate sedation, > 5 yr, 30 min, other
|
$228.45 |
$228.45 |
$228.45 |
$230.00
|
|
Ghs moderate sedation ea addtl 15 min
|
$228.45 |
$228.45 |
$228.45 |
$151.50
|
|
Ghs moderate sedation ea addtl 15 min, other
|
$228.45 |
$228.45 |
$228.45 |
$147.75
|
|
Ghs musc tst done w/nerv tst lim
|
$272.25 |
$272.25 |
$272.25 |
$266.59
|
|
Ghs musc tst done w/n tst non ext
|
$333.30 |
$333.30 |
$333.30 |
$184.80
|
|
Ghs nerve blk intercostal, ea addtl level
|
$1,382.70 |
$1,382.70 |
$1,382.70 |
$1,546.50
|
|
Ghs nerve blk intercostal, single level
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$1,107.00
|
|
Ghs nerve block brachial plexus
|
$1,382.70 |
$1,382.70 |
$1,382.70 |
$1,689.00
|
|
Ghs nerve block celiac plexus
|
$1,382.70 |
$1,382.70 |
$1,382.70 |
$1,661.40
|
|
Ghs nerve block interscaline
|
$1,382.70 |
$1,382.70 |
$1,382.70 |
$1,526.09
|
|
Ghs nerve block lumbar or thoracic symp
|
$1,355.25 |
$1,355.25 |
$1,355.25 |
$1,710.80
|
|
Ghs nerve block sciatic nerve
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$1,450.80
|
|
Ghs nerve block suprascapular
|
$1,045.65 |
$1,045.65 |
$1,045.65 |
$1,141.36
|
|
Ghs o2 saturation
|
$86.55 |
$86.55 |
$86.55 |
$70.80
|
|
Ghs ot dds rom
|
$109.65 |
$109.65 |
$109.65 |
$62.28
|
|
Ghs ot prosthetic training/15 min
|
$109.65 |
$109.65 |
$109.65 |
$90.50
|
|
Ghs ot sensory integrative tech/15min
|
$134.70 |
$134.70 |
$134.70 |
$94.80
|
|
Ghs paravert facet/nerve cerv ea add bil
|
$741.45 |
$741.45 |
$741.45 |
$851.04
|
|
Ghs paravert facet/nerve lumb ea add bil
|
$741.45 |
$741.45 |
$741.45 |
$962.00
|
|
Ghs plngl fx pm cl
|
$211.95 |
$211.95 |
$211.95 |
$564.80
|
|
Ghs ppd (tb intradermal)
|
$20.81 |
$20.81 |
$20.81 |
$37.70
|
|
Ghs prostatic acid phosphatase (mayo)
|
$87.00 |
$87.00 |
$87.00 |
$43.55
|
|
Ghs protein, misc fluid
|
$25.65 |
$25.65 |
$25.65 |
$24.60
|
|
Ghs pt - work hardening/int 2hrs
|
$407.55 |
$407.55 |
$407.55 |
$275.60
|
|
Ghs removal intranasal foreign body
|
$217.20 |
$217.20 |
$217.20 |
$287.50
|
|
Ghs rsv eia (respir synctial vrs)
|
$193.05 |
$193.05 |
$193.05 |
$96.60
|
|
Ghs sedimentation rate
|
$84.00 |
$84.00 |
$84.00 |
$45.50
|
|
Ghs sensitivity (per antimicro)
|
$97.65 |
$97.65 |
$97.65 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$449.25 |
$449.25 |
$449.25 |
$553.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$607.35 |
$607.35 |
$607.35 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$449.25 |
$449.25 |
$449.25 |
$575.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$607.35 |
$607.35 |
$607.35 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$312.90 |
$312.90 |
$312.90 |
$448.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$235.35 |
$235.35 |
$235.35 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$312.90 |
$312.90 |
$312.90 |
$484.80
|
|
Ghs simple repair over 30 cm - 12007
|
$235.35 |
$235.35 |
$235.35 |
$582.00
|
|
Ghs somatosensory testing lower extremit
|
$781.05 |
$781.05 |
$781.05 |
$922.35
|
