Geisinger Bloomsburg Hospital Published: July 1, 2019 DESCRIPTION CHARGE 3D Rendering With Interpretation And Reporting Of Computed Tomography, Magnetic Resonance Imaging, Ultrasound, Or Other Tomographic Modality With Image Postprocessing Under $ 1,230.00 Concurrent Supervision; Requiring Image Postprocessing On An Independent Workstation Abatacept 250 Mg Iv Solr $ 8,383.48 Acarbose 50 Mg Po Tabs $ 9.55 Ace Bandage $ 22.00 Ace Harmnic Crvd Shears Ace36E $ 3,617.00 Acebutolol Hcl 200 Mg Po Caps $ 9.34 Acetaminophen 120 Mg Pr Supp $ 6.70 Acetaminophen 325 Mg Po Tabs $ 6.70 Acetaminophen 325 Mg Pr Supp $ 6.99 Acetaminophen 650 Mg Pr Supp $ 6.70 Acetaminophen 80 Mg Po Chew $ 6.70 Acetaminophen 80 Mg Pr Supp $ 6.99 Acetazolamide 125 Mg Po Tabs $ 15.66 Acetazolamide 250 Mg Po Tabs $ 28.29 Acetazolamide 62.5 Mg (1/2 X 125 Mg) Po Tabs $ 8.81 Acetazolamide Er 500 Mg Po Cp12 $ 28.93 Acetylcholine Chloride 20 Mg Io Solr $ 748.45 Acl Kit Ar-1897S $ 2,819.00 Acute Hepatitis Panel This Panel Must Include The Following: Hepatitis A Antibody (Haab), Igm Antibody (86709) Hepatitis B Core Antibody (Hbcab), Igm Antibody (86705) Hepatitis B Surface $ 672.00 Antigen (Hbsag) (87340) Hepatitis C Antibody (86803) Acyclovir 200 Mg Po Caps $ 11.57 Acyclovir 400 Mg Po Tabs $ 13.81 Adalimumab 40 Mg/0.8Ml Subq Pskt $ 19,539.52 Administration Of Influenza Virus Vaccine $ 35.00 Administration Of Pneumococcal Vaccine $ 35.00 Ado-Trastuzumab Emtansine 100 Mg Iv Solr $ 31,827.85 Ado-Trastuzumab Emtansine 160 Mg Iv Solr $ 50,909.88 Adrenocorticotropic Hormone (Acth) $ 233.00 Albendazole 200 Mg Po Tabs $ 1,833.63 Albumin (Urine) Test Vi Strp $ 6.70 Albumin; Serum, Plasma Or Whole Blood $ 35.00 Albumin; Urine, Microalbumin, Quantitative $ 153.00 Albuterol Sulfate 2 Mg Po Tabs $ 38.90 Aldesleukin 22000000 Units Iv Solr $ 41,577.84 Aldosterone $ 224.00 Aldosterone $ 235.00 Alendronate Sodium 70 Mg Po Tabs $ 243.19 Alexis Wound Protector/Retr $ 540.00 Allergen Specific Ige; Quantitative Or Semiquantitative, Each Allergen $ 109.00 Allergen Specific Ige; Quantitative Or Semiquantitative, Each Allergen $ 188.00 Allergen Specific Ige; Quantitative Or Semiquantitative, Each Allergen $ 232.00 Allograft Nrv 1-2X15Mm $ 20,940.00 Allopurinol 100 Mg Po Tabs $ 6.70 Allopurinol 150 Mg (1/2 X 300 Mg) Po Tabs $ 6.70 Allopurinol 25 Mg (1/4 X 100 Mg) Po Tabs $ 6.70 Allopurinol 300 Mg Po Tabs $ 6.72 Allopurinol 50 Mg (1/2 X 100 Mg) Po Tabs $ 6.70 Allopurinol 75 Mg (1/4 X 300 Mg) Po Tabs $ 6.70 Alpha-1-Antitrypsin; Total $ 56.00 Alpha-Fetoprotein (Afp); Serum $ 112.00 Alpha-Fetoprotein (Afp); Serum $ 345.00 Alpha-Fetoprotein (Afp); Serum $ 68.00 Alprazolam 0.125 Mg (1/2 X 0.25 Mg) Po Tabs $ 6.70 Alprazolam 0.25 Mg Po Tabs $ 6.70 Alprazolam 1 Mg Po Tabs $ 7.60 Alteplase 100 Mg Iv Solr $ 66,437.61 Alteplase 2 Mg Ij Solr $ 1,167.79 Alteplase 2 Mg Inj Solution $ 1,167.79 Alteplase 50 Mg Iv Solr $ 33,225.08 Alteplase For Pe Without Cardiac Arrest $ 66,437.61 Alteplase Inj Bolus For Cardiac Arrest With Pe $ 33,225.08 Alteplase Inj Bolus For Ischemic Stroke $ 66,437.61 Alteplase Iv Soln For Ischemic Stroke $ 66,437.61 Alum Sulfate-Ca Acetate Ex Pack $ 9.08 Alvimopan 12 Mg Po Caps $ 1,248.05 Amantadine Hcl 100 Mg Po Caps $ 15.49 Page 1 of 46 Geisinger Bloomsburg Hospital Published: July 1, 2019 DESCRIPTION CHARGE Amifostine 500 Mg Iv Solr $ 8,436.45 Amiloride Hcl 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 6.70 Amiloride Hcl 5 Mg Po Tabs $ 10.06 Aminocaproic Acid 125 Mg (1/4 X 500 Mg) Po Tabs $ 7.20 Aminocaproic Acid 250 Mg (1/2 X 500 Mg) Po Tabs $ 12.44 Aminocaproic Acid 500 Mg Po Tabs $ 22.93 Amiodarone Hcl 100 Mg Po Tabs $ 48.68 Amiodarone Hcl 200 Mg Po Tabs $ 6.70 Amiodarone Hcl 25 Mg (1/4 X 100) Po Tabs $ 13.64 Amiodarone Hcl 50 Mg (1/2 X 100 Mg) Po Tabs $ 25.32 Amitriptyline Hcl 10 Mg Po Tabs $ 6.70 Amitriptyline Hcl 12.5 Mg (1/2 X 25 Mg) Po Tabs $ 6.70 Amitriptyline Hcl 2.5 Mg (1/4 X 10 Mg) Po Tabs $ 6.70 Amitriptyline Hcl 25 Mg Po Tabs $ 6.70 Amitriptyline Hcl 5 Mg (1/2 X 10 Mg) Po Tabs $ 6.70 Amitriptyline Hcl 50 Mg Po Tabs $ 9.28 Amlodipine Besy-Benazepril Hcl 2.5-10 Mg Po Caps $ 54.65 Amlodipine Besy-Benazepril Hcl 5-10 Mg Po Caps $ 18.98 Amlodipine Besylate 1.25 Mg (1/2 X 2.5 Mg) Po Tabs $ 7.39 Amlodipine Besylate 2.5 Mg Po Tabs $ 12.83 Amlodipine Besylate 5 Mg Po Tabs $ 12.28 Ammonia $ 198.00 Ammonia $ 43.00 Ammonia Aromatic In Inha $ 6.70 Amobarbital Sodium 500 Mg Ij Solr $ 5,535.01 Amoxicillin 250 Mg Po Caps $ 6.70 Amoxicillin 500 Mg Po Caps $ 6.70 Amoxicillin-Pot Clavulanate 250-125 Mg Po Tabs $ 39.17 Amoxicillin-Pot Clavulanate 500-125 Mg Po Tabs $ 25.76 Amoxicillin-Pot Clavulanate 875-125 Mg Po Tabs $ 33.73 Amphetamine-Dextroamphet Er 10 Mg Po Cp24 $ 40.52 Amphetamine-Dextroamphet Er 20 Mg Po Cp24 $ 40.52 Amphetamine-Dextroamphetamine 10 Mg Po Tabs $ 55.06 Amphetamine-Dextroamphetamine 2.5 Mg (1/2 X 5 Mg) Po Tabs $ 8.42 Amphetamine-Dextroamphetamine 20 Mg Po Tabs $ 12.73 Amphetamine-Dextroamphetamine 5 Mg Po Tabs $ 14.89 Amphotericin B 50 Mg Iv Solr $ 416.97 Amphotericin B Liposome 50 Mg Iv Susr $ 2,643.08 Ampicillin Sodium 1 G Iv Solr $ 157.70 Ampicillin Sodium 2 G Ij Solr $ 161.10 Ampicillin Sodium 500 Mg Ij Solr $ 49.62 Ampicillin-Sulbactam Sodium 1.5 (1-0.5) G Ij Solr $ 93.38 Ampicillin-Sulbactam Sodium 3 (2-1) G Ij Solr $ 94.57 Amylase $ 182.00 Anagrelide Hcl 0.5 Mg Po Caps $ 72.17 Anastrozole 1 Mg Po Tabs $ 77.40 Anchor/Screw For Opposing Bone-To-Bone Or Soft Tissue-To-Bone (Implantable) $ 39.00 Anchor/Screw For Opposing Bone-To-Bone Or Soft Tissue-To-Bone (Implantable) $ 3,437.00 Anchor/Screw For Opposing Bone-To-Bone Or Soft Tissue-To-Bone (Implantable) $ 771.00 Anchor/Screw For Opposing Bone-To-Bone Or Soft Tissue-To-Bone (Implantable) $ 1,477.00 Anchor/Screw For Opposing Bone-To-Bone Or Soft Tissue-To-Bone (Implantable) $ 2,921.00 Anchor/Screw For Opposing Bone-To-Bone Or Soft Tissue-To-Bone (Implantable) $ 657.00 Anchor/Screw For Opposing Bone-To-Bone Or Soft Tissue-To-Bone (Implantable) $ 192.00 Anchor/Screw For Opposing Bone-To-Bone Or Soft Tissue-To-Bone (Implantable) $ 86.00 Anchor/Screw For Opposing Bone-To-Bone Or Soft Tissue-To-Bone (Implantable) $ 484.00 Anchor/Screw For Opposing Bone-To-Bone Or Soft Tissue-To-Bone (Implantable) $ 991.00 Anchor/Screw For Opposing Bone-To-Bone Or Soft Tissue-To-Bone (Implantable) $ 340.00 Anchor/Screw For Opposing Bone-To-Bone Or Soft Tissue-To-Bone (Implantable) $ 1,100.00 Anchor/Screw For Opposing Bone-To-Bone Or Soft Tissue-To-Bone (Implantable) $ 359.00 Anchor/Screw For Opposing Bone-To-Bone Or Soft Tissue-To-Bone (Implantable) $ 1,814.00 Anchor/Screw For Opposing Bone-To-Bone Or Soft Tissue-To-Bone (Implantable) $ 2,951.00 Anchor/Screw For Opposing Bone-To-Bone Or Soft Tissue-To-Bone (Implantable) $ 3,848.00 Anchor/Screw For Opposing Bone-To-Bone Or Soft Tissue-To-Bone (Implantable) $ 1,344.00 Anchor/Screw For Opposing Bone-To-Bone Or Soft Tissue-To-Bone (Implantable) $ 3,040.00 Anchor/Screw For Opposing Bone-To-Bone Or Soft Tissue-To-Bone (Implantable) $ 10,674.00 Androstenedione $ 188.00 Anesthesia Disbursement 000-030 Min $ 466.00 Page 2 of 46 Geisinger Bloomsburg Hospital Published: July 1, 2019 DESCRIPTION CHARGE Anesthesia Disbursement 031-090 Min $ 932.00 Anesthesia Disbursement 091-150 Min $ 1,399.00 Anesthesia Disbursement 151-210 Min $ 1,863.00 Anesthesia Disbursement 211-270 Min $ 2,330.00 Anesthesia Disbursement 271-330 Min $ 2,796.00 Anesthesia Disbursement 331-390 Min $ 3,263.00 Anesthesia Disbursement 391-450 Min $ 3,729.00 Anesthesia Disbursement 451-510 Min $ 4,193.00 Anesthesia Disbursement 511-570 Min $ 4,661.00 Anesthesia Disbursement 571-630 Min $ 5,128.00 Anesthesia Disbursement 631-690 Min $ 5,594.00 Anesthesia Ed 00-60 Min $ 2,573.00 Anesthesia Ed 61-90 Min $ 3,431.00 Anesthesia Ed 91-150 Min $ 4,929.00 Angiotensin I - Converting Enzyme (Ace) $ 152.00 Antibody Identification, Rbc Antibodies, Each Panel For Each Serum Technique $ 267.00 Antibody Screen, Rbc, Each Serum Technique $ 155.00 Antibody; Bartonella $ 99.00 Antibody; Borrelia Burgdorferi (Lyme Disease) $ 206.00 Antibody; Borrelia Burgdorferi (Lyme Disease) Confirmatory Test (Eg, Western Blot Or Immunoblot) $ 463.00 Antibody; Cytomegalovirus (Cmv) $ 185.00 Antibody; Cytomegalovirus (Cmv), Igm $ 185.00 Antibody; Ehrlichia $ 429.00 Antibody; Epstein-Barr (Eb) Virus, Early Antigen (Ea) $ 133.00 Antibody; Epstein-Barr (Eb) Virus, Nuclear Antigen (Ebna) $ 187.00 Antibody; Epstein-Barr (Eb) Virus, Viral Capsid (Vca) $ 202.00 Antibody; Herpes Simplex, Non-Specific Type Test $ 165.00 Antibody; Herpes Simplex, Type 1 $ 158.00 Antibody; Herpes Simplex, Type 2 $ 158.00 Antibody; Mumps $ 237.00 Antibody; Mumps $ 799.00 Antibody; Mycoplasma $ 85.00 Antibody; Mycoplasma $ 103.00 Antibody; Parvovirus $ 68.00 Antibody; Parvovirus $ 67.00 Antibody; Rubella $ 187.00 Antibody; Rubeola $ 251.00 Antibody; Tetanus $ 282.00 Antibody; Toxoplasma $ 138.00 Antibody; Toxoplasma, Igm $ 178.00 Antibody; Treponema Pallidum $ 62.00 Antibody; Treponema Pallidum $ 72.00 Antibody; Varicella-Zoster $ 185.00 Antibody; Varicella-Zoster $ 251.00 Antihuman Globulin Test (Coombs Test); Direct, Each Antiserum $ 237.00 Antinuclear Antibodies (Ana) $ 182.00 Antinuclear Antibodies (Ana); Titer $ 182.00 Antistreptolysin 0; Titer $ 41.00 Anti-Thymocyte Glob (Rabbit) 25 Mg Iv Solr $ 6,351.37 Antivenin Latrodectus Mactans Ij Kit $ 221.64 Apixaban 2.5 Mg Po Tabs $ 57.82 Apixaban 2.5 Mg Po Tabs $ 57.83 Apixaban 5 Mg Po Tabs $ 57.82 Apixaban 5 Mg Po Tabs $ 57.83 Application Of Finger Splint; Static $ 427.00 Application Of Long Arm Splint (Shoulder To Hand) $ 220.00 Application Of Short Arm