|
Ghs phenylketonurid
|
$304.20 |
$304.20 |
$304.20 |
$53.76
|
|
Ghs picc line insert < 5
|
$1,109.40 |
$1,109.40 |
$1,109.40 |
$2,019.50
|
|
Ghs plngl fx pm cl
|
$648.60 |
$648.60 |
$648.60 |
$564.80
|
|
Ghs polysom <6 yrs 4/> parameters
|
$4,249.20 |
$4,249.20 |
$4,249.20 |
$3,557.58
|
|
Ghs ppd (tb intradermal)
|
$54.60 |
$54.60 |
$54.60 |
$37.70
|
|
Ghs prostatic acid phosphatase (mayo)
|
$116.40 |
$116.40 |
$116.40 |
$43.55
|
|
Ghs protoporphyrins fract
|
$346.80 |
$346.80 |
$346.80 |
$64.28
|
|
Ghs pr without cont pulse ox
|
$442.20 |
$442.20 |
$442.20 |
$146.86
|
|
Ghs pt - work hardening/int 2hrs
|
$361.20 |
$361.20 |
$361.20 |
$275.60
|
|
Ghs quinidine
|
$123.60 |
$123.60 |
$123.60 |
$85.00
|
|
Ghs removal intranasal foreign body
|
$145.80 |
$145.80 |
$145.80 |
$287.50
|
|
Ghs removal pharyngeal foreign body
|
$282.00 |
$282.00 |
$282.00 |
$459.90
|
|
Ghs reticulocyte count
|
$101.40 |
$101.40 |
$101.40 |
$34.45
|
|
Ghs rsv eia (respir synctial vrs)
|
$255.00 |
$255.00 |
$255.00 |
$96.60
|
|
Ghs sedimentation rate
|
$78.60 |
$78.60 |
$78.60 |
$45.50
|
|
Ghs semen analysis fert
|
$198.00 |
$198.00 |
$198.00 |
$129.00
|
|
Ghs sensitivity (per antimicro)
|
$163.80 |
$163.80 |
$163.80 |
$57.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12005
|
$421.20 |
$421.20 |
$421.20 |
$553.60
|
|
Ghs simple repair 12.6 - 20.0 cm - 12016
|
$557.40 |
$557.40 |
$557.40 |
$607.35
|
|
Ghs simple repair 20.1 - 30.0 cm - 12006
|
$384.60 |
$384.60 |
$384.60 |
$575.00
|
|
Ghs simple repair 20.1 - 30.0 cm - 12017
|
$757.80 |
$757.80 |
$757.80 |
$607.35
|
|
Ghs simple repair 5.1 - 7.5 cm - 12014
|
$358.80 |
$358.80 |
$358.80 |
$448.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12004
|
$393.60 |
$393.60 |
$393.60 |
$436.80
|
|
Ghs simple repair 7.6 - 12.5 cm - 12015
|
$395.40 |
$395.40 |
$395.40 |
$484.80
|
|
Ghs simple repair over 30 cm - 12007
|
$514.80 |
$514.80 |
$514.80 |
$582.00
|
|
Ghs simple repair over 30 cm - 12018
|
$861.60 |
$861.60 |
$861.60 |
$537.60
|
|
Ghs somatosensory testing lower extremit
|
$771.60 |
$771.60 |
$771.60 |
$922.35
|
|
Ghs somatosensory testing upper & lower limbs
|
$1,538.40 |
$1,538.40 |
$1,538.40 |
$1,290.02
|
|
Ghs speech-gen aug dev eval iii, st
|
$183.00 |
$183.00 |
$183.00 |
$146.40
|
|
Ghs sp train/fitting sp device - kx
|
$286.80 |
$286.80 |
$286.80 |
$250.50
|
|
Ghs strapping shoulder - 29240
|
$176.40 |
$176.40 |
$176.40 |
$213.20
|
|
Ghs st - re-eval for alt comm
|
$402.00 |
$402.00 |
$402.00 |
$309.00
|
|
Ghs superficial wnd dehiscence simp12020
|
$552.00 |
$552.00 |
$552.00 |
$861.75
|
|
Ghs superficial wnd dehis w packing12021
|
$878.40 |
$878.40 |
$878.40 |
$661.50
|
|
Ghs tracheostomy emergency - transtracheal
|
$933.00 |
$933.00 |
$933.00 |
$1,752.89
|
|
Ghs trypsin (fecal)
|
$201.00 |
$201.00 |
$201.00 |
$50.93
|
|
Ghs tx distal phalangeal fx with manipulation
|
$546.60 |
$546.60 |
$546.60 |
$523.00
|
|
Ghs tx sp hip disloc abd splnt/trac wo
|
$383.40 |
$383.40 |
$383.40 |
$486.35
|
|
Ghs urine, hydroxproline total
|
$266.40 |
$266.40 |
$266.40 |
$109.60
|
|
Ghs urine, porphyrins quant
|
$165.00 |
$165.00 |
$165.00 |
$75.00
|
|
Ghs vaginal delivery only
|
$3,225.60 |
$3,225.60 |
$3,225.60 |
$3,152.00
|
|
Ghs veeg 12-26 hr intmt mont
|
$3,358.20 |
$3,358.20 |
$3,358.20 |
$1,910.25
|
|
Giardia lamblia antibody
|
$118.20 |
$118.20 |
$118.20 |
$83.44
|
|
Gi inhouse confirmation
|
$201.00 |
$201.00 |
$201.00 |
$83.70
|
|
Gjb2 gene full sequence
|
$1,051.80 |
$1,051.80 |
$1,051.80 |
$502.80
|
|
Glucagon plasma - sendout
|
$139.20 |
$139.20 |
$139.20 |
$63.00
|
|
Glucose 1 hr post dose
|
$111.60 |
$111.60 |
$111.60 |
$47.20
|
|
Glucose blood by monitoring device cleared by fda for home use
|
$35.40 |
$35.40 |
$35.40 |
$23.86
|
|
Glucose blood quantitative
|
$82.20 |
$82.20 |
$82.20 |
$40.00
|
|
Glucose body fluid
|
$82.80 |
$82.80 |
$82.80 |
$52.20
|
|
Glucose tolerance test (gtt) 3 specimens
|
$217.80 |
$217.80 |
$217.80 |
$100.16
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$87.00 |
$87.00 |
$87.00 |
$35.00
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$169.20 |
$169.20 |
$169.20 |
$115.05
|
|
Gonadotropin luteinizing hormone (lh)
|
$382.80 |
$382.80 |
$382.80 |
$129.00
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$125.40 |
$125.40 |
$125.40 |
$672.50
|
|
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm
|
$174.00 |
$174.00 |
$174.00 |
$1,455.76
|
|
Graft puraplyam antimicrob 1.6-q4196-cost per sq cm
|
$301.80 |
$301.80 |
$301.80 |
$1,181.41
|
|
Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm
|
$588.60 |
$588.60 |
$588.60 |
$1,132.47
|
|
Granulocyte pheresis ea unit
|
$4,306.20 |
$4,306.20 |
$4,306.20 |
$2,309.40
|
|
Great toe with reduction 28495
|
$600.00 |
$600.00 |
$600.00 |
$482.40
|
|
G-tube reposition
|
$1,183.20 |
$1,183.20 |
$1,183.20 |
$759.36
|
|
Guided cath fluid drainage 10030
|
$4,113.60 |
$4,113.60 |
$4,113.60 |
$1,372.15
|
|
Guid loc target vol rad tx
|
$1,087.20 |
$1,087.20 |
$1,087.20 |
$536.00
|
|
Hand X-ray
|
$676.20 |
$676.20 |
$676.20 |
$356.00
|
|
Haptoglobin quantitative
|
$210.00 |
$210.00 |
$210.00 |
$91.14
|
|
Hba1/hba2 full gene sequence
|
$1,054.20 |
$1,054.20 |
$1,054.20 |
$769.95
|
|
Hba1/hba2 gene dup/del vrnts
|
$913.80 |
$913.80 |
$913.80 |
$404.80
|
|
Hbb full gene sequence
|
$1,054.20 |
$1,054.20 |
$1,054.20 |
$633.25
|
|
Hbb gene dup/del variants
|
$984.00 |
$984.00 |
$984.00 |
$455.00
|
|
Hbot, full body chamber, 30m
|
$838.80 |
$838.80 |
$838.80 |
$526.90
|
|
Hcg qualitative
|
$199.80 |
$199.80 |
$199.80 |
$89.70
|
|
Hcg quantitative
|
$354.60 |
$354.60 |
$354.60 |
$139.20
|
|
Hc nm fusion spect CT unlisted
|
$982.80 |
$982.80 |
$982.80 |
$463.68
|
|
Hc nm kidney imaging with flow
|
$1,381.80 |
$1,381.80 |
$1,381.80 |
$822.60
|
|
Head CT scan (with and without contrast)
|
$3,491.40 |
$3,491.40 |
$3,491.40 |
$1,849.90
|
|
Head CT scan (with contrast)
|
$3,491.40 |
$3,491.40 |
$3,491.40 |
$1,545.60
|
|
Head CT scan (without contrast)
|
$3,491.40 |
$3,491.40 |
$3,491.40 |
$1,268.90
|
|
Helicobacter pylori antibody igm
|
$282.00 |
$282.00 |
$282.00 |
$91.98
|
|
Hematocrit
|
$79.80 |
$79.80 |
$79.80 |
$33.57
|
|
Hemodialysis one evaluation
|
$2,899.20 |
$2,899.20 |
$2,899.20 |
$1,319.44
|
|
Hemoglobin
|
$67.80 |
$67.80 |
$67.80 |
$31.80
|
|
Hemoglobin fetal qualitative
|
$116.40 |
$116.40 |
$116.40 |
$51.75
|
|
Hemoglobin methemoglobin quantitative
|
$168.60 |
$168.60 |
$168.60 |
$53.60
|
|
Hemoglobin-oxygen affinity
|
$319.80 |
$319.80 |
$319.80 |
$84.76
|
|
Hemoglobin plasma
|
$163.80 |
$163.80 |
$163.80 |
$41.25
|
|
Hemolysins/agglutinins auto
|
$70.80 |
$70.80 |
$70.80 |
$57.14
|
|
Hemolysins and agglutinins incubated
|
$232.80 |
$232.80 |
$232.80 |
$57.14
|
|
Hemophilus influenza antibdy
|
$88.20 |
$88.20 |
$88.20 |
$62.70
|
|
Heparin assay
|
$455.40 |
$455.40 |
$455.40 |
$140.10
|
|
Hepatitis a antibody igm
|
$362.40 |
$362.40 |
$362.40 |
$87.75
|
|
Hepatitis b core antibody igm
|
$154.80 |
$154.80 |
$154.80 |
$87.98
|
|
Hepatitis b core antibody total
|
$271.80 |
$271.80 |
$271.80 |
$77.50
|
|
Hepatitis b surface antibody
|
$165.60 |
$165.60 |
$165.60 |
$82.05
|
|
Hepatitis c antibody
|
$103.80 |
$103.80 |
$103.80 |
$108.00
|
|
Hepatitis d quantification
|
$1,470.60 |
$1,470.60 |
$1,470.60 |
$91.28
|
|
Hepatobiliary system imaging
|
$1,506.60 |
$1,506.60 |
$1,506.60 |
$1,438.58
|
|
Hereditary colon ca dsordrs
|
$3,677.40 |
$3,677.40 |
$3,677.40 |
$1,799.45
|
|
Herpes simplex type 1 antibody igg
|
$176.40 |
$176.40 |
$176.40 |
$70.00
|
|
Herpes simplex type 2 antibody igg
|
$176.40 |
$176.40 |
$176.40 |
$87.10
|
|
Herpes simplex virus isolation
|
$183.00 |
$183.00 |
$183.00 |
$104.10
|
