|
Frenulotomy of penis
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,897.55
|
|
Fresh frozen plasma 8-24 hours collection each unit
|
$35.07 |
$35.07 |
$35.07 |
$168.75
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$35.07 |
$35.07 |
$35.07 |
$149.50
|
|
Frozen cell preparation
|
$13.30 |
$13.30 |
$13.30 |
$16.68
|
|
Fructosamine glycated protein
|
$18.44 |
$18.44 |
$18.44 |
$60.42
|
|
Ftl cgen abnor four anal
|
$168.85 |
$168.85 |
$168.85 |
$211.83
|
|
Full thick gft/nose/ear/lid/lip/20sqcm or< 15260
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,919.95
|
|
Full thick gft/scalp/arm/leg/20sqcm or< 15220
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,465.10
|
|
Full thick gft w/close donor fccmnaghf <=20sqcm 15240
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,501.10
|
|
Fusion/graft of finger joint
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,839.54
|
|
Fusion/graft of hand joint
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,886.74
|
|
Fusion of ankle joint open
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$8,827.37
|
|
Fusion of big toe joint
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,855.00
|
|
Fusion of big toe joint
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,419.00
|
|
Fusion of finger joint
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,986.00
|
|
Fusion of finger tendons
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,594.44
|
|
Fusion of finger tendons
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,893.86
|
|
Fusion of foot bones
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,697.18
|
|
Fusion of foot bones
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$8,144.39
|
|
Fusion of foot bones
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,419.00
|
|
Fusion of hand joint
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,886.74
|
|
Fusion of knuckle
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,886.74
|
|
Fusion of knuckle joint
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,545.97
|
|
Fusion of knuckle joints
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$4,110.40
|
|
Fusion of knuckle joints
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,839.00
|
|
Fusion of knuckle with graft
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,855.00
|
|
Fusion of spermatic ducts
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,424.12
|
|
Fusion of spermatic ducts
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,986.00
|
|
Fusion of tendons at wrist
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,839.54
|
|
Fusion of tendons at wrist
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,591.33
|
|
Fusion of thumb
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,886.74
|
|
Fusion of tibiofibular joint
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$8,299.09
|
|
Fusion of toes
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,821.05
|
|
G6pc gene
|
$64.34 |
$64.34 |
$64.34 |
$104.65
|
|
G6pd full gene sequence
|
$660.00 |
$660.00 |
$660.00 |
$1,320.00
|
|
G6pd gene alys cmn variant
|
$192.29 |
$192.29 |
$192.29 |
$243.00
|
|
G6pd known familial variant
|
$412.78 |
$412.78 |
$412.78 |
$412.78
|
|
Galac-1-phosphate uridyltran - sendout
|
$23.18 |
$23.18 |
$23.18 |
$82.50
|
|
Galactokinase - sendout
|
$23.63 |
$23.63 |
$23.63 |
$175.00
|
|
Galactose transferase test
|
$12.91 |
$12.91 |
$12.91 |
$22.40
|
|
Galectin-3
|
$48.68 |
$48.68 |
$48.68 |
$110.65
|
|
Gallbladder Removal (Laparoscopic)
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,904.15
|
|
Gammaglobulin iga
|
$10.23 |
$10.23 |
$10.23 |
$75.30
|
|
Gammaglobulin ige
|
$18.11 |
$18.11 |
$18.11 |
$85.00
|
|
Gamma glutamyltransferase
|
$7.92 |
$7.92 |
$7.92 |
$55.28
|
|
Gardner vag dna quant
|
$45.94 |
$45.94 |
$45.94 |
$89.70
|
|
Gastric analy w/ph ea spec
|
$7.38 |
$7.38 |
$7.38 |
$23.01
|
|
Gastric motility studies
|
$290.59 |
$290.59 |
$290.59 |
$627.89
|
|
Gastrin test
|
$19.46 |
$19.46 |
$19.46 |
$44.80
|
|
Gastroesophageal reflux test
|
$185.20 |
$185.20 |
$185.20 |
$1,129.63
|
|
Gastrostomy open neonatal
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,154.78
|
|
Gba gene
|
$51.98 |
$51.98 |
$51.98 |
$140.00
|
|
Genetic tstg severe inh cond
|
$2,693.42 |
$2,693.42 |
$2,693.42 |
$4,156.20
|
|
Genioplasty augmentation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$5,339.00
|
|
Geniop sldg augmentation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,837.72
|
|
Geniop sldg osteot 1
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,592.74
|
|
Geniop sldg osteot 2/>
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$6,311.00
|
|
Genome sequence analysis
|
$5,534.32 |
$5,534.32 |
$5,534.32 |
$5,534.32
|
|
Gentamicin peak therapeutic drug level
|
$18.02 |
$18.02 |
$18.02 |
$119.00
|
|
G-esoph reflx tst w/electrod
|
$214.70 |
$214.70 |
$214.70 |
$1,352.03
|
|
Ghs abscess perianal iandd
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,530.50
|
|
Ghs abscess postoperative iandd complex
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$3,776.00
|
|
Ghs acetylcholinesterase, rbc
|
$10.79 |
$10.79 |
$10.79 |
$42.21
|
|
Ghs alcohol, methyl (methanol)-medtox
|
$18.82 |
$18.82 |
$18.82 |
$103.14
|
|
Ghs alpha thalasemia, 7 deletions
|
$112.49 |
$112.49 |
$112.49 |
$382.20
|
|
Ghs antibodies (torch) igm
|
$15.83 |
$15.83 |
$15.83 |
$73.70
|
|
Ghs aspiration bladder - needle
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$590.84
|
|
Ghs bladder cath - complex-foley
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$344.48
|
|
Ghs bleeding time (ivy)
|
$5.30 |
$5.30 |
$5.30 |
$55.90
|
|
Ghs block ilioinguinal/gentitofemoral
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,050.00
|
|
Ghs central line insert < age 5, failed
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,676.75
|
|
Ghs change cysto/gastrost
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$699.60
|
|
Ghs chemo >8 hrs
|
$324.68 |
$324.68 |
$324.68 |
$714.87
|
|
Ghs chemo IV push, ea addtl
|
$198.48 |
$198.48 |
$198.48 |
$291.60
|
|
Ghs chlamydia pneumoniae by pcr (arup) (306630)
|
$38.60 |
$38.60 |
$38.60 |
$134.55
|
|
Ghs closd tx interphalang jt disloc w/ma
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$596.55
|
|
Ghs closed reduction ankle dislocation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$731.04
|
|
Ghs closed tx bimalleolar fracture w/manip
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,707.42
|
|
Ghs closed tx radiocarpal disloc w manip
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$534.99
|
|
Ghs closed tx tibial fracture w/manip
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,621.64
|
|
Ghs closure surg wound/dehiscence-13160
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,973.33
|
|
Ghs clsd red med malleolus fx without manip
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$581.60
|
|
Ghs clsd red med malleolus fx w manip
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,459.25
|
|
Ghs clsd tx frac distal tibia w/manipulation
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$2,399.46
|
|
Ghs cl tx knee disl; wo anesth
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$716.95
|
|
Ghs cl tx metacarpophal disloc without anes
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$547.94
|
|
Ghs conjunctiva foreign body-embed bil
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$448.80
|
|
Ghs conjunctiva foreign body-superf bil
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$316.25
|
|
Ghs corneal fb without slit lamp bilat
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$435.07
|
|
Ghs corneal fb with slit lamp bilat
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$368.16
|
|
Ghs cricothyroidotomy
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,207.80
|
|
Ghs cutdown placement age 1 and over
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$411.84
|
|
Ghs cutdown placement under 1 yr
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$152.54
|
|
Ghs diphtheria toxoid ab igg
|
$16.73 |
$16.73 |
$16.73 |
$72.05
|
|
Ghs dislocation elbow closed treatment
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$687.73
|
|
Ghs ed peritoneal lavage w guidance if performed
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,313.95
|
|
Ghs ed rmvl or bivalving cast
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$351.46
|
|
Ghs ed therapeutic lp, drain csf w fluoro
|
$5,110.00 |
$5,110.00 |
$5,110.00 |
$1,439.40
|
|
Ghs eeg cont rec w/video by tec min 8 chnls
|
$175.04 |
$175.04 |
$175.04 |
$586.80
|
|
Ghs electrostagmgraphy
|
$127.18 |
$127.18 |
$127.18 |
$218.00
|
