|
Brain MRA (blood vessel MRI, without contrast)
|
$15,311.20 |
$15,311.20 |
$15,311.20 |
$1,806.75
|
|
Brain MRI (with and without contrast)
|
$19,281.85 |
$19,281.85 |
$19,281.85 |
$2,854.80
|
|
Brain MRI (with contrast)
|
$17,890.50 |
$17,890.50 |
$17,890.50 |
$2,224.96
|
|
Brain MRI (without contrast)
|
$15,311.20 |
$15,311.20 |
$15,311.20 |
$1,927.04
|
|
Breath recording infant
|
$2,545.20 |
$2,545.20 |
$2,545.20 |
$1,077.10
|
|
Bronchial challenge
|
$3,775.50 |
$3,775.50 |
$3,775.50 |
$835.20
|
|
Budesonide non-comp unit
|
$82.35 |
$82.35 |
$82.35 |
$32.78
|
|
Bundle his recording
|
$2,787.25 |
$2,787.25 |
$2,787.25 |
$5,157.39
|
|
C1 esterase inhibitor func - sendout
|
$27.35 |
$27.35 |
$27.35 |
$106.60
|
|
Caffeine citrate 20 mg/ml inj for po
|
$152.25 |
$152.25 |
$152.25 |
$43.81
|
|
Calcium gluconate 100 mg/ml (10 %) intravenous solution
|
$63.85 |
$63.85 |
$63.85 |
$45.30
|
|
Calcium total
|
$1,086.85 |
$1,086.85 |
$1,086.85 |
$48.75
|
|
Calculi urinary-sendout
|
$13.30 |
$13.30 |
$13.30 |
$68.05
|
|
Calprotectin fecal
|
$230.45 |
$230.45 |
$230.45 |
$170.00
|
|
Carbon dioxide
|
$858.50 |
$858.50 |
$858.50 |
$44.82
|
|
Carboplatin 10 mg/ml desensitization
|
$55.00 |
$55.00 |
$55.00 |
$141.98
|
|
Carcinoembryonic ag (cea)
|
$905.50 |
$905.50 |
$905.50 |
$146.90
|
|
Cardiac drug stress test
|
$6,559.70 |
$6,559.70 |
$6,559.70 |
$543.20
|
|
Cardiac perf spect sgl/ef/wm rst/strs
|
$25,898.30 |
$25,898.30 |
$25,898.30 |
$2,792.00
|
|
Carotene
|
$10.65 |
$10.65 |
$10.65 |
$46.80
|
|
Catecholamines,fractionated, urine
|
$25.75 |
$25.75 |
$25.75 |
$55.20
|
|
Cdna analysis for variants
|
$633.60 |
$633.60 |
$633.60 |
$564.86
|
|
Cefotaxime sodium injection
|
$171.25 |
$171.25 |
$171.25 |
$40.63
|
|
Ceftazidime 4.5 mg/0.2 ml intraocular injection - cnr
|
$179.75 |
$179.75 |
$179.75 |
$51.66
|
|
Ceftazidime and avibactam
|
$1,427.55 |
$1,427.55 |
$1,427.55 |
$935.40
|
|
Cell function assay w/stim
|
$261.65 |
$261.65 |
$261.65 |
$335.20
|
|
Cell marker study
|
$1,200.80 |
$1,200.80 |
$1,200.80 |
$239.85
|
|
Cetuximab 100 mg/50 ml intravenous solution
|
$2,372.75 |
$2,372.75 |
$2,372.75 |
$3,358.00
|
|
#cf-97variants
|
$80.65 |
$80.65 |
$80.65 |
$612.26
|
|
Chlamydia trachomatis ag if
|
$250.00 |
$250.00 |
$250.00 |
$30.40
|
|
Chloride
|
$830.20 |
$830.20 |
$830.20 |
$38.50
|
|
Chloride 24 hour urine
|
$657.25 |
$657.25 |
$657.25 |
$46.13
|
|
Chlorothiazide sodium 500 mg intravenous solution
|
$62.75 |
$62.75 |
$62.75 |
$333.01
|
|
Chlorpromazine 0.125 mg/ml IV syringe - cnr
|
$115.00 |
$115.00 |
$115.00 |
$89.81
|
|
Cholesterol (Lipid) Test
|
$1,915.20 |
$1,915.20 |
$1,915.20 |
$115.70
|
|
Cholinesterase
|
$11.60 |
$11.60 |
$11.60 |
$38.69
|
|
Chrom analysis
|
$760.95 |
$760.95 |
$760.95 |
$127.86
|
|
Chromatography
|
$22.30 |
$22.30 |
$22.30 |
$80.60
|
|
Chromogenic substrate assay
|
$134.35 |
$134.35 |
$134.35 |
$183.52
|
|
Chromo high res and frag x - sendout
|
$254.35 |
$254.35 |
$254.35 |
$264.25
|
|
Chromosome analysis 15-20 cell count
|
$175.60 |
$175.60 |
$175.60 |
$448.80
|
|
Chromosome analysis 5
|
$1,020.55 |
$1,020.55 |
$1,020.55 |
$644.80
|
|
Chromosome analysis 50-100
|
$697.80 |
$697.80 |
$697.80 |
$301.50
|
|
Chromosome count additional
|
$109.75 |
$109.75 |
$109.75 |
$110.00
|
|
Chromosome karyotype study
|
$70.75 |
$70.75 |
$70.75 |
$102.72
|
|
Chromosome study additional
|
$426.30 |
$426.30 |
$426.30 |
$147.03
|
|
Chylomicron screen, bf - sendout
|
$33.40 |
$33.40 |
$33.40 |
$123.20
|
|
Cilastatin sodium injection
|
$135.75 |
$135.75 |
$135.75 |
$65.86
|
|
Clonidine (pf) 1,000 mcg/10 ml (100 mcg/ml) epidural solution
|
$357.00 |
$357.00 |
$357.00 |
$81.02
|
|
Clot factor xiii fibrin scrn
|
$99.05 |
$99.05 |
$99.05 |
$47.30
|
|
Clot factor xiii fibrin stab
|
$74.25 |
$74.25 |
$74.25 |
$84.27
|
|
Cmv pcr-sendout
|
$105.95 |
$105.95 |
$105.95 |
$172.25
|
|
Coagulation time activated teg
|
$1,099.85 |
$1,099.85 |
$1,099.85 |
$50.05
|
|
Colistimethate sodium inj
|
$141.00 |
$141.00 |
$141.00 |
$84.22
|
|
Collar cerv 18.25x3.5in serp firm density sm
|
$40.30 |
$40.30 |
$40.30 |
$46.88
|
|
Compatibility test each unit immediate spin technique
|
$145.35 |
$145.35 |
$145.35 |
$159.95
|
|
Compatibility test incubate
|
$170.80 |
$170.80 |
$170.80 |
$143.64
|
|
Complement fixation each
|
$141.45 |
$141.45 |
$141.45 |
$25.70
|
|
Conjugated estrogens 25 mg solution for injection
|
$331.75 |
$331.75 |
$331.75 |
$792.24
|
|
Consultation pathology during surgery cytological exam initial site
|
$152.75 |
$152.75 |
$152.75 |
$402.05
|
|
Consultation pathology during surgery frozen section each additional block
|
$639.30 |
$639.30 |
$639.30 |
$112.20
|
|
Contrast exam abdominl aorta 75625-26
|
$14,131.80 |
$14,131.80 |
$14,131.80 |
$3,389.09
|
|
Contrast exam thoracic aorta 75605-26
|
$13,227.85 |
$13,227.85 |
$13,227.85 |
$3,780.00
|
|
Coombs indirect qualitative each reagent red cell reference
|
$169.70 |
$169.70 |
$169.70 |
$100.29
|
|
Coombs indirect titer reference
|
$183.90 |
$183.90 |
$183.90 |
$143.40
|
|
Cosyntropin 0.25 mg solution for injection
|
$171.00 |
$171.00 |
$171.00 |
$258.83
|
|
Crbrospnl fld flw imag cistern
|
$4,582.00 |
$4,582.00 |
$4,582.00 |
$1,409.85
|
|
C-reactive protein high sensitivity
|
$804.25 |
$804.25 |
$804.25 |
$91.20
|
|
Creatine kinase
|
$1,481.75 |
$1,481.75 |
$1,481.75 |
$58.30
|
|
Creatine kinase isoenzymes
|
$7.95 |
$7.95 |
$7.95 |
$49.40
|
|
Creatine kinase mb
|
$1,645.55 |
$1,645.55 |
$1,645.55 |
$105.95
|
|
Creatinine
|
$1,073.10 |
$1,073.10 |
$1,073.10 |
$42.50
|
|
Creatinine clearance urine
|
$977.65 |
$977.65 |
$977.65 |
$85.80
|
|
Crotalidae poly immune fab
|
$5,205.75 |
$5,205.75 |
$5,205.75 |
$6,208.33
|
|
Cryofibrinogen qualitative - sendout
|
$2.65 |
$2.65 |
$2.65 |
$50.88
|
|
Crystal identification light microscopy
|
$810.75 |
$810.75 |
$810.75 |
$58.50
|
|
Culture aerobic additional method definitive id each
|
$962.75 |
$962.75 |
$962.75 |
$62.65
|
|
Culture anaerobic additional method definitive id each
|
$76.35 |
$76.35 |
$76.35 |
$75.29
|
|
Culture anaerobic except blood
|
$2,401.00 |
$2,401.00 |
$2,401.00 |
$120.00
|
|
Culture fungi definitive id mold
|
$962.75 |
$962.75 |
$962.75 |
$70.00
|
|
Culture quantitative aerobic other source
|
$2,032.80 |
$2,032.80 |
$2,032.80 |
$85.80
|
|
Culture typing immunologic
|
$758.10 |
$758.10 |
$758.10 |
$41.19
|
|
Culture urine each isolate
|
$918.50 |
$918.50 |
$918.50 |
$46.20
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$22.00 |
$22.00 |
$22.00 |
$26.73
|
|
Cyclophosphamide 25 mg capsule
|
$35.65 |
$35.65 |
$35.65 |
$22.51
|
|
Cyclosporine 250 mg/5 ml intravenous solution
|
$1,559.25 |
$1,559.25 |
$1,559.25 |
$150.79
|
|
Cyclosporine modified 25 mg capsule
|
$22.00 |
$22.00 |
$22.00 |
$9.79
|
|
Cyclosporine oral 100 mg
|
$120.50 |
$120.50 |
$120.50 |
$42.97
|
|
Cystine urine quantitative
|
$262.35 |
$262.35 |
$262.35 |
$103.35
|
|
Cytarabine 20 mg/ml injection solution
|
$16.25 |
$16.25 |
$16.25 |
$66.95
|
|
Cytomegalovirus dfa
|
$25.45 |
$25.45 |
$25.45 |
$51.20
|
|
Cytopathology concentration technique smears & interpretation
|
$1,439.55 |
$1,439.55 |
$1,439.55 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$651.70 |
$651.70 |
$651.70 |
$122.40
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$757.05 |
$757.05 |
$757.05 |
$203.08
|
|
Cytopath smear other source
|
$187.05 |
$187.05 |
$187.05 |
$135.27
|
|
Dacarbazine 100 mg intravenous solution
|
$46.00 |
$46.00 |
$46.00 |
$61.64
|
|
Dactinomycin 0.5 mg intravenous solution
|
$2,409.50 |
$2,409.50 |
$2,409.50 |
$2,281.50
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$1,117.00 |
$1,117.00 |
$1,117.00 |
$544.35
|
|
Dch pulmonary stress test
|
$4,561.55 |
$4,561.55 |
$4,561.55 |
$964.41
|
|
Dch validity tests
|
$53.10 |
$53.10 |
$53.10 |
$25.00
|
