|
Emg 2 ext w-w/o paraspinal area 95861
|
$1,049.80 |
$1,049.80 |
$1,049.80 |
$434.00
|
|
Emg 3 ext w-w/o paraspinal area 95863
|
$1,178.85 |
$1,178.85 |
$1,178.85 |
$512.85
|
|
Emg needle test 4-extremities
|
$1,307.25 |
$1,307.25 |
$1,307.25 |
$547.00
|
|
Encephalitis, california igg/igm
|
$65.95 |
$65.95 |
$65.95 |
$46.77
|
|
Encephalitis, st louis igg/igm
|
$65.95 |
$65.95 |
$65.95 |
$48.03
|
|
Encephalitis, western equine igg/igm
|
$65.95 |
$65.95 |
$65.95 |
$50.35
|
|
Endo cath bile duct s&i
|
$8,837.85 |
$8,837.85 |
$8,837.85 |
$569.40
|
|
Endoscopy swallow (fees) vid
|
$1,092.25 |
$1,092.25 |
$1,092.25 |
$414.06
|
|
Enzyme histochemistry
|
$2,377.80 |
$2,377.80 |
$2,377.80 |
$460.32
|
|
Ep & ablate supravent arrhyt
|
$64,058.95 |
$64,058.95 |
$64,058.95 |
$29,766.10
|
|
Ep & ablate ventric tachy
|
$64,058.95 |
$64,058.95 |
$64,058.95 |
$30,975.00
|
|
Ep induct arrhy by elect pacing
|
$2,743.35 |
$2,743.35 |
$2,743.35 |
$2,753.40
|
|
Epirubicin 200 mg/100 ml intravenous solution
|
$176.00 |
$176.00 |
$176.00 |
$195.23
|
|
Epstein barr nuclear antigen antibody
|
$82.55 |
$82.55 |
$82.55 |
$81.81
|
|
Eribulin 1 mg/2 ml (0.5 mg/ml) intravenous solution
|
$5,241.75 |
$5,241.75 |
$5,241.75 |
$2,528.17
|
|
Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr
|
$608.00 |
$608.00 |
$608.00 |
$323.00
|
|
Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr
|
$199.00 |
$199.00 |
$199.00 |
$240.87
|
|
Esophageal recording
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$1,674.16
|
|
Esophageal recording
|
$2,862.05 |
$2,862.05 |
$2,862.05 |
$1,674.16
|
|
Esophagus motility study
|
$4,183.85 |
$4,183.85 |
$4,183.85 |
$1,289.20
|
|
Estradiol total
|
$31.10 |
$31.10 |
$31.10 |
$153.00
|
|
Estradiol valerate 10 mg inj
|
$53.00 |
$53.00 |
$53.00 |
$53.00
|
|
Estrogens total-sendout
|
$6.15 |
$6.15 |
$6.15 |
$85.20
|
|
Ethanolamine oleate 100 mg
|
$1,795.75 |
$1,795.75 |
$1,795.75 |
$1,011.00
|
|
Ethylene glycol -sendout
|
$15.70 |
$15.70 |
$15.70 |
$77.40
|
|
Etoposide 50 mg cap
|
$274.00 |
$274.00 |
$274.00 |
$203.41
|
|
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen
|
$181.80 |
$181.80 |
$181.80 |
$221.00
|
|
Evaluation heart device
|
$6,329.20 |
$6,329.20 |
$6,329.20 |
$2,523.52
|
|
Evoked potentials upper limbs
|
$2,957.40 |
$2,957.40 |
$2,957.40 |
$908.54
|
|
Evoked potential visual not glaucoma
|
$1,276.65 |
$1,276.65 |
$1,276.65 |
$852.80
|
|
External pretreatment of serum for use in antibody identification by dilution
|
$153.20 |
$153.20 |
$153.20 |
$64.90
|
|
Factor ix
|
$9.05 |
$9.05 |
$9.05 |
$139.20
|
|
Factor ix non-recombinant
|
$3,400.00 |
$3,400.00 |
$3,400.00 |
$1.41
|
|
Factor ix recombinant nos
|
$10.00 |
$10.00 |
$10.00 |
$2.80
|
|
Factor viii
|
$63.55 |
$63.55 |
$63.55 |
$148.34
|
|
Factor viii
|
$2,310.00 |
$2,310.00 |
$2,310.00 |
$1.60
|
|
Factor viii recombinant nos
|
$7.50 |
$7.50 |
$7.50 |
$4.80
|
|
Fat/lipids feces qualitative
|
$33.00 |
$33.00 |
$33.00 |
$37.40
|
|
Fecal microbiota, live-jslm 150 ml rectal suspension enema
|
$42,203.75 |
$42,203.75 |
$42,203.75 |
$63.30
|
|
Felbamate (felbatol(r)) - sendout
|
$18.05 |
$18.05 |
$18.05 |
$66.43
|
|
Fetal biophys profile w/nst 76818
|
$364.70 |
$364.70 |
$364.70 |
$541.74
|
|
Fetal contract stress test 59020 - 26
|
$4,348.25 |
$4,348.25 |
$4,348.25 |
$559.32
|
|
Fetal hemoglobin (kleihauer betke)
|
$127.10 |
$127.10 |
$127.10 |
$85.00
|
|
Fetal hemoglobin rosette
|
$149.65 |
$149.65 |
$149.65 |
$78.30
|
|
Fetal non stress test
|
$1,252.85 |
$1,252.85 |
$1,252.85 |
$507.90
|
|
#_fet/norfentcnfrmur
|
$40.25 |
$40.25 |
$40.25 |
$120.85
|
|
Fibrin degradation products
|
$922.90 |
$922.90 |
$922.90 |
$58.85
|
|
Fibrinolysins/coagulopathy screen interpretation/report
|
$96.55 |
$96.55 |
$96.55 |
$66.00
|
|
Flecainide (tambocor)-sendout
|
$19.05 |
$19.05 |
$19.05 |
$66.43
|
|
Fludarabine 50 mg intravenous solution
|
$330.00 |
$330.00 |
$330.00 |
$592.00
|
|
Fluidotherapy charges pt
|
$1,082.55 |
$1,082.55 |
$1,082.55 |
$101.40
|
|
Fluorouracil 50 mg/ml intravenous solution (wrapper)
|
$117.00 |
$117.00 |
$117.00 |
$97.74
|
|
Fomepizole 1 gram/ml intravenous solution
|
$1,604.00 |
$1,604.00 |
$1,604.00 |
$2,993.41
|
|
Fosaprepitant 150 mg intravenous powder for solution
|
$1,063.75 |
$1,063.75 |
$1,063.75 |
$462.82
|
|
Foscarnet sodium injection
|
$1,509.00 |
$1,509.00 |
$1,509.00 |
$714.25
|
|
Fresh frozen plasma thawing ea un
|
$59.50 |
$59.50 |
$59.50 |
$131.25
|
|
Fructosamine glycated protein
|
$7.00 |
$7.00 |
$7.00 |
$63.05
|
|
Ftl cgen abnor four anal
|
$38.65 |
$38.65 |
$38.65 |
$211.83
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$211.00 |
$211.00 |
$211.00 |
$177.43
|
|
Gammaglobulin ige
|
$13.25 |
$13.25 |
$13.25 |
$85.00
|
|
Gamma glutamyltransferase
|
$217.75 |
$217.75 |
$217.75 |
$55.28
|
|
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr
|
$288.00 |
$288.00 |
$288.00 |
$211.20
|
|
Gemtuzumab ozogamicin 4.5 mg (1 mg/ml initial concentration) IV soln
|
$28,700.00 |
$28,700.00 |
$28,700.00 |
$21,306.71
|
|
G-esoph reflx tst w/electrod
|
$6,289.10 |
$6,289.10 |
$6,289.10 |
$1,352.03
|
|
Ghs acetylcholinesterase, rbc
|
$12.10 |
$12.10 |
$12.10 |
$39.60
|
|
Ghs alcohol, methyl (methanol)-medtox
|
$19.05 |
$19.05 |
$19.05 |
$103.14
|
|
Ghs chemo IV push, ea addtl
|
$900.40 |
$900.40 |
$900.40 |
$295.00
|
|
Ghs community re-entry 15 minutes
|
$205.35 |
$205.35 |
$205.35 |
$89.65
|
|
Ghs fish hybrid in situ 100-300
|
$71.25 |
$71.25 |
$71.25 |
$229.45
|
|
Ghs flow volume loop
|
$1,550.50 |
$1,550.50 |
$1,550.50 |
$311.10
|
|
Ghs histoplasma antigen
|
$91.20 |
$91.20 |
$91.20 |
$144.50
|
|
Ghs hla-dr/dq, multiple antigens
|
$120.80 |
$120.80 |
$120.80 |
$462.60
|
|
Ghs immun0electrophoresis
|
$16.05 |
$16.05 |
$16.05 |
$102.70
|
|
Ghs leukocyte alkaline phos (mayo)
|
$2.60 |
$2.60 |
$2.60 |
$59.40
|
|
Ghs myocardial strain img spckl track
|
$2,309.15 |
$2,309.15 |
$2,309.15 |
$501.79
|
|
Ghs ob unlisted IV or art inj or infusion
|
$218.95 |
$218.95 |
$218.95 |
$86.19
|
|
Ghs phenylketonurid
|
$25.45 |
$25.45 |
$25.45 |
$55.50
|
|
Ghs prostatic acid phosphatase (mayo)
|
$6.35 |
$6.35 |
$6.35 |
$40.56
|
|
Ghs protoporphyrins fract
|
$10.15 |
$10.15 |
$10.15 |
$64.35
|
|
Ghs quinidine
|
$15.45 |
$15.45 |
$15.45 |
$68.40
|
|
Ghs sedimentation rate
|
$764.25 |
$764.25 |
$764.25 |
$45.50
|
|
Ghs sensitivity (per antimicro)
|
$24.25 |
$24.25 |
$24.25 |
$59.90
|
|
Ghs somatosensory testing lower extremit
|
$2,957.40 |
$2,957.40 |
$2,957.40 |
$947.48
|
|
Ghs somatosensory testing upper & lower limbs
|
$5,909.05 |
$5,909.05 |
$5,909.05 |
$1,357.40
|
|
Giardia lamblia antibody
|
$435.10 |
$435.10 |
$435.10 |
$81.60
|
|
Gi inhouse confirmation
|
$2,110.30 |
$2,110.30 |
$2,110.30 |
$84.60
|
|
Glucagon 1 mg solution for injection
|
$927.00 |
$927.00 |
$927.00 |
$594.00
|
|
Glucagon plasma - sendout
|
$21.75 |
$21.75 |
$21.75 |
$58.20
|
|
Glucose-6-phosphate dhydrogenase screen
|
$71.60 |
$71.60 |
$71.60 |
$39.00
|
|
Glucose blood quantitative
|
$300.10 |
$300.10 |
$300.10 |
$44.80
|
|
Glucose tolerance test (gtt) 3 specimens
|
$69.50 |
$69.50 |
$69.50 |
$100.10
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$3.10 |
$3.10 |
$3.10 |
$110.10
|
|
Gonadotropin luteinizing hormone (lh)
|
$3.65 |
$3.65 |
$3.65 |
$125.68
|
|
Goserelin 10.8 mg subcutaneous implant
|
$5,339.00 |
$5,339.00 |
$5,339.00 |
$2,529.74
|
|
Graft apligraf 3in 44sqcm-q4101-cost per sq cm
|
$94.00 |
$94.00 |
$94.00 |
$70.97
|
|
Graft jckt xpress 2ml flowable scaffold-q4113-cost per sq cm
|
$5,703.00 |
$5,703.00 |
$5,703.00 |
$2,274.83
|
|
Granisetron 1 mg tab
|
$7.50 |
$7.50 |
$7.50 |
$10.04
|
|
Granisetron hcl injection
|
$21.00 |
$21.00 |
$21.00 |
$40.33
|
|
Group mnt 2 or more 30 mins
|
$90.05 |
$90.05 |
$90.05 |
$35.20
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$84.00 |
$84.00 |
$84.00 |
$28.23
|
