|
11-desoxycortisol - sendout
|
$291.20 |
$291.20 |
$291.20 |
$84.56
|
|
17-hydroxypregnenolone
|
$228.00 |
$228.00 |
$228.00 |
$85.15
|
|
17-ketosteroids
|
$268.00 |
$268.00 |
$268.00 |
$49.45
|
|
3d recon without postprocess indpndt
|
$2,965.60 |
$2,965.60 |
$2,965.60 |
$469.20
|
|
5' nucleotidase - sendout
|
$217.60 |
$217.60 |
$217.60 |
$50.05
|
|
Abdominal CT scan (with and without contrast)
|
$3,264.00 |
$3,264.00 |
$3,264.00 |
$1,976.94
|
|
Abdominal CT scan (with contrast)
|
$2,709.60 |
$2,709.60 |
$2,709.60 |
$1,664.40
|
|
Abdominal CT scan (without contrast)
|
$2,639.20 |
$2,639.20 |
$2,639.20 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$4,437.60 |
$4,437.60 |
$4,437.60 |
$3,015.94
|
|
Abdominal MRI (with contrast)
|
$3,937.60 |
$3,937.60 |
$3,937.60 |
$2,200.55
|
|
Abdominal MRI (without contrast)
|
$3,828.00 |
$3,828.00 |
$3,828.00 |
$1,993.50
|
|
Abdominal paracentesis w/image guidance
|
$1,586.40 |
$1,586.40 |
$1,586.40 |
$1,668.08
|
|
Abdominal Ultrasound (complete)
|
$1,445.60 |
$1,445.60 |
$1,445.60 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$1,161.60 |
$1,161.60 |
$1,161.60 |
$604.43
|
|
Abd paracentesis/w/o image guide 49082
|
$1,767.20 |
$1,767.20 |
$1,767.20 |
$1,176.00
|
|
Abl1 gene
|
$1,712.80 |
$1,712.80 |
$1,712.80 |
$668.85
|
|
Acetaminophen level
|
$487.20 |
$487.20 |
$487.20 |
$117.01
|
|
Acetone qualitative
|
$143.20 |
$143.20 |
$143.20 |
$45.65
|
|
Acetylcholine receptor modulating antibody
|
$210.40 |
$210.40 |
$210.40 |
$61.80
|
|
Acetylcholinesterase assay
|
$248.80 |
$248.80 |
$248.80 |
$106.70
|
|
Aco cont gluc mnt phys/qhp eqp 95250aco
|
$431.20 |
$431.20 |
$431.20 |
$381.70
|
|
Acute hepatitis panel
|
$627.20 |
$627.20 |
$627.20 |
$281.05
|
|
#acylcarnitineprfl
|
$400.00 |
$400.00 |
$400.00 |
$110.25
|
|
Adenovirus ag ia
|
$350.40 |
$350.40 |
$350.40 |
$40.70
|
|
Adh-sendout
|
$372.80 |
$372.80 |
$372.80 |
$109.71
|
|
Administration chemotherapy IV infusion each additional hour
|
$268.00 |
$268.00 |
$268.00 |
$235.00
|
|
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug
|
$639.20 |
$639.20 |
$639.20 |
$688.88
|
|
Administration chemotherapy IV push single/initial substance/drug
|
$365.60 |
$365.60 |
$365.60 |
$448.00
|
|
Administration chemotherapy subcutaneous/im anti neoplastic hormonal
|
$295.20 |
$295.20 |
$295.20 |
$220.00
|
|
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal
|
$193.60 |
$193.60 |
$193.60 |
$265.50
|
|
Administration immunization 1 vaccine
|
$128.00 |
$128.00 |
$128.00 |
$67.60
|
|
Administration immunization each additional vaccine
|
$110.40 |
$110.40 |
$110.40 |
$46.23
|
|
Administration vaccine hepatitis b
|
$68.00 |
$68.00 |
$68.00 |
$54.60
|
|
Administration vaccine influenza virus
|
$78.40 |
$78.40 |
$78.40 |
$48.35
|
|
Administration vaccine pneumococcal
|
$84.80 |
$84.80 |
$84.80 |
$49.17
|
|
_afb org id by sequencing rflx ast-sendout
|
$615.20 |
$615.20 |
$615.20 |
$289.60
|
|
Afo molded ankle gauntlet
|
$225.60 |
$225.60 |
$225.60 |
$724.73
|
|
Afo rig ant tib tcf/= custom
|
$4,564.00 |
$4,564.00 |
$4,564.00 |
$1,402.44
|
|
Albumin body fluid quantitative each specimen
|
$219.20 |
$219.20 |
$219.20 |
$47.50
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$70.40 |
$70.40 |
$70.40 |
$55.90
|
|
Albumin serum plasma or whole blood
|
$172.00 |
$172.00 |
$172.00 |
$39.90
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$167.20 |
$167.20 |
$167.20 |
$94.90
|
|
Alkaline phosphatase
|
$95.20 |
$95.20 |
$95.20 |
$46.20
|
|
Allergen alpha lactalbumin ige
|
$567.20 |
$567.20 |
$567.20 |
$48.57
|
|
Allergen egg white ige
|
$237.60 |
$237.60 |
$237.60 |
$36.60
|
|
Allergy Skin Testing
|
$52.80 |
$52.80 |
$52.80 |
$53.43
|
|
Allograft epieffect 2x3cm-q4186-cost per sq cm
|
$922.40 |
$922.40 |
$922.40 |
$989.09
|
|
Allograft graftjacket 2x12cm-q4107-cost per sq cm
|
$592.80 |
$592.80 |
$592.80 |
$4,677.40
|
|
Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm
|
$922.40 |
$922.40 |
$922.40 |
$1,671.06
|
|
Alpha-fetoprotein tumor marker
|
$228.00 |
$228.00 |
$228.00 |
$103.60
|
|
Alt/sgpt
|
$155.20 |
$155.20 |
$155.20 |
$44.68
|
|
Aluminum - quest
|
$247.20 |
$247.20 |
$247.20 |
$81.49
|
|
Amino acid screen, urine
|
$738.40 |
$738.40 |
$738.40 |
$76.05
|
|
Aminolevulinic acid delta
|
$316.80 |
$316.80 |
$316.80 |
$74.10
|
|
Amitriptyline (elavil) -sendout
|
$225.60 |
$225.60 |
$225.60 |
$92.50
|
|
Ammonia
|
$173.60 |
$173.60 |
$173.60 |
$115.80
|
|
Amniocentesisdiagnostic 59000
|
$731.20 |
$731.20 |
$731.20 |
$943.50
|
|
Amphetamine confirm urine -sendout
|
$475.20 |
$475.20 |
$475.20 |
$93.61
|
|
Amphetamines 5 or more
|
$333.60 |
$333.60 |
$333.60 |
$87.75
|
|
Amylase
|
$301.60 |
$301.60 |
$301.60 |
$83.20
|
|
Anabolic steroid 1 or 2
|
$240.00 |
$240.00 |
$240.00 |
$80.08
|
|
Ana ds-dna
|
$203.20 |
$203.20 |
$203.20 |
$58.63
|
|
Analysis gene f2 20210g>a variant
|
$820.80 |
$820.80 |
$820.80 |
$210.26
|
|
Analysis gene f5 leiden variant
|
$352.00 |
$352.00 |
$352.00 |
$219.13
|
|
Anaplsma phgcytophlm amp prb
|
$52.80 |
$52.80 |
$52.80 |
$88.00
|
|
Anca screen with reflex to titer -quest
|
$316.80 |
$316.80 |
$316.80 |
$100.89
|
|
An cholangiogram percutaneous compl
|
$3,173.60 |
$3,173.60 |
$3,173.60 |
$2,547.00
|
|
An fluoro guide for cvp
|
$1,859.20 |
$1,859.20 |
$1,859.20 |
$510.17
|
|
Ankle X-ray
|
$836.80 |
$836.80 |
$836.80 |
$351.20
|
|
Anora (draw only)
|
$16.80 |
$16.80 |
$16.80 |
$35.00
|
|
Antibody bacterium, not elsewhere specified
|
$371.20 |
$371.20 |
$371.20 |
$57.85
|
|
Antibody elution rbc reference
|
$217.60 |
$217.60 |
$217.60 |
$175.50
|
|
Antibody htlv/hiv confirm test
|
$350.40 |
$350.40 |
$350.40 |
$118.30
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$454.40 |
$454.40 |
$454.40 |
$218.30
|
|
Antibody id rbc panel
|
$305.60 |
$305.60 |
$305.60 |
$283.80
|
|
Antibody influenza virus
|
$307.20 |
$307.20 |
$307.20 |
$53.28
|
|
Antibody screen rbc
|
$233.60 |
$233.60 |
$233.60 |
$102.60
|
|
Antibody tetanus
|
$88.00 |
$88.00 |
$88.00 |
$52.20
|
|
Antineutrophil cytoplasmic antibody screen each antibody
|
$40.00 |
$40.00 |
$40.00 |
$42.35
|
|
Antinuclear antibodies
|
$197.60 |
$197.60 |
$197.60 |
$90.00
|
|
Antinuclear antibodies titer
|
$213.60 |
$213.60 |
$213.60 |
$77.40
|
|
Antiphosphatidylserine antibody
|
$447.20 |
$447.20 |
$447.20 |
$67.60
|
|
Antistreptolysin o titer
|
$176.00 |
$176.00 |
$176.00 |
$54.94
|
|
Antithrombin iii activity
|
$160.80 |
$160.80 |
$160.80 |
$113.40
|
|
Aortic dysfunction/dilation
|
$10,606.40 |
$10,606.40 |
$10,606.40 |
$992.40
|
|
App high cost ss f/n/g/h/f >100sq cm 1st 100sq cm
|
$3,105.60 |
$3,105.60 |
$3,105.60 |
$2,164.64
|
|
App high cost ss f/n/g/h/f >100sq cm addl 100sq cm
|
$1,863.20 |
$1,863.20 |
$1,863.20 |
$1,011.14
|
|
App high cost ss f/n/g/h/f <100sq cm addl <25sq cm
|
$1,863.20 |
$1,863.20 |
$1,863.20 |
$549.08
|
|
App high cost ss t/a/l >100sq cm 1st 100sq cm
|
$6,384.80 |
$6,384.80 |
$6,384.80 |
$3,661.35
|
|
App high cost ss t/a/l >100sq cm addl 100sq cm
|
$3,830.40 |
$3,830.40 |
$3,830.40 |
$1,148.00
|
|
App high cost ss t/a/l <100sq cm addl <25sq cm
|
$1,863.20 |
$1,863.20 |
$1,863.20 |
$549.08
|
|
Application finger splntstatic 29130
|
$625.60 |
$625.60 |
$625.60 |
$222.28
|
|
Application long leg splint 29505
|
$827.20 |
$827.20 |
$827.20 |
$363.00
|
|
Application lower leg splint 29515
|
$1,195.20 |
$1,195.20 |
$1,195.20 |
$363.00
|
|
Application multi layer compression below knee (both sides)
|
$386.40 |
$386.40 |
$386.40 |
$378.00
|
|
Application of forearm cast 29075
|
$347.20 |
$347.20 |
$347.20 |
$370.80
|
|
Application of long arm cast 29065
|
$347.20 |
$347.20 |
$347.20 |
$404.63
|
|
Application of long leg cast
|
$538.40 |
$538.40 |
$538.40 |
$444.00
|
|
Application of long leg cast 29345
|
$410.40 |
$410.40 |
$410.40 |
$499.20
|
|
Application of paste boot 29580
|
$2,097.60 |
$2,097.60 |
$2,097.60 |
$331.74
|
