|
5% dextrose and 0.45% saline
|
$115.06 |
$115.06 |
$115.06 |
$48.00
|
|
Abdominal CT scan (with and without contrast)
|
$11,362.99 |
$11,362.99 |
$11,362.99 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$10,032.50 |
$10,032.50 |
$10,032.50 |
$1,680.60
|
|
Abdominal CT scan (without contrast)
|
$8,785.96 |
$8,785.96 |
$8,785.96 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$18,321.12 |
$18,321.12 |
$18,321.12 |
$3,015.94
|
|
Abdominal MRI (without contrast)
|
$14,820.96 |
$14,820.96 |
$14,820.96 |
$2,050.14
|
|
Abdominal Ultrasound (complete)
|
$3,756.01 |
$3,756.01 |
$3,756.01 |
$785.55
|
|
Abdominal Ultrasound (limited)
|
$2,315.56 |
$2,315.56 |
$2,315.56 |
$590.00
|
|
Acetaminophen 10 mg/ml soln 100 ml glass cont
|
$129.60 |
$129.60 |
$129.60 |
$74.96
|
|
Acetaminophen level
|
$74.35 |
$74.35 |
$74.35 |
$107.62
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$4,071.50 |
$4,071.50 |
$4,071.50 |
$216.00
|
|
Acute hepatitis panel
|
$2,004.90 |
$2,004.90 |
$2,004.90 |
$291.00
|
|
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr
|
$447.67 |
$447.67 |
$447.67 |
$63.48
|
|
Adenosine 3 mg/250 ml bag for osm
|
$178.52 |
$178.52 |
$178.52 |
$255.41
|
|
Administration immunization 1 vaccine
|
$342.03 |
$342.03 |
$342.03 |
$69.00
|
|
Administration immunization each additional vaccine
|
$380.86 |
$380.86 |
$380.86 |
$47.40
|
|
Administration vaccine influenza virus
|
$179.17 |
$179.17 |
$179.17 |
$50.43
|
|
#afb mycobacteria suscep. #1
|
$972.27 |
$972.27 |
$972.27 |
$35.51
|
|
_afb org id by sequencing rflx ast-sendout
|
$300.00 |
$300.00 |
$300.00 |
$315.00
|
|
Albumin (human), 25%, 50ml
|
$690.12 |
$690.12 |
$690.12 |
$244.70
|
|
Albumin (human), 5%, 250 ml
|
$2,023.62 |
$2,023.62 |
$2,023.62 |
$243.59
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$829.39 |
$829.39 |
$829.39 |
$56.07
|
|
Albumin serum plasma or whole blood
|
$422.93 |
$422.93 |
$422.93 |
$40.45
|
|
Albuterol comp unit
|
$326.90 |
$326.90 |
$326.90 |
$0.80
|
|
Albuterol ipratrop non-comp
|
$52.77 |
$52.77 |
$52.77 |
$5.40
|
|
Albuterol non-comp con
|
$32.69 |
$32.69 |
$32.69 |
$6.07
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$88.00 |
$88.00 |
$88.00 |
$93.60
|
|
Alkaline phosphatase
|
$447.66 |
$447.66 |
$447.66 |
$46.40
|
|
Allergen alpha lactalbumin ige
|
$286.00 |
$286.00 |
$286.00 |
$48.00
|
|
Allergen egg white ige
|
$286.00 |
$286.00 |
$286.00 |
$38.00
|
|
Alpha-fetoprotein tumor marker
|
$1,241.37 |
$1,241.37 |
$1,241.37 |
$105.00
|
|
Alt/sgpt
|
$653.62 |
$653.62 |
$653.62 |
$47.45
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$1,165.83 |
$1,165.83 |
$1,165.83 |
$40.28
|
|
Ammonia
|
$1,590.18 |
$1,590.18 |
$1,590.18 |
$119.70
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$1,136.79 |
$1,136.79 |
$1,136.79 |
$117.75
|
|
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr
|
$2,536.93 |
$2,536.93 |
$2,536.93 |
$543.85
|
|
Antibody screen rbc
|
$1,016.18 |
$1,016.18 |
$1,016.18 |
$100.00
|
|
Antinuclear antibodies
|
$1,855.00 |
$1,855.00 |
$1,855.00 |
$89.40
|
|
Assay of salicylate
|
$74.35 |
$74.35 |
$74.35 |
$95.00
|
|
Ast/sgot
|
$736.03 |
$736.03 |
$736.03 |
$45.65
|
|
Atropine 0.1 mg/ml injection syringe
|
$216.51 |
$216.51 |
$216.51 |
$51.28
|
|
Azathioprine 50 mg tablet
|
$31.30 |
$31.30 |
$31.30 |
$3.46
|
|
Azithromycin 500 mg intravenous solution
|
$259.04 |
$259.04 |
$259.04 |
$35.08
|
|
Belt ostomy lg 34-65in
|
$19.50 |
$19.50 |
$19.50 |
$7.45
|
|
Benztropine 1 mg/ml injection solution
|
$1,184.60 |
$1,184.60 |
$1,184.60 |
$103.20
|
|
Betamethasone acetate and sodium phos 6 mg/ml suspension for injection
|
$198.10 |
$198.10 |
$198.10 |
$64.15
|
|
Bilirubin direct
|
$384.47 |
$384.47 |
$384.47 |
$49.86
|
|
Bilirubin total
|
$351.00 |
$351.00 |
$351.00 |
$52.57
|
|
Blood Clotting (PT/INR) Test
|
$606.94 |
$606.94 |
$606.94 |
$52.80
|
|
Blood Clotting (PTT) Test
|
$747.03 |
$747.03 |
$747.03 |
$73.15
|
|
Blood Count (CBC) Test (without differential)
|
$655.00 |
$655.00 |
$655.00 |
$61.80
|
|
Blood Culture Test
|
$892.58 |
$892.58 |
$892.58 |
$145.60
|
|
Blood occult feces 1-3 determinations other than neoplasm screening qualitative
|
$474.00 |
$474.00 |
$474.00 |
$33.15
|
|
Blood occult feces colorectal neoplasm screening qualitative
|
$474.00 |
$474.00 |
$474.00 |
$33.57
|
|
Blood occult peroxidase activity qualitative gastric
|
$422.93 |
$422.93 |
$422.93 |
$34.00
|
|
Blood smear microscopic w manual differential wbc count
|
$626.15 |
$626.15 |
$626.15 |
$38.61
|
|
Blood typing abo
|
$584.96 |
$584.96 |
$584.96 |
$83.03
|
|
Blood typing ag donor ea ag
|
$958.48 |
$958.48 |
$958.48 |
$190.80
|
|
Blood typing rh (d)
|
$447.66 |
$447.66 |
$447.66 |
$57.14
|
|
Borrelia burgdorferi (lyme disease) antibody nonspecific
|
$1,647.87 |
$1,647.87 |
$1,647.87 |
$94.80
|
|
Braf gene
|
$1,708.36 |
$1,708.36 |
$1,708.36 |
$427.50
|
|
Brain MRA (blood vessel MRI, with and without contrast)
|
$18,797.98 |
$18,797.98 |
$18,797.98 |
$2,785.50
|
|
Brain MRA (blood vessel MRI, without contrast)
|
$11,471.75 |
$11,471.75 |
$11,471.75 |
$1,902.00
|
|
Brain MRI (with and without contrast)
|
$19,592.10 |
$19,592.10 |
$19,592.10 |
$2,854.80
|
|
Brain MRI (without contrast)
|
$10,544.21 |
$10,544.21 |
$10,544.21 |
$1,976.82
|
|
Bumetanide in d5w IV syringe 0.04 mg/ml (neo/ped) - cnr
|
$200.53 |
$200.53 |
$200.53 |
$23.92
|
|
Bundled special stain group 1 microorganisms
|
$260.88 |
$260.88 |
$260.88 |
$160.00
|
|
Bundled special stain group 2
|
$260.88 |
$260.88 |
$260.88 |
$173.40
|
|
Calcium 24 hour urine
|
$480.60 |
$480.60 |
$480.60 |
$53.00
|
|
Calcium chloride 100 mg/ml (10 %) intravenous syringe
|
$176.41 |
$176.41 |
$176.41 |
$45.49
|
|
Calcium gluconate 100 mg/ml (10 %) intravenous solution
|
$160.55 |
$160.55 |
$160.55 |
$64.49
|
|
Calcium ionized
|
$1,356.71 |
$1,356.71 |
$1,356.71 |
$89.88
|
|
Calprotectin fecal
|
$2,392.14 |
$2,392.14 |
$2,392.14 |
$169.95
|
|
Carboprost tromethamine 250 mcg/ml intramuscular solution
|
$3,244.45 |
$3,244.45 |
$3,244.45 |
$513.08
|
|
Carboxyhemoglobin quantitative
|
$1,518.75 |
$1,518.75 |
$1,518.75 |
$85.00
|
|
Carotid Artery Ultrasound (Duplex)
|
$4,686.65 |
$4,686.65 |
$4,686.65 |
$1,007.40
|
|
Cefazolin 10 mg/10 ml (dilution #2) IV desensitization - cnr
|
$158.44 |
$158.44 |
$158.44 |
$37.70
|
|
Chest CT scan (with and without contrast)
|
$12,467.43 |
$12,467.43 |
$12,467.43 |
$1,975.00
|
|
Chest CT scan (with contrast)
|
$9,909.77 |
$9,909.77 |
$9,909.77 |
$1,689.00
|
|
Chest CT scan (without contrast)
|
$9,728.92 |
$9,728.92 |
$9,728.92 |
$1,350.03
|
|
Chest X-ray
|
$1,421.27 |
$1,421.27 |
$1,421.27 |
$294.06
|
|
Chest X-ray (single view)
|
$1,223.47 |
$1,223.47 |
$1,223.47 |
$239.04
|
|
Chlamydia type
|
$300.00 |
$300.00 |
$300.00 |
$34.20
|
|
Chloramphenicol sodium injec
|
$895.35 |
$895.35 |
$895.35 |
$113.84
|
|
Chloride
|
$530.01 |
$530.01 |
$530.01 |
$40.95
|
|
Chloride 24 hour urine
|
$1,241.37 |
$1,241.37 |
$1,241.37 |
$49.47
|
|
Cholesterol
|
$1,647.87 |
$1,647.87 |
$1,647.87 |
$45.75
|
|
Cholesterol (Lipid) Test
|
$1,896.00 |
$1,896.00 |
$1,896.00 |
$115.80
|
|
Clozapine, 25 mg
|
$56.78 |
$56.78 |
$56.78 |
$4.87
|
|
#cmvcul-virus inoculation shell
|
$1,052.00 |
$1,052.00 |
$1,052.00 |
$100.20
|
|
Cmv pcr-sendout
|
$1,040.87 |
$1,040.87 |
$1,040.87 |
$177.10
|
|
Cocaine 4 % nasal solution
|
$1,955.08 |
$1,955.08 |
$1,955.08 |
$629.41
|
|
Cocaine hcl nasal (numbrino)
|
$2,291.86 |
$2,291.86 |
$2,291.86 |
$512.30
|
|
Collection of venous blood by venipuncture
|
$98.00 |
$98.00 |
$98.00 |
$21.00
|
|
Compatibility test each unit immediate spin technique
|
$1,101.32 |
$1,101.32 |
$1,101.32 |
$169.52
|
|
Computed tomographic angiography head and neck with contrast
|
$29,884.33 |
$29,884.33 |
$29,884.33 |
$2,237.25
|
|
C-peptide
|
$1,540.75 |
$1,540.75 |
$1,540.75 |
$97.30
|
|
C-reactive protein
|
$694.80 |
$694.80 |
$694.80 |
$68.38
|
|
Creatine kinase
|
$892.58 |
$892.58 |
$892.58 |
$66.30
|
|
Creatinine
|
$626.15 |
$626.15 |
$626.15 |
$44.72
|
