|
Creatinine 24 hour urine
|
$626.15 |
$626.15 |
$626.15 |
$58.85
|
|
Creatinine clearance urine
|
$845.88 |
$845.88 |
$845.88 |
$89.50
|
|
Cta abdomen without & /or w/contrast
|
$13,896.95 |
$13,896.95 |
$13,896.95 |
$2,050.23
|
|
Cta abdominal aorta & (both sides) ileofemoral lower extremity w runoff without & w/contrast
|
$16,299.59 |
$16,299.59 |
$16,299.59 |
$1,940.00
|
|
Cta neck without &/or w/contrast
|
$15,020.75 |
$15,020.75 |
$15,020.75 |
$1,931.40
|
|
CT Angiogram of Abdomen and Pelvis
|
$14,062.70 |
$14,062.70 |
$14,062.70 |
$2,849.55
|
|
CT Angiogram of the Chest (for blood clot)
|
$13,896.95 |
$13,896.95 |
$13,896.95 |
$1,940.00
|
|
CT Angiogram of the Head
|
$14,863.58 |
$14,863.58 |
$14,863.58 |
$1,996.80
|
|
CT heart w/evaluation of calcium without contrast
|
$960.60 |
$960.60 |
$960.60 |
$171.60
|
|
CT neck soft tissue w/contrast
|
$9,909.77 |
$9,909.77 |
$9,909.77 |
$1,652.00
|
|
CT neck soft tissue without contrast
|
$9,728.92 |
$9,728.92 |
$9,728.92 |
$1,327.95
|
|
CT neck soft tissue without & w/contrast
|
$9,424.89 |
$9,424.89 |
$9,424.89 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$806.40 |
$806.40 |
$806.40 |
$1,728.18
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$9,728.92 |
$9,728.92 |
$9,728.92 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$9,728.92 |
$9,728.92 |
$9,728.92 |
$1,360.00
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$22,435.33 |
$22,435.33 |
$22,435.33 |
$3,493.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$19,972.44 |
$19,972.44 |
$19,972.44 |
$2,971.80
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$18,859.39 |
$18,859.39 |
$18,859.39 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$10,964.70 |
$10,964.70 |
$10,964.70 |
$1,690.32
|
|
CT thoracic spine without contrast
|
$10,964.70 |
$10,964.70 |
$10,964.70 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$599.13 |
$599.13 |
$599.13 |
$331.50
|
|
Culture aerobic additional method definitive id each
|
$49.12 |
$49.12 |
$49.12 |
$68.64
|
|
Culture afb any source
|
$573.97 |
$573.97 |
$573.97 |
$109.20
|
|
Culture anaerobic additional method definitive id each
|
$49.12 |
$49.12 |
$49.12 |
$79.00
|
|
Culture anaerobic except blood
|
$1,117.83 |
$1,117.83 |
$1,117.83 |
$120.00
|
|
Culture bact stool aero addl path ea
|
$1,117.83 |
$1,117.83 |
$1,117.83 |
$51.45
|
|
Culture fungi definitive id mold
|
$49.12 |
$49.12 |
$49.12 |
$77.28
|
|
Culture fungi definitive id yeast
|
$49.12 |
$49.12 |
$49.12 |
$79.10
|
|
Culture fungi other (except blood)
|
$1,101.32 |
$1,101.32 |
$1,101.32 |
$108.00
|
|
Culture fungi skin/hair/nail
|
$998.00 |
$998.00 |
$998.00 |
$74.88
|
|
Culture mycobacteria definitive id each isolate
|
$147.31 |
$147.31 |
$147.31 |
$89.70
|
|
Culture quantitative aerobic other source
|
$1,052.00 |
$1,052.00 |
$1,052.00 |
$90.35
|
|
Culture typing added method
|
$50.00 |
$50.00 |
$50.00 |
$38.58
|
|
Culture typing immunologic
|
$300.00 |
$300.00 |
$300.00 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$1,415.67 |
$1,415.67 |
$1,415.67 |
$133.90
|
|
Culture urine each isolate
|
$25.00 |
$25.00 |
$25.00 |
$57.00
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$125.13 |
$125.13 |
$125.13 |
$25.20
|
|
Cyclic citrullinated peptide antibody
|
$1,329.24 |
$1,329.24 |
$1,329.24 |
$70.72
|
|
Cytomegalovirus (cmv) antibody igg
|
$939.29 |
$939.29 |
$939.29 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$249.94 |
$249.94 |
$249.94 |
$97.50
|
|
Decalcification
|
$175.74 |
$175.74 |
$175.74 |
$68.90
|
|
Deferoxamine 500 mg solution for injection
|
$190.35 |
$190.35 |
$190.35 |
$95.85
|
|
Depo-estradiol cypionate inj
|
$251.82 |
$251.82 |
$251.82 |
$71.51
|
|
Desmopressin 4 mcg/ml injection solution
|
$1,117.71 |
$1,117.71 |
$1,117.71 |
$89.78
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$130.77 |
$130.77 |
$130.77 |
$38.08
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$133.39 |
$133.39 |
$133.39 |
$45.40
|
|
Dextrose 5 % IV bolus
|
$130.77 |
$130.77 |
$130.77 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$1,040.87 |
$1,040.87 |
$1,040.87 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$1,010.65 |
$1,010.65 |
$1,010.65 |
$79.20
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$475.63 |
$475.63 |
$475.63 |
$74.76
|
|
Dicyclomine injection
|
$559.85 |
$559.85 |
$559.85 |
$153.29
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$191.12 |
$191.12 |
$191.12 |
$69.03
|
|
Digoxin immune fab 40 mg intravenous solution
|
$31,418.01 |
$31,418.01 |
$31,418.01 |
$10,079.82
|
|
Digoxin total therapeutic drug level
|
$1,194.69 |
$1,194.69 |
$1,194.69 |
$102.00
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$805.14 |
$805.14 |
$805.14 |
$297.86
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$176.16 |
$176.16 |
$176.16 |
$17.75
|
|
Dna antibody native/double stranded
|
$1,137.02 |
$1,137.02 |
$1,137.02 |
$97.50
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$642.49 |
$642.49 |
$642.49 |
$98.43
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$408.96 |
$408.96 |
$408.96 |
$65.40
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$452.62 |
$452.62 |
$452.62 |
$84.80
|
|
Droperidol 2.5 mg/ml injection solution
|
$108.48 |
$108.48 |
$108.48 |
$31.07
|
|
Drug assay posaconazole
|
$400.00 |
$400.00 |
$400.00 |
$96.75
|
|
Drug test def 1-7 classes
|
$499.35 |
$499.35 |
$499.35 |
$250.52
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$718.00 |
$718.00 |
$718.00 |
$278.85
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$5,211.98 |
$5,211.98 |
$5,211.98 |
$887.25
|
|
Ecg 12 lead tracing only
|
$771.53 |
$771.53 |
$771.53 |
$226.50
|
|
Echocardiogram (Heart Ultrasound)
|
$3,175.91 |
$3,175.91 |
$3,175.91 |
$2,001.17
|
|
Egfr gene com variants
|
$1,708.36 |
$1,708.36 |
$1,708.36 |
$657.00
|
|
Electrolyte panel
|
$1,554.48 |
$1,554.48 |
$1,554.48 |
$84.24
|
|
Eptifibatide 0.75 mg/ml intravenous solution
|
$1,150.20 |
$1,150.20 |
$1,150.20 |
$393.98
|
|
Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr
|
$1,763.06 |
$1,763.06 |
$1,763.06 |
$222.98
|
|
Estradiol total
|
$1,518.75 |
$1,518.75 |
$1,518.75 |
$146.50
|
|
Estrogens total-sendout
|
$606.94 |
$606.94 |
$606.94 |
$96.20
|
|
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen
|
$1,018.92 |
$1,018.92 |
$1,018.92 |
$219.60
|
|
Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr
|
$80.90 |
$80.90 |
$80.90 |
$22.20
|
|
Fat/lipids feces qualitative
|
$541.04 |
$541.04 |
$541.04 |
$38.35
|
|
Ferritin
|
$1,175.45 |
$1,175.45 |
$1,175.45 |
$100.94
|
|
#_fet/norfentcnfrmur
|
$254.00 |
$254.00 |
$254.00 |
$95.68
|
|
Fibrin degradation d dimer quantitative
|
$1,510.00 |
$1,510.00 |
$1,510.00 |
$117.70
|
|
Finasteride, 5 mg
|
$82.84 |
$82.84 |
$82.84 |
$7.71
|
|
Flow cytometry marker each additional
|
$272.62 |
$272.62 |
$272.62 |
$97.50
|
|
Flow cytometry one marker technical component
|
$272.62 |
$272.62 |
$272.62 |
$284.40
|
|
Folic acid
|
$747.03 |
$747.03 |
$747.03 |
$101.50
|
|
Folic acid 5 mg/ml injection solution
|
$47.00 |
$47.00 |
$47.00 |
$54.75
|
|
Fomepizole 1 gram/ml intravenous solution
|
$20,731.87 |
$20,731.87 |
$20,731.87 |
$2,581.14
|
|
Fondaparinux sodium
|
$1,335.51 |
$1,335.51 |
$1,335.51 |
$185.12
|
|
Formoterol fumarate, inh
|
$204.85 |
$204.85 |
$204.85 |
$59.40
|
|
Fosphenytoin 50 mg pe/ml injection (wrapper)
|
$351.93 |
$351.93 |
$351.93 |
$106.10
|
|
Fructosamine glycated protein
|
$504.67 |
$504.67 |
$504.67 |
$60.75
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$1,873.64 |
$1,873.64 |
$1,873.64 |
$250.83
|
|
Gammaglobulin ige
|
$2,004.90 |
$2,004.90 |
$2,004.90 |
$83.85
|
|
Gamma glutamyltransferase
|
$1,062.88 |
$1,062.88 |
$1,062.88 |
$57.54
|
|
Ghs histoplasma antigen
|
$2,257.58 |
$2,257.58 |
$2,257.58 |
$141.00
|
|
Ghs sedimentation rate
|
$606.94 |
$606.94 |
$606.94 |
$45.50
|
|
Ghs sensitivity (per antimicro)
|
$40.71 |
$40.71 |
$40.71 |
$57.60
|
|
Ghs urine, porphyrins quant
|
$450.00 |
$450.00 |
$450.00 |
$75.00
|
|
Gi inhouse confirmation
|
$1,117.83 |
$1,117.83 |
$1,117.83 |
$83.70
|
|
Glucagon 1 mg solution for injection
|
$1,425.70 |
$1,425.70 |
$1,425.70 |
$601.79
|
|
Glucose 1 hr post dose
|
$678.35 |
$678.35 |
$678.35 |
$47.20
|
|
Glucose blood quantitative
|
$694.80 |
$694.80 |
$694.80 |
$40.00
|
