|
3d recon without postprocess indpndt
|
$1,809.69 |
$1,809.69 |
$1,809.69 |
$425.10
|
|
88334 ap bill cytologic exam each additional site
|
$150.03 |
$150.03 |
$150.03 |
$97.65
|
|
Abdominal CT scan (with and without contrast)
|
$6,083.80 |
$6,083.80 |
$6,083.80 |
$2,009.80
|
|
Abdominal CT scan (with contrast)
|
$4,721.21 |
$4,721.21 |
$4,721.21 |
$1,683.63
|
|
Abdominal CT scan (without contrast)
|
$3,995.02 |
$3,995.02 |
$3,995.02 |
$1,358.76
|
|
Abdominal MRI (with and without contrast)
|
$11,123.29 |
$11,123.29 |
$11,123.29 |
$2,933.60
|
|
Abdominal MRI (with contrast)
|
$11,123.29 |
$11,123.29 |
$11,123.29 |
$2,200.55
|
|
Abdominal MRI (without contrast)
|
$10,152.15 |
$10,152.15 |
$10,152.15 |
$1,975.74
|
|
Abdominal Ultrasound (complete)
|
$3,089.02 |
$3,089.02 |
$3,089.02 |
$785.25
|
|
Acetaminophen level
|
$416.70 |
$416.70 |
$416.70 |
$117.01
|
|
Acetazolamide 500 mg solution for injection
|
$456.75 |
$456.75 |
$456.75 |
$120.90
|
|
Acetone qualitative
|
$826.09 |
$826.09 |
$826.09 |
$48.00
|
|
Acetylcholine receptor modulating antibody
|
$262.63 |
$262.63 |
$262.63 |
$64.50
|
|
Acetylcysteine 200 mg/ml (20 %) intravenous solution
|
$4,657.52 |
$4,657.52 |
$4,657.52 |
$306.72
|
|
Acute hepatitis panel
|
$745.65 |
$745.65 |
$745.65 |
$284.70
|
|
#afb mycobacteria suscep. #1
|
$93.54 |
$93.54 |
$93.54 |
$38.58
|
|
Albumin body fluid quantitative each specimen
|
$93.54 |
$93.54 |
$93.54 |
$48.00
|
|
Albumin (microalbumin) 24 hour urine quantitative
|
$775.96 |
$775.96 |
$775.96 |
$58.00
|
|
Albumin serum plasma or whole blood
|
$464.31 |
$464.31 |
$464.31 |
$43.45
|
|
Albuterol ipratrop non-comp
|
$22.45 |
$22.45 |
$22.45 |
$7.43
|
|
Albuterol non-comp con
|
$9.18 |
$9.18 |
$9.18 |
$9.25
|
|
Alcohol (ethanol) any specimen except urine/breath
|
$876.60 |
$876.60 |
$876.60 |
$94.90
|
|
Alkaline phosphatase
|
$603.09 |
$603.09 |
$603.09 |
$46.50
|
|
Allergen egg white ige
|
$202.78 |
$202.78 |
$202.78 |
$39.78
|
|
Alpha-fetoprotein tumor marker
|
$1,063.67 |
$1,063.67 |
$1,063.67 |
$103.60
|
|
Alt/sgpt
|
$233.46 |
$233.46 |
$233.46 |
$49.00
|
|
Amifostine
|
$3,504.55 |
$3,504.55 |
$3,504.55 |
$2,507.10
|
|
Amikacin 4 mg/ml intravitreal injection - cnr
|
$99.20 |
$99.20 |
$99.20 |
$44.00
|
|
Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr
|
$109.37 |
$109.37 |
$109.37 |
$39.15
|
|
Aminophylline 25 mg/ml intravenous solution (wrapper)
|
$109.74 |
$109.74 |
$109.74 |
$48.29
|
|
Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV
|
$339.93 |
$339.93 |
$339.93 |
$152.84
|
|
Ammonia
|
$625.55 |
$625.55 |
$625.55 |
$123.48
|
|
Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr
|
$368.29 |
$368.29 |
$368.29 |
$130.08
|
|
Analysis gene f5 leiden variant
|
$1,070.41 |
$1,070.41 |
$1,070.41 |
$226.60
|
|
Anaplsma phgcytophlm amp prb
|
$1,160.56 |
$1,160.56 |
$1,160.56 |
$95.45
|
|
Antibody elution rbc reference
|
$377.14 |
$377.14 |
$377.14 |
$179.62
|
|
Antibody identification platelet antibodies heparin-pf4 igg
|
$1,807.07 |
$1,807.07 |
$1,807.07 |
$218.30
|
|
Antibody id rbc panel
|
$1,406.88 |
$1,406.88 |
$1,406.88 |
$291.75
|
|
Antibody screen rbc
|
$392.09 |
$392.09 |
$392.09 |
$105.00
|
|
Antinuclear antibodies
|
$211.76 |
$211.76 |
$211.76 |
$91.70
|
|
Antistreptolysin o titer
|
$510.70 |
$510.70 |
$510.70 |
$57.85
|
|
Artery xray each vessel 7577426
|
$9,962.46 |
$9,962.46 |
$9,962.46 |
$1,865.50
|
|
Artery xray of abdomen 75726-26
|
$9,962.46 |
$9,962.46 |
$9,962.46 |
$4,658.99
|
|
Artery x-rays lungs
|
$9,962.46 |
$9,962.46 |
$9,962.46 |
$3,724.63
|
|
Artery xrays of pelvis 75736 26
|
$9,962.41 |
$9,962.41 |
$9,962.41 |
$4,551.20
|
|
Assay of salicylate
|
$416.70 |
$416.70 |
$416.70 |
$104.00
|
|
Ast/sgot
|
$497.97 |
$497.97 |
$497.97 |
$46.20
|
|
Autoimmune rheumatoid arthr anl 12 mrk ia
|
$1,635.12 |
$1,635.12 |
$1,635.12 |
$924.72
|
|
Bendamustine 100 mg intravenous powder for solution
|
$4,368.35 |
$4,368.35 |
$4,368.35 |
$5,305.05
|
|
Benztropine 1 mg/ml injection solution
|
$905.71 |
$905.71 |
$905.71 |
$118.00
|
|
Betamethasone acetate and sodium phos 6 mg/ml suspension for injection
|
$125.97 |
$125.97 |
$125.97 |
$70.37
|
|
Bevacizumab 25 mg/ml intravenous solution
|
$6,759.96 |
$6,759.96 |
$6,759.96 |
$4,773.00
|
|
Bilicheck
|
$174.45 |
$174.45 |
$174.45 |
$22.75
|
|
Bilirubin direct
|
$245.43 |
$245.43 |
$245.43 |
$49.31
|
|
Bilirubin total
|
$245.43 |
$245.43 |
$245.43 |
$51.50
|
|
Bivalirudin
|
$9,061.47 |
$9,061.47 |
$9,061.47 |
$1,310.40
|
|
Bleomycin 15 unit solution for injection
|
$3,005.53 |
$3,005.53 |
$3,005.53 |
$250.00
|
|
Blood Clotting (PT/INR) Test
|
$359.16 |
$359.16 |
$359.16 |
$52.46
|
|
Blood Clotting (PTT) Test
|
$359.16 |
$359.16 |
$359.16 |
$73.15
|
|
Blood Count (CBC) Test (without differential)
|
$304.55 |
$304.55 |
$304.55 |
$62.15
|
|
Blood Culture Test
|
$771.10 |
$771.10 |
$771.10 |
$145.60
|
|
Blood draw capillary 36416
|
$95.41 |
$95.41 |
$95.41 |
$22.40
|
|
Blood occult feces 1-3 determinations other than neoplasm screening qualitative
|
$84.24 |
$84.24 |
$84.24 |
$33.57
|
|
Blood occult feces colorectal neoplasm screening qualitative
|
$195.69 |
$195.69 |
$195.69 |
$33.57
|
|
Blood occult peroxidase activity qualitative gastric
|
$545.49 |
$545.49 |
$545.49 |
$33.85
|
|
Blood typing abo
|
$165.36 |
$165.36 |
$165.36 |
$83.03
|
|
Blood typing ag donor ea ag
|
$40.41 |
$40.41 |
$40.41 |
$166.80
|
|
Blood typing rbc ag non abo/rh ea
|
$202.78 |
$202.78 |
$202.78 |
$181.74
|
|
Blood typing rh (d)
|
$203.54 |
$203.54 |
$203.54 |
$57.10
|
|
Bone Density Scan (DEXA)
|
$1,588.20 |
$1,588.20 |
$1,588.20 |
$395.00
|
|
Bone marrow interpretation
|
$178.08 |
$178.08 |
$178.08 |
$436.00
|
|
Bone survey-lead poisoning
|
$1,362.23 |
$1,362.23 |
$1,362.23 |
$370.18
|
|
Bone tendon board add on
|
$621.00 |
$621.00 |
$621.00 |
$5,689.43
|
|
Borrelia burgdorferi (lyme disease) antibody nonspecific
|
$923.00 |
$923.00 |
$923.00 |
$96.72
|
|
Bortezomib 3.5 mg (2.5 mg/ml) solution for subcutaneous injection
|
$15,963.77 |
$15,963.77 |
$15,963.77 |
$2,880.64
|
|
Braf gene
|
$731.16 |
$731.16 |
$731.16 |
$421.00
|
|
Brain image w/flow 4 + views
|
$1,457.97 |
$1,457.97 |
$1,457.97 |
$1,365.72
|
|
Brain MRA (blood vessel MRI, with and without contrast)
|
$9,927.14 |
$9,927.14 |
$9,927.14 |
$2,623.74
|
|
Brain MRA (blood vessel MRI, without contrast)
|
$5,786.65 |
$5,786.65 |
$5,786.65 |
$1,806.75
|
|
Brain MRI (with and without contrast)
|
$11,569.87 |
$11,569.87 |
$11,569.87 |
$2,854.80
|
|
Brain MRI (with contrast)
|
$7,306.38 |
$7,306.38 |
$7,306.38 |
$2,267.23
|
|
Brain MRI (without contrast)
|
$7,306.38 |
$7,306.38 |
$7,306.38 |
$1,949.38
|
|
Bundled special stain group 1 microorganisms
|
$482.27 |
$482.27 |
$482.27 |
$165.10
|
|
Bundled special stain group 2
|
$688.78 |
$688.78 |
$688.78 |
$169.00
|
|
Buprenorphine 2 mg-naloxone 0.5 mg sublingual tablet
|
$17.05 |
$17.05 |
$17.05 |
$9.56
|
|
Buprenorphine 8 mg-naloxone 2 mg sublingual tablet
|
$45.96 |
$45.96 |
$45.96 |
$14.01
|
|
Calcitonin (salmon) 200 unit/ml injection solution
|
$12,689.28 |
$12,689.28 |
$12,689.28 |
$2,802.31
|
|
Calcium acetate(phosphate binders) 667 mg tablet
|
$11.12 |
$11.12 |
$11.12 |
$1.03
|
|
Calcium chloride 100 mg/ml (10 %) intravenous syringe
|
$59.32 |
$59.32 |
$59.32 |
$55.47
|
|
Calcium gluconate 2 gram/100 ml in sodium chloride,iso-osm IV solution
|
$125.03 |
$125.03 |
$125.03 |
$92.91
|
|
Calcium ionized
|
$582.91 |
$582.91 |
$582.91 |
$88.40
|
|
Calcium total
|
$477.39 |
$477.39 |
$477.39 |
$48.75
|
|
Calprotectin fecal
|
$216.25 |
$216.25 |
$216.25 |
$169.20
|
|
Carbamazepine total therapeutic drug level
|
$612.22 |
$612.22 |
$612.22 |
$117.74
|
|
Carboprost tromethamine 250 mcg/ml intramuscular solution
|
$706.81 |
$706.81 |
$706.81 |
$455.00
|
|
Carboxyhemoglobin quantitative
|
$491.98 |
$491.98 |
$491.98 |
$84.73
|
|
Carcinoembryonic ag (cea)
|
$685.03 |
$685.03 |
$685.03 |
$146.25
|
|
Cardiac perf spect sgl/ef/wm rst/strs
|
$5,160.18 |
$5,160.18 |
$5,160.18 |
$2,752.20
|
|
Cardioversion elective electrical conversion arrhythmia external
|
$2,756.46 |
$2,756.46 |
$2,756.46 |
$1,519.00
|
|
Carotid Artery Ultrasound (Duplex)
|
$2,151.84 |
$2,151.84 |
$2,151.84 |
$1,068.06
|
