|
Decalcification
|
$327.37 |
$327.37 |
$327.37 |
$73.60
|
|
Deferoxamine 500 mg solution for injection
|
$251.36 |
$251.36 |
$251.36 |
$96.41
|
|
Desmopressin 4 mcg/ml injection solution
|
$523.47 |
$523.47 |
$523.47 |
$116.22
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$319.58 |
$319.58 |
$319.58 |
$61.49
|
|
Dextrose 5 % IV bolus
|
$319.58 |
$319.58 |
$319.58 |
$48.58
|
|
Dhea-s (dehydroepiand sulfate)
|
$351.68 |
$351.68 |
$351.68 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$577.08 |
$577.08 |
$577.08 |
$78.03
|
|
Diagnostic Mammogram (both breasts)
|
$1,292.85 |
$1,292.85 |
$1,292.85 |
$424.00
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$213.55 |
$213.55 |
$213.55 |
$73.22
|
|
Dicyclomine injection
|
$541.64 |
$541.64 |
$541.64 |
$202.91
|
|
Digoxin immune fab 40 mg intravenous solution
|
$4,885.90 |
$4,885.90 |
$4,885.90 |
$10,388.97
|
|
Digoxin total therapeutic drug level
|
$402.95 |
$402.95 |
$402.95 |
$102.00
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$1,017.28 |
$1,017.28 |
$1,017.28 |
$309.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$156.07 |
$156.07 |
$156.07 |
$24.70
|
|
Dna antibody native/double stranded
|
$551.86 |
$551.86 |
$551.86 |
$102.60
|
|
Doppler echo complete
|
$1,804.33 |
$1,804.33 |
$1,804.33 |
$608.25
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$1,091.04 |
$1,091.04 |
$1,091.04 |
$696.80
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$1,028.17 |
$1,028.17 |
$1,028.17 |
$482.03
|
|
Dornase alfa non-comp unit
|
$557.95 |
$557.95 |
$557.95 |
$350.67
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$214.78 |
$214.78 |
$214.78 |
$88.05
|
|
Droperidol 2.5 mg/ml injection solution
|
$126.41 |
$126.41 |
$126.41 |
$34.85
|
|
Drug test def 1-7 classes
|
$1,626.36 |
$1,626.36 |
$1,626.36 |
$268.00
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$1,626.36 |
$1,626.36 |
$1,626.36 |
$278.85
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$2,782.54 |
$2,782.54 |
$2,782.54 |
$903.00
|
|
Ecg 12 lead tracing only
|
$704.92 |
$704.92 |
$704.92 |
$245.00
|
|
Echocardiogram (Heart Ultrasound)
|
$7,143.14 |
$7,143.14 |
$7,143.14 |
$2,049.45
|
|
Echocardiography doppler color flow mapping
|
$1,599.37 |
$1,599.37 |
$1,599.37 |
$469.95
|
|
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler
|
$7,143.14 |
$7,143.14 |
$7,143.14 |
$2,070.12
|
|
Echocardiography transthoracic 2d followup/limited
|
$1,145.35 |
$1,145.35 |
$1,145.35 |
$724.20
|
|
Echocardiograpy doppler follow up/limited study
|
$783.15 |
$783.15 |
$783.15 |
$353.46
|
|
Echo exam uterus 76831-
|
$2,438.27 |
$2,438.27 |
$2,438.27 |
$547.20
|
|
Echo tee probe placement image acquisition interpretation & report
|
$6,568.62 |
$6,568.62 |
$6,568.62 |
$1,871.10
|
|
Echo transthoracic
|
$4,763.19 |
$4,763.19 |
$4,763.19 |
$1,492.50
|
|
Echo transthoracic
|
$773.44 |
$773.44 |
$773.44 |
$953.10
|
|
Eeg recording awake and asleep
|
$2,543.45 |
$2,543.45 |
$2,543.45 |
$1,030.27
|
|
Egfr gene com variants
|
$1,774.90 |
$1,774.90 |
$1,774.90 |
$619.04
|
|
Electrolyte panel
|
$761.37 |
$761.37 |
$761.37 |
$86.33
|
|
Electrophysiology evaluation
|
$3,061.10 |
$3,061.10 |
$3,061.10 |
$2,845.10
|
|
Epinephrine 1 mg/ml im kit - adult
|
$61.17 |
$61.17 |
$61.17 |
$50.40
|
|
Epoetin alfa-epbx 40,000 unit/ml injection solution
|
$4,256.01 |
$4,256.01 |
$4,256.01 |
$874.20
|
|
Epstein barr early antigen antibody
|
$210.25 |
$210.25 |
$210.25 |
$72.08
|
|
Epstein barr nuclear antigen antibody
|
$244.68 |
$244.68 |
$244.68 |
$81.81
|
|
Ercp biliary & pancreas
|
$1,683.98 |
$1,683.98 |
$1,683.98 |
$943.50
|
|
Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr
|
$1,052.15 |
$1,052.15 |
$1,052.15 |
$265.40
|
|
Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr
|
$527.55 |
$527.55 |
$527.55 |
$248.39
|
|
Estradiol total
|
$1,074.15 |
$1,074.15 |
$1,074.15 |
$153.00
|
|
Ethylene glycol -sendout
|
$237.20 |
$237.20 |
$237.20 |
$75.00
|
|
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen
|
$689.54 |
$689.54 |
$689.54 |
$219.60
|
|
Evaluation heart device
|
$2,831.18 |
$2,831.18 |
$2,831.18 |
$2,368.17
|
|
External chromosome analysis 20-25 cells
|
$1,170.00 |
$1,170.00 |
$1,170.00 |
$389.35
|
|
External tissue culture neoplastic disorders bone marrow/blood cells
|
$2,070.00 |
$2,070.00 |
$2,070.00 |
$458.73
|
|
Facial bones <3
|
$792.81 |
$792.81 |
$792.81 |
$248.60
|
|
Factor viii
|
$676.06 |
$676.06 |
$676.06 |
$144.30
|
|
Ferritin
|
$210.25 |
$210.25 |
$210.25 |
$103.68
|
|
Fetal biophys profile w/nst 76818
|
$1,797.96 |
$1,797.96 |
$1,797.96 |
$541.74
|
|
Fetal fibronectin
|
$1,929.04 |
$1,929.04 |
$1,929.04 |
$352.95
|
|
Fetal hemoglobin (kleihauer betke)
|
$558.21 |
$558.21 |
$558.21 |
$88.80
|
|
Fetal hemoglobin rosette
|
$610.61 |
$610.61 |
$610.61 |
$76.70
|
|
Fetal non stress test
|
$1,740.63 |
$1,740.63 |
$1,740.63 |
$507.90
|
|
Fibrin degradation d dimer quantitative
|
$815.25 |
$815.25 |
$815.25 |
$112.80
|
|
Fibrin degradation products
|
$597.88 |
$597.88 |
$597.88 |
$62.40
|
|
Fibrinogen activity
|
$615.83 |
$615.83 |
$615.83 |
$82.38
|
|
Finasteride, 5 mg
|
$47.09 |
$47.09 |
$47.09 |
$4.87
|
|
Flow cytometry marker each additional
|
$264.14 |
$264.14 |
$264.14 |
$103.00
|
|
Flow cytometry one marker technical component
|
$1,779.36 |
$1,779.36 |
$1,779.36 |
$270.75
|
|
Fluorouracil 50 mg/ml intravenous solution (wrapper)
|
$87.49 |
$87.49 |
$87.49 |
$136.92
|
|
Fluphenazine decanoate 25 mg/ml injection solution
|
$295.46 |
$295.46 |
$295.46 |
$79.52
|
|
Folic acid
|
$704.86 |
$704.86 |
$704.86 |
$90.60
|
|
Folic acid 5 mg/ml injection solution
|
$8.96 |
$8.96 |
$8.96 |
$56.70
|
|
Fomepizole 1 gram/ml intravenous solution
|
$44.86 |
$44.86 |
$44.86 |
$2,581.14
|
|
Formoterol fumarate, inh
|
$63.75 |
$63.75 |
$63.75 |
$53.00
|
|
Fresh frozen plasma thawing ea un
|
$211.58 |
$211.58 |
$211.58 |
$123.90
|
|
Frozen blood thaw
|
$54.37 |
$54.37 |
$54.37 |
$189.84
|
|
Fructosamine glycated protein
|
$237.20 |
$237.20 |
$237.20 |
$60.42
|
|
Ga-67 gallium 0.1 mci
|
$346.73 |
$346.73 |
$346.73 |
$163.80
|
|
Gammaglobulin ige
|
$603.09 |
$603.09 |
$603.09 |
$85.00
|
|
Gamma glutamyltransferase
|
$237.95 |
$237.95 |
$237.95 |
$55.28
|
|
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr
|
$969.11 |
$969.11 |
$969.11 |
$197.40
|
|
Gemcitabine 1 gram intravenous solution
|
$847.51 |
$847.51 |
$847.51 |
$269.06
|
|
Ghs chlamydia pneumoniae by pcr (arup) (306630)
|
$917.76 |
$917.76 |
$917.76 |
$134.55
|
|
Ghs community re-entry 15 minutes
|
$227.02 |
$227.02 |
$227.02 |
$89.28
|
|
Ghs ot group caregiver training
|
$24.19 |
$24.19 |
$24.19 |
$43.20
|
|
Ghs phenylketonurid
|
$183.93 |
$183.93 |
$183.93 |
$51.58
|
|
Ghs respiratory syncytical virus igg/m
|
$563.44 |
$563.44 |
$563.44 |
$42.40
|
|
Ghs sedimentation rate
|
$411.92 |
$411.92 |
$411.92 |
$45.50
|
|
Gi inhouse confirmation
|
$927.48 |
$927.48 |
$927.48 |
$87.00
|
|
Glucagon 1 mg solution for injection
|
$1,859.23 |
$1,859.23 |
$1,859.23 |
$655.20
|
|
Glucose blood quantitative
|
$545.49 |
$545.49 |
$545.49 |
$44.76
|
|
Glucose tolerance test (gtt) 3 specimens
|
$590.77 |
$590.77 |
$590.77 |
$100.10
|
|
Glucose tolerance test (gtt) >3 specimens each additional
|
$590.77 |
$590.77 |
$590.77 |
$34.45
|
|
Gonadotropin follicle stimulating hormone (fsh)
|
$868.37 |
$868.37 |
$868.37 |
$110.04
|
|
Gonadotropin luteinizing hormone (lh)
|
$868.37 |
$868.37 |
$868.37 |
$123.75
|
|
Graft impl ult thck 6x12cm -cost per sq cm
|
$345.00 |
$345.00 |
$345.00 |
$27,279.40
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$413.75 |
$413.75 |
$413.75 |
$120.02
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$131.98 |
$131.98 |
$131.98 |
$36.04
|
|
Haptoglobin quantitative
|
$440.36 |
$440.36 |
$440.36 |
$89.95
|
|
Hcg qualitative
|
$625.55 |
$625.55 |
$625.55 |
$77.50
|
|
Hcg quantitative
|
$1,140.74 |
$1,140.74 |
$1,140.74 |
$124.80
|
|
Hc i-131 sodium iodide cap dx per mci
|
$1,438.69 |
$1,438.69 |
$1,438.69 |
$136.50
|
|
Head CT scan (with and without contrast)
|
$4,683.42 |
$4,683.42 |
$4,683.42 |
$1,878.75
|
