|
CT Scan of Abdomen and Pelvis (without contrast)
|
$10,162.00 |
$10,162.00 |
$10,162.00 |
$2,284.15
|
|
CT thoracic spine w/contrast
|
$7,559.00 |
$7,559.00 |
$7,559.00 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$6,856.00 |
$6,856.00 |
$6,856.00 |
$1,443.00
|
|
CT thorax low dose for lung screening without contrast
|
$545.00 |
$545.00 |
$545.00 |
$400.20
|
|
Culture afb any source
|
$545.00 |
$545.00 |
$545.00 |
$110.50
|
|
Culture anaerobic additional method definitive id each
|
$435.00 |
$435.00 |
$435.00 |
$77.31
|
|
Culture anaerobic except blood
|
$507.00 |
$507.00 |
$507.00 |
$123.20
|
|
Culture fungi definitive id mold
|
$118.00 |
$118.00 |
$118.00 |
$70.00
|
|
Culture fungi definitive id yeast
|
$545.00 |
$545.00 |
$545.00 |
$80.60
|
|
Culture fungi skin/hair/nail
|
$356.00 |
$356.00 |
$356.00 |
$77.40
|
|
Culture mycobacteria definitive id each isolate
|
$37.00 |
$37.00 |
$37.00 |
$84.75
|
|
Culture mycoplasma any source
|
$699.00 |
$699.00 |
$699.00 |
$90.37
|
|
Culture quantitative aerobic other source
|
$129.00 |
$129.00 |
$129.00 |
$87.02
|
|
Culture typing added method
|
$20.00 |
$20.00 |
$20.00 |
$34.45
|
|
Culture typing immunologic
|
$105.00 |
$105.00 |
$105.00 |
$41.60
|
|
Culture urine each isolate
|
$75.00 |
$75.00 |
$75.00 |
$46.20
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$82.00 |
$82.00 |
$82.00 |
$28.00
|
|
Cyclic citrullinated peptide antibody
|
$1,022.00 |
$1,022.00 |
$1,022.00 |
$80.05
|
|
Cyclosporine 2 hour
|
$437.00 |
$437.00 |
$437.00 |
$121.80
|
|
Cystogram >= 3 views supervision & interpretation
|
$1,703.00 |
$1,703.00 |
$1,703.00 |
$539.55
|
|
Cytogenetics 25-99
|
$180.00 |
$180.00 |
$180.00 |
$180.32
|
|
Cytomegalovirus (cmv) antibody igg
|
$275.00 |
$275.00 |
$275.00 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$513.00 |
$513.00 |
$513.00 |
$96.80
|
|
Cytopathology cellular enhancement technique non-gyn
|
$137.00 |
$137.00 |
$137.00 |
$163.43
|
|
Cytopathology concentration technique smears & interpretation
|
$68.00 |
$68.00 |
$68.00 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$54.00 |
$54.00 |
$54.00 |
$124.80
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$33.00 |
$33.00 |
$33.00 |
$73.45
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$94.00 |
$94.00 |
$94.00 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$105.00 |
$105.00 |
$105.00 |
$205.00
|
|
Cytopath smear oth prep screen & interp
|
$149.00 |
$149.00 |
$149.00 |
$95.89
|
|
Dch validity tests
|
$181.00 |
$181.00 |
$181.00 |
$25.20
|
|
Decalcification
|
$33.00 |
$33.00 |
$33.00 |
$73.60
|
|
Desmopressin 4 mcg/ml injection solution
|
$752.00 |
$752.00 |
$752.00 |
$116.22
|
|
Detect agnt mult dna direc
|
$730.00 |
$730.00 |
$730.00 |
$109.60
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$47.00 |
$47.00 |
$47.00 |
$43.65
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$33.00 |
$33.00 |
$33.00 |
$61.49
|
|
Dextrose 5 % IV bolus
|
$54.00 |
$54.00 |
$54.00 |
$48.58
|
|
Dhea-s (dehydroepiand sulfate)
|
$483.00 |
$483.00 |
$483.00 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$290.00 |
$290.00 |
$290.00 |
$78.03
|
|
Diagnostic Mammogram (both breasts)
|
$1,043.00 |
$1,043.00 |
$1,043.00 |
$424.00
|
|
Diatrizoate meglumine 18 % urethral solution
|
$387.00 |
$387.00 |
$387.00 |
$122.25
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$357.00 |
$357.00 |
$357.00 |
$78.40
|
|
Digoxin immune fab 40 mg intravenous solution
|
$16,992.00 |
$16,992.00 |
$16,992.00 |
$10,388.97
|
|
Digoxin total therapeutic drug level
|
$477.00 |
$477.00 |
$477.00 |
$102.00
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$504.00 |
$504.00 |
$504.00 |
$309.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$92.00 |
$92.00 |
$92.00 |
$24.70
|
|
Dna antibody native/double stranded
|
$261.00 |
$261.00 |
$261.00 |
$102.60
|
|
Dna probe chlamydia
|
$358.00 |
$358.00 |
$358.00 |
$82.20
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$2,082.00 |
$2,082.00 |
$2,082.00 |
$101.04
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$923.00 |
$923.00 |
$923.00 |
$76.20
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$360.00 |
$360.00 |
$360.00 |
$88.05
|
|
Droperidol 2.5 mg/ml injection solution
|
$183.00 |
$183.00 |
$183.00 |
$34.85
|
|
Drug assay vedolizumab
|
$97.00 |
$97.00 |
$97.00 |
$164.16
|
|
Drug of abuse screen urine
|
$931.00 |
$931.00 |
$931.00 |
$63.75
|
|
Drug test def 1-7 classes
|
$1,009.00 |
$1,009.00 |
$1,009.00 |
$268.00
|
|
Drug test def 22+ classes
|
$903.00 |
$903.00 |
$903.00 |
$340.70
|
|
Drug test prsmv instrmnt
|
$931.00 |
$931.00 |
$931.00 |
$83.20
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$931.00 |
$931.00 |
$931.00 |
$278.85
|
|
E equine encephalitis igg
|
$414.00 |
$414.00 |
$414.00 |
$48.73
|
|
Egfr gene com variants
|
$1,698.00 |
$1,698.00 |
$1,698.00 |
$619.04
|
|
Ehrlicha chaffeensis amp prb
|
$829.00 |
$829.00 |
$829.00 |
$105.00
|
|
Electrolyte panel
|
$545.00 |
$545.00 |
$545.00 |
$86.33
|
|
Encephalitis, california igg/igm
|
$414.00 |
$414.00 |
$414.00 |
$46.75
|
|
Encephalitis, st louis igg/igm
|
$414.00 |
$414.00 |
$414.00 |
$48.03
|
|
Encephalitis, western equine igg/igm
|
$414.00 |
$414.00 |
$414.00 |
$50.70
|
|
Epstein barr early antigen antibody
|
$248.00 |
$248.00 |
$248.00 |
$72.08
|
|
Epstein barr nuclear antigen antibody
|
$300.00 |
$300.00 |
$300.00 |
$81.81
|
|
Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr
|
$687.00 |
$687.00 |
$687.00 |
$265.40
|
|
Estradiol total
|
$592.00 |
$592.00 |
$592.00 |
$153.00
|
|
Estrogens total-sendout
|
$478.00 |
$478.00 |
$478.00 |
$89.25
|
|
Ethylene glycol -sendout
|
$404.00 |
$404.00 |
$404.00 |
$75.00
|
|
Evaluation of speech fluency 92521
|
$354.00 |
$354.00 |
$354.00 |
$347.75
|
|
External chromosome analysis 20-25 cells
|
$1,348.00 |
$1,348.00 |
$1,348.00 |
$389.35
|
|
External pretreatment of serum for use in antibody identification by dilution
|
$56.00 |
$56.00 |
$56.00 |
$61.32
|
|
External tissue culture neoplastic disorders bone marrow/blood cells
|
$1,231.00 |
$1,231.00 |
$1,231.00 |
$458.73
|
|
Facial bones <3
|
$843.00 |
$843.00 |
$843.00 |
$248.60
|
|
Factor ix
|
$1,044.00 |
$1,044.00 |
$1,044.00 |
$131.30
|
|
Factor viii
|
$1,868.00 |
$1,868.00 |
$1,868.00 |
$144.30
|
|
Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr
|
$63.00 |
$63.00 |
$63.00 |
$24.21
|
|
Fat/lipids feces qualitative
|
$275.00 |
$275.00 |
$275.00 |
$34.56
|
|
Felbamate (felbatol(r)) - sendout
|
$261.00 |
$261.00 |
$261.00 |
$66.43
|
|
Ferritin
|
$404.00 |
$404.00 |
$404.00 |
$103.68
|
|
Fetal hemoglobin (kleihauer betke)
|
$407.00 |
$407.00 |
$407.00 |
$88.80
|
|
Fetal hemoglobin rosette
|
$370.00 |
$370.00 |
$370.00 |
$76.70
|
|
Fibrin degradation d dimer quantitative
|
$1,157.00 |
$1,157.00 |
$1,157.00 |
$112.80
|
|
Fibrin degradation products
|
$816.00 |
$816.00 |
$816.00 |
$62.40
|
|
Fibrin degrade semiquant
|
$888.00 |
$888.00 |
$888.00 |
$92.00
|
|
Fibrinogen activity
|
$352.00 |
$352.00 |
$352.00 |
$82.38
|
|
Fibrinolytic plasminogen xcpt antgnc asa
|
$208.00 |
$208.00 |
$208.00 |
$59.89
|
|
Flecainide (tambocor)-sendout
|
$477.00 |
$477.00 |
$477.00 |
$66.43
|
|
Flow cytometry one marker technical component
|
$372.00 |
$372.00 |
$372.00 |
$270.75
|
|
Flt3 gene
|
$522.00 |
$522.00 |
$522.00 |
$352.95
|
|
Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback
|
$3,619.00 |
$3,619.00 |
$3,619.00 |
$74.00
|
|
Fluoroguide for spine inject 77003-26
|
$2,116.00 |
$2,116.00 |
$2,116.00 |
$507.00
|
|
Fluphenazine decanoate 25 mg/ml injection solution
|
$243.00 |
$243.00 |
$243.00 |
$79.52
|
|
Folic acid
|
$435.00 |
$435.00 |
$435.00 |
$90.60
|
|
Folic acid 5 mg/ml injection solution
|
$33.00 |
$33.00 |
$33.00 |
$56.70
|
|
Formoterol fumarate, inh
|
$109.00 |
$109.00 |
$109.00 |
$59.40
|
|
Fructosamine glycated protein
|
$276.00 |
$276.00 |
$276.00 |
$60.42
|
|
Ga-67 gallium 0.1 mci
|
$268.00 |
$268.00 |
$268.00 |
$163.80
|
