Price Transparency Kittson Healthcare Complete …...ED 96365 IV INFUS THER PROPH DIAG INITIAL UP TO 1HR$372.00 ED 96360 IV INFUS THERAPY HYDRATION FLUIDS INITIAL 31 MIN-1HR$500.00

Price Transparency Kittson Healthcare Complete

Ambulance

AMBULANCE SCT RES TO HOSP $2,103.50

AMBULANCE SCT HOSP TO HOSP $2,208.68

AMBULANCE SCT SCENE TO HOSP $2,103.50

GROUND AMBULANCE PER MILE $31.00

AMBULANCE ALS EMERGENCY LVL 1 $2,036.85

AMBULANCE BLS EMERGENCY $1,379.03

AMBULANCE ALS LEVEL 2 $2,051.05

AMBULANCE SCT N HOME TO HOSP $2,103.50

Anesthesia

ANESTHESIA 0-60 MN $42.62

ANESTHESIA 61-75 MN $52.53

ANESTHESIA COMPONENT $160.00

ANESTHESIA PRO FEE INITIAL 15 MIN $371.53

ANESTHESIA PRO FEE ADDL 15 MIN $151.89

Cardiac Rehab

CARD REHAB PHASE 2 WMONITOR $218.00

OP CARD REHAB WO CONT ECG MON $171.00

CARDIAC REHAB PHASE 1 $217.45

CARDIAC REHAB INITIAL VISIT $217.45

Central/Sterile Supply

NEBULIZER KIT $29.50

OXYGEN/HOUR $27.08

OXYGEN DAILY $37.15

DERMABOND $172.11

ARM IMMOBILIZER $87.42

TRAY CATHETER DISP $72.39

�1

COLLAR CERIVCAL FOAM $187.94

IOL $1,886.31

IV SETUP $47.80

OXYGEN 1ST HOUR $131.42

BRIEF ADLT WINGS HVY $20.76

BNDG ELAS PREM W CLIP 2X5YD $50.26



BNDG ELAS PREM W CLIP 6X5.5YD $50.26

BNDG COMP PROFORE MULT LAYER $29.50

DRSG HYDRCOLL DUODERM 8.5X8.75 $33.02

BOOT HEEL PREVALON W WEDGE $22.95

CAST SPLT ONE4X30*VAT 6220395* $16.39

CAST SPLT ONE STE*VAT 6220390* $17.48

CRUTCHES ADLT 5FT2IN-5FT10IN $114.30

CRUTCHES ADLT TALL 5FT10IN-6FT $142.24

TRAY EYELID REPAIR SVH N 4985* $-

TRAY LUMBAR ADLT 20GX3.5 $13.11

TRAY PARACERV CTRL SYR 10ML $86.32

TRAY BX BONE JAMSHIDI 11GX4 $77.58

TRAY IRG 50CC BULB SYR W *CIP* $37.15

PK LAPAROTOMY VI*USE 6259403* $24.04

CNTRST MAGNEVIST GAD 20ML*CIP* $385.74

SOAP HAIR BODY WASH NO RINSE $12.02

OTO HD ONLY 3.5V $128.95

CUFF BP BARE 2TB TP REUS ADLT $16.39

PLUG PERFIX MD 3.3X3.9CM 2CA $337.65

PLUG PERFIX LG 4.1X4.8CM 2CA $337.65

BINDER ABD 3PNL 9X30-45IN $16.39

BRC KNEE NEO OPEN PTLA XSM $13.11

ELTD DEFIB MULT *USE 6239546* $27.53

ELTD PAD PLUS PE*DISC 6239547* $28.41

�2

BRC ANK SWEDE-O WO STBL XL $24.04

BRC ANK SWEDE-O WO STBL MD $24.04

ELTD QK PACE*VAT 6168344* $52.45

SPNG CURITY STER 16PLYPK10 4X4 $-

SPLT CLAV MCLEOD CLSR MD $121.29

DRSG RAPIDRHINO ANT/PSTR 7.5CM $89.60

DRSG MEPILEX TRANSFER 8X8 $18.35

MOUTHPIECE DISP INTOXILYZER 20 $89.60

TRAY THORA-PARA SAFE-T+ 8FR $215.27

DRSG AQUACEL AG XTRA 8X12 $22.95

SUT ETHILON 6-0 PS4 18 $18.58

SUT ETHILON 3-0 PS1 18 $18.35

SUT PROLENE 5-0 RB1/RB1 36 $30.48

SUT PROLENE 5-0 PS3 18 $35.56

SUT VICRYL 5-0 PS4 18 UNDY $26.67

SPLT ORTHOGLS PRECUT 4X30SHT $16.39

TRAY SPINAL EPIDURAL 18GX3.5 $289.57

DRSG MEPILEX BORD AG 4X12 $34.42

DRSG MEPILEX BORD AG 4X4 $18.58

SUPP KNEE ANT CLSR HNG LG $240.03

BOOT ANKLIZERII LOW TOP F*NLU* $33.88

IMMOB KNEE B-COOL PCKT 26IN $152.40

BOOT ANKLIZER II FIXED LG*NLU* $28.41

BOOT ANKLIZERII LOW TOP FIX MD $28.41

SPLT THB SPI LFT LG/XL $133.35

SUT ETHILON 5-0 PS4 18 BLK $24.13

SPLT CAST PRE CUT 3X35IN $17.48

ELTD DEFIB HEARTSTART ADLT $26.22

ELTD DEFIB HEARTSTART INFANT $28.41

SLING ARM W FM ST*VAT 6258664* $32.89

BRC WRIST PRO 8 LFT MD $107.95

�3

Clinic Surgical Procedures

COLONOSCOPY $1,771.53

CYST EXCISION $1,753.82

CATARACT SURGERY $4,334.74

YAG LASER $1,733.67

HERNIA REPAIR $1,294.89

BLOOD ADMIN >8 HRS $1,016.24

TREATMENT RM LVL 1 W PROCEDURE $994.76


COLONOSCOPY WBX $2,019.36

COLONOSCOPY FLEXIBLE $1,757.00

EGD DIAG $1,721.48

EGD WBIOP SING MULT $1,495.94

NG TUBE PLACEMENT $541.55

COLON WREM TUMOR SNARE $2,265.23

TX RM TREATMENT ROOM $663.18

ED 99211 NURSE ONLY VISITS $87.00

OR TIME 1 MIN $29.83

EGD WADDL PROCEDURE $500.00

COLONOSCOPY WADDL PROCEDURE $500.00

TX RM LVL 1 WO PROCEDURE $631.60

CT Scans

CT HEAD WO CONTRAST $1,349.15

CT HEAD W CONTRAST $1,427.11

CT HEAD WO THEN W CONTRAST $1,739.62

CT ORBIT SELLA FOSSA EAR WO CONTRAST$1,410.71

CT MAXILLOFACIAL WO CONTRAST $1,407.85

CT MAXILOFACIAL WCONT $1,855.88

CT SOFT TISSUE NECK WO CON $1,161.57

CT THORAX W CONTRAST $1,933.84

CT THORAX WO THEN W CONTRAST $2,005.15

�4

CTA CHEST WCONT +WO IF PERF $2,483.78

CT THORACIC SPINE WO CONT $1,638.79

CT LUMBAR SPINE WO CONT $1,689.71

CT PELVIS WO CONTRAST $1,238.06

CT PELVIS W CONTRAST $1,588.83

CT PELVIS WO THEN W CONT $1,940.68

CT EXT UPPER WO CONT $1,399.65

CT EXT LOWER WO CONT $1,410.41

CT ABDOMEN WO CONTRAST $2,041.21

CT ABDOMEN W CONTRAST $2,001.04

CT ABDOMEN WO THEN W CONT $2,350.95

CT CERVICAL SPINE WO CONTRAST $1,701.53

CT SOFT TISSUE NECK W CONTRAST $1,638.00

CT SFT TISUE NECK WWO THEN W $2,047.77

CT 3D RECONSTRUCT WO IPP $140.97

PFR 70450 CT HEAD WO CONTRAST $166.10

OPTIRAY 100VDS 300-349MG MLS $337.65

CT ABD PELVIS WO CONTRAST $2,776.62

CT ABD PELVIS W CONTRAST $3,589.95

CT ABD PELVIS WO THEN W CONT $3,568.69

CTA ABD PELVIS W CONTRAST+WO IF PERFORM$2,983.15

EKG & EEG

ECG TRACING WO INTERP $196.69

HOLTER MONITOR APP $291.75

EVENT MONITOR RECORDING 30 DAY $397.84

EKG TRACING MEDICARE $196.69

EKG 12 LEAD W INTERP & REPORT $207.67

EKG 12 LEAD TRACING ONLY $334.38

EKG RHYTHM WPF $360.27

Emergency Room

�5

ED 99291 CRITICAL CARE E&M 30-74 MIN$1,835.78

ED 99284 VISIT LEVEL 4 $672.02


ED 99285 VISIT LEVEL 5 $1,082.00



ED 96375 THER PROPH DIAG INJ IV PUSH ADDL SEQ$110.00

ER O2 $150.00

ED 96366 IV INFUS THER PROPH DIAG EA ADDL HR$103.00

ED 96365 IV INFUS THER PROPH DIAG INITIAL UP TO 1HR$372.00

ED 96360 IV INFUS THERAPY HYDRATION FLUIDS INITIAL 31 MIN-1HR$500.00

ED 96372 THER PROPH DIAG INJECTION SQ IM$116.93

ED 96374 THER PROPH DIAG INJ IV PUSH INITIAL$173.00

ED 90471 IMMUNE ADMIN 1 VACCINE $58.00

ED 90472 IMMUN ADMIN EA ADDL VACCINE$32.00

ED 96367 IV INFUS THER PROPH DIAG ADDL SEQ NEW DRUG UP TO 1 HR$144.00

ED 96368 IV INFUS FOR THER PROPH DIAG CONCUR$123.00

ED 96376 THER PROPH DIAG INJ IV PUSH SAME DRUG >30MINS$106.00

ED 96523 IRRIGATE IMPLANTED VENOUS ACCESS DEVICE$148.00

ED 94640 NON OR PRES'D INHALATION TX$119.00

ED 10060 I&D SKIN ABSCESS SMPL $536.53

ED 10120 INC&REMV FB SMPL $484.08

ED 11730 REMV OF NAIL PLATE $213.09

ED 12001 RPR SUPERFCL WND 2.5CM OR<$359.51

ED 12002 RPR SUPERFCL WND 2.6-7.5CM $370.44

ED 12004 RPR SUPRFCL WND 7.6-12.5CM $371.32

ED 12005 RPR SUPRFL WND 12.6-20.0CM $634.00

ED 12011 RPR SUPERFCL WND 2.5CM OR<$371.53



ED 12015 RPR SUPERFL WND 7.6-12.5CM $646.89

ED 12031 LYR CLSR OF WND 2.5CM OR < $480.00

�6

ED 12032 LYR CLSR OF WND 2.6-7.5CM $655.64


ED 12041 LYR CLSR WND 2.5CM OR <NHF$523.42

ED 12042 LYR CLSR WND 2.6-7.5CM NHF $514.67

ED 12051 LYR CLSR OF WND 2.5CM OR < $420.70


ED 12054 LYR CLSR OF WND 7.6-12.5CM$1,350.61

ED 13101 RPR CMPLX TRUNK 2.6-7.5CM $567.13

ED 13120 RPR CMPLX WND 1.1-2.5CM $387.00

ED 13131RPR CPX WD OR LSN 1.1-2.5CM $338.75

ED 13132RPR CPX WD OR LSN 2.6-7.5CM $882.00

ED 23650 CLSD TX SHOULDER DISLOC $535.75

ED 25500 CLSD TX RAD SHAFT FX $549.64

ED 25530 CLSD TX ULNAR SHAFT FX $523.42

ED 25605 CLSD TX DISTAL RADIAL WMANIP$790.37

ED 26600 CLSD TX METACARPAL FX $569.31

ED 28450 TX TARSAL BONE WO MANIP $427.25

ED 29065 APPL CAST LONG ARM $225.11

ED 29075 APPL CAST FOREARM ARM $308.00

ED 29405 APPL CAST SHORT LEG $151.89

ED 30901 CONTROL NOSEBLEED ANT SMPL$325.63

ED 31500 INTUBATE ENDOTRACEAL $916.80

ED 36680 INSERT NEEDLE BONE CAVITY $581.00

ED 43752 NG TUBE PLACEMENT $516.00

ED 51701 INSERT BLADDER CATH $194.00

ED 51702 INSERT BLADDER CATH TEMP SMPL$301.59

ED 56420 I&D VULVA ABSCESS $372.38

ED 65205 REMV FB EYE CONJ SUPERFCL $201.57

ED 92960 CARDIOVERSION $959.00

ED 99211 EST PAT CASE LEVEL I $84.14

ED 99281 EMER CASE LEVEL I $149.70

ED 99282 EMER CASE LEVEL II $241.49

�7

ED 99283 EMER CASE LEVEL III $403.21

ED 99284 EMER CASE LEVEL IV $672.02

ED 99285 EMER CASE LEVEL V $1,009.68

ED 99211 NURSE ONLY VISITS $87.00

ED 99291 EMER LEVEL 6 $1,835.78

ED 13100 EXC LSN MAL FACE EAR 2.1-3 $567.13

ED NEBULIZER TREATMENT $150.00

ED 36430 BLOOD ADMIN 4-6 HR $1,016.24

ED 36430 BLOOD ADMIN 0-2 HR $1,016.24

ED 36430 BLOOD ADMIN 2-4 HR $1,016.24

ED 36430 BLOOD ADMIN >8 HR $1,016.24

ED 36430 BLOOD ADMIN 6-8 HR $1,016.24

ED 94644 MED NEB TX CONT FIRST HR $131.30

ED 94645 MED NEB TX CONT EA ADDL HR$131.30

IV Department

ED 96361 IV INFUS THERAPY HYDRATION FLUIDS ADDL HR$161.72

TX RM TREATMENT RM LEVEL I $631.60

TX RM TREATMENT RM LEVEL II $947.39

TX RM TREATMENT ROOM LEVEL I (1HR) $631.60

Laboratory

HCG QUANT 84702 $137.68

AFP TUMOR MRKR 82105 $172.65

CULTUR TB ACID FST BACILL87116 $163.91

CONCENTRATION (AFB) 87015 $163.91

SMEAR FLUORES ACD FST STN87206 $113.64

CBC AUTOMATED WDIFF 85025 $152.99

HEMATOCRIT 85014 $54.64

HEMOGLOBIN 85018 $48.08

DIFFERENTAIL MANUAL 85007 $37.15

PROTIME 85610 $77.58

�8

PTT 85730 $95.00

ESR AUTOMATED 85652 $40.43

WBC 85048 $61.19

ABO 86900 $88.51

ANTIBODY SCREEN 86850 $142.00

RH 86901 $63.00

DIRECT COOMBS 86880 $83.05

ALBUMIN 82040 $218.55

ALKALINE PHOSPHATE 84075 $76.49

ALT 84460 $73.21

AMYLASE 82150 $93.00

AST 84450 $72.12

TOTAL BILI 82247 $78.00

DIRECT BILI 82248 $81.96

BUN 84520 $66.65

CALCIUM 82310 $71.03

CARBON DIOXIDE 82374 $77.58

CHLORIDE 82435 $74.30

CHOLESTEROL 82465 $74.30

CPK 82550 $90.00

CREATININE 82565 $63.38

GLUCOSE 82947 $63.00

IRON 83540 $99.40

LDH 83615 $81.96

PHOSPHORUS 84100 $71.03

POTASSIUM 84132 $66.65

SODIUM 84295 $63.38

TRIGLYCERIDES 84478 $101.00

URIC ACID 84550 $71.03

DIGOXIN 80162 $147.52

MAGNESIUM 83735 $92.89

CKMB 82553 $144.00

�9

PSA 84153 $160.63

T4 84436 $61.00

TROPONIN QUANT 84484 $146.00

TSH 84443 $151.89

D DIMER QUAL OR SCREEN 85378 $166.10

MONOSCREEN 86308 $92.89

PREGNANCY TEST (URINE) 81025 $127.85

HCG QUAL 84703 $86.00

RPD GROUP A STREP SCREEN 87880 $108.18

BASIC METABOLIC PANEL 80048 $177.03

COMPREHENS METABOLC PANL 80053 $240.40

PANEL HEPATIC FUNCTION 80076 $178.12

LIPID PROFILE 80061 $156.26

RENAL FUNCTION PANEL 80069 $170.47

ELECTROLYTE PANEL 80051 $120.20

CAPILLARY COLLECTION 36416 $40.13

GRAM STAIN 87205 $88.51

OCCULT BLD SCR 82270 $78.67

URINALYSIS-DIPSTICK ONLY 81003 $52.00

URINALYSIS W MICROSCOPIC 81001 $74.00

MICROALBUMIN 82043 $99.00

VENIPUNCTURE 36415 $27.00

WET MOUNT INFECT AGENT 87210 $64.47

CULTURE ANAEROBIC 87075 $118.00

CULTURE URINE 87086 $125.66

OVA AND PARASITES 87177 $116.93

CLOSTRIDIUM DIFFICILE 87324 $168.28

SENSITIVITY STUDY MIC 87186 $107.09

VITAMIN B12 82607 $128.00

CA 125 86304 $150.00

CREATININE CLEARANCE 82575 $142.06

CA 27-29 86300 $176.00

�10

CEA 82378 $155.00

CYCLOSPORINE 80158 $27.48

PHENYTOIN 80185 $140.97

FERRITIN 82728 $131.00

FOLATE 82746 $120.00

FREE T4 84439 $106.00

H PYLORI IGG 86677 $155.00

LIPASE 83690 $96.00

TACROLIMUS 80197 $230.57

CARBAMAZEPINE (TEGRETOL) 80156 $125.66

CBC AUTOMATED NO DIFF 85027 $130.04

CROSSMATCH ANTIGLOBULIN 86922 $162.81

GLUC TOL 3 SPEC & DOSE 82951 $167.19

HDL 83718 $80.87

GLUCOSE BODY FLD 82945 $78.67

PROTEIN TOT SER 84155 $69.94

B-TYPE NATRI PEPT 83880 $346.40

GLYCOSYLATED (A1C) HGB 83036 $87.00

SPERM PRESENCE MOTILITY 89321 $117.49

CULTURE SPUTUM 87070 $138.77

CULTURE BLOOD 87040 $160.63

CULTURE VIRAL 87252 $170.47

AEROBIC DEFINITIVE ID 87077 $147.52

RBC LR PROC UNIT P9016 $608.00

IRON BINDING 83550 $99.44

PHENOBARBITOL 80184 $140.97

THEOPHYLLINE 80198 $145.33

AMMONIA 82140 $147.00

CALCIUM IONIZED 82330 $120.20

GGTP (GAMMA GT) 82977 $80.87

SODIUM URINE 84300 $59.01

C PEPTIDE 84681 $144.00

�11

ANTITHROMBIN III ACTIVITY85300 $39.34

PROTEIN C ACTIVITY 85303 $39.34

PROTEIN S ACTIVITY 85306 $39.34

FIBRINOGEN QUANT ASSAY 85384 $122.81

ANTINUCLEAR ANTIBODY SCRE86038 $127.00

C REACTIVE PROTEIN QUANT 86140 $102.71

CARDIOLIPIN ANTIBODY IGA 86147 $76.49

ANTI MITOCHONDRIAL ANTIBO86255 $137.14

RPR 86592 $95.07

MYCOPLASMA ANTIBODY TITER86738 $11.91

LEGIONELLA ANTIGEN URINE 87450 $185.66

CELL COUNT BDY FLD WDIFF89051 $93.98

HOMOCYSTEINE PLASMA 83090 $167.19

PSA SCREENING G0103 $167.19

COLD AGGLUTININ 86157 $77.45

STONE ANAL 82365 $114.73

CORTISOL TOTAL SER 82533 $151.00

FSH 83001 $139.00

LUTENIZING HORMONE 83002 $138.77

INSULIN LEVEL 83525 $140.97

LITHIUM 80178 $86.32

ACTH HIGH SENS 82024 $186.85

MUMPS IGG SCREEN 86735 $161.26

HEPATITIS B SURFACE ANTIB86706 $103.00

ELECTROPHORESIS SER 84165 $107.09

RUBELLA ANTIBODY SCRN IGG86762 $110.36

CALCIUM 24 HR UR 82340 $59.01

PLATELET COUNT 85049 $52.00

HEPATITIS PANEL ACUTE 80074 $313.61

IMMUNOFIX ELECT24HR URINE86335 $172.00

CA 19-9PANCREATIC CANCER86301 $163.00

VIT D 1 25-DIHYDROXY SER 82652 $338.38

�12

VITAMIN B6 84207 $220.73

VIT D 25-HYDR 82306 $222.79

HEP B SURF ANTIGEN HBSAG87340 $101.62

COMPLEMENT ANTIGEN EA 86160 $123.00

HEPARIN ANTI-XA ASSAY 85520 $159.00

HEPATITIS C ANTIBODY 86803 $158.44

VALPROIC ACID (DEPAKANE) 80164 $139.00

PHENYTOIN TOTAL 80185 $118.02

DILANTIN FREE (UNBOUND) $137.68

PRIMIDONE (MYSOLINE) 80188 $99.82

TOPIRAMATE (TOPAMAX) 80201 $167.00

CLOMIPRAMINE (ANAFRANIL) 83789 $40.43

LAMOTRIGINE (LAMICTAL) 80299 $213.09

GABAPENTIN (NEURONTIN) 80299 $213.09

URINALYSIS MICRO 81015 $36.00

ALBUMIN URIN OTHER SOURCE82042 $87.97

ALDOLASE 82085 $81.96

ALDOSTERONE 82088 $177.03

ALPHA-1-ANTITRYP 82103 $211.98

ALPHA-1-ANTITRPSIN FECA $196.47

ALPHA-1-ANTITRYP PHE 82104 $120.20

ANDROSTENEDIONE 82157 $314.71

ANGIOTENSION ENZ ACE 82164 $149.70

ARSENIC 82175 $90.69

BETA 2 MICROGLOBULIN 82232 $161.72

BILE ACIDS TOTAL 82239 $123.48

BILIRUBIN AMNIOTIC FL 82247 $74.30

OCCULT BLOOD 82272 $38.24

CALCITONIN 82308 $163.45

CARNITINE SERUM 82379 $213.09

CAROTENE 82380 $91.38

CATECHOLAMINE FRACT BLOOD82384 $163.91

�13

CERULOPLASMIN 82390 $100.53

CHROMIUM 82495 $239.76

CITRATE URINE 82507 $295.59

COPPER 82525 $97.00

CORTISOL SALIVA $298.75

CREATININE FLUID 82570 $74.30

CRYOGLOBULIN QUAL 82595 $80.87

DHEA 82626 $126.75

DHEA SULFATE 82627 $140.97

ERYTHROPOIETIN 82668 $276.46

ESTRADIOL 82670 $171.56

ESTRONE 82679 $98.34

FECAL FAT QUAL 82705 $17.21

FECAL FAT QUANT 82710 $185.76

FOLIC ACID RBC 82747 $183.58

CELIAC DISEASE TOTAL IGA 82784 $66.65

IMMUNOGLOBULIN G $79.77

IGG SUBCLASS IGG 1 2 3 4 82787 $71.25

GASTRIN 82941 $107.27

GLUCOSE POCT 82962 $60.10

HAPTOGLOBIN 83010 $113.64

HEMOGLOBIN ELP 83020 $85.93

HEMOGLOBIN ELP HPLC 83021 $100.79

METHEMOGLOBIN QUANT 83050 $18.38

VMA W HVA - HVA 83150 $66.65

HIAA-5 24 HR URINE 83497 $123.48

HYDROXYPROGESTERONE-17 $208.63

ANTI SMOOTH MUS AB IGG 83516 $138.77

HISTONE ANTIBODIES 83516 $171.00

TISSUE TRANSGLUT $232.00

THYROTROPIN RECEPTOR AB 83519 $165.01

ANTI GLOMERULAR BASEMT 83520 $196.47

�14

ANTIGLIADIN AB IGA IGG 83516 $281.14

LACTATE (LACTIC ACID) 83605 $140.00

LDH ISOENZYME 83625 $72.46

HEAVY METAL SCR LEAD 83655 $100.53

LIPOPROTEIN A 83695 $123.48

LDL DIRECT 83721 $70.00

METANEPHRINE 83835 $242.59

METANEPHRINES PLASMA 83835 $242.59

MYOGLOBIN 83874 $121.29

METHYLMALONIC ACID SER 83921 $231.00

OSMOLALITY FLUID 83930 $65.56

OSMOLALITY URINE 83935 $86.32

PTH INTACT 83970 $289.00

ALK PHOS ISO TOTAL 84075 $29.33

ALKALINE PHOS ISOENZYME 84080 $83.85

PHOSPHORUS UR 84105 $53.00

K: URINE 84133 $46.68

PREALBUMIN 84134 $103.81

PROGESTERONE 84144 $154.08

PROLACTIN 84146 $154.08

PROTEIN TOT UR 84156 $76.49

PROTEIN TOT OTH 84157 $77.04

PROTEIN ELECTRO URI 84166 $141.10

RENIN 84244 $144.24

SELENIUM BLOOD 84255 $74.30

SEX HORMONE BIND GLOB 84270 $125.00

IGF-1 (END SC) 84305 $133.31

SOMATOMEDIN-C (IGF-1) 84305 $143.15

REDUCING SUB FECAL 84376 $46.99

TESTOSTERONE FREE 84402 $160.00

TESTOST TOTAL COMBO 84403 $207.00

TESTOSTERONE TOTAL 84403 $207.00

�15

VITAMIN B1 84425 $174.00

THYROGLOBULIN 84432 $169.37

T4 FREE BY EQU DIR DIAL $106.00

TBG-THYROXIN BDG GLOB 84442 $152.77

THYROID STIM IMMUNOGLOB 84445 $470.13

TOCOPHERAL ALPHA (VIT E) 84446 $125.66

TRANSFERRIN 84466 $125.66

T3 UPTAKE 84479 $54.64

T3 TOTAL (TRIIODOTHYRON) 84480 $128.95

T3 FREE 84481 $215.27

T3 REVERSE 84482 $73.21

UREA NITROGEN URINE 84540 $7.45

URIC ACID OTHER 84560 $74.30

VMA 24HR UR 84585 $202.68

VMA W HVA - VMA 84585 $66.65

VITAMIN A 84590 $180.30

VITAMIN K 84597 $126.25

ZINC 84630 $115.83

FACTOR V 85220 $158.44

FACTOR VIII IH 85240 $116.93

RISTOCETIN COFACTOR 85245 $116.93

VON WILLIBRAND ANTIGEN 85246 $143.00

ANTITHROMBIN III ANTIGN 85301 $158.44

PROTEIN C ANTIGEN 85302 $77.58

PROTEIN S ANTIGEN 85305 $185.76

PROTEIN S AG FREE 85306 $259.92

ACTIVATED PROTEIN C RES 85307 $251.43

D-DIMER QUANT 85379 $166.10

ALKALINE PHOS LEUKOCYTE 85540 $134.40

DILUTE RUSS VIP CONFIRM $32.78

DILUTE RUSSELLS VIPER 85613 $80.87

SICKLE CELL TEST 85660 $78.22

�16

THROMBIN TIME 85670 $83.43

ALERGEN SPEC IGE QNT SO 86003 $73.21

ANCA-MPO MYELOPEROXIDAS 86021 $256.00

ANCA 86255 $262.00

ANCA-PR3 PROTEINASE 3 86021 $138.97

PLATELET ANTIBODY 86022 $248.04

ANTISTREPTOLYSIN O TITR 86060 $62.28

C-REACTIVE PROTEIN HISEN 86141 $104.91

CYCLIC CITR PEP AB(CCP) 86200 $174.83

ANTI DNA DBL STRAND AB 86225 $124.57

ANTI SCL70 86235 $98.53

ENA ANY AB 86235 $98.53

ANTI NEURONAL NUC AB 86255 $231.66

CA 15-3 ANTIGEN 86300 $123.48

CHROMOGRANIN A 86316 $121.98

HIV 1 & 2 RAPID 86703 $104.91

HYPERSENS PN IMMUNODI AB 86331 $19.49

IMMUNOFIXATION 86334 $142.00

CD4 CD8 86360 $180.30

T-HELPER LYMPH MARKER 86361 $97.25

ANTITHYROID AB ANTI TPO 86376 $115.83

CRYPTOCOCCUS ANTIGEN 86403 $64.47

RHEUMATOID FACTOR FLUID 86430 $59.01

RHEUMATOID FACTOR QUANT 86431 $85.23

FUNGAL SEROLOGY ASPER 86606 $63.38

BLASTOMYCES AB SERUM 86612 $67.75

FUNGAL SEROLOGY BLASTO 86612 $63.38

B PERTUSS AB IGG BY MAID 86615 $82.00

LYMES WESTERN BLOT 86617 $150.79

LYMES TOTAL 86618 $175.92

BRUCELLA ANTIBY IGG IGM 86622 $133.31

COCCIDIOIDES ANTIBODY 86635 $88.51

�17

FUNGAL SEROLOGY COCCID 86635 $89.60

CMV IGG AB 86644 $110.36

CMV IGM AB 86645 $113.64

ECHOVIRUS 86658 $232.75

EPSTEIN BARR EARLY AG 86663 $53.54

EB VIRUS-EBNA 86664 $88.51

EPSTEIN B VIRUS-VCA 86665 $88.00

HEMOPHILUS INFLUENZA AB 86684 $175.00

HERPES SIMPLX VIR1 IGG 86695 $150.79

HERPES SMPLX VIR 2 IGG 86696 $150.79

FUNGAL SEROLOGY HISTO 86698 $32.78

HEP B CORE AB TOTAL 86704 $101.62

HEP B CORE AB-IGM ONLY 86705 $113.64

HEP A TOTAL 86708 $21.92

HEP A ACUTE AB-HAV-IGM 86709 $143.15

MUMPS TITER G&M 86735 $10.79

PARVOVIRUS IGM IGG 86747 $82.75

E HISTOLYTICA AB $136.86

RUBEOLA IGG ANTIBODY 86765 $149.59

FLUORES TREPONEMAL AB 86780 $70.00

VARICELLA ZOSTER IGG&IGM 86787 $109.27

VARICELLA ZOSTER SCREEN 86787 $87.96

HANTAVIRUS ANTIBODY 86790 $192.32

W NILE VIR G SER OR CF 86789 $90.69

ANTI THYROGLOBULIN AB 86800 $116.70

THYROGLOBULIN AB 86800 $131.00

HLA-B27 ANTIGEN 86812 $215.27

CROSSMATCH IMMEDIATESPIN 86920 $103.81

CROSSMATCH INCUBAT MDH 86921 $162.81

CULTURE STOOL ADD PATHGN87046 $46.99

CULTURE: STOOL SAL SHIG 87045 $92.89

CULTURE: BACT OTHER 87070 $138.77

�18

CULTURE: BACT RESPITOR 87070 $138.77

ANAEROBIC IDENTIFICATION 87076 $60.10

PATHOGENIC ORGANISM SCR 87081 $57.92

ISOLAT&PRESUMPT ID URINE 87088 $107.09

CULTURE:FC SKN-HAIR-NAIL 87101 $124.00

CULTURE: FUNGUS $136.59

CULTURE: FUNGUS YEAST ID $78.67

CULTURE: FUNGUS MOLD ID $92.89

CULTURE TB BLOOD 87116 $160.63

CULTURE: AFB ID 87118 $160.63

CULTURE: TYPING ANTISERU 87147 $49.17

PARASITE ID-WORM 87169 $38.99

MALARIA SMEAR 87207 $89.60

TRICHROME STAIN 87209 $131.13

KOH SKIN HAIR NAILS 87220 $62.28

HERPES TYPING 87253 $156.33

GIARDIA LAMBLIA 87329 $138.00

H PYLORI AG STOOL 87338 $155.00

ROTAVIRUS FECAL 87425 $68.85

SHIGA-LIKE TOXIN 87427 $81.41

CHLAMYDIA BY AMPLIFICAT 87491 $212.00

CMV PCR 87496 $327.82

HEP B VIRAL DNA 87517 $281.92

HEP C GENOTYPE PCR 87902 $1,834.83

HEP C RNA PCR QNT 87522 $385.00

HIV 1 RNA PCR QNT 87536 $406.30

GC BY DNA AMPLIFICATION 87591 $236.00

PERTUSSIS PCR 87798 $154.08

BK VIRUS DNA QUANT 87799 $452.00

INFLUENZA A B DIRECT 87804 $95.00

RSV DIRECT ELISA 87807 $51.63

FISH DNA PROBE 88271 $92.30

�19

INTERPHASE 100-300 88275 $198.92

SURGICAL PATH LEVEL II 88302 $122.38

SURGICAL PATH LEVEL III 88304 $217.45

SURGICAL PATH LEVEL IV 88305 $208.00

STAIN SPECIAL I 88312 $185.66

STAIN SPECIAL II 88313 $198.79

IMMUNOPEROXIDASE STAIN 88342 $214.00

LEUKOCYTE FECAL 89055 $24.04

SYN FLUID CRYSTAL 89060 $93.98

EOSINOPHIL SMEAR 89190 $112.01

CYTOPATH CONC 88108 $333.28

FNA INTERP REPORT 88173 $245.00

ESR NON AUTOMATED 85651 $61.19

AB BACTERIUM NES 86609 $19.49

MISC CHEMISTRY $-

RSV DFA 87280 $157.35

VALPROIC ACD TOT S.O.80164.003 $93.36

HERPES SIMPLEX VIR PCR 87529 $216.00

ITRACONAZOLE 80299 $199.75

LEAD 83655 $100.53

GLUCOSE & DOSE 82950 $76.49

VALPROIC ACID FREE S.O. 80165 $205.81

CATECHOLAMINES FRAC URINE 24HR 82384$232.00

ALBUMIN BIOAVAILABLE 82040 $218.55

ALKALINE HOS BONE SPEC $162.81

PANCREATIC ELASTASE 1FE $72.20

STREP PNEUMO URINARY AG 87450 $185.66

BORDETELLA PERT IGA & M $72.12

ENDOMYSIAL IGA AB QUAL 86255 $262.00

H PYLORI IGM $138.98

CMV DNA QUANTITATIVE 87497 $399.00

SENSITIVITY ANAEROB MIC SO $63.00

�20

INFECT AGT NUC ACD AMP EA ORG $334.00

VEN BLD COLLECTION IVAD 36591 $91.00

LACTOFERRIN FECAL QUAL 83630 $105.00

THERAPEUTIC PHLEBOTOMY COMPLEX $910.24

W NILE VIR M SER OR CF 86788 $140.97

NOROVIRUS FECAL 87798 $158.44

GLUC TOL ADD SPECS 82952 $37.15

CORTISOL FREE 82530 $232.00

MANGANESE 83785 $74.30

RETICULOCYTE WITH CELLULAR PARAMETER 85046$74.00

INTRINSIC FACTOR ANTIBODY86340 $110.00

FREE LIGHT CHAIN 83883 $100.53

ESTRADIOL (TANNERS) $203.35

ESTRIOL 82677 $194.67

CATECHOL FRA UR 82384 $115.83

WEST NILE VIRUS PCR $158.44

COCCIDIODES AB 86635 $89.60

OXALATE 83945 $104.36

RAD EXAM SPINE LUMB BENDING VWS ONLY 2 OR 3 VWS$402.12

COLLAGEN XLINK LEVEL 2 82523 $168.30

GENTAMICIN PEK TRGH RANDM80170 $187.94

VANCOMYCIN PEK TRGH RNDM 80202 $165.01

UA NON-AUTOMATED W MICROS81000 $67.75

CATECHOLAMINES BLOOD 82383 $210.89

ESTROGENS FRACTIONATED 82671 $174.83

IMMUNOGLOB A G OR M EACH82784 $86.00

HEAVY METAL 83015 $72.12

PORPHY URINE QUANT&FRACT 84120 $184.67

TROPONIN QUAL 84512 $140.97

COLD AGGLUTININ SCREEN 86156 $106.00

ASPERGILLUS ANTIBODY 86606 $79.76

FRESH FROZEN PLASMA THAW 86927 $107.00

�21

BORDETELLA PERTUSSIS DFA 87265 $128.95

BORDETELLA PERTUSSIS PCR 87801 $185.76

INF AG DET BY IMMUNAS NOS87899 $28.59

PLATE PHER LEUK RED IRADP9037 $1,834.00

RBC LR IRR PROC UNIT P9040 $810.00

GLIADIN ANTI 82397 $232.00

EBV DNA QUANT 87799 $452.00

PLATELET PHERES LEUKOREDUCED $688.81

VEN BLD COLLECTION PICC 36592 $74.30

CRYPTOSPORIDIUM AG STOOL 87328 $104.91

ANCA PANEL $169.37

KEPPRA (LEVETIRACETAM) 80299 $255.70

TB TEST CELL MEDIATED IMMUNITY $260.00

SHBG BIIOAVAILABLE 84270 $218.55

TESTOSTERONE TOTAL BIOV 84403 $218.55

TISSUE TRANSGLUT IGA 82397 $232.00

PAE RFLX BILL GAD65 86341 $242.00

PREGABALIN TIAGABINE 80366 G0480 $105.00

CENTROMERE AB 83520 $94.00

PROCALCITONIN 84145 $38.78

CDMR RSV PCR 87798.59 $136.00

MONOSCREEN WHOLE BLD-QW 86308 $92.89

PT INR FINGERSTICK-QW 85610 $61.00

PARVOVIRUS B19 QUAL PCR 87798 $269.47

RECEPTOR SOLUBL TRNSFRN 84238 $211.15

CDMR INFLUENZA PCR FIRST 2 87502.001$331.00

BETA-2 GLYCOPROTEIN G M 86146 $99.44

C DIFFICILE TOXIN GENE AMP PROBE 87493$244.00

CARDIOLIPIN ANTIBODY G M 86147 $168.28

HEAVY METAL SCR COPPER 82525 $86.32

MRSA PCR NASAL COLONIZATN87641 $200.00

VIT D 25-HYDR(TOT D2 D3)82306 $211.00

�22

FUNGUS MOLD ID 87107 $69.00

BABESIA AB G M 86753 $69.94

BABESIA PCR 87798 $334.00

EHRLICHIA ANAPLASMA PCR 87798 $334.00

BORRELIA BODY FLUID PCR 87476 $289.57

CRYOGLOBULIN S.O. 82595 $56.65

CRYOFIBRINOGEN 82585 $76.97

TISSUE TRANSGLUT IGG REFLEXED 83516$161.72

CYSTINURIA 82136 $303.90

VITAMIN B2 84252 $290.67

LYME BORRELLIA PCR 87476 $335.47

IBD CRP 86140 $106.00

GROUP A STREP PCR 87651 $168.28

CEA PANCREATIC CYST 82378 $134.40

COBALT 83018 $272.65

LACTOFERRIN QUANT 83631 $108.21

ENDOMYSTIAL IGG 86255 $28.18

IA2-AB 86341 $242.00

HNDOT(HANDLING OTHER KITS) 99000 $59.01

PTH RELATED PROTEIN 83519 $272.64

STREPTOCOCCUS GRPB AMP PROBE 87653$53.41

VON WILEBRND WRKUP INTRP 85390 $74.70

MYELOPEROXIDASE AB 83876 $150.76

PROTEINASE 3 AB 83516 $150.76

HEXOGONAL PHOSPHOLIPID NEUT 85598 $37.15

ACEYLCHOLIN RECEP BIND AB83519 $123.75

HFE COMMON VARI 81256 $480.80

MTHFR GENE 81291 $1,405.69

PRADER-WILLI (ANGELMAN) GENE 81331 $356.00

FETAL CONGEN ABN QUAD 81511 $262.15

E TEST CHG CODE $31.69

17-HYDROXYPROGESTERONE $215.27

�23

HEMOGLOBIN A1C $84.14

ALPHA-1-ANTITRYPSIN $248.04

ALLERGEN IGE $75.40

ANTIBODY SCREEN $130.04

ACTH $192.32

AEROBIC CULTURE $138.77

AEROBIC ID CHG $151.89

ALPHA FETOPROTEIN $178.12

HEPATITIS ACUTE PANEL $313.61

ALDOLASE $81.96

ALDOSTERONE 82088 $362.79

ALK PHOS $76.49

AEROBIC MIC $148.61

ANA SCREEN WITH REFLEX $116.93

ANTINUCLEAR ANTIBODY (MULTIPLE) S $157.35

ANAEROBIC CULTURE $112.55

ANAEROBIC ID CHG $62.28

ANGIO CONVERTING ENZYME 82164 $154.08

ACTIVATED PROTEIN C RESISTANCE V $269.90

ASO $64.47

ANTITHROMBIN III ACTIVITY $40.43

VITAMIN B12 $103.81

BABESIA SMEAR 87207 $14.63

BONE ALK PHOSPHATASE S 84080 $162.81

BETA-2-MICROGLOBULIN $156.26

BODY FLUID COUNT $97.25

BLOOD CULTURE $160.63

CA27.29 $126.75

CALCIUM $71.03

CANCER ANTIGEN 125 $148.61

CANCER ANTIGEN 15-3 $126.75

CARNITINE $213.09

�24

CATECHOLAMINE FRACT FREE P $169.37

CALCIUM URINE $65.56

CBC WITH PLATELETS $128.95

CYC CITRULLIN PEPTIDE AB $174.83

C. DIFFICILE DNA BY PCR $183.58

CARCINOEMBRYONIC AG $138.77

CERULOPLASMIN $159.54

VENIPUNCTURE $26.22

CK $87.42

C.DIFFICILE TOXIN ASSAY $134.40

CMV PCR MAYO 87496 $337.65

CYTOMEGALOVIRUS IGG AB $110.36

COMP PANEL 14 MCSU $240.40

CONCENTRATE O+P $116.93

CORTISOL 60 MINUTE $142.06

CORTISOL AM $149.70

CORTISOL PM $149.70

CORTISOL POST STIMULATION $149.70

CORTISOL RANDOM $123.48

CREATININE $63.38

CREATININE CLEARANCE $142.06

CREATININE RANDOM URINE (FGO & EF) $74.30

CREATININE URINE $74.30

C-REACTIVE PROTEIN $106.00

CRP HS (CARDIAC) $104.91

CRYSTALS SYNOVIAL FLUID $97.25

CSF $97.25

CULT PROCESS CHG TISSUE $68.96

DHEA-S $140.97

DIGOXIN $147.52

EHRLICHIA ANAPLASMA PCR B $371.53

ELECTROPHORESIS 24HR URINE $97.25

�25

ELECTROPHORESIS PROTEIN $107.09

ELECTROPHORESIS RANDOM URINE $97.25

ENDOMYSIAL ABS S (IGA) $196.69

ERYTHROPOIETIN $285.20

ESTRADIOL WITH ESTRONE 82670 $171.56

ETEST BUNDLING 87181 $63.00

FACTOR V $162.81

FAT STOOL $17.21

IRON $99.44

FERRITIN $126.75

FFP MANUAL CHARGE $217.45

FUNGUS CULT ID CHG MOLD $92.89

FK506 (TACROLIMUS) $237.13

FOLATE $111.46

FREE T3 $215.27

FSH $138.77

FREE THYROXINE $106.00

FREE THYROXINE $106.00

FUNGUS CULTURE $136.59

FUNGUS CULT FOR DERMATOPHYTES $86.32

FUNGUS CULT FOR DERMATOPHYTES $86.32

GENT PEAK (POST) $191.23

GENT TROUGH(PRE) $187.94

GLUCOSE CSF $78.67

GRAM STAIN $66.65

HEPATITIS A VIRUS IGM $143.15

HEPATITIS BS AB $68.85

HEPATITIS B CORE IGM $113.64

HEPATITIS B CORE IGG IGM $87.42

HEPATITIS B SURFACE AG $101.62

HBV DNA DETECT QUANT $281.92

TOTAL BETA HCG $137.68

�26

HEPATITIS C AB $158.44

HCV RNA DETECT QUANT(PCR) $649.08

HELICOBACTER PYLORI IGG $69.94

HEPATIC FUNCTION PANEL $178.12

ZZHEXAGONAL PHOSPHOLIPID NEUT 85598$236.02

HEMOGLOBIN $48.08

HISTONE AUTOANTIBODIES $169.37

HIV-1 HIV-2 $104.91

HANDLING POST-TRANSPLANTS $59.01

HOMOCYSTEINE TOTAL $257.88

HEPARIN XA UNFRACTIONATED $164.44

AEROBIC IDENTIFICATION $230.57

ANAEROBIC IDENTIFICATION $225.11

IMMUNOFIX SERUM $187.94

IMMUNOFIX URINE $210.89

IGA $27.32

IGE IMMUNOGLOBULIN 82785 $195.21

IGG $27.32

IGM $27.32

IMMUNOLOGICAL ID - SINGLE CHARGE $49.17

IMMUNOLOGICAL IDENTIFICATION $49.17

KEPPRA (LEVETIRACETAM) $213.09

POTASSIUM URINE $66.65

LAMOTRIGINE S $213.09

LEUKOCYTE ALKALINE PHOSPHATASE $138.77

LDH $81.96

LEAD BLOOD $103.81

LEGIONELLA AG URINE $171.56

LH 83002 $133.31

LITHIUM $86.32

LIPASE $95.07

LIPOPROTEIN (A) SERUM $126.75

�27

LYME ANTIBODY SCREEN $181.39

MALARIA SMEAR $91.79

MICROALBUMIN $91.79

MIC CHARGE CODE $107.09

UA WITHOUT MICRO $33.88

MITOCHONDRIAL AB M2 S $137.14

METHYLMALONIC ACID $285.20

MYCOPHENOLIC ACID S $194.51

MRSA SCREEN $178.12

MRSA DNA: NASAL SCN $157.35

MTB COMPLEX RAPID PCR $397.58

SODIUM RANDOM URINE $61.19

SED RATE $61.19

OSMOLALITY $65.56

OSMOLALITY URINE $86.32

BORDETELLA PERTUSSIS DNA 87798 $371.53

PHENOBARB $140.97

PHOSPHORUS $71.03

PLASMINOGEN ACTIVITY 85420 $62.12

PROTEIN C ACTIVITY (FUNC) $40.43

PREGNANCY $80.87

PREGABALIN (LYRICA) $135.50

PRENATAL OBSTETRIC PROFILE $25.13

PREGNANCY URINE (FERTILITY) $127.85

PROLACTIN $154.08

PROGESTERONE $154.08

PROLACTIN POOL $154.08

PROTEIN S AG TOTAL $211.98

PROTEIN URINE RANDOM $76.49

PROTEIN S ACTIVITY $40.43

PROSTATIC SPECIFIC AG $160.63

PSA SCREEN $167.19

�28

PTH INTACT $279.74

PTH-RELATED PEPTIDE 82397 $280.83

PHENYTOIN 80185 $121.29

FOLATE (FOLIC ACID) RBC $189.05

RENIN ACTIVITY $204.34

RESPIRATORY CULTURE $138.77

RHEUMATOID FACTOR $59.01

RISTOCETIN COFACTOR $120.20

ROTAVIRUS $112.55

RPR $98.34

RSV $39.34

RUBELLA IGG AB $131.13

RUBEOLA (MEASLES) AB IGG $114.73

SEROTONIN SERUM $205.43

SYNOVIAL FLUID COUNT $101.62

STREP PNEUMONIAE AG U $178.12

STOOL CULTURE $92.89

STOOL CULTURE ADDITIONAL PATHOGEN $46.99

KIDNEY STONE ANALYSIS $118.02

T4(THYROXINE) TOTAL ONLY $73.21

TEGRETOL $125.66

TESTOSTERONE $205.43

THC CONFIRMATION URINE 80299 $154.08

THEOPHYLLINE $145.33

TOPIRAMATE $156.26

TOTAL PROTEIN 84155 $69.94

PROTEIN CSF $79.77

TRANSFERRIN $104.91

TRICHROME O+P $135.50

TRIGLYCERIDE $76.49

TSH $162.81

THYROID-STIMULATING IMM $484.08

�29

URIC ACID RANDOM URINE $74.30

URINE CULTURE SUSCEPTIBILITY $125.66

URIC ACID $71.03

URINE CULT ID CHG $107.09

URINE VOLUME MEASURE 81050 $40.43

VITAMIN D 1 25-DIHYDROXY $348.58

VALPROIC ACID $132.22

VANCO PEAK $170.47

VANCO TROUGH $170.47

VARICELLA IMMUNE IGG TITER $97.25

VITAMIN E $128.95

VRE SCREEN $73.21

VON WILLEBRAND FACTOR AG $120.20

WBC SMEAR $25.13

WET PREP $64.47

WEST NILE VIRUS IGM $192.32

CHG CODE FOR AFBID $275.37

FUNGUS CULT ID CHG YEAST $78.67

17-HYDROXY PROGESTERONE $167.19

VITAMIN D 25-HYDROXY D3 $162.81

JO 1 AB IGG 86235 $128.95

ALBUMIN BODY FLUID 82042 $90.69

ANTINUCLEAR AB (IFA) $116.93

ANDROSTENEDIONE $324.54

APTT $92.89

RNP AB IGG 86235 $128.95

SCL 70 AB IGG 86235 $128.95

SM AB IGG 86235 $128.95

SS-A RO AB IGG $128.95

SS-B LA AB IGG $128.95

BARTONELLA BUNDLE BHG & MB BQG & M 86611$38.00

BARTONELLA IGG/IGM 86611.005 $28.55

�30

BK VIRUS DNA QN BY PCR $437.09

GROUP A STREP SCN:THT $108.18

CARDIOLIPIN IGG AB $143.15

CARDIOLIPIN IGM AB $143.15

CATECHOLAMINE FRACTIONS $185.76

CALCIUM URINE $61.19

CD4% 86361 $100.53

CENTROMERE AB IGG $287.39

CHARGE VMAU $208.71

CHARGE HCVG IF HEPCA POSITIVE $666.56

CITRATE URINE $304.87

CYTOMEGALOVIRUS AB IGM $99.44

CYTOPLASMIC NEUT AB 86255 $231.66

C-PEPTIDE $169.37

CREATININE RANDOM URINE $74.30



CRYPTOSPORIDIUM AG, FECES 87328 $104.91

C TRACHOMATIS NUC. ACID 87491 $212.00

CYSTINE $312.52

DEAMID. GLIADIN AB IGA $147.52

DEAMID. GLIADIN AB IGG $147.52

DSDNA AB IGG $124.57

DRVVT CONFIRM 85612 $87.42

DRVVT SCREEN $33.88

TIBC $99.44

EBNA $203.25

EBV AB PROFILE S $237.13

EBV VCA IGG $237.13

FACTOR VIII $120.20

FENTANYL URINE $191.23

PSA FREE 84154 $80.87

�31

TESTOSTERONE FREE S $158.44

GIARDIA LAMBLIA AG FECES 87329 $138.00

GLUCOSE BODY FLUID $78.67

HEPATITIS A TOTAL AB S $123.48

HCV AMPLIFICATION RT-PCR $774.75

5 HIAA $174.83

HISTOPLASMA AG SERUM $136.25

HSV TYPE 1 AB IGG $42.62

HSV1 DNA BY PCR $98.34

HSV TYPE 2 AB IGG $64.47

HSV2 DNA BY PCR $98.34

IGG 1 SUBCLASS $110.36




IGG TOTAL $113.64

LYME IGG WESTERN BLOT $155.17

INSULIN $160.63

KAPPA FREE LIGHT CHAIN 83883 $171.56

LDH BODY FLUID $78.67

LYME IGM WESTERN BLOT $155.17

LAMBDA FREE LIGHT CHAIN 83883 $171.56

LUPUS ANTICOAGULANT $50.26

METANEPHRINES URINE $175.92

SODIUM URINE $61.19

N GONORRHOEAE NUC. ACID 87591 $236.00

AMMONIA $106.00

OXALATE CONCENTRATION $107.09

PROTEIN C AG $226.20

PHOSPHORUS URINE $54.64

PREGNANCY SERUM $80.87

PROTEIN URINE $76.49

�32

PROTEIN S AG FREE $191.23

PROTHROMBIN TIME $77.58

APTT 50% NP $69.94

Q FEVER PHASE I IGG $163.91

Q FEVER PHASE I IGM $163.91

RETIC $54.64

IONIZED CALCIUM - RT $114.73

STRIATIONAL(MUSCLE) AB 83520 $51.98

GROUP A STREP DNA:THT $173.74

THYROGLOBULIN AB SCREEN $174.83

THYROGLOBULIN TUMOR MRK $174.83

THYROTROPIN RECEPTOR AB 83520 $122.58

PROTEIN BODY FLUID 84157 $79.77

PROTEIN BODY FLUID $79.77

THYROPEROXIDASE AB $135.50

TOTAL PORPHYRINS WB $214.18

TESTOSTERONE TOTAL S $205.43

TISSUE TRANSGLUTAM. IGA 83516 $138.77

TISSUE TRANSGLUTAM. IGG 83516 $138.77

URIC ACID URINE $74.30

A-TOCOPHEROL VITAMIN E $133.31

VARICELLA-ZOSTER IGG AB $112.55

VARICELLA-ZOSTER IGM AB $112.55

ALPHA-1-ANTITRYPSIN S $123.48

ALPHA-1-ANTITRYPSIN PHENO $101.62

TESTOSTERONE BIOAVAIL S $218.55

COCCI COMPLEMENT F $90.69

COCCI IMMUNODIFFUSION IGG $90.69

COCCI IMMUNODIFFUSION IGM $90.69

TESTOSTERONE FREE S $218.55

HERPES SIMPLEX VIRUS TYPES 1 AND 2 $88.51

HUMAN GRAN EHRLICHIOSIS AB $118.78

�33

EHRL.CHAFFEE. (HME) IGG $118.78

HELICOBACTER PYLORI AG F $253.51

LYME DISEASE PCR B $345.30

PNEUMO AB TYPE 12 (12F) $110.36

PNEUMO AB TYPE 14 $110.36



PNEUMO AB TYPE 26 (6B) $110.36


PNEUMO AB TYPE 56 (18C) $110.36





PNEUMO AB TYPE 9 (9N) $110.36

RHEUMATOID FACTOR $59.01

S. PNEUMO IGG 23 SERO 86317 $110.36

SS-A RO AB 86235 $128.95

SS-B LA AB 86235 $128.95

TESTOSTERONE FREE BIOAVAIL 84402 $160.00

OXCARBAZEPINE METABOLITE $213.09

TISSUE TRANSGLUTAM. IGA $138.77

TESTOSTERONE TOTAL S $218.55

URIC ACID $71.03

LISTERIA AB 86609 $107.09

CREAT OTHER SOURCE 82570 $43.75

PHENOBARB WITH PRIMIDONE 80184 $140.97

C DIFF ANTIGEN 87449 $201.07

GABAPENTIN 80171 $224.00

LAMOTRIGINE 80175 $206.53

LEVETIRACETAM 80177 $120.00

MYCOPHENOLATE 80180 $189.05

�34

OXCARBAZEPINE 80183 $206.53

IODINE BLOOD 83789 $184.60

PNEUMOCOCCAL AB EA PNL 23 86317 $9.00

B PERTUSSIS A G M EA ELISA 86615 $160.63

B PERTUSSIS A G M EA IMUNOBLT REFL 86615$74.30

RA FACTOR QUANT 86431 $81.00

EOSINOPHIL SMEAR BODY FLUID 89050 $84.00

CYTOMEGALOVIRUS AB IGG $179.21

CYTOMEGALOVIRUS AB IGM $110.36

CYTOMEGALOVIRUS $50.26

CYTOMEGALOVIRUS IGM $50.26

HLA B27 TYPING 86812 $215.27

HFE GENE ANALYSIS BLOOD $480.80

CDMR RESPIRATORY PCR PANEL 87631.001$499.00

PROTHROMBIN G20210A MUTATION $112.55

FACTOR V LEIDEN GENE 81241 $193.00

EBV IGG $150.65

EBV IGM $150.65

EBV NUCLEAR ANTIGEN IGG $150.65

GABAPENTIN (NERONTIN) $230.57

FLOURESC NONINFECTIOUS AB SCREEN 86255$134.37

TISSUE TRANSGLUTAMINASE AB IGA $143.15

ENDOMYSIAL IGA AB SEMI QUANT $174.83

HV 1 ANTIBODY 86701 $12.98

HIV 2 ANTIBODY 86702 $114.80

HIV1 AG HIV 1 2 AB $102.00

BLOOD CULTURE ORGANISM ID NAD 87149$105.00

PS/PT AB G,M 86148 $170.62

CONNECT TISSUE ANTINUCLEAR AB 86038.007$87.50

CONNECT TISS CYCLIC CITRULLINATED PEPTIDE AB 86200.003$101.06

TISSUE TRANSGLUT IGA REFLEXED 83516.033$88.75

TESTOSTERONE,BIOAVAILALBE DIRECT MEASURE 84410$178.68

�35

HEPATITIS C RNA GENOTYPE 3 NS5A DRUG RESISTANCE 87902$567.25

FIBRINOGEN DEGRADATION PRODUCTS PARACOAGULATION 85366`$125.88

TESTOSTERONE FREE MEASURED 84402 $212.18

ESTRONE WITH ESTRADIOL 82679 $71.55

MALARIA ANTIGEN 87899 $33.68

HPV HIGH-RISK TYPES 87624 $171.87

OPIATES 80361 G0480 $64.75

NICOTINE 80323 G0480 $150.00

OXYCODONE 80365 G0480 $107.10

AMPHETAMINE 80324 G0480 $54.78

METHYLENEDIOXYAMPHETAMINE 80359 G0480$64.98

NEPHELOM KAPPA LAMBDA PROTEIN 83883$38.75

KAPPA LAMBDA PROTEIN URINE 84156 $21.30

IMMUNOFIX KAPPA LAMBDA URINE 86335$100.16

HEP C SCREEN HIGH RISK/OTHER $158.44

CRC SCR OCCULT BLD FIT (1-3 CARDS) 82274$55.12

CRC SCR OCCULT BLD GUAIAC (3 CARDS) 82270$44.00

BASIC ENTERIC PATHOGENIC PANEL NAD 87506$818.00

THYROGLOBLULIN AB FOR REFLEX 86800$174.83

THYROGLOBULIN RUMOR MARKER REFLEXED 84432$176.47

ANGIOTENSIS CONVERTING ENZYME 82164$149.70

SUPERSATURATION, CALCIUM, 82340 $55.00

SUPERSATURATION, CHLORIDE 82436 $52.00

SUPERSATURATION,CITRATE EXCRETN, 82507$209.00

SUPERSATURATION,CREATININE, 82570 $67.00

SUPERSATURATION, MAGNESIUM, 83735 $81.00

SUPERSATURATION, OSMOLALITY, 83935 $80.00

SUPERSATURATION, OXALATE, 83945 $84.00

SUPERSATURATION, PH, 83986 $48.00

SUPERSATURATION, PHOSPHORUS, 84105 $62.00

SUPERSATURATION, POTASSIUM, 84133 $56.00

SUPERSATURATION, SODIUM, 84300 $63.00

�36

SUPERSATURATION, SULFATE, 84392 $100.00

SUPERSATURATION, URIC ACID, 84560 $54.00

SUPERSATURATION, AMMONIUM, 82140 $147.00

SUPERSATURATION, UREA NITROGEN, 84540$87.00

THC CONFIRMATION URINE 80349 G0480 $149.06

MTB RIFAMPIN RESISTANCE 87798.067 $334.00

CARBAPENEM RESIST ENTEROBACTER NAD 87150.004$50.79

MAMMO DX UNILAT INCL CAD $256.79

MAMMO DX BILAT INCL CAD $315.80

MAMMO SCREEN BILAT INCL CAD $293.94

DRUG SCR PRESUMP DIRECT OPTICAL OBS 80305$216.30

DRUG SCR PRESUM INST ASSIST DIRECT OPT 80306$206.00

NICOTINE SCREEN 80305 $65.00

SALICYLATE 80307 $50.13

ACETAMINOPHEN 80307 $46.79

ALCOHOL NOT BREATH 80307 $164.07

ALCOHOL URINE 80307 $262.50

DRUG SCR PRESC OTC 80307 $273.75

TISSUE TRANSGLUTAMINASE IGG AB 83516$55.00

RAD EXAM CHEST SINGLE VW $225.11

RAD EXAM CHEST 2 VWS $336.56

RAD EXAM ABDOMEN 1 VW $309.24

CDMR RSV DNA/RNA AMP PROBE 87634.01$136.00

IGF BINDING PROTEIN 3 83520.053 $61.25

CENTROMERE AB SO 83516.038 $53.75

HIV 1 RNA,QUALIATIVE NAT SO 87535.004 $298.38

Mammorgraphy

US S&I GUID NDLE PLMT $587.88

MAMMO SCREEN UNILAT INCL CAD $293.94

Medical/Surgical

�37

ROUTINE ROOM & BOARD $1,618.33

CHOLECYSTECTOMY $5,469.09

COLONOSCOPY $1,771.53

MULTIPLE SLEEP LATENCY 95805 $2,589.76

PSG 4+ PARAMETERS $3,503.33

SLEEP STUDY SPLT NGHT 95811 $3,731.66

SLEEP STUDY PARTIAL 95810 $3,233.38

ECG TRACING WO INTERP $196.69

CONTINUOUS INHAL TX W AEROSOL ADD HR$131.30

PF A9540 NM TC99M MAAUP 10MCI $211.98


MD 99195 PHLEBOTOMYTHERAPEU(SEP PROC$910.24

CARDIAC EVENT MONITOR APPLICAT $1,254.45

IMMUN ADMIN 1 VACCINE $58.00

CATARACT SURGERY $4,334.74

YAG LASER $1,733.67

CBC AUTOMATED WDIFF 85025 $152.99

ABO 86900 $88.51

ANTIBODY SCREEN 86850 $142.00

RH 86901 $63.00

POTASSIUM 84132 $66.65

COMPREHENS METABOLC PANL 80053 $240.40

URINALYSIS-DIPSTICK ONLY 81003 $52.00

URINALYSIS W MICROSCOPIC 81001 $74.00

VENIPUNCTURE 36415 $27.00

CBC AUTOMATED NO DIFF 85027 $130.04

THERAPEUTIC PHLEBOTOMY $214.18

RECOVERY ROOM $532.38

IV HYDRAT INITIAL 31-60MINS $500.00

IV HYDRATION EACH ADDL HR $135.50

INFUSION TX PROP DX 1HR 1V $372.00

IV INFUSION EA ADD HR $103.00

�38

IV INFUS ADD SEQUEN NEW DRG1HR $144.00

SC IM INJECTION $116.93

IV PUSH INITIAL $173.00

CHEMO SQ IM NON HORMONAL $154.00

CHEMO IV PUSH $340.00

CHEMO IV PUSH EA ADD DRUG $181.00

CHEMO INFUSION 1ST HR $582.00

CHEMO INFUSION EA ADD HR $134.00

IRRIG IMPL VENOUS ACCESS DEVIC $92.70

INFUSION TX CONCURRENT $123.00

CARDIAC REHAB PHASE 1 $217.45

BLOOD ADMIN 0-2 HRS $1,016.24




BLOOD ADMIN >8 HRS $1,016.24

ISOLATION ROOM $2,267.19

PSG CPAP BIPAP 4+ PARAMETERS $3,731.66

IV PUSH SEQUENTIAL NEW DRUG $111.00

IV PUSH ADDL SAME DRUG >30MINS $106.00

SEMI PRIVATE ROOM $1,699.25

RESPITE ROOM & BOARD - LVL III $382.46

IMMUN ADMIN EA ADDL VACCINE $32.00

NEB INITIAL TX $119.00

NEB SUBSEQ TX $59.50

INTUBATION (OP) $916.80

GENERAL CORONARY CARE $2,030.28

SEMI PRIVATE ROOM&BOARD LVL II $2,267.19



TX RM NURSING BLD COLLECTION IVAD $83.81

OR ROOM 15 MIN $421.80

�39

COLONOSCOPY SUBMUC INJECT $1,148.00

UNATTENDED SLEEP STUDY 95806 $2,489.23

TX RM TREATMENT ROOM $663.18

OR TIME 1 MIN $29.83

TX RM CATH BLADDER NON-INDWELLING$194.00

TX RM INSERT TEMP INDEWELLING CATH/SIMPLE$301.59

ED NEBULIZER TREATMENT $150.00

OBSERVATION WITH ISOLATION $81.45

EXCISION OR TRANSPOSITION OF PTERYGIUM W GRAFT$2,173.50

NURSE ONLY VISIT $116.93

THERAPEUTIC PHLEBOTOMY NURSING $232.00

THERAPEUTIC PHLEBOTOMY COMPLEX NURSING$910.24

STAT PRE-OP FOR OBSERVATION $-

MRI

MRI TMJ WO CONTRAST $2,448.96

CT MAXILLOCFACL WO THEN WCONT $1,620.51

CTA HEAD W CONT WO IF PERF $2,042.23

CT ANGIO NECK W CON+WO IF PERF $2,042.23

MRI FACE NECK ORB WO THEN W CONT$3,039.96

MRA HEAD WO CONTRAST $2,514.49

MRA NECK WO CONTRAST $2,137.71

MRA NECK WO THEN W CONT $3,224.55

MRI BRAIN WO CONTRAST $2,420.25

MRI BRAIN W CONTRAST $2,493.60

MRI BRAIN WO THEN W CONT $3,521.86

CT THORAX WO CONTRAST $1,538.78

MRI CHEST WO CONTRAST $2,009.53

CT CERVICAL SPINE W CONTRAST $1,702.59

MRI C SPINE WO CONTRAST $2,424.76

MRI C SPINE W CONTRAST $2,813.77

MRI T SPINE WO CONTRAST $2,903.37

�40

MRI L SPINE WO CONTRAST $2,799.57

MRI L SPINE W CONTRAST $3,097.88

MRI C SPINE WO THEN W CONT $3,233.38

MRI T SPINE WO THEN W CONT $3,589.43

MRI L SPINE WO THEN W CONT $3,683.40

MRI PELVIS WO CONTRAST $2,242.80

MRI PELVIS WO THEN W CONT $2,233.19

CT EXT UPPER W CONT $1,176.00

MRI UP EXT WO CONT $2,302.38

MRI UPPER EXT JT WO CONTRAST $2,394.53

MRI UPPER EXT JT WO THEN W CONT $3,048.68

CT BONE LENGTH STUDY $628.32

CT EXT LOWER W CONT $1,568.70

MRI LOWER EXT WO CONTRAST $3,124.10

MRI LOWER EXT WO THEN W CONT $3,054.18

MRI LOWER EXT JT WO CONTRAST $2,232.04

MRI LOWER EXT JT W CONTRAST $2,420.39

MRI LOWER EXT JT WO THEN W CONT $3,000.11

CTA ABD WCONT +WO IF PERF $2,233.19

MRI ABDOMEN WO CONTRAST $2,949.45

MRI ABDOMEN WO THEN W CONT $3,690.23

CT LIMITED OR LOCALIZED FOLLOW UP STUDY$689.51

US CHEST $418.43

US GUIDED VASCULAR ACCESS $896.46

MRA ABDOMEN W CONTRAST $2,882.97

DOPPLER LIMITED $263.17

ECHO 2-D LIMITED $1,280.92

DUPLEX ABD PELVIS RETROPERITONEAL LTD$626.99

NM THYROID IMG W VASC FLOW $911.31

CT ORBIT SELLA FOSSA EAR W CONTRAST$1,803.00

NM HEPATOBILIARY IMG INCL GALLBLADDER W PHARM INTV$2,327.29

MRI PELVIS W CONTRAST $2,091.42

�41

TC99M MEBROFENIN PER STUDY DOSE UP TO 15 MCI$136.00

TC99M PERTECHNETATE PER MCI $142.42

MRI FACE NECK ORB W CONTRAST $3,388.17

MRI LOWER EXT W CONTRAST $3,123.29

NM PARATHYROID PLANAR IMG W SPECT$719.20

Nuclear Medicine

NM BONE AND OR JNT IMG 3 PHASE STDY$1,360.44

NM BONE AND OR JNT IMG WHOLE BODY$1,433.66

NM BONE AND OR JNT IMG TOMOGRAPHIC SPECT$1,663.13

TC99M MEDRONATE PER STUDY DOSE UP TO 30 MCI$140.97

NM HEPATOBILIARY IMG INCL GALLBLADDER$1,525.45

Observation

OBSERVATION ROOM HOURLY $57.37

OBSERVATION INITIAL ASSESSMENT $57.37

OBSERVATION TELEMETRY 1HR $81.46

OBSERVATION 1HR $349.67












OBSERVATION 13HR $1,011.86



�42










Occupational Therapy

EVAL ORAL & PHARYNGEAL SWALLOW 92610$352.80

DYSPHAGIA THERAPY 92526 $235.46

PARAFFIN BATH 97018 $115.83

THER EXERCISE EA 15 MIN 97110 $108.11

ORTHOTICS MGMT&TRAIN INITIAL 15MIN 97760$95.07

SLFCR HOME MGMT TRN15MIN 97535 $113.64

COMM WORK REINTGR EA15MIN97537 $121.62

HOT COLD PACKS $98.34

VASOPNEUMATIC DVC APPL 97016 $93.36

OT EVAL LOW COMPLEXITY 97165 $249.83

OT EVAL MODERATE COMPLEXITY 97166 $255.23

OT EVAL HIGH COMPLEXITY 97167 $260.64

OT RE-EVAL EST PLAN CARE 97168 $253.38

Operating Room

SURG INS NT CENT CVA >5 $2,068.76

BX LIVER NEEDLE BIOPSY $1,097.09

SURG BIOP LIVER NEEDLE PERCUT $1,097.09

ABD HYSTERECTOMY BSO $449.11

APPENDECTOMY $5,808.93

BREAST BIOPSY $903.68

�43

TONSILLECTOMY $3,078.22

MD 45005 I & D ABCESS RECTUM $1,584.46

SECRETIN STIMULATION $125.66

FLEX SIG DIAG $1,012.95

Physical Therapy

TENS APPLICATION 64550 $95.07

TRACTION MECHANICAL 97012 $100.53

ULTRASOUND 15 MIN 97035 $95.07

THER EXERCISE EA 15 MIN 97110 $108.11

NEUROMUSC RE ED EA 15MIN 97112 $126.53

GAIT TRAINING 15 MIN 97116 $103.81

MASSAGE 15 MIN 97124 $95.07

MANUAL THERAPY 15 MIN 97140 $111.02

THER ACTIVITES EA15 MIN 97530 $112.88

TX RM WND NEG PRESS UTILIZ DME <= 50SQCM 97605$128.75

TENS SETUP 64550 $95.07

WHLCHR MGMT 15 MIN 97542 $130.73

VASOPNEUMATIC DVC APPL 97016 $93.36

TX RM DEBR WUND TIS ADDL 20SQCM97598$195.70

WORK COND INIT 2HR 97545 $120.20

PHYS PERF TST MSRE-15MIN 97750 $349.67

TX RM APPL MULTI-LAYER COMPRESS SYS LWR LEG$211.56

MOBILITY CURRENT STATUS $0.01

MOBILITY GOAL STATUS $0.01

MOBILITY D C STATUS $0.01

BODY POS CURRENT STATUS $0.01

BODY POS GOAL STATUS $0.01

BODY POS D C STATUS $0.01

CARRY CURRENT STATUS $0.01

CARRY GOAL STATUS $0.01

CARRY D C STATUS $0.01

�44

SELF-CARE CURRENT STATUS $0.01

SELF-CARE GOAL STATUS $0.01

SELF-CARE D C STATUS $0.01

OTHER PT OT CURRENT STATUS $0.01

OTHER PT OT GOAL STATUS $0.01

OTHER PT OT D C STATUS $0.01

SUB PT OT CURRENT STATUS $0.01

SUB PT OT GOAL STATUS $0.01

SUB PT OT D. C STATUS $0.01

STRAPPING OF HIP $112.55

STRAPPING OF KNEE $112.55

STRAPPING OF ANKLE FOOT $112.55

PT EVAL LOW COMPLEXITY 97161 $254.15

PT EVAL MODERATE COMPLEXITY 97162 $259.56

PT EVAL HIGH COMPLEXITY 97163 $252.35

PT RE-EVAL EST PLAN CARE 97164 $201.16

Radiology

CT ORBIT SELLA FOSSA EAR WO THEN W CONTRAST$2,200.00

CT LUMBAR SPINE W CONT $1,708.00

RAD EXAM AC JOINTS BILAT W WO WTS $337.65

RAD EXAM ANKLE MIN 3 VWS $297.22

RAD EXAM ANKLE 2 VWS $239.31

RAD EXAM SPINE CERV 6 + VWS $587.88

RAD EXAM SPINE CERV 4 OR 5 VWS $485.17

RAD EXAM SPINE CERV 2 OR 3 VWS $360.60

RAD S&I CHOLANGIO AND OR PANCREATO INTRAOP$731.30

RAD EXAM CLAVICLE COMPL $270.99

RAD EXAM SPINE THOR MIN 4 VWS $475.33

RAD EXAM SPINE THOR 3 VWS $438.18

RAD EXAM ELBOW COMPL MIN 3 VWS $297.22

RAD EXAM ELBOW 2 VWS $250.24

�45

RAD EXAM FACIAL BONES COMPL MIN 3 VWS$359.51

RAD EXAM FINGER(S) MIN 2 VWS $237.13

RAD EXAM FOOT MIN 3 VWS $309.24

RAD EXAM FOOT 2 VWS $235.84

RAD EXAM FOREARM 2 VWS $257.88

RAD EXAM HAND MIN 3 VWS $297.22

RAD EXAM HAND 2 VWS $205.43

RAD EXAM CALCANEUS MIN 2 VWS $237.13

RAD EXAM HUMERUS MIN 2 VWS $297.22

RAD UROGRAPHY IV W WO KUB W WO TOMO$802.06

RAD EXAM KNEE 1 OR 2 VWS $297.22

RAD EXAM KNEE COMPL 4 + VWS $375.90

RAD EXAM KNEE BOTH STANDING ANTEROPOSTERIOR$296.13

PFT SCREEN SPIROMETRY (WITH BD) $381.92

RAD EXAM OSSEOUS SURVEY LTD $540.90

RAD EXAM SPINE LUMB 2 OR 3 VWS $402.12

RAD EXAM SPINE LUMB MIN 4 VWS $466.59

RAD EXAM MANDIBLE COMPL MIN 4 VWS$502.65

RAD EXAM OSSEOUS SURVEY COMPL $545.90

RAD EXAM NASAL BONES COMPL MIN 3 VWS$359.51

RAD EXAM NECK SOFT TISSUE $238.22

RAD EXAM OPTIC FORAMINA COMPL MIN 4 VWS$471.57

RAD ORTHOPANTOGRAM $268.81

RAD EXAM SINUSES PARANASAL COMPL MIN 3 VWS$394.47

RAD EXAM PELVIS 1 OR 2 VWS $297.22

RAD EXAM RIBS UNILAT W CHEST MIN 3 VWS$437.09

RAD EXAM RIBS BILAT W CHEST MIN 4 VWS$507.03

RAD EXAM SACROILIAC JNTS 3 + VWS $402.12

RAD EXAM SACRUM COCCYX MIN 2 VWS $297.22

RAD EXAM SCAPULA COMPL $332.19

RAD EXAM SHOULDER 1 VW $246.95

RAD EXAM SHOULDER COMPL MIN 2 VWS$298.32

�46

RAD EXAM SINUSES PARANASAL < 3 VWS$268.81

RAD EXAM SKULL COMPL MIN 4 VWS $526.69

RAD EXAM SKULL < 4 VWS $336.56

RAD EXAM SMALL INTESTINE INCL MULT SER IMG$249.15

RAD EXAM SPINE SINGLE VW $142.06

RAD EXAM STERNUM MIN 2 VWS $297.22

RAD EXAM TIBIA FIBULA 2 VWS $297.22

RAD EXAM TOES MIN 2 VWS $237.13

RAD EXAM UPPER EXTREM INFANT MIN 2 VWS$257.88

RAD EXAM WRIST 2 VWS $261.17

RAD EXAM WRIST COMPL MIN 3 VWS $284.10

PFT SCREEN SPIROMETRY (NO BD) $167.19

DUP CAROTID BILAT $853.42

DUPLEX VENOUS EXT LTD UNILAT $668.28

RAD EXAM RIBS UNILAT 2 VWS $351.86

RAD EXAM PELVIS COMPL MIN 3 VWS $442.55

RAD EXAM SPINE THOR 2 VWS $401.03

BONE DENSITY DEXA AXIAL SKELET $647.98

RAD EXAM KNEE 3 VWS $296.57

RAD EXAM RIBS BILAT 3 VWS $449.11

CT THORACIC SPINE W CONTRAST $1,831.00

RAD EXAM EYE FOREIGN BODY $297.22

RAD EXAM MANDIBLE PARTIAL < 4 VWS $466.59

RAD EXAM FACIAL BONES < 3 VWS $297.22

RAD EXAM SPINE THORACOLUMBAR JUNC MIN 2 VWS$401.03

RAD EXAM SPINE LUMB BENDING VWS ONLY 2 OR 3 VWS$402.12

RAD EXAM ABDOMEN COMPL ACUTE ABD SINGL CHEST$560.57

RAD EXAM NOSE TO RECTUM FB SNGL VW CHILD$248.99

RAD EXAM SACROILIAC JNTS < 3 VWS $286.30

RAD EXAM SPINE ENTIRE THOR LUMB 1 VW$401.03

RAD EXAM SPINE ENTIRE THOR LUMB 2 OR 3 VWS$426.78

RAD EXAM SPINE ENTIRE THOR LUMB 4 OR 5 VWS$452.53

�47

RAD EXAM SPINE ENTIRE THOR LUMB 6 + VWS$478.28

RAD EXAM HIP UNILAT W PELV WHEN PERF 1 VW$258.01

RAD EXAM HIP UNILAT W PELV WHEN PERF 2 OR 3 VWS$300.30

RAD EXAM HIP UNILAT W PELV WHEN PERF MIN 4 VWS$312.08

RAD EXAM HIPS BILAT W PELV WHEN PERF 2 VWS$382.46

RAD EXAM HIPS BILAT W PELV WHEN PERF 3 OR 4 VWS$408.21

RAD EXAM HIPS BILAT W PELV WHEN PERF MIN 5 VWS$433.96

RAD EXAM FEMUR 1 VW $290.67

RAD EXAM FEMUR MIN 2 VWS $290.67

RAD EXAM ABDOMEN 2 VWS $449.11

Speech Therapy

DYSPHAGIA THERAPY 92526 $235.46

COGNITIVE TEST STNDRD HR 96125 $297.05

SWALLOW DYSFUNCTN TREAT $115.83

SWALLOW CURRENT STATUS $0.01

SWALLOW GOAL STATUS $0.01

SWALLOW D C STATUS $0.01

MOTOR SPEECH CURRENT STATUS $0.01

MOTOR SPEECH GOAL STATUS $0.01

MOTOR SPEECH D C STATUS $0.01

LANG COMP CURRENT STATUS $0.01

LANG COMP GOAL STATUS $0.01

LANG COMP D C STATUS $0.01

LANG EXPRESS CURRENT STATUS $0.01

LANG EXPRESS GOAL STATUS $0.01

LANG EXPRESS D C STATUS $0.01

ATTEN CURRENT STATUS $0.01

ATTEN GOAL STATUS $0.01

ATTEN D C STATUS $0.01

MEMORY CURRENT STATUS $0.01

MEMORY GOAL STATUS $0.01

�48

MEMORY D C STATUS $0.01

VOICE CURRENT STATUS $0.01

VOICE GOAL STATUS $0.01

VOICE D C STATUS $0.01

SPEECH LANG CURRENT STATUS $0.01

SPEECH LANG GOAL SATUS $0.01

SPEECH LANG D C STATUS $0.01

SPEECH EVAL FLUENCY 92521 $507.14

Swingbed

RESPITE ROOM & BOARD $213.09

SKILLED SWING ROOM & BRD SEMI $1,699.25

RESPITE ROOM & BOARD - LVL II $289.57

Ultrasound

US SOFT TISSUE HEAD NECK $477.52

US ABD COMPLETE $608.65

US ABD LIMITED $430.53

US RETROPERITONEUM $561.49

US RETROPERITONEUM LTD $401.70

US PREG UTER 1ST TRI SGL $552.92

US TRANSVAGINAL $492.42

US PELVIC COMPLETE $543.09

US SCROTUM $397.43

US LIMITED JNT REAL TIME W IMAGE DOC$450.88

COLOR FLOW VEL MAP $440.37

DUP CAROTID BILAT $853.42

DUPLEX VENOUS EXT CMPL BILAT $884.02

DUPLEX ABD PELVIS RETROPERITONEAL CMPL$868.61

DUPLEX ART LOWER EXT CMPL BILAT $605.00

DUPLEX ABD PELVIS RETROPERITONEAL LTD$626.99

US PELVIC LIMITED $363.88

�49

ECHO (2D) COMPLETE W DOPPLER & COLOR$1,972.37

US COMPLETE JNT REAL TIME W IMAGE DOC$503.93

DUPLEX ABD PELVIS RETROPERITONEAL CMPL$868.61

US ABD AORTA SCREEN AAA $375.19

�50

Documents

Price Transparency Kittson Healthcare Complete …...ED 96365 IV INFUS THER PROPH DIAG INITIAL UP TO 1HR$372.00 ED 96360 IV INFUS THERAPY HYDRATION FLUIDS INITIAL 31 MIN-1HR$500.00