Boulder City Hospital Last Updated: 07/07/2024 "De-Identified Minimum Reimbursement *Items and services that do not easily translate to an individual line are not included. " "De-Identified Maximum Reimbursement *Items and services that do not easily translate to an individual line are not included. " Aetna - Medicare Aetna Anthem Blue Cross Blue Shield - Indemnity; Traditional; PAR/PPO Anthem Blue Cross Blue Shield - HMO; Pathway PPO/HMO Networks; Pathway X HMO/PPO Networks Anthem Medicaid Cigna Managed Care Coalition-Health Services Humana - Medicare Advantage (Choicecare) Humana - Commerical MultiPlan One Health Saint Mary's Health Plans Sierra Healthcare Options HPN Medicaid Sierra/HPN Southpoint (Gaughan South) Teachers Trust TriWest United Healthcare UHN-Universal Health Network PPO Select Health P3 Health Partners Blue Cross Blue Shield Medicare Alignment Medicare Silversummit Medicare Optum Medicare Self-Pay Charge Code Department Billing Description CPT Code HCPCS Code Rev Code Gross Charge Inpatient Outpatient Professional Inpatient Outpatient Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. Outpatient Professional Inpatient: paid at a per day rate. All other hospital services are included in payment (excluding MRI and CT). Outpatient Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. Outpatient Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. Outpatient Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. Outpatient Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. Outpatient Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. Outpatient Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. Outpatient Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. Outpatient: Emergency paid at 70% of billed charge with a max of $2313. Observation paid at 70% of charge with a max of $1850 Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. Outpatient Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. Outpatient: Emergency paid at 55% of billed charge with a max of $3300. Observation paid at 55% of charge with a max of $3300. PT/OT/ST is $200 per visit total. Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. Excluding MRI and CT " Outpatient: Paid at 70% of charge, not to exceed $3710 for Emergency, Therapy, Radiology, Lab and Misc outpatinet services. Observation paid at 70% of charge not to exceed $1300. Same day surgery paid at 65% of charges not to exceed $4770. " Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. " Outpatient: Paid at 70% of charge, not to exceed $1400, excluding same day surgery. " Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. Outpatient Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. " Outpatient: Paid at 60% of charge, not to exceed $2250, excluding same day surgery. " Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. Outpatient Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. " Outpatient: Emergency 68% of charge not to exceed $3581. Observation $100 per/hr not to exceed $2387. General Radiology 65% of charge not to exceed $2387, excluding Emergency " Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. Outpatient Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. Outpatient Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. Excluding MRI and CT " Outpatient: 70% of charge not to exceed $$5913.18 for Emergency, Observation, Therapy, Radiology, Lab and Misc Outpatient Services. Same Day Surgery 65% of charge not to exceed $7602.66 " Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. Outpatient Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. Outpatient Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. Outpatient Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. Outpatient Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. Outpatient Professional Inpatient: paid at a per day rate. All other hospital services are included in payment. Outpatient Professional Inpatient Outpatient Professional 4180008 Cardiac/Cardiac Rehab Charges 93005 EKG TRACING ONLY CHARGE 93005 730 $723.00 $- $6.96 $- $- $578.40 $- N/A $187.98 N/A N/A $273.29 N/A N/A $433.80 N/A N/A $361.50 N/A N/A $6.96 N/A N/A $491.64 N/A N/A $426.57 N/A N/A $281.97 N/A N/A $506.10 N/A N/A $578.40 N/A N/A $397.65 N/A N/A $506.10 N/A N/A $242.21 N/A N/A $6.96 N/A N/A $433.80 N/A N/A $253.05 N/A N/A $469.95 N/A N/A $216.90 N/A N/A $433.80 N/A N/A $506.10 N/A N/A $216.90 N/A N/A $216.90 N/A N/A $216.90 N/A N/A $216.90 N/A N/A $216.90 N/A N/A $216.90 N/A $723.00 $723.00 N/A 4180008 Cardiac/Cardiac Rehab Charges 93005 EKG TRACING ONLY CHARGE 93005 730 $723.00 $- $6.96 $- $- $578.40 $- N/A $187.98 N/A N/A $273.29 N/A N/A $433.80 N/A N/A $361.50 N/A N/A $6.96 N/A N/A $491.64 N/A N/A $426.57 N/A N/A $281.97 N/A N/A $506.10 N/A N/A $578.40 N/A N/A $397.65 N/A N/A $506.10 N/A N/A $242.21 N/A N/A $6.96 N/A N/A $433.80 N/A N/A $253.05 N/A N/A $469.95 N/A N/A $216.90 N/A N/A $433.80 N/A N/A $506.10 N/A N/A $216.90 N/A N/A $216.90 N/A N/A $216.90 N/A N/A $216.90 N/A N/A $216.90 N/A N/A $216.90 N/A $723.00 $723.00 N/A 3230047 Critical Care "96360 - Hydration, first hour" 96360 260 "$1,098.00 " $- $47.80 $- $- $878.40 $- N/A $285.48 N/A N/A $415.04 N/A N/A $658.80 N/A N/A $549.00 N/A N/A $47.80 N/A N/A $746.64 N/A N/A $647.82 N/A N/A $428.22 N/A N/A $768.60 N/A N/A $878.40 N/A N/A $603.90 N/A N/A $768.60 N/A N/A $367.83 N/A N/A $47.80 N/A N/A $658.80 N/A N/A $384.30 N/A N/A $746.64 N/A N/A $329.40 N/A N/A $658.80 N/A N/A $768.60 N/A N/A $329.40 N/A N/A $329.40 N/A N/A $329.40 N/A N/A $329.40 N/A N/A $329.40 N/A N/A $329.40 N/A "$1,098.00 " "$1,098.00 " N/A 3230053 Critical Care "96374 - IV Injection, single/initial" 96374 260 $289.00 $- $47.18 $- $- $231.20 $- N/A $75.14 N/A N/A $109.24 N/A N/A $173.40 N/A N/A $144.50 N/A N/A $47.18 N/A N/A $196.52 N/A N/A $170.51 N/A N/A $112.71 N/A N/A $202.30 N/A N/A $231.20 N/A N/A $158.95 N/A N/A $202.30 N/A N/A $96.82 N/A N/A $47.18 N/A N/A $173.40 N/A N/A $101.15 N/A N/A $196.52 N/A N/A $86.70 N/A N/A $173.40 N/A N/A $202.30 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A $289.00 $289.00 N/A 3230054 Critical Care "96375 - IV Injection, add new drug" 96375 260 $289.00 $- $18.59 $- $- $231.20 $- N/A $75.14 N/A N/A $109.24 N/A N/A $173.40 N/A N/A $144.50 N/A N/A $18.59 N/A N/A $196.52 N/A N/A $170.51 N/A N/A $112.71 N/A N/A $202.30 N/A N/A $231.20 N/A N/A $158.95 N/A N/A $202.30 N/A N/A $96.82 N/A N/A $18.59 N/A N/A $173.40 N/A N/A $101.15 N/A N/A $196.52 N/A N/A $86.70 N/A N/A $173.40 N/A N/A $202.30 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A $289.00 $289.00 N/A 3230094 Critical Care "96365 - IV tx, first hour" 96365 260 $823.00 $- $57.70 $- $- $658.40 $- N/A $213.98 N/A N/A $311.09 N/A N/A $493.80 N/A N/A $411.50 N/A N/A $57.70 N/A N/A $559.64 N/A N/A $485.57 N/A N/A $320.97 N/A N/A $576.10 N/A N/A $658.40 N/A N/A $452.65 N/A N/A $576.10 N/A N/A $275.71 N/A N/A $57.70 N/A N/A $493.80 N/A N/A $288.05 N/A N/A $559.64 N/A N/A $246.90 N/A N/A $493.80 N/A N/A $576.10 N/A N/A $246.90 N/A N/A $246.90 N/A N/A $246.90 N/A N/A $246.90 N/A N/A $246.90 N/A N/A $246.90 N/A $823.00 $823.00 N/A 3236366 Critical Care "96366 - IV tx, each additional hour" 96366 260 $316.00 $- $15.44 $- $- $252.80 $- N/A $82.16 N/A N/A $119.45 N/A N/A $189.60 N/A N/A $158.00 N/A N/A $15.44 N/A N/A $214.88 N/A N/A $186.44 N/A N/A $123.24 N/A N/A $221.20 N/A N/A $252.80 N/A N/A $173.80 N/A N/A $221.20 N/A N/A $105.86 N/A N/A $15.44 N/A N/A $189.60 N/A N/A $110.60 N/A N/A $214.88 N/A N/A $94.80 N/A N/A $189.60 N/A N/A $221.20 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A $316.00 $316.00 N/A 3450135 Dialysis Charges 90945 DIALYSIS ONE EVAL CHARGE 90945 800 "$2,431.00 " $- $632.06 $- $- "$1,944.80 " $- N/A $632.06 N/A N/A $918.92 N/A N/A "$1,458.60 " N/A N/A "$1,215.50 " N/A N/A N/A N/A N/A "$1,653.08 " N/A N/A "$1,434.29 " N/A N/A $948.09 N/A N/A "$1,701.70 " N/A N/A "$1,944.80 " N/A N/A "$1,337.05 " N/A N/A "$1,701.70 " N/A N/A $814.39 N/A N/A N/A N/A N/A "$1,458.60 " N/A N/A $850.85 N/A N/A "$1,580.15 " N/A N/A $729.30 N/A N/A "$1,458.60 " N/A N/A "$1,701.70 " N/A N/A $729.30 N/A N/A $729.30 N/A N/A $729.30 N/A N/A $729.30 N/A N/A $729.30 N/A N/A $729.30 N/A "$2,431.00 " "$2,431.00 " N/A 3450160 Dialysis Charges 90935 HEMODIALYSIS ONE EVAL CHARGE 90935 800 "$1,888.00 " $- $490.88 $- $- "$1,510.40 " $- N/A $490.88 N/A N/A $713.66 N/A N/A "$1,132.80 " N/A N/A $944.00 N/A N/A N/A N/A N/A "$1,283.84 " N/A N/A "$1,113.92 " N/A N/A $736.32 N/A N/A "$1,321.60 " N/A N/A "$1,510.40 " N/A N/A "$1,038.40 " N/A N/A "$1,321.60 " N/A N/A $632.48 N/A N/A N/A N/A N/A "$1,132.80 " N/A N/A $660.80 N/A N/A "$1,227.20 " N/A N/A $566.40 N/A N/A "$1,132.80 " N/A N/A "$1,321.60 " N/A N/A $566.40 N/A N/A $566.40 N/A N/A $566.40 N/A N/A $566.40 N/A N/A $566.40 N/A N/A $566.40 N/A "$1,888.00 " "$1,888.00 " N/A 3230047 Emer Charges IV HYDRATION INFUSIUON 31 96360 260 "$1,098.00 " $- $47.80 $- $- $878.40 $- N/A $285.48 N/A N/A Included in ER case rate N/A N/A $658.80 N/A N/A $549.00 N/A N/A $47.80 N/A N/A $746.64 N/A N/A $647.82 N/A N/A $428.22 N/A N/A $768.60 N/A N/A $878.40 N/A N/A $603.90 N/A N/A $768.60 N/A N/A $367.83 N/A N/A $47.80 N/A N/A $658.80 N/A N/A $384.30 N/A N/A $746.64 N/A N/A $329.40 N/A N/A $658.80 N/A N/A $768.60 N/A N/A $329.40 N/A N/A $329.40 N/A N/A $329.40 N/A N/A $329.40 N/A N/A $329.40 N/A N/A $329.40 N/A "$1,098.00 " "$1,098.00 " N/A 3230053 Emer Charges IV PUSH SGL/INITIAL USE D 96374 260 $289.00 $- $47.18 $- $- $231.20 $- N/A $75.14 N/A N/A Included in ER case rate N/A N/A $173.40 N/A N/A $144.50 N/A N/A $47.18 N/A N/A $196.52 N/A N/A $170.51 N/A N/A $112.71 N/A N/A $202.30 N/A N/A $231.20 N/A N/A $158.95 N/A N/A $202.30 N/A N/A $96.82 N/A N/A $47.18 N/A N/A $173.40 N/A N/A $101.15 N/A N/A $196.52 N/A N/A $86.70 N/A N/A $173.40 N/A N/A $202.30 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A $289.00 $289.00 N/A 3230054 Emer Charges "EA. ADDL SEQ IV PUSH, DIF" 96375 260 $289.00 $- $18.59 $- $- $231.20 $- N/A $75.14 N/A N/A Included in ER case rate N/A N/A $173.40 N/A N/A $144.50 N/A N/A $18.59 N/A N/A $196.52 N/A N/A $170.51 N/A N/A $112.71 N/A N/A $202.30 N/A N/A $231.20 N/A N/A $158.95 N/A N/A $202.30 N/A N/A $96.82 N/A N/A $18.59 N/A N/A $173.40 N/A N/A $101.15 N/A N/A $196.52 N/A N/A $86.70 N/A N/A $173.40 N/A N/A $202.30 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A $289.00 $289.00 N/A 3230094 Emer Charges INITIAL IVPB UNDER 60 MIN 96365 260 $823.00 $- $57.70 $- $- $658.40 $- N/A $213.98 N/A N/A Included in ER case rate N/A N/A $493.80 N/A N/A $411.50 N/A N/A $57.70 N/A N/A $559.64 N/A N/A $485.57 N/A N/A $320.97 N/A N/A $576.10 N/A N/A $658.40 N/A N/A $452.65 N/A N/A $576.10 N/A N/A $275.71 N/A N/A $57.70 N/A N/A $493.80 N/A N/A $288.05 N/A N/A $559.64 N/A N/A $246.90 N/A N/A $493.80 N/A N/A $576.10 N/A N/A $246.90 N/A N/A $246.90 N/A N/A $246.90 N/A N/A $246.90 N/A N/A $246.90 N/A N/A $246.90 N/A $823.00 $823.00 N/A 3230095 Emer Charges 36569 PICC LINE AGE 5 YRS OR OLDER ED CHARGE 36569 450 "$4,391.00 " $- $82.34 $- $- "$3,512.80 " $- N/A "$1,141.66 " N/A N/A Included in ER case rate N/A N/A "$2,634.60 " N/A N/A "$2,195.50 " N/A N/A $82.34 N/A N/A "$2,985.88 " N/A N/A "$2,590.69 " N/A N/A "$1,712.49 " N/A N/A "$3,073.70 " N/A N/A "$3,512.80 " N/A N/A "$2,415.05 " N/A N/A "$3,073.70 " N/A N/A "$1,470.99 " N/A N/A $82.34 N/A N/A "$2,634.60 " N/A N/A "$1,536.85 " N/A N/A "$2,985.88 " N/A N/A "$1,317.30 " N/A N/A "$2,634.60 " N/A N/A "$3,073.70 " N/A N/A "$1,317.30 " N/A N/A "$1,317.30 " N/A N/A "$1,317.30 " N/A N/A "$1,317.30 " N/A N/A "$1,317.30 " N/A N/A "$1,317.30 " N/A "$4,391.00 " "$4,391.00 " N/A 3230109 Emer Charges 32554 THORACENTESIS W/O IMAGING 32554 450 "$2,018.00 " $- $80.41 $- $- "$1,614.40 " $- N/A $524.68 N/A N/A Included in ER case rate N/A N/A "$1,210.80 " N/A N/A "$1,009.00 " N/A N/A $80.41 N/A N/A "$1,372.24 " N/A N/A "$1,190.62 " N/A N/A $787.02 N/A N/A "$1,412.60 " N/A N/A "$1,614.40 " N/A N/A "$1,109.90 " N/A N/A "$1,412.60 " N/A N/A $676.03 N/A N/A $80.41 N/A N/A "$1,210.80 " N/A N/A $706.30 N/A N/A "$1,372.24 " N/A N/A $605.40 N/A N/A "$1,210.80 " N/A N/A "$1,412.60 " N/A N/A $605.40 N/A N/A $605.40 N/A N/A $605.40 N/A N/A $605.40 N/A N/A $605.40 N/A N/A $605.40 N/A "$2,018.00 " "$2,018.00 " N/A 3230112 Emer Charges 11760 ED REPAIR OF NAIL BED CHARGE 11760 450 $591.00 $- $119.23 $- $- $472.80 $- N/A $153.66 N/A N/A Included in ER case rate N/A N/A $354.60 N/A N/A $295.50 N/A N/A $119.23 N/A N/A $401.88 N/A N/A $348.69 N/A N/A $230.49 N/A N/A $413.70 N/A N/A $472.80 N/A N/A $325.05 N/A N/A $413.70 N/A N/A $197.99 N/A N/A $119.23 N/A N/A $354.60 N/A N/A $206.85 N/A N/A $401.88 N/A N/A $177.30 N/A N/A $354.60 N/A N/A $413.70 N/A N/A $177.30 N/A N/A $177.30 N/A N/A $177.30 N/A N/A $177.30 N/A N/A $177.30 N/A N/A $177.30 N/A $591.00 $591.00 N/A 3230560 Emer Charges IMMUNIZATION ADMIN ER 90471 771 $171.00 $- $20.89 $- $- $136.80 $- N/A $44.46 N/A N/A Included in ER case rate N/A N/A $102.60 N/A N/A $85.50 N/A N/A $20.89 N/A N/A $116.28 N/A N/A $100.89 N/A N/A $66.69 N/A N/A $119.70 N/A N/A $136.80 N/A N/A $94.05 N/A N/A $119.70 N/A N/A $57.29 N/A N/A $20.89 N/A N/A $102.60 N/A N/A $59.85 N/A N/A $116.28 N/A N/A $51.30 N/A N/A $102.60 N/A N/A $119.70 N/A N/A $51.30 N/A N/A $51.30 N/A N/A $51.30 N/A N/A $51.30 N/A N/A $51.30 N/A N/A $51.30 N/A $171.00 $171.00 N/A 3232103 Emer Charges 69210 CERUMEN REMOVAL 69210 450 $281.00 $- $29.49 $- $- $224.80 $- N/A $73.06 N/A N/A Included in ER case rate N/A N/A $168.60 N/A N/A $140.50 N/A N/A $29.49 N/A N/A $191.08 N/A N/A $165.79 N/A N/A $109.59 N/A N/A $196.70 N/A N/A $224.80 N/A N/A $154.55 N/A N/A $196.70 N/A N/A $94.14 N/A N/A $29.49 N/A N/A $168.60 N/A N/A $98.35 N/A N/A $191.08 N/A N/A $84.30 N/A N/A $168.60 N/A N/A $196.70 N/A N/A $84.30 N/A N/A $84.30 N/A N/A $84.30 N/A N/A $84.30 N/A N/A $84.30 N/A N/A $84.30 N/A $281.00 $281.00 N/A 3233349 Emer Charges 46320 ENUC/EXC EXT THROMBOTIC HEMORR ED CHARGE 46320 450 "$5,476.00 " $- $99.77 $- $- "$4,380.80 " $- N/A "$1,423.76 " N/A N/A Included in ER case rate N/A N/A "$3,285.60 " N/A N/A "$2,738.00 " N/A N/A $99.77 N/A N/A "$3,723.68 " N/A N/A "$3,230.84 " N/A N/A "$2,135.64 " N/A N/A "$3,833.20 " N/A N/A "$4,380.80 " N/A N/A "$3,011.80 " N/A N/A "$3,833.20 " N/A N/A "$1,834.46 " N/A N/A $99.77 N/A N/A "$3,285.60 " N/A N/A "$1,916.60 " N/A N/A "$3,723.68 " N/A N/A "$1,642.80 " N/A N/A "$3,285.60 " N/A N/A "$3,833.20 " N/A N/A "$1,642.80 " N/A N/A "$1,642.80 " N/A N/A "$1,642.80 " N/A N/A "$1,642.80 " N/A N/A "$1,642.80 " N/A N/A "$1,642.80 " N/A "$5,476.00 " "$5,476.00 " N/A 3235503 Emer Charges 27550 CLO TX KNEE DISLOC WO ANE 27550 450 $872.00 $- $226.72 $- $- $697.60 $- N/A $226.72 N/A N/A Included in ER case rate N/A N/A $523.20 N/A N/A $436.00 N/A N/A $419.35 N/A N/A $592.96 N/A N/A $514.48 N/A N/A $340.08 N/A N/A $610.40 N/A N/A $697.60 N/A N/A $479.60 N/A N/A $610.40 N/A N/A $292.12 N/A N/A $419.35 N/A N/A $523.20 N/A N/A $305.20 N/A N/A $592.96 N/A N/A $261.60 N/A N/A $523.20 N/A N/A $610.40 N/A N/A $261.60 N/A N/A $261.60 N/A N/A $261.60 N/A N/A $261.60 N/A N/A $261.60 N/A N/A $261.60 N/A $872.00 $872.00 N/A 3236365 Emer Charges OUT PATIENT IV THERAPY 1S 96365 260 $764.00 $- $57.70 $- $- $611.20 $- N/A $198.64 N/A N/A Included in ER case rate N/A N/A $458.40 N/A N/A $382.00 N/A N/A $57.70 N/A N/A $519.52 N/A N/A $450.76 N/A N/A $297.96 N/A N/A $534.80 N/A N/A $611.20 N/A N/A $420.20 N/A N/A $534.80 N/A N/A $255.94 N/A N/A $57.70 N/A N/A $458.40 N/A N/A $267.40 N/A N/A $519.52 N/A N/A $229.20 N/A N/A $458.40 N/A N/A $534.80 N/A N/A $229.20 N/A N/A $229.20 N/A N/A $229.20 N/A N/A $229.20 N/A N/A $229.20 N/A N/A $229.20 N/A $764.00 $764.00 N/A 3236366 Emer Charges ADDL DRUG INFUSION 96366 260 $316.00 $- $15.44 $- $- $252.80 $- N/A $82.16 N/A N/A Included in ER case rate N/A N/A $189.60 N/A N/A $158.00 N/A N/A $15.44 N/A N/A $214.88 N/A N/A $186.44 N/A N/A $123.24 N/A N/A $221.20 N/A N/A $252.80 N/A N/A $173.80 N/A N/A $221.20 N/A N/A $105.86 N/A N/A $15.44 N/A N/A $189.60 N/A N/A $110.60 N/A N/A $214.88 N/A N/A $94.80 N/A N/A $189.60 N/A N/A $221.20 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A $316.00 $316.00 N/A 3236430 Emer Charges TRANSFUSION BLOOD PR 36430 391 "$1,418.00 " $- $30.40 $- $- "$1,134.40 " $- N/A $368.68 N/A N/A Included in ER case rate N/A N/A $850.80 N/A N/A $709.00 N/A N/A $30.40 N/A N/A $964.24 N/A N/A $836.62 N/A N/A $553.02 N/A N/A $992.60 N/A N/A "$1,134.40 " N/A N/A $779.90 N/A N/A $992.60 N/A N/A $475.03 N/A N/A $30.40 N/A N/A $850.80 N/A N/A $496.30 N/A N/A $964.24 N/A N/A $425.40 N/A N/A $850.80 N/A N/A $992.60 N/A N/A $425.40 N/A N/A $425.40 N/A N/A $425.40 N/A N/A $425.40 N/A N/A $425.40 N/A N/A $425.40 N/A "$1,418.00 " "$1,418.00 " N/A 3237510 Emer Charges 11765 ED WEDGE EXCISION SKIN OF NAIL FOLD CHARGE 11765 450 "$1,581.00 " $- $82.87 $- $- "$1,264.80 " $- N/A $411.06 N/A N/A Included in ER case rate N/A N/A $948.60 N/A N/A $790.50 N/A N/A $82.87 N/A N/A "$1,075.08 " N/A N/A $932.79 N/A N/A $616.59 N/A N/A "$1,106.70 " N/A N/A "$1,264.80 " N/A N/A $869.55 N/A N/A "$1,106.70 " N/A N/A $529.64 N/A N/A $82.87 N/A N/A $948.60 N/A N/A $553.35 N/A N/A "$1,075.08 " N/A N/A $474.30 N/A N/A $948.60 N/A N/A "$1,106.70 " N/A N/A $474.30 N/A N/A $474.30 N/A N/A $474.30 N/A N/A $474.30 N/A N/A $474.30 N/A N/A $474.30 N/A "$1,581.00 " "$1,581.00 " N/A 3238001 Emer Charges 10080 ED ID PILONIDAL CYST SIMPLE CHARGE 10080 450 $811.00 $- $91.98 $- $- $648.80 $- N/A $210.86 N/A N/A Included in ER case rate N/A N/A $486.60 N/A N/A $405.50 N/A N/A $91.98 N/A N/A $551.48 N/A N/A $478.49 N/A N/A $316.29 N/A N/A $567.70 N/A N/A $648.80 N/A N/A $446.05 N/A N/A $567.70 N/A N/A $271.69 N/A N/A $91.98 N/A N/A $486.60 N/A N/A $283.85 N/A N/A $551.48 N/A N/A $243.30 N/A N/A $486.60 N/A N/A $567.70 N/A N/A $243.30 N/A N/A $243.30 N/A N/A $243.30 N/A N/A $243.30 N/A N/A $243.30 N/A N/A $243.30 N/A $811.00 $811.00 N/A 24453382 Emer Charges INJ SINGLE TENDON SHEATH/LIGAMENT 20550 450 "$2,952.00 " $- $36.95 $- $- "$2,361.60 " $- N/A $767.52 N/A N/A Included in ER case rate N/A N/A "$1,771.20 " N/A N/A "$1,476.00 " N/A N/A $36.95 N/A N/A "$2,007.36 " N/A N/A "$1,741.68 " N/A N/A "$1,151.28 " N/A N/A "$2,066.40 " N/A N/A "$2,361.60 " N/A N/A "$1,623.60 " N/A N/A "$2,066.40 " N/A N/A $988.92 N/A N/A $36.95 N/A N/A "$1,771.20 " N/A N/A "$1,033.20 " N/A N/A "$2,007.36 " N/A N/A $885.60 N/A N/A "$1,771.20 " N/A N/A "$2,066.40 " N/A N/A $885.60 N/A N/A $885.60 N/A N/A $885.60 N/A N/A $885.60 N/A N/A $885.60 N/A N/A $885.60 N/A "$2,952.00 " "$2,952.00 " N/A 24453387 Emer Charges EXC BENIGN LESION W/MARGINS EXCEPT SKIN TAG-SCALP-NECK-HAND 11421 450 "$2,337.00 " $- $98.33 $- $- "$1,869.60 " $- N/A $607.62 N/A N/A Included in ER case rate N/A N/A "$1,402.20 " N/A N/A "$1,168.50 " N/A N/A $98.33 N/A N/A "$1,589.16 " N/A N/A "$1,378.83 " N/A N/A $911.43 N/A N/A "$1,635.90 " N/A N/A "$1,869.60 " N/A N/A "$1,285.35 " N/A N/A "$1,635.90 " N/A N/A $782.90 N/A N/A $98.33 N/A N/A "$1,402.20 " N/A N/A $817.95 N/A N/A "$1,589.16 " N/A N/A $701.10 N/A N/A "$1,402.20 " N/A N/A "$1,635.90 " N/A N/A $701.10 N/A N/A $701.10 N/A N/A $701.10 N/A N/A $701.10 N/A N/A $701.10 N/A N/A $701.10 N/A "$2,337.00 " "$2,337.00 " N/A 45069209 Emer Charges UNILATERAL REMOVAL OF IMPACTED EAR WAX BY LAVAGE 69209 450 $281.00 $- $11.45 $- $- $224.80 $- N/A $73.06 N/A N/A Included in ER case rate N/A N/A $168.60 N/A N/A $140.50 N/A N/A $11.45 N/A N/A $191.08 N/A N/A $165.79 N/A N/A $109.59 N/A N/A $196.70 N/A N/A $224.80 N/A N/A $154.55 N/A N/A $196.70 N/A N/A $94.14 N/A N/A $11.45 N/A N/A $168.60 N/A N/A $98.35 N/A N/A $191.08 N/A N/A $84.30 N/A N/A $168.60 N/A N/A $196.70 N/A N/A $84.30 N/A N/A $84.30 N/A N/A $84.30 N/A N/A $84.30 N/A N/A $84.30 N/A N/A $84.30 N/A $281.00 $281.00 N/A 99203 Evaluation and Management Office/New Patient-Detailed (30) 99203 521 $241.94 $- $62.90 $- $- $193.55 $- N/A $62.90 N/A N/A $91.45 N/A N/A $145.16 N/A N/A $120.97 N/A N/A $66.63 N/A N/A $164.52 N/A N/A $142.74 N/A N/A $94.36 N/A N/A $169.36 N/A N/A $193.55 N/A N/A $133.07 N/A N/A $169.36 N/A N/A $81.05 N/A N/A $66.63 N/A N/A $145.16 N/A N/A $84.68 N/A N/A $157.26 N/A N/A $72.58 N/A N/A $145.16 N/A N/A $169.36 N/A N/A $72.58 N/A N/A $72.58 N/A N/A $72.58 N/A N/A $72.58 N/A N/A $72.58 N/A N/A $72.58 N/A $241.94 $241.94 N/A 99204 Evaluation and Management Office/New Patient-Comprehensive (45) 99204 521 $369.29 $- $96.02 $- $- $295.43 $- N/A $96.02 N/A N/A $139.59 N/A N/A $221.57 N/A N/A $184.65 N/A N/A $114.04 N/A N/A $251.12 N/A N/A $217.88 N/A N/A $144.02 N/A N/A $258.50 N/A N/A $295.43 N/A N/A $203.11 N/A N/A $258.50 N/A N/A $123.71 N/A N/A $114.04 N/A N/A $221.57 N/A N/A $129.25 N/A N/A $240.04 N/A N/A $110.79 N/A N/A $221.57 N/A N/A $258.50 N/A N/A $110.79 N/A N/A $110.79 N/A N/A $110.79 N/A N/A $110.79 N/A N/A $110.79 N/A N/A $110.79 N/A $369.29 $369.29 N/A 99205 Evaluation and Management Office/New Patient-Comprehensive/High Complexity (60) 99205 521 $382.02 $- $99.33 $- $- $305.62 $- N/A $99.33 N/A N/A $144.40 N/A N/A $229.21 N/A N/A $191.01 N/A N/A $147.10 N/A N/A $259.77 N/A N/A $225.39 N/A N/A $148.99 N/A N/A $267.41 N/A N/A $305.62 N/A N/A $210.11 N/A N/A $267.41 N/A N/A $127.98 N/A N/A $147.10 N/A N/A $229.21 N/A N/A $133.71 N/A N/A $248.31 N/A N/A $114.61 N/A N/A $229.21 N/A N/A $267.41 N/A N/A $114.61 N/A N/A $114.61 N/A N/A $114.61 N/A N/A $114.61 N/A N/A $114.61 N/A N/A $114.61 N/A $382.02 $382.02 N/A 99212 Evaluation and Management Office/Established Patient-Focused (10) 99212 521 $151.55 $- $21.98 $- $- $121.24 $- N/A $39.40 N/A N/A $57.29 N/A N/A $90.93 N/A N/A $75.78 N/A N/A $21.98 N/A N/A $103.05 N/A N/A $89.41 N/A N/A $59.10 N/A N/A $106.09 N/A N/A $121.24 N/A N/A $83.35 N/A N/A $106.09 N/A N/A $50.77 N/A N/A $21.98 N/A N/A $90.93 N/A N/A $53.04 N/A N/A $98.51 N/A N/A $45.47 N/A N/A $90.93 N/A N/A $106.09 N/A N/A $45.47 N/A N/A $45.47 N/A N/A $45.47 N/A N/A $45.47 N/A N/A $45.47 N/A N/A $45.47 N/A $151.55 $151.55 N/A 99213 Evaluation and Management Office/Established Patient-Expanded (15) 99213 521 $181.74 $- $44.57 $- $- $145.39 $- N/A $47.25 N/A N/A $68.70 N/A N/A $109.04 N/A N/A $90.87 N/A N/A $44.57 N/A N/A $123.58 N/A N/A $107.23 N/A N/A $70.88 N/A N/A $127.22 N/A N/A $145.39 N/A N/A $99.96 N/A N/A $127.22 N/A N/A $60.88 N/A N/A $44.57 N/A N/A $109.04 N/A N/A $63.61 N/A N/A $118.13 N/A N/A $54.52 N/A N/A $109.04 N/A N/A $127.22 N/A N/A $54.52 N/A N/A $54.52 N/A N/A $54.52 N/A N/A $54.52 N/A N/A $54.52 N/A N/A $54.52 N/A $181.74 $181.74 N/A 99214 Evaluation and Management Office/Established Patient-Detailed (25) 99214 521 $252.37 $- $65.62 $- $- $201.90 $- N/A $65.62 N/A N/A $95.40 N/A N/A $151.42 N/A N/A $126.19 N/A N/A $68.37 N/A N/A $171.61 N/A N/A $148.90 N/A N/A $98.42 N/A N/A $176.66 N/A N/A $201.90 N/A N/A $138.80 N/A N/A $176.66 N/A N/A $84.54 N/A N/A $68.37 N/A N/A $151.42 N/A N/A $88.33 N/A N/A $164.04 N/A N/A $75.71 N/A N/A $151.42 N/A N/A $176.66 N/A N/A $75.71 N/A N/A $75.71 N/A N/A $75.71 N/A N/A $75.71 N/A N/A $75.71 N/A N/A $75.71 N/A $252.37 $252.37 N/A 99215 Evaluation and Management Office/Established Patient-Comprehensive/High Complexity (45 99215 521 $286.65 $- $74.53 $- $- $229.32 $- N/A $74.53 N/A N/A $108.35 N/A N/A $171.99 N/A N/A $143.33 N/A N/A $96.20 N/A N/A $194.92 N/A N/A $169.12 N/A N/A $111.79 N/A N/A $200.66 N/A N/A $229.32 N/A N/A $157.66 N/A N/A $200.66 N/A N/A $96.03 N/A N/A $96.20 N/A N/A $171.99 N/A N/A $100.33 N/A N/A $186.32 N/A N/A $86.00 N/A N/A $171.99 N/A N/A $200.66 N/A N/A $86.00 N/A N/A $86.00 N/A N/A $86.00 N/A N/A $86.00 N/A N/A $86.00 N/A N/A $86.00 N/A $286.65 $286.65 N/A 1000615 General Lab Cardio IQ Lipid Panel QLS 80061 301 $261.00 $- $8.60 $- $- $208.80 $- N/A $67.86 N/A N/A $14.36 N/A N/A $156.60 N/A N/A $130.50 N/A N/A $8.60 N/A N/A $177.48 N/A N/A $127.89 N/A N/A $101.79 N/A N/A $182.70 N/A N/A $208.80 N/A N/A $143.55 N/A N/A $182.70 N/A N/A $87.44 N/A N/A $8.60 N/A N/A $156.60 N/A N/A $91.35 N/A N/A $169.65 N/A N/A $78.30 N/A N/A $156.60 N/A N/A $182.70 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A $261.00 $261.00 N/A 1000615 General Lab Cardio IQ® Lipid Panel w/ Reflex to Direct LDL QST 80061 301 $261.00 $- $8.60 $- $- $208.80 $- N/A $67.86 N/A N/A $14.36 N/A N/A $156.60 N/A N/A $130.50 N/A N/A $8.60 N/A N/A $177.48 N/A N/A $127.89 N/A N/A $101.79 N/A N/A $182.70 N/A N/A $208.80 N/A N/A $143.55 N/A N/A $182.70 N/A N/A $87.44 N/A N/A $8.60 N/A N/A $156.60 N/A N/A $91.35 N/A N/A $169.65 N/A N/A $78.30 N/A N/A $156.60 N/A N/A $182.70 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A $261.00 $261.00 N/A 1000651 General Lab "PSA, Total w/ Rflx to PSA, FREE QST" 84153 G0103 301 $292.00 $- $11.80 $- $- $233.60 $- N/A $75.92 N/A N/A $19.73 N/A N/A $175.20 N/A N/A $146.00 N/A N/A $11.80 N/A N/A $198.56 N/A N/A $143.08 N/A N/A $113.88 N/A N/A $204.40 N/A N/A $233.60 N/A N/A $160.60 N/A N/A $204.40 N/A N/A $97.82 N/A N/A $11.80 N/A N/A $175.20 N/A N/A $102.20 N/A N/A $189.80 N/A N/A $87.60 N/A N/A $175.20 N/A N/A $204.40 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A $292.00 $292.00 N/A 1000651 General Lab "Prostate Specific Antigen (PSA), Total w/Reflex to Free QLS" 84153 G0103 301 $292.00 $- $11.80 $- $- $233.60 $- N/A $75.92 N/A N/A $19.73 N/A N/A $175.20 N/A N/A $146.00 N/A N/A $11.80 N/A N/A $198.56 N/A N/A $143.08 N/A N/A $113.88 N/A N/A $204.40 N/A N/A $233.60 N/A N/A $160.60 N/A N/A $204.40 N/A N/A $97.82 N/A N/A $11.80 N/A N/A $175.20 N/A N/A $102.20 N/A N/A $189.80 N/A N/A $87.60 N/A N/A $175.20 N/A N/A $204.40 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A $292.00 $292.00 N/A 4000002 General Lab UA Complete 1 81003 307 $44.00 $- $1.44 $- $- $35.20 $- N/A $11.44 N/A N/A $2.41 N/A N/A $26.40 N/A N/A $22.00 N/A N/A $1.44 N/A N/A $29.92 N/A N/A $21.56 N/A N/A $17.16 N/A N/A $30.80 N/A N/A $35.20 N/A N/A $24.20 N/A N/A $30.80 N/A N/A $14.74 N/A N/A $1.44 N/A N/A $26.40 N/A N/A $15.40 N/A N/A $28.60 N/A N/A $13.20 N/A N/A $26.40 N/A N/A $30.80 N/A N/A $13.20 N/A N/A $13.20 N/A N/A $13.20 N/A N/A $13.20 N/A N/A $13.20 N/A N/A $13.20 N/A $44.00 $44.00 N/A 4000002 General Lab UA Complete 2 81003 307 $44.00 $- $1.44 $- $- $35.20 $- N/A $11.44 N/A N/A $2.41 N/A N/A $26.40 N/A N/A $22.00 N/A N/A $1.44 N/A N/A $29.92 N/A N/A $21.56 N/A N/A $17.16 N/A N/A $30.80 N/A N/A $35.20 N/A N/A $24.20 N/A N/A $30.80 N/A N/A $14.74 N/A N/A $1.44 N/A N/A $26.40 N/A N/A $15.40 N/A N/A $28.60 N/A N/A $13.20 N/A N/A $26.40 N/A N/A $30.80 N/A N/A $13.20 N/A N/A $13.20 N/A N/A $13.20 N/A N/A $13.20 N/A N/A $13.20 N/A N/A $13.20 N/A $44.00 $44.00 N/A 4000002 General Lab UA Complete w/ Culture if indicated 81001 307 $44.00 $- $2.04 $- $- $35.20 $- N/A $11.44 N/A N/A $3.40 N/A N/A $26.40 N/A N/A $22.00 N/A N/A $2.04 N/A N/A $29.92 N/A N/A $21.56 N/A N/A $17.16 N/A N/A $30.80 N/A N/A $35.20 N/A N/A $24.20 N/A N/A $30.80 N/A N/A $14.74 N/A N/A $2.04 N/A N/A $26.40 N/A N/A $15.40 N/A N/A $28.60 N/A N/A $13.20 N/A N/A $26.40 N/A N/A $30.80 N/A N/A $13.20 N/A N/A $13.20 N/A N/A $13.20 N/A N/A $13.20 N/A N/A $13.20 N/A N/A $13.20 N/A $44.00 $44.00 N/A 4000002 General Lab UA Complete 81003 307 $44.00 $- $1.44 $- $- $35.20 $- N/A $11.44 N/A N/A $2.41 N/A N/A $26.40 N/A N/A $22.00 N/A N/A $1.44 N/A N/A $29.92 N/A N/A $21.56 N/A N/A $17.16 N/A N/A $30.80 N/A N/A $35.20 N/A N/A $24.20 N/A N/A $30.80 N/A N/A $14.74 N/A N/A $1.44 N/A N/A $26.40 N/A N/A $15.40 N/A N/A $28.60 N/A N/A $13.20 N/A N/A $26.40 N/A N/A $30.80 N/A N/A $13.20 N/A N/A $13.20 N/A N/A $13.20 N/A N/A $13.20 N/A N/A $13.20 N/A N/A $13.20 N/A $44.00 $44.00 N/A 4000002 General Lab UA Complete 81003 307 $44.00 $- $1.44 $- $- $35.20 $- N/A $11.44 N/A N/A $2.41 N/A N/A $26.40 N/A N/A $22.00 N/A N/A $1.44 N/A N/A $29.92 N/A N/A $21.56 N/A N/A $17.16 N/A N/A $30.80 N/A N/A $35.20 N/A N/A $24.20 N/A N/A $30.80 N/A N/A $14.74 N/A N/A $1.44 N/A N/A $26.40 N/A N/A $15.40 N/A N/A $28.60 N/A N/A $13.20 N/A N/A $26.40 N/A N/A $30.80 N/A N/A $13.20 N/A N/A $13.20 N/A N/A $13.20 N/A N/A $13.20 N/A N/A $13.20 N/A N/A $13.20 N/A $44.00 $44.00 N/A 4000003 General Lab "Uric Acid, Synovial Fluid QST" 84550 301 $86.00 $- $2.90 $- $- $68.80 $- N/A $22.36 N/A N/A $4.85 N/A N/A $51.60 N/A N/A $43.00 N/A N/A $2.90 N/A N/A $58.48 N/A N/A $42.14 N/A N/A $33.54 N/A N/A $60.20 N/A N/A $68.80 N/A N/A $47.30 N/A N/A $60.20 N/A N/A $28.81 N/A N/A $2.90 N/A N/A $51.60 N/A N/A $30.10 N/A N/A $55.90 N/A N/A $25.80 N/A N/A $51.60 N/A N/A $60.20 N/A N/A $25.80 N/A N/A $25.80 N/A N/A $25.80 N/A N/A $25.80 N/A N/A $25.80 N/A N/A $25.80 N/A $86.00 $86.00 N/A 4000003 General Lab "Uric Acid, Synovial Fluid QLS" 301 $86.00 $- $22.36 $- $- $68.80 $- N/A $22.36 N/A N/A N/A N/A $51.60 N/A N/A $43.00 N/A N/A N/A N/A N/A $58.48 N/A N/A $42.14 N/A N/A $33.54 N/A N/A $60.20 N/A N/A $68.80 N/A N/A $47.30 N/A N/A $60.20 N/A N/A $28.81 N/A N/A N/A N/A N/A $51.60 N/A N/A $30.10 N/A N/A $55.90 N/A N/A $25.80 N/A N/A $51.60 N/A N/A $60.20 N/A N/A $25.80 N/A N/A $25.80 N/A N/A $25.80 N/A N/A $25.80 N/A N/A $25.80 N/A N/A $25.80 N/A $86.00 $86.00 N/A 4000037 General Lab Electrolyte Panel QST 80051 300 $130.00 $- $4.51 $- $- $104.00 $- N/A $33.80 N/A N/A $7.52 N/A N/A $78.00 N/A N/A $65.00 N/A N/A $4.51 N/A N/A $88.40 N/A N/A $63.70 N/A N/A $50.70 N/A N/A $91.00 N/A N/A $104.00 N/A N/A $71.50 N/A N/A $91.00 N/A N/A $43.55 N/A N/A $4.51 N/A N/A $78.00 N/A N/A $45.50 N/A N/A $84.50 N/A N/A $39.00 N/A N/A $78.00 N/A N/A $91.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A $130.00 $130.00 N/A 4000037 General Lab Electrolytes 80051 300 $130.00 $- $4.51 $- $- $104.00 $- N/A $33.80 N/A N/A $7.52 N/A N/A $78.00 N/A N/A $65.00 N/A N/A $4.51 N/A N/A $88.40 N/A N/A $63.70 N/A N/A $50.70 N/A N/A $91.00 N/A N/A $104.00 N/A N/A $71.50 N/A N/A $91.00 N/A N/A $43.55 N/A N/A $4.51 N/A N/A $78.00 N/A N/A $45.50 N/A N/A $84.50 N/A N/A $39.00 N/A N/A $78.00 N/A N/A $91.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A $130.00 $130.00 N/A 4000061 General Lab Basic Metabolic Panel 9 80048 301 $167.00 $- $5.43 $- $- $133.60 $- N/A $43.42 N/A N/A $9.07 N/A N/A $100.20 N/A N/A $83.50 N/A N/A $5.43 N/A N/A $113.56 N/A N/A $81.83 N/A N/A $65.13 N/A N/A $116.90 N/A N/A $133.60 N/A N/A $91.85 N/A N/A $116.90 N/A N/A $55.95 N/A N/A $5.43 N/A N/A $100.20 N/A N/A $58.45 N/A N/A $108.55 N/A N/A $50.10 N/A N/A $100.20 N/A N/A $116.90 N/A N/A $50.10 N/A N/A $50.10 N/A N/A $50.10 N/A N/A $50.10 N/A N/A $50.10 N/A N/A $50.10 N/A $167.00 $167.00 N/A 4000061 General Lab Basic Metabolic 982 QLS 80048 301 $167.00 $- $5.43 $- $- $133.60 $- N/A $43.42 N/A N/A $9.07 N/A N/A $100.20 N/A N/A $83.50 N/A N/A $5.43 N/A N/A $113.56 N/A N/A $81.83 N/A N/A $65.13 N/A N/A $116.90 N/A N/A $133.60 N/A N/A $91.85 N/A N/A $116.90 N/A N/A $55.95 N/A N/A $5.43 N/A N/A $100.20 N/A N/A $58.45 N/A N/A $108.55 N/A N/A $50.10 N/A N/A $100.20 N/A N/A $116.90 N/A N/A $50.10 N/A N/A $50.10 N/A N/A $50.10 N/A N/A $50.10 N/A N/A $50.10 N/A N/A $50.10 N/A $167.00 $167.00 N/A 4000061 General Lab Basic Metabolic Panel QST 80048 301 $167.00 $- $5.43 $- $- $133.60 $- N/A $43.42 N/A N/A $9.07 N/A N/A $100.20 N/A N/A $83.50 N/A N/A $5.43 N/A N/A $113.56 N/A N/A $81.83 N/A N/A $65.13 N/A N/A $116.90 N/A N/A $133.60 N/A N/A $91.85 N/A N/A $116.90 N/A N/A $55.95 N/A N/A $5.43 N/A N/A $100.20 N/A N/A $58.45 N/A N/A $108.55 N/A N/A $50.10 N/A N/A $100.20 N/A N/A $116.90 N/A N/A $50.10 N/A N/A $50.10 N/A N/A $50.10 N/A N/A $50.10 N/A N/A $50.10 N/A N/A $50.10 N/A $167.00 $167.00 N/A 4000180 General Lab Hemoglobin 85018 305 $47.00 $- $1.53 $- $- $37.60 $- N/A $12.22 N/A N/A $2.54 N/A N/A $28.20 N/A N/A $23.50 N/A N/A $1.53 N/A N/A $31.96 N/A N/A $23.03 N/A N/A $18.33 N/A N/A $32.90 N/A N/A $37.60 N/A N/A $25.85 N/A N/A $32.90 N/A N/A $15.75 N/A N/A $1.53 N/A N/A $28.20 N/A N/A $16.45 N/A N/A $30.55 N/A N/A $14.10 N/A N/A $28.20 N/A N/A $32.90 N/A N/A $14.10 N/A N/A $14.10 N/A N/A $14.10 N/A N/A $14.10 N/A N/A $14.10 N/A N/A $14.10 N/A $47.00 $47.00 N/A 4000180 General Lab Hemoglobin 85018 305 $47.00 $- $1.53 $- $- $37.60 $- N/A $12.22 N/A N/A $2.54 N/A N/A $28.20 N/A N/A $23.50 N/A N/A $1.53 N/A N/A $31.96 N/A N/A $23.03 N/A N/A $18.33 N/A N/A $32.90 N/A N/A $37.60 N/A N/A $25.85 N/A N/A $32.90 N/A N/A $15.75 N/A N/A $1.53 N/A N/A $28.20 N/A N/A $16.45 N/A N/A $30.55 N/A N/A $14.10 N/A N/A $28.20 N/A N/A $32.90 N/A N/A $14.10 N/A N/A $14.10 N/A N/A $14.10 N/A N/A $14.10 N/A N/A $14.10 N/A N/A $14.10 N/A $47.00 $47.00 N/A 4000180 General Lab Hemoglobin QST 85018 305 $47.00 $- $1.53 $- $- $37.60 $- N/A $12.22 N/A N/A $2.54 N/A N/A $28.20 N/A N/A $23.50 N/A N/A $1.53 N/A N/A $31.96 N/A N/A $23.03 N/A N/A $18.33 N/A N/A $32.90 N/A N/A $37.60 N/A N/A $25.85 N/A N/A $32.90 N/A N/A $15.75 N/A N/A $1.53 N/A N/A $28.20 N/A N/A $16.45 N/A N/A $30.55 N/A N/A $14.10 N/A N/A $28.20 N/A N/A $32.90 N/A N/A $14.10 N/A N/A $14.10 N/A N/A $14.10 N/A N/A $14.10 N/A N/A $14.10 N/A N/A $14.10 N/A $47.00 $47.00 N/A 4000194 General Lab Comprehensive Metabolic Panel 12 80053 301 $830.00 $- $6.78 $- $- $664.00 $- N/A $215.80 N/A N/A $11.33 N/A N/A $498.00 N/A N/A $415.00 N/A N/A $6.78 N/A N/A $564.40 N/A N/A $406.70 N/A N/A $323.70 N/A N/A $581.00 N/A N/A $664.00 N/A N/A $456.50 N/A N/A $581.00 N/A N/A $278.05 N/A N/A $6.78 N/A N/A $498.00 N/A N/A $290.50 N/A N/A $539.50 N/A N/A $249.00 N/A N/A $498.00 N/A N/A $581.00 N/A N/A $249.00 N/A N/A $249.00 N/A N/A $249.00 N/A N/A $249.00 N/A N/A $249.00 N/A N/A $249.00 N/A $830.00 $830.00 N/A 4000207 General Lab Chromogranin A QST 86316 302 $565.00 $- $13.35 $- $- $452.00 $- N/A $146.90 N/A N/A $22.32 N/A N/A $339.00 N/A N/A $282.50 N/A N/A $13.35 N/A N/A $384.20 N/A N/A $276.85 N/A N/A $220.35 N/A N/A $395.50 N/A N/A $452.00 N/A N/A $310.75 N/A N/A $395.50 N/A N/A $189.28 N/A N/A $13.35 N/A N/A $339.00 N/A N/A $197.75 N/A N/A $367.25 N/A N/A $169.50 N/A N/A $339.00 N/A N/A $395.50 N/A N/A $169.50 N/A N/A $169.50 N/A N/A $169.50 N/A N/A $169.50 N/A N/A $169.50 N/A N/A $169.50 N/A $565.00 $565.00 N/A 4000207 General Lab "Chromogranin A, Electrochemiluminescence QLS" 86316 302 $565.00 $- $13.35 $- $- $452.00 $- N/A $146.90 N/A N/A $22.32 N/A N/A $339.00 N/A N/A $282.50 N/A N/A $13.35 N/A N/A $384.20 N/A N/A $276.85 N/A N/A $220.35 N/A N/A $395.50 N/A N/A $452.00 N/A N/A $310.75 N/A N/A $395.50 N/A N/A $189.28 N/A N/A $13.35 N/A N/A $339.00 N/A N/A $197.75 N/A N/A $367.25 N/A N/A $169.50 N/A N/A $339.00 N/A N/A $395.50 N/A N/A $169.50 N/A N/A $169.50 N/A N/A $169.50 N/A N/A $169.50 N/A N/A $169.50 N/A N/A $169.50 N/A $565.00 $565.00 N/A 4000222 General Lab CBC w/ Auto Diff 6 85027 305 $264.00 $- $4.16 $- $- $211.20 $- N/A $68.64 N/A N/A $6.94 N/A N/A $158.40 N/A N/A $132.00 N/A N/A $4.16 N/A N/A $179.52 N/A N/A $129.36 N/A N/A $102.96 N/A N/A $184.80 N/A N/A $211.20 N/A N/A $145.20 N/A N/A $184.80 N/A N/A $88.44 N/A N/A $4.16 N/A N/A $158.40 N/A N/A $92.40 N/A N/A $171.60 N/A N/A $79.20 N/A N/A $158.40 N/A N/A $184.80 N/A N/A $79.20 N/A N/A $79.20 N/A N/A $79.20 N/A N/A $79.20 N/A N/A $79.20 N/A N/A $79.20 N/A $264.00 $264.00 N/A 4000222 General Lab CBC w/ Auto Diff 10 85025 305 $264.00 $- $5.00 $- $- $211.20 $- N/A $68.64 N/A N/A $8.34 N/A N/A $158.40 N/A N/A $132.00 N/A N/A $5.00 N/A N/A $179.52 N/A N/A $129.36 N/A N/A $102.96 N/A N/A $184.80 N/A N/A $211.20 N/A N/A $145.20 N/A N/A $184.80 N/A N/A $88.44 N/A N/A $5.00 N/A N/A $158.40 N/A N/A $92.40 N/A N/A $171.60 N/A N/A $79.20 N/A N/A $158.40 N/A N/A $184.80 N/A N/A $79.20 N/A N/A $79.20 N/A N/A $79.20 N/A N/A $79.20 N/A N/A $79.20 N/A N/A $79.20 N/A $264.00 $264.00 N/A 4000232 General Lab Influenza B 87804 306 $84.00 $- $7.69 $- $- $67.20 $- N/A $21.84 N/A N/A $12.86 N/A N/A $50.40 N/A N/A $42.00 N/A N/A $7.69 N/A N/A $57.12 N/A N/A $41.16 N/A N/A $32.76 N/A N/A $58.80 N/A N/A $67.20 N/A N/A $46.20 N/A N/A $58.80 N/A N/A $28.14 N/A N/A $7.69 N/A N/A $50.40 N/A N/A $29.40 N/A N/A $54.60 N/A N/A $25.20 N/A N/A $50.40 N/A N/A $58.80 N/A N/A $25.20 N/A N/A $25.20 N/A N/A $25.20 N/A N/A $25.20 N/A N/A $25.20 N/A N/A $25.20 N/A $84.00 $84.00 N/A 4000233 General Lab Influenza A 87804 306 $84.00 $- $7.69 $- $- $67.20 $- N/A $21.84 N/A N/A $12.86 N/A N/A $50.40 N/A N/A $42.00 N/A N/A $7.69 N/A N/A $57.12 N/A N/A $41.16 N/A N/A $32.76 N/A N/A $58.80 N/A N/A $67.20 N/A N/A $46.20 N/A N/A $58.80 N/A N/A $28.14 N/A N/A $7.69 N/A N/A $50.40 N/A N/A $29.40 N/A N/A $54.60 N/A N/A $25.20 N/A N/A $50.40 N/A N/A $58.80 N/A N/A $25.20 N/A N/A $25.20 N/A N/A $25.20 N/A N/A $25.20 N/A N/A $25.20 N/A N/A $25.20 N/A $84.00 $84.00 N/A 4000233 General Lab Influenza A 87804 306 $84.00 $- $7.69 $- $- $67.20 $- N/A $21.84 N/A N/A $12.86 N/A N/A $50.40 N/A N/A $42.00 N/A N/A $7.69 N/A N/A $57.12 N/A N/A $41.16 N/A N/A $32.76 N/A N/A $58.80 N/A N/A $67.20 N/A N/A $46.20 N/A N/A $58.80 N/A N/A $28.14 N/A N/A $7.69 N/A N/A $50.40 N/A N/A $29.40 N/A N/A $54.60 N/A N/A $25.20 N/A N/A $50.40 N/A N/A $58.80 N/A N/A $25.20 N/A N/A $25.20 N/A N/A $25.20 N/A N/A $25.20 N/A N/A $25.20 N/A N/A $25.20 N/A $84.00 $84.00 N/A 4000273 General Lab "Norovirus, EIA, Stool QST" 87449 306 $196.00 $- $7.69 $- $- $156.80 $- N/A $50.96 N/A N/A $12.86 N/A N/A $117.60 N/A N/A $98.00 N/A N/A $7.69 N/A N/A $133.28 N/A N/A $96.04 N/A N/A $76.44 N/A N/A $137.20 N/A N/A $156.80 N/A N/A $107.80 N/A N/A $137.20 N/A N/A $65.66 N/A N/A $7.69 N/A N/A $117.60 N/A N/A $68.60 N/A N/A $127.40 N/A N/A $58.80 N/A N/A $117.60 N/A N/A $137.20 N/A N/A $58.80 N/A N/A $58.80 N/A N/A $58.80 N/A N/A $58.80 N/A N/A $58.80 N/A N/A $58.80 N/A $196.00 $196.00 N/A 4000273 General Lab "Norovirus, Stool QLS" 87449 306 $196.00 $- $7.69 $- $- $156.80 $- N/A $50.96 N/A N/A $12.86 N/A N/A $117.60 N/A N/A $98.00 N/A N/A $7.69 N/A N/A $133.28 N/A N/A $96.04 N/A N/A $76.44 N/A N/A $137.20 N/A N/A $156.80 N/A N/A $107.80 N/A N/A $137.20 N/A N/A $65.66 N/A N/A $7.69 N/A N/A $117.60 N/A N/A $68.60 N/A N/A $127.40 N/A N/A $58.80 N/A N/A $117.60 N/A N/A $137.20 N/A N/A $58.80 N/A N/A $58.80 N/A N/A $58.80 N/A N/A $58.80 N/A N/A $58.80 N/A N/A $58.80 N/A $196.00 $196.00 N/A 4000364 General Lab Hemoglobin A1c 83036 301 $237.00 $- $6.23 $- $- $189.60 $- N/A $61.62 N/A N/A $10.40 N/A N/A $142.20 N/A N/A $118.50 N/A N/A $6.23 N/A N/A $161.16 N/A N/A $116.13 N/A N/A $92.43 N/A N/A $165.90 N/A N/A $189.60 N/A N/A $130.35 N/A N/A $165.90 N/A N/A $79.40 N/A N/A $6.23 N/A N/A $142.20 N/A N/A $82.95 N/A N/A $154.05 N/A N/A $71.10 N/A N/A $142.20 N/A N/A $165.90 N/A N/A $71.10 N/A N/A $71.10 N/A N/A $71.10 N/A N/A $71.10 N/A N/A $71.10 N/A N/A $71.10 N/A $237.00 $237.00 N/A 4000364 General Lab Hemoglobin A1c QLS 83036 301 $237.00 $- $6.23 $- $- $189.60 $- N/A $61.62 N/A N/A $10.40 N/A N/A $142.20 N/A N/A $118.50 N/A N/A $6.23 N/A N/A $161.16 N/A N/A $116.13 N/A N/A $92.43 N/A N/A $165.90 N/A N/A $189.60 N/A N/A $130.35 N/A N/A $165.90 N/A N/A $79.40 N/A N/A $6.23 N/A N/A $142.20 N/A N/A $82.95 N/A N/A $154.05 N/A N/A $71.10 N/A N/A $142.20 N/A N/A $165.90 N/A N/A $71.10 N/A N/A $71.10 N/A N/A $71.10 N/A N/A $71.10 N/A N/A $71.10 N/A N/A $71.10 N/A $237.00 $237.00 N/A 4000364 General Lab Hemoglobin A1C QST 83036 301 $237.00 $- $6.23 $- $- $189.60 $- N/A $61.62 N/A N/A $10.40 N/A N/A $142.20 N/A N/A $118.50 N/A N/A $6.23 N/A N/A $161.16 N/A N/A $116.13 N/A N/A $92.43 N/A N/A $165.90 N/A N/A $189.60 N/A N/A $130.35 N/A N/A $165.90 N/A N/A $79.40 N/A N/A $6.23 N/A N/A $142.20 N/A N/A $82.95 N/A N/A $154.05 N/A N/A $71.10 N/A N/A $142.20 N/A N/A $165.90 N/A N/A $71.10 N/A N/A $71.10 N/A N/A $71.10 N/A N/A $71.10 N/A N/A $71.10 N/A N/A $71.10 N/A $237.00 $237.00 N/A 4000364 General Lab Glycohemoglobin 83036 301 $237.00 $- $6.23 $- $- $189.60 $- N/A $61.62 N/A N/A $10.40 N/A N/A $142.20 N/A N/A $118.50 N/A N/A $6.23 N/A N/A $161.16 N/A N/A $116.13 N/A N/A $92.43 N/A N/A $165.90 N/A N/A $189.60 N/A N/A $130.35 N/A N/A $165.90 N/A N/A $79.40 N/A N/A $6.23 N/A N/A $142.20 N/A N/A $82.95 N/A N/A $154.05 N/A N/A $71.10 N/A N/A $142.20 N/A N/A $165.90 N/A N/A $71.10 N/A N/A $71.10 N/A N/A $71.10 N/A N/A $71.10 N/A N/A $71.10 N/A N/A $71.10 N/A $237.00 $237.00 N/A 4000402 General Lab "Culture, Blood QST" 87040 306 $738.00 $- $6.63 $- $- $590.40 $- N/A $191.88 N/A N/A $11.06 N/A N/A $442.80 N/A N/A $369.00 N/A N/A $6.63 N/A N/A $501.84 N/A N/A $361.62 N/A N/A $287.82 N/A N/A $516.60 N/A N/A $590.40 N/A N/A $405.90 N/A N/A $516.60 N/A N/A $247.23 N/A N/A $6.63 N/A N/A $442.80 N/A N/A $258.30 N/A N/A $479.70 N/A N/A $221.40 N/A N/A $442.80 N/A N/A $516.60 N/A N/A $221.40 N/A N/A $221.40 N/A N/A $221.40 N/A N/A $221.40 N/A N/A $221.40 N/A N/A $221.40 N/A $738.00 $738.00 N/A 4000402 General Lab "Culture, Blood QLS" 87040 306 $738.00 $- $6.63 $- $- $590.40 $- N/A $191.88 N/A N/A $11.06 N/A N/A $442.80 N/A N/A $369.00 N/A N/A $6.63 N/A N/A $501.84 N/A N/A $361.62 N/A N/A $287.82 N/A N/A $516.60 N/A N/A $590.40 N/A N/A $405.90 N/A N/A $516.60 N/A N/A $247.23 N/A N/A $6.63 N/A N/A $442.80 N/A N/A $258.30 N/A N/A $479.70 N/A N/A $221.40 N/A N/A $442.80 N/A N/A $516.60 N/A N/A $221.40 N/A N/A $221.40 N/A N/A $221.40 N/A N/A $221.40 N/A N/A $221.40 N/A N/A $221.40 N/A $738.00 $738.00 N/A 4000407 General Lab Albumin Level 82040 301 $98.00 $- $3.18 $- $- $78.40 $- N/A $25.48 N/A N/A $5.30 N/A N/A $58.80 N/A N/A $49.00 N/A N/A $3.18 N/A N/A $66.64 N/A N/A $48.02 N/A N/A $38.22 N/A N/A $68.60 N/A N/A $78.40 N/A N/A $53.90 N/A N/A $68.60 N/A N/A $32.83 N/A N/A $3.18 N/A N/A $58.80 N/A N/A $34.30 N/A N/A $63.70 N/A N/A $29.40 N/A N/A $58.80 N/A N/A $68.60 N/A N/A $29.40 N/A N/A $29.40 N/A N/A $29.40 N/A N/A $29.40 N/A N/A $29.40 N/A N/A $29.40 N/A $98.00 $98.00 N/A 4000407 General Lab "Albumin, Serum QLS" 82040 301 $98.00 $- $3.18 $- $- $78.40 $- N/A $25.48 N/A N/A $5.30 N/A N/A $58.80 N/A N/A $49.00 N/A N/A $3.18 N/A N/A $66.64 N/A N/A $48.02 N/A N/A $38.22 N/A N/A $68.60 N/A N/A $78.40 N/A N/A $53.90 N/A N/A $68.60 N/A N/A $32.83 N/A N/A $3.18 N/A N/A $58.80 N/A N/A $34.30 N/A N/A $63.70 N/A N/A $29.40 N/A N/A $58.80 N/A N/A $68.60 N/A N/A $29.40 N/A N/A $29.40 N/A N/A $29.40 N/A N/A $29.40 N/A N/A $29.40 N/A N/A $29.40 N/A $98.00 $98.00 N/A 4000425 General Lab Renal Function Panel 80069 301 $365.00 $- $5.58 $- $- $292.00 $- N/A $94.90 N/A N/A $9.31 N/A N/A $219.00 N/A N/A $182.50 N/A N/A $5.58 N/A N/A $248.20 N/A N/A $178.85 N/A N/A $142.35 N/A N/A $255.50 N/A N/A $292.00 N/A N/A $200.75 N/A N/A $255.50 N/A N/A $122.28 N/A N/A $5.58 N/A N/A $219.00 N/A N/A $127.75 N/A N/A $237.25 N/A N/A $109.50 N/A N/A $219.00 N/A N/A $255.50 N/A N/A $109.50 N/A N/A $109.50 N/A N/A $109.50 N/A N/A $109.50 N/A N/A $109.50 N/A N/A $109.50 N/A $365.00 $365.00 N/A 4000425 General Lab Renal Function Panel QST 80069 301 $365.00 $- $5.58 $- $- $292.00 $- N/A $94.90 N/A N/A $9.31 N/A N/A $219.00 N/A N/A $182.50 N/A N/A $5.58 N/A N/A $248.20 N/A N/A $178.85 N/A N/A $142.35 N/A N/A $255.50 N/A N/A $292.00 N/A N/A $200.75 N/A N/A $255.50 N/A N/A $122.28 N/A N/A $5.58 N/A N/A $219.00 N/A N/A $127.75 N/A N/A $237.25 N/A N/A $109.50 N/A N/A $219.00 N/A N/A $255.50 N/A N/A $109.50 N/A N/A $109.50 N/A N/A $109.50 N/A N/A $109.50 N/A N/A $109.50 N/A N/A $109.50 N/A $365.00 $365.00 N/A 4000581 General Lab Hepatic Panel 1 80076 301 $160.00 $- $5.24 $- $- $128.00 $- N/A $41.60 N/A N/A $8.76 N/A N/A $96.00 N/A N/A $80.00 N/A N/A $5.24 N/A N/A $108.80 N/A N/A $78.40 N/A N/A $62.40 N/A N/A $112.00 N/A N/A $128.00 N/A N/A $88.00 N/A N/A $112.00 N/A N/A $53.60 N/A N/A $5.24 N/A N/A $96.00 N/A N/A $56.00 N/A N/A $104.00 N/A N/A $48.00 N/A N/A $96.00 N/A N/A $112.00 N/A N/A $48.00 N/A N/A $48.00 N/A N/A $48.00 N/A N/A $48.00 N/A N/A $48.00 N/A N/A $48.00 N/A $160.00 $160.00 N/A 4000615 General Lab Lipid Panel 3 80061 301 $261.00 $- $8.60 $- $- $208.80 $- N/A $67.86 N/A N/A $14.36 N/A N/A $156.60 N/A N/A $130.50 N/A N/A $8.60 N/A N/A $177.48 N/A N/A $127.89 N/A N/A $101.79 N/A N/A $182.70 N/A N/A $208.80 N/A N/A $143.55 N/A N/A $182.70 N/A N/A $87.44 N/A N/A $8.60 N/A N/A $156.60 N/A N/A $91.35 N/A N/A $169.65 N/A N/A $78.30 N/A N/A $156.60 N/A N/A $182.70 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A $261.00 $261.00 N/A 4000615 General Lab Lipid Profile 80061 301 $261.00 $- $8.60 $- $- $208.80 $- N/A $67.86 N/A N/A $14.36 N/A N/A $156.60 N/A N/A $130.50 N/A N/A $8.60 N/A N/A $177.48 N/A N/A $127.89 N/A N/A $101.79 N/A N/A $182.70 N/A N/A $208.80 N/A N/A $143.55 N/A N/A $182.70 N/A N/A $87.44 N/A N/A $8.60 N/A N/A $156.60 N/A N/A $91.35 N/A N/A $169.65 N/A N/A $78.30 N/A N/A $156.60 N/A N/A $182.70 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A $261.00 $261.00 N/A 4000651 General Lab PSA Screen 84153 G0103 301 $292.00 $- $11.80 $- $- $233.60 $- N/A $75.92 N/A N/A $19.73 N/A N/A $175.20 N/A N/A $146.00 N/A N/A $11.80 N/A N/A $198.56 N/A N/A $143.08 N/A N/A $113.88 N/A N/A $204.40 N/A N/A $233.60 N/A N/A $160.60 N/A N/A $204.40 N/A N/A $97.82 N/A N/A $11.80 N/A N/A $175.20 N/A N/A $102.20 N/A N/A $189.80 N/A N/A $87.60 N/A N/A $175.20 N/A N/A $204.40 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A $292.00 $292.00 N/A 4000857 General Lab "Culture, Urine QST" 87086 306 $301.00 $- $5.18 $- $- $240.80 $- N/A $78.26 N/A N/A $8.66 N/A N/A $180.60 N/A N/A $150.50 N/A N/A $5.18 N/A N/A $204.68 N/A N/A $147.49 N/A N/A $117.39 N/A N/A $210.70 N/A N/A $240.80 N/A N/A $165.55 N/A N/A $210.70 N/A N/A $100.84 N/A N/A $5.18 N/A N/A $180.60 N/A N/A $105.35 N/A N/A $195.65 N/A N/A $90.30 N/A N/A $180.60 N/A N/A $210.70 N/A N/A $90.30 N/A N/A $90.30 N/A N/A $90.30 N/A N/A $90.30 N/A N/A $90.30 N/A N/A $90.30 N/A $301.00 $301.00 N/A 4000857 General Lab "Culture, Urine, Routine QLS" 87086 306 $301.00 $- $5.18 $- $- $240.80 $- N/A $78.26 N/A N/A $8.66 N/A N/A $180.60 N/A N/A $150.50 N/A N/A $5.18 N/A N/A $204.68 N/A N/A $147.49 N/A N/A $117.39 N/A N/A $210.70 N/A N/A $240.80 N/A N/A $165.55 N/A N/A $210.70 N/A N/A $100.84 N/A N/A $5.18 N/A N/A $180.60 N/A N/A $105.35 N/A N/A $195.65 N/A N/A $90.30 N/A N/A $180.60 N/A N/A $210.70 N/A N/A $90.30 N/A N/A $90.30 N/A N/A $90.30 N/A N/A $90.30 N/A N/A $90.30 N/A N/A $90.30 N/A $301.00 $301.00 N/A 4001402 General Lab "C Reactive Protein, Quantitative QLS" 86140 302 $101.00 $- $3.32 $- $- $80.80 $- N/A $26.26 N/A N/A $5.54 N/A N/A $60.60 N/A N/A $50.50 N/A N/A $3.32 N/A N/A $68.68 N/A N/A $49.49 N/A N/A $39.39 N/A N/A $70.70 N/A N/A $80.80 N/A N/A $55.55 N/A N/A $70.70 N/A N/A $33.84 N/A N/A $3.32 N/A N/A $60.60 N/A N/A $35.35 N/A N/A $65.65 N/A N/A $30.30 N/A N/A $60.60 N/A N/A $70.70 N/A N/A $30.30 N/A N/A $30.30 N/A N/A $30.30 N/A N/A $30.30 N/A N/A $30.30 N/A N/A $30.30 N/A $101.00 $101.00 N/A 4001402 General Lab C-Reactive Protein QST 86140 302 $101.00 $- $3.32 $- $- $80.80 $- N/A $26.26 N/A N/A $5.54 N/A N/A $60.60 N/A N/A $50.50 N/A N/A $3.32 N/A N/A $68.68 N/A N/A $49.49 N/A N/A $39.39 N/A N/A $70.70 N/A N/A $80.80 N/A N/A $55.55 N/A N/A $70.70 N/A N/A $33.84 N/A N/A $3.32 N/A N/A $60.60 N/A N/A $35.35 N/A N/A $65.65 N/A N/A $30.30 N/A N/A $60.60 N/A N/A $70.70 N/A N/A $30.30 N/A N/A $30.30 N/A N/A $30.30 N/A N/A $30.30 N/A N/A $30.30 N/A N/A $30.30 N/A $101.00 $101.00 N/A 4001405 General Lab Ammonia Level 82140 301 $350.00 $- $9.35 $- $- $280.00 $- N/A $91.00 N/A N/A $15.62 N/A N/A $210.00 N/A N/A $175.00 N/A N/A $9.35 N/A N/A $238.00 N/A N/A $171.50 N/A N/A $136.50 N/A N/A $245.00 N/A N/A $280.00 N/A N/A $192.50 N/A N/A $245.00 N/A N/A $117.25 N/A N/A $9.35 N/A N/A $210.00 N/A N/A $122.50 N/A N/A $227.50 N/A N/A $105.00 N/A N/A $210.00 N/A N/A $245.00 N/A N/A $105.00 N/A N/A $105.00 N/A N/A $105.00 N/A N/A $105.00 N/A N/A $105.00 N/A N/A $105.00 N/A $350.00 $350.00 N/A 4001445 General Lab Progesterone Level QST 84144 301 $366.00 $- $13.38 $- $- $292.80 $- N/A $95.16 N/A N/A $22.37 N/A N/A $219.60 N/A N/A $183.00 N/A N/A $13.38 N/A N/A $248.88 N/A N/A $179.34 N/A N/A $142.74 N/A N/A $256.20 N/A N/A $292.80 N/A N/A $201.30 N/A N/A $256.20 N/A N/A $122.61 N/A N/A $13.38 N/A N/A $219.60 N/A N/A $128.10 N/A N/A $237.90 N/A N/A $109.80 N/A N/A $219.60 N/A N/A $256.20 N/A N/A $109.80 N/A N/A $109.80 N/A N/A $109.80 N/A N/A $109.80 N/A N/A $109.80 N/A N/A $109.80 N/A $366.00 $366.00 N/A 4001445 General Lab Progesterone QLS 84144 301 $366.00 $- $13.38 $- $- $292.80 $- N/A $95.16 N/A N/A $22.37 N/A N/A $219.60 N/A N/A $183.00 N/A N/A $13.38 N/A N/A $248.88 N/A N/A $179.34 N/A N/A $142.74 N/A N/A $256.20 N/A N/A $292.80 N/A N/A $201.30 N/A N/A $256.20 N/A N/A $122.61 N/A N/A $13.38 N/A N/A $219.60 N/A N/A $128.10 N/A N/A $237.90 N/A N/A $109.80 N/A N/A $219.60 N/A N/A $256.20 N/A N/A $109.80 N/A N/A $109.80 N/A N/A $109.80 N/A N/A $109.80 N/A N/A $109.80 N/A N/A $109.80 N/A $366.00 $366.00 N/A 4001445 General Lab "Progesterone, LC/MS QST" 84144 301 $366.00 $- $13.38 $- $- $292.80 $- N/A $95.16 N/A N/A $22.37 N/A N/A $219.60 N/A N/A $183.00 N/A N/A $13.38 N/A N/A $248.88 N/A N/A $179.34 N/A N/A $142.74 N/A N/A $256.20 N/A N/A $292.80 N/A N/A $201.30 N/A N/A $256.20 N/A N/A $122.61 N/A N/A $13.38 N/A N/A $219.60 N/A N/A $128.10 N/A N/A $237.90 N/A N/A $109.80 N/A N/A $219.60 N/A N/A $256.20 N/A N/A $109.80 N/A N/A $109.80 N/A N/A $109.80 N/A N/A $109.80 N/A N/A $109.80 N/A N/A $109.80 N/A $366.00 $366.00 N/A 4001493 General Lab CEA (Carcinoembryonic Antigen) QLS 82378 302 $366.00 $- $12.17 $- $- $292.80 $- N/A $95.16 N/A N/A $20.34 N/A N/A $219.60 N/A N/A $183.00 N/A N/A $12.17 N/A N/A $248.88 N/A N/A $179.34 N/A N/A $142.74 N/A N/A $256.20 N/A N/A $292.80 N/A N/A $201.30 N/A N/A $256.20 N/A N/A $122.61 N/A N/A $12.17 N/A N/A $219.60 N/A N/A $128.10 N/A N/A $237.90 N/A N/A $109.80 N/A N/A $219.60 N/A N/A $256.20 N/A N/A $109.80 N/A N/A $109.80 N/A N/A $109.80 N/A N/A $109.80 N/A N/A $109.80 N/A N/A $109.80 N/A $366.00 $366.00 N/A 4001493 General Lab Carcinoembryonic Antigen QST 82378 302 $366.00 $- $12.17 $- $- $292.80 $- N/A $95.16 N/A N/A $20.34 N/A N/A $219.60 N/A N/A $183.00 N/A N/A $12.17 N/A N/A $248.88 N/A N/A $179.34 N/A N/A $142.74 N/A N/A $256.20 N/A N/A $292.80 N/A N/A $201.30 N/A N/A $256.20 N/A N/A $122.61 N/A N/A $12.17 N/A N/A $219.60 N/A N/A $128.10 N/A N/A $237.90 N/A N/A $109.80 N/A N/A $219.60 N/A N/A $256.20 N/A N/A $109.80 N/A N/A $109.80 N/A N/A $109.80 N/A N/A $109.80 N/A N/A $109.80 N/A N/A $109.80 N/A $366.00 $366.00 N/A 4001504 General Lab Amylase Level 82150 301 $139.00 $- $4.16 $- $- $111.20 $- N/A $36.14 N/A N/A $6.95 N/A N/A $83.40 N/A N/A $69.50 N/A N/A $4.16 N/A N/A $94.52 N/A N/A $68.11 N/A N/A $54.21 N/A N/A $97.30 N/A N/A $111.20 N/A N/A $76.45 N/A N/A $97.30 N/A N/A $46.57 N/A N/A $4.16 N/A N/A $83.40 N/A N/A $48.65 N/A N/A $90.35 N/A N/A $41.70 N/A N/A $83.40 N/A N/A $97.30 N/A N/A $41.70 N/A N/A $41.70 N/A N/A $41.70 N/A N/A $41.70 N/A N/A $41.70 N/A N/A $41.70 N/A $139.00 $139.00 N/A 4001504 General Lab Amylase QLS 82150 301 $139.00 $- $4.16 $- $- $111.20 $- N/A $36.14 N/A N/A $6.95 N/A N/A $83.40 N/A N/A $69.50 N/A N/A $4.16 N/A N/A $94.52 N/A N/A $68.11 N/A N/A $54.21 N/A N/A $97.30 N/A N/A $111.20 N/A N/A $76.45 N/A N/A $97.30 N/A N/A $46.57 N/A N/A $4.16 N/A N/A $83.40 N/A N/A $48.65 N/A N/A $90.35 N/A N/A $41.70 N/A N/A $83.40 N/A N/A $97.30 N/A N/A $41.70 N/A N/A $41.70 N/A N/A $41.70 N/A N/A $41.70 N/A N/A $41.70 N/A N/A $41.70 N/A $139.00 $139.00 N/A 4001743 General Lab PSA (Free and Total) QST 84153 G0103 301 $170.00 $- $11.80 $- $- $136.00 $- N/A $44.20 N/A N/A $19.73 N/A N/A $102.00 N/A N/A $85.00 N/A N/A $11.80 N/A N/A $115.60 N/A N/A $83.30 N/A N/A $66.30 N/A N/A $119.00 N/A N/A $136.00 N/A N/A $93.50 N/A N/A $119.00 N/A N/A $56.95 N/A N/A $11.80 N/A N/A $102.00 N/A N/A $59.50 N/A N/A $110.50 N/A N/A $51.00 N/A N/A $102.00 N/A N/A $119.00 N/A N/A $51.00 N/A N/A $51.00 N/A N/A $51.00 N/A N/A $51.00 N/A N/A $51.00 N/A N/A $51.00 N/A $170.00 $170.00 N/A 4001743 General Lab PSA Free and Total QLS 84153 G0103 301 $170.00 $- $11.80 $- $- $136.00 $- N/A $44.20 N/A N/A $19.73 N/A N/A $102.00 N/A N/A $85.00 N/A N/A $11.80 N/A N/A $115.60 N/A N/A $83.30 N/A N/A $66.30 N/A N/A $119.00 N/A N/A $136.00 N/A N/A $93.50 N/A N/A $119.00 N/A N/A $56.95 N/A N/A $11.80 N/A N/A $102.00 N/A N/A $59.50 N/A N/A $110.50 N/A N/A $51.00 N/A N/A $102.00 N/A N/A $119.00 N/A N/A $51.00 N/A N/A $51.00 N/A N/A $51.00 N/A N/A $51.00 N/A N/A $51.00 N/A N/A $51.00 N/A $170.00 $170.00 N/A 4001743 General Lab PSA Free and Total QLS 84154 G0103 301 $170.00 $- $11.80 $- $- $136.00 $- N/A $44.20 N/A N/A $19.73 N/A N/A $102.00 N/A N/A $85.00 N/A N/A $11.80 N/A N/A $115.60 N/A N/A $83.30 N/A N/A $66.30 N/A N/A $119.00 N/A N/A $136.00 N/A N/A $93.50 N/A N/A $119.00 N/A N/A $56.95 N/A N/A $11.80 N/A N/A $102.00 N/A N/A $59.50 N/A N/A $110.50 N/A N/A $51.00 N/A N/A $102.00 N/A N/A $119.00 N/A N/A $51.00 N/A N/A $51.00 N/A N/A $51.00 N/A N/A $51.00 N/A N/A $51.00 N/A N/A $51.00 N/A $170.00 $170.00 N/A 4001743 General Lab "PSA, Free QST" 84154 301 $170.00 $- $11.80 $- $- $136.00 $- N/A $44.20 N/A N/A $19.73 N/A N/A $102.00 N/A N/A $85.00 N/A N/A $11.80 N/A N/A $115.60 N/A N/A $83.30 N/A N/A $66.30 N/A N/A $119.00 N/A N/A $136.00 N/A N/A $93.50 N/A N/A $119.00 N/A N/A $56.95 N/A N/A $11.80 N/A N/A $102.00 N/A N/A $59.50 N/A N/A $110.50 N/A N/A $51.00 N/A N/A $102.00 N/A N/A $119.00 N/A N/A $51.00 N/A N/A $51.00 N/A N/A $51.00 N/A N/A $51.00 N/A N/A $51.00 N/A N/A $51.00 N/A $170.00 $170.00 N/A 4001743 General Lab Prostate Specific Antigen QST 84153 G0103 301 $170.00 $- $11.80 $- $- $136.00 $- N/A $44.20 N/A N/A $19.73 N/A N/A $102.00 N/A N/A $85.00 N/A N/A $11.80 N/A N/A $115.60 N/A N/A $83.30 N/A N/A $66.30 N/A N/A $119.00 N/A N/A $136.00 N/A N/A $93.50 N/A N/A $119.00 N/A N/A $56.95 N/A N/A $11.80 N/A N/A $102.00 N/A N/A $59.50 N/A N/A $110.50 N/A N/A $51.00 N/A N/A $102.00 N/A N/A $119.00 N/A N/A $51.00 N/A N/A $51.00 N/A N/A $51.00 N/A N/A $51.00 N/A N/A $51.00 N/A N/A $51.00 N/A $170.00 $170.00 N/A 4002059 General Lab Occult Blood Diagnostic 1 82270 301 $65.00 $- $2.09 $- $- $52.00 $- N/A $16.90 N/A N/A $3.49 N/A N/A $39.00 N/A N/A $32.50 N/A N/A $2.09 N/A N/A $44.20 N/A N/A $31.85 N/A N/A $25.35 N/A N/A $45.50 N/A N/A $52.00 N/A N/A $35.75 N/A N/A $45.50 N/A N/A $21.78 N/A N/A $2.09 N/A N/A $39.00 N/A N/A $22.75 N/A N/A $42.25 N/A N/A $19.50 N/A N/A $39.00 N/A N/A $45.50 N/A N/A $19.50 N/A N/A $19.50 N/A N/A $19.50 N/A N/A $19.50 N/A N/A $19.50 N/A N/A $19.50 N/A $65.00 $65.00 N/A 4002059 General Lab Occult Blood Screen 1-3 82270 301 $65.00 $- $2.09 $- $- $52.00 $- N/A $16.90 N/A N/A $3.49 N/A N/A $39.00 N/A N/A $32.50 N/A N/A $2.09 N/A N/A $44.20 N/A N/A $31.85 N/A N/A $25.35 N/A N/A $45.50 N/A N/A $52.00 N/A N/A $35.75 N/A N/A $45.50 N/A N/A $21.78 N/A N/A $2.09 N/A N/A $39.00 N/A N/A $22.75 N/A N/A $42.25 N/A N/A $19.50 N/A N/A $39.00 N/A N/A $45.50 N/A N/A $19.50 N/A N/A $19.50 N/A N/A $19.50 N/A N/A $19.50 N/A N/A $19.50 N/A N/A $19.50 N/A $65.00 $65.00 N/A 4002059 General Lab Occult Blood Diagnostic 1-3 82270 301 $65.00 $- $2.09 $- $- $52.00 $- N/A $16.90 N/A N/A $3.49 N/A N/A $39.00 N/A N/A $32.50 N/A N/A $2.09 N/A N/A $44.20 N/A N/A $31.85 N/A N/A $25.35 N/A N/A $45.50 N/A N/A $52.00 N/A N/A $35.75 N/A N/A $45.50 N/A N/A $21.78 N/A N/A $2.09 N/A N/A $39.00 N/A N/A $22.75 N/A N/A $42.25 N/A N/A $19.50 N/A N/A $39.00 N/A N/A $45.50 N/A N/A $19.50 N/A N/A $19.50 N/A N/A $19.50 N/A N/A $19.50 N/A N/A $19.50 N/A N/A $19.50 N/A $65.00 $65.00 N/A 4002059 General Lab Occult Blood Screening 1-3 BCH 82270 301 $65.00 $- $2.09 $- $- $52.00 $- N/A $16.90 N/A N/A $3.49 N/A N/A $39.00 N/A N/A $32.50 N/A N/A $2.09 N/A N/A $44.20 N/A N/A $31.85 N/A N/A $25.35 N/A N/A $45.50 N/A N/A $52.00 N/A N/A $35.75 N/A N/A $45.50 N/A N/A $21.78 N/A N/A $2.09 N/A N/A $39.00 N/A N/A $22.75 N/A N/A $42.25 N/A N/A $19.50 N/A N/A $39.00 N/A N/A $45.50 N/A N/A $19.50 N/A N/A $19.50 N/A N/A $19.50 N/A N/A $19.50 N/A N/A $19.50 N/A N/A $19.50 N/A $65.00 $65.00 N/A 4002059 General Lab Occult Blood Diagnostic 1-3 BCH 82270 301 $65.00 $- $2.09 $- $- $52.00 $- N/A $16.90 N/A N/A $3.49 N/A N/A $39.00 N/A N/A $32.50 N/A N/A $2.09 N/A N/A $44.20 N/A N/A $31.85 N/A N/A $25.35 N/A N/A $45.50 N/A N/A $52.00 N/A N/A $35.75 N/A N/A $45.50 N/A N/A $21.78 N/A N/A $2.09 N/A N/A $39.00 N/A N/A $22.75 N/A N/A $42.25 N/A N/A $19.50 N/A N/A $39.00 N/A N/A $45.50 N/A N/A $19.50 N/A N/A $19.50 N/A N/A $19.50 N/A N/A $19.50 N/A N/A $19.50 N/A N/A $19.50 N/A $65.00 $65.00 N/A 4002225 General Lab Cardio IQ Advance Lipid Panel QLS 80061 301 $150.00 $- $8.60 $- $- $120.00 $- N/A $39.00 N/A N/A $14.36 N/A N/A $90.00 N/A N/A $75.00 N/A N/A $8.60 N/A N/A $102.00 N/A N/A $73.50 N/A N/A $58.50 N/A N/A $105.00 N/A N/A $120.00 N/A N/A $82.50 N/A N/A $105.00 N/A N/A $50.25 N/A N/A $8.60 N/A N/A $90.00 N/A N/A $52.50 N/A N/A $97.50 N/A N/A $45.00 N/A N/A $90.00 N/A N/A $105.00 N/A N/A $45.00 N/A N/A $45.00 N/A N/A $45.00 N/A N/A $45.00 N/A N/A $45.00 N/A N/A $45.00 N/A $150.00 $150.00 N/A 4002225 General Lab Cardio IQ(R) Advanced Lipid Panel QST 80061 301 $150.00 $- $8.60 $- $- $120.00 $- N/A $39.00 N/A N/A $14.36 N/A N/A $90.00 N/A N/A $75.00 N/A N/A $8.60 N/A N/A $102.00 N/A N/A $73.50 N/A N/A $58.50 N/A N/A $105.00 N/A N/A $120.00 N/A N/A $82.50 N/A N/A $105.00 N/A N/A $50.25 N/A N/A $8.60 N/A N/A $90.00 N/A N/A $52.50 N/A N/A $97.50 N/A N/A $45.00 N/A N/A $90.00 N/A N/A $105.00 N/A N/A $45.00 N/A N/A $45.00 N/A N/A $45.00 N/A N/A $45.00 N/A N/A $45.00 N/A N/A $45.00 N/A $150.00 $150.00 N/A 4002502 General Lab Bilirubin Total 82247 301 $99.00 $- $3.22 $- $- $79.20 $- N/A $25.74 N/A N/A $5.39 N/A N/A $59.40 N/A N/A $49.50 N/A N/A $3.22 N/A N/A $67.32 N/A N/A $48.51 N/A N/A $38.61 N/A N/A $69.30 N/A N/A $79.20 N/A N/A $54.45 N/A N/A $69.30 N/A N/A $33.17 N/A N/A $3.22 N/A N/A $59.40 N/A N/A $34.65 N/A N/A $64.35 N/A N/A $29.70 N/A N/A $59.40 N/A N/A $69.30 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A $99.00 $99.00 N/A 4003104 General Lab Calcium Level 82310 301 $49.00 $- $3.31 $- $- $39.20 $- N/A $12.74 N/A N/A $5.53 N/A N/A $29.40 N/A N/A $24.50 N/A N/A $3.31 N/A N/A $33.32 N/A N/A $24.01 N/A N/A $19.11 N/A N/A $34.30 N/A N/A $39.20 N/A N/A $26.95 N/A N/A $34.30 N/A N/A $16.42 N/A N/A $3.31 N/A N/A $29.40 N/A N/A $17.15 N/A N/A $31.85 N/A N/A $14.70 N/A N/A $29.40 N/A N/A $34.30 N/A N/A $14.70 N/A N/A $14.70 N/A N/A $14.70 N/A N/A $14.70 N/A N/A $14.70 N/A N/A $14.70 N/A $49.00 $49.00 N/A 4003104 General Lab Calcium QLS 82310 301 $49.00 $- $3.31 $- $- $39.20 $- N/A $12.74 N/A N/A $5.53 N/A N/A $29.40 N/A N/A $24.50 N/A N/A $3.31 N/A N/A $33.32 N/A N/A $24.01 N/A N/A $19.11 N/A N/A $34.30 N/A N/A $39.20 N/A N/A $26.95 N/A N/A $34.30 N/A N/A $16.42 N/A N/A $3.31 N/A N/A $29.40 N/A N/A $17.15 N/A N/A $31.85 N/A N/A $14.70 N/A N/A $29.40 N/A N/A $34.30 N/A N/A $14.70 N/A N/A $14.70 N/A N/A $14.70 N/A N/A $14.70 N/A N/A $14.70 N/A N/A $14.70 N/A $49.00 $49.00 N/A 4003104 General Lab Calcium QST 82310 301 $49.00 $- $3.31 $- $- $39.20 $- N/A $12.74 N/A N/A $5.53 N/A N/A $29.40 N/A N/A $24.50 N/A N/A $3.31 N/A N/A $33.32 N/A N/A $24.01 N/A N/A $19.11 N/A N/A $34.30 N/A N/A $39.20 N/A N/A $26.95 N/A N/A $34.30 N/A N/A $16.42 N/A N/A $3.31 N/A N/A $29.40 N/A N/A $17.15 N/A N/A $31.85 N/A N/A $14.70 N/A N/A $29.40 N/A N/A $34.30 N/A N/A $14.70 N/A N/A $14.70 N/A N/A $14.70 N/A N/A $14.70 N/A N/A $14.70 N/A N/A $14.70 N/A $49.00 $49.00 N/A 4003121 General Lab Potassium Level 84132 301 $92.00 $- $2.96 $- $- $73.60 $- N/A $23.92 N/A N/A $4.93 N/A N/A $55.20 N/A N/A $46.00 N/A N/A $2.96 N/A N/A $62.56 N/A N/A $45.08 N/A N/A $35.88 N/A N/A $64.40 N/A N/A $73.60 N/A N/A $50.60 N/A N/A $64.40 N/A N/A $30.82 N/A N/A $2.96 N/A N/A $55.20 N/A N/A $32.20 N/A N/A $59.80 N/A N/A $27.60 N/A N/A $55.20 N/A N/A $64.40 N/A N/A $27.60 N/A N/A $27.60 N/A N/A $27.60 N/A N/A $27.60 N/A N/A $27.60 N/A N/A $27.60 N/A $92.00 $92.00 N/A 4003134 General Lab Lupus Anticoagulant Evaluation w/ Reflex QST 85613 300 $113.00 $- $6.14 $- $- $90.40 $- N/A $29.38 N/A N/A $10.26 N/A N/A $67.80 N/A N/A $56.50 N/A N/A $6.14 N/A N/A $76.84 N/A N/A $55.37 N/A N/A $44.07 N/A N/A $79.10 N/A N/A $90.40 N/A N/A $62.15 N/A N/A $79.10 N/A N/A $37.86 N/A N/A $6.14 N/A N/A $67.80 N/A N/A $39.55 N/A N/A $73.45 N/A N/A $33.90 N/A N/A $67.80 N/A N/A $79.10 N/A N/A $33.90 N/A N/A $33.90 N/A N/A $33.90 N/A N/A $33.90 N/A N/A $33.90 N/A N/A $33.90 N/A $113.00 $113.00 N/A 4003134 General Lab Lupus Anticoagulant Evaluation w/ Reflex QST 85730 300 $113.00 $- $3.86 $- $- $90.40 $- N/A $29.38 N/A N/A $6.43 N/A N/A $67.80 N/A N/A $56.50 N/A N/A $3.86 N/A N/A $76.84 N/A N/A $55.37 N/A N/A $44.07 N/A N/A $79.10 N/A N/A $90.40 N/A N/A $62.15 N/A N/A $79.10 N/A N/A $37.86 N/A N/A $3.86 N/A N/A $67.80 N/A N/A $39.55 N/A N/A $73.45 N/A N/A $33.90 N/A N/A $67.80 N/A N/A $79.10 N/A N/A $33.90 N/A N/A $33.90 N/A N/A $33.90 N/A N/A $33.90 N/A N/A $33.90 N/A N/A $33.90 N/A $113.00 $113.00 N/A 4003165 General Lab PTH Intact w/o Calcium QLS 83970 301 $560.00 $- $26.48 $- $- $448.00 $- N/A $145.60 N/A N/A $44.26 N/A N/A $336.00 N/A N/A $280.00 N/A N/A $26.48 N/A N/A $380.80 N/A N/A $274.40 N/A N/A $218.40 N/A N/A $392.00 N/A N/A $448.00 N/A N/A $308.00 N/A N/A $392.00 N/A N/A $187.60 N/A N/A $26.48 N/A N/A $336.00 N/A N/A $196.00 N/A N/A $364.00 N/A N/A $168.00 N/A N/A $336.00 N/A N/A $392.00 N/A N/A $168.00 N/A N/A $168.00 N/A N/A $168.00 N/A N/A $168.00 N/A N/A $168.00 N/A N/A $168.00 N/A $560.00 $560.00 N/A 4003165 General Lab "PTH, Intact w/o Calcium QST" 83970 301 $560.00 $- $26.48 $- $- $448.00 $- N/A $145.60 N/A N/A $44.26 N/A N/A $336.00 N/A N/A $280.00 N/A N/A $26.48 N/A N/A $380.80 N/A N/A $274.40 N/A N/A $218.40 N/A N/A $392.00 N/A N/A $448.00 N/A N/A $308.00 N/A N/A $392.00 N/A N/A $187.60 N/A N/A $26.48 N/A N/A $336.00 N/A N/A $196.00 N/A N/A $364.00 N/A N/A $168.00 N/A N/A $336.00 N/A N/A $392.00 N/A N/A $168.00 N/A N/A $168.00 N/A N/A $168.00 N/A N/A $168.00 N/A N/A $168.00 N/A N/A $168.00 N/A $560.00 $560.00 N/A 4003183 General Lab D-Dimer 85378 305 $225.00 $- $4.58 $- $- $180.00 $- N/A $58.50 N/A N/A $7.66 N/A N/A $135.00 N/A N/A $112.50 N/A N/A $4.58 N/A N/A $153.00 N/A N/A $110.25 N/A N/A $87.75 N/A N/A $157.50 N/A N/A $180.00 N/A N/A $123.75 N/A N/A $157.50 N/A N/A $75.38 N/A N/A $4.58 N/A N/A $135.00 N/A N/A $78.75 N/A N/A $146.25 N/A N/A $67.50 N/A N/A $135.00 N/A N/A $157.50 N/A N/A $67.50 N/A N/A $67.50 N/A N/A $67.50 N/A N/A $67.50 N/A N/A $67.50 N/A N/A $67.50 N/A $225.00 $225.00 N/A 4003183 General Lab D-Dimer QST 85378 305 $225.00 $- $4.58 $- $- $180.00 $- N/A $58.50 N/A N/A $7.66 N/A N/A $135.00 N/A N/A $112.50 N/A N/A $4.58 N/A N/A $153.00 N/A N/A $110.25 N/A N/A $87.75 N/A N/A $157.50 N/A N/A $180.00 N/A N/A $123.75 N/A N/A $157.50 N/A N/A $75.38 N/A N/A $4.58 N/A N/A $135.00 N/A N/A $78.75 N/A N/A $146.25 N/A N/A $67.50 N/A N/A $135.00 N/A N/A $157.50 N/A N/A $67.50 N/A N/A $67.50 N/A N/A $67.50 N/A N/A $67.50 N/A N/A $67.50 N/A N/A $67.50 N/A $225.00 $225.00 N/A 4003595 General Lab Celiac Disease Comprehensive Panel QLS 83516 305 $143.00 $- $37.18 $- $- $114.40 $- N/A $37.18 N/A N/A N/A N/A N/A $85.80 N/A N/A $71.50 N/A N/A N/A N/A N/A $97.24 N/A N/A $70.07 N/A N/A $55.77 N/A N/A $100.10 N/A N/A $114.40 N/A N/A $78.65 N/A N/A $100.10 N/A N/A $47.91 N/A N/A N/A N/A N/A $85.80 N/A N/A $50.05 N/A N/A $92.95 N/A N/A $42.90 N/A N/A $85.80 N/A N/A $100.10 N/A N/A $42.90 N/A N/A $42.90 N/A N/A $42.90 N/A N/A $42.90 N/A N/A $42.90 N/A N/A $42.90 N/A $143.00 $143.00 N/A 4003595 General Lab Celiac Disease Comprehensive Panel QLS 82784 305 $143.00 $- $4.30 $- $- $114.40 $- N/A $37.18 N/A N/A $7.18 N/A N/A $85.80 N/A N/A $71.50 N/A N/A $4.30 N/A N/A $97.24 N/A N/A $70.07 N/A N/A $55.77 N/A N/A $100.10 N/A N/A $114.40 N/A N/A $78.65 N/A N/A $100.10 N/A N/A $47.91 N/A N/A $4.30 N/A N/A $85.80 N/A N/A $50.05 N/A N/A $92.95 N/A N/A $42.90 N/A N/A $85.80 N/A N/A $100.10 N/A N/A $42.90 N/A N/A $42.90 N/A N/A $42.90 N/A N/A $42.90 N/A N/A $42.90 N/A N/A $42.90 N/A $143.00 $143.00 N/A 4003595 General Lab Celiac Disease Comprehensive Panel QST 82784 305 $143.00 $- $4.30 $- $- $114.40 $- N/A $37.18 N/A N/A $7.18 N/A N/A $85.80 N/A N/A $71.50 N/A N/A $4.30 N/A N/A $97.24 N/A N/A $70.07 N/A N/A $55.77 N/A N/A $100.10 N/A N/A $114.40 N/A N/A $78.65 N/A N/A $100.10 N/A N/A $47.91 N/A N/A $4.30 N/A N/A $85.80 N/A N/A $50.05 N/A N/A $92.95 N/A N/A $42.90 N/A N/A $85.80 N/A N/A $100.10 N/A N/A $42.90 N/A N/A $42.90 N/A N/A $42.90 N/A N/A $42.90 N/A N/A $42.90 N/A N/A $42.90 N/A $143.00 $143.00 N/A 4003652 General Lab Legionella Antigen Urine QST 87449 306 $221.00 $- $7.69 $- $- $176.80 $- N/A $57.46 N/A N/A $12.86 N/A N/A $132.60 N/A N/A $110.50 N/A N/A $7.69 N/A N/A $150.28 N/A N/A $108.29 N/A N/A $86.19 N/A N/A $154.70 N/A N/A $176.80 N/A N/A $121.55 N/A N/A $154.70 N/A N/A $74.04 N/A N/A $7.69 N/A N/A $132.60 N/A N/A $77.35 N/A N/A $143.65 N/A N/A $66.30 N/A N/A $132.60 N/A N/A $154.70 N/A N/A $66.30 N/A N/A $66.30 N/A N/A $66.30 N/A N/A $66.30 N/A N/A $66.30 N/A N/A $66.30 N/A $221.00 $221.00 N/A 4003652 General Lab "Legionella Antigen, EIA, Urine QLS" 87449 306 $221.00 $- $7.69 $- $- $176.80 $- N/A $57.46 N/A N/A $12.86 N/A N/A $132.60 N/A N/A $110.50 N/A N/A $7.69 N/A N/A $150.28 N/A N/A $108.29 N/A N/A $86.19 N/A N/A $154.70 N/A N/A $176.80 N/A N/A $121.55 N/A N/A $154.70 N/A N/A $74.04 N/A N/A $7.69 N/A N/A $132.60 N/A N/A $77.35 N/A N/A $143.65 N/A N/A $66.30 N/A N/A $132.60 N/A N/A $154.70 N/A N/A $66.30 N/A N/A $66.30 N/A N/A $66.30 N/A N/A $66.30 N/A N/A $66.30 N/A N/A $66.30 N/A $221.00 $221.00 N/A 4004306 General Lab Rheumatoid Factor 3 86431 302 $113.00 $- $3.64 $- $- $90.40 $- N/A $29.38 N/A N/A $6.08 N/A N/A $67.80 N/A N/A $56.50 N/A N/A $3.64 N/A N/A $76.84 N/A N/A $55.37 N/A N/A $44.07 N/A N/A $79.10 N/A N/A $90.40 N/A N/A $62.15 N/A N/A $79.10 N/A N/A $37.86 N/A N/A $3.64 N/A N/A $67.80 N/A N/A $39.55 N/A N/A $73.45 N/A N/A $33.90 N/A N/A $67.80 N/A N/A $79.10 N/A N/A $33.90 N/A N/A $33.90 N/A N/A $33.90 N/A N/A $33.90 N/A N/A $33.90 N/A N/A $33.90 N/A $113.00 $113.00 N/A 4004306 General Lab Rheumatoid Factor 2 86431 302 $113.00 $- $3.64 $- $- $90.40 $- N/A $29.38 N/A N/A $6.08 N/A N/A $67.80 N/A N/A $56.50 N/A N/A $3.64 N/A N/A $76.84 N/A N/A $55.37 N/A N/A $44.07 N/A N/A $79.10 N/A N/A $90.40 N/A N/A $62.15 N/A N/A $79.10 N/A N/A $37.86 N/A N/A $3.64 N/A N/A $67.80 N/A N/A $39.55 N/A N/A $73.45 N/A N/A $33.90 N/A N/A $67.80 N/A N/A $79.10 N/A N/A $33.90 N/A N/A $33.90 N/A N/A $33.90 N/A N/A $33.90 N/A N/A $33.90 N/A N/A $33.90 N/A $113.00 $113.00 N/A 4004431 General Lab Hemoglobin A1c MCL 84443 301 $324.00 $- $10.79 $- $- $259.20 $- N/A $84.24 N/A N/A $18.02 N/A N/A $194.40 N/A N/A $162.00 N/A N/A $10.79 N/A N/A $220.32 N/A N/A $158.76 N/A N/A $126.36 N/A N/A $226.80 N/A N/A $259.20 N/A N/A $178.20 N/A N/A $226.80 N/A N/A $108.54 N/A N/A $10.79 N/A N/A $194.40 N/A N/A $113.40 N/A N/A $210.60 N/A N/A $97.20 N/A N/A $194.40 N/A N/A $226.80 N/A N/A $97.20 N/A N/A $97.20 N/A N/A $97.20 N/A N/A $97.20 N/A N/A $97.20 N/A N/A $97.20 N/A $324.00 $324.00 N/A 4004431 General Lab TSH QLS 84443 301 $324.00 $- $10.79 $- $- $259.20 $- N/A $84.24 N/A N/A $18.02 N/A N/A $194.40 N/A N/A $162.00 N/A N/A $10.79 N/A N/A $220.32 N/A N/A $158.76 N/A N/A $126.36 N/A N/A $226.80 N/A N/A $259.20 N/A N/A $178.20 N/A N/A $226.80 N/A N/A $108.54 N/A N/A $10.79 N/A N/A $194.40 N/A N/A $113.40 N/A N/A $210.60 N/A N/A $97.20 N/A N/A $194.40 N/A N/A $226.80 N/A N/A $97.20 N/A N/A $97.20 N/A N/A $97.20 N/A N/A $97.20 N/A N/A $97.20 N/A N/A $97.20 N/A $324.00 $324.00 N/A 4004431 General Lab "TSH, 3rd Generation QST" 84443 301 $324.00 $- $10.79 $- $- $259.20 $- N/A $84.24 N/A N/A $18.02 N/A N/A $194.40 N/A N/A $162.00 N/A N/A $10.79 N/A N/A $220.32 N/A N/A $158.76 N/A N/A $126.36 N/A N/A $226.80 N/A N/A $259.20 N/A N/A $178.20 N/A N/A $226.80 N/A N/A $108.54 N/A N/A $10.79 N/A N/A $194.40 N/A N/A $113.40 N/A N/A $210.60 N/A N/A $97.20 N/A N/A $194.40 N/A N/A $226.80 N/A N/A $97.20 N/A N/A $97.20 N/A N/A $97.20 N/A N/A $97.20 N/A N/A $97.20 N/A N/A $97.20 N/A $324.00 $324.00 N/A 4004431 General Lab Thyroid Stimulating Hormone 84443 301 $324.00 $- $10.79 $- $- $259.20 $- N/A $84.24 N/A N/A $18.02 N/A N/A $194.40 N/A N/A $162.00 N/A N/A $10.79 N/A N/A $220.32 N/A N/A $158.76 N/A N/A $126.36 N/A N/A $226.80 N/A N/A $259.20 N/A N/A $178.20 N/A N/A $226.80 N/A N/A $108.54 N/A N/A $10.79 N/A N/A $194.40 N/A N/A $113.40 N/A N/A $210.60 N/A N/A $97.20 N/A N/A $194.40 N/A N/A $226.80 N/A N/A $97.20 N/A N/A $97.20 N/A N/A $97.20 N/A N/A $97.20 N/A N/A $97.20 N/A N/A $97.20 N/A $324.00 $324.00 N/A 4004431 General Lab TSH 84443 301 $324.00 $- $10.79 $- $- $259.20 $- N/A $84.24 N/A N/A $18.02 N/A N/A $194.40 N/A N/A $162.00 N/A N/A $10.79 N/A N/A $220.32 N/A N/A $158.76 N/A N/A $126.36 N/A N/A $226.80 N/A N/A $259.20 N/A N/A $178.20 N/A N/A $226.80 N/A N/A $108.54 N/A N/A $10.79 N/A N/A $194.40 N/A N/A $113.40 N/A N/A $210.60 N/A N/A $97.20 N/A N/A $194.40 N/A N/A $226.80 N/A N/A $97.20 N/A N/A $97.20 N/A N/A $97.20 N/A N/A $97.20 N/A N/A $97.20 N/A N/A $97.20 N/A $324.00 $324.00 N/A 4004656 General Lab Cholesterol (f) QLS 82465 301 $82.00 $- $2.80 $- $- $65.60 $- N/A $21.32 N/A N/A $4.67 N/A N/A $49.20 N/A N/A $41.00 N/A N/A $2.80 N/A N/A $55.76 N/A N/A $40.18 N/A N/A $31.98 N/A N/A $57.40 N/A N/A $65.60 N/A N/A $45.10 N/A N/A $57.40 N/A N/A $27.47 N/A N/A $2.80 N/A N/A $49.20 N/A N/A $28.70 N/A N/A $53.30 N/A N/A $24.60 N/A N/A $49.20 N/A N/A $57.40 N/A N/A $24.60 N/A N/A $24.60 N/A N/A $24.60 N/A N/A $24.60 N/A N/A $24.60 N/A N/A $24.60 N/A $82.00 $82.00 N/A 4004656 General Lab Cholesterol Total 82465 301 $82.00 $- $2.80 $- $- $65.60 $- N/A $21.32 N/A N/A $4.67 N/A N/A $49.20 N/A N/A $41.00 N/A N/A $2.80 N/A N/A $55.76 N/A N/A $40.18 N/A N/A $31.98 N/A N/A $57.40 N/A N/A $65.60 N/A N/A $45.10 N/A N/A $57.40 N/A N/A $27.47 N/A N/A $2.80 N/A N/A $49.20 N/A N/A $28.70 N/A N/A $53.30 N/A N/A $24.60 N/A N/A $49.20 N/A N/A $57.40 N/A N/A $24.60 N/A N/A $24.60 N/A N/A $24.60 N/A N/A $24.60 N/A N/A $24.60 N/A N/A $24.60 N/A $82.00 $82.00 N/A 4004803 General Lab "T3, Total QLS" 84480 301 $274.00 $- $9.09 $- $- $219.20 $- N/A $71.24 N/A N/A $15.20 N/A N/A $164.40 N/A N/A $137.00 N/A N/A $9.09 N/A N/A $186.32 N/A N/A $134.26 N/A N/A $106.86 N/A N/A $191.80 N/A N/A $219.20 N/A N/A $150.70 N/A N/A $191.80 N/A N/A $91.79 N/A N/A $9.09 N/A N/A $164.40 N/A N/A $95.90 N/A N/A $178.10 N/A N/A $82.20 N/A N/A $164.40 N/A N/A $191.80 N/A N/A $82.20 N/A N/A $82.20 N/A N/A $82.20 N/A N/A $82.20 N/A N/A $82.20 N/A N/A $82.20 N/A $274.00 $274.00 N/A 4004803 General Lab Total T3 QST 84480 301 $274.00 $- $9.09 $- $- $219.20 $- N/A $71.24 N/A N/A $15.20 N/A N/A $164.40 N/A N/A $137.00 N/A N/A $9.09 N/A N/A $186.32 N/A N/A $134.26 N/A N/A $106.86 N/A N/A $191.80 N/A N/A $219.20 N/A N/A $150.70 N/A N/A $191.80 N/A N/A $91.79 N/A N/A $9.09 N/A N/A $164.40 N/A N/A $95.90 N/A N/A $178.10 N/A N/A $82.20 N/A N/A $164.40 N/A N/A $191.80 N/A N/A $82.20 N/A N/A $82.20 N/A N/A $82.20 N/A N/A $82.20 N/A N/A $82.20 N/A N/A $82.20 N/A $274.00 $274.00 N/A 4005206 General Lab BUN 84520 301 $78.00 $- $2.54 $- $- $62.40 $- N/A $20.28 N/A N/A $4.24 N/A N/A $46.80 N/A N/A $39.00 N/A N/A $2.54 N/A N/A $53.04 N/A N/A $38.22 N/A N/A $30.42 N/A N/A $54.60 N/A N/A $62.40 N/A N/A $42.90 N/A N/A $54.60 N/A N/A $26.13 N/A N/A $2.54 N/A N/A $46.80 N/A N/A $27.30 N/A N/A $50.70 N/A N/A $23.40 N/A N/A $46.80 N/A N/A $54.60 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A $78.00 $78.00 N/A 4005206 General Lab Blood Urea Nitrogen 84520 301 $78.00 $- $2.54 $- $- $62.40 $- N/A $20.28 N/A N/A $4.24 N/A N/A $46.80 N/A N/A $39.00 N/A N/A $2.54 N/A N/A $53.04 N/A N/A $38.22 N/A N/A $30.42 N/A N/A $54.60 N/A N/A $62.40 N/A N/A $42.90 N/A N/A $54.60 N/A N/A $26.13 N/A N/A $2.54 N/A N/A $46.80 N/A N/A $27.30 N/A N/A $50.70 N/A N/A $23.40 N/A N/A $46.80 N/A N/A $54.60 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A $78.00 $78.00 N/A 4005503 General Lab Uric Acid 84550 301 $91.00 $- $2.90 $- $- $72.80 $- N/A $23.66 N/A N/A $4.85 N/A N/A $54.60 N/A N/A $45.50 N/A N/A $2.90 N/A N/A $61.88 N/A N/A $44.59 N/A N/A $35.49 N/A N/A $63.70 N/A N/A $72.80 N/A N/A $50.05 N/A N/A $63.70 N/A N/A $30.49 N/A N/A $2.90 N/A N/A $54.60 N/A N/A $31.85 N/A N/A $59.15 N/A N/A $27.30 N/A N/A $54.60 N/A N/A $63.70 N/A N/A $27.30 N/A N/A $27.30 N/A N/A $27.30 N/A N/A $27.30 N/A N/A $27.30 N/A N/A $27.30 N/A $91.00 $91.00 N/A 4005503 General Lab Uric Acid QLS 84550 301 $91.00 $- $2.90 $- $- $72.80 $- N/A $23.66 N/A N/A $4.85 N/A N/A $54.60 N/A N/A $45.50 N/A N/A $2.90 N/A N/A $61.88 N/A N/A $44.59 N/A N/A $35.49 N/A N/A $63.70 N/A N/A $72.80 N/A N/A $50.05 N/A N/A $63.70 N/A N/A $30.49 N/A N/A $2.90 N/A N/A $54.60 N/A N/A $31.85 N/A N/A $59.15 N/A N/A $27.30 N/A N/A $54.60 N/A N/A $63.70 N/A N/A $27.30 N/A N/A $27.30 N/A N/A $27.30 N/A N/A $27.30 N/A N/A $27.30 N/A N/A $27.30 N/A $91.00 $91.00 N/A 4005653 General Lab BUN/Creat Ratio QST 82565 301 $168.00 $- $3.29 $- $- $134.40 $- N/A $43.68 N/A N/A $5.50 N/A N/A $100.80 N/A N/A $84.00 N/A N/A $3.29 N/A N/A $114.24 N/A N/A $82.32 N/A N/A $65.52 N/A N/A $117.60 N/A N/A $134.40 N/A N/A $92.40 N/A N/A $117.60 N/A N/A $56.28 N/A N/A $3.29 N/A N/A $100.80 N/A N/A $58.80 N/A N/A $109.20 N/A N/A $50.40 N/A N/A $100.80 N/A N/A $117.60 N/A N/A $50.40 N/A N/A $50.40 N/A N/A $50.40 N/A N/A $50.40 N/A N/A $50.40 N/A N/A $50.40 N/A $168.00 $168.00 N/A 4005653 General Lab Creatinine 82565 301 $168.00 $- $3.29 $- $- $134.40 $- N/A $43.68 N/A N/A $5.50 N/A N/A $100.80 N/A N/A $84.00 N/A N/A $3.29 N/A N/A $114.24 N/A N/A $82.32 N/A N/A $65.52 N/A N/A $117.60 N/A N/A $134.40 N/A N/A $92.40 N/A N/A $117.60 N/A N/A $56.28 N/A N/A $3.29 N/A N/A $100.80 N/A N/A $58.80 N/A N/A $109.20 N/A N/A $50.40 N/A N/A $100.80 N/A N/A $117.60 N/A N/A $50.40 N/A N/A $50.40 N/A N/A $50.40 N/A N/A $50.40 N/A N/A $50.40 N/A N/A $50.40 N/A $168.00 $168.00 N/A 4005653 General Lab Creatinine Level 82565 301 $168.00 $- $3.29 $- $- $134.40 $- N/A $43.68 N/A N/A $5.50 N/A N/A $100.80 N/A N/A $84.00 N/A N/A $3.29 N/A N/A $114.24 N/A N/A $82.32 N/A N/A $65.52 N/A N/A $117.60 N/A N/A $134.40 N/A N/A $92.40 N/A N/A $117.60 N/A N/A $56.28 N/A N/A $3.29 N/A N/A $100.80 N/A N/A $58.80 N/A N/A $109.20 N/A N/A $50.40 N/A N/A $100.80 N/A N/A $117.60 N/A N/A $50.40 N/A N/A $50.40 N/A N/A $50.40 N/A N/A $50.40 N/A N/A $50.40 N/A N/A $50.40 N/A $168.00 $168.00 N/A 4006056 General Lab Lactic Acid 83605 301 $389.00 $- $6.86 $- $- $311.20 $- N/A $101.14 N/A N/A $11.45 N/A N/A $233.40 N/A N/A $194.50 N/A N/A $6.86 N/A N/A $264.52 N/A N/A $190.61 N/A N/A $151.71 N/A N/A $272.30 N/A N/A $311.20 N/A N/A $213.95 N/A N/A $272.30 N/A N/A $130.32 N/A N/A $6.86 N/A N/A $233.40 N/A N/A $136.15 N/A N/A $252.85 N/A N/A $116.70 N/A N/A $233.40 N/A N/A $272.30 N/A N/A $116.70 N/A N/A $116.70 N/A N/A $116.70 N/A N/A $116.70 N/A N/A $116.70 N/A N/A $116.70 N/A $389.00 $389.00 N/A 4006056 General Lab Lactic Acid 3 83605 301 $389.00 $- $6.86 $- $- $311.20 $- N/A $101.14 N/A N/A $11.45 N/A N/A $233.40 N/A N/A $194.50 N/A N/A $6.86 N/A N/A $264.52 N/A N/A $190.61 N/A N/A $151.71 N/A N/A $272.30 N/A N/A $311.20 N/A N/A $213.95 N/A N/A $272.30 N/A N/A $130.32 N/A N/A $6.86 N/A N/A $233.40 N/A N/A $136.15 N/A N/A $252.85 N/A N/A $116.70 N/A N/A $233.40 N/A N/A $272.30 N/A N/A $116.70 N/A N/A $116.70 N/A N/A $116.70 N/A N/A $116.70 N/A N/A $116.70 N/A N/A $116.70 N/A $389.00 $389.00 N/A 4006065 General Lab Vitamin B12 Level 82607 301 $289.00 $- $9.67 $- $- $231.20 $- N/A $75.14 N/A N/A $16.16 N/A N/A $173.40 N/A N/A $144.50 N/A N/A $9.67 N/A N/A $196.52 N/A N/A $141.61 N/A N/A $112.71 N/A N/A $202.30 N/A N/A $231.20 N/A N/A $158.95 N/A N/A $202.30 N/A N/A $96.82 N/A N/A $9.67 N/A N/A $173.40 N/A N/A $101.15 N/A N/A $187.85 N/A N/A $86.70 N/A N/A $173.40 N/A N/A $202.30 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A $289.00 $289.00 N/A 4006065 General Lab Vitamin B12 Level QST 82607 301 $289.00 $- $9.67 $- $- $231.20 $- N/A $75.14 N/A N/A $16.16 N/A N/A $173.40 N/A N/A $144.50 N/A N/A $9.67 N/A N/A $196.52 N/A N/A $141.61 N/A N/A $112.71 N/A N/A $202.30 N/A N/A $231.20 N/A N/A $158.95 N/A N/A $202.30 N/A N/A $96.82 N/A N/A $9.67 N/A N/A $173.40 N/A N/A $101.15 N/A N/A $187.85 N/A N/A $86.70 N/A N/A $173.40 N/A N/A $202.30 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A $289.00 $289.00 N/A 4006065 General Lab Vitamin B12 QLS 82607 301 $289.00 $- $9.67 $- $- $231.20 $- N/A $75.14 N/A N/A $16.16 N/A N/A $173.40 N/A N/A $144.50 N/A N/A $9.67 N/A N/A $196.52 N/A N/A $141.61 N/A N/A $112.71 N/A N/A $202.30 N/A N/A $231.20 N/A N/A $158.95 N/A N/A $202.30 N/A N/A $96.82 N/A N/A $9.67 N/A N/A $173.40 N/A N/A $101.15 N/A N/A $187.85 N/A N/A $86.70 N/A N/A $173.40 N/A N/A $202.30 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A N/A $86.70 N/A $289.00 $289.00 N/A 4006104 General Lab PT/INR and PTT QST 85610 305 $120.00 $- $2.53 $- $- $96.00 $- N/A $31.20 N/A N/A $4.21 N/A N/A $72.00 N/A N/A $60.00 N/A N/A $2.53 N/A N/A $81.60 N/A N/A $58.80 N/A N/A $46.80 N/A N/A $84.00 N/A N/A $96.00 N/A N/A $66.00 N/A N/A $84.00 N/A N/A $40.20 N/A N/A $2.53 N/A N/A $72.00 N/A N/A $42.00 N/A N/A $78.00 N/A N/A $36.00 N/A N/A $72.00 N/A N/A $84.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A $120.00 $120.00 N/A 4006104 General Lab PT/INR 85610 305 $120.00 $- $2.53 $- $- $96.00 $- N/A $31.20 N/A N/A $4.21 N/A N/A $72.00 N/A N/A $60.00 N/A N/A $2.53 N/A N/A $81.60 N/A N/A $58.80 N/A N/A $46.80 N/A N/A $84.00 N/A N/A $96.00 N/A N/A $66.00 N/A N/A $84.00 N/A N/A $40.20 N/A N/A $2.53 N/A N/A $72.00 N/A N/A $42.00 N/A N/A $78.00 N/A N/A $36.00 N/A N/A $72.00 N/A N/A $84.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A $120.00 $120.00 N/A 4006104 General Lab Prothrombin with INR 85610 305 $120.00 $- $2.53 $- $- $96.00 $- N/A $31.20 N/A N/A $4.21 N/A N/A $72.00 N/A N/A $60.00 N/A N/A $2.53 N/A N/A $81.60 N/A N/A $58.80 N/A N/A $46.80 N/A N/A $84.00 N/A N/A $96.00 N/A N/A $66.00 N/A N/A $84.00 N/A N/A $40.20 N/A N/A $2.53 N/A N/A $72.00 N/A N/A $42.00 N/A N/A $78.00 N/A N/A $36.00 N/A N/A $72.00 N/A N/A $84.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A $120.00 $120.00 N/A 4006155 General Lab Lactate Dehydrogenase 83615 301 $121.00 $- $3.88 $- $- $96.80 $- N/A $31.46 N/A N/A $6.48 N/A N/A $72.60 N/A N/A $60.50 N/A N/A $3.88 N/A N/A $82.28 N/A N/A $59.29 N/A N/A $47.19 N/A N/A $84.70 N/A N/A $96.80 N/A N/A $66.55 N/A N/A $84.70 N/A N/A $40.54 N/A N/A $3.88 N/A N/A $72.60 N/A N/A $42.35 N/A N/A $78.65 N/A N/A $36.30 N/A N/A $72.60 N/A N/A $84.70 N/A N/A $36.30 N/A N/A $36.30 N/A N/A $36.30 N/A N/A $36.30 N/A N/A $36.30 N/A N/A $36.30 N/A $121.00 $121.00 N/A 4006500 General Lab Sedimentation Rate 85652 305 $55.00 $- $1.74 $- $- $44.00 $- N/A $14.30 N/A N/A $2.89 N/A N/A $33.00 N/A N/A $27.50 N/A N/A $1.74 N/A N/A $37.40 N/A N/A $26.95 N/A N/A $21.45 N/A N/A $38.50 N/A N/A $44.00 N/A N/A $30.25 N/A N/A $38.50 N/A N/A $18.43 N/A N/A $1.74 N/A N/A $33.00 N/A N/A $19.25 N/A N/A $35.75 N/A N/A $16.50 N/A N/A $33.00 N/A N/A $38.50 N/A N/A $16.50 N/A N/A $16.50 N/A N/A $16.50 N/A N/A $16.50 N/A N/A $16.50 N/A N/A $16.50 N/A $55.00 $55.00 N/A 4006505 General Lab Rheumatoid Factor QST 86431 302 $106.00 $- $3.64 $- $- $84.80 $- N/A $27.56 N/A N/A $6.08 N/A N/A $63.60 N/A N/A $53.00 N/A N/A $3.64 N/A N/A $72.08 N/A N/A $51.94 N/A N/A $41.34 N/A N/A $74.20 N/A N/A $84.80 N/A N/A $58.30 N/A N/A $74.20 N/A N/A $35.51 N/A N/A $3.64 N/A N/A $63.60 N/A N/A $37.10 N/A N/A $68.90 N/A N/A $31.80 N/A N/A $63.60 N/A N/A $74.20 N/A N/A $31.80 N/A N/A $31.80 N/A N/A $31.80 N/A N/A $31.80 N/A N/A $31.80 N/A N/A $31.80 N/A $106.00 $106.00 N/A 4006505 General Lab "Rheumatoid Factor, (RA) Quant. QLS" 86431 302 $106.00 $- $3.64 $- $- $84.80 $- N/A $27.56 N/A N/A $6.08 N/A N/A $63.60 N/A N/A $53.00 N/A N/A $3.64 N/A N/A $72.08 N/A N/A $51.94 N/A N/A $41.34 N/A N/A $74.20 N/A N/A $84.80 N/A N/A $58.30 N/A N/A $74.20 N/A N/A $35.51 N/A N/A $3.64 N/A N/A $63.60 N/A N/A $37.10 N/A N/A $68.90 N/A N/A $31.80 N/A N/A $63.60 N/A N/A $74.20 N/A N/A $31.80 N/A N/A $31.80 N/A N/A $31.80 N/A N/A $31.80 N/A N/A $31.80 N/A N/A $31.80 N/A $106.00 $106.00 N/A 4007287 General Lab Ferritin Level 82728 301 $251.00 $- $8.75 $- $- $200.80 $- N/A $65.26 N/A N/A $14.60 N/A N/A $150.60 N/A N/A $125.50 N/A N/A $8.75 N/A N/A $170.68 N/A N/A $122.99 N/A N/A $97.89 N/A N/A $175.70 N/A N/A $200.80 N/A N/A $138.05 N/A N/A $175.70 N/A N/A $84.09 N/A N/A $8.75 N/A N/A $150.60 N/A N/A $87.85 N/A N/A $163.15 N/A N/A $75.30 N/A N/A $150.60 N/A N/A $175.70 N/A N/A $75.30 N/A N/A $75.30 N/A N/A $75.30 N/A N/A $75.30 N/A N/A $75.30 N/A N/A $75.30 N/A $251.00 $251.00 N/A 4007287 General Lab Ferritin QLS 82728 301 $251.00 $- $8.75 $- $- $200.80 $- N/A $65.26 N/A N/A $14.60 N/A N/A $150.60 N/A N/A $125.50 N/A N/A $8.75 N/A N/A $170.68 N/A N/A $122.99 N/A N/A $97.89 N/A N/A $175.70 N/A N/A $200.80 N/A N/A $138.05 N/A N/A $175.70 N/A N/A $84.09 N/A N/A $8.75 N/A N/A $150.60 N/A N/A $87.85 N/A N/A $163.15 N/A N/A $75.30 N/A N/A $150.60 N/A N/A $175.70 N/A N/A $75.30 N/A N/A $75.30 N/A N/A $75.30 N/A N/A $75.30 N/A N/A $75.30 N/A N/A $75.30 N/A $251.00 $251.00 N/A 4007300 General Lab PTT 85730 305 $120.00 $- $3.86 $- $- $96.00 $- N/A $31.20 N/A N/A $6.43 N/A N/A $72.00 N/A N/A $60.00 N/A N/A $3.86 N/A N/A $81.60 N/A N/A $58.80 N/A N/A $46.80 N/A N/A $84.00 N/A N/A $96.00 N/A N/A $66.00 N/A N/A $84.00 N/A N/A $40.20 N/A N/A $3.86 N/A N/A $72.00 N/A N/A $42.00 N/A N/A $78.00 N/A N/A $36.00 N/A N/A $72.00 N/A N/A $84.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A $120.00 $120.00 N/A 4007303 General Lab "Fibrinogen Activity, Clauss QLS" 85384 301 $148.00 $- $5.45 $- $- $118.40 $- N/A $38.48 N/A N/A $9.11 N/A N/A $88.80 N/A N/A $74.00 N/A N/A $5.45 N/A N/A $100.64 N/A N/A $72.52 N/A N/A $57.72 N/A N/A $103.60 N/A N/A $118.40 N/A N/A $81.40 N/A N/A $103.60 N/A N/A $49.58 N/A N/A $5.45 N/A N/A $88.80 N/A N/A $51.80 N/A N/A $96.20 N/A N/A $44.40 N/A N/A $88.80 N/A N/A $103.60 N/A N/A $44.40 N/A N/A $44.40 N/A N/A $44.40 N/A N/A $44.40 N/A N/A $44.40 N/A N/A $44.40 N/A $148.00 $148.00 N/A 4007351 General Lab Magnesium Level 83735 301 $130.00 $- $4.30 $- $- $104.00 $- N/A $33.80 N/A N/A $7.19 N/A N/A $78.00 N/A N/A $65.00 N/A N/A $4.30 N/A N/A $88.40 N/A N/A $63.70 N/A N/A $50.70 N/A N/A $91.00 N/A N/A $104.00 N/A N/A $71.50 N/A N/A $91.00 N/A N/A $43.55 N/A N/A $4.30 N/A N/A $78.00 N/A N/A $45.50 N/A N/A $84.50 N/A N/A $39.00 N/A N/A $78.00 N/A N/A $91.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A $130.00 $130.00 N/A 4007400 General Lab B-Natriuretic Peptide QLS 83880 301 $439.00 $- $21.78 $- $- $351.20 $- N/A $114.14 N/A N/A $36.40 N/A N/A $263.40 N/A N/A $219.50 N/A N/A $21.78 N/A N/A $298.52 N/A N/A $215.11 N/A N/A $171.21 N/A N/A $307.30 N/A N/A $351.20 N/A N/A $241.45 N/A N/A $307.30 N/A N/A $147.07 N/A N/A $21.78 N/A N/A $263.40 N/A N/A $153.65 N/A N/A $285.35 N/A N/A $131.70 N/A N/A $263.40 N/A N/A $307.30 N/A N/A $131.70 N/A N/A $131.70 N/A N/A $131.70 N/A N/A $131.70 N/A N/A $131.70 N/A N/A $131.70 N/A $439.00 $439.00 N/A 4007400 General Lab Brain Natriuretic Peptide 83880 301 $439.00 $- $21.78 $- $- $351.20 $- N/A $114.14 N/A N/A $36.40 N/A N/A $263.40 N/A N/A $219.50 N/A N/A $21.78 N/A N/A $298.52 N/A N/A $215.11 N/A N/A $171.21 N/A N/A $307.30 N/A N/A $351.20 N/A N/A $241.45 N/A N/A $307.30 N/A N/A $147.07 N/A N/A $21.78 N/A N/A $263.40 N/A N/A $153.65 N/A N/A $285.35 N/A N/A $131.70 N/A N/A $263.40 N/A N/A $307.30 N/A N/A $131.70 N/A N/A $131.70 N/A N/A $131.70 N/A N/A $131.70 N/A N/A $131.70 N/A N/A $131.70 N/A $439.00 $439.00 N/A 4007469 General Lab Folate Level 82746 301 $468.00 $- $9.43 $- $- $374.40 $- N/A $121.68 N/A N/A $15.77 N/A N/A $280.80 N/A N/A $234.00 N/A N/A $9.43 N/A N/A $318.24 N/A N/A $229.32 N/A N/A $182.52 N/A N/A $327.60 N/A N/A $374.40 N/A N/A $257.40 N/A N/A $327.60 N/A N/A $156.78 N/A N/A $9.43 N/A N/A $280.80 N/A N/A $163.80 N/A N/A $304.20 N/A N/A $140.40 N/A N/A $280.80 N/A N/A $327.60 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A $468.00 $468.00 N/A 4007469 General Lab Folate 82746 301 $468.00 $- $9.43 $- $- $374.40 $- N/A $121.68 N/A N/A $15.77 N/A N/A $280.80 N/A N/A $234.00 N/A N/A $9.43 N/A N/A $318.24 N/A N/A $229.32 N/A N/A $182.52 N/A N/A $327.60 N/A N/A $374.40 N/A N/A $257.40 N/A N/A $327.60 N/A N/A $156.78 N/A N/A $9.43 N/A N/A $280.80 N/A N/A $163.80 N/A N/A $304.20 N/A N/A $140.40 N/A N/A $280.80 N/A N/A $327.60 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A $468.00 $468.00 N/A 4007469 General Lab Folate QLS 82746 301 $468.00 $- $9.43 $- $- $374.40 $- N/A $121.68 N/A N/A $15.77 N/A N/A $280.80 N/A N/A $234.00 N/A N/A $9.43 N/A N/A $318.24 N/A N/A $229.32 N/A N/A $182.52 N/A N/A $327.60 N/A N/A $374.40 N/A N/A $257.40 N/A N/A $327.60 N/A N/A $156.78 N/A N/A $9.43 N/A N/A $280.80 N/A N/A $163.80 N/A N/A $304.20 N/A N/A $140.40 N/A N/A $280.80 N/A N/A $327.60 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A $468.00 $468.00 N/A 4007469 General Lab Folate QST 82746 301 $468.00 $- $9.43 $- $- $374.40 $- N/A $121.68 N/A N/A $15.77 N/A N/A $280.80 N/A N/A $234.00 N/A N/A $9.43 N/A N/A $318.24 N/A N/A $229.32 N/A N/A $182.52 N/A N/A $327.60 N/A N/A $374.40 N/A N/A $257.40 N/A N/A $327.60 N/A N/A $156.78 N/A N/A $9.43 N/A N/A $280.80 N/A N/A $163.80 N/A N/A $304.20 N/A N/A $140.40 N/A N/A $280.80 N/A N/A $327.60 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A $468.00 $468.00 N/A 4008186 General Lab Hemogram 5 85027 305 $101.00 $- $4.16 $- $- $80.80 $- N/A $26.26 N/A N/A $6.94 N/A N/A $60.60 N/A N/A $50.50 N/A N/A $4.16 N/A N/A $68.68 N/A N/A $49.49 N/A N/A $39.39 N/A N/A $70.70 N/A N/A $80.80 N/A N/A $55.55 N/A N/A $70.70 N/A N/A $33.84 N/A N/A $4.16 N/A N/A $60.60 N/A N/A $35.35 N/A N/A $65.65 N/A N/A $30.30 N/A N/A $60.60 N/A N/A $70.70 N/A N/A $30.30 N/A N/A $30.30 N/A N/A $30.30 N/A N/A $30.30 N/A N/A $30.30 N/A N/A $30.30 N/A $101.00 $101.00 N/A 4008186 General Lab Hemogram1 85027 305 $101.00 $- $4.16 $- $- $80.80 $- N/A $26.26 N/A N/A $6.94 N/A N/A $60.60 N/A N/A $50.50 N/A N/A $4.16 N/A N/A $68.68 N/A N/A $49.49 N/A N/A $39.39 N/A N/A $70.70 N/A N/A $80.80 N/A N/A $55.55 N/A N/A $70.70 N/A N/A $33.84 N/A N/A $4.16 N/A N/A $60.60 N/A N/A $35.35 N/A N/A $65.65 N/A N/A $30.30 N/A N/A $60.60 N/A N/A $70.70 N/A N/A $30.30 N/A N/A $30.30 N/A N/A $30.30 N/A N/A $30.30 N/A N/A $30.30 N/A N/A $30.30 N/A $101.00 $101.00 N/A 4008632 General Lab "IgA, Serum QLS" 82784 301 $130.00 $- $4.30 $- $- $104.00 $- N/A $33.80 N/A N/A $7.18 N/A N/A $78.00 N/A N/A $65.00 N/A N/A $4.30 N/A N/A $88.40 N/A N/A $63.70 N/A N/A $50.70 N/A N/A $91.00 N/A N/A $104.00 N/A N/A $71.50 N/A N/A $91.00 N/A N/A $43.55 N/A N/A $4.30 N/A N/A $78.00 N/A N/A $45.50 N/A N/A $84.50 N/A N/A $39.00 N/A N/A $78.00 N/A N/A $91.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A $130.00 $130.00 N/A 4008632 General Lab Immunoglobulin A QST 82784 301 $130.00 $- $4.30 $- $- $104.00 $- N/A $33.80 N/A N/A $7.18 N/A N/A $78.00 N/A N/A $65.00 N/A N/A $4.30 N/A N/A $88.40 N/A N/A $63.70 N/A N/A $50.70 N/A N/A $91.00 N/A N/A $104.00 N/A N/A $71.50 N/A N/A $91.00 N/A N/A $43.55 N/A N/A $4.30 N/A N/A $78.00 N/A N/A $45.50 N/A N/A $84.50 N/A N/A $39.00 N/A N/A $78.00 N/A N/A $91.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A $130.00 $130.00 N/A 4008632 General Lab IgA Serum QLS 82784 301 $130.00 $- $4.30 $- $- $104.00 $- N/A $33.80 N/A N/A $7.18 N/A N/A $78.00 N/A N/A $65.00 N/A N/A $4.30 N/A N/A $88.40 N/A N/A $63.70 N/A N/A $50.70 N/A N/A $91.00 N/A N/A $104.00 N/A N/A $71.50 N/A N/A $91.00 N/A N/A $43.55 N/A N/A $4.30 N/A N/A $78.00 N/A N/A $45.50 N/A N/A $84.50 N/A N/A $39.00 N/A N/A $78.00 N/A N/A $91.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A $130.00 $130.00 N/A 4008657 General Lab "IgG,serum QLS" 82784 301 $130.00 $- $4.30 $- $- $104.00 $- N/A $33.80 N/A N/A $7.18 N/A N/A $78.00 N/A N/A $65.00 N/A N/A $4.30 N/A N/A $88.40 N/A N/A $63.70 N/A N/A $50.70 N/A N/A $91.00 N/A N/A $104.00 N/A N/A $71.50 N/A N/A $91.00 N/A N/A $43.55 N/A N/A $4.30 N/A N/A $78.00 N/A N/A $45.50 N/A N/A $84.50 N/A N/A $39.00 N/A N/A $78.00 N/A N/A $91.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A $130.00 $130.00 N/A 4008657 General Lab Immunoglobulin G QST 82784 301 $130.00 $- $4.30 $- $- $104.00 $- N/A $33.80 N/A N/A $7.18 N/A N/A $78.00 N/A N/A $65.00 N/A N/A $4.30 N/A N/A $88.40 N/A N/A $63.70 N/A N/A $50.70 N/A N/A $91.00 N/A N/A $104.00 N/A N/A $71.50 N/A N/A $91.00 N/A N/A $43.55 N/A N/A $4.30 N/A N/A $78.00 N/A N/A $45.50 N/A N/A $84.50 N/A N/A $39.00 N/A N/A $78.00 N/A N/A $91.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A $130.00 $130.00 N/A 4008657 General Lab IgG Serum QLS 82784 301 $130.00 $- $4.30 $- $- $104.00 $- N/A $33.80 N/A N/A $7.18 N/A N/A $78.00 N/A N/A $65.00 N/A N/A $4.30 N/A N/A $88.40 N/A N/A $63.70 N/A N/A $50.70 N/A N/A $91.00 N/A N/A $104.00 N/A N/A $71.50 N/A N/A $91.00 N/A N/A $43.55 N/A N/A $4.30 N/A N/A $78.00 N/A N/A $45.50 N/A N/A $84.50 N/A N/A $39.00 N/A N/A $78.00 N/A N/A $91.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A $130.00 $130.00 N/A 4008665 General Lab "IgM, Serum QLS" 82784 301 $130.00 $- $4.30 $- $- $104.00 $- N/A $33.80 N/A N/A $7.18 N/A N/A $78.00 N/A N/A $65.00 N/A N/A $4.30 N/A N/A $88.40 N/A N/A $63.70 N/A N/A $50.70 N/A N/A $91.00 N/A N/A $104.00 N/A N/A $71.50 N/A N/A $91.00 N/A N/A $43.55 N/A N/A $4.30 N/A N/A $78.00 N/A N/A $45.50 N/A N/A $84.50 N/A N/A $39.00 N/A N/A $78.00 N/A N/A $91.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A $130.00 $130.00 N/A 4008665 General Lab Immunoglobulin M QST 82784 301 $130.00 $- $4.30 $- $- $104.00 $- N/A $33.80 N/A N/A $7.18 N/A N/A $78.00 N/A N/A $65.00 N/A N/A $4.30 N/A N/A $88.40 N/A N/A $63.70 N/A N/A $50.70 N/A N/A $91.00 N/A N/A $104.00 N/A N/A $71.50 N/A N/A $91.00 N/A N/A $43.55 N/A N/A $4.30 N/A N/A $78.00 N/A N/A $45.50 N/A N/A $84.50 N/A N/A $39.00 N/A N/A $78.00 N/A N/A $91.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A $130.00 $130.00 N/A 4008665 General Lab IgM Serum QLS 82784 301 $130.00 $- $4.30 $- $- $104.00 $- N/A $33.80 N/A N/A $7.18 N/A N/A $78.00 N/A N/A $65.00 N/A N/A $4.30 N/A N/A $88.40 N/A N/A $63.70 N/A N/A $50.70 N/A N/A $91.00 N/A N/A $104.00 N/A N/A $71.50 N/A N/A $91.00 N/A N/A $43.55 N/A N/A $4.30 N/A N/A $78.00 N/A N/A $45.50 N/A N/A $84.50 N/A N/A $39.00 N/A N/A $78.00 N/A N/A $91.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A $130.00 $130.00 N/A 4008681 General Lab Immunoglobulins Panel QLS 82784 301 $334.00 $- $4.30 $- $- $267.20 $- N/A $86.84 N/A N/A $7.18 N/A N/A $200.40 N/A N/A $167.00 N/A N/A $4.30 N/A N/A $227.12 N/A N/A $163.66 N/A N/A $130.26 N/A N/A $233.80 N/A N/A $267.20 N/A N/A $183.70 N/A N/A $233.80 N/A N/A $111.89 N/A N/A $4.30 N/A N/A $200.40 N/A N/A $116.90 N/A N/A $217.10 N/A N/A $100.20 N/A N/A $200.40 N/A N/A $233.80 N/A N/A $100.20 N/A N/A $100.20 N/A N/A $100.20 N/A N/A $100.20 N/A N/A $100.20 N/A N/A $100.20 N/A $334.00 $334.00 N/A 4009135 General Lab RSV Antigen QLS 87807 302 $330.00 $- $7.69 $- $- $264.00 $- N/A $85.80 N/A N/A $12.86 N/A N/A $198.00 N/A N/A $165.00 N/A N/A $7.69 N/A N/A $224.40 N/A N/A $161.70 N/A N/A $128.70 N/A N/A $231.00 N/A N/A $264.00 N/A N/A $181.50 N/A N/A $231.00 N/A N/A $110.55 N/A N/A $7.69 N/A N/A $198.00 N/A N/A $115.50 N/A N/A $214.50 N/A N/A $99.00 N/A N/A $198.00 N/A N/A $231.00 N/A N/A $99.00 N/A N/A $99.00 N/A N/A $99.00 N/A N/A $99.00 N/A N/A $99.00 N/A N/A $99.00 N/A $330.00 $330.00 N/A 4009135 General Lab RSV Immunoassay QST 87807 302 $330.00 $- $7.69 $- $- $264.00 $- N/A $85.80 N/A N/A $12.86 N/A N/A $198.00 N/A N/A $165.00 N/A N/A $7.69 N/A N/A $224.40 N/A N/A $161.70 N/A N/A $128.70 N/A N/A $231.00 N/A N/A $264.00 N/A N/A $181.50 N/A N/A $231.00 N/A N/A $110.55 N/A N/A $7.69 N/A N/A $198.00 N/A N/A $115.50 N/A N/A $214.50 N/A N/A $99.00 N/A N/A $198.00 N/A N/A $231.00 N/A N/A $99.00 N/A N/A $99.00 N/A N/A $99.00 N/A N/A $99.00 N/A N/A $99.00 N/A N/A $99.00 N/A $330.00 $330.00 N/A 4009471 General Lab CSF Glucose 82947 301 $78.00 $- $2.52 $- $- $62.40 $- N/A $20.28 N/A N/A $4.20 N/A N/A $46.80 N/A N/A $39.00 N/A N/A $2.52 N/A N/A $53.04 N/A N/A $38.22 N/A N/A $30.42 N/A N/A $54.60 N/A N/A $62.40 N/A N/A $42.90 N/A N/A $54.60 N/A N/A $26.13 N/A N/A $2.52 N/A N/A $46.80 N/A N/A $27.30 N/A N/A $50.70 N/A N/A $23.40 N/A N/A $46.80 N/A N/A $54.60 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A $78.00 $78.00 N/A 4009473 General Lab .Gestational GTT 1-Hr 82947 301 $78.00 $- $2.52 $- $- $62.40 $- N/A $20.28 N/A N/A $4.20 N/A N/A $46.80 N/A N/A $39.00 N/A N/A $2.52 N/A N/A $53.04 N/A N/A $38.22 N/A N/A $30.42 N/A N/A $54.60 N/A N/A $62.40 N/A N/A $42.90 N/A N/A $54.60 N/A N/A $26.13 N/A N/A $2.52 N/A N/A $46.80 N/A N/A $27.30 N/A N/A $50.70 N/A N/A $23.40 N/A N/A $46.80 N/A N/A $54.60 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A $78.00 $78.00 N/A 4009473 General Lab .Gestational GTT 1-Hr 82947 301 $78.00 $- $2.52 $- $- $62.40 $- N/A $20.28 N/A N/A $4.20 N/A N/A $46.80 N/A N/A $39.00 N/A N/A $2.52 N/A N/A $53.04 N/A N/A $38.22 N/A N/A $30.42 N/A N/A $54.60 N/A N/A $62.40 N/A N/A $42.90 N/A N/A $54.60 N/A N/A $26.13 N/A N/A $2.52 N/A N/A $46.80 N/A N/A $27.30 N/A N/A $50.70 N/A N/A $23.40 N/A N/A $46.80 N/A N/A $54.60 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A $78.00 $78.00 N/A 4009473 General Lab Glucose Level 82947 301 $78.00 $- $2.52 $- $- $62.40 $- N/A $20.28 N/A N/A $4.20 N/A N/A $46.80 N/A N/A $39.00 N/A N/A $2.52 N/A N/A $53.04 N/A N/A $38.22 N/A N/A $30.42 N/A N/A $54.60 N/A N/A $62.40 N/A N/A $42.90 N/A N/A $54.60 N/A N/A $26.13 N/A N/A $2.52 N/A N/A $46.80 N/A N/A $27.30 N/A N/A $50.70 N/A N/A $23.40 N/A N/A $46.80 N/A N/A $54.60 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A $78.00 $78.00 N/A 4009507 General Lab GTT 3-Hr 82951 301 $246.00 $- $6.69 $- $- $196.80 $- N/A $63.96 N/A N/A $11.17 N/A N/A $147.60 N/A N/A $123.00 N/A N/A $6.69 N/A N/A $167.28 N/A N/A $120.54 N/A N/A $95.94 N/A N/A $172.20 N/A N/A $196.80 N/A N/A $135.30 N/A N/A $172.20 N/A N/A $82.41 N/A N/A $6.69 N/A N/A $147.60 N/A N/A $86.10 N/A N/A $159.90 N/A N/A $73.80 N/A N/A $147.60 N/A N/A $172.20 N/A N/A $73.80 N/A N/A $73.80 N/A N/A $73.80 N/A N/A $73.80 N/A N/A $73.80 N/A N/A $73.80 N/A $246.00 $246.00 N/A 4009980 General Lab "PTH, Intact and Calcium QLS" 83970 301 $658.00 $- $171.08 $- $- $526.40 $- N/A $171.08 N/A N/A N/A N/A N/A $394.80 N/A N/A $329.00 N/A N/A N/A N/A N/A $447.44 N/A N/A $322.42 N/A N/A $256.62 N/A N/A $460.60 N/A N/A $526.40 N/A N/A $361.90 N/A N/A $460.60 N/A N/A $220.43 N/A N/A N/A N/A N/A $394.80 N/A N/A $230.30 N/A N/A $427.70 N/A N/A $197.40 N/A N/A $394.80 N/A N/A $460.60 N/A N/A $197.40 N/A N/A $197.40 N/A N/A $197.40 N/A N/A $197.40 N/A N/A $197.40 N/A N/A $197.40 N/A $658.00 $658.00 N/A 4009980 General Lab "PTH, Intact and Calcium QLS" 82310 301 $658.00 $- $3.31 $- $- $526.40 $- N/A $171.08 N/A N/A $5.53 N/A N/A $394.80 N/A N/A $329.00 N/A N/A $3.31 N/A N/A $447.44 N/A N/A $322.42 N/A N/A $256.62 N/A N/A $460.60 N/A N/A $526.40 N/A N/A $361.90 N/A N/A $460.60 N/A N/A $220.43 N/A N/A $3.31 N/A N/A $394.80 N/A N/A $230.30 N/A N/A $427.70 N/A N/A $197.40 N/A N/A $394.80 N/A N/A $460.60 N/A N/A $197.40 N/A N/A $197.40 N/A N/A $197.40 N/A N/A $197.40 N/A N/A $197.40 N/A N/A $197.40 N/A $658.00 $658.00 N/A 4009980 General Lab Parathyroid Hormone (PTH) QST 83970 301 $658.00 $- $26.48 $- $- $526.40 $- N/A $171.08 N/A N/A $44.26 N/A N/A $394.80 N/A N/A $329.00 N/A N/A $26.48 N/A N/A $447.44 N/A N/A $322.42 N/A N/A $256.62 N/A N/A $460.60 N/A N/A $526.40 N/A N/A $361.90 N/A N/A $460.60 N/A N/A $220.43 N/A N/A $26.48 N/A N/A $394.80 N/A N/A $230.30 N/A N/A $427.70 N/A N/A $197.40 N/A N/A $394.80 N/A N/A $460.60 N/A N/A $197.40 N/A N/A $197.40 N/A N/A $197.40 N/A N/A $197.40 N/A N/A $197.40 N/A N/A $197.40 N/A $658.00 $658.00 N/A 4010008 General Lab "Amylase, Pleural Fluid QLS" 82150 301 $139.00 $- $4.16 $- $- $111.20 $- N/A $36.14 N/A N/A $6.95 N/A N/A $83.40 N/A N/A $69.50 N/A N/A $4.16 N/A N/A $94.52 N/A N/A $68.11 N/A N/A $54.21 N/A N/A $97.30 N/A N/A $111.20 N/A N/A $76.45 N/A N/A $97.30 N/A N/A $46.57 N/A N/A $4.16 N/A N/A $83.40 N/A N/A $48.65 N/A N/A $90.35 N/A N/A $41.70 N/A N/A $83.40 N/A N/A $97.30 N/A N/A $41.70 N/A N/A $41.70 N/A N/A $41.70 N/A N/A $41.70 N/A N/A $41.70 N/A N/A $41.70 N/A $139.00 $139.00 N/A 4010008 General Lab "Amylase, Pleural Fluid QST" 82150 301 $139.00 $- $4.16 $- $- $111.20 $- N/A $36.14 N/A N/A $6.95 N/A N/A $83.40 N/A N/A $69.50 N/A N/A $4.16 N/A N/A $94.52 N/A N/A $68.11 N/A N/A $54.21 N/A N/A $97.30 N/A N/A $111.20 N/A N/A $76.45 N/A N/A $97.30 N/A N/A $46.57 N/A N/A $4.16 N/A N/A $83.40 N/A N/A $48.65 N/A N/A $90.35 N/A N/A $41.70 N/A N/A $83.40 N/A N/A $97.30 N/A N/A $41.70 N/A N/A $41.70 N/A N/A $41.70 N/A N/A $41.70 N/A N/A $41.70 N/A N/A $41.70 N/A $139.00 $139.00 N/A 4010009 General Lab "LD, Pleural Fluid QST" 83615 301 $92.00 $- $3.88 $- $- $73.60 $- N/A $23.92 N/A N/A $6.48 N/A N/A $55.20 N/A N/A $46.00 N/A N/A $3.88 N/A N/A $62.56 N/A N/A $45.08 N/A N/A $35.88 N/A N/A $64.40 N/A N/A $73.60 N/A N/A $50.60 N/A N/A $64.40 N/A N/A $30.82 N/A N/A $3.88 N/A N/A $55.20 N/A N/A $32.20 N/A N/A $59.80 N/A N/A $27.60 N/A N/A $55.20 N/A N/A $64.40 N/A N/A $27.60 N/A N/A $27.60 N/A N/A $27.60 N/A N/A $27.60 N/A N/A $27.60 N/A N/A $27.60 N/A $92.00 $92.00 N/A 4010009 General Lab "LDH, Pleural Fluid QLS" 83615 301 $92.00 $- $3.88 $- $- $73.60 $- N/A $23.92 N/A N/A $6.48 N/A N/A $55.20 N/A N/A $46.00 N/A N/A $3.88 N/A N/A $62.56 N/A N/A $45.08 N/A N/A $35.88 N/A N/A $64.40 N/A N/A $73.60 N/A N/A $50.60 N/A N/A $64.40 N/A N/A $30.82 N/A N/A $3.88 N/A N/A $55.20 N/A N/A $32.20 N/A N/A $59.80 N/A N/A $27.60 N/A N/A $55.20 N/A N/A $64.40 N/A N/A $27.60 N/A N/A $27.60 N/A N/A $27.60 N/A N/A $27.60 N/A N/A $27.60 N/A N/A $27.60 N/A $92.00 $92.00 N/A 4010013 General Lab CBC (Includes Diff/Plt) QST 85025 305 $238.00 $- $5.00 $- $- $190.40 $- N/A $61.88 N/A N/A $8.34 N/A N/A $142.80 N/A N/A $119.00 N/A N/A $5.00 N/A N/A $161.84 N/A N/A $116.62 N/A N/A $92.82 N/A N/A $166.60 N/A N/A $190.40 N/A N/A $130.90 N/A N/A $166.60 N/A N/A $79.73 N/A N/A $5.00 N/A N/A $142.80 N/A N/A $83.30 N/A N/A $154.70 N/A N/A $71.40 N/A N/A $142.80 N/A N/A $166.60 N/A N/A $71.40 N/A N/A $71.40 N/A N/A $71.40 N/A N/A $71.40 N/A N/A $71.40 N/A N/A $71.40 N/A $238.00 $238.00 N/A 4010013 General Lab CBC (Includes Diff/Platelets) QLS 85025 305 $238.00 $- $5.00 $- $- $190.40 $- N/A $61.88 N/A N/A $8.34 N/A N/A $142.80 N/A N/A $119.00 N/A N/A $5.00 N/A N/A $161.84 N/A N/A $116.62 N/A N/A $92.82 N/A N/A $166.60 N/A N/A $190.40 N/A N/A $130.90 N/A N/A $166.60 N/A N/A $79.73 N/A N/A $5.00 N/A N/A $142.80 N/A N/A $83.30 N/A N/A $154.70 N/A N/A $71.40 N/A N/A $142.80 N/A N/A $166.60 N/A N/A $71.40 N/A N/A $71.40 N/A N/A $71.40 N/A N/A $71.40 N/A N/A $71.40 N/A N/A $71.40 N/A $238.00 $238.00 N/A 4010014 General Lab Comprehensive Metabolic Panel QLS 80053 301 $790.00 $- $6.78 $- $- $632.00 $- N/A $205.40 N/A N/A $11.33 N/A N/A $474.00 N/A N/A $395.00 N/A N/A $6.78 N/A N/A $537.20 N/A N/A $387.10 N/A N/A $308.10 N/A N/A $553.00 N/A N/A $632.00 N/A N/A $434.50 N/A N/A $553.00 N/A N/A $264.65 N/A N/A $6.78 N/A N/A $474.00 N/A N/A $276.50 N/A N/A $513.50 N/A N/A $237.00 N/A N/A $474.00 N/A N/A $553.00 N/A N/A $237.00 N/A N/A $237.00 N/A N/A $237.00 N/A N/A $237.00 N/A N/A $237.00 N/A N/A $237.00 N/A $790.00 $790.00 N/A 4010014 General Lab Comprehensive Metabolic Panel QST 80053 301 $790.00 $- $6.78 $- $- $632.00 $- N/A $205.40 N/A N/A $11.33 N/A N/A $474.00 N/A N/A $395.00 N/A N/A $6.78 N/A N/A $537.20 N/A N/A $387.10 N/A N/A $308.10 N/A N/A $553.00 N/A N/A $632.00 N/A N/A $434.50 N/A N/A $553.00 N/A N/A $264.65 N/A N/A $6.78 N/A N/A $474.00 N/A N/A $276.50 N/A N/A $513.50 N/A N/A $237.00 N/A N/A $474.00 N/A N/A $553.00 N/A N/A $237.00 N/A N/A $237.00 N/A N/A $237.00 N/A N/A $237.00 N/A N/A $237.00 N/A N/A $237.00 N/A $790.00 $790.00 N/A 4010022 General Lab Allergy-Shellfish Panel QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010022 General Lab Bermuda Grass (G2) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010022 General Lab Clam (F207) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010022 General Lab Coconut (f36) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010022 General Lab Cottonwood (T14) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010022 General Lab False Ragweed (w4) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010022 General Lab False Ragweed (w4) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010022 General Lab Food Allergy Profile QLS 82785 302 $40.00 $- $10.40 $- $- $32.00 $- N/A $10.40 N/A N/A $17.66 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $10.57 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $10.57 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010022 General Lab Johnson Grass (g10) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010022 General Lab Maize/Corn (F8) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010022 General Lab Mesquite Tree (t20) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010022 General Lab Mugwort (w6) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010022 General Lab Oak (T7) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010022 General Lab Olive Tree (t9) IgE 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010022 General Lab Perennial Rye Grass (g5) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010022 General Lab Rough Pigweed (W14) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010022 General Lab Sesame Seed (f10) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010022 General Lab Sycamore (T11) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010022 General Lab Timothy Grass (G6) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010022 General Lab Tree Nut Allergy Panel QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010022 General Lab Western Ragweed (w2) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010022 General Lab White Mulberry (t70) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010022 General Lab Food Allergy Profile QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010044 General Lab Thyroid Cascading Reflex QLS 84443 301 $954.00 $- $10.79 $- $- $763.20 $- N/A $248.04 N/A N/A $18.02 N/A N/A $572.40 N/A N/A $477.00 N/A N/A $10.79 N/A N/A $648.72 N/A N/A $467.46 N/A N/A $372.06 N/A N/A $667.80 N/A N/A $763.20 N/A N/A $524.70 N/A N/A $667.80 N/A N/A $319.59 N/A N/A $10.79 N/A N/A $572.40 N/A N/A $333.90 N/A N/A $620.10 N/A N/A $286.20 N/A N/A $572.40 N/A N/A $667.80 N/A N/A $286.20 N/A N/A $286.20 N/A N/A $286.20 N/A N/A $286.20 N/A N/A $286.20 N/A N/A $286.20 N/A $954.00 $954.00 N/A 4010044 General Lab Thyroid Cascading Relex QST 84443 301 $954.00 $- $10.79 $- $- $763.20 $- N/A $248.04 N/A N/A $18.02 N/A N/A $572.40 N/A N/A $477.00 N/A N/A $10.79 N/A N/A $648.72 N/A N/A $467.46 N/A N/A $372.06 N/A N/A $667.80 N/A N/A $763.20 N/A N/A $524.70 N/A N/A $667.80 N/A N/A $319.59 N/A N/A $10.79 N/A N/A $572.40 N/A N/A $333.90 N/A N/A $620.10 N/A N/A $286.20 N/A N/A $572.40 N/A N/A $667.80 N/A N/A $286.20 N/A N/A $286.20 N/A N/A $286.20 N/A N/A $286.20 N/A N/A $286.20 N/A N/A $286.20 N/A $954.00 $954.00 N/A 4010045 General Lab A. Alternata (M6) IGE QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab A. fumigatus (M3) QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Beef (F27) QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Bermuda grass (G2) QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Box maple elder(T1) QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab C. Herbarum (M2) IGE QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Cat Dander (E1) IGE QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Chicken meat (F83) QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Class QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Cockroach (I6) IGE QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Coffee (F221) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Common pigweed (W14) QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Common ragweed(W1) QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Cottonwood (T14) QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab D. Farinae (D2) IGE QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab D. Pteronyssinus (D1) IGE QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Dog Dander (E5) IGE QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Elm (T8) QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab IgE QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Interpretation QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Mountain juniper(T6) QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Mugwort (W6) QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Mulberry tree (T70) QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Oak (T7) QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Oats (F7) QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Olive tree (T9) QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Orange (food) (F33) QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab P. notatum (M1) QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Pineapple (F210) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Potato (F35) QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab "Respiratory Allergy Profile, Region XV QLS" 82785 302 $40.00 $- $10.40 $- $- $32.00 $- N/A $10.40 N/A N/A $17.66 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $10.57 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $10.57 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Respiratory Allergy Profile Region XV QST 82785 302 $40.00 $- $10.40 $- $- $32.00 $- N/A $10.40 N/A N/A $17.66 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $10.57 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $10.57 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Rice (F9) QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Russian thistle (W11) QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Rye (F5) QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Strawberry (F44) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Timothy grass (G6) QLS 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010045 General Lab Tomato (F25) QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010050 General Lab Vitamin B12 and Folate QLS 82607 301 $468.00 $- $9.67 $- $- $374.40 $- N/A $121.68 N/A N/A $16.16 N/A N/A $280.80 N/A N/A $234.00 N/A N/A $9.67 N/A N/A $318.24 N/A N/A $229.32 N/A N/A $182.52 N/A N/A $327.60 N/A N/A $374.40 N/A N/A $257.40 N/A N/A $327.60 N/A N/A $156.78 N/A N/A $9.67 N/A N/A $280.80 N/A N/A $163.80 N/A N/A $304.20 N/A N/A $140.40 N/A N/A $280.80 N/A N/A $327.60 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A $468.00 $468.00 N/A 4010050 General Lab Vitamin B12/Folate Panel QST 82607 301 $468.00 $- $9.67 $- $- $374.40 $- N/A $121.68 N/A N/A $16.16 N/A N/A $280.80 N/A N/A $234.00 N/A N/A $9.67 N/A N/A $318.24 N/A N/A $229.32 N/A N/A $182.52 N/A N/A $327.60 N/A N/A $374.40 N/A N/A $257.40 N/A N/A $327.60 N/A N/A $156.78 N/A N/A $9.67 N/A N/A $280.80 N/A N/A $163.80 N/A N/A $304.20 N/A N/A $140.40 N/A N/A $280.80 N/A N/A $327.60 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A N/A $140.40 N/A $468.00 $468.00 N/A 4010057 General Lab Allergen Specific IgE 86003 302 $42.00 $- $3.35 $- $- $33.60 $- N/A $10.92 N/A N/A $5.59 N/A N/A $25.20 N/A N/A $21.00 N/A N/A $3.35 N/A N/A $28.56 N/A N/A $20.58 N/A N/A $16.38 N/A N/A $29.40 N/A N/A $33.60 N/A N/A $23.10 N/A N/A $29.40 N/A N/A $14.07 N/A N/A $3.35 N/A N/A $25.20 N/A N/A $14.70 N/A N/A $27.30 N/A N/A $12.60 N/A N/A $25.20 N/A N/A $29.40 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A $42.00 $42.00 N/A 4010115 General Lab "Cardio IQ ProBNP, N-Termal QLS" 83880 301 $316.00 $- $21.78 $- $- $252.80 $- N/A $82.16 N/A N/A $36.40 N/A N/A $189.60 N/A N/A $158.00 N/A N/A $21.78 N/A N/A $214.88 N/A N/A $154.84 N/A N/A $123.24 N/A N/A $221.20 N/A N/A $252.80 N/A N/A $173.80 N/A N/A $221.20 N/A N/A $105.86 N/A N/A $21.78 N/A N/A $189.60 N/A N/A $110.60 N/A N/A $205.40 N/A N/A $94.80 N/A N/A $189.60 N/A N/A $221.20 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A $316.00 $316.00 N/A 4010115 General Lab Cardio IQ(R) NT-PRO BNP QST 83880 301 $316.00 $- $21.78 $- $- $252.80 $- N/A $82.16 N/A N/A $36.40 N/A N/A $189.60 N/A N/A $158.00 N/A N/A $21.78 N/A N/A $214.88 N/A N/A $154.84 N/A N/A $123.24 N/A N/A $221.20 N/A N/A $252.80 N/A N/A $173.80 N/A N/A $221.20 N/A N/A $105.86 N/A N/A $21.78 N/A N/A $189.60 N/A N/A $110.60 N/A N/A $205.40 N/A N/A $94.80 N/A N/A $189.60 N/A N/A $221.20 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A $316.00 $316.00 N/A 4010115 General Lab NT-PRO BNP QST 83880 301 $316.00 $- $21.78 $- $- $252.80 $- N/A $82.16 N/A N/A $36.40 N/A N/A $189.60 N/A N/A $158.00 N/A N/A $21.78 N/A N/A $214.88 N/A N/A $154.84 N/A N/A $123.24 N/A N/A $221.20 N/A N/A $252.80 N/A N/A $173.80 N/A N/A $221.20 N/A N/A $105.86 N/A N/A $21.78 N/A N/A $189.60 N/A N/A $110.60 N/A N/A $205.40 N/A N/A $94.80 N/A N/A $189.60 N/A N/A $221.20 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A $316.00 $316.00 N/A 4010127 General Lab Pro B-Type Natriuretic Peptide N-Terminal QLS 83880 301 $316.00 $- $21.78 $- $- $252.80 $- N/A $82.16 N/A N/A $36.40 N/A N/A $189.60 N/A N/A $158.00 N/A N/A $21.78 N/A N/A $214.88 N/A N/A $154.84 N/A N/A $123.24 N/A N/A $221.20 N/A N/A $252.80 N/A N/A $173.80 N/A N/A $221.20 N/A N/A $105.86 N/A N/A $21.78 N/A N/A $189.60 N/A N/A $110.60 N/A N/A $205.40 N/A N/A $94.80 N/A N/A $189.60 N/A N/A $221.20 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A N/A $94.80 N/A $316.00 $316.00 N/A 4010133 General Lab "Magnesium, RBC QST" 83735 301 $130.00 $- $4.30 $- $- $104.00 $- N/A $33.80 N/A N/A $7.19 N/A N/A $78.00 N/A N/A $65.00 N/A N/A $4.30 N/A N/A $88.40 N/A N/A $63.70 N/A N/A $50.70 N/A N/A $91.00 N/A N/A $104.00 N/A N/A $71.50 N/A N/A $91.00 N/A N/A $43.55 N/A N/A $4.30 N/A N/A $78.00 N/A N/A $45.50 N/A N/A $84.50 N/A N/A $39.00 N/A N/A $78.00 N/A N/A $91.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A $130.00 $130.00 N/A 4010187 General Lab "Testosterone Free, Total, Bio QST" 82040 301 $70.00 $- $3.18 $- $- $56.00 $- N/A $18.20 N/A N/A $5.30 N/A N/A $42.00 N/A N/A $35.00 N/A N/A $3.18 N/A N/A $47.60 N/A N/A $34.30 N/A N/A $27.30 N/A N/A $49.00 N/A N/A $56.00 N/A N/A $38.50 N/A N/A $49.00 N/A N/A $23.45 N/A N/A $3.18 N/A N/A $42.00 N/A N/A $24.50 N/A N/A $45.50 N/A N/A $21.00 N/A N/A $42.00 N/A N/A $49.00 N/A N/A $21.00 N/A N/A $21.00 N/A N/A $21.00 N/A N/A $21.00 N/A N/A $21.00 N/A N/A $21.00 N/A $70.00 $70.00 N/A 4010195 General Lab Olive (RF342) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 4010275 General Lab .Glucose Fasting 82947 301 $78.00 $- $2.52 $- $- $62.40 $- N/A $20.28 N/A N/A $4.20 N/A N/A $46.80 N/A N/A $39.00 N/A N/A $2.52 N/A N/A $53.04 N/A N/A $38.22 N/A N/A $30.42 N/A N/A $54.60 N/A N/A $62.40 N/A N/A $42.90 N/A N/A $54.60 N/A N/A $26.13 N/A N/A $2.52 N/A N/A $46.80 N/A N/A $27.30 N/A N/A $50.70 N/A N/A $23.40 N/A N/A $46.80 N/A N/A $54.60 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A $78.00 $78.00 N/A 4010281 General Lab .GTT-3 Hr 82951 301 $246.00 $- $6.69 $- $- $196.80 $- N/A $63.96 N/A N/A $11.17 N/A N/A $147.60 N/A N/A $123.00 N/A N/A $6.69 N/A N/A $167.28 N/A N/A $120.54 N/A N/A $95.94 N/A N/A $172.20 N/A N/A $196.80 N/A N/A $135.30 N/A N/A $172.20 N/A N/A $82.41 N/A N/A $6.69 N/A N/A $147.60 N/A N/A $86.10 N/A N/A $159.90 N/A N/A $73.80 N/A N/A $147.60 N/A N/A $172.20 N/A N/A $73.80 N/A N/A $73.80 N/A N/A $73.80 N/A N/A $73.80 N/A N/A $73.80 N/A N/A $73.80 N/A $246.00 $246.00 N/A 4167002 General Lab Venous Blood Gas 4 82803 301 "$1,190.00 " $- $12.41 $- $- $952.00 $- N/A $309.40 N/A N/A $20.75 N/A N/A $714.00 N/A N/A $595.00 N/A N/A $12.41 N/A N/A $809.20 N/A N/A $583.10 N/A N/A $464.10 N/A N/A $833.00 N/A N/A $952.00 N/A N/A $654.50 N/A N/A $833.00 N/A N/A $398.65 N/A N/A $12.41 N/A N/A $714.00 N/A N/A $416.50 N/A N/A $773.50 N/A N/A $357.00 N/A N/A $714.00 N/A N/A $833.00 N/A N/A $357.00 N/A N/A $357.00 N/A N/A $357.00 N/A N/A $357.00 N/A N/A $357.00 N/A N/A $357.00 N/A "$1,190.00 " "$1,190.00 " N/A 18407825 General Lab Egg White 86003 302 $42.00 $- $3.35 $- $- $33.60 $- N/A $10.92 N/A N/A $5.59 N/A N/A $25.20 N/A N/A $21.00 N/A N/A $3.35 N/A N/A $28.56 N/A N/A $20.58 N/A N/A $16.38 N/A N/A $29.40 N/A N/A $33.60 N/A N/A $23.10 N/A N/A $29.40 N/A N/A $14.07 N/A N/A $3.35 N/A N/A $25.20 N/A N/A $14.70 N/A N/A $27.30 N/A N/A $12.60 N/A N/A $25.20 N/A N/A $29.40 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A $42.00 $42.00 N/A 18407825 General Lab Egg White (F1) IgE QST 86003 302 $42.00 $- $3.35 $- $- $33.60 $- N/A $10.92 N/A N/A $5.59 N/A N/A $25.20 N/A N/A $21.00 N/A N/A $3.35 N/A N/A $28.56 N/A N/A $20.58 N/A N/A $16.38 N/A N/A $29.40 N/A N/A $33.60 N/A N/A $23.10 N/A N/A $29.40 N/A N/A $14.07 N/A N/A $3.35 N/A N/A $25.20 N/A N/A $14.70 N/A N/A $27.30 N/A N/A $12.60 N/A N/A $25.20 N/A N/A $29.40 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A $42.00 $42.00 N/A 18407826 General Lab Cow's Milk 86003 302 $42.00 $- $3.35 $- $- $33.60 $- N/A $10.92 N/A N/A $5.59 N/A N/A $25.20 N/A N/A $21.00 N/A N/A $3.35 N/A N/A $28.56 N/A N/A $20.58 N/A N/A $16.38 N/A N/A $29.40 N/A N/A $33.60 N/A N/A $23.10 N/A N/A $29.40 N/A N/A $14.07 N/A N/A $3.35 N/A N/A $25.20 N/A N/A $14.70 N/A N/A $27.30 N/A N/A $12.60 N/A N/A $25.20 N/A N/A $29.40 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A $42.00 $42.00 N/A 18407826 General Lab Cow's Milk (f2) IgE QST 86003 302 $42.00 $- $3.35 $- $- $33.60 $- N/A $10.92 N/A N/A $5.59 N/A N/A $25.20 N/A N/A $21.00 N/A N/A $3.35 N/A N/A $28.56 N/A N/A $20.58 N/A N/A $16.38 N/A N/A $29.40 N/A N/A $33.60 N/A N/A $23.10 N/A N/A $29.40 N/A N/A $14.07 N/A N/A $3.35 N/A N/A $25.20 N/A N/A $14.70 N/A N/A $27.30 N/A N/A $12.60 N/A N/A $25.20 N/A N/A $29.40 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A $42.00 $42.00 N/A 18407827 General Lab Codfish 86003 302 $42.00 $- $3.35 $- $- $33.60 $- N/A $10.92 N/A N/A $5.59 N/A N/A $25.20 N/A N/A $21.00 N/A N/A $3.35 N/A N/A $28.56 N/A N/A $20.58 N/A N/A $16.38 N/A N/A $29.40 N/A N/A $33.60 N/A N/A $23.10 N/A N/A $29.40 N/A N/A $14.07 N/A N/A $3.35 N/A N/A $25.20 N/A N/A $14.70 N/A N/A $27.30 N/A N/A $12.60 N/A N/A $25.20 N/A N/A $29.40 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A $42.00 $42.00 N/A 18407828 General Lab Wheat 86003 302 $42.00 $- $3.35 $- $- $33.60 $- N/A $10.92 N/A N/A $5.59 N/A N/A $25.20 N/A N/A $21.00 N/A N/A $3.35 N/A N/A $28.56 N/A N/A $20.58 N/A N/A $16.38 N/A N/A $29.40 N/A N/A $33.60 N/A N/A $23.10 N/A N/A $29.40 N/A N/A $14.07 N/A N/A $3.35 N/A N/A $25.20 N/A N/A $14.70 N/A N/A $27.30 N/A N/A $12.60 N/A N/A $25.20 N/A N/A $29.40 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A $42.00 $42.00 N/A 18407828 General Lab Wheat (f4) IGE QST 86003 302 $42.00 $- $3.35 $- $- $33.60 $- N/A $10.92 N/A N/A $5.59 N/A N/A $25.20 N/A N/A $21.00 N/A N/A $3.35 N/A N/A $28.56 N/A N/A $20.58 N/A N/A $16.38 N/A N/A $29.40 N/A N/A $33.60 N/A N/A $23.10 N/A N/A $29.40 N/A N/A $14.07 N/A N/A $3.35 N/A N/A $25.20 N/A N/A $14.70 N/A N/A $27.30 N/A N/A $12.60 N/A N/A $25.20 N/A N/A $29.40 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A $42.00 $42.00 N/A 18407830 General Lab Sesame Seed 86003 302 $42.00 $- $3.35 $- $- $33.60 $- N/A $10.92 N/A N/A $5.59 N/A N/A $25.20 N/A N/A $21.00 N/A N/A $3.35 N/A N/A $28.56 N/A N/A $20.58 N/A N/A $16.38 N/A N/A $29.40 N/A N/A $33.60 N/A N/A $23.10 N/A N/A $29.40 N/A N/A $14.07 N/A N/A $3.35 N/A N/A $25.20 N/A N/A $14.70 N/A N/A $27.30 N/A N/A $12.60 N/A N/A $25.20 N/A N/A $29.40 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A $42.00 $42.00 N/A 18407831 General Lab Peanut 86003 302 $42.00 $- $3.35 $- $- $33.60 $- N/A $10.92 N/A N/A $5.59 N/A N/A $25.20 N/A N/A $21.00 N/A N/A $3.35 N/A N/A $28.56 N/A N/A $20.58 N/A N/A $16.38 N/A N/A $29.40 N/A N/A $33.60 N/A N/A $23.10 N/A N/A $29.40 N/A N/A $14.07 N/A N/A $3.35 N/A N/A $25.20 N/A N/A $14.70 N/A N/A $27.30 N/A N/A $12.60 N/A N/A $25.20 N/A N/A $29.40 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A $42.00 $42.00 N/A 18407831 General Lab Peanut IgE QST 86003 302 $42.00 $- $3.35 $- $- $33.60 $- N/A $10.92 N/A N/A $5.59 N/A N/A $25.20 N/A N/A $21.00 N/A N/A $3.35 N/A N/A $28.56 N/A N/A $20.58 N/A N/A $16.38 N/A N/A $29.40 N/A N/A $33.60 N/A N/A $23.10 N/A N/A $29.40 N/A N/A $14.07 N/A N/A $3.35 N/A N/A $25.20 N/A N/A $14.70 N/A N/A $27.30 N/A N/A $12.60 N/A N/A $25.20 N/A N/A $29.40 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A $42.00 $42.00 N/A 18407832 General Lab SOYBEAN (F14) IGE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 18407832 General Lab Soybean 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 18407833 General Lab Shrimp 86003 302 $42.00 $- $3.35 $- $- $33.60 $- N/A $10.92 N/A N/A $5.59 N/A N/A $25.20 N/A N/A $21.00 N/A N/A $3.35 N/A N/A $28.56 N/A N/A $20.58 N/A N/A $16.38 N/A N/A $29.40 N/A N/A $33.60 N/A N/A $23.10 N/A N/A $29.40 N/A N/A $14.07 N/A N/A $3.35 N/A N/A $25.20 N/A N/A $14.70 N/A N/A $27.30 N/A N/A $12.60 N/A N/A $25.20 N/A N/A $29.40 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A $42.00 $42.00 N/A 18407833 General Lab Shrimp (F24) IgE QST 86003 302 $42.00 $- $3.35 $- $- $33.60 $- N/A $10.92 N/A N/A $5.59 N/A N/A $25.20 N/A N/A $21.00 N/A N/A $3.35 N/A N/A $28.56 N/A N/A $20.58 N/A N/A $16.38 N/A N/A $29.40 N/A N/A $33.60 N/A N/A $23.10 N/A N/A $29.40 N/A N/A $14.07 N/A N/A $3.35 N/A N/A $25.20 N/A N/A $14.70 N/A N/A $27.30 N/A N/A $12.60 N/A N/A $25.20 N/A N/A $29.40 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A $42.00 $42.00 N/A 18407835 General Lab Walnut 86003 302 $42.00 $- $3.35 $- $- $33.60 $- N/A $10.92 N/A N/A $5.59 N/A N/A $25.20 N/A N/A $21.00 N/A N/A $3.35 N/A N/A $28.56 N/A N/A $20.58 N/A N/A $16.38 N/A N/A $29.40 N/A N/A $33.60 N/A N/A $23.10 N/A N/A $29.40 N/A N/A $14.07 N/A N/A $3.35 N/A N/A $25.20 N/A N/A $14.70 N/A N/A $27.30 N/A N/A $12.60 N/A N/A $25.20 N/A N/A $29.40 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A $42.00 $42.00 N/A 18407836 General Lab Scallop 86003 302 $42.00 $- $3.35 $- $- $33.60 $- N/A $10.92 N/A N/A $5.59 N/A N/A $25.20 N/A N/A $21.00 N/A N/A $3.35 N/A N/A $28.56 N/A N/A $20.58 N/A N/A $16.38 N/A N/A $29.40 N/A N/A $33.60 N/A N/A $23.10 N/A N/A $29.40 N/A N/A $14.07 N/A N/A $3.35 N/A N/A $25.20 N/A N/A $14.70 N/A N/A $27.30 N/A N/A $12.60 N/A N/A $25.20 N/A N/A $29.40 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A $42.00 $42.00 N/A 25632484 General Lab Hazelnut 86003 302 $42.00 $- $3.35 $- $- $33.60 $- N/A $10.92 N/A N/A $5.59 N/A N/A $25.20 N/A N/A $21.00 N/A N/A $3.35 N/A N/A $28.56 N/A N/A $20.58 N/A N/A $16.38 N/A N/A $29.40 N/A N/A $33.60 N/A N/A $23.10 N/A N/A $29.40 N/A N/A $14.07 N/A N/A $3.35 N/A N/A $25.20 N/A N/A $14.70 N/A N/A $27.30 N/A N/A $12.60 N/A N/A $25.20 N/A N/A $29.40 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A $42.00 $42.00 N/A 25632489 General Lab Almond 86003 302 $42.00 $- $3.35 $- $- $33.60 $- N/A $10.92 N/A N/A $5.59 N/A N/A $25.20 N/A N/A $21.00 N/A N/A $3.35 N/A N/A $28.56 N/A N/A $20.58 N/A N/A $16.38 N/A N/A $29.40 N/A N/A $33.60 N/A N/A $23.10 N/A N/A $29.40 N/A N/A $14.07 N/A N/A $3.35 N/A N/A $25.20 N/A N/A $14.70 N/A N/A $27.30 N/A N/A $12.60 N/A N/A $25.20 N/A N/A $29.40 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A $42.00 $42.00 N/A 25632489 General Lab Almond (f20) IgE QST 86003 302 $42.00 $- $3.35 $- $- $33.60 $- N/A $10.92 N/A N/A $5.59 N/A N/A $25.20 N/A N/A $21.00 N/A N/A $3.35 N/A N/A $28.56 N/A N/A $20.58 N/A N/A $16.38 N/A N/A $29.40 N/A N/A $33.60 N/A N/A $23.10 N/A N/A $29.40 N/A N/A $14.07 N/A N/A $3.35 N/A N/A $25.20 N/A N/A $14.70 N/A N/A $27.30 N/A N/A $12.60 N/A N/A $25.20 N/A N/A $29.40 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A $42.00 $42.00 N/A 25632502 General Lab Codfish (f3) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 25632502 General Lab Salmon (f41) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 25632502 General Lab Tuna 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 25632502 General Lab Tuna (F40) IgE QST 86003 302 $40.00 $- $3.35 $- $- $32.00 $- N/A $10.40 N/A N/A $5.59 N/A N/A $24.00 N/A N/A $20.00 N/A N/A $3.35 N/A N/A $27.20 N/A N/A $19.60 N/A N/A $15.60 N/A N/A $28.00 N/A N/A $32.00 N/A N/A $22.00 N/A N/A $28.00 N/A N/A $13.40 N/A N/A $3.35 N/A N/A $24.00 N/A N/A $14.00 N/A N/A $26.00 N/A N/A $12.00 N/A N/A $24.00 N/A N/A $28.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A N/A $12.00 N/A $40.00 $40.00 N/A 25632517 General Lab Cashew Nut 86003 302 $42.00 $- $3.35 $- $- $33.60 $- N/A $10.92 N/A N/A $5.59 N/A N/A $25.20 N/A N/A $21.00 N/A N/A $3.35 N/A N/A $28.56 N/A N/A $20.58 N/A N/A $16.38 N/A N/A $29.40 N/A N/A $33.60 N/A N/A $23.10 N/A N/A $29.40 N/A N/A $14.07 N/A N/A $3.35 N/A N/A $25.20 N/A N/A $14.70 N/A N/A $27.30 N/A N/A $12.60 N/A N/A $25.20 N/A N/A $29.40 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A $42.00 $42.00 N/A 25632518 General Lab Salmon 86003 302 $42.00 $- $3.35 $- $- $33.60 $- N/A $10.92 N/A N/A $5.59 N/A N/A $25.20 N/A N/A $21.00 N/A N/A $3.35 N/A N/A $28.56 N/A N/A $20.58 N/A N/A $16.38 N/A N/A $29.40 N/A N/A $33.60 N/A N/A $23.10 N/A N/A $29.40 N/A N/A $14.07 N/A N/A $3.35 N/A N/A $25.20 N/A N/A $14.70 N/A N/A $27.30 N/A N/A $12.60 N/A N/A $25.20 N/A N/A $29.40 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A N/A $12.60 N/A $42.00 $42.00 N/A 90084439 General Lab Free T4 84439 301 $281.00 $- $5.79 $- $- $224.80 $- N/A $73.06 N/A N/A $9.67 N/A N/A $168.60 N/A N/A $140.50 N/A N/A $5.79 N/A N/A $191.08 N/A N/A $137.69 N/A N/A $109.59 N/A N/A $196.70 N/A N/A $224.80 N/A N/A $154.55 N/A N/A $196.70 N/A N/A $94.14 N/A N/A $5.79 N/A N/A $168.60 N/A N/A $98.35 N/A N/A $182.65 N/A N/A $84.30 N/A N/A $168.60 N/A N/A $196.70 N/A N/A $84.30 N/A N/A $84.30 N/A N/A $84.30 N/A N/A $84.30 N/A N/A $84.30 N/A N/A $84.30 N/A $281.00 $281.00 N/A 90084439 General Lab "T4 Free, Direct Dialysis QLS" 84439 301 $281.00 $- $5.79 $- $- $224.80 $- N/A $73.06 N/A N/A $9.67 N/A N/A $168.60 N/A N/A $140.50 N/A N/A $5.79 N/A N/A $191.08 N/A N/A $137.69 N/A N/A $109.59 N/A N/A $196.70 N/A N/A $224.80 N/A N/A $154.55 N/A N/A $196.70 N/A N/A $94.14 N/A N/A $5.79 N/A N/A $168.60 N/A N/A $98.35 N/A N/A $182.65 N/A N/A $84.30 N/A N/A $168.60 N/A N/A $196.70 N/A N/A $84.30 N/A N/A $84.30 N/A N/A $84.30 N/A N/A $84.30 N/A N/A $84.30 N/A N/A $84.30 N/A $281.00 $281.00 N/A 90084439 General Lab "T4, Free Direct Dialysis QST" 84439 301 $281.00 $- $5.79 $- $- $224.80 $- N/A $73.06 N/A N/A $9.67 N/A N/A $168.60 N/A N/A $140.50 N/A N/A $5.79 N/A N/A $191.08 N/A N/A $137.69 N/A N/A $109.59 N/A N/A $196.70 N/A N/A $224.80 N/A N/A $154.55 N/A N/A $196.70 N/A N/A $94.14 N/A N/A $5.79 N/A N/A $168.60 N/A N/A $98.35 N/A N/A $182.65 N/A N/A $84.30 N/A N/A $168.60 N/A N/A $196.70 N/A N/A $84.30 N/A N/A $84.30 N/A N/A $84.30 N/A N/A $84.30 N/A N/A $84.30 N/A N/A $84.30 N/A $281.00 $281.00 N/A 91000651 General Lab "PSA, Total (Diagnostic) (f) QLS" 84153 G0103 301 $292.00 $- $11.80 $- $- $233.60 $- N/A $75.92 N/A N/A $19.73 N/A N/A $175.20 N/A N/A $146.00 N/A N/A $11.80 N/A N/A $198.56 N/A N/A $143.08 N/A N/A $113.88 N/A N/A $204.40 N/A N/A $233.60 N/A N/A $160.60 N/A N/A $204.40 N/A N/A $97.82 N/A N/A $11.80 N/A N/A $175.20 N/A N/A $102.20 N/A N/A $189.80 N/A N/A $87.60 N/A N/A $175.20 N/A N/A $204.40 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A $292.00 $292.00 N/A 94000615 General Lab Lipid Panel QLS 80061 301 $261.00 $- $8.60 $- $- $208.80 $- N/A $67.86 N/A N/A $14.36 N/A N/A $156.60 N/A N/A $130.50 N/A N/A $8.60 N/A N/A $177.48 N/A N/A $127.89 N/A N/A $101.79 N/A N/A $182.70 N/A N/A $208.80 N/A N/A $143.55 N/A N/A $182.70 N/A N/A $87.44 N/A N/A $8.60 N/A N/A $156.60 N/A N/A $91.35 N/A N/A $169.65 N/A N/A $78.30 N/A N/A $156.60 N/A N/A $182.70 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A $261.00 $261.00 N/A 94000615 General Lab Lipid Panel QST 80061 301 $261.00 $- $8.60 $- $- $208.80 $- N/A $67.86 N/A N/A $14.36 N/A N/A $156.60 N/A N/A $130.50 N/A N/A $8.60 N/A N/A $177.48 N/A N/A $127.89 N/A N/A $101.79 N/A N/A $182.70 N/A N/A $208.80 N/A N/A $143.55 N/A N/A $182.70 N/A N/A $87.44 N/A N/A $8.60 N/A N/A $156.60 N/A N/A $91.35 N/A N/A $169.65 N/A N/A $78.30 N/A N/A $156.60 N/A N/A $182.70 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A N/A $78.30 N/A $261.00 $261.00 N/A 94003121 General Lab Potassium QLS 84132 301 $92.00 $- $2.96 $- $- $73.60 $- N/A $23.92 N/A N/A $4.93 N/A N/A $55.20 N/A N/A $46.00 N/A N/A $2.96 N/A N/A $62.56 N/A N/A $45.08 N/A N/A $35.88 N/A N/A $64.40 N/A N/A $73.60 N/A N/A $50.60 N/A N/A $64.40 N/A N/A $30.82 N/A N/A $2.96 N/A N/A $55.20 N/A N/A $32.20 N/A N/A $59.80 N/A N/A $27.60 N/A N/A $55.20 N/A N/A $64.40 N/A N/A $27.60 N/A N/A $27.60 N/A N/A $27.60 N/A N/A $27.60 N/A N/A $27.60 N/A N/A $27.60 N/A $92.00 $92.00 N/A 94003121 General Lab Potassium QST 84132 301 $92.00 $- $2.96 $- $- $73.60 $- N/A $23.92 N/A N/A $4.93 N/A N/A $55.20 N/A N/A $46.00 N/A N/A $2.96 N/A N/A $62.56 N/A N/A $45.08 N/A N/A $35.88 N/A N/A $64.40 N/A N/A $73.60 N/A N/A $50.60 N/A N/A $64.40 N/A N/A $30.82 N/A N/A $2.96 N/A N/A $55.20 N/A N/A $32.20 N/A N/A $59.80 N/A N/A $27.60 N/A N/A $55.20 N/A N/A $64.40 N/A N/A $27.60 N/A N/A $27.60 N/A N/A $27.60 N/A N/A $27.60 N/A N/A $27.60 N/A N/A $27.60 N/A $92.00 $92.00 N/A 94006104 General Lab Prothrombin with INR 85610 305 $78.00 $- $2.53 $- $- $62.40 $- N/A $20.28 N/A N/A $4.21 N/A N/A $46.80 N/A N/A $39.00 N/A N/A $2.53 N/A N/A $53.04 N/A N/A $38.22 N/A N/A $30.42 N/A N/A $54.60 N/A N/A $62.40 N/A N/A $42.90 N/A N/A $54.60 N/A N/A $26.13 N/A N/A $2.53 N/A N/A $46.80 N/A N/A $27.30 N/A N/A $50.70 N/A N/A $23.40 N/A N/A $46.80 N/A N/A $54.60 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A N/A $23.40 N/A $78.00 $78.00 N/A 94006155 General Lab LD QLS 83615 301 $121.00 $- $3.88 $- $- $96.80 $- N/A $31.46 N/A N/A $6.48 N/A N/A $72.60 N/A N/A $60.50 N/A N/A $3.88 N/A N/A $82.28 N/A N/A $59.29 N/A N/A $47.19 N/A N/A $84.70 N/A N/A $96.80 N/A N/A $66.55 N/A N/A $84.70 N/A N/A $40.54 N/A N/A $3.88 N/A N/A $72.60 N/A N/A $42.35 N/A N/A $78.65 N/A N/A $36.30 N/A N/A $72.60 N/A N/A $84.70 N/A N/A $36.30 N/A N/A $36.30 N/A N/A $36.30 N/A N/A $36.30 N/A N/A $36.30 N/A N/A $36.30 N/A $121.00 $121.00 N/A 94006155 General Lab LD QST 83615 301 $121.00 $- $3.88 $- $- $96.80 $- N/A $31.46 N/A N/A $6.48 N/A N/A $72.60 N/A N/A $60.50 N/A N/A $3.88 N/A N/A $82.28 N/A N/A $59.29 N/A N/A $47.19 N/A N/A $84.70 N/A N/A $96.80 N/A N/A $66.55 N/A N/A $84.70 N/A N/A $40.54 N/A N/A $3.88 N/A N/A $72.60 N/A N/A $42.35 N/A N/A $78.65 N/A N/A $36.30 N/A N/A $72.60 N/A N/A $84.70 N/A N/A $36.30 N/A N/A $36.30 N/A N/A $36.30 N/A N/A $36.30 N/A N/A $36.30 N/A N/A $36.30 N/A $121.00 $121.00 N/A 94006500 General Lab Sed Rate By Modified Westergren QST 85652 305 $51.00 $- $1.74 $- $- $40.80 $- N/A $13.26 N/A N/A $2.89 N/A N/A $30.60 N/A N/A $25.50 N/A N/A $1.74 N/A N/A $34.68 N/A N/A $24.99 N/A N/A $19.89 N/A N/A $35.70 N/A N/A $40.80 N/A N/A $28.05 N/A N/A $35.70 N/A N/A $17.09 N/A N/A $1.74 N/A N/A $30.60 N/A N/A $17.85 N/A N/A $33.15 N/A N/A $15.30 N/A N/A $30.60 N/A N/A $35.70 N/A N/A $15.30 N/A N/A $15.30 N/A N/A $15.30 N/A N/A $15.30 N/A N/A $15.30 N/A N/A $15.30 N/A $51.00 $51.00 N/A 94006500 General Lab Sed Rate By Modified Westergren QST 85652 305 $51.00 $- $1.74 $- $- $40.80 $- N/A $13.26 N/A N/A $2.89 N/A N/A $30.60 N/A N/A $25.50 N/A N/A $1.74 N/A N/A $34.68 N/A N/A $24.99 N/A N/A $19.89 N/A N/A $35.70 N/A N/A $40.80 N/A N/A $28.05 N/A N/A $35.70 N/A N/A $17.09 N/A N/A $1.74 N/A N/A $30.60 N/A N/A $17.85 N/A N/A $33.15 N/A N/A $15.30 N/A N/A $30.60 N/A N/A $35.70 N/A N/A $15.30 N/A N/A $15.30 N/A N/A $15.30 N/A N/A $15.30 N/A N/A $15.30 N/A N/A $15.30 N/A $51.00 $51.00 N/A 94007300 General Lab PTT QLS 85730 305 $120.00 $- $3.86 $- $- $96.00 $- N/A $31.20 N/A N/A $6.43 N/A N/A $72.00 N/A N/A $60.00 N/A N/A $3.86 N/A N/A $81.60 N/A N/A $58.80 N/A N/A $46.80 N/A N/A $84.00 N/A N/A $96.00 N/A N/A $66.00 N/A N/A $84.00 N/A N/A $40.20 N/A N/A $3.86 N/A N/A $72.00 N/A N/A $42.00 N/A N/A $78.00 N/A N/A $36.00 N/A N/A $72.00 N/A N/A $84.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A $120.00 $120.00 N/A 94007300 General Lab "Partial Thromboplastin Time, Active QST" 85730 305 $120.00 $- $3.86 $- $- $96.00 $- N/A $31.20 N/A N/A $6.43 N/A N/A $72.00 N/A N/A $60.00 N/A N/A $3.86 N/A N/A $81.60 N/A N/A $58.80 N/A N/A $46.80 N/A N/A $84.00 N/A N/A $96.00 N/A N/A $66.00 N/A N/A $84.00 N/A N/A $40.20 N/A N/A $3.86 N/A N/A $72.00 N/A N/A $42.00 N/A N/A $78.00 N/A N/A $36.00 N/A N/A $72.00 N/A N/A $84.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A N/A $36.00 N/A $120.00 $120.00 N/A 94007351 General Lab Magnesium QLS 83735 301 $130.00 $- $4.30 $- $- $104.00 $- N/A $33.80 N/A N/A $7.19 N/A N/A $78.00 N/A N/A $65.00 N/A N/A $4.30 N/A N/A $88.40 N/A N/A $63.70 N/A N/A $50.70 N/A N/A $91.00 N/A N/A $104.00 N/A N/A $71.50 N/A N/A $91.00 N/A N/A $43.55 N/A N/A $4.30 N/A N/A $78.00 N/A N/A $45.50 N/A N/A $84.50 N/A N/A $39.00 N/A N/A $78.00 N/A N/A $91.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A $130.00 $130.00 N/A 94007351 General Lab Magnesium QST 83735 301 $130.00 $- $4.30 $- $- $104.00 $- N/A $33.80 N/A N/A $7.19 N/A N/A $78.00 N/A N/A $65.00 N/A N/A $4.30 N/A N/A $88.40 N/A N/A $63.70 N/A N/A $50.70 N/A N/A $91.00 N/A N/A $104.00 N/A N/A $71.50 N/A N/A $91.00 N/A N/A $43.55 N/A N/A $4.30 N/A N/A $78.00 N/A N/A $45.50 N/A N/A $84.50 N/A N/A $39.00 N/A N/A $78.00 N/A N/A $91.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A N/A $39.00 N/A $130.00 $130.00 N/A 4506984 Occupational Therapy Charges Therapeutic Exercise Charges 97110 430 $99.00 $- $25.74 $- $- $111.00 $- N/A $25.74 N/A N/A $32.48 N/A N/A $59.40 N/A N/A $49.50 N/A N/A $26.50 N/A N/A $67.32 N/A N/A $111.00 N/A N/A $38.61 N/A N/A $69.30 N/A N/A $79.20 N/A N/A $200 per visit N/A N/A $69.30 N/A N/A $33.17 N/A N/A $26.50 N/A N/A $59.40 N/A N/A $34.65 N/A N/A $103.00/treatment; $163.00 max/day N/A N/A $29.70 N/A N/A $59.40 N/A N/A $69.30 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A $99.00 $99.00 N/A 4550216 Occupational Therapy Charges OT Moderate Complex Units 97166 434 $387.00 $- $64.24 $- $- $309.60 $- N/A $100.62 N/A N/A $79.12 N/A N/A $232.20 N/A N/A $193.50 N/A N/A $64.24 N/A N/A $263.16 N/A N/A $111.00 N/A N/A $150.93 N/A N/A $270.90 N/A N/A $309.60 N/A N/A $200 per visit N/A N/A $270.90 N/A N/A $129.65 N/A N/A $64.24 N/A N/A $232.20 N/A N/A $135.45 N/A N/A $103.00/treatment; $163.00 max/day N/A N/A $116.10 N/A N/A $232.20 N/A N/A $270.90 N/A N/A $116.10 N/A N/A $116.10 N/A N/A $116.10 N/A N/A $116.10 N/A N/A $116.10 N/A N/A $116.10 N/A $387.00 $387.00 N/A 4556959 Occupational Therapy Charges Neuromuscular Reeducation Charges 97112 430 $99.00 $- $25.74 $- $- $111.00 $- N/A $25.74 N/A N/A $33.90 N/A N/A $59.40 N/A N/A $49.50 N/A N/A $27.71 N/A N/A $67.32 N/A N/A $111.00 N/A N/A $38.61 N/A N/A $69.30 N/A N/A $79.20 N/A N/A $200 per visit N/A N/A $69.30 N/A N/A $33.17 N/A N/A $27.71 N/A N/A $59.40 N/A N/A $34.65 N/A N/A $103.00/treatment; $163.00 max/day N/A N/A $29.70 N/A N/A $59.40 N/A N/A $69.30 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A $99.00 $99.00 N/A 4556959 Occupational Therapy Charges Therapeutic Activities Charges 97530 430 $99.00 $- $25.74 $- $- $111.00 $- N/A $25.74 N/A N/A $35.69 N/A N/A $59.40 N/A N/A $49.50 N/A N/A $28.93 N/A N/A $67.32 N/A N/A $111.00 N/A N/A $38.61 N/A N/A $69.30 N/A N/A $79.20 N/A N/A $200 per visit N/A N/A $69.30 N/A N/A $33.17 N/A N/A $28.93 N/A N/A $59.40 N/A N/A $34.65 N/A N/A $103.00/treatment; $163.00 max/day N/A N/A $29.70 N/A N/A $59.40 N/A N/A $69.30 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A $99.00 $99.00 N/A 4556959 Occupational Therapy Charges OT Paraffin Bath Charge 97018 430 $99.00 $- $9.29 $- $- $111.00 $- N/A $25.74 N/A N/A $11.63 N/A N/A $59.40 N/A N/A $49.50 N/A N/A $9.29 N/A N/A $67.32 N/A N/A $111.00 N/A N/A $38.61 N/A N/A $69.30 N/A N/A $79.20 N/A N/A $200 per visit N/A N/A $69.30 N/A N/A $33.17 N/A N/A $9.29 N/A N/A $59.40 N/A N/A $34.65 N/A N/A $103.00/treatment; $163.00 max/day N/A N/A $29.70 N/A N/A $59.40 N/A N/A $69.30 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A $99.00 $99.00 N/A 4556961 Occupational Therapy Charges Ultrasound Charges 97035 430 $99.00 $- $10.57 $- $- $111.00 $- N/A $25.74 N/A N/A $12.76 N/A N/A $59.40 N/A N/A $49.50 N/A N/A $10.57 N/A N/A $67.32 N/A N/A $111.00 N/A N/A $38.61 N/A N/A $69.30 N/A N/A $79.20 N/A N/A $200 per visit N/A N/A $69.30 N/A N/A $33.17 N/A N/A $10.57 N/A N/A $59.40 N/A N/A $34.65 N/A N/A $103.00/treatment; $163.00 max/day N/A N/A $29.70 N/A N/A $59.40 N/A N/A $69.30 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A $99.00 $99.00 N/A 4557108 Occupational Therapy Charges OTBU: OT Therapeutic Exercise Charges 97110 430 $99.00 $- $25.74 $- $- $111.00 $- N/A $25.74 N/A N/A $32.48 N/A N/A $59.40 N/A N/A $49.50 N/A N/A $26.50 N/A N/A $67.32 N/A N/A $111.00 N/A N/A $38.61 N/A N/A $69.30 N/A N/A $79.20 N/A N/A $200 per visit N/A N/A $69.30 N/A N/A $33.17 N/A N/A $26.50 N/A N/A $59.40 N/A N/A $34.65 N/A N/A $103.00/treatment; $163.00 max/day N/A N/A $29.70 N/A N/A $59.40 N/A N/A $69.30 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A $99.00 $99.00 N/A 4557110 Occupational Therapy Charges Therapeutic Activities Charges 97530 430 $99.00 $- $25.74 $- $- $111.00 $- N/A $25.74 N/A N/A $35.69 N/A N/A $59.40 N/A N/A $49.50 N/A N/A $28.93 N/A N/A $67.32 N/A N/A $111.00 N/A N/A $38.61 N/A N/A $69.30 N/A N/A $79.20 N/A N/A $200 per visit N/A N/A $69.30 N/A N/A $33.17 N/A N/A $28.93 N/A N/A $59.40 N/A N/A $34.65 N/A N/A $103.00/treatment; $163.00 max/day N/A N/A $29.70 N/A N/A $59.40 N/A N/A $69.30 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A $99.00 $99.00 N/A 4557114 Occupational Therapy Charges OT Moderate Complex Units 97166 434 $387.00 $- $64.24 $- $- $309.60 $- N/A $100.62 N/A N/A $79.12 N/A N/A $232.20 N/A N/A $193.50 N/A N/A $64.24 N/A N/A $263.16 N/A N/A $111.00 N/A N/A $150.93 N/A N/A $270.90 N/A N/A $309.60 N/A N/A $200 per visit N/A N/A $270.90 N/A N/A $129.65 N/A N/A $64.24 N/A N/A $232.20 N/A N/A $135.45 N/A N/A $103.00/treatment; $163.00 max/day N/A N/A $116.10 N/A N/A $232.20 N/A N/A $270.90 N/A N/A $116.10 N/A N/A $116.10 N/A N/A $116.10 N/A N/A $116.10 N/A N/A $116.10 N/A N/A $116.10 N/A $387.00 $387.00 N/A 4557100 OT Tx/Procedures Occupational Therapy Eval and Treatment 97166 434 $387.00 $- $64.24 $- $- $309.60 $- N/A $100.62 N/A N/A $79.12 N/A N/A $232.20 N/A N/A $193.50 N/A N/A $64.24 N/A N/A $263.16 N/A N/A $111.00 N/A N/A $150.93 N/A N/A $270.90 N/A N/A $309.60 N/A N/A $200 per visit N/A N/A $270.90 N/A N/A $129.65 N/A N/A $64.24 N/A N/A $232.20 N/A N/A $135.45 N/A N/A $103.00/treatment; $163.00 max/day N/A N/A $116.10 N/A N/A $232.20 N/A N/A $270.90 N/A N/A $116.10 N/A N/A $116.10 N/A N/A $116.10 N/A N/A $116.10 N/A N/A $116.10 N/A N/A $116.10 N/A $387.00 $387.00 N/A 4557102 OT Tx/Procedures Occupational Therapy Evaluation and Treatment LTC 97166 434 $387.00 $- $64.24 $- $- $309.60 $- N/A $100.62 N/A N/A $79.12 N/A N/A $232.20 N/A N/A $193.50 N/A N/A $64.24 N/A N/A $263.16 N/A N/A $111.00 N/A N/A $150.93 N/A N/A $270.90 N/A N/A $309.60 N/A N/A $200 per visit N/A N/A $270.90 N/A N/A $129.65 N/A N/A $64.24 N/A N/A $232.20 N/A N/A $135.45 N/A N/A $103.00/treatment; $163.00 max/day N/A N/A $116.10 N/A N/A $232.20 N/A N/A $270.90 N/A N/A $116.10 N/A N/A $116.10 N/A N/A $116.10 N/A N/A $116.10 N/A N/A $116.10 N/A N/A $116.10 N/A $387.00 $387.00 N/A 4500109 Physical Therapy Charges Wound Vac Charge 97605 420 $292.00 $- $22.53 $- $- $233.60 $- N/A $75.92 N/A N/A $30.90 N/A N/A $175.20 N/A N/A $146.00 N/A N/A $22.53 N/A N/A $198.56 N/A N/A $111.00 N/A N/A $113.88 N/A N/A $204.40 N/A N/A $233.60 N/A N/A $200 per visit N/A N/A $204.40 N/A N/A $97.82 N/A N/A $22.53 N/A N/A $175.20 N/A N/A $102.20 N/A N/A $103.00/treatment; $163.00 max/day N/A N/A $87.60 N/A N/A $175.20 N/A N/A $204.40 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A $292.00 $292.00 N/A 4500109 Physical Therapy Charges Wound Vac Charge 97605 420 $292.00 $- $22.53 $- $- $233.60 $- N/A $75.92 N/A N/A $30.90 N/A N/A $175.20 N/A N/A $146.00 N/A N/A $22.53 N/A N/A $198.56 N/A N/A $111.00 N/A N/A $113.88 N/A N/A $204.40 N/A N/A $233.60 N/A N/A $200 per visit N/A N/A $204.40 N/A N/A $97.82 N/A N/A $22.53 N/A N/A $175.20 N/A N/A $102.20 N/A N/A $103.00/treatment; $163.00 max/day N/A N/A $87.60 N/A N/A $175.20 N/A N/A $204.40 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A $292.00 $292.00 N/A 4500316 Physical Therapy Charges PT Moderate Complex Units 97162 424 $387.00 $- $66.32 $- $- $309.60 $- N/A $100.62 N/A N/A $81.67 N/A N/A $232.20 N/A N/A $193.50 N/A N/A $66.32 N/A N/A $263.16 N/A N/A $111.00 N/A N/A $150.93 N/A N/A $270.90 N/A N/A $309.60 N/A N/A $200 per visit N/A N/A $270.90 N/A N/A $129.65 N/A N/A $66.32 N/A N/A $232.20 N/A N/A $135.45 N/A N/A $103.00/treatment; $163.00 max/day N/A N/A $116.10 N/A N/A $232.20 N/A N/A $270.90 N/A N/A $116.10 N/A N/A $116.10 N/A N/A $116.10 N/A N/A $116.10 N/A N/A $116.10 N/A N/A $116.10 N/A $387.00 $387.00 N/A 4506977 Physical Therapy Charges Gait Training Charges 97116 420 $99.00 $- $23.56 $- $- $111.00 $- N/A $25.74 N/A N/A $28.68 N/A N/A $59.40 N/A N/A $49.50 N/A N/A $23.56 N/A N/A $67.32 N/A N/A $111.00 N/A N/A $38.61 N/A N/A $69.30 N/A N/A $79.20 N/A N/A $200 per visit N/A N/A $69.30 N/A N/A $33.17 N/A N/A $23.56 N/A N/A $59.40 N/A N/A $34.65 N/A N/A $103.00/treatment; $163.00 max/day N/A N/A $29.70 N/A N/A $59.40 N/A N/A $69.30 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A $99.00 $99.00 N/A 4506994 Physical Therapy Charges Ultrasound Charges 97035 420 $99.00 $- $10.57 $- $- $111.00 $- N/A $25.74 N/A N/A $12.76 N/A N/A $59.40 N/A N/A $49.50 N/A N/A $10.57 N/A N/A $67.32 N/A N/A $111.00 N/A N/A $38.61 N/A N/A $69.30 N/A N/A $79.20 N/A N/A $200 per visit N/A N/A $69.30 N/A N/A $33.17 N/A N/A $10.57 N/A N/A $59.40 N/A N/A $34.65 N/A N/A $103.00/treatment; $163.00 max/day N/A N/A $29.70 N/A N/A $59.40 N/A N/A $69.30 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A $99.00 $99.00 N/A 4556959 Physical Therapy Charges Neuromuscular Reeducation Charges 97112 420 $99.00 $- $25.74 $- $- $111.00 $- N/A $25.74 N/A N/A $33.90 N/A N/A $59.40 N/A N/A $49.50 N/A N/A $27.71 N/A N/A $67.32 N/A N/A $111.00 N/A N/A $38.61 N/A N/A $69.30 N/A N/A $79.20 N/A N/A $200 per visit N/A N/A $69.30 N/A N/A $33.17 N/A N/A $27.71 N/A N/A $59.40 N/A N/A $34.65 N/A N/A $103.00/treatment; $163.00 max/day N/A N/A $29.70 N/A N/A $59.40 N/A N/A $69.30 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A $99.00 $99.00 N/A 4556959 Physical Therapy Charges Therapeutic Activities Charge 97530 420 $99.00 $- $25.74 $- $- $111.00 $- N/A $25.74 N/A N/A $35.69 N/A N/A $59.40 N/A N/A $49.50 N/A N/A $28.93 N/A N/A $67.32 N/A N/A $111.00 N/A N/A $38.61 N/A N/A $69.30 N/A N/A $79.20 N/A N/A $200 per visit N/A N/A $69.30 N/A N/A $33.17 N/A N/A $28.93 N/A N/A $59.40 N/A N/A $34.65 N/A N/A $103.00/treatment; $163.00 max/day N/A N/A $29.70 N/A N/A $59.40 N/A N/A $69.30 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A $99.00 $99.00 N/A 4556959 Physical Therapy Charges Therapeutic Exercise Charges 97110 420 $99.00 $- $25.74 $- $- $111.00 $- N/A $25.74 N/A N/A $32.48 N/A N/A $59.40 N/A N/A $49.50 N/A N/A $26.50 N/A N/A $67.32 N/A N/A $111.00 N/A N/A $38.61 N/A N/A $69.30 N/A N/A $79.20 N/A N/A $200 per visit N/A N/A $69.30 N/A N/A $33.17 N/A N/A $26.50 N/A N/A $59.40 N/A N/A $34.65 N/A N/A $103.00/treatment; $163.00 max/day N/A N/A $29.70 N/A N/A $59.40 N/A N/A $69.30 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A $99.00 $99.00 N/A 4556959 Physical Therapy Charges PT Paraffin Bath Charge 97018 420 $99.00 $- $9.29 $- $- $111.00 $- N/A $25.74 N/A N/A $11.63 N/A N/A $59.40 N/A N/A $49.50 N/A N/A $9.29 N/A N/A $67.32 N/A N/A $111.00 N/A N/A $38.61 N/A N/A $69.30 N/A N/A $79.20 N/A N/A $200 per visit N/A N/A $69.30 N/A N/A $33.17 N/A N/A $9.29 N/A N/A $59.40 N/A N/A $34.65 N/A N/A $103.00/treatment; $163.00 max/day N/A N/A $29.70 N/A N/A $59.40 N/A N/A $69.30 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A $99.00 $99.00 N/A 4556961 Physical Therapy Charges Checkout for Prosth/Orth Use Charges 97035 420 $99.00 $- $10.57 $- $- $111.00 $- N/A $25.74 N/A N/A $12.76 N/A N/A $59.40 N/A N/A $49.50 N/A N/A $10.57 N/A N/A $67.32 N/A N/A $111.00 N/A N/A $38.61 N/A N/A $69.30 N/A N/A $79.20 N/A N/A $200 per visit N/A N/A $69.30 N/A N/A $33.17 N/A N/A $10.57 N/A N/A $59.40 N/A N/A $34.65 N/A N/A $103.00/treatment; $163.00 max/day N/A N/A $29.70 N/A N/A $59.40 N/A N/A $69.30 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A $99.00 $99.00 N/A 4556961 Physical Therapy Charges Vasopneumatic Device Charge 97016 420 $99.00 $- $16.05 $- $- $111.00 $- N/A $25.74 N/A N/A $20.26 N/A N/A $59.40 N/A N/A $49.50 N/A N/A $16.05 N/A N/A $67.32 N/A N/A $111.00 N/A N/A $38.61 N/A N/A $69.30 N/A N/A $79.20 N/A N/A $200 per visit N/A N/A $69.30 N/A N/A $33.17 N/A N/A $16.05 N/A N/A $59.40 N/A N/A $34.65 N/A N/A $103.00/treatment; $163.00 max/day N/A N/A $29.70 N/A N/A $59.40 N/A N/A $69.30 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A N/A $29.70 N/A $99.00 $99.00 N/A 4050202 Radiology Xray Chest 2 Views 71046 320 $648.00 $- $29.27 $- $- $518.40 $- N/A $168.48 N/A N/A $34.92 N/A N/A $388.80 N/A N/A $324.00 N/A N/A $29.27 N/A N/A $440.64 N/A N/A $369.36 N/A N/A $252.72 N/A N/A $453.60 N/A N/A $518.40 N/A N/A $356.40 N/A N/A $453.60 N/A N/A $217.08 N/A N/A $29.27 N/A N/A $388.80 N/A N/A $226.80 N/A N/A $421.20 N/A N/A $194.40 N/A N/A $388.80 N/A N/A $453.60 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A $648.00 $648.00 N/A 4050236 Radiology Xray Chest 2 Views w/ Fluoro 71046 320 $854.00 $- $29.27 $- $- $683.20 $- N/A $222.04 N/A N/A $34.92 N/A N/A $512.40 N/A N/A $427.00 N/A N/A $29.27 N/A N/A $580.72 N/A N/A $486.78 N/A N/A $333.06 N/A N/A $597.80 N/A N/A $683.20 N/A N/A $469.70 N/A N/A $597.80 N/A N/A $286.09 N/A N/A $29.27 N/A N/A $512.40 N/A N/A $298.90 N/A N/A $555.10 N/A N/A $256.20 N/A N/A $512.40 N/A N/A $597.80 N/A N/A $256.20 N/A N/A $256.20 N/A N/A $256.20 N/A N/A $256.20 N/A N/A $256.20 N/A N/A $256.20 N/A $854.00 $854.00 N/A 4050309 Radiology Xray Shoulder Comp Min 2 Views Lt 73030 320 $643.00 $- $31.36 $- $- $514.40 $- N/A $167.18 N/A N/A $37.63 N/A N/A $385.80 N/A N/A $321.50 N/A N/A $31.36 N/A N/A $437.24 N/A N/A $366.51 N/A N/A $250.77 N/A N/A $450.10 N/A N/A $514.40 N/A N/A $353.65 N/A N/A $450.10 N/A N/A $215.41 N/A N/A $31.36 N/A N/A $385.80 N/A N/A $225.05 N/A N/A $417.95 N/A N/A $192.90 N/A N/A $385.80 N/A N/A $450.10 N/A N/A $192.90 N/A N/A $192.90 N/A N/A $192.90 N/A N/A $192.90 N/A N/A $192.90 N/A N/A $192.90 N/A $643.00 $643.00 N/A 4050309 Radiology Xray Shoulder Comp Min 2 Views Rt 73030 320 $643.00 $- $31.36 $- $- $514.40 $- N/A $167.18 N/A N/A $37.63 N/A N/A $385.80 N/A N/A $321.50 N/A N/A $31.36 N/A N/A $437.24 N/A N/A $366.51 N/A N/A $250.77 N/A N/A $450.10 N/A N/A $514.40 N/A N/A $353.65 N/A N/A $450.10 N/A N/A $215.41 N/A N/A $31.36 N/A N/A $385.80 N/A N/A $225.05 N/A N/A $417.95 N/A N/A $192.90 N/A N/A $385.80 N/A N/A $450.10 N/A N/A $192.90 N/A N/A $192.90 N/A N/A $192.90 N/A N/A $192.90 N/A N/A $192.90 N/A N/A $192.90 N/A $643.00 $643.00 N/A 4050350 Radiology Xray Chest Decubitus Rt 71046 320 $415.00 $- $29.27 $- $- $332.00 $- N/A $107.90 N/A N/A $34.92 N/A N/A $249.00 N/A N/A $207.50 N/A N/A $29.27 N/A N/A $282.20 N/A N/A $236.55 N/A N/A $161.85 N/A N/A $290.50 N/A N/A $332.00 N/A N/A $228.25 N/A N/A $290.50 N/A N/A $139.03 N/A N/A $29.27 N/A N/A $249.00 N/A N/A $145.25 N/A N/A $269.75 N/A N/A $124.50 N/A N/A $249.00 N/A N/A $290.50 N/A N/A $124.50 N/A N/A $124.50 N/A N/A $124.50 N/A N/A $124.50 N/A N/A $124.50 N/A N/A $124.50 N/A $415.00 $415.00 N/A 4050351 Radiology Xray Chest Decubitus Lt 71046 320 $415.00 $- $29.27 $- $- $332.00 $- N/A $107.90 N/A N/A $34.92 N/A N/A $249.00 N/A N/A $207.50 N/A N/A $29.27 N/A N/A $282.20 N/A N/A $236.55 N/A N/A $161.85 N/A N/A $290.50 N/A N/A $332.00 N/A N/A $228.25 N/A N/A $290.50 N/A N/A $139.03 N/A N/A $29.27 N/A N/A $249.00 N/A N/A $145.25 N/A N/A $269.75 N/A N/A $124.50 N/A N/A $249.00 N/A N/A $290.50 N/A N/A $124.50 N/A N/A $124.50 N/A N/A $124.50 N/A N/A $124.50 N/A N/A $124.50 N/A N/A $124.50 N/A $415.00 $415.00 N/A 4050352 Radiology Xray Chest Decubitus Bil 71046 320 $415.00 $- $29.27 $- $- $332.00 $- N/A $107.90 N/A N/A $34.92 N/A N/A $249.00 N/A N/A $207.50 N/A N/A $29.27 N/A N/A $282.20 N/A N/A $236.55 N/A N/A $161.85 N/A N/A $290.50 N/A N/A $332.00 N/A N/A $228.25 N/A N/A $290.50 N/A N/A $139.03 N/A N/A $29.27 N/A N/A $249.00 N/A N/A $145.25 N/A N/A $269.75 N/A N/A $124.50 N/A N/A $249.00 N/A N/A $290.50 N/A N/A $124.50 N/A N/A $124.50 N/A N/A $124.50 N/A N/A $124.50 N/A N/A $124.50 N/A N/A $124.50 N/A $415.00 $415.00 N/A 4050508 Radiology Xray Spine Cerv Comp w/ Flex +Ext 72050 320 $996.00 $- $48.89 $- $- $796.80 $- N/A $258.96 N/A N/A $58.24 N/A N/A $597.60 N/A N/A $498.00 N/A N/A $48.89 N/A N/A $677.28 N/A N/A $567.72 N/A N/A $388.44 N/A N/A $697.20 N/A N/A $796.80 N/A N/A $547.80 N/A N/A $697.20 N/A N/A $333.66 N/A N/A $48.89 N/A N/A $597.60 N/A N/A $348.60 N/A N/A $647.40 N/A N/A $298.80 N/A N/A $597.60 N/A N/A $697.20 N/A N/A $298.80 N/A N/A $298.80 N/A N/A $298.80 N/A N/A $298.80 N/A N/A $298.80 N/A N/A $298.80 N/A $996.00 $996.00 N/A 4050508 Radiology Xray Spine Cerv Min 4 Views 72050 320 $996.00 $- $48.89 $- $- $796.80 $- N/A $258.96 N/A N/A $58.24 N/A N/A $597.60 N/A N/A $498.00 N/A N/A $48.89 N/A N/A $677.28 N/A N/A $567.72 N/A N/A $388.44 N/A N/A $697.20 N/A N/A $796.80 N/A N/A $547.80 N/A N/A $697.20 N/A N/A $333.66 N/A N/A $48.89 N/A N/A $597.60 N/A N/A $348.60 N/A N/A $647.40 N/A N/A $298.80 N/A N/A $597.60 N/A N/A $697.20 N/A N/A $298.80 N/A N/A $298.80 N/A N/A $298.80 N/A N/A $298.80 N/A N/A $298.80 N/A N/A $298.80 N/A $996.00 $996.00 N/A 4050805 Radiology Xray Spine Thoracolumbar 2 Views 72080 320 $648.00 $- $36.62 $- $- $518.40 $- N/A $168.48 N/A N/A $44.38 N/A N/A $388.80 N/A N/A $324.00 N/A N/A $36.62 N/A N/A $440.64 N/A N/A $369.36 N/A N/A $252.72 N/A N/A $453.60 N/A N/A $518.40 N/A N/A $356.40 N/A N/A $453.60 N/A N/A $217.08 N/A N/A $36.62 N/A N/A $388.80 N/A N/A $226.80 N/A N/A $421.20 N/A N/A $194.40 N/A N/A $388.80 N/A N/A $453.60 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A $648.00 $648.00 N/A 4051001 Radiology Xray Spine Lumbosacral 2 or 3 Views 72100 320 $363.00 $- $36.27 $- $- $290.40 $- N/A $94.38 N/A N/A $43.57 N/A N/A $217.80 N/A N/A $181.50 N/A N/A $36.27 N/A N/A $246.84 N/A N/A $206.91 N/A N/A $141.57 N/A N/A $254.10 N/A N/A $290.40 N/A N/A $199.65 N/A N/A $254.10 N/A N/A $121.61 N/A N/A $36.27 N/A N/A $217.80 N/A N/A $127.05 N/A N/A $235.95 N/A N/A $108.90 N/A N/A $217.80 N/A N/A $254.10 N/A N/A $108.90 N/A N/A $108.90 N/A N/A $108.90 N/A N/A $108.90 N/A N/A $108.90 N/A N/A $108.90 N/A $363.00 $363.00 N/A 4051100 Radiology Xray Spine Lumbosacral Min 4 Views w/ Obl 72110 320 $996.00 $- $49.60 $- $- $796.80 $- N/A $258.96 N/A N/A $59.04 N/A N/A $597.60 N/A N/A $498.00 N/A N/A $49.60 N/A N/A $677.28 N/A N/A $567.72 N/A N/A $388.44 N/A N/A $697.20 N/A N/A $796.80 N/A N/A $547.80 N/A N/A $697.20 N/A N/A $333.66 N/A N/A $49.60 N/A N/A $597.60 N/A N/A $348.60 N/A N/A $647.40 N/A N/A $298.80 N/A N/A $597.60 N/A N/A $697.20 N/A N/A $298.80 N/A N/A $298.80 N/A N/A $298.80 N/A N/A $298.80 N/A N/A $298.80 N/A N/A $298.80 N/A $996.00 $996.00 N/A 4052301 Radiology Xray Fluoro Modified Esophagram 74230 320 "$1,161.00 " $- $92.19 $- $- $928.80 $- N/A $301.86 N/A N/A $109.16 N/A N/A $696.60 N/A N/A $580.50 N/A N/A $92.19 N/A N/A $789.48 N/A N/A $661.77 N/A N/A $452.79 N/A N/A $812.70 N/A N/A $928.80 N/A N/A $638.55 N/A N/A $812.70 N/A N/A $388.94 N/A N/A $92.19 N/A N/A $696.60 N/A N/A $406.35 N/A N/A $754.65 N/A N/A $348.30 N/A N/A $696.60 N/A N/A $812.70 N/A N/A $348.30 N/A N/A $348.30 N/A N/A $348.30 N/A N/A $348.30 N/A N/A $348.30 N/A N/A $348.30 N/A "$1,161.00 " "$1,161.00 " N/A 4052700 Radiology Xray Barium Enema w/ or w/o KUB 74270 320 "$1,720.00 " $- $159.06 $- $- "$1,376.00 " $- N/A $447.20 N/A N/A $183.20 N/A N/A "$1,032.00 " N/A N/A $860.00 N/A N/A $159.06 N/A N/A "$1,169.60 " N/A N/A $980.40 N/A N/A $670.80 N/A N/A "$1,204.00 " N/A N/A "$1,376.00 " N/A N/A $946.00 N/A N/A "$1,204.00 " N/A N/A $576.20 N/A N/A $159.06 N/A N/A "$1,032.00 " N/A N/A $602.00 N/A N/A "$1,118.00 " N/A N/A $516.00 N/A N/A "$1,032.00 " N/A N/A "$1,204.00 " N/A N/A $516.00 N/A N/A $516.00 N/A N/A $516.00 N/A N/A $516.00 N/A N/A $516.00 N/A N/A $516.00 N/A "$1,720.00 " "$1,720.00 " N/A 4053030 Radiology Xray Shoulder Comp Min 2 Views Bil 73030 320 $648.00 $- $168.48 $- $- $518.40 $- N/A $168.48 N/A N/A $37.63 N/A N/A $388.80 N/A N/A $324.00 N/A N/A $31.36 N/A N/A $440.64 N/A N/A $369.36 N/A N/A $252.72 N/A N/A $453.60 N/A N/A $518.40 N/A N/A $356.40 N/A N/A $453.60 N/A N/A $217.08 N/A N/A $31.36 N/A N/A $388.80 N/A N/A $226.80 N/A N/A $421.20 N/A N/A $194.40 N/A N/A $388.80 N/A N/A $453.60 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A $648.00 $648.00 N/A 4053502 Radiology Xray Hip 2-3 Views Lt w/ Pelvis 73502 320 $810.00 $- $40.68 $- $- $648.00 $- N/A $210.60 N/A N/A $48.25 N/A N/A $486.00 N/A N/A $405.00 N/A N/A $40.68 N/A N/A $550.80 N/A N/A $461.70 N/A N/A $315.90 N/A N/A $567.00 N/A N/A $648.00 N/A N/A $445.50 N/A N/A $567.00 N/A N/A $271.35 N/A N/A $40.68 N/A N/A $486.00 N/A N/A $283.50 N/A N/A $526.50 N/A N/A $243.00 N/A N/A $486.00 N/A N/A $567.00 N/A N/A $243.00 N/A N/A $243.00 N/A N/A $243.00 N/A N/A $243.00 N/A N/A $243.00 N/A N/A $243.00 N/A $810.00 $810.00 N/A 4053502 Radiology Xray Hip 2-3 Views Rt w/ Pelvis 73502 320 $810.00 $- $40.68 $- $- $648.00 $- N/A $210.60 N/A N/A $48.25 N/A N/A $486.00 N/A N/A $405.00 N/A N/A $40.68 N/A N/A $550.80 N/A N/A $461.70 N/A N/A $315.90 N/A N/A $567.00 N/A N/A $648.00 N/A N/A $445.50 N/A N/A $567.00 N/A N/A $271.35 N/A N/A $40.68 N/A N/A $486.00 N/A N/A $283.50 N/A N/A $526.50 N/A N/A $243.00 N/A N/A $486.00 N/A N/A $567.00 N/A N/A $243.00 N/A N/A $243.00 N/A N/A $243.00 N/A N/A $243.00 N/A N/A $243.00 N/A N/A $243.00 N/A $810.00 $810.00 N/A 4054020 Radiology Xray Abdomen 2 Views 74019 320 $415.00 $- $32.00 $- $- $332.00 $- N/A $107.90 N/A N/A $38.18 N/A N/A $249.00 N/A N/A $207.50 N/A N/A $32.00 N/A N/A $282.20 N/A N/A $236.55 N/A N/A $161.85 N/A N/A $290.50 N/A N/A $332.00 N/A N/A $228.25 N/A N/A $290.50 N/A N/A $139.03 N/A N/A $32.00 N/A N/A $249.00 N/A N/A $145.25 N/A N/A $269.75 N/A N/A $124.50 N/A N/A $249.00 N/A N/A $290.50 N/A N/A $124.50 N/A N/A $124.50 N/A N/A $124.50 N/A N/A $124.50 N/A N/A $124.50 N/A N/A $124.50 N/A $415.00 $415.00 N/A 4054516 Radiology Xray Urethrocystography Retrograde 74420 320 "$1,069.00 " $- $115.35 $- $- $855.20 $- N/A $277.94 N/A N/A $139.79 N/A N/A $641.40 N/A N/A $534.50 N/A N/A $115.35 N/A N/A $726.92 N/A N/A $609.33 N/A N/A $416.91 N/A N/A $748.30 N/A N/A $855.20 N/A N/A $587.95 N/A N/A $748.30 N/A N/A $358.12 N/A N/A $115.35 N/A N/A $641.40 N/A N/A $374.15 N/A N/A $694.85 N/A N/A $320.70 N/A N/A $641.40 N/A N/A $748.30 N/A N/A $320.70 N/A N/A $320.70 N/A N/A $320.70 N/A N/A $320.70 N/A N/A $320.70 N/A N/A $320.70 N/A "$1,069.00 " "$1,069.00 " N/A 4055100 Radiology Xray Hip Comp Min 2 Views Lt 73502 320 $648.00 $- $40.68 $- $- $518.40 $- N/A $168.48 N/A N/A $48.25 N/A N/A $388.80 N/A N/A $324.00 N/A N/A $40.68 N/A N/A $440.64 N/A N/A $369.36 N/A N/A $252.72 N/A N/A $453.60 N/A N/A $518.40 N/A N/A $356.40 N/A N/A $453.60 N/A N/A $217.08 N/A N/A $40.68 N/A N/A $388.80 N/A N/A $226.80 N/A N/A $421.20 N/A N/A $194.40 N/A N/A $388.80 N/A N/A $453.60 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A $648.00 $648.00 N/A 4055100 Radiology Xray Hip Comp Min 2 Views Rt 73502 320 $648.00 $- $40.68 $- $- $518.40 $- N/A $168.48 N/A N/A $48.25 N/A N/A $388.80 N/A N/A $324.00 N/A N/A $40.68 N/A N/A $440.64 N/A N/A $369.36 N/A N/A $252.72 N/A N/A $453.60 N/A N/A $518.40 N/A N/A $356.40 N/A N/A $453.60 N/A N/A $217.08 N/A N/A $40.68 N/A N/A $388.80 N/A N/A $226.80 N/A N/A $421.20 N/A N/A $194.40 N/A N/A $388.80 N/A N/A $453.60 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A $648.00 $648.00 N/A 4055100 Radiology Xray Hip Min 2 Views Bil w/ Pelvis 73521 320 $648.00 $- $38.91 $- $- $518.40 $- N/A $168.48 N/A N/A $46.15 N/A N/A $388.80 N/A N/A $324.00 N/A N/A $38.91 N/A N/A $440.64 N/A N/A $369.36 N/A N/A $252.72 N/A N/A $453.60 N/A N/A $518.40 N/A N/A $356.40 N/A N/A $453.60 N/A N/A $217.08 N/A N/A $38.91 N/A N/A $388.80 N/A N/A $226.80 N/A N/A $421.20 N/A N/A $194.40 N/A N/A $388.80 N/A N/A $453.60 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A N/A $194.40 N/A $648.00 $648.00 N/A 4060103 Radiology CT Abdomen +Pelvis w/ Cont 74177 352 "$4,139.00 " $425.00 $321.59 $- $831.09 "$3,311.20 " $- N/A "$1,076.14 " N/A $425.00 $425.00 N/A N/A "$2,483.40 " N/A N/A "$2,069.50 " N/A N/A $321.59 N/A N/A $632.07 N/A N/A $861.00 N/A N/A "$1,614.21 " N/A N/A "$2,897.30 " N/A N/A "$3,311.20 " N/A N/A $694.00 N/A $521.00 $521.00 N/A N/A "$1,386.57 " N/A N/A $321.59 N/A N/A "$2,483.40 " N/A N/A $701.79 N/A N/A $707.00 N/A N/A "$1,241.70 " N/A N/A "$2,483.40 " N/A $831.09 $831.09 N/A N/A "$1,241.70 " N/A N/A "$1,241.70 " N/A N/A "$1,241.70 " N/A N/A "$1,241.70 " N/A N/A "$1,241.70 " N/A N/A "$1,241.70 " N/A "$4,139.00 " "$4,139.00 " N/A 4060105 Radiology CT UE w/ Cont Lt 73201 352 "$3,385.00 " $425.00 $232.15 $- $831.09 "$2,708.00 " $- N/A $880.10 N/A $425.00 $425.00 N/A N/A "$2,031.00 " N/A N/A "$1,692.50 " N/A N/A $232.15 N/A N/A $632.07 N/A N/A $861.00 N/A N/A "$1,320.15 " N/A N/A "$2,369.50 " N/A N/A "$2,708.00 " N/A N/A $694.00 N/A $521.00 $521.00 N/A N/A "$1,133.98 " N/A N/A $232.15 N/A N/A "$2,031.00 " N/A N/A $701.79 N/A N/A $707.00 N/A N/A "$1,015.50 " N/A N/A "$2,031.00 " N/A $831.09 $831.09 N/A N/A "$1,015.50 " N/A N/A "$1,015.50 " N/A N/A "$1,015.50 " N/A N/A "$1,015.50 " N/A N/A "$1,015.50 " N/A N/A "$1,015.50 " N/A "$3,385.00 " "$3,385.00 " N/A 4060105 Radiology CT UE w/ Cont Rt 73201 352 "$3,385.00 " $425.00 $232.15 $- $831.09 "$2,708.00 " $- N/A $880.10 N/A $425.00 $425.00 N/A N/A "$2,031.00 " N/A N/A "$1,692.50 " N/A N/A $232.15 N/A N/A $632.07 N/A N/A $861.00 N/A N/A "$1,320.15 " N/A N/A "$2,369.50 " N/A N/A "$2,708.00 " N/A N/A $694.00 N/A $521.00 $521.00 N/A N/A "$1,133.98 " N/A N/A $232.15 N/A N/A "$2,031.00 " N/A N/A $701.79 N/A N/A $707.00 N/A N/A "$1,015.50 " N/A N/A "$2,031.00 " N/A $831.09 $831.09 N/A N/A "$1,015.50 " N/A N/A "$1,015.50 " N/A N/A "$1,015.50 " N/A N/A "$1,015.50 " N/A N/A "$1,015.50 " N/A N/A "$1,015.50 " N/A "$3,385.00 " "$3,385.00 " N/A 4060106 Radiology CT UE w/ + w/o Cont Lt 73202 352 "$3,232.00 " $425.00 $296.34 $- $831.09 "$2,585.60 " $- N/A $840.32 N/A $425.00 $425.00 N/A N/A "$1,939.20 " N/A N/A "$1,616.00 " N/A N/A $296.34 N/A N/A $632.07 N/A N/A $861.00 N/A N/A "$1,260.48 " N/A N/A "$2,262.40 " N/A N/A "$2,585.60 " N/A N/A $694.00 N/A $521.00 $521.00 N/A N/A "$1,082.72 " N/A N/A $296.34 N/A N/A "$1,939.20 " N/A N/A $701.79 N/A N/A $707.00 N/A N/A $969.60 N/A N/A "$1,939.20 " N/A $831.09 $831.09 N/A N/A $969.60 N/A N/A $969.60 N/A N/A $969.60 N/A N/A $969.60 N/A N/A $969.60 N/A N/A $969.60 N/A "$3,232.00 " "$3,232.00 " N/A 4060106 Radiology CT UE w/ + w/o Cont Rt 73202 352 "$3,232.00 " $425.00 $296.34 $- $831.09 "$2,585.60 " $- N/A $840.32 N/A $425.00 $425.00 N/A N/A "$1,939.20 " N/A N/A "$1,616.00 " N/A N/A $296.34 N/A N/A $632.07 N/A N/A $861.00 N/A N/A "$1,260.48 " N/A N/A "$2,262.40 " N/A N/A "$2,585.60 " N/A N/A $694.00 N/A $521.00 $521.00 N/A N/A "$1,082.72 " N/A N/A $296.34 N/A N/A "$1,939.20 " N/A N/A $701.79 N/A N/A $707.00 N/A N/A $969.60 N/A N/A "$1,939.20 " N/A $831.09 $831.09 N/A N/A $969.60 N/A N/A $969.60 N/A N/A $969.60 N/A N/A $969.60 N/A N/A $969.60 N/A N/A $969.60 N/A "$3,232.00 " "$3,232.00 " N/A 4061936 Radiology CT Pelvis w/ Cont 72193 352 "$4,158.00 " $425.00 $233.92 $- $831.09 "$3,326.40 " $- N/A "$1,081.08 " N/A $425.00 $425.00 N/A N/A "$2,494.80 " N/A N/A "$2,079.00 " N/A N/A $233.92 N/A N/A $632.07 N/A N/A $861.00 N/A N/A "$1,621.62 " N/A N/A "$2,910.60 " N/A N/A "$3,326.40 " N/A N/A $694.00 N/A $521.00 $521.00 N/A N/A "$1,392.93 " N/A N/A $233.92 N/A N/A "$2,494.80 " N/A N/A $701.79 N/A N/A $707.00 N/A N/A "$1,247.40 " N/A N/A "$2,494.80 " N/A $831.09 $831.09 N/A N/A "$1,247.40 " N/A N/A "$1,247.40 " N/A N/A "$1,247.40 " N/A N/A "$1,247.40 " N/A N/A "$1,247.40 " N/A N/A "$1,247.40 " N/A "$4,158.00 " "$4,158.00 " N/A 4062008 Radiology CT UE w/o Cont Lt 73200 352 "$2,432.00 " $425.00 $189.81 $- $831.09 "$1,945.60 " $- N/A $632.32 N/A $425.00 $425.00 N/A N/A "$1,459.20 " N/A N/A "$1,216.00 " N/A N/A $189.81 N/A N/A $632.07 N/A N/A $861.00 N/A N/A $948.48 N/A N/A "$1,702.40 " N/A N/A "$1,945.60 " N/A N/A $694.00 N/A $521.00 $521.00 N/A N/A $814.72 N/A N/A $189.81 N/A N/A "$1,459.20 " N/A N/A $701.79 N/A N/A $707.00 N/A N/A $729.60 N/A N/A "$1,459.20 " N/A $831.09 $831.09 N/A N/A $729.60 N/A N/A $729.60 N/A N/A $729.60 N/A N/A $729.60 N/A N/A $729.60 N/A N/A $729.60 N/A "$2,432.00 " "$2,432.00 " N/A 4062008 Radiology CT UE w/o Cont Rt 73200 352 "$2,432.00 " $425.00 $189.81 $- $831.09 "$1,945.60 " $- N/A $632.32 N/A $425.00 $425.00 N/A N/A "$1,459.20 " N/A N/A "$1,216.00 " N/A N/A $189.81 N/A N/A $632.07 N/A N/A $861.00 N/A N/A $948.48 N/A N/A "$1,702.40 " N/A N/A "$1,945.60 " N/A N/A $694.00 N/A $521.00 $521.00 N/A N/A $814.72 N/A N/A $189.81 N/A N/A "$1,459.20 " N/A N/A $701.79 N/A N/A $707.00 N/A N/A $729.60 N/A N/A "$1,459.20 " N/A $831.09 $831.09 N/A N/A $729.60 N/A N/A $729.60 N/A N/A $729.60 N/A N/A $729.60 N/A N/A $729.60 N/A N/A $729.60 N/A "$2,432.00 " "$2,432.00 " N/A 4062604 Radiology CT Angio Chest PE w/ Cont 71275 352 "$4,158.00 " $425.00 $370.81 $- $831.09 "$3,326.40 " $- N/A "$1,081.08 " N/A $425.00 $425.00 N/A N/A "$2,494.80 " N/A N/A "$2,079.00 " N/A N/A $370.81 N/A N/A $632.07 N/A N/A $861.00 N/A N/A "$1,621.62 " N/A N/A "$2,910.60 " N/A N/A "$3,326.40 " N/A N/A $694.00 N/A $521.00 $521.00 N/A N/A "$1,392.93 " N/A N/A $370.81 N/A N/A "$2,494.80 " N/A N/A $701.79 N/A N/A $707.00 N/A N/A "$1,247.40 " N/A N/A "$2,494.80 " N/A $831.09 $831.09 N/A N/A "$1,247.40 " N/A N/A "$1,247.40 " N/A N/A "$1,247.40 " N/A N/A "$1,247.40 " N/A N/A "$1,247.40 " N/A N/A "$1,247.40 " N/A "$4,158.00 " "$4,158.00 " N/A 4062604 Radiology CT Angio Chest +Abdomen +Pelvis w/ Cont 71275 352 "$4,158.00 " $425.00 $370.81 $- $831.09 "$3,326.40 " $- N/A "$1,081.08 " N/A $425.00 $425.00 N/A N/A "$2,494.80 " N/A N/A "$2,079.00 " N/A N/A $370.81 N/A N/A $632.07 N/A N/A $861.00 N/A N/A "$1,621.62 " N/A N/A "$2,910.60 " N/A N/A "$3,326.40 " N/A N/A $694.00 N/A $521.00 $521.00 N/A N/A "$1,392.93 " N/A N/A $370.81 N/A N/A "$2,494.80 " N/A N/A $701.79 N/A N/A $707.00 N/A N/A "$1,247.40 " N/A N/A "$2,494.80 " N/A $831.09 $831.09 N/A N/A "$1,247.40 " N/A N/A "$1,247.40 " N/A N/A "$1,247.40 " N/A N/A "$1,247.40 " N/A N/A "$1,247.40 " N/A N/A "$1,247.40 " N/A "$4,158.00 " "$4,158.00 " N/A 4062604 Radiology CT Chest w/ Cont 71260 352 "$4,158.00 " $425.00 $237.68 $- $831.09 "$3,326.40 " $- N/A "$1,081.08 " N/A $425.00 $425.00 N/A N/A "$2,494.80 " N/A N/A "$2,079.00 " N/A N/A $237.68 N/A N/A $632.07 N/A N/A $861.00 N/A N/A "$1,621.62 " N/A N/A "$2,910.60 " N/A N/A "$3,326.40 " N/A N/A $694.00 N/A $521.00 $521.00 N/A N/A "$1,392.93 " N/A N/A $237.68 N/A N/A "$2,494.80 " N/A N/A $701.79 N/A N/A $707.00 N/A N/A "$1,247.40 " N/A N/A "$2,494.80 " N/A $831.09 $831.09 N/A N/A "$1,247.40 " N/A N/A "$1,247.40 " N/A N/A "$1,247.40 " N/A N/A "$1,247.40 " N/A N/A "$1,247.40 " N/A N/A "$1,247.40 " N/A "$4,158.00 " "$4,158.00 " N/A 4064502 Radiology CT Head or Brain w/o Cont 70450 351 "$2,432.00 " $425.00 $122.53 $- $831.09 "$1,945.60 " $- N/A $632.32 N/A $425.00 $425.00 N/A N/A "$1,459.20 " N/A N/A "$1,216.00 " N/A N/A $122.53 N/A N/A $632.07 N/A N/A $861.00 N/A N/A $948.48 N/A N/A "$1,702.40 " N/A N/A "$1,945.60 " N/A N/A $694.00 N/A $521.00 $521.00 N/A N/A $814.72 N/A N/A $122.53 N/A N/A "$1,459.20 " N/A N/A $701.79 N/A N/A $707.00 N/A N/A $729.60 N/A N/A "$1,459.20 " N/A $831.09 $831.09 N/A N/A $729.60 N/A N/A $729.60 N/A N/A $729.60 N/A N/A $729.60 N/A N/A $729.60 N/A N/A $729.60 N/A "$2,432.00 " "$2,432.00 " N/A 4064882 Radiology CT Maxillofacial w/ + w/o Cont 70488 351 "$4,618.00 " $425.00 $297.77 $- $831.09 "$3,694.40 " $- N/A "$1,200.68 " N/A $425.00 $425.00 N/A N/A "$2,770.80 " N/A N/A "$2,309.00 " N/A N/A $297.77 N/A N/A $632.07 N/A N/A $861.00 N/A N/A "$1,801.02 " N/A N/A "$3,232.60 " N/A N/A "$3,694.40 " N/A N/A $694.00 N/A $521.00 $521.00 N/A N/A "$1,547.03 " N/A N/A $297.77 N/A N/A "$2,770.80 " N/A N/A $701.79 N/A N/A $707.00 N/A N/A "$1,385.40 " N/A N/A "$2,770.80 " N/A $831.09 $831.09 N/A N/A "$1,385.40 " N/A N/A "$1,385.40 " N/A N/A "$1,385.40 " N/A N/A "$1,385.40 " N/A N/A "$1,385.40 " N/A N/A "$1,385.40 " N/A "$4,618.00 " "$4,618.00 " N/A 4067007 Radiology CT LE w/o Cont Lt 73700 352 "$2,061.00 " $425.00 $189.81 $- $831.09 "$1,648.80 " $- N/A $535.86 N/A $425.00 $425.00 N/A N/A "$1,236.60 " N/A N/A "$1,030.50 " N/A N/A $189.81 N/A N/A $632.07 N/A N/A $861.00 N/A N/A $803.79 N/A N/A "$1,442.70 " N/A N/A "$1,648.80 " N/A N/A $694.00 N/A $521.00 $521.00 N/A N/A $690.44 N/A N/A $189.81 N/A N/A "$1,236.60 " N/A N/A $701.79 N/A N/A $707.00 N/A N/A $618.30 N/A N/A "$1,236.60 " N/A $831.09 $831.09 N/A N/A $618.30 N/A N/A $618.30 N/A N/A $618.30 N/A N/A $618.30 N/A N/A $618.30 N/A N/A $618.30 N/A "$2,061.00 " "$2,061.00 " N/A 4067007 Radiology CT LE w/o Cont Rt 73700 352 "$2,061.00 " $425.00 $189.81 $- $831.09 "$1,648.80 " $- N/A $535.86 N/A $425.00 $425.00 N/A N/A "$1,236.60 " N/A N/A "$1,030.50 " N/A N/A $189.81 N/A N/A $632.07 N/A N/A $861.00 N/A N/A $803.79 N/A N/A "$1,442.70 " N/A N/A "$1,648.80 " N/A N/A $694.00 N/A $521.00 $521.00 N/A N/A $690.44 N/A N/A $189.81 N/A N/A "$1,236.60 " N/A N/A $701.79 N/A N/A $707.00 N/A N/A $618.30 N/A N/A "$1,236.60 " N/A $831.09 $831.09 N/A N/A $618.30 N/A N/A $618.30 N/A N/A $618.30 N/A N/A $618.30 N/A N/A $618.30 N/A N/A $618.30 N/A "$2,061.00 " "$2,061.00 " N/A 4067015 Radiology CT LE w/ Cont Lt 73701 352 "$2,279.00 " $425.00 $234.99 $- $831.09 "$1,823.20 " $- N/A $592.54 N/A $425.00 $425.00 N/A N/A "$1,367.40 " N/A N/A "$1,139.50 " N/A N/A $234.99 N/A N/A $632.07 N/A N/A $861.00 N/A N/A $888.81 N/A N/A "$1,595.30 " N/A N/A "$1,823.20 " N/A N/A $694.00 N/A $521.00 $521.00 N/A N/A $763.47 N/A N/A $234.99 N/A N/A "$1,367.40 " N/A N/A $701.79 N/A N/A $707.00 N/A N/A $683.70 N/A N/A "$1,367.40 " N/A $831.09 $831.09 N/A N/A $683.70 N/A N/A $683.70 N/A N/A $683.70 N/A N/A $683.70 N/A N/A $683.70 N/A N/A $683.70 N/A "$2,279.00 " "$2,279.00 " N/A 4067015 Radiology CT LE w/ Cont Rt 73701 352 "$2,279.00 " $425.00 $234.99 $- $831.09 "$1,823.20 " $- N/A $592.54 N/A $425.00 $425.00 N/A N/A "$1,367.40 " N/A N/A "$1,139.50 " N/A N/A $234.99 N/A N/A $632.07 N/A N/A $861.00 N/A N/A $888.81 N/A N/A "$1,595.30 " N/A N/A "$1,823.20 " N/A N/A $694.00 N/A $521.00 $521.00 N/A N/A $763.47 N/A N/A $234.99 N/A N/A "$1,367.40 " N/A N/A $701.79 N/A N/A $707.00 N/A N/A $683.70 N/A N/A "$1,367.40 " N/A $831.09 $831.09 N/A N/A $683.70 N/A N/A $683.70 N/A N/A $683.70 N/A N/A $683.70 N/A N/A $683.70 N/A N/A $683.70 N/A "$2,279.00 " "$2,279.00 " N/A 4067020 Radiology CT LE w/ + w/o Cont Lt 73702 352 "$3,540.00 " $425.00 $293.86 $- $831.09 "$2,832.00 " $- N/A $920.40 N/A $425.00 $425.00 N/A N/A "$2,124.00 " N/A N/A "$1,770.00 " N/A N/A $293.86 N/A N/A $632.07 N/A N/A $861.00 N/A N/A "$1,380.60 " N/A N/A "$2,478.00 " N/A N/A "$2,832.00 " N/A N/A $694.00 N/A $521.00 $521.00 N/A N/A "$1,185.90 " N/A N/A $293.86 N/A N/A "$2,124.00 " N/A N/A $701.79 N/A N/A $707.00 N/A N/A "$1,062.00 " N/A N/A "$2,124.00 " N/A $831.09 $831.09 N/A N/A "$1,062.00 " N/A N/A "$1,062.00 " N/A N/A "$1,062.00 " N/A N/A "$1,062.00 " N/A N/A "$1,062.00 " N/A N/A "$1,062.00 " N/A "$3,540.00 " "$3,540.00 " N/A 4067020 Radiology CT LE w/ + w/o Cont Rt 73702 352 "$3,540.00 " $425.00 $293.86 $- $831.09 "$2,832.00 " $- N/A $920.40 N/A $425.00 $425.00 N/A N/A "$2,124.00 " N/A N/A "$1,770.00 " N/A N/A $293.86 N/A N/A $632.07 N/A N/A $861.00 N/A N/A "$1,380.60 " N/A N/A "$2,478.00 " N/A N/A "$2,832.00 " N/A N/A $694.00 N/A $521.00 $521.00 N/A N/A "$1,185.90 " N/A N/A $293.86 N/A N/A "$2,124.00 " N/A N/A $701.79 N/A N/A $707.00 N/A N/A "$1,062.00 " N/A N/A "$2,124.00 " N/A $831.09 $831.09 N/A N/A "$1,062.00 " N/A N/A "$1,062.00 " N/A N/A "$1,062.00 " N/A N/A "$1,062.00 " N/A N/A "$1,062.00 " N/A N/A "$1,062.00 " N/A "$3,540.00 " "$3,540.00 " N/A 4078010 Radiology NM Thyroid Only 78012 340 "$1,212.00 " $- $77.50 $- $- $969.60 $- N/A $315.12 N/A N/A $97.73 N/A N/A $727.20 N/A N/A $606.00 N/A N/A $77.50 N/A N/A $824.16 N/A N/A $690.84 N/A N/A $472.68 N/A N/A $848.40 N/A N/A $969.60 N/A N/A $666.60 N/A N/A $848.40 N/A N/A $406.02 N/A N/A $77.50 N/A N/A $727.20 N/A N/A $424.20 N/A N/A $787.80 N/A N/A $363.60 N/A N/A $727.20 N/A N/A $848.40 N/A N/A $363.60 N/A N/A $363.60 N/A N/A $363.60 N/A N/A $363.60 N/A N/A $363.60 N/A N/A $363.60 N/A "$1,212.00 " "$1,212.00 " N/A 4078480 Radiology NM Myocard Perf Spect Mult Rest+Stress 78452 340 "$4,554.00 " $- $479.65 $- $- "$3,643.20 " $- N/A "$1,184.04 " N/A N/A $589.97 N/A N/A "$2,732.40 " N/A N/A "$2,277.00 " N/A N/A $479.65 N/A N/A "$3,096.72 " N/A N/A "$2,595.78 " N/A N/A "$1,776.06 " N/A N/A "$3,187.80 " N/A N/A "$3,643.20 " N/A N/A "$2,504.70 " N/A N/A "$3,187.80 " N/A N/A "$1,525.59 " N/A N/A $479.65 N/A N/A "$2,732.40 " N/A N/A "$1,593.90 " N/A N/A "$2,960.10 " N/A N/A "$1,366.20 " N/A N/A "$2,732.40 " N/A N/A "$3,187.80 " N/A N/A "$1,366.20 " N/A N/A "$1,366.20 " N/A N/A "$1,366.20 " N/A N/A "$1,366.20 " N/A N/A "$1,366.20 " N/A N/A "$1,366.20 " N/A "$4,554.00 " "$4,554.00 " N/A 4085225 Radiology US Thoracentesis 32555 402 "$2,220.00 " $- $101.19 $- $- "$1,776.00 " $- N/A $577.20 N/A N/A $117.98 N/A N/A "$1,332.00 " N/A N/A "$1,110.00 " N/A N/A $101.19 N/A N/A "$1,509.60 " N/A N/A "$1,265.40 " N/A N/A $865.80 N/A N/A "$1,554.00 " N/A N/A "$1,776.00 " N/A N/A "$1,221.00 " N/A N/A "$1,554.00 " N/A N/A $743.70 N/A N/A $101.19 N/A N/A "$1,332.00 " N/A N/A $777.00 N/A N/A "$1,443.00 " N/A N/A $666.00 N/A N/A "$1,332.00 " N/A N/A "$1,554.00 " N/A N/A $666.00 N/A N/A $666.00 N/A N/A $666.00 N/A N/A $666.00 N/A N/A $666.00 N/A N/A $666.00 N/A "$2,220.00 " "$2,220.00 " N/A 4086538 Radiology US Extremity Nonvascular Comp Lt 76881 320 $818.00 $- $117.96 $- $- $654.40 $- N/A $212.68 N/A N/A $145.97 N/A N/A $490.80 N/A N/A $409.00 N/A N/A $117.96 N/A N/A $556.24 N/A N/A $466.26 N/A N/A $319.02 N/A N/A $572.60 N/A N/A $654.40 N/A N/A $449.90 N/A N/A $572.60 N/A N/A $274.03 N/A N/A $117.96 N/A N/A $490.80 N/A N/A $286.30 N/A N/A $531.70 N/A N/A $245.40 N/A N/A $490.80 N/A N/A $572.60 N/A N/A $245.40 N/A N/A $245.40 N/A N/A $245.40 N/A N/A $245.40 N/A N/A $245.40 N/A N/A $245.40 N/A $818.00 $818.00 N/A 4086538 Radiology US Extremity Nonvascular Comp Rt 76881 320 $818.00 $- $117.96 $- $- $654.40 $- N/A $212.68 N/A N/A $145.97 N/A N/A $490.80 N/A N/A $409.00 N/A N/A $117.96 N/A N/A $556.24 N/A N/A $466.26 N/A N/A $319.02 N/A N/A $572.60 N/A N/A $654.40 N/A N/A $449.90 N/A N/A $572.60 N/A N/A $274.03 N/A N/A $117.96 N/A N/A $490.80 N/A N/A $286.30 N/A N/A $531.70 N/A N/A $245.40 N/A N/A $490.80 N/A N/A $572.60 N/A N/A $245.40 N/A N/A $245.40 N/A N/A $245.40 N/A N/A $245.40 N/A N/A $245.40 N/A N/A $245.40 N/A $818.00 $818.00 N/A 4087004 Radiology US Abdomen Comp 76700 402 "$1,393.00 " $- $140.37 $- $- "$1,114.40 " $- N/A $362.18 N/A N/A $162.05 N/A N/A $835.80 N/A N/A $696.50 N/A N/A $140.37 N/A N/A $947.24 N/A N/A $794.01 N/A N/A $543.27 N/A N/A $975.10 N/A N/A "$1,114.40 " N/A N/A $766.15 N/A N/A $975.10 N/A N/A $466.66 N/A N/A $140.37 N/A N/A $835.80 N/A N/A $487.55 N/A N/A $905.45 N/A N/A $417.90 N/A N/A $835.80 N/A N/A $975.10 N/A N/A $417.90 N/A N/A $417.90 N/A N/A $417.90 N/A N/A $417.90 N/A N/A $417.90 N/A N/A $417.90 N/A "$1,393.00 " "$1,393.00 " N/A 4088051 Radiology US Pregnant < 14 Weeks 1st Gest 76801 402 $602.00 $- $125.10 $- $- $481.60 $- N/A $156.52 N/A N/A $150.34 N/A N/A $361.20 N/A N/A $301.00 N/A N/A $125.10 N/A N/A $409.36 N/A N/A $343.14 N/A N/A $234.78 N/A N/A $421.40 N/A N/A $481.60 N/A N/A $331.10 N/A N/A $421.40 N/A N/A $201.67 N/A N/A $125.10 N/A N/A $361.20 N/A N/A $210.70 N/A N/A $391.30 N/A N/A $180.60 N/A N/A $361.20 N/A N/A $421.40 N/A N/A $180.60 N/A N/A $180.60 N/A N/A $180.60 N/A N/A $180.60 N/A N/A $180.60 N/A N/A $180.60 N/A $602.00 $602.00 N/A 4088051 Radiology US Pregnant < 14 Weeks 1st Gest 76805 402 $602.00 $- $144.99 $- $- $481.60 $- N/A $156.52 N/A N/A $172.43 N/A N/A $361.20 N/A N/A $301.00 N/A N/A $144.99 N/A N/A $409.36 N/A N/A $343.14 N/A N/A $234.78 N/A N/A $421.40 N/A N/A $481.60 N/A N/A $331.10 N/A N/A $421.40 N/A N/A $201.67 N/A N/A $144.99 N/A N/A $361.20 N/A N/A $210.70 N/A N/A $391.30 N/A N/A $180.60 N/A N/A $361.20 N/A N/A $421.40 N/A N/A $180.60 N/A N/A $180.60 N/A N/A $180.60 N/A N/A $180.60 N/A N/A $180.60 N/A N/A $180.60 N/A $602.00 $602.00 N/A 4088051 Radiology US Pregnant > 14 Weeks 1st Gest 76805 402 $602.00 $- $144.99 $- $- $481.60 $- N/A $156.52 N/A N/A $172.43 N/A N/A $361.20 N/A N/A $301.00 N/A N/A $144.99 N/A N/A $409.36 N/A N/A $343.14 N/A N/A $234.78 N/A N/A $421.40 N/A N/A $481.60 N/A N/A $331.10 N/A N/A $421.40 N/A N/A $201.67 N/A N/A $144.99 N/A N/A $361.20 N/A N/A $210.70 N/A N/A $391.30 N/A N/A $180.60 N/A N/A $361.20 N/A N/A $421.40 N/A N/A $180.60 N/A N/A $180.60 N/A N/A $180.60 N/A N/A $180.60 N/A N/A $180.60 N/A N/A $180.60 N/A $602.00 $602.00 N/A 4088051 Radiology US Pregnant > 14 Weeks 1st Gest 76801 402 $602.00 $- $125.10 $- $- $481.60 $- N/A $156.52 N/A N/A $150.34 N/A N/A $361.20 N/A N/A $301.00 N/A N/A $125.10 N/A N/A $409.36 N/A N/A $343.14 N/A N/A $234.78 N/A N/A $421.40 N/A N/A $481.60 N/A N/A $331.10 N/A N/A $421.40 N/A N/A $201.67 N/A N/A $125.10 N/A N/A $361.20 N/A N/A $210.70 N/A N/A $391.30 N/A N/A $180.60 N/A N/A $361.20 N/A N/A $421.40 N/A N/A $180.60 N/A N/A $180.60 N/A N/A $180.60 N/A N/A $180.60 N/A N/A $180.60 N/A N/A $180.60 N/A $602.00 $602.00 N/A 4088301 Radiology US Transvaginal 76830 402 "$1,224.00 " $- $88.73 $- $- $979.20 $- N/A $318.24 N/A N/A $88.73 N/A N/A $734.40 N/A N/A $612.00 N/A N/A $125.65 N/A N/A $832.32 N/A N/A $697.68 N/A N/A $477.36 N/A N/A $856.80 N/A N/A $979.20 N/A N/A $673.20 N/A N/A $856.80 N/A N/A $410.04 N/A N/A $125.65 N/A N/A $734.40 N/A N/A $428.40 N/A N/A $795.60 N/A N/A $367.20 N/A N/A $734.40 N/A N/A $856.80 N/A N/A $367.20 N/A N/A $367.20 N/A N/A $367.20 N/A N/A $367.20 N/A N/A $367.20 N/A N/A $367.20 N/A "$1,224.00 " "$1,224.00 " N/A 4088570 Radiology US Bladder +Residual Post Voiding 76857 402 $908.00 $- $53.38 $- $- $726.40 $- N/A $236.08 N/A N/A $97.85 N/A N/A $544.80 N/A N/A $454.00 N/A N/A $53.38 N/A N/A $617.44 N/A N/A $517.56 N/A N/A $354.12 N/A N/A $635.60 N/A N/A $726.40 N/A N/A $499.40 N/A N/A $635.60 N/A N/A $304.18 N/A N/A $53.38 N/A N/A $544.80 N/A N/A $317.80 N/A N/A $590.20 N/A N/A $272.40 N/A N/A $544.80 N/A N/A $635.60 N/A N/A $272.40 N/A N/A $272.40 N/A N/A $272.40 N/A N/A $272.40 N/A N/A $272.40 N/A N/A $272.40 N/A $908.00 $908.00 N/A 4088704 Radiology US Carotid Duplex Bil 93880 921 "$2,135.00 " $- $161.01 $- $- "$1,708.00 " $- N/A $555.10 N/A N/A $220.58 N/A N/A "$1,281.00 " N/A N/A "$1,067.50 " N/A N/A $161.01 N/A N/A "$1,451.80 " N/A N/A "$1,216.95 " N/A N/A $832.65 N/A N/A "$1,494.50 " N/A N/A "$1,708.00 " N/A N/A "$1,174.25 " N/A N/A "$1,494.50 " N/A N/A $715.23 N/A N/A $161.01 N/A N/A "$1,281.00 " N/A N/A $747.25 N/A N/A "$1,387.75 " N/A N/A $640.50 N/A N/A "$1,281.00 " N/A N/A "$1,494.50 " N/A N/A $640.50 N/A N/A $640.50 N/A N/A $640.50 N/A N/A $640.50 N/A N/A $640.50 N/A N/A $640.50 N/A "$2,135.00 " "$2,135.00 " N/A 4089257 Radiology US LE Veins Duplex Bil 93970 921 "$2,135.00 " $- $158.18 $- $- "$1,708.00 " $- N/A $555.10 N/A N/A $227.12 N/A N/A "$1,281.00 " N/A N/A "$1,067.50 " N/A N/A $158.18 N/A N/A "$1,451.80 " N/A N/A "$1,216.95 " N/A N/A $832.65 N/A N/A "$1,494.50 " N/A N/A "$1,708.00 " N/A N/A "$1,174.25 " N/A N/A "$1,494.50 " N/A N/A $715.23 N/A N/A $158.18 N/A N/A "$1,281.00 " N/A N/A $747.25 N/A N/A "$1,387.75 " N/A N/A $640.50 N/A N/A "$1,281.00 " N/A N/A "$1,494.50 " N/A N/A $640.50 N/A N/A $640.50 N/A N/A $640.50 N/A N/A $640.50 N/A N/A $640.50 N/A N/A $640.50 N/A "$2,135.00 " "$2,135.00 " N/A 4089257 Radiology US UE Veins Duplex Bil 93970 921 "$2,135.00 " $- $158.18 $- $- "$1,708.00 " $- N/A $555.10 N/A N/A $227.12 N/A N/A "$1,281.00 " N/A N/A "$1,067.50 " N/A N/A $158.18 N/A N/A "$1,451.80 " N/A N/A "$1,216.95 " N/A N/A $832.65 N/A N/A "$1,494.50 " N/A N/A "$1,708.00 " N/A N/A "$1,174.25 " N/A N/A "$1,494.50 " N/A N/A $715.23 N/A N/A $158.18 N/A N/A "$1,281.00 " N/A N/A $747.25 N/A N/A "$1,387.75 " N/A N/A $640.50 N/A N/A "$1,281.00 " N/A N/A "$1,494.50 " N/A N/A $640.50 N/A N/A $640.50 N/A N/A $640.50 N/A N/A $640.50 N/A N/A $640.50 N/A N/A $640.50 N/A "$2,135.00 " "$2,135.00 " N/A 4090553 Radiology MRI Brain w/ + w/o Cont 70553 611 "$5,946.00 " $770.00 $390.07 $- "$1,227.27 " "$4,756.80 " $- N/A "$1,545.96 " N/A $650 per service date $650 per service date N/A N/A "$3,567.60 " N/A N/A "$2,973.00 " N/A N/A $390.07 N/A N/A $827.70 N/A N/A "$1,266.00 " N/A N/A "$2,318.94 " N/A N/A $618 per service date N/A N/A "$4,756.80 " N/A N/A $912.00 N/A $770.00 N/A N/A N/A "$1,991.91 " N/A N/A $390.07 N/A N/A "$3,567.60 " N/A N/A $978.09 N/A N/A "$1,038.00 " N/A N/A "$1,783.80 " N/A N/A "$3,567.60 " N/A "$1,227.27 " N/A N/A N/A "$1,783.80 " N/A N/A "$1,783.80 " N/A N/A "$1,783.80 " N/A N/A "$1,783.80 " N/A N/A "$1,783.80 " N/A N/A "$1,783.80 " N/A "$5,946.00 " "$5,946.00 " N/A 4091480 Radiology MRI Spine Lumbar w/o Cont 72148 612 "$4,314.00 " $770.00 $241.57 $- "$1,227.27 " "$3,451.20 " $- N/A "$1,121.64 " N/A $650 per service date $650 per service date N/A N/A "$2,588.40 " N/A N/A "$2,157.00 " N/A N/A $241.57 N/A N/A $827.70 N/A N/A "$1,266.00 " N/A N/A "$1,682.46 " N/A N/A $618 per service date N/A N/A "$3,451.20 " N/A N/A $912.00 N/A $770.00 N/A N/A N/A "$1,445.19 " N/A N/A $241.57 N/A N/A "$2,588.40 " N/A N/A $978.09 N/A N/A "$1,038.00 " N/A N/A "$1,294.20 " N/A N/A "$2,588.40 " N/A "$1,227.27 " N/A N/A N/A "$1,294.20 " N/A N/A "$1,294.20 " N/A N/A "$1,294.20 " N/A N/A "$1,294.20 " N/A N/A "$1,294.20 " N/A N/A "$1,294.20 " N/A "$4,314.00 " "$4,314.00 " N/A 4095510 Radiology MRI Chest w/ + w/o Cont 71552 610 "$4,688.00 " $770.00 $589.38 $- "$1,227.27 " "$3,750.40 " $- N/A "$1,218.88 " N/A $650 per service date $650 per service date N/A N/A "$2,812.80 " N/A N/A "$2,344.00 " N/A N/A $589.38 N/A N/A $827.70 N/A N/A "$1,266.00 " N/A N/A "$1,828.32 " N/A N/A $618 per service date N/A N/A "$3,750.40 " N/A N/A $912.00 N/A $770.00 N/A N/A N/A "$1,570.48 " N/A N/A $589.38 N/A N/A "$2,812.80 " N/A N/A $978.09 N/A N/A "$1,038.00 " N/A N/A "$1,406.40 " N/A N/A "$2,812.80 " N/A "$1,227.27 " N/A N/A N/A "$1,406.40 " N/A N/A "$1,406.40 " N/A N/A "$1,406.40 " N/A N/A "$1,406.40 " N/A N/A "$1,406.40 " N/A N/A "$1,406.40 " N/A "$4,688.00 " "$4,688.00 " N/A 4095514 Radiology MRI Abdomen w/ + w/o Cont 74183 610 "$5,670.00 " $770.00 $516.55 $- "$1,227.27 " "$4,536.00 " $- N/A "$1,474.20 " N/A $650 per service date $650 per service date N/A N/A "$3,402.00 " N/A N/A "$2,835.00 " N/A N/A $516.55 N/A N/A $827.70 N/A N/A "$1,266.00 " N/A N/A "$2,211.30 " N/A N/A $618 per service date N/A N/A "$4,536.00 " N/A N/A $912.00 N/A $770.00 N/A N/A N/A "$1,899.45 " N/A N/A $516.55 N/A N/A "$3,402.00 " N/A N/A $978.09 N/A N/A "$1,038.00 " N/A N/A "$1,701.00 " N/A N/A "$3,402.00 " N/A "$1,227.27 " N/A N/A N/A "$1,701.00 " N/A N/A "$1,701.00 " N/A N/A "$1,701.00 " N/A N/A "$1,701.00 " N/A N/A "$1,701.00 " N/A N/A "$1,701.00 " N/A "$5,670.00 " "$5,670.00 " N/A 4095516 Radiology MRI Pelvis w/ + w/o Cont 72197 610 "$5,576.00 " $770.00 $514.78 $- "$1,227.27 " "$4,460.80 " $- N/A "$1,449.76 " N/A $650 per service date $650 per service date N/A N/A "$3,345.60 " N/A N/A "$2,788.00 " N/A N/A $514.78 N/A N/A $827.70 N/A N/A "$1,266.00 " N/A N/A "$2,174.64 " N/A N/A $618 per service date N/A N/A "$4,460.80 " N/A N/A $912.00 N/A $770.00 N/A N/A N/A "$1,867.96 " N/A N/A $514.78 N/A N/A "$3,345.60 " N/A N/A $978.09 N/A N/A "$1,038.00 " N/A N/A "$1,672.80 " N/A N/A "$3,345.60 " N/A "$1,227.27 " N/A N/A N/A "$1,672.80 " N/A N/A "$1,672.80 " N/A N/A "$1,672.80 " N/A N/A "$1,672.80 " N/A N/A "$1,672.80 " N/A N/A "$1,672.80 " N/A "$5,576.00 " "$5,576.00 " N/A 4097213 Radiology MRI LE Joint w/ + w/o Cont Lt 73721 610 "$3,990.00 " $770.00 $253.18 $- "$1,227.27 " "$3,192.00 " $- N/A "$1,037.40 " N/A $650 per service date $650 per service date N/A N/A "$2,394.00 " N/A N/A "$1,995.00 " N/A N/A $253.18 N/A N/A $827.70 N/A N/A "$1,266.00 " N/A N/A "$1,556.10 " N/A N/A $618 per service date N/A N/A "$3,192.00 " N/A N/A $912.00 N/A $770.00 N/A N/A N/A "$1,336.65 " N/A N/A $253.18 N/A N/A "$2,394.00 " N/A N/A $978.09 N/A N/A "$1,038.00 " N/A N/A "$1,197.00 " N/A N/A "$2,394.00 " N/A "$1,227.27 " N/A N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A "$3,990.00 " "$3,990.00 " N/A 4097213 Radiology MRI LE Joint w/ + w/o Cont Rt 73721 610 "$3,990.00 " $770.00 $253.18 $- "$1,227.27 " "$3,192.00 " $- N/A "$1,037.40 " N/A $650 per service date $650 per service date N/A N/A "$2,394.00 " N/A N/A "$1,995.00 " N/A N/A $253.18 N/A N/A $827.70 N/A N/A "$1,266.00 " N/A N/A "$1,556.10 " N/A N/A $618 per service date N/A N/A "$3,192.00 " N/A N/A $912.00 N/A $770.00 N/A N/A N/A "$1,336.65 " N/A N/A $253.18 N/A N/A "$2,394.00 " N/A N/A $978.09 N/A N/A "$1,038.00 " N/A N/A "$1,197.00 " N/A N/A "$2,394.00 " N/A "$1,227.27 " N/A N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A "$3,990.00 " "$3,990.00 " N/A 4097213 Radiology MRI LE Joint w/o Cont Lt 73721 610 "$3,990.00 " $770.00 $253.18 $- "$1,227.27 " "$3,192.00 " $- N/A "$1,037.40 " N/A $650 per service date $650 per service date N/A N/A "$2,394.00 " N/A N/A "$1,995.00 " N/A N/A $253.18 N/A N/A $827.70 N/A N/A "$1,266.00 " N/A N/A "$1,556.10 " N/A N/A $618 per service date N/A N/A "$3,192.00 " N/A N/A $912.00 N/A $770.00 N/A N/A N/A "$1,336.65 " N/A N/A $253.18 N/A N/A "$2,394.00 " N/A N/A $978.09 N/A N/A "$1,038.00 " N/A N/A "$1,197.00 " N/A N/A "$2,394.00 " N/A "$1,227.27 " N/A N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A "$3,990.00 " "$3,990.00 " N/A 4097213 Radiology MRI LE Joint w/o Cont Rt 73721 610 "$3,990.00 " $770.00 $253.18 $- "$1,227.27 " "$3,192.00 " $- N/A "$1,037.40 " N/A $650 per service date $650 per service date N/A N/A "$2,394.00 " N/A N/A "$1,995.00 " N/A N/A $253.18 N/A N/A $827.70 N/A N/A "$1,266.00 " N/A N/A "$1,556.10 " N/A N/A $618 per service date N/A N/A "$3,192.00 " N/A N/A $912.00 N/A $770.00 N/A N/A N/A "$1,336.65 " N/A N/A $253.18 N/A N/A "$2,394.00 " N/A N/A $978.09 N/A N/A "$1,038.00 " N/A N/A "$1,197.00 " N/A N/A "$2,394.00 " N/A "$1,227.27 " N/A N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A "$3,990.00 " "$3,990.00 " N/A 4097213 Radiology MRI LE Joint w/ Cont Lt 73721 610 "$3,990.00 " $770.00 $253.18 $- "$1,227.27 " "$3,192.00 " $- N/A "$1,037.40 " N/A $650 per service date $650 per service date N/A N/A "$2,394.00 " N/A N/A "$1,995.00 " N/A N/A $253.18 N/A N/A $827.70 N/A N/A "$1,266.00 " N/A N/A "$1,556.10 " N/A N/A $618 per service date N/A N/A "$3,192.00 " N/A N/A $912.00 N/A $770.00 N/A N/A N/A "$1,336.65 " N/A N/A $253.18 N/A N/A "$2,394.00 " N/A N/A $978.09 N/A N/A "$1,038.00 " N/A N/A "$1,197.00 " N/A N/A "$2,394.00 " N/A "$1,227.27 " N/A N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A "$3,990.00 " "$3,990.00 " N/A 4097213 Radiology MRI LE Joint w/ Cont Rt 73721 610 "$3,990.00 " $770.00 $253.18 $- "$1,227.27 " "$3,192.00 " $- N/A "$1,037.40 " N/A $650 per service date $650 per service date N/A N/A "$2,394.00 " N/A N/A "$1,995.00 " N/A N/A $253.18 N/A N/A $827.70 N/A N/A "$1,266.00 " N/A N/A "$1,556.10 " N/A N/A $618 per service date N/A N/A "$3,192.00 " N/A N/A $912.00 N/A $770.00 N/A N/A N/A "$1,336.65 " N/A N/A $253.18 N/A N/A "$2,394.00 " N/A N/A $978.09 N/A N/A "$1,038.00 " N/A N/A "$1,197.00 " N/A N/A "$2,394.00 " N/A "$1,227.27 " N/A N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A N/A "$1,197.00 " N/A "$3,990.00 " "$3,990.00 " N/A 49045391 Respiratory Therapy "Noninvasive ear or pulse oximetry for oxygen saturation, sin" 93005 730 $725.00 $- $6.96 $- $- $580.00 $- N/A $188.50 N/A N/A $274.05 N/A N/A $435.00 N/A N/A $362.50 N/A N/A $6.96 N/A N/A $493.00 N/A N/A $427.75 N/A N/A $282.75 N/A N/A $507.50 N/A N/A $580.00 N/A N/A $398.75 N/A N/A $507.50 N/A N/A $242.88 N/A N/A $6.96 N/A N/A $435.00 N/A N/A $253.75 N/A N/A $471.25 N/A N/A $217.50 N/A N/A $435.00 N/A N/A $507.50 N/A N/A $217.50 N/A N/A $217.50 N/A N/A $217.50 N/A N/A $217.50 N/A N/A $217.50 N/A N/A $217.50 N/A $725.00 $725.00 N/A 4167002 Respiratory Therapy Charges ABG ANALYSIS 82803 301 "$1,190.00 " $- $12.41 $- $- $952.00 $- N/A $309.40 N/A N/A $449.82 N/A N/A $714.00 N/A N/A $595.00 N/A N/A $12.41 N/A N/A $809.20 N/A N/A $702.10 N/A N/A $464.10 N/A N/A $833.00 N/A N/A $952.00 N/A N/A $654.50 N/A N/A $833.00 N/A N/A $398.65 N/A N/A $12.41 N/A N/A $714.00 N/A N/A $416.50 N/A N/A $773.50 N/A N/A $357.00 N/A N/A $714.00 N/A N/A $833.00 N/A N/A $357.00 N/A N/A $357.00 N/A N/A $357.00 N/A N/A $357.00 N/A N/A $357.00 N/A N/A $357.00 N/A "$1,190.00 " "$1,190.00 " N/A 4514052 Speech/Audiology Charges Speech Fluency Eval Charge 92521 444 $292.00 $- $75.92 $- $- $233.60 $- N/A $75.92 N/A N/A $119.59 N/A N/A $175.20 N/A N/A $146.00 N/A N/A $93.69 N/A N/A $198.56 N/A N/A $111.00 N/A N/A $113.88 N/A N/A $204.40 N/A N/A $233.60 N/A N/A $200 per visit N/A N/A $204.40 N/A N/A $97.82 N/A N/A $93.69 N/A N/A $175.20 N/A N/A $102.20 N/A N/A $103.00/treatment; $163.00 max/day N/A N/A $87.60 N/A N/A $175.20 N/A N/A $204.40 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A N/A $87.60 N/A $292.00 $292.00 N/A 49010080 Surgery Incision and Drainage Pilonidal Cyst 10080 490 $350.00 $- $91.00 $- $- "$1,625.00 " $- N/A $91.00 N/A N/A $750.00 N/A N/A $210.00 N/A N/A $175.00 N/A N/A N/A N/A N/A "$1,625.00 " N/A N/A $542.00 N/A N/A $136.50 N/A N/A $159.25 N/A N/A $280.00 N/A N/A N/A N/A N/A $227.50 N/A N/A $165.29 N/A N/A N/A N/A N/A $165.29 N/A N/A $122.50 N/A N/A $432.00 N/A N/A $105.00 N/A N/A $686.00 N/A N/A $227.50 N/A N/A $105.00 N/A N/A $105.00 N/A N/A $105.00 N/A N/A $105.00 N/A N/A $105.00 N/A N/A $105.00 N/A $350.00 $350.00 N/A 49019100 Surgery Biopsy Breast 19100 490 "$1,299.00 " $- $337.74 $- $- "$1,061.00 " $- N/A $337.74 N/A N/A $750.00 N/A N/A $779.40 N/A N/A $649.50 N/A N/A $416.34 N/A N/A $756.00 N/A N/A $878.00 N/A N/A $506.61 N/A N/A $591.05 N/A N/A "$1,039.20 " N/A N/A N/A N/A N/A $844.35 N/A N/A $576.39 N/A N/A $416.34 N/A N/A $576.39 N/A N/A $454.65 N/A N/A $700.00 N/A N/A $389.70 N/A N/A "$1,061.00 " N/A N/A $844.35 N/A N/A $389.70 N/A N/A $389.70 N/A N/A $389.70 N/A N/A $389.70 N/A N/A $389.70 N/A N/A $389.70 N/A "$1,299.00 " "$1,299.00 " N/A 49019120 Surgery REMOVAL OF BREAST LESION 19120 490 "$6,249.00 " $- $967.04 $- $- "$4,999.20 " $- N/A "$1,624.74 " N/A N/A "$1,150.00 " N/A N/A "$3,749.40 " N/A N/A "$3,124.50 " N/A N/A $967.04 N/A N/A "$1,157.00 " N/A N/A "$1,343.00 " N/A N/A "$2,437.11 " N/A N/A "$2,843.30 " N/A N/A "$4,999.20 " N/A N/A N/A N/A N/A "$4,061.85 " N/A N/A "$1,118.44 " N/A N/A $967.04 N/A N/A "$1,118.44 " N/A N/A "$2,187.15 " N/A N/A "$1,071.00 " N/A N/A "$1,874.70 " N/A N/A "$1,273.00 " N/A N/A "$4,061.85 " N/A N/A "$1,874.70 " N/A N/A "$1,874.70 " N/A N/A "$1,874.70 " N/A N/A "$1,874.70 " N/A N/A "$1,874.70 " N/A N/A "$1,874.70 " N/A "$6,249.00 " "$6,249.00 " N/A 49029826 Surgery Shoulder Decompression Subacromial with Partial Acromioplast 29826 490 "$5,939.00 " $- $- $- $- "$4,751.20 " $- N/A "$1,544.14 " N/A N/A "$1,150.00 " N/A N/A "$3,563.40 " N/A N/A "$2,969.50 " N/A N/A N/A N/A N/A "$1,157.00 " N/A N/A "$1,343.00 " N/A N/A "$2,316.21 " N/A N/A "$2,702.25 " N/A N/A "$4,751.20 " N/A N/A N/A N/A N/A "$3,860.35 " N/A N/A $- N/A N/A N/A N/A N/A $- N/A N/A "$2,078.65 " N/A N/A "$1,071.00 " N/A N/A "$1,781.70 " N/A N/A $474.00 N/A N/A "$3,860.35 " N/A N/A "$1,781.70 " N/A N/A "$1,781.70 " N/A N/A "$1,781.70 " N/A N/A "$1,781.70 " N/A N/A "$1,781.70 " N/A N/A "$1,781.70 " N/A "$5,939.00 " "$5,939.00 " N/A 49042820 Surgery Tonsillectomy and Adenoidectomy 42820 490 "$4,697.00 " $- $714.65 $- $- "$3,757.60 " $- N/A "$1,221.22 " N/A N/A "$1,150.00 " N/A N/A "$2,818.20 " N/A N/A "$2,348.50 " N/A N/A $714.65 N/A N/A "$1,157.00 " N/A N/A "$1,343.00 " N/A N/A "$1,831.83 " N/A N/A "$2,137.14 " N/A N/A "$3,757.60 " N/A N/A N/A N/A N/A "$3,053.05 " N/A N/A "$2,246.55 " N/A N/A $714.65 N/A N/A "$2,246.55 " N/A N/A "$1,643.95 " N/A N/A "$1,071.00 " N/A N/A "$1,409.10 " N/A N/A "$1,273.00 " N/A N/A "$3,053.05 " N/A N/A "$1,409.10 " N/A N/A "$1,409.10 " N/A N/A "$1,409.10 " N/A N/A "$1,409.10 " N/A N/A "$1,409.10 " N/A N/A "$1,409.10 " N/A "$4,697.00 " "$4,697.00 " N/A 49042820 Surgery Tonsillectomy and Adenoidectomy 42820 490 "$4,697.00 " $- $714.65 $- $- "$3,757.60 " $- N/A "$1,221.22 " N/A N/A "$1,150.00 " N/A N/A "$2,818.20 " N/A N/A "$2,348.50 " N/A N/A $714.65 N/A N/A "$1,157.00 " N/A N/A "$1,343.00 " N/A N/A "$1,831.83 " N/A N/A "$2,137.14 " N/A N/A "$3,757.60 " N/A N/A N/A N/A N/A "$3,053.05 " N/A N/A "$2,246.55 " N/A N/A $714.65 N/A N/A "$2,246.55 " N/A N/A "$1,643.95 " N/A N/A "$1,071.00 " N/A N/A "$1,409.10 " N/A N/A "$1,273.00 " N/A N/A "$3,053.05 " N/A N/A "$1,409.10 " N/A N/A "$1,409.10 " N/A N/A "$1,409.10 " N/A N/A "$1,409.10 " N/A N/A "$1,409.10 " N/A N/A "$1,409.10 " N/A "$4,697.00 " "$4,697.00 " N/A 49043235 Surgery Esophagogastroduodenoscopy 43235 490 "$1,935.00 " $- $329.44 $- $- "$1,548.00 " $- N/A $503.10 N/A N/A $750.00 N/A N/A "$1,161.00 " N/A N/A $967.50 N/A N/A $329.44 N/A N/A $756.00 N/A N/A $878.00 N/A N/A $754.65 N/A N/A $880.43 N/A N/A "$1,548.00 " N/A N/A N/A N/A N/A "$1,257.75 " N/A N/A $397.12 N/A N/A $329.44 N/A N/A $397.12 N/A N/A $677.25 N/A N/A $700.00 N/A N/A $580.50 N/A N/A "$1,061.00 " N/A N/A "$1,257.75 " N/A N/A $580.50 N/A N/A $580.50 N/A N/A $580.50 N/A N/A $580.50 N/A N/A $580.50 N/A N/A $580.50 N/A "$1,935.00 " "$1,935.00 " N/A 49043235 Surgery Esophagogastroduodenoscopy 43235 490 "$1,935.00 " $- $329.44 $- $- "$1,548.00 " $- N/A $503.10 N/A N/A $750.00 N/A N/A "$1,161.00 " N/A N/A $967.50 N/A N/A $329.44 N/A N/A $756.00 N/A N/A $878.00 N/A N/A $754.65 N/A N/A $880.43 N/A N/A "$1,548.00 " N/A N/A N/A N/A N/A "$1,257.75 " N/A N/A $397.12 N/A N/A $329.44 N/A N/A $397.12 N/A N/A $677.25 N/A N/A $700.00 N/A N/A $580.50 N/A N/A "$1,061.00 " N/A N/A "$1,257.75 " N/A N/A $580.50 N/A N/A $580.50 N/A N/A $580.50 N/A N/A $580.50 N/A N/A $580.50 N/A N/A $580.50 N/A "$1,935.00 " "$1,935.00 " N/A 49043239 Surgery Esophagogastroduodenoscopy with Biopsy 43239 490 "$1,999.00 " $- $329.44 $- $- "$1,599.20 " $- N/A $519.74 N/A N/A $950.00 N/A N/A "$1,199.40 " N/A N/A $999.50 N/A N/A $329.44 N/A N/A "$1,014.00 " N/A N/A "$1,177.00 " N/A N/A $779.61 N/A N/A $909.55 N/A N/A "$1,599.20 " N/A N/A N/A N/A N/A "$1,299.35 " N/A N/A $397.12 N/A N/A $329.44 N/A N/A $397.12 N/A N/A $699.65 N/A N/A $939.00 N/A N/A $599.70 N/A N/A "$1,061.00 " N/A N/A "$1,299.35 " N/A N/A $599.70 N/A N/A $599.70 N/A N/A $599.70 N/A N/A $599.70 N/A N/A $599.70 N/A N/A $599.70 N/A "$1,999.00 " "$1,999.00 " N/A 49045378 Surgery Colonoscopy 45378 G0121 490 "$2,307.00 " $- $332.71 $- $- "$1,845.60 " $- N/A $599.82 N/A N/A $950.00 N/A N/A "$1,384.20 " N/A N/A "$1,153.50 " N/A N/A $332.71 N/A N/A "$1,014.00 " N/A N/A "$1,177.00 " N/A N/A $899.73 N/A N/A "$1,049.69 " N/A N/A "$1,845.60 " N/A N/A N/A N/A N/A "$1,499.55 " N/A N/A $385.98 N/A N/A $332.71 N/A N/A $385.98 N/A N/A $807.45 N/A N/A $939.00 N/A N/A $692.10 N/A N/A "$1,061.00 " N/A N/A "$1,499.55 " N/A N/A $692.10 N/A N/A $692.10 N/A N/A $692.10 N/A N/A $692.10 N/A N/A $692.10 N/A N/A $692.10 N/A "$2,307.00 " "$2,307.00 " N/A 49045378 Surgery Colonoscopy 45378 G0121 490 "$2,307.00 " $- $332.71 $- $- "$1,845.60 " $- N/A $599.82 N/A N/A $950.00 N/A N/A "$1,384.20 " N/A N/A "$1,153.50 " N/A N/A $332.71 N/A N/A "$1,014.00 " N/A N/A "$1,177.00 " N/A N/A $899.73 N/A N/A "$1,049.69 " N/A N/A "$1,845.60 " N/A N/A N/A N/A N/A "$1,499.55 " N/A N/A $385.98 N/A N/A $332.71 N/A N/A $385.98 N/A N/A $807.45 N/A N/A $939.00 N/A N/A $692.10 N/A N/A "$1,061.00 " N/A N/A "$1,499.55 " N/A N/A $692.10 N/A N/A $692.10 N/A N/A $692.10 N/A N/A $692.10 N/A N/A $692.10 N/A N/A $692.10 N/A "$2,307.00 " "$2,307.00 " N/A 49045380 Surgery Colonoscopy with Biopsy 45380 490 "$2,349.00 " $- $332.71 $- $- "$1,879.20 " $- N/A $610.74 N/A N/A $950.00 N/A N/A "$1,409.40 " N/A N/A "$1,174.50 " N/A N/A $332.71 N/A N/A "$1,014.00 " N/A N/A "$1,177.00 " N/A N/A $916.11 N/A N/A "$1,068.80 " N/A N/A "$1,879.20 " N/A N/A N/A N/A N/A "$1,526.85 " N/A N/A $507.42 N/A N/A $332.71 N/A N/A $507.42 N/A N/A $822.15 N/A N/A $939.00 N/A N/A $704.70 N/A N/A "$1,061.00 " N/A N/A "$1,526.85 " N/A N/A $704.70 N/A N/A $704.70 N/A N/A $704.70 N/A N/A $704.70 N/A N/A $704.70 N/A N/A $704.70 N/A "$2,349.00 " "$2,349.00 " N/A 49045385 Surgery Colonoscopy with Lesion Removal Snare Technique 45385 490 "$2,200.00 " $- $332.71 $- $- "$1,760.00 " $- N/A $572.00 N/A N/A $950.00 N/A N/A "$1,320.00 " N/A N/A "$1,100.00 " N/A N/A $332.71 N/A N/A "$1,014.00 " N/A N/A "$1,177.00 " N/A N/A $858.00 N/A N/A "$1,001.00 " N/A N/A "$1,760.00 " N/A N/A N/A N/A N/A "$1,430.00 " N/A N/A $507.42 N/A N/A $332.71 N/A N/A $507.42 N/A N/A $770.00 N/A N/A $939.00 N/A N/A $660.00 N/A N/A "$1,061.00 " N/A N/A "$1,430.00 " N/A N/A $660.00 N/A N/A $660.00 N/A N/A $660.00 N/A N/A $660.00 N/A N/A $660.00 N/A N/A $660.00 N/A "$2,200.00 " "$2,200.00 " N/A 49047562 Surgery Cholecystectomy Laparoscopic 47562 490 "$8,090.00 " $- "$1,505.00 " $- $- "$6,472.00 " $- N/A "$2,103.40 " N/A N/A "$1,550.00 " N/A N/A "$4,854.00 " N/A N/A "$4,045.00 " N/A N/A "$1,589.51 " N/A N/A N/A N/A N/A "$1,887.00 " N/A N/A "$3,155.10 " N/A N/A "$3,680.95 " N/A N/A "$6,472.00 " N/A N/A N/A N/A N/A "$5,258.50 " N/A N/A "$2,194.07 " N/A N/A "$1,589.51 " N/A N/A "$2,194.07 " N/A N/A "$2,831.50 " N/A N/A "$1,505.00 " N/A N/A "$2,427.00 " N/A N/A "$2,818.00 " N/A N/A "$5,258.50 " N/A N/A "$2,427.00 " N/A N/A "$2,427.00 " N/A N/A "$2,427.00 " N/A N/A "$2,427.00 " N/A N/A "$2,427.00 " N/A N/A "$2,427.00 " N/A "$8,090.00 " "$8,090.00 " N/A 49047562 Surgery Cholecystectomy Laparoscopic 47562 490 "$8,090.00 " $- "$1,505.00 " $- $- "$6,472.00 " $- N/A "$2,103.40 " N/A N/A "$1,550.00 " N/A N/A "$4,854.00 " N/A N/A "$4,045.00 " N/A N/A "$1,589.51 " N/A N/A N/A N/A N/A "$1,887.00 " N/A N/A "$3,155.10 " N/A N/A "$3,680.95 " N/A N/A "$6,472.00 " N/A N/A N/A N/A N/A "$5,258.50 " N/A N/A "$2,194.07 " N/A N/A "$1,589.51 " N/A N/A "$2,194.07 " N/A N/A "$2,831.50 " N/A N/A "$1,505.00 " N/A N/A "$2,427.00 " N/A N/A "$2,818.00 " N/A N/A "$5,258.50 " N/A N/A "$2,427.00 " N/A N/A "$2,427.00 " N/A N/A "$2,427.00 " N/A N/A "$2,427.00 " N/A N/A "$2,427.00 " N/A N/A "$2,427.00 " N/A "$8,090.00 " "$8,090.00 " N/A 49049505 Surgery Hernia Repair Inguinal 49505 490 "$6,719.00 " $- "$1,154.72 " $- $- "$5,375.20 " $- N/A "$1,746.94 " N/A N/A "$1,350.00 " N/A N/A "$4,031.40 " N/A N/A "$3,359.50 " N/A N/A "$1,154.72 " N/A N/A "$1,427.00 " N/A N/A "$1,656.00 " N/A N/A "$2,620.41 " N/A N/A "$3,057.15 " N/A N/A "$5,375.20 " N/A N/A N/A N/A N/A "$4,367.35 " N/A N/A "$1,377.21 " N/A N/A "$1,154.72 " N/A N/A "$1,377.21 " N/A N/A "$2,351.65 " N/A N/A "$1,321.00 " N/A N/A "$2,015.70 " N/A N/A "$1,441.00 " N/A N/A "$4,367.35 " N/A N/A "$2,015.70 " N/A N/A "$2,015.70 " N/A N/A "$2,015.70 " N/A N/A "$2,015.70 " N/A N/A "$2,015.70 " N/A N/A "$2,015.70 " N/A "$6,719.00 " "$6,719.00 " N/A 49049505 Surgery Hernia Repair Inguinal 49505 490 "$6,719.00 " $- "$1,154.72 " $- $- "$5,375.20 " $- N/A "$1,746.94 " N/A N/A "$1,350.00 " N/A N/A "$4,031.40 " N/A N/A "$3,359.50 " N/A N/A "$1,154.72 " N/A N/A "$1,427.00 " N/A N/A "$1,656.00 " N/A N/A "$2,620.41 " N/A N/A "$3,057.15 " N/A N/A "$5,375.20 " N/A N/A N/A N/A N/A "$4,367.35 " N/A N/A "$1,377.21 " N/A N/A "$1,154.72 " N/A N/A "$1,377.21 " N/A N/A "$2,351.65 " N/A N/A "$1,321.00 " N/A N/A "$2,015.70 " N/A N/A "$1,441.00 " N/A N/A "$4,367.35 " N/A N/A "$2,015.70 " N/A N/A "$2,015.70 " N/A N/A "$2,015.70 " N/A N/A "$2,015.70 " N/A N/A "$2,015.70 " N/A N/A "$2,015.70 " N/A "$6,719.00 " "$6,719.00 " N/A 49049650 Surgery Hernia Repair Inguinal Laparoscopic 49650 490 "$9,743.00 " $- "$1,321.00 " $- $- "$7,794.40 " $- N/A "$2,533.18 " N/A N/A "$1,350.00 " N/A N/A "$5,845.80 " N/A N/A "$4,871.50 " N/A N/A "$1,589.51 " N/A N/A "$1,427.00 " N/A N/A "$1,656.00 " N/A N/A "$3,799.77 " N/A N/A "$4,433.07 " N/A N/A "$7,794.40 " N/A N/A N/A N/A N/A "$6,332.95 " N/A N/A "$2,194.07 " N/A N/A "$1,589.51 " N/A N/A "$2,194.07 " N/A N/A "$3,410.05 " N/A N/A "$1,321.00 " N/A N/A "$2,922.90 " N/A N/A "$2,818.00 " N/A N/A "$6,332.95 " N/A N/A "$2,922.90 " N/A N/A "$2,922.90 " N/A N/A "$2,922.90 " N/A N/A "$2,922.90 " N/A N/A "$2,922.90 " N/A N/A "$2,922.90 " N/A "$9,743.00 " "$9,743.00 " N/A 49049650 Surgery Hernia Repair Incisional Laparoscopic 49650 490 "$9,743.00 " $- "$1,321.00 " $- $- "$7,794.40 " $- N/A "$2,533.18 " N/A N/A "$1,350.00 " N/A N/A "$5,845.80 " N/A N/A "$4,871.50 " N/A N/A "$1,589.51 " N/A N/A "$1,427.00 " N/A N/A "$1,656.00 " N/A N/A "$3,799.77 " N/A N/A "$4,433.07 " N/A N/A "$7,794.40 " N/A N/A N/A N/A N/A "$6,332.95 " N/A N/A "$2,194.07 " N/A N/A "$1,589.51 " N/A N/A "$2,194.07 " N/A N/A "$3,410.05 " N/A N/A "$1,321.00 " N/A N/A "$2,922.90 " N/A N/A "$2,818.00 " N/A N/A "$6,332.95 " N/A N/A "$2,922.90 " N/A N/A "$2,922.90 " N/A N/A "$2,922.90 " N/A N/A "$2,922.90 " N/A N/A "$2,922.90 " N/A N/A "$2,922.90 " N/A "$9,743.00 " "$9,743.00 " N/A 49049652 Surgery LAPAROSCOPY SURG REP VENTRAL/UMBILICAL/SPIGELIAN OR EPIGASTR 49652 490 "$14,932.00 " $- "$1,321.00 " $- $- "$11,945.60 " $- N/A "$3,882.32 " N/A N/A "$1,350.00 " N/A N/A "$8,959.20 " N/A N/A "$7,466.00 " N/A N/A "$1,589.51 " N/A N/A "$2,266.00 " N/A N/A "$1,656.00 " N/A N/A "$5,823.48 " N/A N/A "$6,794.06 " N/A N/A "$11,945.60 " N/A N/A N/A N/A N/A "$9,705.80 " N/A N/A "$2,194.07 " N/A N/A "$1,589.51 " N/A N/A "$2,194.07 " N/A N/A "$5,226.20 " N/A N/A "$1,321.00 " N/A N/A "$4,479.60 " N/A N/A "$2,818.00 " N/A N/A "$9,705.80 " N/A N/A "$4,479.60 " N/A N/A "$4,479.60 " N/A N/A "$4,479.60 " N/A N/A "$4,479.60 " N/A N/A "$4,479.60 " N/A N/A "$4,479.60 " N/A "$14,932.00 " "$14,932.00 " N/A 49058670 Surgery Tubal Ligation 58670 490 "$6,912.00 " $- "$1,071.00 " $- $- "$5,529.60 " $- N/A "$1,797.12 " N/A N/A "$1,150.00 " N/A N/A "$4,147.20 " N/A N/A "$3,456.00 " N/A N/A "$1,589.51 " N/A N/A "$1,157.00 " N/A N/A "$1,343.00 " N/A N/A "$2,695.68 " N/A N/A "$3,144.96 " N/A N/A "$5,529.60 " N/A N/A N/A N/A N/A "$4,492.80 " N/A N/A "$2,194.07 " N/A N/A "$1,589.51 " N/A N/A "$2,194.07 " N/A N/A "$2,419.20 " N/A N/A "$1,071.00 " N/A N/A "$2,073.60 " N/A N/A "$2,818.00 " N/A N/A "$4,492.80 " N/A N/A "$2,073.60 " N/A N/A "$2,073.60 " N/A N/A "$2,073.60 " N/A N/A "$2,073.60 " N/A N/A "$2,073.60 " N/A N/A "$2,073.60 " N/A "$6,912.00 " "$6,912.00 " N/A 49066821 Surgery DISCISSION OF SECONDARY MEMBRANOUS CATARACT; LASER SURGERY-Y 66821 490 "$2,126.00 " $- $194.64 $- $- "$1,700.80 " $- N/A $552.76 N/A N/A $950.00 N/A N/A "$1,275.60 " N/A N/A "$1,063.00 " N/A N/A $194.64 N/A N/A "$1,014.00 " N/A N/A "$1,177.00 " N/A N/A $829.14 N/A N/A $967.33 N/A N/A "$1,700.80 " N/A N/A N/A N/A N/A "$1,381.90 " N/A N/A $256.14 N/A N/A $194.64 N/A N/A $256.14 N/A N/A $744.10 N/A N/A $939.00 N/A N/A $637.80 N/A N/A $686.00 N/A N/A "$1,381.90 " N/A N/A $637.80 N/A N/A $637.80 N/A N/A $637.80 N/A N/A $637.80 N/A N/A $637.80 N/A N/A $637.80 N/A "$2,126.00 " "$2,126.00 " N/A 49066984 Surgery Cataract Extraction with Intraocular Lens Implantation 66984 490 "$5,783.00 " $- $771.57 $- $- "$4,626.40 " $- N/A "$1,503.58 " N/A N/A "$2,150.00 " N/A N/A "$3,469.80 " N/A N/A "$2,891.50 " N/A N/A $771.57 N/A N/A "$2,217.00 " N/A N/A "$2,574.00 " N/A N/A "$2,255.37 " N/A N/A "$2,631.27 " N/A N/A "$4,626.40 " N/A N/A N/A N/A N/A "$3,758.95 " N/A N/A "$1,012.72 " N/A N/A $771.57 N/A N/A "$1,012.72 " N/A N/A "$2,024.05 " N/A N/A "$2,053.00 " N/A N/A "$1,734.90 " N/A N/A "$1,273.00 " N/A N/A "$3,758.95 " N/A N/A "$1,734.90 " N/A N/A "$1,734.90 " N/A N/A "$1,734.90 " N/A N/A "$1,734.90 " N/A N/A "$1,734.90 " N/A N/A "$1,734.90 " N/A "$5,783.00 " "$5,783.00 " N/A