Procedure description Charge (P) METHODONE 80 (P) ABO 60 (P) ABO GROUPING 60 (P) ABSLUT CD4 & CD8 CT W/RATO 140 (P) ACHR BINDING AB 148 (P) ACHR BLOCKING AB 148 (P) ADH 131 (P) AEROBIC CULTURE 132 (P) ALBUMIN, SERUM 56 (P) AMPHETAMINES 8 (P) AMPHETAMINES 80 (P) ANA 36 (P) ANTI - SSA 143 (P) ANTI - SSB 143 (P) ANTI CENTROMERE B 39 (P) ANTI CHROMATIN AB 35 (P) ANTI DS DNA 41 (P) ANTI HISTONE 39 (P) ANTI Jo-1 39 (P) ANTI RNP 39 (P) ANTI RNP SLP AB 39 (P) ANTI Scl-70 39 (P) ANTI SM 39 (P) ANTI SM SLP AB 39 (P) ANTI-DNA (DS) Ab Qn 41 (P) ANTI-GROUP B STREPTOCOCCUS 104 (P) ANTI-H INFLUENZA TYPE B 104 (P) ANTI-N MENINGITIS A/Y 104 (P) ANTI-N MENINGITIS C/W 135 104 (P) ANTI-STREP PNEUMONIA 104 (P) ANTI-THYROGLOBULIN AB 194 (P) ANTI-THYROID MICROSOMAL AB 192 (P) ANTIBODY SCREEN 109 (P) ANTICARDIOLYPIN AB IGA 58 (P) ANTICARDIOLYPIN AB IGG 58 (P) ANTICARDIOLYPIN AB IGM 58 (P) ANTIGEN TYPING,C 74 (P) ANTIGEN TYPING,c 74 (P) ANTIGEN TYPING,E 74 (P) ANTIGEN TYPING,e 74 (P) ANTIGEN TYPING,M 74 (P) ANTIGEN TYPING,N 74 (P) ANTIGEN TYPING,S 74 (P) ANTIGEN TYPING,s 74 (P) ARSENIC, BLOOD 87 (P) ARSENIC, URINE 90 (P) B. HENSELAE IGG 55 (P) B. HENSELAE IGM 55 (P) B. QUINTANA IGG 55 (P) B. QUINTANA IGM 55 (P) BARBITURATES 8 (P) BARBITURATES 80 (P) BEEF 52 (P) BENZODIAZEPINES 8 (P) BENZODIAZEPINES 80 (P) BETA 2 GLYCO IGA 65 (P) BETA 2 GLYCO IGG 65 (P) BETA 2 GLYCO IGM 65 (P) BLEEDING TIME, IVY 52 (P) BLOOD GASES 158 (P) BONE MARROW/BLOOD CULTURE 480 (P) Bordetella pertussis DNA 90 (P) BRUCELLA ABORTUS 70 (P) BRUCELLA IGG 39 (P) BRUCELLA IGM 39 (P) BUFFY COAT PREP 70 (P) BV A. vaginae 119 (P) BV Megaspaera 119 (P) BVAB-2 119 (P) C-ANCA, CYTOPLASMIC 102 (P) CADMIUM, BLOOD 82 (P) CALIFORNIA ENCEPH IGG CSF 96 (P) CALIFORNIA ENCEPH IGG SER 96 (P) CALIFORNIA ENCEPH IGM CSF 96 (P) CALIFORNIA ENCEPH IGM SER 96 (P) Candida albicans 173 (P) Candida glabrata 173 (P) CARDIOLYPIN AB, IGA 171 (P) CARDIOLYPIN AB, IGG 171 (P) CARDIOLYPIN AB, IGM 171 (P) CCP IGA/IGG 72 (P) CD10 202 (P) CD103 202 (P) CD13 202 (P) CD14 202 (P) CD19 202 (P) CD20 202 (P) CD23 202 (P) CD33 202 (P) CD34 202 (P) CD38 202 (P) CD41 202 (P) CD45 202 (P) CD5 202 (P) CD7 202 (P) CD79B 267 (P) Chalmydia pneumo DNA 150 (P) CHLAMYDIA NAA 135 (P) CHLAMYDIA PROBE 110 (P) CHOCOLATE 52 (P) CK-MB 167 (P) CMV IGG 56 (P) COCAINE 8 (P) COCAINE 80 (P) COMPLETE BLOOD COUNT/DIFF 122 (P) CORN 52 (P) CORTISOL - 60 MINUTE 185 (P) CORTISOL-30 MINUTE 185 (P) CORTISOL-BASELINE 185 (P) CPK, TOTAL 82 (P) CREATININE, RANDOM URINE 44 (P) CREATININE, URINE 43 (P) CREATININE, URINE 72 (P) CROSSMATCH 124 (P) CRP 68 (P) CULTURE, AEROBIC 159 (P) CULTURE, AFB 167 (P) CULTURE, AFB 167 (P) CULTURE, ANAEROBIC 113 (P) CULTURE, BLOOD 128 (P) CULTURE, FUNGUS 150 (P) CULTURE,FUNGUS 150 (P) CULTURE,STOOL OR RECTL SWB 166 (P) EAST EQUINE ENCEPH IGG CSF 96 (P) EAST EQUINE ENCEPH IGG SER 96 (P) EAST EQUINE ENCEPH IGM CSF 96 (P) EAST EQUINE ENCEPH IGM SER 96 (P) EBV-CA, IgG 66 (P) EBV-CA, IgM 66 (P) EBV-EA 66 (P) EBV-NA 66 (P) EGG, WHOLE 52 (P) ENDOMYSIAL IGA 189 (P) ESR 38 (P) ESTRADIOL 133 (P) ESTRADIOL, FREE 100 (P) ESTRADIOL, SERUM 127 (P) ESTRADIOL, TOTAL 151 (P) ESTROGENS, SERUM 152 (P) FETAL MTRNL HEMMORAGE SCRN 88 (P) FIBRINOGEN, QUANTITATIVE 90 (P) FISH/SHELL MIX 52 (P) FLOW CYTOM, EA CELL SURF 1 96 (P) FLOW CYTOM,EA CELL SURF 2 96 (P) FLOW CYTOM,EA CELL SURF 3 96 (P) FREE KAPPA LIGHT CHAINS 99 (P) FREE LAMBDA LIGHT CHAINS 99 (P) FSH 115 (P) GASTRIN 168 (P) GC GONOCOCCUS NAA 135 (P) GC PROBE 183 (P) GLIADIN AB IGA 206 (P) GLIADIN AB IGG 206 (P) GLU/LACTOSE TOL SPEC # 1-3 122 (P) GLU/LACTOSE TOL SPEC # 4 39 (P) GLU/LACTOSE TOL SPEC # 5 39 (P) GLU/LACTOSE TOL SPEC # 6 39 (P) GLU/LACTOSE TOL SPEC # 7 39 (P) GLU/LACTOSE TOL SPEC # 8 39 (P) GN BROTH 47 (P) GRAM STAIN 36 (P) GROWTH HORMONE, SPEC #1 50 (P) GROWTH HORMONE, SPEC #2 50 (P) GROWTH HORMONE, SPEC #3 50 (P) GROWTH HORMONE, SPEC #4 50 (P) GROWTH HORMONE, SPEC #5 50 (P) GROWTH HORMONE, SPEC #6 50 (P) H PYLORI EVALUATION, IgA 126 (P) H PYLORI EVALUATION, IgG 126 (P) H PYLORI EVALUATION, IgM 126 (P) HEMATOCRIT 38 (P) HEMOGLOBIN 39 (P) HERPES I/II IGG 56 (P) HSV I IGG 63 (P) HSV I IGM 80 (P) HSV I NAA 207 (P) HSV II IGG 94 (P) HSV II IGM 119 (P) HSV II NAA 207 (P) HSV TYPE I, PCR 179 (P) HSV TYPE II, PCR 179 (P) IFE (SERUM) 195 (P) IGA 58 (P) IMMUNOGLOBULIN A (IgA) 68 (P) IMMUNOGLOBULIN E (IgE) 68 (P) IMMUNOGLOBULIN G (IgG) 68 (P) IMMUNOGLOBULIN IgG1 67 (P) IMMUNOGLOBULIN IgG2 67 (P) IMMUNOGLOBULIN IgG3 67 (P) IMMUNOGLOBULIN IgG4 67 (P) IMMUNOGLOBULIN M (IgM) 68 (P) INHIBIN A 103 (P) INSULIN 2 HOUR 61 (P) INSULIN FASTING 61 (P) INSULIN HALF HOUR 61 (P) INSULIN HOUR 61 (P) INSULIN, FREE 83 (P) INSULIN, TOTAL 61 (P) INTRINSIC FACTOR BLCKNG AB 174 (P) KAPPA MARKER 202 (P) KARYOTYPE ADDITIONAL 255 (P) LAMBDA MARKER 202 (P) LDH, TOTAL 77 (P) LEAD, BLOOD 68 (P) LEAD, URINE 90 (P) LIPID 159 (P) LYMPHOCYTE CULTURE 411 (P) MEASLES (RUBEOLA) 40 (P) MERCURY, BLOOD 81 (P) MERCURY, URINE 90 (P) METHYLMALONIC ACID 212 (P) MILK (COW 52 (P) MUMPS 40 (P) MYCOPLASMA IGG 215 (P) MYCOPLASMA IGM 215 (P) Mycoplasma pneumo DNA 150 (P) NMR PROFILE 131 (P) OPIATES 8 (P) OPIATES (MORPHINE) 80 (P) OSMOLALITY 29 (P) P-ANCA, PERINUCLEAR 102 (P) PARTIAL THROMBOPLASTN TIME 76 (P) PARVOVIRUS B19, IGG 106 (P) PARVOVIRUS B19, IGM 106 (P) PCP 80 (P) PE (SERUM) 131 (P) PEANUT 52 (P) PHENCYCLIDINE 80 (P) PLATELET COUNT 56 (P) PORK 52 (P) PROG 206 (P) PROGESTERONE, FREE 100 (P) PROGESTERONE, TOTAL 171 (P) PROTEIN, SERUM 71 (P) PROTEIN, URINE 47 (P) PROTEUS OX19 70 (P) PROTEUS OX2 70 (P) PROTEUS OXK 70 (P) PROTHROMBIN TIME 63 (P) PSAD 166 (P) Respiratory Virus Panel DN 810 (P) RF 49 (P) RH 60 (P) Rh (D) TYPING 60 (P) RHEUMATOID FACTOR 30 (P) RICKETTSIA RICKETTSIAE IGG 55 (P) RICKETTSIA RICKETTSIAE IGM 55 (P) RICKETTSIA TYPHI IGG 55 (P) RICKETTSIA TYPHI IGM 55 (P) RNP ANTIBODIES 39 (P) RUBELLA 33 (P) RUBELLA IGG 47 (P) SALMONELLA H GROUP a 70 (P) SALMONELLA H GROUP b 70 (P) SALMONELLA H GROUP d 70 (P) SALMONELLA O GROUP D 70 (P) SEROTYPE 1 33 (P) SEROTYPE 12 33 (P) SEROTYPE 14 33 (P) SEROTYPE 17 33 (P) SEROTYPE 19 33 (P) SEROTYPE 2 33 (P) SEROTYPE 20 33 (P) SEROTYPE 22 33 (P) SEROTYPE 23 33 (P) SEROTYPE 26 33 (P) SEROTYPE 3 33 (P) SEROTYPE 34 33 (P) SEROTYPE 4 33 (P) SEROTYPE 43 33 (P) SEROTYPE 5 33 (P) SEROTYPE 51 33 (P) SEROTYPE 54 33 (P) SEROTYPE 56 33 (P) SEROTYPE 57 33 (P) SEROTYPE 68 33 (P) SEROTYPE 70 33 (P) SEROTYPE 8 33 (P) SEROTYPE 9 33 (P) SHBG 150 (P) SHIGA TOXIN 1 95 (P) SHIGA TOXIN 2 95 (P) SJOGREN'S ANTI-SS-A 39 (P) SJOGREN'S ANTI-SS-B 39 (P) SMEAR, AFB 88 (P) SMEAR, AFB 88 (P) SMEAR, FUNGUS 66 (P) SMEAR, FUNGUS 66 (P) SMITH ANTIBODIES 39 (P) SOYBEAN 52 (P) ST LOUIS ENCEPH IGG CSF 96 (P) ST LOUIS ENCEPH IGG SER 96 (P) ST LOUIS ENCEPH IGM CSF 96 (P) ST LOUIS ENCEPH IGM SER 96 (P) STOOL, CAMPYLOBACTER 45 (P) T CELLS, TOTAL COUNT 113 (P) T3 FREE 104 (P) T4 80 (P) TCBC 11 (P) TCP7 12 (P) TDT 202 (P) TESTFREE 184 (P) TESTOSTERONE 127 (P) TESTOSTERONE, FREE 260 (P) TESTOSTERONE, TOTAL 130 (P) THC 8 (P) THC 80 (P) Thyroglobulin 125 (P) Thyroglobulin AB 93 (P) TISSUE CULTURE 495 (P) TISSUE TRANS IGA 113 (P) TLIPID 16 (P) TLIVER 11 (P) TOXOPLASMA IGG 62 (P) TPO AB 54 (P) TRICH NAA 135 (P) TROPONIN I 171 (P) TSH 123 (P) TTSH 23 (P) VIT B12 74 (P) VIT D 25 OH 138 (P) VITAMIN B12 174 (P) WEST EQUINE ENCEPH IGG CSF 96 (P) WEST EQUINE ENCEPH IGG SER 96 (P) WEST EQUINE ENCEPH IGM CSF 96 (P) WEST EQUINE ENCEPH IGM SER 96 (P) WEST NILE CSF, IGG 152 (P) WEST NILE CSF, IGM 152 (P) WEST NILE IGG CSF 102 (P) WEST NILE IGM CSF 101 (P) WEST NILE SERUM, IGM 152 (P) WHEAT 52 (P)ALDOSTERONE 189 (P)ALPHA FETO-PROTEIN (MATRNL) 183 (P)ANAEROBIC CULTURE 87 (P)ANTI-MENINGITIS B/E,COLI K1 104 (P)BETA HCG, SERUM, QUANTATIVE 223 (P)BILIRUBIN, NEONATAL DIRECT 54 (P)BILIRUBIN, NEONATAL, TOTAL 54 (P)ESTRIOL (PLACENTAL), SERUM 159 (P)IMMUNOFIXATION ELECT 195 (P)IMMUNOFIXATION ELECT 195 (P)PROTEIN ELECTROPHERESIS 131 (P)PROTEIN ELECTROPHORESIS 131 (P)RENIN 103 (P)WEST NILE SERUM, IGG 152 *NON COVERED PVT.ROOM PORTION 58 *NON COVERED PVT.ROOM PORTION 58 #NAME? 391 +PHYSC ADD'L 30 MIN (ADD ON) 230 +PHYSC ADD'L 45 MIN (ADD ON) 333 +PHYSC ADD'L 60 MIN (ADD ON) 475 .45% NS 1000cc 147 .45% NS 100cc 10 .45% NS 250cc 21 .45% NS 500cc 103 .9 NS 1000cc (1 LITER) 135 .9 NS 150cc 97 .9 NS 250 97 .9 NS 500cc (HALF LITER) 97 .9% NS 1000cc 147 .9% NS 100cc 83 .9% NS 150cc 83 .9% NS 250cc 83 .9% NS 500cc 83 .9% NS 50cc 83 .9% SALINE 1000 CC 7 0.45% NACL WITH 20 mEq KCl 34 0.45% NCAL 1000 ML (045 NS) 43 0.9% NaCl W/20 mEq KCL 37 0.9% NaCl W/40 mEq KCL 39 0.9% NS 1000cc 29 0.9% NS 100cc 14 02.107.102 PLATE 2.7/3.5MM 1521 02.118.520 SCREW 2.7 SELFTAP 116 02.211.034 SCREW 2.7 SELFTAP 280 0N07A GORE SUTURE TH-50 12/BX 63 0U01A SUTURE GORE THX-36 12/BX 63 1.3 CORTEX SCREW 209 1.35MM GUIDE WIRE DUAL TROCAR 284 1.5 7MM SCREW 400.807.96 115 1.5 9MM SCREW 400.809.96 109 1.5 10MM SCREW 400.810.96 109 1.5 12MM SCREW 400.812.96 109 1.5 13MM SCREW 400.813.96 109 1.5 14MM SCREW 400.814.96 109 1.5 16MM SCREW 400.816.96 109 1.5 18MM SCREW 400.818.96 109 1.5 20MM SCREW 400.820.96 109 1.5 22MM SCREW 400.822.96 109 1.5 24MM SCREW 400.824.96 109 1.5 DRILL BIT 310.507 336 1.5 PLATE 11 HOLE (T) 446.612 366 1.5 PLATE 12 HOLE (T) 446.234 366 1.5 PLATE 11 HOLE 446.233 366 1.5 PLATE 12 HOLE 446.032 397 1.5 PLATE 6 HOLE 446.031 366 1.5 PLATE CONDYLAR LT 446.63 469 1.5 PLATE LEFT 446.483 366 1.5 PLATE RIGHT 446.482 366 1.5 PLATE RT CONDYLAR 446.64 469 1.5 SCREW 11MM 400.811.96 109 1.5 SCREW 6MM 400.806.96 109 1.5 SCREW 8MM 400.808.96 109 1.5MM DRILL BIT 310.141 511 1.8MM DRILL BIT 110MM 310.509 336 1/2 NS W/20KCL 2B1357X 11 10 cc OPTEFORM 3436 10% DEX 1000ML BAG 36 10% DEX 500cc