Charleston Surgical Hospital Number Decscription Charge 380000 ABO BLOOD TYPING $ 16.07 380008 ANA $ 90.59 380012 ANTI MICROSOMAL ANTIBODIE $ 81.11 380013 ANTIBODY SCREEN $ 143.96 380016 BARTONELLA $ 54.75 380017 BETA HCG $ 41.87 380020 BUN $ 22.01 380022 CALCIUM $ 28.72 380023 CBC-DIFF $ 36.09 380026 CKMB $ 55.76 380027 CLOSTRIDIUM CULTURE $ 110.02 380029 URINALYSIS $ 17.63 380032 C-REACTIVE PROTEIN $ 28.85 380033 CROSSMATCH ADDL LEVEL $ 41.69 380035 CULTURE-ANAEROBIC $ 52.73 380037 CYTOLOGY INTERP.& REPORT NEEDLE ASPI $ 232.32 380038 DECALCIFICATION $ 26.06 380042 DIRECT ANTIGEN FOR CULT $ 56.82 380044 DIRECT FUNGAL SMEAR $ 32.01 380048 ELECTROLYTES $ 32.87 380050 EXT STUDY OVER 5 SLIDES $ 33.42 380051 FACTOR VIII $ 236.75 380052 FERRITIN $ 102.14 380053 FIRST CROSS MATCH $ 41.69 380055 FLOW CYTOMETRY 9 - 15 $ 162.94 380056 FLOW CYTOMETRY EACH MARK $ 48.63 380058 FOLATE LEVEL $ 81.93 380059 FREE T4 $ 50.26 380061 FROZEN SECTION/SINGL SPEC $ 129.69 380063 FUNGUS CULTURE, OTHER $ 46.82 380064 GLUCOSE BY GLUCOMETER $ 13.06 380065 GLUCOSE FAST P C OR RANDM $ 21.87 380066 GRAM SMEAR $ 32.01 380068 HBSAG $ 51.92 380070 HELICOBACTOR PYLORI ANTI $ 80.90 380071 HEMATOCRIT $ 13.19 380072 HEMOGLOBIN $ 13.19 380074 HEPATIC PANEL $ 45.54 380079 HGB A1C $ 72.71 380080 HIV $ 45.10 380083 IDENTIFICATION PANEL $ 45.06 380084 IMMUNOPEROXIDASE STAIN $ 211.23 380085 INHALENT ALLERGEN $ 29.09 380089 IRON $ 36.12 380091 LEUKOCYTE-FLOW CYTOMETRY $ 126.52 380092 LIPID PANEL I $ 82.08 380094 MAGNESIUM $ 37.35 380095 METABOLIC-BASIC $ 47.14 380096 METABOLIC-COMPREHENSIVE $ 58.92 380098 MONO CHETEROPHILE ANTIBOD $ 28.85 380105 OTHER CULTURE ROUTINE $ 64.57 380106 PARATHYROID HORMONE $ 230.04 380107 PARTIAL THROMBOPLASTIN TIME $ 44.16 380109 PATHOLOGY-LEVEL 1 $ 80.71 380110 PATHOLOGY-LEVEL 2 $ 161.34 380111 PATHOLOGY-LEVEL 3 $ 166.90 380112 PATHOLOGY-LEVEL 4 $ 227.89 380113 PATHOLOGY-LEVEL 5 $ 498.61 380116 PLATELET FUNCTION ASSAY PFA $ 61.23 380120 PROSTATE SPEC ANT $ 102.55 380121 PROTEIN SERUM TOTAL $ 20.43 380122 PROTHOMBIN TIME $ 21.87 380124 R A LATEX FLOC SCREEN $ 31.64 380125 RENAL FUNCTION PANEL $ 48.40 380127 RH (D) BLOOD TYPING $ 16.07 380128 RUBELLA H I TITER $ 80.25 380131 SEDIMENTATION RATE $ 20.24 380132 SENSITIVITY $ 48.22 380133 SENSITIVITY KIRBY BAUER $ 38.27 380135 SJORGEN'S SYNDROME - A $ 99.94 380136 SJORGENS SYNDROME - B $ 99.94 380137 SPECIAL STAIN $ 221.23 380138 SPECIAL STAIN (COMPLEX) $ 176.88 380141 STOOL CULTURE $ 70.73 380142 STOOL IDENTIFICATION $ 52.57 380144 T3 $ 36.09 380146 THYROID ANTIBODIES $ 88.66 380149 TOTAL IGE $ 91.77 380153 TSH $ 93.65 380154 URIC ACID $ 24.30 380155 URINALYSIS W/O MICROSCOPY $ 12.65 380156 URINE CULTURE $ 44.99 380157 URINE PREGNANCY TEST $ 35.25 380159 VENIPUNCTURE COLLECT SPEC $ 11.81 380163 VITAMIN B12 $ 84.02 380164 VON WILLEBRANDS FACTOR $ 127.89 380166 T4 $ 38.29 380176 URINE MICROALBUMIN QUANTITATIVE $ 32.24 380178 VITAMIN D25 A $ 165.04 380179 VITAMIN D25 $ 63.15 380180 VITAMIN D125 $ 214.59 380184 MUMPS TITER $ 72.76 380185 VARICELLA TITER $ 71.81 380187 TOTAL TESTOSTERONE S $ 152.63 380188 G6PD $ 33.73 380189 GIARDIA $ 66.86 380190 CRYPTOSPORDIUM $ 66.86 380191 STOOL WBL $ 18.66 380193 HBsAg AB $ 59.85 380194 CK $ 36.33 380195 STOOL YERSENIA $ 70.73 380198 SHIG 1 $ 66.86 380199 SHIG 2 $ 66.86 380205 PROLACTIN $ 108.02 380207 LH $ 103.22 380208 FSH $ 103.57 380210 URINE CR RATION $ 28.85 380212 TIBC $ 65.51 380214 LAB-TROPONIN I $ 60.03 380225 ANA TITER $ 83.60 380231 IMMUNOGLOBULINS $ 51.83 380246 CREATININE BLOOD $ 28.58 380250 ESTRADIOL $ 155.75 380252 DHEA S $ 123.91 380260 FAT OR LIPIDS FECES QUANTITATIVE $ 9.36 380263 HEPATITIS PANEL ACUTE $ 341.00 380266 TRANSFERRIN SATURATION $ 67.57 380275 CORTISOL TOTAL PROTEIN ELECTROPHORES $ 87.70 380281 HP FAST $ 48.01 380286 BUN WAIVED $ 28.97 380287 CREATININE WAIVED $ 34.60 380288 BMP WAIVED $ 50.52 380289 POTASSIUM WAIVED $ 32.07 380290 ELECTROLYTES WAIVED $ 38.28 380291 HEMATOCRIT WAIVED $ 21.43 380293 LATEX ALLERGY RAST $ 29.09 380299 CARDIAC PANEL $ 100.32 380308 TTG $ 60.21 380310 DAILY CBC-DIFF $ 36.09 380311 DAILY CMP $ 36.09 380312 DAILY BMP $ 36.09 380313 DAILY CALCIUM $ 28.72 380314 DAILY IONIZED CALCIUM $ 28.72 380315 DAILY H & H $ 28.72 380316 LEUKODEPLETED RBC $ 675.28 380317 CCP $ 40.62 380318 CA 19-9 $ 73.12 380319 ACE LEVEL $ 54.98 380320 COCCIDIOSIS $ 129.50 380321 HEP C AMP PROBE $ 262.90 380322 ANTI-MITOCHONDRIAL AB $ 73.85 380323 ANTI-SMOOTH MUSCLE AB $ 73.85 380324 CERULOPLASMIN $ 65.84 380325 QUANTIFERON GOLD TB TEST $ 379.94 380326 TPMT $ 110.70 380327 T3 UPTAKE $ 44.61 380328 P-ANCA $ 270.77 380329 C-ANCA $ 270.77 380330 CEA $ 142.12 380331 FRACTIONATED ALK PHOS $ 49.70 380332 GGT $ 53.96 380333 BILIRUBIN TOTAL $ 30.25 380334 MYOSITIS PANEL $ 260.05 380335 T3 RIA $ 114.04 380336 LYME DISEASE ANTIBODY SCREEN $ 127.60 380337 LYME DISEASE ANTIBODIES (IGG,IGM) $ 116.05 380338 FREE TESTOSTERONE S $ 190.78 380339 HCV GENOTYPE, RNA $ 1,928.80 380340 HCV VIRAL LOAD $ 320.93 380341 BB CROSSMATCH $ 250.00 380342 BB CROSSMATCH 2ND UNIT $ 250.00 380343 ANTIBODY EB NUC ANTIGEN $ 84.33 380344 AMMONIA $ 49.98 380345 LDL (DIRECT) $ 32.76 380346 DEPAKOTE LEVEL $ 30.00 380347 RETIC COUNT $ 13.70 380348 FREE T3 $ 36.09 380349 D DIMER $ 36.09 380350 VANCOMYCIN PEAK $ 78.00 380351 VANCOMYCIN TROUGH $ 78.00 380352 IMMEDIATE SPIN COMPATIBLE $ 200.00 411500 ANES-CRNA SERVICES $ 5.29 411501 ANES-GENERAL $ 430.50 411502 ANES-MAC $ 225.50 411504 ANES-AIR $ 20.32 411505 ANES-OXYGEN $ 218.01 411507 ANES-NITROUS OXIDE $ 38.79 411508 ANES-OXYGEN PORTABLE $ 59.50 411509 ANES-BARD PUMP & SUPPLIES $ 34.79 411510 ANES-NIBP MONITOR $ 38.68 411511 ANES-VENTILATOR $ 95.47 411514 ANES-PERIPHERAL NERVE STIM $ 8.38 411516 ANES-CRNA SERVICES $ 51.25 411517 ANES-SPINAL EPIDURAL TRAY $ 63.23 411518 ANES-PUDENDAL BLOCK TRAY $ 49.61 411519 ANES-PEDS IV FLUID KIT $ 76.78 411520 ANES-MODERATE SEDATION $ 125.00 411900 ANES-CRNA SERVICES $ 5.29 420000 PRO - RNFA SERVICES $ 5.29 440000 PRO - PA SVS NEW PATIENT - VISIT LEVEL 1 $ 45.00 440001 PRO - PA SVS NEW PATIENT - VISIT LEVEL 2 $ 55.00 440002 PRO - PA SVS NEW PATIENT - VISIT LEVEL 3 $ 75.00 440003 PRO - PA SVS NEW PATIENT - VISIT LEVEL 4 $ 95.00 440004 PRO - PA SVS NEW PATIENT - VISIT LEVEL 5 $ 105.00 440005 PRO - PA SVS EST PATIENT - VISIT LEVEL 1 $ 35.00 440006 PRO - PA SVS EST PATIENT - VISIT LEVEL 2 $ 45.00 440007 PRO - PA SVS EST PATIENT - VISIT LEVEL 3 $ 65.00 440008 PRO - PA SVS EST PATIENT - VISIT LEVEL 4 $ 85.00 440009 PRO - PA SVS EST PATIENT - VISIT LEVEL 5 $ 95.00 590050 XR CHEST AP SINGLE VIEW $ 59.39 590051 XR CHEST PA & LATERAL $ 108.83 590052 XR CLAVICLE COMPLETE LEFT $ 88.23 590053 XR FACIAL BONES MINIMUM 3 VW $ 140.43 590054 XR LATERAL NASOPHARYNX $ 59.39 590055 XR MASTOIDS > 3 VIEWS $ 197.05 590056 XR NASAL BONES $ 82.51 590057 XR PARANASAL SINUSES MIN 3VW $ 170.96 590058 XR SALIVARY GLAND $ 86.75 590059 XR SINUS $ 84.62 590060 XR AAA SCREENING $ 172.47 590061 XR ABDOMEN AP SINGLE VIEW $ 172.47 590062 XR ABDOMEN COMP 2 VIEWS $ 228.87 590063 XR ACROMIOCLVICULAR JOINTS LEFT $ 148.60 590064 XR ACROMIOCLVICULAR JOINTS RIGHT $ 148.60 590065 XR ANKLE AP AND LAT LEFT $ 119.32 590066 XR ANKLE AP AND LAT RIGHT $ 119.32 590067 XR ANKLE COMP MIN 3 VIEWS LEFT $ 147.52 590068 XR ANKLE COMP MIN 3 VIEWS RIGHT $ 147.52 590070 XR BONE AGE STUDIES $ 130.16 590071 XR CALCANEUS MIN 2 VIEWS LEFT $ 149.69 590072 XR CALCANEUS MIN 2 VIEWS RIGHT $ 149.69 590073 XR CHEST 2 VIEWS W AP LORDOTIC $ 235.38 590074 XR CHEST 2 VIEWS W OBLIQUE $ 231.05 590075 XR CHEST COMPLETE MIN 4 VIEWS $ 148.60 590076 XR CHEST FLUOROSCOPY COMPLETE $ 313.48 590077 XR CLAVICAL COMPLETE RIGHT $ 88.23 590078 XR CYST ASPIRATION BREAST $ 264.67 590079 XR DECUBITIS VIEW OF CHEST $ 120.41 590080 XR DUPLEX SCAN EXT VEINS UNILAT LEFT $ 609.61 590081 XR DUPLEX SCAN EXT VEINS UNILAT RIGHT $ 609.61 590082 XR DUPLEX SCAN LOWER UNILAT LEFT $ 609.61 590083 XR DUPLEX SCAN LOWER UNILAT RIGHT $ 609.61 590084 XR DUPLEX SCAN UPPER EXT ARTERIES LEFT $ 129.08 590085 XR DUPLEX SCAN UPPER EXT ARTERIES RIGHT $ 129.08 590086 XR DUPLEX SCAN UPPER EXT ARTERIES BILAT $ 83.53 590087 XR ELBOW AP AND LAT LEFT $ 135.59 590088 XR ELBOW AP AND LAT RIGHT $ 135.59 590089 XR ELBOW COMP MIN 3 VIEWS LEFT $ 181.15 590090 XR ELBOW COMP MIN 3 VIEWS RIGHT $ 181.15 590091 XR FACIAL BONES LESS THAN 3 VIEWS $ 149.69 590092 XR FEMUR MIN 2 VIEWS LEFT $ 178.98 590093 XR FEMUR MIN 2 VIEWS RIGHT $ 178.98 590095 XR FINGER MIN 2 VIEWS LEFT $ 110.64 590096 XR FINGER MIN 2 VIEWS RIGHT $ 110.64 590097 XR FOOT AP AND LAT LEFT $ 122.57 590098 XR FOOT AP AND LAT RIGHT $ 122.57 590099 XR FOOT COMP MIN 3 VIEWS LEFT $ 156.20 590100 XR FOOT COMP MIN 3 VIEWS RIGHT $ 156.20 590101 XR FOREARM AP AND LAT LEFT $ 146.43 590102 XR FOREARM AP AND LAT RIGHT $ 146.43 590103 XR HAND 2 VIEWS LEFT $ 107.39 590104 XR HAND 2 VIEWS RIGHT $ 107.39 590105 XR HAND MIN 3 VIEWS LEFT $ 173.55 590106 XR HAND MIN 3 VIEWS RIGHT $ 173.55 590112 XR HUMERUS 2 VIEWS LEFT $ 186.57 590113 XR HUMERUS 2 VIEWS RIGHT $ 186.57 590116 XR KNEE 1 OR 2 VIEWS LEFT $ 123.66 590117 XR KNEE 1 OR 2 VIEWS RIGHT $ 123.66 590118 XR KNEE AP AND LAT W OBL MIN 3 VIEWS LEF $ 198.50 590119 XR KNEE AP AND LAT W OBL MIN 3 VIEWS RIG $ 198.50 590120 XR KNEE COMPLETE W OBL AND ADD VIEWS LEF $ 356.86 590121 XR KNEE COMPLETE W OBL AND ADD VIEWS RIG $ 356.86 590122 XR KNEES BILAT STANDING $ 154.03 590123 XR LOWER EXTREMITY INFANT LEFT $ 136.67 590124 XR LOWER EXTREMITY INFANT RIGHT $ 136.67 590125 XR MANDIBLE LESS THAN 4 VIEWS $ 122.57 590126 XR MANDIBLE MIN 4 VIEWS $ 237.55 590127 XR MASTOID LIMITED $ 67.25 590128 XR NECK SOFT TISSUE $ 121.48 590129 XR