17-Hydroxyprogesterone $37.0024 hour holter monitor $124.005% dextrose/normal saline (500 ml = 1 unit) $57.00Abdomen, 2 views $101.00Abdomen, 3 or more views $139.00Abdomen, complete acute series $159.00Abdomen, single view $89.00ABO & RH $23.00Acetabulum (hip socket) Fracture, w/o manipulation $623.00Acetone, Serum $23.00Acromioclavicular Joint $116.00ACTH $53.00AFP Tetra $186.00Airheel _OTC $40.00Albumin $20.00Albuterol Sulfate Inhalation Sol .083% (1 vial = qty 3) $4.00Alcohol, Legal $42.00Alcohols $53.00Alkaline phosphatase $20.00Alkaline Phosphatase Isoenzymes $20.00Allergen specific IgE $30.00Allergen Specific IgE for Alpah Gal $40.50Allergen Specific IgE, Recombinant or purified $23.00Allergy Injection; multiple $29.00Allergy Injection; single $18.00Alpa-1-antitrypsin, Serum $45.00Alpha-Fetoprotein AFP, Tumor Marker $45.00ALPHA-FETOPROTEIN SERUM $0.00Alpha-Fetoprotein, serum (Triple Screen) $169.00ALT (SGPT) $21.00Amphetamine Confirmation, Urine $55.00Amylase $21.00Amylase Isoenzymes Charge Set $58.00Anesthesia for Vaginal Procedure $0.00Angiotensin I enzyme test $38.00Ankle, 3 views $90.00Annual GYN Exam 12-17 $45.00Annual GYN Exam 18-39 $45.00Annual GYN Exam 40-64 $45.00Annual GYN Exam 65+ $45.00ANTB HIV-1 (DHEC) $22.00Anti Centromere B $36.00Anti Sjogren (SSA, SSB) $44.00Antibody ID $47.00Anticardiolipin Antibodies IgA, IgG, IgM $48.00

Student Health Services 2020 Service Charges

Anti-Glomerular Basement Membrane $126.00Anti-Histone AB $59.00Anti-Mullerian Hormone $69.00Anti-Neutrophil Cytoplasmic AB charge set $120.00Anti-Nuclear Antibody $34.00Anti-Nuclear Antibody Reflex $34.00Antiphospholipid Syndrome Profile $545.00Anti-SARS-COV-2 $35.00Anti-Smooth Muscle Antibody $51.00Anti-Streptolysin O $38.00Antithrombin III Activity $138.00Application of Finger Splint-Static $45.00Application of Long Arm Splint (shoulder to hand) $100.00Application of Long Leg Splint (thigh to ankle) $110.00Application of Short Arm Splint (forearm to hand) $85.00Application of Short Leg Splint (calf to foot) $90.00Arthrocentesis- Intermediate Joint or Bursa $65.00Arthrocentesis- Major Joint or Bursa $50.00Arthrocentesis- Small Joint or Bursa $125.00Aspiration of Breast Cyst; each add'l $49.00Aspiration of Hematoma/Bulla/Cyst/Abcess $45.00Aspiration/Injection(s) - Ganglion Cyst(s) $80.00ASSAY IGA/IGD/IGG/IGM $27.00ASSAY NEPHELOMETRY NOT SPEC $16.00Assay of 5-hiaa $35.00Assay of aldolase $41.00Assay of aldosterone $62.00Assay of amonia $42.00Assay of androstenedione $93.00Assay of blood osmolality $20.00Assay of catecholamines, Fractionated $58.00Assay of copper $55.00Assay of c-peptide $41.00Assay of cyclosporine $59.00Assay of erythropoietin $47.00ASSAY OF ESTRIOL $61.00Assay of folic acid, rbc $62.00Assay of gammaglobulin ige $54.00Assay of gammaglobulin IgM $20.00Assay of gastrin $59.00Assay of haptoglobin, quant $26.00Assay of homocystine $80.00Assay of lead $35.00Assay of mercury $78.00Assay of metanephrines $71.00Assay of myoglobin - serum $63.00Assay of myoglobin - Urine $54.00Assay of porphobilinogen $54.00

Assay of pregnenolone $56.00Assay of progesterone $42.00assay of protein urine, random $9.00Assay of psa, total $49.00Assay of renin $43.33ASSAY OF SELENIUM $61.00Assay of sex hormone globul $72.00Assay of somatomedin $69.00Assay of tacrolimus $135.00ASSAY OF THYROGLOBULIN $40.00ASSAY OF THYROGLOBULIN $40.00ASSAY OF TRANSCORTIN $45.00Assay of troponin, quant $32.00Assay of urine osmolality $21.00Assay of urine vma $50.00Assay of vitamin B-1 $68.00Assay of vitamin B-6 $69.00Assay of vitamin E $34.00ASSAY OF VITAMIN K $51.00Assay of zinc $45.00Assay or urine sodium $29.00Assay, blood carbon monoxide $32.00Assay, growth hormone (hgh) $53.00AST (SGOT) $21.00AUDIT $10.00Avulsion of Nail Plate; each add'l $59.00Avulsion of Nail Plate; partial or complete; single $128.00Bartonella antibody $24.00Basic Metabolic Panel $29.00Beta 2 Transferrin $167.00Beta-2 Glycoprotein Antibodies $56.00Beta-2 Microglobulin, Serum $60.00Bile Acid, Total $40.00Bile Acids, Fractionated and Total $40.00Bilirubin, Direct $25.00Bilirubin, Total $20.00Biofreeze Gel Pad $12.00Biopsy of Cervix; single or multiple lesion(s) $100.00Biopsy of Skin Lesion; each add'l (incisional) $55.00Biopsy of Skin Lesion; each add'l (punch) $55.00Biopsy of Skin Lesion; each add'l (shave, etc.) $55.00Biopsy of Skin Lesion; single (incisional) $132.00Biopsy of Skin Lesion; single (punch w simple closure) $132.00Biopsy of Skin Lesion; single (shave, scoop, etc.) $132.00Blood Typing, ABO $25.00Blood Typing, Rh $5.00BNP (B-Type Natriuretic Peptide) $137.00Bordetella Pertussis Antibodies, IgG $46.00

Bordetella Pertussis Antibodies, IgG & IgM $67.00Bordetella Pertussis Antibodies, IgM $50.00Bordetella Pertussis by PCR $190.00Brief OV - NP $25.00Brief OV - NP Women's Clinic $25.00Brief OV - Nurse $25.00Brief OV - Nurse No Charge $0.00Brief OV - Suture Removal $10.00Brucella Antibody IgG $63.00Brucella Antibody IgM $38.00Budesonide Inhalation Susp (Pulmicort), 0.5mg/2ml $19.50C difficile PCR with (027) Stain $72.00C Difficile Toxin B Cytotoxin Assay $47.00CA 125 $44.00CA 15-3 Cancer Antigen $47.00Calcaneus (Heel) $72.00Calcitonin $57.00Calcium $20.00Calcium, 24 Hour Urine $41.00Calcium, Ionized $25.00Calprotectiin (Stool) $206.00Carbamazepine, Total $35.00Carbon Monoxide, Whole Blood $30.00Carcinoembryonic antigen $48.00Carnitine, Total and Free $52.00Casting Application; elbow to finger (short arm) $125.00Cat Scratch $72.00Catecholamines, fractioned, Plasma $53.00Catheterization for collection of specimen $0.00CBC w/ Diff $30.00CBC w/Diff -AnMed $25.00CBC w/o Diff.-AnMed $25.00CBG $45.00CCP (Cyclic Citrullinated Peptide) AB $54.00CD57 Panel $147.00CELIAC AB PANEL $54.00Celiac AB Panel $108.00Ceruloplasmin $42.00Charge - Did Not Keep Appointment $0.00Chemiluminescent Assay $171.50CHEST X-RAY SPECIAL VIEWS $92.00Chest, 2 views $87.00Chest, 3 views $92.00Chest, 4 or more views $92.00Chest, PA & lateral $87.00Chest, single view $82.00Chest, single view $82.00Chest, w/apical lordotic $92.00

Chest, w/expiratory $92.00CHLAM/GON (LABCORP) $0.00Chlamydia Trachomatis Culture $44.00Chlamydia trachomatis, amplified probe technique $28.50Chlamydia/GC, Aptima $39.00Cholera Vaccine Live, Oral (Vaxchora) $299.00Cholesterol, Total $20.00CHORIONIC GONADOTROPIN TEST $0.00Chromosome Analysis $278.00Chromosome Analysis High Resolution $842.00Chromosome analysis, 15-20 $206.00CHROMOSOME STUDY ADDITIONAL $114.00Chronic Urticaria Index $184.00Citrate 24 hr. Urine $50.00Clavicle $78.00CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION $126.00CLOSED TREATMENT STERNUM FRACTURE $171.00CLOSED TREATMENT ULNAR STYLOID FRACTURE $349.00CLOSED TX CARPAL SCAPHOID FRACTURE W/O MNPJ $314.00CLOSED TX LUNATE DISLOCATION W/MANIPULATION $581.00CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MNPJ $627.00CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION $292.00CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION $299.00CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MNPJ $298.00CLOSED TX RIB FRACTURE UNCOMPLICATED EACH $150.00CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION $258.00CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ $97.00CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MNPJ $306.00CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION $278.00CLOSED TX VERTEBRAL PROCESS FRACTURE $422.00Clostridium Difficile Toxin $36.00Clot inhibit Prot C Activity $71.00Clot Inhibit Prot S Free $62.00CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION $274.00CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION $250.00CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION $369.00CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION $422.00CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES $377.00CLSD TX STERNOCLAVICULAR DISLC W/O MANIPULATION $248.00CLTX CARP/MTCRPL DISLC THMB MNPJ EA W/O ANES $412.00CLTX CARP/MTCRPL DISLC THMB W/MNPJ $422.00CLTX CARP/MTCRPL FX DISLC THMB W/MNPJ $494.00CLTX CARPL B1 FX W/O MNPJ EA B1 $332.00CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MNPJ $322.00CLTX GREATER HUMERAL TUBEROSITY FX W/O MNPJ $336.00CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MNPJ $330.00CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MNPJ $336.00CLTX MTCARPHLNGL DISLC 1 W/MNPJ REQ ANES $440.00

CLTX MTCARPHLNGL DISLC 1 W/MNPJ W/O ANES $362.00CLTX MTCRPL FX 1 W/MNPJ EA B1 $375.00CLTX MTCRPL FX 1 W/O MNPJ EA B1 $267.00CLTX PEL RING FX DISLC DIAST/SUBLXTJ W/O MNPJ $334.00CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MNPJ EA $356.00CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MNPJ EA $196.00CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION $373.00CLTX RDCRPL/INTERCARPL DISLC 1+ B1S W/MNPJ $452.00CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MNPJ $192.00CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT $663.00CMV antibody $43.00CMV antibody, IgM $34.00CMV PCR Plasma $337.00Coccygeal Fracture, closed treatment $639.00Complement Antigen each component $33.00Complement, Total (CH50) $39.00Comprehensive Metabolic Panel $95.00Consultation on X-Ray Examine made Elsewhere $0.00Consultation with Client $0.00Coombs test, direct $29.00Copay Patient $0.00Copper Urinary 24 Hour/Random $35.00Cortisol, free $57.00Cortisol, Free, Total with CBG $33.50Cortisol, Salivary $73.00Cortisol, total $39.00Cortisol, urinary free by HPLC $47.00COVID-19 $85.00Coxsackie A Virus Antibody Profile, IgG and IgM $24.63Coxsackie A Virus Antibody Profile, IgG and IgM (CS) $197.00C-Reactive Protein $29.00C-reactive protein, hs $29.00Creatine Kinase Isoenzymes $41.00Creatine Kinase, Total $20.00Creatine, MB fraction $43.00Creatinine $20.00Creatinine clearance test $27.00Creatinine, other source $21.00Creatinine, other source (For charge set) $4.00Crisis Psychotherapy, each add'l 30 min $0.00Crisis Psychotherapy, first 60 min $0.00Cryoglobulin, Qualitative $35.00Crypto $48.50Culture, Blood $54.00Culture, Body Fluid $44.00Culture, Genial Strep Screen - Group B $32.00Culture, Miscellaneous $45.00Culture, Nasal $0.00

Culture, Stool (Campylobacter, Salmonella/Shigella) $53.00Culture, Stool (each add'l aerobic pathogen) $18.00Culture, Stool (Salmonella/Shigella only) $35.00Culture, Throat (Anderson) $45.00Culture, Throat GC $45.00Culture, Urine, Routine $44.00Culture, Vaginal/Cervical $44.00Culture, Vibrio $37.00Culture, Viral $35.00Cystatin C $73.00Cystic Fibrosis Gene analysis $132.00Cyto/molecular report $29.00Cytomegalovirus Panel $52.00Cytopathology, Thin Layer Prep (Breast Smear) $39.00D-Dimer $50.00Debride Infected Skin, up to 10% Body Surface $71.00Debridement of nail(s); 1-5 $41.00Debridement of nail(s); 6 or more $57.00Dehydroepiandrosterone $80.00Delta Aminolevulinic Acid, Random Urine $45.00Dermabond $40.00Destruction- Molluscum/Warts; 1-14 lesion(s) $45.00Destruction- Molluscum/Warts; 15 or more $67.00Destruction of Vulva Lesions; simple $161.00Destruction- Premalignant Skin Lesions; 1 lesion $65.00Destruction- Premalignant Skin Lesions; ea add'l (2-14) $5.00Dexamethasone Suppression Test (Cortisol) $128.00Dexamtehasone, Serum $68.00DHEA Sulfate $50.00Diaphragm Fitting $83.00Digital Nerve Block, Other $140.00Digoxin $29.00Dihydrotesterone, DTH $36.00Distal Phalangeal Fracture, closed $250.00DonJoy Ortho Supply - billed by DonJoy $0.00Double-Stranded DNA Ab $45.00Dressing Change by Nurse $10.00Dressing Change by Provider $10.00Drug Panel 13 $113.00Drug Panel 7 $80.00Drug Panel 9 $80.00Drug Screen 11 Panel $69.00Drug Screen, Medical $215.00DSTL PHLNGL FX, CLOSED, FNGR/THMB W/MNPJ EA $334.00E coli Toxin $67.00Ear Wick $10.00EBV Quantitative by PCR (Viral Load) $295.00Educational Supplies $0.00

Ehrlichia Antibody Panel $177.00EKG w/interpretation $56.00Elastic Bandage, < 3" wide _OTC $3.00Elastic Bandage, > 5" wide _OTC $5.00Elastic Bandage, >/= 3" and < 5" wide _OTC $4.00Elbow Surround, Universal _OTC $18.00Elbow, 2 views $79.00Elbow, complete $85.00Electrolyte Panel $23.00Endometrial Biopsy $95.00Enteric Bacterial Panel $127.00Epstein-Barr Virus, NA IgG $70.00Epstein-Barr Virus, VCA IgG or IgM $70.00Established Patient; Brief OV - MD $25.00Established Patient; Comprehensive OV - MD $191.00Established Patient; Comprehensive OV - NP $191.00Established Patient; Comprehensive OV - NP Women's Clin $191.00Established Patient; Detailed OV - MD $141.00Established Patient; Detailed OV - NP $141.00Established Patient; Detailed OV - NP Women's Clinic $141.00Established Patient; Expanded Problem Focused OV - MD $95.00Established Patient; Problem Focused OV - MD $56.00Estradiol $56.00Estrogen, total $42.72Ethanol, Urine $35.00Evacuation of Subungual Hematoma $30.00Everolimus $460.00Exam synovial fluid crystals $26.00Excision Benign Lesion =<0.5 scalp/nck/hand/foot/gen $90.00Excision Benign Lesion 0.6-1 cm scalp/nck/hand/foot/gen $75.00Excision Benign Lesion 1.1-2 cm scalp/nck/hand/foot/gen $75.00Excision Benign Lesion; 0.5 cm or less (face) $165.00Excision Benign Lesion; 0.5 cm or less (trunk/arm/leg) $155.00Excision Benign Lesion; 0.6-1.0 cm (face) $215.00Excision Benign Lesion; 0.6-1.0 cm (trunk/arm/leg) $85.00Excision Benign Lesion; 1.1-2.0 (face) $241.00Excision Benign Lesion; 1.1-2.0 cm (trunk/arm/leg) $100.00Expanded Problem Focused OV - NP $95.00Expanded Problem Focused OV - NP Women's Clinic $95.00Facial Bones, complete $90.00Facial Laceration Repair; 2.5 cm or less $105.00Factor II DNA Analysis $189.00Family/Conjoint Psychotherapy $50.00Family/Conjoint Psychotherapy - NC $0.00Fat Stain, feces, urine or sputum $59.00Fats/lipids, feces, qual $44.00Felbatol $42.00Femoral Fracture, without manipulation $594.00

Femur, 2 views $80.00Ferritin $32.00Fibrinogen $39.00Finger(s) $65.00First Step IBD $462.00FLU- (FLUAD) Quadrivalent 65+; 0.5mL IM; 2020-21 $60.00FLU- (FLUAD) Trivalent 65+ 0.5mL IM $50.00FLU- (Flucelvax) Quadrivalent 0.5mL IM $29.99Flu Study $49.00Fluorescent Noninfectious agent antibody;screen each ab $31.00Folate $32.00Foot, complete $72.00Football Screening $112.00Forearm $72.00FSH $35.00Fungal Culture $48.00Fungal Culture, Yeast or Mold $63.00Fungus antibody $33.00Gamma Glutamyl Tranferase $20.00Gastrointestional Profile, Stool, PCR $385.00Gentian Violet Treatment $15.00GHB (Serum) $185.00Giardia $48.50Giardia AB IGG/IGM/IGA $93.00Giardia Ag, EIA, Stool $92.00Giardia lamblia antibody $51.00Gliadin AB Panel $107.00Gliadin IgG/IgA AB $17.00Glucose GTt (1 HR) $27.00Glucose, 2hr PP $25.00Glucose, fasting $25.00Glucose, fasting or random $25.00Glucose, Whole Blood 2 HR PP $25.00Glucose-6-Phosphate Dehydrogenase $51.00Glutamic Acid Decarboxylase AB $68.00GlycoMark© $54.00Group B Strep Molecular Test $97.00Group Health Education $0.00Group Psychotherapy $15.00GYN Final Report for Thinprep PAP Smear $0.00Haemophilus B Conjugate Vaccine (HIB) $55.00Haemophilus Influenza B, IgG $135.00Hand $84.00Heatwraps, ThermaCare Back, Lg. $12.00Heatwraps, ThermaCare Menstrual $12.00Heel Cup _OTC $10.00Helicobacter pylori $37.00Helicobacter Pylori Antibodies, IgA, IgG, IgM $10.00

HELMINTH ANTIBODY $102.00Hematocrit $22.00Hemoglobin A1C $27.00Hemoglobinopathy $78.00Hep A Vaccine, Pediatric/Adolescent $50.00Hep A-Hep B Vaccine, Adult (Twinrix) $125.00Hep B Surface Ag Confirmation $138.00Hep be antibody $42.00Hep C ab test, confirm $105.00Hepatic Function Panel $28.00Hepatitis A Ab, IgM $35.00Hepatitis A Antibody, Total $41.00Hepatitis A Vaccine, Adult (Vaqta Vial) $92.00Hepatitis B Antigen $43.00Hepatitis B Core Ab, IgM $35.00Hepatitis B Core Antibody, Total $39.00Hepatitis B PCR (Viral Load) $310.00Hepatitis B Surface Ab $35.00Hepatitis B Surface Antigen $35.00Hepatitis B Vaccine, Adolescent $50.00Hepatitis B Vaccine, Adult (Engerix) $70.00Hepatitis C Antibody $32.00Hepatitis C Reverse PCR, Quant $257.00Hepatitis C Virus RNA, Qualitative, NAA $155.00Hepatitis Panel, Acute $95.00Heplisav-B $117.00Hereditary Hemochromatosis, DNA Analysis $202.00Herpes Culture $45.00Herpes simplex type 2 $47.00Herpes simplex type 2 (For charge set) $21.00Herpes Simplex Virus IgM w/reflex $71.00Herpes Simplex, Type 1/2 IgG $60.00Herpes Type 1 IgG $47.00Hip Complete (AP/Lateral) 2-3 views $85.00Hip, unilateral, with pelvis, 1 view $80.00Hips, Bilateral w/Pelvis 2 views $85.00Hips, Bilateral w/Pelvis 3-4 Views $85.00HIV - Confirmation Multi-Spot $74.00HIV-1 and HIV-2, single assay $10.00HIV-1, amplified probe technique $77.00HIV-1, Quantitative, PCR $170.00HLA II High Rsolution 1 Allele/Allele Group $76.50HLA II Resolution 1 Antigen Equivalent EA $76.50HLA II TYPING 1 LOC HR $0.00HLA typing, A, B, or C $69.00Holter Monitor $124.00HPV Digene $81.00HPV DNA (High Risk) $81.00

HPV-Gardisil-9 $249.00HPYLORI STOOL EIA $88.00HSV I/II IgM $62.00HTLV 1/2 Ab $108.00HTLV/HIV confirmatory test $66.00Humerus $75.00Ice pack, Reusable _OTC $6.75IGA Subclass 1-2 $59.00IgG Subclass 1-4 $93.00Immune Globulin $0.00Immunization Admin, Oral/Nasal; each add'l, >=19y $10.00Immunization Admin, Oral/Nasal; one vaccine, >=19y $10.00Immunization Administration, ANY; each add'l, <=18y $10.00Immunization Administration, ANY; one vaccine, <=18y $10.00Immunization Administration, SC/IM; each add'l, >=19y $10.00Immunization Administration, SC/IM; one vaccine, >=19y $10.00Immunoassay for tumor antigen, quantitative $71.00Immunoassay Quant Nos Nonab $0.00Immunoassay, nonantibody $39.00Immunofixation (IFE), Serum $77.00IMMUNOFLUORESCENT STUDY $0.00Immunoglobulin Profile $54.00Incision And Drainage, Bartholin's Gland $95.00Incision and Drainage, Hematoma/Seroma/Fluid $100.00Incision and Drainage, Pilonidal Cyst $100.00Incision and Drainage, Skin Abscess $75.00Incision And Drainage, Vulvar or Perineal Abcess $75.00Individual Assessment $0.00Individual Assessment- AOD $75.00Individual Assessment- AOD NC $0.00Infectious agent by EIA $36.00Influenza A/B $30.00Ingrown Toenail Removal $90.00INHIBIN A $39.00Initial Treatment of 1st Degree Burns, Local Only $81.00Inj, Penicillin G Benzathine per 100,000 units (1.2 M) $23.00Injection- Intralesional; 1-7 lesion(s) $51.00Injection- Intralesional; more than 7 lesions $62.00Injection- IV Push $64.50Injection- IV Push; each add'l $26.00Injection- SC/IM $10.00Injection(s)- Carpal Tunnel $100.00Injection(s)- Tendon Sheath $70.00Injection(s)-Trigger Point(s) 1 or 2 muscle(s) $55.00Injection(s)-Trigger point(s), 3 or more muscle(s) $75.00Injection, Adrenalin, Epinephrine, 0.1 mg $10.00Injection, Betamethasone 3/3 (Celestone), per 6 mg $20.00Injection, Ceftriaxone (Rocephin) per 250 mg $7.50

Injection, Cyanocobalamin (Vitamin B12), up to 1,000mcg $10.00Injection, Dexamethasone Sodium Phosphate, 1mg $1.25Injection, Dextrose 50% $15.00Injection, Diphenhydramine HCl, up to 50 mg $10.00Injection, Ketorolac Tromethamine (Toradol), per 15 mg $10.00Injection, Lorazepam, per 2 mg $21.50Injection, Medroxyprogesterone (DepoProvera), 1 mg $0.78Injection, Methylprednisolone (Depo-Medrol), 40mg $15.00Injection, Methylprednisolone (Depo-Medrol), 80mg $25.00Injection, MPSS (Solu-Medrol), up to 125 mg $21.00Injection, Naloxone HCl (Narcan), per 1 mg $15.00Injection, Ondansetron HCl (Zofran), per 1 mg $2.50Injection, Promethazine HCl (Phenergan), up to 50 mg $10.00Injection, Sumatriptan Succinate (Imitrex), 6 mg $81.00Injection, Triamcinolone Acetonide (Kenalog40), per10mg $5.00Insertion of Intrauterine Device (IUD) $150.00Insertion of Non-Biodegradable Drug Delivery Implant $140.00Insulin $35.00Interactive Complexity (add-on) $0.00Interleukin-6, Serum [i] $41.00Interphalangeal Joint Dislocation, closed $300.00Interphalangeal Joint Dislocation, closed, require anes $403.00Interpretation of Evaluation Results $0.00Intrinsic factor antibody $38.00Iodine, Random Urine $72.00Ipratopium Bromide and Albuterol Sulfate Inhalation Sol $19.00Ipratropium Bromoide Inhalation Solution 0.02% - 1 Vial $9.50Iron Saturation $54.00Iron, Total $54.00Isoenzymes $14.00IV Fluid D5 1/2 normal saline (1) liter 1st Bag $57.00IV Fluid D5 1/2 normal saline (1) liter add'tl bag $57.00IV Fluid Hydration; each add'l hour, up to 8 hours $57.00IV Fluid Hydration; up to one hour $57.00IV Fluid, D5, Lactated Ringers (1) liter 1st bag $57.00IV Fluid, D5, Lactated Ringers add'l bag $57.00IV Fluid, lactated ringers one (1) liter add'tl bag $42.00IV Fluid, lactated ringers one (1) liter first bag $42.00IV Fluid, normal saline one (1) liter add'tl bag $57.00IV Fluid, normal saline one (1) liter first bag $57.00Japenese Encephalitis (Ixiaro) $300.00KAPPA:LAMBDA Free Light Chains, Quant. Serum $101.00Ketamine $79.00Ketone Screen $25.00Kidney Stone Analysis $53.00Knee dislocation, closed; without anesthesia $581.00Knee Strap _OTC $17.00Knee, 2 views (AP/Lateral) $84.00

Knee, 3 views $102.00Knee, both, standing $125.00Knee, Complete (4 view AP/Lateral/Obl's) $110.00Kneecap Stabilizer _OTC $41.00KOH $25.00KOH/Wet Prep $25.00KOH/Wet Prep $25.00Laceration Repair; 2.5 cm or less $85.00Laceration Repair; 2.6-7.5 cm $90.00Laceration Repair; 7.6-12.5 cm $125.00Lactoferrin, Stool $81.00Lamictal $76.00Late Cancel Fee for CAPS Appointment $0.00Late Cancel Fee for Psychiatry Diagnostic Interview $0.00Late Cancel Fee for Psychiatry Follow-up/Med Management $0.00Latex IgE $35.00LDH $21.00Legionella $47.00Lesion/Mole for Pathology - Level IV $92.00Levalbuterol Inhalation Sol (Xopenex), 1.25mg/3ml $5.00Lipase $26.00Lipid Panel $32.00Lipoprotein (a) $181.00Lipoprotein, quntitation by NMR $73.00Lithium $29.00Liver-Kidney Microsomal (LKM) Antibodies $42.00Loperamide 2mg Tablet PO $0.00Lupus Anticoagulant $134.00Luteinizing Hormone $38.00Lyme Disease Ab, IgG and IgM, Western Blot $43.00Lyme Disease Ab, IgG and IgM, Western Blot $86.00Lyme Disease, C6 Antigen Reflex $184.00Lyme Disease, Real Tiem PCR $184.00Lyme Disease, Western Blot Only $23.50Macroprolactin $58.50Macroprolactin Charge Set $117.00MACROSCOPIC EXAM PARASITE $33.00Magnesium $21.00Magnesium 24 hr. Urine $41.00Magnesium, RBC $38.00Malaria PCR $171.00Mandible, complete $95.00Manganese Level $57.00Mannose Binding Lectin $80.00Mastoids, complete $95.00Measles Antibody, IgG (Rubeola) (For charge set) $37.00MENB RECOMBINANT LIPOPROTEIN VACCINE IM (Trumemba) $187.00MENB RECOMBINANT PROT w/out MEMBR VESIC IM (Bexsero) $210.00

Menveo Vaccine $140.00Metanephrines $71.00Metanephrines, Franctionated, Plasma Free $213.00Metered Dose Inhaler Demo/Eval $26.00Methylmalonic Acid $77.00Microalbumin Urine, Random $39.00Microalbumin, 24 Hour Urine $41.00Microalbumin/Creatinine $45.00MICROBE SUSCEPTIBLE MIC $112.00Mitochondrial AB $35.00MMR (Mumps-Measles-Rubella) Vaccine $96.00MMR Immunity Profile $73.00Molecule nucleic ampli, each (Factor V Leiden) $72.00Mono Test $30.00MONONUCLEAR CELL ANTIGEN $73.50Mononucleosis Serology $30.00MRSA Screening by PCR $82.00MTHFR, DNA Analysis $124.00Multiple Inhalant Allergen (MIA) Test $29.00Mumps Antibodies, IgM $39.00Mumps Antibody, IgG $39.00Mumps Antibody, IgG (For charge set) $25.00Mycobacteria culture $35.00Mycoplasma $80.00Mycoplasma $80.00Mycoplasma Genitalium, Swab or Urine $31.00Nasal Bones, complete $72.00NATURAL KILLER CELLS TOTAL COUNT $73.50Nebulizer Treatment $30.00Neck, Soft Tissue $75.00Neisseria Gonorrhoeae (GC) Culture $48.00Neisseria gonorrhoeae, amplified probe $28.50No Show Fee for Allergy Injection or Immunization Visit $10.00No Show Fee for CAPS Visit $25.00No Show Fee for Nutritionist Visit Long $24.00No Show Fee for Nutritionist Visit Short $12.00No Show Fee for Physical Exam $25.00No Show Fee for Primary Care Visit $25.00No Show Fee for Psychiatric Diagnostic Interview $149.00No Show Fee for Psychiatric Follow-up/Med Management $102.00No Show Fee for Sports Medicine Visit $25.00No Show Fee for Travel Clinic Group $25.00No Show Fee for Women's Annual Exam $25.00No Show Fee for Women's Health Visit $25.00Norovirus Detection, by PCR $184.00Nuclear antigen antibody - Lupus Profile $83.00Nurse Procedure Only (no charge) $0.00Occult Blood (AnMed) $43.00

Occult Blood (Hemoccult Package) $35.00Occult Blood, Fecal (1-3 specimens) $22.00Orbits, complete $90.00Osteopathic Manipulative Treatment, 1-2 Regions $40.00Osteopathic Manipulative Treatment, 3-4 Regions $50.00Osteopathic Manipulative Treatment, 5-6 Regions $60.00Osteopathic Manipulative Treatment, 5-6 Regions $70.00Osteopathic Manipulative Treatment, 9-10 Regions $80.00Ova and Parasites x1 (For charge set) $16.00Ova and Parasites x 1 $27.00Ova and Parasites x 3 $48.00Oxalate 24 hr. Urine $48.00Oxygen Therapy $15.00Pancreatic Elastase, Fecal $255.00Pancreatic Islet cell antibody $68.00Parathyroid Hormone, Intact $42.00Partial Thromboplastin Time, Activated $27.00Parvovirus Antibodies $84.00Parvovirus antibody $42.00Patella Stabilizer, Lateral_OTC $42.00Patellar Dislocation, closed; without anesthesia $415.00Patellar Fracture, closed; without manipulation $370.00Pelvis, complete $105.00Pelvis, single view $90.00Phalaneal Fracture, closed w/o reduction $160.00Phenytoin $35.00Phone E/M by Provider, 11-20 min $15.00Phone E/M by Provider, 21-30 min $20.00Phone E/M by Provider, 5-10 min $10.00Phone E/M by Psychiatrist, 11-20 min $15.00Phone E/M by Psychiatrist, 21-30 min $20.00Phone E/M by Psychiatrist, 5-10 min $10.00Phosphorous (as phosphate), Serum $21.00Phosphorus 24 hr. Urine $26.00Physical (Sports Clearance, ROTC, preemployment) $45.00Pinworm Prep $20.00Platelet Count $20.00Pneumococcal 13 [PVC-13] (Prevnar-13) $235.00Pneumococcal Vaccine (Pneumovax 23) $123.00Polio AB Immune Status $59.00Polio AB Immune Status $177.00Poliomyelitis (IPV) Vaccine $100.00Polychlorinated Biphenyls (PCB) Congeners, Screen-Conf $72.00Porphyrins, quantitative, 24 hour urine $145.00Post Surgical Follow-up $0.00Potassium $21.00PPD (Tubersol) $23.00PPD Vial (Box for Sale) $67.68

PreAlbumin $54.00Pregancy Test, Serum, Quantitative $29.00Pregnancy Test Urine $25.00Prenatal Plus $54.00PREV VISIT PHYSICAL EST AGE 12-17 $45.00PREV VISIT PHYSICAL EST AGE 18-39 $45.00PREV VISIT PHYSICAL EST AGE 40-64 $45.00PREV VISIT PHYSICAL EST AGE 65+ $45.00Preventative Medicine Counseling; 45 min $6.00Preventative Medicine Counseling; 60 min $6.00Preventative Medicine Counseling; Individual 15 min $39.00Preventative Medicine Counseling; Individual 30 min $71.00Preventative Medicine Counseling; Individual 30 min $12.00Preventative Medicine Counseling; Individual 60 min $24.00Preventive Medicine Counseling: Group 60 min. $18.00Problem Focused OV - NP $56.00Problem Focused OV - NP Women's Clinic $56.00Procedure Not Carried Out $0.00Prolactin $36.00Prolonged Services- Indirect Contact; 30-60 min $15.00Prolonged Services- Indirect Contact; each add'l 30 min $5.00Prometheus Celiac Plus $993.00Prometheus Celiac Serology $323.00Prometheus Thiopurine Metabolites $432.00Protein C Antigen $69.00Protein electrophoresis, serum $35.00Protein Electrophoresis, urine $38.00Protein electrophoresis, urine (CS) $30.00Protein electrophoresis, urine/csf $38.00Protein S Antigen, Total $61.00Protein, Total $21.00Protein, Total, 24 Hour Urine $26.00Protein, Total, 24 Hour Urine $8.00Prothrombin Antibodies, IGG $115.00Prothrombin G20210A $118.00Prothrombin Time with INR $23.00PROTOZOA ANTIBODY NOS $61.00PSA Screen $36.00Psychiatric Diagnostic Interview $149.00Psychiatric Diagnostic Interview w Medical Services $149.00Psychiatric Med Management, Comprehensive $102.00Psychiatric Med Management, Detailed $102.00Psychiatric Med Management, Focused $102.00Psychiatric Med Managment, Expanded Prob Focused $102.00Psychotherapy, 30 min (16-37 min.) $25.00Psychotherapy, 30 min (16-37) TAO $25.00Psychotherapy, 45 min (38-52 min.) $50.00Psychotherapy, 60 min (53+ min.) $50.00

Psychotherapy, 60 min (add-on) $15.00Pulse Oximetry $3.00Q Fever, Acute $60.00Quantitation of Therapeutic Drug - Remicade $171.50Quantitative assay, drug not elsewhere specified $76.00Rabies Immune Globulin, HT Human Im/Subq (Imogam) $970.00Rabies Titer $77.00Rabies Vaccine; Intramuscular (RabAvert) $355.00Rabies Vaccine; Intramuscular Post-Exposure (Imovax) $390.00Radiological Exam, Ankle, 2 Views $50.00Radiology- Film Copy Fee $0.00Rapid Strep Test $27.00Rast Allergen Profile Zone 3 $287.00RBC antibody screen $29.00Removal of Foreign Body, External Auditory Canal $161.00Removal of Foreign Body, External Eye $75.00Removal of Foreign Body, Subcutaneous $81.00Removal of Impacted Cerumen w/ instrumentation $50.00Removal of Impacted Cerumen, irrigation/lavage $35.00Removal of Intrauterine Device (IUD) $110.00Removal of Non-Biodegradable Drug Delivery Implant $140.00Removal of Skin Tags; each add'l 10 $26.00Removal of Skin Tags; up to 15 lesions $30.00Removal of sutures by MD other than MD that closed $10.00Removal w Reinsertion, Non-Biodegradable Drug Delivery $175.00Renal Function Panel $32.00Repair of Nail Bed $291.00Respiratory Panel $317.00Reticulocyte Count, automated $26.00Rheumatoid factor, quant $27.00Rib Belt, Female _OTC $17.00Rib Belt, Male _OTC $12.00Ribs, 3 views $120.00RIBS, UNI 2 VIEWS $90.00Ribs, unilateral, w/PA chest $100.00RIBS/CHEST4/> VIEWS $115.00Rickettsia $34.25Rocky Mountain Spotted Fever $62.00Rocky Mountain Spotted Fever $62.00Rohypnol (Urine) $129.00Rotavirus $35.00RPR Test Quantitative MHA $45.00RPR titer $62.00RSV Antigen $80.00RT3, T3/RT3 Ratio $161.00Rubella Antibody, IgG $24.00Rubella Antibody, IgG (For charge set) $12.00Rubeola IgG Ab (Rubeola) $44.00

Russel viper venon, diluted $67.00Sacroiliac Joints $88.00Sacrum and Coccyx $80.00Saline, Normal 1000 cc $57.00Scapula $78.00Sedimentation Rate $24.00Sedimentation Rate, manual $25.00Semen anal vol/count/mot $39.00Semen analysis & motility $79.00Serum Keppra Level $133.00Shingrix $195.00Shipping Medicine Charge $0.00SHOULDER, 1 VIEW $78.00Shoulder, 2 views $87.00Shoulder, 3 views $87.00Shoulder, 4 views $87.00Sickle Cell Screen $29.00Sinus, complete $100.00Sinus, Water's 1 view $80.00Skin Lesion Shave; 0.6-1.0 cm (trunk/arm/leg) $84.00Skull, < 4 views $95.00Skull, complete $100.00Sleeve Compression Knee Safe-T Sport _OTC $25.00Slide Review/Differential Manual $30.00Smear, fluorescent/acid stai $54.00Smear, Malaria $34.00Sofia 2 SARS COVID ANTIGEN $37.00Special Reports or Forms $0.00Special Supplies $0.00Specimen Handling/ Collection Fee $30.00Sperm Morphology Panel $79.00SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS $120.00SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6 $150.00SPINE, 1 VIEW, SPECIFY LEVEL $75.00Spine, Cervical, complete $120.00Spine, Cervical, flexion & extension $97.00Spine, Cervical, limited AP & lateral $90.00Spine, Cervical, min. 4 views $110.00SPINE, ENTIRE (SCOLIOSIS) 1 View $120.00SPINE, ENTIRE (SCOLIOSIS) 2-3 VIEWS $120.00Spine, Lumbar, AP & lateral $95.00Spine, Lumbar, complete $130.00Spine, Thoracic, 2 views $90.00Spine, Thoracic, 3 views including Swimmer's $100.00Spine, Thoracolumbar junction, 2/> views $95.00Sport Knee Sleeve (open patella only) _OTC $25.00Squared Toe Post-Op Shoe _OTC $13.00Statement of Health (Physical) $25.00

Sternoclavicular Joints $93.00Sternum $90.00Streptococcus Pneumonia IgG (23 Serotypes) $19.00Summer Health Fee $66.00Surgical Pathology|FP $0.00Syphilis Screen EIA $21.00Syphilis Test - RPR or VDRL $21.00T3, Free $26.00T3, Reverse $33.00T3, Total $27.00T3, Uptake $32.00T4 (Thyroxine), Total $32.00T4, Free $25.00TB TEST, CELL IMMUN MEASURE $81.00Tdap (Boostrix) $56.00Telepsychiatric Diagnostic Interview $149.00Telepsychiatric Diagnostic Interview w Medical Services $149.00Telepsychiatric Med Management, Comprehensive $102.00Telepsychiatric Med Management, Detailed $102.00Telepsychiatric Med Management, Expanded Prob Focused $102.00Telepsychiatric Med Management, Focused $102.00Temperomandibular Joint, bilateral $110.00Tennis Elbow Splint/Forearm Strap _OTC $17.00Testosterone, Free $29.00Testosterone, Free $39.00Testosterone, Free and Weakly Bound $35.00Testosterone, Total $26.00Testosterone, Total $40.00Tetanus/Diphtheria AB Profile $37.00Tetanus-diphtheria (Td) Vaccine, preservative free $46.00Thinprep Pap $84.00Thiopurine Metabolites (Labcorp) $162.00THROMBOPLASTIN TIME, PARTIAL $67.00Thumb-O-Prene, Universal _OTC $25.00Thyroglobulin Antibodies $45.00Thyroglobulin Antibodies $33.00Thyroglobulin, Quant. $73.00Thyroid Antibodies $64.00Thyroid Peroxidase Antibodies $66.00Thyroid Stimulating Hormone $24.00Thyroid Stimulating Immunoglobulin (TSI) $200.00Thyrotropin Receptor Antibody, Serum $34.00Thyroxine-Binding Globulin (TBG) $52.00Tibia and Fibula, 2 views $78.00Tibial Fracture, closed; proximal(plateau) without mani $466.00Tissue culture, lymphocyte $160.00Tissue Transglutaminase $31.00Toe(s) $70.00

Topiramate (Topamax) $80.00Toxoplasma antibody $36.00Toxoplasma antibody, IgM $46.00Toxoplasmosis, IgG, IgM $72.00TP/Creatinine Panel $30.00Transferrin $33.00TREAT EYE SOCKET FRACTURE $192.00Treponema pallidum (FTA) $45.00Triglycerides $21.00Trileptal (Oxcarbazepine) $33.00Tryptase $171.00T-SPOT REDRAW $0.00T-Spot TB AG RESPONSE T-CELL SUSP $74.00TT3, T3/RT3 Ratio $161.00Typhoid Vaccine, IM (Typhim) $128.00Typhoid Vaccine, Live, Oral $107.00Unlisted Psychiatric Service/Procedure $0.00Urea Nitrogen (Bun) $20.00Uric Acid $21.00Uric Acid 24 hr Urine $29.00Uric Acid, Body Fluid $33.00Urinalysis $24.00Urinalysis automated, w/o Micro. $24.00Urinalysis w/ Micro $24.00US XTR NON-VASC COMPLETE $151.00Valproic Acid $32.00Varicella [Chickenpox] Vaccine (Varivax) $169.00Varicella Antibody, IgG $35.00Varicella Antibody, IgM $50.00Venipuncture, Routine $10.00Vitamin A, Serum $44.00Vitamin B-12 $28.00Vitamin C $38.00Vitamin D 25-Hydroxy $39.00Vitamin D 25-Hydroxy, D2+D3 $81.00Vitamin D, 1, 25 dihydroxy $66.00Vitamin, not otherwise specified $94.00VMA, 24 hour urine $0.00Von Willebrand Factor (vWF) Activity $42.00WBC, Stool $26.00West Nile virus $71.00West Nile virus, IgM $71.00Western Blot, Lyme $43.00White Blood Cell Differential $23.00Wound Care by Provider $12.00WRIST, 2 VIEWS $90.00Wrist, complete $84.00Wrist-O-Prene, Universal _OTC $19.00

Yersinia Culture $44.00Zinc, RBC $78.00Zonisamide Level $117.00