|
Culture fungi other (except blood)
|
$77.44 |
$77.44 |
$77.44 |
$108.00
|
|
Culture fungi skin/hair/nail
|
$41.44 |
$41.44 |
$41.44 |
$74.88
|
|
Culture mycobacteria definitive id each isolate
|
$31.04 |
$31.04 |
$31.04 |
$89.70
|
|
Culture mycoplasma any source
|
$7.02 |
$7.02 |
$7.02 |
$85.26
|
|
Culture screening strep group a
|
$48.96 |
$48.96 |
$48.96 |
$81.00
|
|
Culture typing added method
|
$3.29 |
$3.29 |
$3.29 |
$38.58
|
|
Culture typing immunologic
|
$22.08 |
$22.08 |
$22.08 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$3.69 |
$3.69 |
$3.69 |
$133.90
|
|
Culture urine each isolate
|
$51.52 |
$51.52 |
$51.52 |
$57.00
|
|
Cutter lead
|
$401.12 |
$401.12 |
$401.12 |
$6,092.06
|
|
Cv line/pic reposition
|
$652.16 |
$652.16 |
$652.16 |
$1,720.93
|
|
Cyanocobalamin unsat binding capacity
|
$2.04 |
$2.04 |
$2.04 |
$64.00
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$8.00 |
$8.00 |
$8.00 |
$25.20
|
|
Cyclic citrullinated peptide antibody
|
$3.20 |
$3.20 |
$3.20 |
$70.72
|
|
Cyclosporine 2 hour
|
$2.57 |
$2.57 |
$2.57 |
$129.48
|
|
Cyclosporine modified 25 mg capsule
|
$3.40 |
$3.40 |
$3.40 |
$7.48
|
|
Cyclosporine oral 100 mg
|
$12.97 |
$12.97 |
$12.97 |
$34.88
|
|
Cyp2c19 gene com variants
|
$20.80 |
$20.80 |
$20.80 |
$504.00
|
|
Cyp2c9 gene com variants
|
$16.00 |
$16.00 |
$16.00 |
$275.10
|
|
Cyp2d6 gene com variants
|
$28.80 |
$28.80 |
$28.80 |
$554.00
|
|
Cyp3a4 gene common variants
|
$11.20 |
$11.20 |
$11.20 |
$245.31
|
|
Cyp3a5 gene common variants
|
$11.20 |
$11.20 |
$11.20 |
$245.31
|
|
Cystatin c
|
$38.56 |
$38.56 |
$38.56 |
$77.50
|
|
Cystic fibrosis cftr
|
$198.97 |
$198.97 |
$198.97 |
$1,100.00
|
|
Cystine urine quantitative
|
$2.94 |
$2.94 |
$2.94 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$284.48 |
$284.48 |
$284.48 |
$542.10
|
|
Cytogenetics 3-5
|
$3.00 |
$3.00 |
$3.00 |
$170.27
|
|
Cytogenomic neo microra alys
|
$245.60 |
$245.60 |
$245.60 |
$2,020.20
|
|
Cytomegalovirus (cmv) antibody igg
|
$19.95 |
$19.95 |
$19.95 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$2.30 |
$2.30 |
$2.30 |
$97.50
|
|
Cytopath c/v manual
|
$10.56 |
$10.56 |
$10.56 |
$36.80
|
|
Cytopath fl nongyn filter
|
$23.20 |
$23.20 |
$23.20 |
$92.63
|
|
Cytopathology cellular enhancement technique non-gyn
|
$90.72 |
$90.72 |
$90.72 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$5.41 |
$5.41 |
$5.41 |
$91.84
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$28.96 |
$28.96 |
$28.96 |
$87.50
|
|
Cytopathology concentration technique smears & interpretation
|
$56.00 |
$56.00 |
$56.00 |
$129.60
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$46.56 |
$46.56 |
$46.56 |
$129.35
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$24.00 |
$24.00 |
$24.00 |
$67.20
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$85.60 |
$85.60 |
$85.60 |
$187.28
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$53.76 |
$53.76 |
$53.76 |
$209.23
|
|
Cytopath smear other source
|
$51.36 |
$51.36 |
$51.36 |
$88.13
|
|
Cytopath smear other source
|
$56.64 |
$56.64 |
$56.64 |
$140.00
|
|
Cytopath smear oth prep screen & interp
|
$35.20 |
$35.20 |
$35.20 |
$96.20
|
|
Cytopath tbs c/v manual
|
$12.32 |
$12.32 |
$12.32 |
$59.28
|
|
Cytp urine 3-5 probes cmptr
|
$71.52 |
$71.52 |
$71.52 |
$690.00
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$73.56 |
$73.56 |
$73.56 |
$168.53
|
|
Dark field exam without collj
|
$1.67 |
$1.67 |
$1.67 |
$28.80
|
|
Dch glucoscan
|
$23.52 |
$23.52 |
$23.52 |
$28.10
|
|
Dch validity tests
|
$14.88 |
$14.88 |
$14.88 |
$24.50
|
|
Dcm pq ndl dsk sgl/mlt lv lmbr w/guide
|
$1,020.96 |
$1,020.96 |
$1,020.96 |
$4,952.36
|
|
Deamidated gliadin antibody iga
|
$85.44 |
$85.44 |
$85.44 |
$43.60
|
|
Debridement (>20 cm) charge pt
|
$102.08 |
$102.08 |
$102.08 |
$260.61
|
|
Decalcification
|
$23.04 |
$23.04 |
$23.04 |
$68.90
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$368.48 |
$368.48 |
$368.48 |
$543.00
|
|
Deferoxamine 500 mg solution for injection
|
$14.20 |
$14.20 |
$14.20 |
$95.85
|
|
Delivery of placenta 59414
|
$192.00 |
$192.00 |
$192.00 |
$3,070.56
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$43.84 |
$43.84 |
$43.84 |
$185.17
|
|
Desmopressin 4 mcg/ml injection solution
|
$45.73 |
$45.73 |
$45.73 |
$89.78
|
|
Desoxycorticosterone
|
$5.08 |
$5.08 |
$5.08 |
$109.28
|
|
Devel tst phys/qhp 1st hr
|
$157.60 |
$157.60 |
$157.60 |
$337.50
|
|
Device ablt adv novasure
|
$360.00 |
$360.00 |
$360.00 |
$6,097.50
|
|
Device hemospray 7frx220cm endo hemostat min access
|
$2,400.00 |
$2,400.00 |
$2,400.00 |
$4,200.00
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$55.84 |
$55.84 |
$55.84 |
$200.00
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$170.40 |
$170.40 |
$170.40 |
$227.15
|
|
Dexamethasone 4 mg tablet
|
$1.28 |
$1.28 |
$1.28 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$14.33 |
$14.33 |
$14.33 |
$21.17
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$20.36 |
$20.36 |
$20.36 |
$38.08
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$20.53 |
$20.53 |
$20.53 |
$45.40
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$18.93 |
$18.93 |
$18.93 |
$47.48
|
|
Dextrose 5 % IV bolus
|
$19.20 |
$19.20 |
$19.20 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$3.14 |
$3.14 |
$3.14 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$54.08 |
$54.08 |
$54.08 |
$79.20
|
|
Diagnostic anoscopy spx 46600
|
$39.84 |
$39.84 |
$39.84 |
$190.68
|
|
Diagnostic Mammogram (both breasts)
|
$174.72 |
$174.72 |
$174.72 |
$399.30
|
|
Diagnostic Mammogram (one breast)
|
$136.48 |
$136.48 |
$136.48 |
$301.55
|
|
Dialysis circuit perm vascular embolization 36909
|
$1,598.40 |
$1,598.40 |
$1,598.40 |
$5,419.00
|
|
Dialysis one evaluation
|
$341.12 |
$341.12 |
$341.12 |
$919.55
|
|
Dialysis repeated eval
|
$238.72 |
$238.72 |
$238.72 |
$1,267.50
|
|
Diatrizoate meglumine 18 % urethral solution
|
$0.51 |
$0.51 |
$0.51 |
$115.15
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$40.31 |
$40.31 |
$40.31 |
$74.76
|
|
Dicyclomine injection
|
$92.34 |
$92.34 |
$92.34 |
$153.29
|
|
Diffusing capacity
|
$170.88 |
$170.88 |
$170.88 |
$332.00
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$10.61 |
$10.61 |
$10.61 |
$69.03
|
|
Digoxin total therapeutic drug level
|
$63.52 |
$63.52 |
$63.52 |
$102.00
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$100.11 |
$100.11 |
$100.11 |
$297.86
|
|
Dilation of salivary duct
|
$120.16 |
$120.16 |
$120.16 |
$741.60
|
|
Dilator fascial 10fx20cm
|
$508.48 |
$508.48 |
$508.48 |
$402.10
|
|
Diltiazem 5 mg/ml intravenous solution
|
$16.16 |
$16.16 |
$16.16 |
$47.94
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$8.00 |
$8.00 |
$8.00 |
$17.75
|
|
Disaccharidases
|
$53.89 |
$53.89 |
$53.89 |
$216.00
|
|
Discography cerv/thor spine
|
$732.16 |
$732.16 |
$732.16 |
$2,565.00
|
|
Dmd dup/delet analysis
|
$44.64 |
$44.64 |
$44.64 |
$404.03
|
|
Dmpk gene detc abnor allele
|
$17.54 |
$17.54 |
$17.54 |
$313.60
|
|
Dna antibody native/double stranded
|
$8.48 |
$8.48 |
$8.48 |
$97.50
|
|
Dna gardnerella
|
$23.36 |
$23.36 |
$23.36 |
$62.50
|
|
Dna probe chlamydia
|
$54.88 |
$54.88 |
$54.88 |
$79.38
|
|
Dna trichomonas
|
$23.36 |
$23.36 |
$23.36 |
$67.80
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$33.11 |
$33.11 |
$33.11 |
$98.43
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$16.09 |
$16.09 |
$16.09 |
$65.40
|
|
Doppler echo complete
|
$276.00 |
$276.00 |
$276.00 |
$540.00
|
