|
CT Angiogram of the Head
|
$20,779.02 |
$20,779.02 |
$20,779.02 |
$2,041.78
|
|
CT angio hrt w/3d image
|
$17,508.85 |
$17,508.85 |
$17,508.85 |
$1,601.60
|
|
CT angio pelvis
|
$24,525.04 |
$24,525.04 |
$24,525.04 |
$1,778.40
|
|
CT guid parench tis ablat
|
$13,534.61 |
$13,534.61 |
$13,534.61 |
$1,282.50
|
|
CT heart w/evaluation of calcium without contrast
|
$107.03 |
$107.03 |
$107.03 |
$192.00
|
|
CT limited or localized follow-up study
|
$4,731.18 |
$4,731.18 |
$4,731.18 |
$630.50
|
|
CT neck soft tissue w/contrast
|
$15,930.50 |
$15,930.50 |
$15,930.50 |
$1,667.00
|
|
CT neck soft tissue without contrast
|
$10,807.30 |
$10,807.30 |
$10,807.30 |
$1,316.71
|
|
CT neck soft tissue without & w/contrast
|
$16,648.76 |
$16,648.76 |
$16,648.76 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$16,461.78 |
$16,461.78 |
$16,461.78 |
$1,661.25
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$14,564.92 |
$14,564.92 |
$14,564.92 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$12,110.99 |
$12,110.99 |
$12,110.99 |
$1,345.05
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$45,154.48 |
$45,154.48 |
$45,154.48 |
$3,328.00
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$41,714.09 |
$41,714.09 |
$41,714.09 |
$2,883.20
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$36,406.50 |
$36,406.50 |
$36,406.50 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$16,310.91 |
$16,310.91 |
$16,310.91 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$13,939.51 |
$13,939.51 |
$13,939.51 |
$1,436.50
|
|
CT thorax low dose for lung screening without contrast
|
$13,200.63 |
$13,200.63 |
$13,200.63 |
$420.60
|
|
CT t-spine w /wo contrast
|
$17,083.33 |
$17,083.33 |
$17,083.33 |
$2,030.60
|
|
Culture anaerobic additional method definitive id each
|
$500.72 |
$500.72 |
$500.72 |
$75.29
|
|
Culture anaerobic except blood
|
$1,912.12 |
$1,912.12 |
$1,912.12 |
$120.00
|
|
Culture bact stool aero addl path ea
|
$144.95 |
$144.95 |
$144.95 |
$52.50
|
|
Culture fungi definitive id yeast
|
$16.29 |
$16.29 |
$16.29 |
$79.00
|
|
Culture mycobacteria definitive id each isolate
|
$515.36 |
$515.36 |
$515.36 |
$88.14
|
|
Culture mycoplasma any source
|
$325.03 |
$325.03 |
$325.03 |
$90.37
|
|
Culture urine each isolate
|
$1,330.87 |
$1,330.87 |
$1,330.87 |
$46.20
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$6.75 |
$6.75 |
$6.75 |
$26.73
|
|
Cyclosporine 250 mg/5 ml intravenous solution
|
$591.00 |
$591.00 |
$591.00 |
$150.79
|
|
Cyclosporine modified 25 mg capsule
|
$24.50 |
$24.50 |
$24.50 |
$9.79
|
|
Cystine urine quantitative
|
$13.48 |
$13.48 |
$13.48 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$3,982.35 |
$3,982.35 |
$3,982.35 |
$527.50
|
|
Cytopath c/v index add-on
|
$108.34 |
$108.34 |
$108.34 |
$29.60
|
|
Cytopathology concentration technique smears & interpretation
|
$862.36 |
$862.36 |
$862.36 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$714.48 |
$714.48 |
$714.48 |
$122.40
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$325.03 |
$325.03 |
$325.03 |
$75.60
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$408.49 |
$408.49 |
$408.49 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$934.10 |
$934.10 |
$934.10 |
$203.08
|
|
Cytopath smear other source
|
$219.62 |
$219.62 |
$219.62 |
$135.27
|
|
Cytopath smear oth prep screen & interp
|
$219.62 |
$219.62 |
$219.62 |
$95.00
|
|
Dacarbazine 100 mg intravenous solution
|
$155.25 |
$155.25 |
$155.25 |
$61.64
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$4,125.50 |
$4,125.50 |
$4,125.50 |
$5,500.25
|
|
Decalcification
|
$437.77 |
$437.77 |
$437.77 |
$75.38
|
|
Deferoxamine 500 mg solution for injection
|
$440.25 |
$440.25 |
$440.25 |
$112.87
|
|
Detect agent nos dna dir
|
$8.00 |
$8.00 |
$8.00 |
$67.15
|
|
Device intraute mirena
|
$4,957.65 |
$4,957.65 |
$4,957.65 |
$2,289.60
|
|
Dextran 40 infusion
|
$227.00 |
$227.00 |
$227.00 |
$173.97
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$103.75 |
$103.75 |
$103.75 |
$43.65
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$10.85 |
$10.85 |
$10.85 |
$68.25
|
|
Dextrose 5 % IV bolus
|
$102.00 |
$102.00 |
$102.00 |
$68.25
|
|
Diab manage trn ind/group
|
$37.51 |
$37.51 |
$37.51 |
$49.50
|
|
Diagnostic Mammogram (both breasts)
|
$472.90 |
$472.90 |
$472.90 |
$403.32
|
|
Dialysis one evaluation
|
$919.55 |
$919.55 |
$919.55 |
$827.97
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$55.00 |
$55.00 |
$55.00 |
$67.89
|
|
Dicyclomine injection
|
$272.75 |
$272.75 |
$272.75 |
$210.00
|
|
Diffusing capacity
|
$1,117.11 |
$1,117.11 |
$1,117.11 |
$357.50
|
|
Digital analysis of eeg
|
$747.82 |
$747.82 |
$747.82 |
$641.56
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$42.50 |
$42.50 |
$42.50 |
$53.00
|
|
Digoxin immune fab 40 mg intravenous solution
|
$10,593.50 |
$10,593.50 |
$10,593.50 |
$9,684.65
|
|
Digoxin total therapeutic drug level
|
$1,390.90 |
$1,390.90 |
$1,390.90 |
$99.35
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$604.00 |
$604.00 |
$604.00 |
$308.90
|
|
Dimenhydrinate injection
|
$30.75 |
$30.75 |
$30.75 |
$24.68
|
|
Dimethyl sulfoxide 50% 50 ml
|
$1,488.50 |
$1,488.50 |
$1,488.50 |
$1,001.55
|
|
Diphenhydramine 12.5 mg/5 ml oral elixir
|
$6.75 |
$6.75 |
$6.75 |
$1.62
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$30.75 |
$30.75 |
$30.75 |
$22.58
|
|
Disability dlco
|
$331.22 |
$331.22 |
$331.22 |
$302.40
|
|
Discography cerv/thor spine
|
$8,907.58 |
$8,907.58 |
$8,907.58 |
$2,360.70
|
|
Dna probe chlamydia
|
$1,065.87 |
$1,065.87 |
$1,065.87 |
$82.20
|
|
Doppler echo complete
|
$3,290.39 |
$3,290.39 |
$3,290.39 |
$644.00
|
|
Dornase alfa non-comp unit
|
$446.75 |
$446.75 |
$446.75 |
$500.29
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$2,286.25 |
$2,286.25 |
$2,286.25 |
$2,469.31
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$144.96 |
$144.96 |
$144.96 |
$89.34
|
|
Droperidol 2.5 mg/ml injection solution
|
$30.75 |
$30.75 |
$30.75 |
$33.99
|
|
Drug assay caffeine
|
$128.84 |
$128.84 |
$128.84 |
$86.45
|
|
Drug test def 1-7 classes
|
$1,841.84 |
$1,841.84 |
$1,841.84 |
$263.86
|
|
Drug test def 8-14 classes
|
$96.00 |
$96.00 |
$96.00 |
$172.25
|
|
Drvvt confirm - quest
|
$21.00 |
$21.00 |
$21.00 |
$102.30
|
|
Dup scan/hemodialysis access 93990
|
$4,020.42 |
$4,020.42 |
$4,020.42 |
$499.38
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$5,373.25 |
$5,373.25 |
$5,373.25 |
$885.60
|
|
Ecg external < 48 hours recording
|
$1,374.88 |
$1,374.88 |
$1,374.88 |
$461.76
|
|
Ecg external < 48 hours scanning analysis w/report
|
$1,374.88 |
$1,374.88 |
$1,374.88 |
$567.00
|
|
Echocardiograpy doppler follow up/limited study
|
$1,499.29 |
$1,499.29 |
$1,499.29 |
$354.90
|
|
Echo guidance radiotherapy
|
$4,396.69 |
$4,396.69 |
$4,396.69 |
$769.18
|
|
Echo guide for amniocentesis
|
$4,412.79 |
$4,412.79 |
$4,412.79 |
$377.11
|
|
Echo guide for artery repair
|
$8,906.12 |
$8,906.12 |
$8,906.12 |
$676.80
|
|
Echo stress
|
$7,127.02 |
$7,127.02 |
$7,127.02 |
$1,607.45
|
|
Echo tee cngntl wo ctrst probe plcmnt
|
$9,675.68 |
$9,675.68 |
$9,675.68 |
$648.84
|
|
Echo transesophageal intraop
|
$9,675.68 |
$9,675.68 |
$9,675.68 |
$1,571.70
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$6,580.78 |
$6,580.78 |
$6,580.78 |
$1,020.09
|
|
Eeg/cerebral death evaluation only 95824 -26
|
$2,406.33 |
$2,406.33 |
$2,406.33 |
$1,048.30
|
|
Eeg during surgery
|
$2,560.32 |
$2,560.32 |
$2,560.32 |
$775.45
|
|
Eeg monitor/record/awake/drowsy 95816
|
$2,406.33 |
$2,406.33 |
$2,406.33 |
$861.12
|
|
Eeg over 1 hour 95813 - 26
|
$1,102.94 |
$1,102.94 |
$1,102.94 |
$1,100.40
|
|
Eeg recording awake and asleep
|
$2,406.33 |
$2,406.33 |
$2,406.33 |
$1,030.27
|
|
E equine encephalitis igg
|
$40.75 |
$40.75 |
$40.75 |
$48.73
|
|
Egfr gene com variants
|
$1,098.49 |
$1,098.49 |
$1,098.49 |
$646.75
|
|
Electrolyte panel
|
$2,426.02 |
$2,426.02 |
$2,426.02 |
$86.33
|
|
Electron microscopy diagnostic
|
$75.00 |
$75.00 |
$75.00 |
$1,006.20
|
|
Encephalitis, california igg/igm
|
$40.75 |
$40.75 |
$40.75 |
$48.57
|
|
Encephalitis, st louis igg/igm
|
$40.75 |
$40.75 |
$40.75 |
$48.57
|
|
Encephalitis, western equine igg/igm
|
$40.75 |
$40.75 |
$40.75 |
$50.35
|