|
Cryofibrinogen qualitative - sendout
|
$2.00 |
$2.00 |
$2.00 |
$50.88
|
|
Crystal identification light microscopy
|
$629.92 |
$629.92 |
$629.92 |
$58.50
|
|
CT 3d report other modality w/workstation
|
$247.48 |
$247.48 |
$247.48 |
$613.47
|
|
Cta abdomen without & /or w/contrast
|
$26,341.51 |
$26,341.51 |
$26,341.51 |
$2,050.23
|
|
Cta abdominal aorta & (both sides) ileofemoral lower extremity w runoff without & w/contrast
|
$26,341.51 |
$26,341.51 |
$26,341.51 |
$2,092.73
|
|
Cta neck without &/or w/contrast
|
$21,773.00 |
$21,773.00 |
$21,773.00 |
$1,944.00
|
|
CT Angiogram of Abdomen and Pelvis
|
$52,683.01 |
$52,683.01 |
$52,683.01 |
$2,839.85
|
|
CT Angiogram of the Chest (for blood clot)
|
$26,341.51 |
$26,341.51 |
$26,341.51 |
$2,017.89
|
|
CT Angiogram of the Head
|
$19,883.85 |
$19,883.85 |
$19,883.85 |
$2,041.78
|
|
CT angio hrt w/3d image
|
$25,949.47 |
$25,949.47 |
$25,949.47 |
$1,601.60
|
|
CT angio pelvis
|
$26,341.51 |
$26,341.51 |
$26,341.51 |
$1,778.40
|
|
CT colonography dx
|
$5,362.40 |
$5,362.40 |
$5,362.40 |
$770.90
|
|
CT colonography dx w/dye
|
$5,362.40 |
$5,362.40 |
$5,362.40 |
$1,009.98
|
|
CT colonography screening
|
$5,362.40 |
$5,362.40 |
$5,362.40 |
$1,084.20
|
|
CT guidance for needle placement
|
$9,238.70 |
$9,238.70 |
$9,238.70 |
$1,506.04
|
|
CT guidance for percutaneous drain w/catheter placement supervision & interpretation
|
$9,638.86 |
$9,638.86 |
$9,638.86 |
$1,058.40
|
|
CT guid parench tis ablat
|
$9,238.70 |
$9,238.70 |
$9,238.70 |
$1,282.50
|
|
CT limited or localized follow-up study
|
$6,687.99 |
$6,687.99 |
$6,687.99 |
$630.50
|
|
CT neck soft tissue w/contrast
|
$17,846.46 |
$17,846.46 |
$17,846.46 |
$1,667.00
|
|
CT neck soft tissue without contrast
|
$19,390.13 |
$19,390.13 |
$19,390.13 |
$1,316.71
|
|
CT neck soft tissue without & w/contrast
|
$22,125.84 |
$22,125.84 |
$22,125.84 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$19,812.79 |
$19,812.79 |
$19,812.79 |
$1,661.25
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$15,940.16 |
$15,940.16 |
$15,940.16 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$17,464.22 |
$17,464.22 |
$17,464.22 |
$1,345.05
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$44,436.68 |
$44,436.68 |
$44,436.68 |
$3,328.00
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$44,521.21 |
$44,521.21 |
$44,521.21 |
$2,883.20
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$36,982.99 |
$36,982.99 |
$36,982.99 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$25,834.31 |
$25,834.31 |
$25,834.31 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$22,008.23 |
$22,008.23 |
$22,008.23 |
$1,436.50
|
|
CT thorax low dose for lung screening without contrast
|
$18,417.38 |
$18,417.38 |
$18,417.38 |
$420.60
|
|
CT t-spine w /wo contrast
|
$29,509.70 |
$29,509.70 |
$29,509.70 |
$2,030.60
|
|
Culture aerobic additional method definitive id each
|
$537.27 |
$537.27 |
$537.27 |
$62.65
|
|
Culture anaerobic except blood
|
$2,191.83 |
$2,191.83 |
$2,191.83 |
$120.00
|
|
Culture mycobacteria definitive id each isolate
|
$22.64 |
$22.64 |
$22.64 |
$88.14
|
|
Culture mycoplasma any source
|
$35.00 |
$35.00 |
$35.00 |
$90.37
|
|
Culture typing immunologic
|
$195.44 |
$195.44 |
$195.44 |
$41.19
|
|
Culture urine each isolate
|
$78.28 |
$78.28 |
$78.28 |
$46.20
|
|
Cyanocobalamin unsat binding capacity
|
$8.15 |
$8.15 |
$8.15 |
$60.75
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$16.57 |
$16.57 |
$16.57 |
$26.73
|
|
Cyclosporine 250 mg/5 ml intravenous solution
|
$445.08 |
$445.08 |
$445.08 |
$150.79
|
|
Cystogram >= 3 views supervision & interpretation
|
$1,384.24 |
$1,384.24 |
$1,384.24 |
$527.50
|
|
Cytarabine 20 mg/ml injection solution
|
$45.00 |
$45.00 |
$45.00 |
$66.95
|
|
Cytopathology cellular enhancement technique non-gyn
|
$240.71 |
$240.71 |
$240.71 |
$163.43
|
|
Cytopathology concentration technique smears & interpretation
|
$1,191.31 |
$1,191.31 |
$1,191.31 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$780.11 |
$780.11 |
$780.11 |
$122.40
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$71.91 |
$71.91 |
$71.91 |
$75.60
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$467.89 |
$467.89 |
$467.89 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$1,445.58 |
$1,445.58 |
$1,445.58 |
$203.08
|
|
Cytopath smear oth prep screen & interp
|
$411.63 |
$411.63 |
$411.63 |
$95.00
|
|
Cytopath tbs c/v manual
|
$101.11 |
$101.11 |
$101.11 |
$57.94
|
|
Dacarbazine 100 mg intravenous solution
|
$38.14 |
$38.14 |
$38.14 |
$61.64
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$2,088.42 |
$2,088.42 |
$2,088.42 |
$544.35
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$7,572.04 |
$7,572.04 |
$7,572.04 |
$5,500.25
|
|
Dch glucoscan
|
$327.88 |
$327.88 |
$327.88 |
$23.25
|
|
Decalcification
|
$473.83 |
$473.83 |
$473.83 |
$75.38
|
|
Decitabine 50 mg intravenous solution
|
$2,719.26 |
$2,719.26 |
$2,719.26 |
$1,026.60
|
|
Deferoxamine 500 mg solution for injection
|
$332.25 |
$332.25 |
$332.25 |
$112.87
|
|
Degarelix 120 mg subcutaneous solution
|
$3,087.76 |
$3,087.76 |
$3,087.76 |
$1,963.06
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$4,279.77 |
$4,279.77 |
$4,279.77 |
$222.30
|
|
Dextran 40 infusion
|
$299.12 |
$299.12 |
$299.12 |
$173.97
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$29.00 |
$29.00 |
$29.00 |
$43.65
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$19.17 |
$19.17 |
$19.17 |
$68.25
|
|
Dextrose 5 % IV bolus
|
$28.75 |
$28.75 |
$28.75 |
$68.25
|
|
Diab manage trn ind/group
|
$91.96 |
$91.96 |
$91.96 |
$49.50
|
|
Diagnostic Mammogram (both breasts)
|
$968.00 |
$968.00 |
$968.00 |
$403.32
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$167.21 |
$167.21 |
$167.21 |
$67.89
|
|
Dicyclomine injection
|
$604.80 |
$604.80 |
$604.80 |
$210.00
|
|
Diffusing capacity
|
$1,459.26 |
$1,459.26 |
$1,459.26 |
$357.50
|
|
Digoxin immune fab 40 mg intravenous solution
|
$19,761.84 |
$19,761.84 |
$19,761.84 |
$9,684.65
|
|
Digoxin total therapeutic drug level
|
$840.18 |
$840.18 |
$840.18 |
$99.35
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$418.82 |
$418.82 |
$418.82 |
$308.90
|
|
Dimenhydrinate injection
|
$38.76 |
$38.76 |
$38.76 |
$24.68
|
|
Dimethyl sulfoxide 50% 50 ml
|
$1,507.47 |
$1,507.47 |
$1,507.47 |
$1,001.55
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$16.57 |
$16.57 |
$16.57 |
$22.58
|
|
Disability dlco
|
$1,732.72 |
$1,732.72 |
$1,732.72 |
$302.40
|
|
Discography cerv/thor spine
|
$6,125.02 |
$6,125.02 |
$6,125.02 |
$2,360.70
|
|
Dna probe chlamydia
|
$3.25 |
$3.25 |
$3.25 |
$82.20
|
|
Dna probe gc
|
$3.25 |
$3.25 |
$3.25 |
$88.67
|
|
Doppler echo complete
|
$3,721.76 |
$3,721.76 |
$3,721.76 |
$644.00
|
|
Dornase alfa non-comp unit
|
$498.89 |
$498.89 |
$498.89 |
$500.29
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$10,716.38 |
$10,716.38 |
$10,716.38 |
$2,469.31
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$50.96 |
$50.96 |
$50.96 |
$89.34
|
|
Droperidol 2.5 mg/ml injection solution
|
$44.28 |
$44.28 |
$44.28 |
$33.99
|
|
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm
|
$853.51 |
$853.51 |
$853.51 |
$189.68
|
|
Drug test def 1-7 classes
|
$511.47 |
$511.47 |
$511.47 |
$263.86
|
|
Dup scan/hemodialysis access 93990
|
$6,072.99 |
$6,072.99 |
$6,072.99 |
$499.38
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$10,807.72 |
$10,807.72 |
$10,807.72 |
$750.20
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$12,965.15 |
$12,965.15 |
$12,965.15 |
$885.60
|
|
Ecg/1-3 leads/tracing only 93041
|
$552.01 |
$552.01 |
$552.01 |
$129.83
|
|
Ecg < 30 days transmission & analysis
|
$3,691.07 |
$3,691.07 |
$3,691.07 |
$441.40
|
|
Ecg external < 48 hours recording
|
$2,350.47 |
$2,350.47 |
$2,350.47 |
$461.76
|
|
Ecg external < 48 hours scanning analysis w/report
|
$3,691.07 |
$3,691.07 |
$3,691.07 |
$567.00
|
|
Echocardiogram (Heart Ultrasound)
|
$14,193.16 |
$14,193.16 |
$14,193.16 |
$2,049.45
|
|
Echocardiography doppler color flow mapping
|
$6,566.67 |
$6,566.67 |
$6,566.67 |
$461.61
|
|
Echocardiography transthoracic 2d followup/limited
|
$4,921.41 |
$4,921.41 |
$4,921.41 |
$773.30
|
|
Echocardiograpy doppler follow up/limited study
|
$4,405.23 |
$4,405.23 |
$4,405.23 |
$354.90
|
|
Echo guidance radiotherapy
|
$7,573.39 |
$7,573.39 |
$7,573.39 |
$769.18
|
|
Echo guide for amniocentesis
|
$3,902.25 |
$3,902.25 |
$3,902.25 |
$377.11
|
|
Echo stress
|
$18,887.18 |
$18,887.18 |
$18,887.18 |
$1,607.45
|
|
Echo tee guidance
|
$12,683.92 |
$12,683.92 |
$12,683.92 |
$2,007.00
|