|
Cta abdominal aorta & (both sides) ileofemoral lower extremity w runoff without & w/contrast
|
$2,561.60 |
$2,561.60 |
$2,561.60 |
$2,092.73
|
|
Cta lower extremity without & w/contrast (both sides)
|
$1,460.80 |
$1,460.80 |
$1,460.80 |
$2,079.00
|
|
Cta neck without &/or w/contrast
|
$2,140.40 |
$2,140.40 |
$2,140.40 |
$1,987.50
|
|
CT Angiogram of Abdomen and Pelvis
|
$3,413.60 |
$3,413.60 |
$3,413.60 |
$2,839.85
|
|
CT Angiogram of the Chest (for blood clot)
|
$1,460.80 |
$1,460.80 |
$1,460.80 |
$2,057.90
|
|
CT Angiogram of the Head
|
$2,039.20 |
$2,039.20 |
$2,039.20 |
$2,080.00
|
|
CT angio hrt w/3d image
|
$507.20 |
$507.20 |
$507.20 |
$1,601.60
|
|
CT angio pelvis
|
$2,567.60 |
$2,567.60 |
$2,567.60 |
$1,802.35
|
|
Cta upper extremity w &/or without contrast left
|
$2,563.60 |
$2,563.60 |
$2,563.60 |
$1,691.30
|
|
CT guidance for needle placement
|
$1,110.00 |
$1,110.00 |
$1,110.00 |
$1,506.04
|
|
CT guidance for percutaneous drain w/catheter placement supervision & interpretation
|
$1,836.80 |
$1,836.80 |
$1,836.80 |
$1,058.40
|
|
CT guid parench tis ablat
|
$2,968.40 |
$2,968.40 |
$2,968.40 |
$1,282.50
|
|
CT hrt w/3d image
|
$507.20 |
$507.20 |
$507.20 |
$1,481.04
|
|
CT limited or localized follow-up study
|
$528.40 |
$528.40 |
$528.40 |
$640.48
|
|
CT lower extremity w/contrast (both sides)
|
$1,152.40 |
$1,152.40 |
$1,152.40 |
$1,693.20
|
|
CT lower extremity without contrast (both sides)
|
$1,152.40 |
$1,152.40 |
$1,152.40 |
$1,403.73
|
|
CT lwr extremity w/o&w/dye
|
$1,152.40 |
$1,152.40 |
$1,152.40 |
$1,844.52
|
|
CT neck soft tissue w/contrast
|
$1,042.80 |
$1,042.80 |
$1,042.80 |
$1,669.00
|
|
CT neck soft tissue without contrast
|
$1,110.00 |
$1,110.00 |
$1,110.00 |
$1,344.60
|
|
CT neck soft tissue without & w/contrast
|
$1,110.00 |
$1,110.00 |
$1,110.00 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$1,647.20 |
$1,647.20 |
$1,647.20 |
$1,661.25
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$1,384.00 |
$1,384.00 |
$1,384.00 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$1,384.40 |
$1,384.40 |
$1,384.40 |
$1,365.36
|
|
CT scan for therapy guide
|
$577.20 |
$577.20 |
$577.20 |
$771.10
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$1,460.80 |
$1,460.80 |
$1,460.80 |
$3,472.30
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$1,460.80 |
$1,460.80 |
$1,460.80 |
$2,979.85
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$1,460.80 |
$1,460.80 |
$1,460.80 |
$2,405.40
|
|
CT thoracic spine w/contrast
|
$1,578.40 |
$1,578.40 |
$1,578.40 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$1,413.60 |
$1,413.60 |
$1,413.60 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$1,313.20 |
$1,313.20 |
$1,313.20 |
$420.60
|
|
CT t-spine w /wo contrast
|
$1,878.80 |
$1,878.80 |
$1,878.80 |
$2,033.46
|
|
CT upper extremity w/contrast (both sides)
|
$1,421.20 |
$1,421.20 |
$1,421.20 |
$1,714.05
|
|
CT upper extremity without contrast (both sides)
|
$1,421.20 |
$1,421.20 |
$1,421.20 |
$1,473.75
|
|
CT uppr extremity w/o&w/dye
|
$1,692.40 |
$1,692.40 |
$1,692.40 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$34.90 |
$34.90 |
$34.90 |
$64.58
|
|
Culture afb any source
|
$82.98 |
$82.98 |
$82.98 |
$108.63
|
|
Culture anaerobic additional method definitive id each
|
$34.90 |
$34.90 |
$34.90 |
$77.31
|
|
Culture anaerobic except blood
|
$90.31 |
$90.31 |
$90.31 |
$123.20
|
|
Culture bact stool aero addl path ea
|
$22.42 |
$22.42 |
$22.42 |
$52.50
|
|
Culture body fluid
|
$227.45 |
$227.45 |
$227.45 |
$130.50
|
|
Culture fungi definitive id mold
|
$39.34 |
$39.34 |
$39.34 |
$70.00
|
|
Culture fungi definitive id yeast
|
$39.34 |
$39.34 |
$39.34 |
$79.10
|
|
Culture fungi other (except blood)
|
$76.84 |
$76.84 |
$76.84 |
$96.00
|
|
Culture fungi skin/hair/nail
|
$16.64 |
$16.64 |
$16.64 |
$76.80
|
|
Culture mycobacteria definitive id each isolate
|
$30.72 |
$30.72 |
$30.72 |
$88.14
|
|
Culture quantitative aerobic other source
|
$19.32 |
$19.32 |
$19.32 |
$85.80
|
|
Culture screening strep group a
|
$78.47 |
$78.47 |
$78.47 |
$78.80
|
|
Culture typing immunologic
|
$13.21 |
$13.21 |
$13.21 |
$42.12
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$101.45 |
$101.45 |
$101.45 |
$124.02
|
|
Culture urine each isolate
|
$35.95 |
$35.95 |
$35.95 |
$46.20
|
|
Cyanocobalamin unsat binding capacity
|
$6.82 |
$6.82 |
$6.82 |
$60.00
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$39.37 |
$39.37 |
$39.37 |
$27.13
|
|
Cyclic citrullinated peptide antibody
|
$21.56 |
$21.56 |
$21.56 |
$83.20
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$1.44 |
$1.44 |
$1.44 |
$779.37
|
|
Cyclophosphamide 25 mg capsule
|
$10.04 |
$10.04 |
$10.04 |
$25.76
|
|
Cyclosporine 2 hour
|
$99.06 |
$99.06 |
$99.06 |
$119.40
|
|
Cyclosporine modified 25 mg capsule
|
$5.11 |
$5.11 |
$5.11 |
$9.79
|
|
Cyclosporine oral 100 mg
|
$16.32 |
$16.32 |
$16.32 |
$43.84
|
|
Cyp2c19 gene com variants
|
$151.46 |
$151.46 |
$151.46 |
$553.00
|
|
Cystatin c
|
$24.80 |
$24.80 |
$24.80 |
$82.50
|
|
Cystic fibrosis cftr
|
$480.00 |
$480.00 |
$480.00 |
$1,041.95
|
|
Cystine urine quantitative
|
$56.70 |
$56.70 |
$56.70 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$392.80 |
$392.80 |
$392.80 |
$527.50
|
|
Cytarabine 20 mg/ml injection solution
|
$52.02 |
$52.02 |
$52.02 |
$70.80
|
|
Cytogenomic neo microra alys
|
$614.00 |
$614.00 |
$614.00 |
$1,742.40
|
|
Cytomegalovirus (cmv) antibody igg
|
$92.70 |
$92.70 |
$92.70 |
$102.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$64.38 |
$64.38 |
$64.38 |
$101.24
|
|
Cyto/molecular report
|
$45.14 |
$45.14 |
$45.14 |
$150.30
|
|
Cytopathology cellular enhancement technique non-gyn
|
$48.00 |
$48.00 |
$48.00 |
$163.43
|
|
Cytopathology concentration technique smears & interpretation
|
$104.40 |
$104.40 |
$104.40 |
$142.94
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$147.60 |
$147.60 |
$147.60 |
$205.00
|
|
Cytopath tbs c/v manual
|
$29.60 |
$29.60 |
$29.60 |
$57.94
|
|
Cytp urine 3-5 probes cmptr
|
$226.84 |
$226.84 |
$226.84 |
$690.00
|
|
Dacarbazine 100 mg intravenous solution
|
$7.74 |
$7.74 |
$7.74 |
$65.60
|
|
Dactinomycin 0.5 mg intravenous solution
|
$1,225.86 |
$1,225.86 |
$1,225.86 |
$2,281.50
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$0.18 |
$0.18 |
$0.18 |
$466.31
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$32.22 |
$32.22 |
$32.22 |
$5,500.25
|
|
Darbepoetin alfa, esrd use
|
$6.28 |
$6.28 |
$6.28 |
$3.04
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$85.16 |
$85.16 |
$85.16 |
$194.08
|
|
Dch glucoscan
|
$4.54 |
$4.54 |
$4.54 |
$23.25
|
|
Dch validity tests
|
$13.52 |
$13.52 |
$13.52 |
$25.00
|
|
Deamidated gliadin antibody iga
|
$20.12 |
$20.12 |
$20.12 |
$43.86
|
|
Decalcification
|
$6.80 |
$6.80 |
$6.80 |
$75.38
|
|
Decitabine 50 mg intravenous solution
|
$66.17 |
$66.17 |
$66.17 |
$1,026.54
|
|
Deferoxamine 500 mg solution for injection
|
$71.20 |
$71.20 |
$71.20 |
$112.80
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$39.08 |
$39.08 |
$39.08 |
$7,703.58
|
|
Desmopressin 4 mcg/ml injection solution
|
$28.82 |
$28.82 |
$28.82 |
$163.62
|
|
Desoxycorticosterone
|
$98.80 |
$98.80 |
$98.80 |
$109.28
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$71.20 |
$71.20 |
$71.20 |
$225.60
|
|
Dexamethasone 4 mg tablet
|
$4.28 |
$4.28 |
$4.28 |
$5.40
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$8.76 |
$8.76 |
$8.76 |
$23.79
|
|
Dextran 40 infusion
|
$50.22 |
$50.22 |
$50.22 |
$173.97
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$8.78 |
$8.78 |
$8.78 |
$43.65
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$7.56 |
$7.56 |
$7.56 |
$47.66
|
|
Dhea-s (dehydroepiand sulfate)
|
$111.78 |
$111.78 |
$111.78 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$207.28 |
$207.28 |
$207.28 |
$79.30
|
|
Diagnostic Mammogram (both breasts)
|
$509.20 |
$509.20 |
$509.20 |
$421.20
|
|
Diagnostic Mammogram (one breast)
|
$346.00 |
$346.00 |
$346.00 |
$289.85
|
|
Diagnostic radio unlisted proc
|
$355.60 |
$355.60 |
$355.60 |
$259.00
|
|
Diatrizoate meglumine 18 % urethral solution
|
$0.17 |
$0.17 |
$0.17 |
$122.25
|