|
Cta neck without &/or w/contrast
|
$18,197.00 |
$18,197.00 |
$18,197.00 |
$1,944.00
|
|
CT Angiogram of Abdomen and Pelvis
|
$36,390.00 |
$36,390.00 |
$36,390.00 |
$2,839.85
|
|
CT Angiogram of the Chest (for blood clot)
|
$18,197.00 |
$18,197.00 |
$18,197.00 |
$2,017.89
|
|
CT Angiogram of the Head
|
$18,197.00 |
$18,197.00 |
$18,197.00 |
$2,041.78
|
|
CT angio hrt w/3d image
|
$2,397.00 |
$2,397.00 |
$2,397.00 |
$1,601.60
|
|
CT angio pelvis
|
$18,197.00 |
$18,197.00 |
$18,197.00 |
$1,778.40
|
|
CT guidance for needle placement
|
$11,370.00 |
$11,370.00 |
$11,370.00 |
$1,506.04
|
|
CT guid parench tis ablat
|
$11,370.00 |
$11,370.00 |
$11,370.00 |
$1,282.50
|
|
CT heart w/evaluation of calcium without contrast
|
$355.00 |
$355.00 |
$355.00 |
$192.00
|
|
CT limited or localized follow-up study
|
$5,342.00 |
$5,342.00 |
$5,342.00 |
$630.50
|
|
CT neck soft tissue w/contrast
|
$14,742.00 |
$14,742.00 |
$14,742.00 |
$1,667.00
|
|
CT neck soft tissue without contrast
|
$13,402.00 |
$13,402.00 |
$13,402.00 |
$1,316.71
|
|
CT neck soft tissue without & w/contrast
|
$17,689.00 |
$17,689.00 |
$17,689.00 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$11,716.00 |
$11,716.00 |
$11,716.00 |
$1,661.25
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$14,054.00 |
$14,054.00 |
$14,054.00 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$10,643.00 |
$10,643.00 |
$10,643.00 |
$1,345.05
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$38,736.00 |
$38,736.00 |
$38,736.00 |
$3,328.00
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$32,279.00 |
$32,279.00 |
$32,279.00 |
$2,883.20
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$29,346.00 |
$29,346.00 |
$29,346.00 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$13,424.00 |
$13,424.00 |
$13,424.00 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$12,200.00 |
$12,200.00 |
$12,200.00 |
$1,436.50
|
|
CT thorax low dose for lung screening without contrast
|
$14,928.50 |
$14,928.50 |
$14,928.50 |
$420.60
|
|
Culture aerobic additional method definitive id each
|
$1,088.00 |
$1,088.00 |
$1,088.00 |
$62.65
|
|
Culture afb any source
|
$1,243.00 |
$1,243.00 |
$1,243.00 |
$107.50
|
|
Culture anaerobic additional method definitive id each
|
$171.00 |
$171.00 |
$171.00 |
$75.29
|
|
Culture anaerobic except blood
|
$1,088.00 |
$1,088.00 |
$1,088.00 |
$120.00
|
|
Culture fungi definitive id mold
|
$34.00 |
$34.00 |
$34.00 |
$70.00
|
|
Culture fungi definitive id yeast
|
$142.00 |
$142.00 |
$142.00 |
$79.00
|
|
Culture fungi other (except blood)
|
$638.00 |
$638.00 |
$638.00 |
$94.90
|
|
Culture fungi skin/hair/nail
|
$638.00 |
$638.00 |
$638.00 |
$76.05
|
|
Culture mycobacteria definitive id each isolate
|
$679.00 |
$679.00 |
$679.00 |
$88.14
|
|
Culture mycoplasma any source
|
$820.00 |
$820.00 |
$820.00 |
$90.37
|
|
Culture quantitative aerobic other source
|
$61.00 |
$61.00 |
$61.00 |
$85.80
|
|
Culture typing immunologic
|
$81.00 |
$81.00 |
$81.00 |
$41.19
|
|
Culture urine each isolate
|
$753.00 |
$753.00 |
$753.00 |
$46.20
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$98.00 |
$98.00 |
$98.00 |
$26.73
|
|
Cyclic citrullinated peptide antibody
|
$201.00 |
$201.00 |
$201.00 |
$85.03
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$3,956.00 |
$3,956.00 |
$3,956.00 |
$779.37
|
|
Cyclophosphamide 25 mg capsule
|
$49.00 |
$49.00 |
$49.00 |
$22.51
|
|
Cyclosporine 250 mg/5 ml intravenous solution
|
$106.00 |
$106.00 |
$106.00 |
$150.79
|
|
Cyclosporine 2 hour
|
$1,402.00 |
$1,402.00 |
$1,402.00 |
$119.40
|
|
Cyclosporine modified 25 mg capsule
|
$22.00 |
$22.00 |
$22.00 |
$9.79
|
|
Cystatin c
|
$211.00 |
$211.00 |
$211.00 |
$82.50
|
|
Cystogram >= 3 views supervision & interpretation
|
$2,441.00 |
$2,441.00 |
$2,441.00 |
$527.50
|
|
Cytomegalovirus (cmv) antibody igg
|
$529.00 |
$529.00 |
$529.00 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$470.00 |
$470.00 |
$470.00 |
$101.94
|
|
Cytopathology cellular enhancement technique non-gyn
|
$98.00 |
$98.00 |
$98.00 |
$163.43
|
|
Cytopathology concentration technique smears & interpretation
|
$689.00 |
$689.00 |
$689.00 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$1,233.00 |
$1,233.00 |
$1,233.00 |
$122.40
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$1,269.00 |
$1,269.00 |
$1,269.00 |
$75.60
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$1,269.00 |
$1,269.00 |
$1,269.00 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$1,269.00 |
$1,269.00 |
$1,269.00 |
$203.08
|
|
Dacarbazine 100 mg intravenous solution
|
$91.00 |
$91.00 |
$91.00 |
$61.64
|
|
Dactinomycin 0.5 mg intravenous solution
|
$8,961.00 |
$8,961.00 |
$8,961.00 |
$2,281.50
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$1,126.00 |
$1,126.00 |
$1,126.00 |
$194.08
|
|
Decalcification
|
$679.00 |
$679.00 |
$679.00 |
$75.38
|
|
Decitabine 50 mg intravenous solution
|
$14,334.00 |
$14,334.00 |
$14,334.00 |
$1,026.60
|
|
Deferoxamine 500 mg solution for injection
|
$259.00 |
$259.00 |
$259.00 |
$112.87
|
|
Desmopressin 4 mcg/ml injection solution
|
$505.00 |
$505.00 |
$505.00 |
$172.46
|
|
Device intraute mirena
|
$7,288.00 |
$7,288.00 |
$7,288.00 |
$2,289.60
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$1,248.00 |
$1,248.00 |
$1,248.00 |
$222.30
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$1,623.00 |
$1,623.00 |
$1,623.00 |
$465.34
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$58.00 |
$58.00 |
$58.00 |
$68.25
|
|
Dextrose 5 % IV bolus
|
$179.00 |
$179.00 |
$179.00 |
$68.25
|
|
Dhea-s (dehydroepiand sulfate)
|
$279.00 |
$279.00 |
$279.00 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$500.00 |
$500.00 |
$500.00 |
$78.03
|
|
Diab manage trn ind/group
|
$102.00 |
$102.00 |
$102.00 |
$49.50
|
|
Diagnostic Mammogram (both breasts)
|
$1,745.00 |
$1,745.00 |
$1,745.00 |
$403.32
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$122.00 |
$122.00 |
$122.00 |
$67.89
|
|
Diffusing capacity
|
$1,794.00 |
$1,794.00 |
$1,794.00 |
$357.50
|
|
Digital analysis of eeg
|
$6,944.00 |
$6,944.00 |
$6,944.00 |
$641.56
|
|
Digoxin immune fab 40 mg intravenous solution
|
$19,426.00 |
$19,426.00 |
$19,426.00 |
$9,684.65
|
|
Digoxin total therapeutic drug level
|
$927.00 |
$927.00 |
$927.00 |
$99.35
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$862.00 |
$862.00 |
$862.00 |
$308.90
|
|
Dimethyl sulfoxide 50% 50 ml
|
$1,279.00 |
$1,279.00 |
$1,279.00 |
$1,001.55
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$98.00 |
$98.00 |
$98.00 |
$22.58
|
|
Disability dlco
|
$1,055.00 |
$1,055.00 |
$1,055.00 |
$302.40
|
|
Disaccharidases
|
$72.00 |
$72.00 |
$72.00 |
$224.58
|
|
Dna antibody native/double stranded
|
$354.00 |
$354.00 |
$354.00 |
$101.40
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$2,768.00 |
$2,768.00 |
$2,768.00 |
$712.02
|
|
Doppler echo complete
|
$3,881.00 |
$3,881.00 |
$3,881.00 |
$644.00
|
|
Dornase alfa non-comp unit
|
$720.00 |
$720.00 |
$720.00 |
$500.29
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$300.00 |
$300.00 |
$300.00 |
$89.34
|
|
Drsg wound matrix sheet 2.5x2.5cm-7 sq cm-cost per sq cm
|
$26,250.00 |
$26,250.00 |
$26,250.00 |
$448.16
|
|
Drug assay voriconazole
|
$519.00 |
$519.00 |
$519.00 |
$96.75
|
|
Drug test def 1-7 classes
|
$1,971.00 |
$1,971.00 |
$1,971.00 |
$263.86
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$4,910.00 |
$4,910.00 |
$4,910.00 |
$278.85
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$1,835.00 |
$1,835.00 |
$1,835.00 |
$750.20
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$2,903.00 |
$2,903.00 |
$2,903.00 |
$885.60
|
|
Ecallantide injection
|
$34,239.45 |
$34,239.45 |
$34,239.45 |
$6,132.60
|
|
Ecg 12 lead tracing only
|
$1,354.00 |
$1,354.00 |
$1,354.00 |
$243.61
|
|
Ecg/1-3 leads/tracing only 93041
|
$262.00 |
$262.00 |
$262.00 |
$129.83
|
|
Echocardiogram (Heart Ultrasound)
|
$5,288.00 |
$5,288.00 |
$5,288.00 |
$2,049.45
|
|
Echocardiography transthoracic 2d followup/limited
|
$3,015.00 |
$3,015.00 |
$3,015.00 |
$773.30
|
|
Echocardiograpy doppler follow up/limited study
|
$6,989.00 |
$6,989.00 |
$6,989.00 |
$354.90
|
|
Echo exam of fetal heart
|
$2,164.00 |
$2,164.00 |
$2,164.00 |
$855.38
|
|
Echo exam uterus 76831-
|
$2,044.00 |
$2,044.00 |
$2,044.00 |
$547.23
|
|
Echo guide for amniocentesis
|
$3,713.00 |
$3,713.00 |
$3,713.00 |
$377.11
|
|
Echo transthoracic
|
$1,919.00 |
$1,919.00 |
$1,919.00 |
$1,475.25
|
|
Echo transthoracic
|
$1,919.00 |
$1,919.00 |
$1,919.00 |
$944.14
|
