|
Culture fungi definitive id mold
|
$42.00 |
$42.00 |
$42.00 |
$70.00
|
|
Culture fungi definitive id yeast
|
$14.80 |
$14.80 |
$14.80 |
$80.40
|
|
Culture fungi other (except blood)
|
$111.09 |
$111.09 |
$159.19 |
$104.00
|
|
Culture fungi skin/hair/nail
|
$18.22 |
$18.22 |
$77.22 |
$77.37
|
|
Culture mycobacteria definitive id each isolate
|
$19.43 |
$19.43 |
$111.67 |
$88.14
|
|
Culture mycoplasma any source
|
$46.62 |
$46.62 |
$46.62 |
$90.37
|
|
Culture quantitative aerobic other source
|
$89.10 |
$89.10 |
$107.21 |
$85.80
|
|
Culture screening strep group a
|
$39.22 |
$39.22 |
$39.22 |
$80.60
|
|
Culture typing added method
|
$25.90 |
$25.90 |
$25.90 |
$34.45
|
|
Culture typing immunologic
|
$8.14 |
$8.14 |
$8.14 |
$43.46
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$81.40 |
$81.40 |
$81.40 |
$124.02
|
|
Culture urine each isolate
|
$17.85 |
$17.85 |
$81.97 |
$46.20
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$47.43 |
$47.43 |
$61.56 |
$27.88
|
|
Cyclic citrullinated peptide antibody
|
$17.82 |
$17.82 |
$17.82 |
$82.00
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$1.90 |
$1.90 |
$2,553.12 |
$790.41
|
|
Cyclophosphamide 25 mg capsule
|
$1.70 |
$1.70 |
$1.70 |
$25.76
|
|
Cyclosporine 250 mg/5 ml intravenous solution
|
$606.96 |
$606.96 |
$606.96 |
$173.50
|
|
Cyclosporine 2 hour
|
$73.45 |
$73.45 |
$332.64 |
$119.40
|
|
Cyclosporine modified 25 mg capsule
|
$1.50 |
$1.50 |
$48.60 |
$9.79
|
|
Cyclosporine oral 100 mg
|
$3.65 |
$3.65 |
$3.65 |
$43.04
|
|
Cystatin c
|
$44.40 |
$44.40 |
$44.40 |
$82.26
|
|
Cystogram >= 3 views supervision & interpretation
|
$366.02 |
$366.02 |
$366.02 |
$527.50
|
|
Cytarabine 20 mg/ml injection solution
|
$32.93 |
$32.93 |
$32.93 |
$79.98
|
|
Cytogenetics 3-5
|
$281.56 |
$281.56 |
$281.56 |
$127.64
|
|
Cytomegalovirus (cmv) antibody igg
|
$16.37 |
$16.37 |
$16.37 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$23.68 |
$23.68 |
$321.95 |
$98.35
|
|
Cytomegalovirus dfa
|
$5.18 |
$5.18 |
$5.18 |
$51.20
|
|
Cyto/molecular report
|
$18.50 |
$18.50 |
$18.50 |
$144.80
|
|
Cytopath fl nongyn filter
|
$18.22 |
$18.22 |
$18.22 |
$66.61
|
|
Cytopathology cellular enhancement technique non-gyn
|
$47.52 |
$47.52 |
$52.08 |
$163.43
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$23.68 |
$23.68 |
$23.68 |
$84.50
|
|
Cytopathology concentration technique smears & interpretation
|
$26.46 |
$26.46 |
$26.46 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$17.11 |
$17.11 |
$17.11 |
$124.30
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$61.78 |
$61.78 |
$78.90 |
$75.60
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$89.73 |
$89.73 |
$1,444.61 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$137.55 |
$137.55 |
$137.55 |
$205.00
|
|
Cytopath smear other source
|
$776.95 |
$776.95 |
$776.95 |
$85.80
|
|
Cytopath smear other source
|
$526.28 |
$526.28 |
$526.28 |
$135.01
|
|
Cytopath smear oth prep screen & interp
|
$71.50 |
$71.50 |
$520.34 |
$96.20
|
|
Cytopath tbs c/v manual
|
$12.40 |
$12.40 |
$12.40 |
$57.94
|
|
Cytp urine 3-5 probes cmptr
|
$166.50 |
$166.50 |
$166.50 |
$690.00
|
|
Dacarbazine 100 mg intravenous solution
|
$171.72 |
$171.72 |
$171.72 |
$74.65
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$9.51 |
$9.51 |
$2,347.92 |
$404.00
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$3.55 |
$3.55 |
$2,608.20 |
$5,546.48
|
|
Darbepoetin alfa, esrd use
|
$2.31 |
$2.31 |
$2.31 |
$3.04
|
|
Dch pulmonary stress test
|
$964.41 |
$964.41 |
$8,771.33 |
$964.41
|
|
Dch validity tests
|
$4.90 |
$4.90 |
$4.90 |
$25.00
|
|
Deamidated gliadin antibody iga
|
$17.06 |
$17.06 |
$17.06 |
$43.60
|
|
Debridement (>20 cm) charge pt
|
$168.81 |
$168.81 |
$168.81 |
$262.60
|
|
Decalcification
|
$14.34 |
$14.34 |
$886.25 |
$75.38
|
|
Deferoxamine 500 mg solution for injection
|
$48.29 |
$48.29 |
$135.00 |
$116.00
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$141.62 |
$141.62 |
$141.62 |
$193.05
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$10,619.64 |
$10,619.64 |
$10,619.64 |
$7,744.96
|
|
Depo-estradiol cypionate inj
|
$500.04 |
$500.04 |
$500.04 |
$104.32
|
|
Dermagraft
|
$2,569.93 |
$2,569.93 |
$2,569.93 |
$352.35
|
|
Desmopressin 4 mcg/ml injection solution
|
$33.80 |
$33.80 |
$33.80 |
$121.30
|
|
Developmental screen/score/document 96110
|
$1,424.22 |
$1,424.22 |
$1,424.22 |
$139.10
|
|
Device intraute mirena
|
$4,338.00 |
$4,338.00 |
$4,338.00 |
$2,900.62
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$129.69 |
$129.69 |
$129.69 |
$221.90
|
|
Dexamethasone 4 mg tablet
|
$1.40 |
$1.40 |
$1.40 |
$5.61
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$48.29 |
$48.29 |
$48.29 |
$24.28
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$80.72 |
$80.72 |
$80.72 |
$68.93
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$73.29 |
$73.29 |
$73.29 |
$49.68
|
|
Dextrose 5 % IV bolus
|
$81.18 |
$81.18 |
$462.24 |
$68.93
|
|
Dhea-s (dehydroepiand sulfate)
|
$58.28 |
$58.28 |
$418.18 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$11.38 |
$11.38 |
$554.80 |
$78.41
|
|
Diagnostic digital breast tomosynthesis bil
|
$114.15 |
$114.15 |
$114.15 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$78.63 |
$78.63 |
$78.63 |
$75.93
|
|
Diagnostic Mammogram (both breasts)
|
$303.96 |
$303.96 |
$1,555.98 |
$420.35
|
|
Diagnostic Mammogram (one breast)
|
$301.55 |
$301.55 |
$301.55 |
$295.10
|
|
Dialysis one evaluation
|
$987.53 |
$987.53 |
$987.53 |
$827.97
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$19.30 |
$19.30 |
$314.28 |
$70.87
|
|
Dicyclomine injection
|
$121.18 |
$121.18 |
$568.08 |
$211.00
|
|
Diffusing capacity
|
$462.13 |
$462.13 |
$2,268.00 |
$359.70
|
|
Digital analysis of eeg
|
$1,845.24 |
$1,845.24 |
$1,845.24 |
$641.56
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$124.14 |
$124.14 |
$124.14 |
$64.31
|
|
Digoxin immune fab 40 mg intravenous solution
|
$12,585.24 |
$12,585.24 |
$12,585.24 |
$10,649.28
|
|
Digoxin total therapeutic drug level
|
$67.25 |
$67.25 |
$67.25 |
$102.00
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$530.28 |
$530.28 |
$530.28 |
$308.90
|
|
Diphenhydramine 12.5 mg/5 ml oral elixir
|
$12.96 |
$12.96 |
$12.96 |
$2.27
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$50.14 |
$50.14 |
$224.64 |
$25.12
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$48.29 |
$48.29 |
$254.88 |
$110.48
|
|
Disability dlco
|
$369.08 |
$369.08 |
$4,436.99 |
$300.28
|
|
Disaccharidases
|
$29.60 |
$29.60 |
$29.60 |
$223.80
|
|
Discography cerv/thor spine
|
$3,761.64 |
$3,761.64 |
$3,761.64 |
$2,310.83
|
|
Dna antibody native/double stranded
|
$256.61 |
$256.61 |
$256.61 |
$101.40
|
|
Dna probe chlamydia
|
$551.23 |
$551.23 |
$551.23 |
$82.20
|
|
Dna probe gc
|
$551.23 |
$551.23 |
$551.23 |
$88.67
|
|
Dna trichomonas
|
$6.75 |
$6.75 |
$6.75 |
$68.25
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$35.98 |
$35.98 |
$35.98 |
$101.04
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$9.66 |
$9.66 |
$9.66 |
$74.39
|
|
Doppler echo complete
|
$503.85 |
$503.85 |
$503.85 |
$635.20
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$515.50 |
$515.50 |
$515.50 |
$696.80
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$437.99 |
$437.99 |
$437.99 |
$482.03
|
|
Dornase alfa non-comp unit
|
$455.76 |
$455.76 |
$455.76 |
$495.28
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$1,677.24 |
$1,677.24 |
$1,677.24 |
$264.42
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$5,556.60 |
$5,556.60 |
$5,556.60 |
$2,469.31
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$2.98 |
$2.98 |
$2,072.00 |
$89.34
|
|
Drain chst dry seal exp thorastat
|
$102.58 |
$102.58 |
$102.58 |
$119.43
|
|
Dressing wound matrix 2x2in 25sqcm-q4108-cost per sq cm
|
$6,438.00 |
$6,438.00 |
$6,438.00 |
$4,069.80
|
