|
Crbrospnl fld flw imag cistern
|
$9,321.20 |
$9,321.20 |
$9,321.20 |
$1,409.85
|
|
C-reactive protein
|
$1,176.31 |
$1,176.31 |
$1,176.31 |
$61.10
|
|
Creatine kinase mb
|
$2,100.45 |
$2,100.45 |
$2,100.45 |
$105.95
|
|
Creatine - sendout
|
$10.00 |
$10.00 |
$10.00 |
$40.59
|
|
Creatinine
|
$1,124.95 |
$1,124.95 |
$1,124.95 |
$42.50
|
|
Creatinine clearance urine
|
$1,891.98 |
$1,891.98 |
$1,891.98 |
$85.80
|
|
#creutz-prot.,western blot
|
$724.85 |
$724.85 |
$724.85 |
$179.28
|
|
Critical care 30-74 minutes
|
$5,808.56 |
$5,808.56 |
$5,808.56 |
$2,595.34
|
|
Critical care each additional 30 minutes
|
$3,051.72 |
$3,051.72 |
$3,051.72 |
$756.00
|
|
Crotalidae poly immune fab
|
$8,530.00 |
$8,530.00 |
$8,530.00 |
$6,208.33
|
|
Cryptococcus abs qn - sendout
|
$75.60 |
$75.60 |
$75.60 |
$80.85
|
|
Crystal identification light microscopy
|
$802.87 |
$802.87 |
$802.87 |
$58.50
|
|
Cta abdomen without & /or w/contrast
|
$18,693.41 |
$18,693.41 |
$18,693.41 |
$2,050.23
|
|
Cta abdominal aorta & (both sides) ileofemoral lower extremity w runoff without & w/contrast
|
$18,693.41 |
$18,693.41 |
$18,693.41 |
$2,092.73
|
|
Cta neck without &/or w/contrast
|
$16,377.69 |
$16,377.69 |
$16,377.69 |
$1,944.00
|
|
CT Angiogram of Abdomen and Pelvis
|
$37,381.44 |
$37,381.44 |
$37,381.44 |
$2,839.85
|
|
CT Angiogram of the Chest (for blood clot)
|
$18,866.43 |
$18,866.43 |
$18,866.43 |
$2,017.89
|
|
CT Angiogram of the Head
|
$17,107.28 |
$17,107.28 |
$17,107.28 |
$2,041.78
|
|
CT angio hrt w/3d image
|
$14,466.74 |
$14,466.74 |
$14,466.74 |
$1,601.60
|
|
CT angio pelvis
|
$18,693.41 |
$18,693.41 |
$18,693.41 |
$1,778.40
|
|
CT guidance for needle placement
|
$18,693.41 |
$18,693.41 |
$18,693.41 |
$1,506.04
|
|
CT guid parench tis ablat
|
$6,411.69 |
$6,411.69 |
$6,411.69 |
$1,282.50
|
|
CT heart w/evaluation of calcium without contrast
|
$3,389.00 |
$3,389.00 |
$3,389.00 |
$192.00
|
|
CT hrt c+ strux cgen hrt ds
|
$14,466.74 |
$14,466.74 |
$14,466.74 |
$1,217.45
|
|
CT hrt w/3d image
|
$19,387.52 |
$19,387.52 |
$19,387.52 |
$1,477.35
|
|
CT limited or localized follow-up study
|
$2,033.35 |
$2,033.35 |
$2,033.35 |
$630.50
|
|
CT neck soft tissue w/contrast
|
$16,377.69 |
$16,377.69 |
$16,377.69 |
$1,667.00
|
|
CT neck soft tissue without contrast
|
$15,207.65 |
$15,207.65 |
$15,207.65 |
$1,316.71
|
|
CT neck soft tissue without & w/contrast
|
$16,377.69 |
$16,377.69 |
$16,377.69 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$18,693.41 |
$18,693.41 |
$18,693.41 |
$1,661.25
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$13,286.50 |
$13,286.50 |
$13,286.50 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$18,693.41 |
$18,693.41 |
$18,693.41 |
$1,345.05
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$37,381.44 |
$37,381.44 |
$37,381.44 |
$3,328.00
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$37,381.44 |
$37,381.44 |
$37,381.44 |
$2,883.20
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$32,086.62 |
$32,086.62 |
$32,086.62 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$7,961.93 |
$7,961.93 |
$7,961.93 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$7,961.93 |
$7,961.93 |
$7,961.93 |
$1,436.50
|
|
CT thorax low dose for lung screening without contrast
|
$11,531.36 |
$11,531.36 |
$11,531.36 |
$420.60
|
|
CT t-spine w /wo contrast
|
$11,395.00 |
$11,395.00 |
$11,395.00 |
$2,030.60
|
|
Culture anaerobic additional method definitive id each
|
$543.04 |
$543.04 |
$543.04 |
$75.29
|
|
Culture anaerobic except blood
|
$2,894.03 |
$2,894.03 |
$2,894.03 |
$120.00
|
|
Culture fungi definitive id mold
|
$105.91 |
$105.91 |
$105.91 |
$70.00
|
|
Culture fungi skin/hair/nail
|
$2,881.57 |
$2,881.57 |
$2,881.57 |
$76.05
|
|
Culture urine each isolate
|
$84.14 |
$84.14 |
$84.14 |
$46.20
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$61.00 |
$61.00 |
$61.00 |
$26.73
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$1,062.00 |
$1,062.00 |
$1,062.00 |
$779.37
|
|
Cyclosporine 250 mg/5 ml intravenous solution
|
$843.00 |
$843.00 |
$843.00 |
$150.79
|
|
Cyclosporine modified 25 mg capsule
|
$37.00 |
$37.00 |
$37.00 |
$9.79
|
|
Cyp2c19 gene com variants
|
$23.98 |
$23.98 |
$23.98 |
$553.00
|
|
Cystatin c
|
$107.75 |
$107.75 |
$107.75 |
$82.50
|
|
Cystogram >= 3 views supervision & interpretation
|
$2,035.47 |
$2,035.47 |
$2,035.47 |
$527.50
|
|
Cytarabine 20 mg/ml injection solution
|
$199.00 |
$199.00 |
$199.00 |
$66.95
|
|
Cytogenetics 25-99
|
$300.00 |
$300.00 |
$300.00 |
$180.00
|
|
Cytopathology cellular enhancement technique non-gyn
|
$93.43 |
$93.43 |
$93.43 |
$163.43
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$22.06 |
$22.06 |
$22.06 |
$91.53
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$28.00 |
$28.00 |
$28.00 |
$84.50
|
|
Cytopathology concentration technique smears & interpretation
|
$3,094.69 |
$3,094.69 |
$3,094.69 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$3,094.69 |
$3,094.69 |
$3,094.69 |
$122.40
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$23.36 |
$23.36 |
$23.36 |
$75.60
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$748.46 |
$748.46 |
$748.46 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$4,063.95 |
$4,063.95 |
$4,063.95 |
$203.08
|
|
Cytopath smear other source
|
$154.08 |
$154.08 |
$154.08 |
$135.27
|
|
Cytopath smear oth prep screen & interp
|
$91.84 |
$91.84 |
$91.84 |
$95.00
|
|
Dacarbazine 100 mg intravenous solution
|
$285.00 |
$285.00 |
$285.00 |
$61.64
|
|
Dactinomycin 0.5 mg intravenous solution
|
$521.00 |
$521.00 |
$521.00 |
$2,281.50
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$842.00 |
$842.00 |
$842.00 |
$194.08
|
|
Dch glucoscan
|
$384.31 |
$384.31 |
$384.31 |
$23.25
|
|
Decalcification
|
$893.10 |
$893.10 |
$893.10 |
$75.38
|
|
Decitabine 50 mg intravenous solution
|
$453.81 |
$453.81 |
$453.81 |
$1,026.60
|
|
Deferoxamine 500 mg solution for injection
|
$450.00 |
$450.00 |
$450.00 |
$112.87
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$257.73 |
$257.73 |
$257.73 |
$182.40
|
|
Desmopressin 4 mcg/ml injection solution
|
$1,018.00 |
$1,018.00 |
$1,018.00 |
$172.46
|
|
Detect agnt mult dna direc
|
$27.85 |
$27.85 |
$27.85 |
$109.60
|
|
Devel tst phys/qhp 1st hr
|
$1,010.23 |
$1,010.23 |
$1,010.23 |
$343.20
|
|
Device intraute mirena
|
$4,545.94 |
$4,545.94 |
$4,545.94 |
$2,289.60
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$505.78 |
$505.78 |
$505.78 |
$196.30
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$1,519.85 |
$1,519.85 |
$1,519.85 |
$222.30
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$3,315.00 |
$3,315.00 |
$3,315.00 |
$465.34
|
|
Dextran 40 infusion
|
$852.00 |
$852.00 |
$852.00 |
$173.97
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$233.00 |
$233.00 |
$233.00 |
$43.65
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$40.07 |
$40.07 |
$40.07 |
$68.25
|
|
Dextrose 5 % IV bolus
|
$280.00 |
$280.00 |
$280.00 |
$68.25
|
|
Diagnostic Mammogram (both breasts)
|
$1,141.06 |
$1,141.06 |
$1,141.06 |
$403.32
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$356.94 |
$356.94 |
$356.94 |
$67.89
|
|
Dicyclomine injection
|
$558.00 |
$558.00 |
$558.00 |
$210.00
|
|
Diffusing capacity
|
$298.85 |
$298.85 |
$298.85 |
$357.50
|
|
Digital analysis of eeg
|
$1,453.16 |
$1,453.16 |
$1,453.16 |
$641.56
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$39.00 |
$39.00 |
$39.00 |
$53.00
|
|
Digoxin immune fab 40 mg intravenous solution
|
$4,235.00 |
$4,235.00 |
$4,235.00 |
$9,684.65
|
|
Digoxin total therapeutic drug level
|
$1,745.74 |
$1,745.74 |
$1,745.74 |
$99.35
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$536.00 |
$536.00 |
$536.00 |
$308.90
|
|
Dimethyl sulfoxide 50% 50 ml
|
$621.00 |
$621.00 |
$621.00 |
$1,001.55
|
|
Diphenhydramine 12.5 mg/5 ml oral elixir
|
$1.00 |
$1.00 |
$1.00 |
$1.62
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$174.00 |
$174.00 |
$174.00 |
$22.58
|
|
Disability dlco
|
$307.58 |
$307.58 |
$307.58 |
$302.40
|
|
Dmd dup/delet analysis
|
$331.00 |
$331.00 |
$331.00 |
$385.02
|
|
Dna gardnerella
|
$10.00 |
$10.00 |
$10.00 |
$66.05
|
|
Dna probe gc
|
$9.94 |
$9.94 |
$9.94 |
$88.67
|
|
Dolasetron mesylate oral
|
$915.00 |
$915.00 |
$915.00 |
$910.67
|
|
Doppler echo complete
|
$3,199.69 |
$3,199.69 |
$3,199.69 |
$644.00
|
