|
CT limited or localized follow-up study
|
$499.20 |
$499.20 |
$499.20 |
$626.07
|
|
CT lower extremity w/contrast (both sides)
|
$886.80 |
$886.80 |
$886.80 |
$1,700.00
|
|
CT lower extremity without contrast (both sides)
|
$908.80 |
$908.80 |
$908.80 |
$1,403.73
|
|
CT lwr extremity w/o&w/dye
|
$900.40 |
$900.40 |
$900.40 |
$1,829.75
|
|
CT neck soft tissue w/contrast
|
$1,296.40 |
$1,296.40 |
$1,296.40 |
$1,669.00
|
|
CT neck soft tissue without contrast
|
$1,376.00 |
$1,376.00 |
$1,376.00 |
$1,363.35
|
|
CT neck soft tissue without & w/contrast
|
$1,422.00 |
$1,422.00 |
$1,422.00 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$2,308.40 |
$2,308.40 |
$2,308.40 |
$1,686.75
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$1,728.80 |
$1,728.80 |
$1,728.80 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$1,728.80 |
$1,728.80 |
$1,728.80 |
$1,370.85
|
|
CT scan for therapy guide
|
$510.80 |
$510.80 |
$510.80 |
$741.78
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$1,780.40 |
$1,780.40 |
$1,780.40 |
$3,301.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$1,780.40 |
$1,780.40 |
$1,780.40 |
$2,855.63
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$1,780.40 |
$1,780.40 |
$1,780.40 |
$2,299.15
|
|
CT thoracic spine w/contrast
|
$987.20 |
$987.20 |
$987.20 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$884.00 |
$884.00 |
$884.00 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$1,260.00 |
$1,260.00 |
$1,260.00 |
$418.50
|
|
CT t-spine w /wo contrast
|
$1,175.20 |
$1,175.20 |
$1,175.20 |
$2,033.46
|
|
CT upper extremity w/contrast (both sides)
|
$1,454.80 |
$1,454.80 |
$1,454.80 |
$1,706.10
|
|
CT upper extremity without contrast (both sides)
|
$1,449.20 |
$1,449.20 |
$1,449.20 |
$1,473.75
|
|
CT uppr extremity w/o&w/dye
|
$1,730.80 |
$1,730.80 |
$1,730.80 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$19.60 |
$19.60 |
$19.60 |
$63.75
|
|
Culture afb any source
|
$80.32 |
$80.32 |
$80.32 |
$110.60
|
|
Culture anaerobic additional method definitive id each
|
$19.72 |
$19.72 |
$19.72 |
$78.65
|
|
Culture anaerobic except blood
|
$68.36 |
$68.36 |
$68.36 |
$123.21
|
|
Culture bact stool aero addl path ea
|
$25.84 |
$25.84 |
$25.84 |
$52.80
|
|
Culture body fluid
|
$105.24 |
$105.24 |
$105.24 |
$130.50
|
|
Culture fungi definitive id mold
|
$20.40 |
$20.40 |
$20.40 |
$70.80
|
|
Culture fungi definitive id yeast
|
$18.76 |
$18.76 |
$18.76 |
$80.40
|
|
Culture fungi other (except blood)
|
$65.04 |
$65.04 |
$65.04 |
$105.60
|
|
Culture fungi skin/hair/nail
|
$13.16 |
$13.16 |
$13.16 |
$78.40
|
|
Culture mycobacteria definitive id each isolate
|
$17.24 |
$17.24 |
$17.24 |
$84.80
|
|
Culture quantitative aerobic other source
|
$23.00 |
$23.00 |
$23.00 |
$87.02
|
|
Culture screening strep group a
|
$42.00 |
$42.00 |
$42.00 |
$81.25
|
|
Culture typing immunologic
|
$16.04 |
$16.04 |
$16.04 |
$42.12
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$84.52 |
$84.52 |
$84.52 |
$124.37
|
|
Culture urine each isolate
|
$28.36 |
$28.36 |
$28.36 |
$46.20
|
|
Cyanocobalamin unsat binding capacity
|
$6.82 |
$6.82 |
$6.82 |
$58.20
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$30.96 |
$30.96 |
$30.96 |
$29.35
|
|
Cyclic citrullinated peptide antibody
|
$24.20 |
$24.20 |
$24.20 |
$82.00
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$6.44 |
$6.44 |
$6.44 |
$884.16
|
|
Cyclosporine 2 hour
|
$134.88 |
$134.88 |
$134.88 |
$121.68
|
|
Cyclosporine modified 25 mg capsule
|
$4.04 |
$4.04 |
$4.04 |
$9.79
|
|
Cyclosporine oral 100 mg
|
$21.13 |
$21.13 |
$21.13 |
$42.33
|
|
Cyp2c19 gene com variants
|
$151.46 |
$151.46 |
$151.46 |
$553.00
|
|
Cystatin c
|
$24.80 |
$24.80 |
$24.80 |
$81.00
|
|
Cystic fibrosis cftr
|
$480.00 |
$480.00 |
$480.00 |
$1,041.95
|
|
Cystine urine quantitative
|
$67.52 |
$67.52 |
$67.52 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$638.00 |
$638.00 |
$638.00 |
$533.61
|
|
Cytarabine 20 mg/ml injection solution
|
$43.56 |
$43.56 |
$43.56 |
$84.56
|
|
Cytogenomic neo microra alys
|
$614.00 |
$614.00 |
$614.00 |
$1,911.78
|
|
Cytomegalovirus (cmv) antibody igg
|
$54.80 |
$54.80 |
$54.80 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$73.16 |
$73.16 |
$73.16 |
$98.35
|
|
Cyto/molecular report
|
$45.14 |
$45.14 |
$45.14 |
$144.75
|
|
Cytopathology cellular enhancement technique non-gyn
|
$48.00 |
$48.00 |
$48.00 |
$163.43
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$62.80 |
$62.80 |
$62.80 |
$90.75
|
|
Cytopathology concentration technique smears & interpretation
|
$97.60 |
$97.60 |
$97.60 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$84.00 |
$84.00 |
$84.00 |
$129.12
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$124.40 |
$124.40 |
$124.40 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$138.00 |
$138.00 |
$138.00 |
$205.00
|
|
Cytopath tbs c/v manual
|
$27.60 |
$27.60 |
$27.60 |
$57.94
|
|
Cytp urine 3-5 probes cmptr
|
$254.40 |
$254.40 |
$254.40 |
$690.00
|
|
Dacarbazine 100 mg intravenous solution
|
$12.00 |
$12.00 |
$12.00 |
$82.91
|
|
Dactinomycin 0.5 mg intravenous solution
|
$1,886.28 |
$1,886.28 |
$1,886.28 |
$2,409.50
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$1.20 |
$1.20 |
$1.20 |
$342.88
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$49.59 |
$49.59 |
$49.59 |
$28,415.40
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$32.22 |
$32.22 |
$32.22 |
$5,546.48
|
|
Darbepoetin alfa, esrd use
|
$17.40 |
$17.40 |
$17.40 |
$3.04
|
|
Daunorubicin 44 mg and cytarabine 100 mg in liposome IV solution
|
$252.46 |
$252.46 |
$252.46 |
$22,284.19
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$86.88 |
$86.88 |
$86.88 |
$237.82
|
|
Dch glucoscan
|
$5.40 |
$5.40 |
$5.40 |
$23.38
|
|
Dch validity tests
|
$8.20 |
$8.20 |
$8.20 |
$25.20
|
|
Deamidated gliadin antibody iga
|
$22.56 |
$22.56 |
$22.56 |
$44.00
|
|
Decalcification
|
$6.80 |
$6.80 |
$6.80 |
$75.38
|
|
Decitabine 50 mg intravenous solution
|
$58.88 |
$58.88 |
$58.88 |
$975.45
|
|
Deferoxamine 500 mg solution for injection
|
$64.80 |
$64.80 |
$64.80 |
$116.00
|
|
Degarelix 120 mg subcutaneous solution
|
$3.47 |
$3.47 |
$3.47 |
$1,963.06
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$26.48 |
$26.48 |
$26.48 |
$7,933.81
|
|
Dermagraft
|
$48.11 |
$48.11 |
$48.11 |
$383.00
|
|
Design mlc device for imrt
|
$756.40 |
$756.40 |
$756.40 |
$1,669.85
|
|
Desmopressin 4 mcg/ml injection solution
|
$21.36 |
$21.36 |
$21.36 |
$111.80
|
|
Desoxycorticosterone
|
$98.80 |
$98.80 |
$98.80 |
$109.28
|
|
Devel tst phys/qhp 1st hr
|
$303.20 |
$303.20 |
$303.20 |
$339.30
|
|
Device intraute mirena
|
$1,520.88 |
$1,520.88 |
$1,520.88 |
$2,832.29
|
|
Dev tst admin phys/qhp ea addl 30 min
|
$151.20 |
$151.20 |
$151.20 |
$196.30
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$175.20 |
$175.20 |
$175.20 |
$220.43
|
|
Dexamethasone 4 mg tablet
|
$1.60 |
$1.60 |
$1.60 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$8.28 |
$8.28 |
$8.28 |
$26.80
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$567.96 |
$567.96 |
$567.96 |
$506.33
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$11.56 |
$11.56 |
$11.56 |
$57.07
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$50.64 |
$50.64 |
$50.64 |
$68.93
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$9.84 |
$9.84 |
$9.84 |
$49.75
|
|
Dextrose 5 % IV bolus
|
$16.40 |
$16.40 |
$16.40 |
$68.93
|
|
Dhea-s (dehydroepiand sulfate)
|
$62.24 |
$62.24 |
$62.24 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$25.68 |
$25.68 |
$25.68 |
$78.40
|
|
Diagnostic digital breast tomosynthesis bil
|
$123.20 |
$123.20 |
$123.20 |
$117.94
|
|
Diagnostic Mammogram (both breasts)
|
$606.80 |
$606.80 |
$606.80 |
$421.26
|
|
Diagnostic Mammogram (one breast)
|
$401.60 |
$401.60 |
$401.60 |
$297.05
|
|
Diagnostic radio unlisted proc
|
$284.00 |
$284.00 |
$284.00 |
$239.25
|
|
Diatrizoate meglumine 18 % urethral solution
|
$0.16 |
$0.16 |
$0.16 |
$101.58
|