|
CT upper extremity without contrast (both sides)
|
$601.44 |
$601.44 |
$601.44 |
$1,473.75
|
|
CT uppr extremity w/o&w/dye
|
$693.10 |
$693.10 |
$693.10 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$25.90 |
$25.90 |
$25.90 |
$62.65
|
|
Culture afb any source
|
$134.31 |
$134.31 |
$134.31 |
$107.50
|
|
Culture anaerobic additional method definitive id each
|
$47.36 |
$47.36 |
$47.36 |
$75.29
|
|
Culture anaerobic except blood
|
$34.60 |
$34.60 |
$34.60 |
$120.00
|
|
Culture bact stool aero addl path ea
|
$11.47 |
$11.47 |
$11.47 |
$52.50
|
|
Culture body fluid
|
$160.49 |
$160.49 |
$160.49 |
$129.21
|
|
Culture fungi definitive id mold
|
$42.00 |
$42.00 |
$42.00 |
$70.00
|
|
Culture fungi definitive id yeast
|
$14.80 |
$14.80 |
$14.80 |
$79.00
|
|
Culture fungi other (except blood)
|
$111.09 |
$111.09 |
$111.09 |
$94.90
|
|
Culture fungi skin/hair/nail
|
$18.22 |
$18.22 |
$18.22 |
$76.05
|
|
Culture mycobacteria definitive id each isolate
|
$19.43 |
$19.43 |
$19.43 |
$88.14
|
|
Culture mycoplasma any source
|
$46.62 |
$46.62 |
$46.62 |
$90.37
|
|
Culture quantitative aerobic other source
|
$107.21 |
$107.21 |
$107.21 |
$85.80
|
|
Culture screening strep group a
|
$39.22 |
$39.22 |
$39.22 |
$78.47
|
|
Culture typing added method
|
$25.90 |
$25.90 |
$25.90 |
$34.45
|
|
Culture typing immunologic
|
$8.14 |
$8.14 |
$8.14 |
$41.19
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$81.40 |
$81.40 |
$81.40 |
$101.45
|
|
Culture urine each isolate
|
$17.85 |
$17.85 |
$17.85 |
$46.20
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$47.86 |
$47.86 |
$47.86 |
$26.73
|
|
Cyclosporine 2 hour
|
$73.45 |
$73.45 |
$73.45 |
$119.40
|
|
Cyclosporine modified 25 mg capsule
|
$0.83 |
$0.83 |
$0.83 |
$9.79
|
|
Cyclosporine oral 100 mg
|
$2.59 |
$2.59 |
$2.59 |
$42.97
|
|
Cystatin c
|
$44.40 |
$44.40 |
$44.40 |
$82.50
|
|
Cystogram >= 3 views supervision & interpretation
|
$366.02 |
$366.02 |
$366.02 |
$527.50
|
|
Cytomegalovirus (cmv) antibody igg
|
$16.37 |
$16.37 |
$16.37 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$23.68 |
$23.68 |
$23.68 |
$101.94
|
|
Cytomegalovirus dfa
|
$5.18 |
$5.18 |
$5.18 |
$51.20
|
|
Cyto/molecular report
|
$18.50 |
$18.50 |
$18.50 |
$150.30
|
|
Cytopath fl nongyn filter
|
$18.22 |
$18.22 |
$18.22 |
$66.61
|
|
Cytopathology cellular enhancement technique non-gyn
|
$52.08 |
$52.08 |
$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 |
$122.40
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$78.90 |
$78.90 |
$78.90 |
$75.60
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$89.73 |
$89.73 |
$89.73 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$137.55 |
$137.55 |
$137.55 |
$203.08
|
|
Cytopath smear oth prep screen & interp
|
$71.50 |
$71.50 |
$71.50 |
$95.00
|
|
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
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$1.44 |
$1.44 |
$1.44 |
$544.35
|
|
Dch pulmonary stress test
|
$964.41 |
$964.41 |
$964.41 |
$964.41
|
|
Dch validity tests
|
$4.90 |
$4.90 |
$4.90 |
$25.00
|
|
Deamidated gliadin antibody iga
|
$17.06 |
$17.06 |
$17.06 |
$44.20
|
|
Debridement (>20 cm) charge pt
|
$168.81 |
$168.81 |
$168.81 |
$262.60
|
|
Decalcification
|
$14.34 |
$14.34 |
$14.34 |
$75.38
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$141.62 |
$141.62 |
$141.62 |
$182.40
|
|
Dermagraft
|
$2,569.93 |
$2,569.93 |
$2,569.93 |
$220.24
|
|
Desmopressin 4 mcg/ml injection solution
|
$24.07 |
$24.07 |
$24.07 |
$172.46
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$162.06 |
$162.06 |
$162.06 |
$222.30
|
|
Dexamethasone 4 mg tablet
|
$0.46 |
$0.46 |
$0.46 |
$5.17
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$33.33 |
$33.33 |
$33.33 |
$23.27
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$80.89 |
$80.89 |
$80.89 |
$68.25
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$68.45 |
$68.45 |
$68.45 |
$46.35
|
|
Dextrose 5 % IV bolus
|
$81.18 |
$81.18 |
$81.18 |
$68.25
|
|
Dhea-s (dehydroepiand sulfate)
|
$58.28 |
$58.28 |
$58.28 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$11.38 |
$11.38 |
$11.38 |
$78.03
|
|
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 |
$303.96 |
$403.32
|
|
Diagnostic Mammogram (one breast)
|
$301.55 |
$301.55 |
$301.55 |
$282.50
|
|
Dialysis one evaluation
|
$987.53 |
$987.53 |
$987.53 |
$827.97
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$18.69 |
$18.69 |
$18.69 |
$67.89
|
|
Dicyclomine injection
|
$121.18 |
$121.18 |
$121.18 |
$210.00
|
|
Diffusing capacity
|
$462.13 |
$462.13 |
$462.13 |
$357.50
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$123.15 |
$123.15 |
$123.15 |
$53.00
|
|
Digoxin total therapeutic drug level
|
$67.25 |
$67.25 |
$67.25 |
$99.35
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$48.08 |
$48.08 |
$48.08 |
$22.58
|
|
Disability dlco
|
$369.08 |
$369.08 |
$369.08 |
$302.40
|
|
Disaccharidases
|
$29.60 |
$29.60 |
$29.60 |
$224.58
|
|
Dna trichomonas
|
$6.75 |
$6.75 |
$6.75 |
$68.50
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$35.98 |
$35.98 |
$35.98 |
$98.43
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$3.52 |
$3.52 |
$3.52 |
$64.77
|
|
Doppler echo complete
|
$503.85 |
$503.85 |
$503.85 |
$644.00
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$515.50 |
$515.50 |
$515.50 |
$681.20
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$437.99 |
$437.99 |
$437.99 |
$490.82
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$1.59 |
$1.59 |
$1.59 |
$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 |
$2,458.05
|
|
Droperidol 2.5 mg/ml injection solution
|
$48.29 |
$48.29 |
$48.29 |
$33.99
|
|
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm
|
$568.14 |
$568.14 |
$568.14 |
$189.68
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$3,711.84 |
$3,711.84 |
$3,711.84 |
$327.39
|
|
Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm
|
$7,721.16 |
$7,721.16 |
$7,721.16 |
$5,085.77
|
|
Drug admin & hemodynmic meas
|
$330.32 |
$330.32 |
$330.32 |
$542.23
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$349.65 |
$349.65 |
$349.65 |
$278.85
|
|
Drvvt confirm - quest
|
$29.60 |
$29.60 |
$29.60 |
$102.30
|
|
Dup scan/hemodialysis access 93990
|
$663.78 |
$663.78 |
$663.78 |
$499.38
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$357.98 |
$357.98 |
$357.98 |
$750.20
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$852.57 |
$852.57 |
$852.57 |
$885.60
|
|
Ecg 12 lead tracing only
|
$124.32 |
$124.32 |
$124.32 |
$243.61
|
|
Ecg/1-3 leads/tracing only 93041
|
$85.29 |
$85.29 |
$85.29 |
$129.83
|
|
Ecg external < 48 hours recording
|
$456.12 |
$456.12 |
$456.12 |
$461.76
|
|
Ecg external < 48 hours scanning analysis w/report
|
$130.33 |
$130.33 |
$130.33 |
$567.00
|
|
Echocardiogram (Heart Ultrasound)
|
$2,144.15 |
$2,144.15 |
$2,144.15 |
$2,049.45
|
|
Echocardiography doppler color flow mapping
|
$423.28 |
$423.28 |
$423.28 |
$461.61
|
|
Echocardiography transthoracic 2d followup/limited
|
$472.95 |
$472.95 |
$472.95 |
$773.30
|
|
Echocardiograpy doppler follow up/limited study
|
$462.32 |
$462.32 |
$462.32 |
$354.90
|
|
Echograp trans r pros study
|
$1,963.78 |
$1,963.78 |
$1,963.78 |
$445.25
|
|
Echo tee guidance
|
$4,111.35 |
$4,111.35 |
$4,111.35 |
$2,007.00
|