|
Creatine kinase mb
|
$3,513.25 |
$3,513.25 |
$3,513.25 |
$105.95
|
|
Creatine - sendout
|
$471.00 |
$471.00 |
$471.00 |
$40.59
|
|
Creatinine
|
$697.75 |
$697.75 |
$697.75 |
$42.50
|
|
Creatinine clearance urine
|
$853.50 |
$853.50 |
$853.50 |
$85.80
|
|
#creutz-prot.,western blot
|
$1,158.25 |
$1,158.25 |
$1,158.25 |
$179.28
|
|
Critical care 30-74 minutes
|
$12,227.00 |
$12,227.00 |
$12,227.00 |
$2,595.34
|
|
Critical care each additional 30 minutes
|
$2,742.75 |
$2,742.75 |
$2,742.75 |
$756.00
|
|
Crystal identification light microscopy
|
$1,110.25 |
$1,110.25 |
$1,110.25 |
$58.50
|
|
Csf leakage imaging
|
$5,812.50 |
$5,812.50 |
$5,812.50 |
$1,433.25
|
|
Cta abdominal aorta & (both sides) ileofemoral lower extremity w runoff without & w/contrast
|
$13,071.75 |
$13,071.75 |
$13,071.75 |
$2,092.73
|
|
Cta neck without &/or w/contrast
|
$20,101.25 |
$20,101.25 |
$20,101.25 |
$1,944.00
|
|
CT Angiogram of Abdomen and Pelvis
|
$1,818.75 |
$1,818.75 |
$1,818.75 |
$2,839.85
|
|
CT Angiogram of the Chest (for blood clot)
|
$19,807.00 |
$19,807.00 |
$19,807.00 |
$2,017.89
|
|
CT Angiogram of the Head
|
$20,101.25 |
$20,101.25 |
$20,101.25 |
$2,041.78
|
|
CT angio hrt w/3d image
|
$15,598.25 |
$15,598.25 |
$15,598.25 |
$1,601.60
|
|
CT angio pelvis
|
$682.75 |
$682.75 |
$682.75 |
$1,778.40
|
|
CT limited or localized follow-up study
|
$6,056.25 |
$6,056.25 |
$6,056.25 |
$630.50
|
|
CT neck soft tissue w/contrast
|
$6,999.75 |
$6,999.75 |
$6,999.75 |
$1,667.00
|
|
CT neck soft tissue without contrast
|
$6,999.75 |
$6,999.75 |
$6,999.75 |
$1,316.71
|
|
CT neck soft tissue without & w/contrast
|
$9,564.25 |
$9,564.25 |
$9,564.25 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$16,744.50 |
$16,744.50 |
$16,744.50 |
$1,661.25
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$18,986.00 |
$18,986.00 |
$18,986.00 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$17,263.50 |
$17,263.50 |
$17,263.50 |
$1,345.05
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$22,631.75 |
$22,631.75 |
$22,631.75 |
$3,328.00
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$21,068.00 |
$21,068.00 |
$21,068.00 |
$2,883.20
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$19,352.50 |
$19,352.50 |
$19,352.50 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$19,707.75 |
$19,707.75 |
$19,707.75 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$19,707.75 |
$19,707.75 |
$19,707.75 |
$1,436.50
|
|
CT t-spine w /wo contrast
|
$19,707.75 |
$19,707.75 |
$19,707.75 |
$2,030.60
|
|
Culture aerobic additional method definitive id each
|
$297.50 |
$297.50 |
$297.50 |
$62.65
|
|
Culture afb any source
|
$604.75 |
$604.75 |
$604.75 |
$107.50
|
|
Culture anaerobic additional method definitive id each
|
$435.75 |
$435.75 |
$435.75 |
$75.29
|
|
Culture anaerobic except blood
|
$572.25 |
$572.25 |
$572.25 |
$120.00
|
|
Culture fungi definitive id yeast
|
$245.75 |
$245.75 |
$245.75 |
$79.00
|
|
Culture fungi other (except blood)
|
$778.00 |
$778.00 |
$778.00 |
$94.90
|
|
Culture mycobacteria definitive id each isolate
|
$1,226.00 |
$1,226.00 |
$1,226.00 |
$88.14
|
|
Culture urine each isolate
|
$297.50 |
$297.50 |
$297.50 |
$46.20
|
|
Cyanocobalamin unsat binding capacity
|
$682.50 |
$682.50 |
$682.50 |
$60.75
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$23.00 |
$23.00 |
$23.00 |
$26.73
|
|
Cyclophosphamide 25 mg capsule
|
$33.00 |
$33.00 |
$33.00 |
$22.51
|
|
Cyclosporine 2 hour
|
$1,240.00 |
$1,240.00 |
$1,240.00 |
$119.40
|
|
Cyclosporine modified 25 mg capsule
|
$16.00 |
$16.00 |
$16.00 |
$9.79
|
|
Cystatin c
|
$164.00 |
$164.00 |
$164.00 |
$82.50
|
|
Cystogram >= 3 views supervision & interpretation
|
$2,364.50 |
$2,364.50 |
$2,364.50 |
$527.50
|
|
Cytarabine 20 mg/ml injection solution
|
$322.00 |
$322.00 |
$322.00 |
$66.95
|
|
Cytomegalovirus (cmv) antibody igg
|
$297.50 |
$297.50 |
$297.50 |
$101.25
|
|
Cytopath fl nongyn filter
|
$440.00 |
$440.00 |
$440.00 |
$66.61
|
|
Cytopathology cellular enhancement technique non-gyn
|
$268.25 |
$268.25 |
$268.25 |
$163.43
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$58.50 |
$58.50 |
$58.50 |
$75.60
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$1,343.00 |
$1,343.00 |
$1,343.00 |
$185.00
|
|
Cytopath smear other source
|
$1,464.00 |
$1,464.00 |
$1,464.00 |
$85.80
|
|
Cytopath smear oth prep screen & interp
|
$1,395.00 |
$1,395.00 |
$1,395.00 |
$95.00
|
|
Dactinomycin 0.5 mg intravenous solution
|
$19,671.00 |
$19,671.00 |
$19,671.00 |
$2,281.50
|
|
Dalbavancin 500 mg intravenous solution
|
$17,916.25 |
$17,916.25 |
$17,916.25 |
$3,753.91
|
|
Daunorubicin 5 mg/ml intravenous solution
|
$1,581.00 |
$1,581.00 |
$1,581.00 |
$194.08
|
|
Dextran 40 infusion
|
$763.68 |
$763.68 |
$763.68 |
$173.97
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$261.00 |
$261.00 |
$261.00 |
$68.25
|
|
Dextrose 5 % IV bolus
|
$175.00 |
$175.00 |
$175.00 |
$68.25
|
|
Diagnostic Mammogram (both breasts)
|
$1,610.25 |
$1,610.25 |
$1,610.25 |
$403.32
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$187.00 |
$187.00 |
$187.00 |
$67.89
|
|
Dicyclomine injection
|
$712.00 |
$712.00 |
$712.00 |
$210.00
|
|
Diffusing capacity
|
$1,358.00 |
$1,358.00 |
$1,358.00 |
$357.50
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$46.00 |
$46.00 |
$46.00 |
$53.00
|
|
Digoxin immune fab 40 mg intravenous solution
|
$31,714.00 |
$31,714.00 |
$31,714.00 |
$9,684.65
|
|
Digoxin total therapeutic drug level
|
$1,105.00 |
$1,105.00 |
$1,105.00 |
$99.35
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$1,406.00 |
$1,406.00 |
$1,406.00 |
$308.90
|
|
Dimenhydrinate injection
|
$23.00 |
$23.00 |
$23.00 |
$24.68
|
|
Dimethyl sulfoxide 50% 50 ml
|
$681.00 |
$681.00 |
$681.00 |
$1,001.55
|
|
Diphenhydramine 12.5 mg/5 ml oral elixir
|
$4.00 |
$4.00 |
$4.00 |
$1.62
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$87.00 |
$87.00 |
$87.00 |
$22.58
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$17.00 |
$17.00 |
$17.00 |
$100.80
|
|
Disability dlco
|
$1,183.00 |
$1,183.00 |
$1,183.00 |
$302.40
|
|
Dna antibody native/double stranded
|
$778.00 |
$778.00 |
$778.00 |
$101.40
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$4,628.00 |
$4,628.00 |
$4,628.00 |
$712.02
|
|
Doppler echo complete
|
$1,658.50 |
$1,658.50 |
$1,658.50 |
$644.00
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$166.89 |
$166.89 |
$166.89 |
$89.34
|
|
Dronabinol 2.5mg oral
|
$119.00 |
$119.00 |
$119.00 |
$10.17
|
|
Droperidol 2.5 mg/ml injection solution
|
$59.00 |
$59.00 |
$59.00 |
$33.99
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$2,529.73 |
$2,529.73 |
$2,529.73 |
$327.39
|
|
Drsg wnd hyalomatrix 10x10cm -cost per sq cm
|
$16,744.00 |
$16,744.00 |
$16,744.00 |
$280.18
|
|
Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm
|
$33,408.00 |
$33,408.00 |
$33,408.00 |
$5,085.77
|
|
Drug assay voriconazole
|
$120.00 |
$120.00 |
$120.00 |
$96.75
|
|
Drug test def 1-7 classes
|
$425.75 |
$425.75 |
$425.75 |
$263.86
|
|
Duplex scan bilateral study 93985
|
$885.50 |
$885.50 |
$885.50 |
$690.95
|
|
Dup scan/hemodialysis access 93990
|
$1,672.25 |
$1,672.25 |
$1,672.25 |
$499.38
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$3,843.50 |
$3,843.50 |
$3,843.50 |
$885.60
|
|
Ecg 12 lead tracing only
|
$2,036.75 |
$2,036.75 |
$2,036.75 |
$243.61
|
|
Ecg/1-3 leads/tracing only 93041
|
$884.75 |
$884.75 |
$884.75 |
$129.83
|
|
Ecg external < 48 hours recording
|
$2,974.50 |
$2,974.50 |
$2,974.50 |
$461.76
|
|
Echocardiogram (Heart Ultrasound)
|
$6,203.00 |
$6,203.00 |
$6,203.00 |
$2,049.45
|
|
Echocardiography doppler color flow mapping
|
$2,277.50 |
$2,277.50 |
$2,277.50 |
$461.61
|
|
Echocardiography transthoracic 2d followup/limited
|
$1,930.25 |
$1,930.25 |
$1,930.25 |
$773.30
|
|
Echocardiograpy doppler follow up/limited study
|
$1,368.50 |
$1,368.50 |
$1,368.50 |
$354.90
|
|
Echo exam uterus 76831-
|
$4,550.25 |
$4,550.25 |
$4,550.25 |
$547.23
|
|
Echo guide for amniocentesis
|
$2,909.25 |
$2,909.25 |
$2,909.25 |
$377.11
|
|
Echo guide for artery repair
|
$2,966.00 |
$2,966.00 |
$2,966.00 |
$676.80
|
|
Echo guide villus sampling
|
$2,909.25 |
$2,909.25 |
$2,909.25 |
$355.80
|
|
Echo stress
|
$2,090.50 |
$2,090.50 |
$2,090.50 |
$1,607.45
|
|
Echo tee probe placement image acquisition interpretation & report
|
$2,277.50 |
$2,277.50 |
$2,277.50 |
$1,938.95
|
|
Echo transesophageal
|
$4,284.00 |
$4,284.00 |
$4,284.00 |
$913.33
|
