|
CT neck soft tissue w/contrast
|
$16,802.80 |
$16,802.80 |
$16,802.80 |
$1,667.00
|
|
CT neck soft tissue without contrast
|
$15,379.15 |
$15,379.15 |
$15,379.15 |
$1,316.71
|
|
CT neck soft tissue without & w/contrast
|
$20,059.67 |
$20,059.67 |
$20,059.67 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$18,832.33 |
$18,832.33 |
$18,832.33 |
$1,661.25
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$19,261.71 |
$19,261.71 |
$19,261.71 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$17,773.47 |
$17,773.47 |
$17,773.47 |
$1,345.05
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$31,577.77 |
$31,577.77 |
$31,577.77 |
$3,328.00
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$27,518.40 |
$27,518.40 |
$27,518.40 |
$2,883.20
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$24,912.90 |
$24,912.90 |
$24,912.90 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$20,242.88 |
$20,242.88 |
$20,242.88 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$19,628.17 |
$19,628.17 |
$19,628.17 |
$1,436.50
|
|
CT thorax low dose for lung screening without contrast
|
$15,969.76 |
$15,969.76 |
$15,969.76 |
$420.60
|
|
CT t-spine w /wo contrast
|
$20,101.89 |
$20,101.89 |
$20,101.89 |
$2,030.60
|
|
Culture afb any source
|
$51.69 |
$51.69 |
$51.69 |
$107.50
|
|
Culture anaerobic additional method definitive id each
|
$1,671.21 |
$1,671.21 |
$1,671.21 |
$75.29
|
|
Culture anaerobic except blood
|
$351.24 |
$351.24 |
$351.24 |
$120.00
|
|
Culture fungi other (except blood)
|
$51.69 |
$51.69 |
$51.69 |
$94.90
|
|
Culture mycoplasma any source
|
$30.79 |
$30.79 |
$30.79 |
$90.37
|
|
Culture typing immunologic
|
$216.60 |
$216.60 |
$216.60 |
$41.19
|
|
Culture urine each isolate
|
$1,999.69 |
$1,999.69 |
$1,999.69 |
$46.20
|
|
Cyanocobalamin unsat binding capacity
|
$8.80 |
$8.80 |
$8.80 |
$60.75
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$24.75 |
$24.75 |
$24.75 |
$26.73
|
|
Cyclosporine 2 hour
|
$130.02 |
$130.02 |
$130.02 |
$119.40
|
|
Cyclosporine modified 25 mg capsule
|
$21.01 |
$21.01 |
$21.01 |
$9.79
|
|
Cyclosporine oral 100 mg
|
$130.27 |
$130.27 |
$130.27 |
$42.97
|
|
Cyp2c19 gene com variants
|
$203.63 |
$203.63 |
$203.63 |
$553.00
|
|
Cystatin c
|
$137.83 |
$137.83 |
$137.83 |
$82.50
|
|
Cystogram >= 3 views supervision & interpretation
|
$5,421.55 |
$5,421.55 |
$5,421.55 |
$527.50
|
|
Cytogenetics 25-99
|
$216.00 |
$216.00 |
$216.00 |
$180.00
|
|
Cytopathology cellular enhancement technique non-gyn
|
$267.50 |
$267.50 |
$267.50 |
$163.43
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$30.81 |
$30.81 |
$30.81 |
$91.53
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$17.10 |
$17.10 |
$17.10 |
$84.50
|
|
Cytopathology concentration technique smears & interpretation
|
$1,947.63 |
$1,947.63 |
$1,947.63 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$3,212.57 |
$3,212.57 |
$3,212.57 |
$122.40
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$519.37 |
$519.37 |
$519.37 |
$75.60
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$776.68 |
$776.68 |
$776.68 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$141.46 |
$141.46 |
$141.46 |
$203.08
|
|
Dacarbazine 100 mg intravenous solution
|
$175.51 |
$175.51 |
$175.51 |
$61.64
|
|
Dactinomycin 0.5 mg intravenous solution
|
$4,830.21 |
$4,830.21 |
$4,830.21 |
$2,281.50
|
|
Debridement (>20 cm) charge pt
|
$2,060.54 |
$2,060.54 |
$2,060.54 |
$262.60
|
|
Decalcification
|
$926.86 |
$926.86 |
$926.86 |
$75.38
|
|
Deferoxamine 500 mg solution for injection
|
$316.97 |
$316.97 |
$316.97 |
$112.87
|
|
Degarelix 120 mg subcutaneous solution
|
$6,313.42 |
$6,313.42 |
$6,313.42 |
$1,963.06
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$5,343.75 |
$5,343.75 |
$5,343.75 |
$7,737.00
|
|
Desmopressin 4 mcg/ml injection solution
|
$972.86 |
$972.86 |
$972.86 |
$172.46
|
|
Dextran 40 infusion
|
$514.35 |
$514.35 |
$514.35 |
$173.97
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$120.12 |
$120.12 |
$120.12 |
$43.65
|
|
Dextrose 5 % IV bolus
|
$120.12 |
$120.12 |
$120.12 |
$68.25
|
|
Dhea-s (dehydroepiand sulfate)
|
$51.69 |
$51.69 |
$51.69 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$528.35 |
$528.35 |
$528.35 |
$78.03
|
|
Diagnostic Mammogram (both breasts)
|
$1,026.47 |
$1,026.47 |
$1,026.47 |
$403.32
|
|
Diatrizoate meglumine 18 % urethral solution
|
$111.49 |
$111.49 |
$111.49 |
$122.25
|
|
Dicyclomine injection
|
$495.09 |
$495.09 |
$495.09 |
$210.00
|
|
Diffusing capacity
|
$786.16 |
$786.16 |
$786.16 |
$357.50
|
|
Digoxin immune fab 40 mg intravenous solution
|
$12,490.22 |
$12,490.22 |
$12,490.22 |
$9,684.65
|
|
Digoxin total therapeutic drug level
|
$965.77 |
$965.77 |
$965.77 |
$99.35
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$667.98 |
$667.98 |
$667.98 |
$308.90
|
|
Dimethyl sulfoxide 50% 50 ml
|
$1,544.41 |
$1,544.41 |
$1,544.41 |
$1,001.55
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$48.13 |
$48.13 |
$48.13 |
$22.58
|
|
Disability dlco
|
$908.17 |
$908.17 |
$908.17 |
$302.40
|
|
Doppler echo complete
|
$5,310.97 |
$5,310.97 |
$5,310.97 |
$644.00
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$2,376.28 |
$2,376.28 |
$2,376.28 |
$681.20
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$1,660.43 |
$1,660.43 |
$1,660.43 |
$490.82
|
|
Dornase alfa non-comp unit
|
$500.29 |
$500.29 |
$500.29 |
$500.29
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$265.42 |
$265.42 |
$265.42 |
$89.34
|
|
Dpyd gene common variants
|
$203.63 |
$203.63 |
$203.63 |
$380.50
|
|
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm
|
$853.47 |
$853.47 |
$853.47 |
$189.68
|
|
Drsg wnd 8.2x9cm sq bilayer theragenesis ster-74sq cm-cost per sq cm
|
$6,399.21 |
$6,399.21 |
$6,399.21 |
$127.14
|
|
Drug assay vedolizumab
|
$62.50 |
$62.50 |
$62.50 |
$169.26
|
|
Drug asy hydroxychloroquine
|
$231.00 |
$231.00 |
$231.00 |
$83.85
|
|
Drug test prsmv instrmnt
|
$102.60 |
$102.60 |
$102.60 |
$78.65
|
|
Drvvt confirm - quest
|
$14.75 |
$14.75 |
$14.75 |
$102.30
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$9,980.65 |
$9,980.65 |
$9,980.65 |
$885.60
|
|
Durvalumab 50 mg/ml intravenous solution
|
$13,949.92 |
$13,949.92 |
$13,949.92 |
$6,529.68
|
|
Ecg/1-3 leads/tracing only 93041
|
$708.29 |
$708.29 |
$708.29 |
$129.83
|
|
Echocardiogram (Heart Ultrasound)
|
$14,271.39 |
$14,271.39 |
$14,271.39 |
$2,049.45
|
|
Echocardiography doppler color flow mapping
|
$5,078.57 |
$5,078.57 |
$5,078.57 |
$461.61
|
|
Echocardiography transthoracic 2d followup/limited
|
$847.98 |
$847.98 |
$847.98 |
$773.30
|
|
Echocardiograpy doppler follow up/limited study
|
$4,389.48 |
$4,389.48 |
$4,389.48 |
$354.90
|
|
Echo exam uterus 76831-
|
$5,726.60 |
$5,726.60 |
$5,726.60 |
$547.23
|
|
Echo guide for amniocentesis
|
$4,526.90 |
$4,526.90 |
$4,526.90 |
$377.11
|
|
Echo stress
|
$18,943.27 |
$18,943.27 |
$18,943.27 |
$1,607.45
|
|
Eculizumab 300 mg/30 ml intravenous solution
|
$29,353.50 |
$29,353.50 |
$29,353.50 |
$17,641.10
|
|
Eeg/cerebral death evaluation only 95824 -26
|
$3,916.87 |
$3,916.87 |
$3,916.87 |
$1,048.30
|
|
Eeg during surgery
|
$800.51 |
$800.51 |
$800.51 |
$775.45
|
|
Eeg recording awake and asleep
|
$5,164.16 |
$5,164.16 |
$5,164.16 |
$1,030.27
|
|
E equine encephalitis igg
|
$8.91 |
$8.91 |
$8.91 |
$48.73
|
|
Electroconvulsive therapy 90870
|
$2,716.22 |
$2,716.22 |
$2,716.22 |
$1,130.00
|
|
Electrolyte panel
|
$4,550.47 |
$4,550.47 |
$4,550.47 |
$86.33
|
|
Electrophysiology evaluation
|
$25,216.76 |
$25,216.76 |
$25,216.76 |
$8,979.45
|
|
Electrophysiology evaluation
|
$38,265.72 |
$38,265.72 |
$38,265.72 |
$11,542.01
|
|
Electrophysiology evaluation
|
$21,046.15 |
$21,046.15 |
$21,046.15 |
$8,393.40
|
|
Electrophysiology evaluation
|
$25,216.76 |
$25,216.76 |
$25,216.76 |
$6,516.00
|
|
Electrophysiology evaluation
|
$37,000.73 |
$37,000.73 |
$37,000.73 |
$2,845.10
|
|
Embolization s&i
|
$39,367.44 |
$39,367.44 |
$39,367.44 |
$2,745.08
|
|
Encephalitis, california igg/igm
|
$8.91 |
$8.91 |
$8.91 |
$48.57
|
|
Encephalitis, st louis igg/igm
|
$9.18 |
$9.18 |
$9.18 |
$48.57
|
|
Encephalitis, western equine igg/igm
|
$97.48 |
$97.48 |
$97.48 |
$50.35
|
|
Ep & ablate supravent arrhyt
|
$76,531.43 |
$76,531.43 |
$76,531.43 |
$29,766.10
|
|
Epinephrine 1 mg/ml im kit - adult
|
$65.00 |
$65.00 |
$65.00 |
$25.61
|