|
CT upper extremity w/contrast (both sides)
|
$2,220.48 |
$2,220.48 |
$2,220.48 |
$1,694.16
|
|
CT upper extremity without contrast (both sides)
|
$1,829.52 |
$1,829.52 |
$1,829.52 |
$1,430.20
|
|
CT uppr extremity w/o&w/dye
|
$2,494.08 |
$2,494.08 |
$2,494.08 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$210.96 |
$210.96 |
$210.96 |
$68.64
|
|
Culture afb any source
|
$186.48 |
$186.48 |
$186.48 |
$109.20
|
|
Culture anaerobic additional method definitive id each
|
$141.12 |
$141.12 |
$141.12 |
$79.00
|
|
Culture anaerobic except blood
|
$220.32 |
$220.32 |
$220.32 |
$120.00
|
|
Culture body fluid
|
$110.88 |
$110.88 |
$110.88 |
$126.75
|
|
Culture fungi definitive id mold
|
$87.84 |
$87.84 |
$87.84 |
$77.28
|
|
Culture fungi definitive id yeast
|
$147.60 |
$147.60 |
$147.60 |
$79.10
|
|
Culture fungi other (except blood)
|
$188.64 |
$188.64 |
$188.64 |
$108.00
|
|
Culture fungi skin/hair/nail
|
$74.88 |
$74.88 |
$74.88 |
$74.88
|
|
Culture mycobacteria definitive id each isolate
|
$90.72 |
$90.72 |
$90.72 |
$89.70
|
|
Culture mycoplasma any source
|
$147.60 |
$147.60 |
$147.60 |
$85.26
|
|
Culture screening strep group a
|
$133.20 |
$133.20 |
$133.20 |
$81.00
|
|
Culture typing immunologic
|
$156.96 |
$156.96 |
$156.96 |
$44.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$807.84 |
$807.84 |
$807.84 |
$392.50
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$189.36 |
$189.36 |
$189.36 |
$133.90
|
|
Culture urine each isolate
|
$100.80 |
$100.80 |
$100.80 |
$57.00
|
|
Cyanocobalamin unsat binding capacity
|
$55.44 |
$55.44 |
$55.44 |
$64.00
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$12.96 |
$12.96 |
$12.96 |
$25.20
|
|
Cyclic citrullinated peptide antibody
|
$87.84 |
$87.84 |
$87.84 |
$70.72
|
|
Cyclosporine 2 hour
|
$198.00 |
$198.00 |
$198.00 |
$129.48
|
|
Cystatin c
|
$106.56 |
$106.56 |
$106.56 |
$77.50
|
|
Cystine urine quantitative
|
$61.92 |
$61.92 |
$61.92 |
$103.35
|
|
Cystogram >= 3 views supervision & interpretation
|
$1,406.88 |
$1,406.88 |
$1,406.88 |
$542.10
|
|
Cystourethroscop/calib/dilat stric 52281
|
$3,954.96 |
$3,954.96 |
$3,954.96 |
$3,065.15
|
|
Cytomegalovirus (cmv) antibody igg
|
$56.88 |
$56.88 |
$56.88 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$177.12 |
$177.12 |
$177.12 |
$97.50
|
|
Cytopath fl nongyn filter
|
$72.72 |
$72.72 |
$72.72 |
$92.63
|
|
Cytopathology cellular enhancement technique non-gyn
|
$134.64 |
$134.64 |
$134.64 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$179.28 |
$179.28 |
$179.28 |
$91.84
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$132.48 |
$132.48 |
$132.48 |
$87.50
|
|
Cytopathology concentration technique smears & interpretation
|
$64.80 |
$64.80 |
$64.80 |
$129.60
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$114.48 |
$114.48 |
$114.48 |
$129.35
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$401.04 |
$401.04 |
$401.04 |
$187.28
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$171.36 |
$171.36 |
$171.36 |
$209.23
|
|
Cytopath smear other source
|
$67.68 |
$67.68 |
$67.68 |
$88.13
|
|
Cytp urine 3-5 probes cmptr
|
$313.92 |
$313.92 |
$313.92 |
$690.00
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$0.21 |
$0.21 |
$0.21 |
$168.53
|
|
Dch glucoscan
|
$38.16 |
$38.16 |
$38.16 |
$28.10
|
|
Deamidated gliadin antibody iga
|
$109.44 |
$109.44 |
$109.44 |
$43.60
|
|
Decalcification
|
$64.08 |
$64.08 |
$64.08 |
$68.90
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$610.56 |
$610.56 |
$610.56 |
$543.00
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$108.03 |
$108.03 |
$108.03 |
$6,324.98
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$367.20 |
$367.20 |
$367.20 |
$408.10
|
|
Desoxycorticosterone
|
$130.32 |
$130.32 |
$130.32 |
$109.28
|
|
Dest mal lesion tal 0.6-1.0cm 17261
|
$226.08 |
$226.08 |
$226.08 |
$262.60
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$639.36 |
$639.36 |
$639.36 |
$227.15
|
|
Dexamethasone 4 mg tablet
|
$0.27 |
$0.27 |
$0.27 |
$5.85
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$32.40 |
$32.40 |
$32.40 |
$45.40
|
|
Dextrose 5 % IV bolus
|
$32.40 |
$32.40 |
$32.40 |
$48.00
|
|
Dhea-s (dehydroepiand sulfate)
|
$136.08 |
$136.08 |
$136.08 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$143.28 |
$143.28 |
$143.28 |
$79.20
|
|
Diab manage trn ind/group
|
$37.44 |
$37.44 |
$37.44 |
$56.55
|
|
Diagnostic laryngoscopy 31575
|
$904.32 |
$904.32 |
$904.32 |
$331.58
|
|
Diagnostic Mammogram (both breasts)
|
$571.68 |
$571.68 |
$571.68 |
$399.30
|
|
Diagnostic Mammogram (one breast)
|
$427.68 |
$427.68 |
$427.68 |
$301.55
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$42.66 |
$42.66 |
$42.66 |
$74.76
|
|
Dicyclomine injection
|
$135.00 |
$135.00 |
$135.00 |
$153.29
|
|
Diffusing capacity
|
$361.44 |
$361.44 |
$361.44 |
$332.00
|
|
Digoxin total therapeutic drug level
|
$135.36 |
$135.36 |
$135.36 |
$102.00
|
|
Dilate esophagus 1/mult pass
|
$2,110.32 |
$2,110.32 |
$2,110.32 |
$1,484.17
|
|
Diltiazem 5 mg/ml intravenous solution
|
$0.26 |
$0.26 |
$0.26 |
$47.94
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$12.96 |
$12.96 |
$12.96 |
$17.75
|
|
Dna antibody native/double stranded
|
$213.84 |
$213.84 |
$213.84 |
$97.50
|
|
Dna gardnerella
|
$103.68 |
$103.68 |
$103.68 |
$62.50
|
|
Dna trichomonas
|
$97.20 |
$97.20 |
$97.20 |
$67.80
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$77.76 |
$77.76 |
$77.76 |
$98.43
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$6.55 |
$6.55 |
$6.55 |
$65.40
|
|
Doppler echo complete
|
$720.00 |
$720.00 |
$720.00 |
$540.00
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$915.12 |
$915.12 |
$915.12 |
$662.35
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$488.16 |
$488.16 |
$488.16 |
$471.17
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$0.87 |
$0.87 |
$0.87 |
$84.80
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$780.48 |
$780.48 |
$780.48 |
$800.00
|
|
Drainage mouth roof lesion
|
$658.80 |
$658.80 |
$658.80 |
$390.39
|
|
Drainage of mouth lesion
|
$3,502.80 |
$3,502.80 |
$3,502.80 |
$3,900.60
|
|
Drain blood from under nail 11740
|
$231.12 |
$231.12 |
$231.12 |
$170.50
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$447.84 |
$447.84 |
$447.84 |
$344.00
|
|
Dress/debrid prtl-thick burn l 16030
|
$431.28 |
$431.28 |
$431.28 |
$523.00
|
|
Droperidol 2.5 mg/ml injection solution
|
$37.08 |
$37.08 |
$37.08 |
$31.07
|
|
Drug assay vedolizumab
|
$226.80 |
$226.80 |
$226.80 |
$152.79
|
|
Drug screen quant tiagabine
|
$95.76 |
$95.76 |
$95.76 |
$114.62
|
|
Drug test def 1-7 classes
|
$144.00 |
$144.00 |
$144.00 |
$250.52
|
|
Drug test def 22+ classes
|
$673.20 |
$673.20 |
$673.20 |
$423.00
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$153.36 |
$153.36 |
$153.36 |
$278.85
|
|
Drvvt confirm - quest
|
$30.24 |
$30.24 |
$30.24 |
$109.20
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$562.32 |
$562.32 |
$562.32 |
$745.00
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$1,277.28 |
$1,277.28 |
$1,277.28 |
$887.25
|
|
Ear irrigation 69209
|
$126.72 |
$126.72 |
$126.72 |
$149.76
|
|
Ecg 12 lead tracing only
|
$258.48 |
$258.48 |
$258.48 |
$226.50
|
|
Ecg/1-3 leads/tracing only 93041
|
$188.64 |
$188.64 |
$188.64 |
$135.80
|
|
Ecg external < 48 hours recording
|
$1,306.80 |
$1,306.80 |
$1,306.80 |
$462.00
|
|
Ecg external < 48 hours scanning analysis w/report
|
$380.88 |
$380.88 |
$380.88 |
$541.20
|
|
Echocardiogram (Heart Ultrasound)
|
$1,915.20 |
$1,915.20 |
$1,915.20 |
$2,001.17
|
|
Echocardiography doppler color flow mapping
|
$577.44 |
$577.44 |
$577.44 |
$469.95
|
|
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler
|
$2,995.20 |
$2,995.20 |
$2,995.20 |
$1,943.50
|
|
Echocardiography transthoracic 2d followup/limited
|
$347.76 |
$347.76 |
$347.76 |
$703.25
|
|
Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast
|
$890.64 |
$890.64 |
$890.64 |
$851.50
|
|
Echocardiograpy doppler follow up/limited study
|
$442.80 |
$442.80 |
$442.80 |
$362.50
|
