|
Culture quantitative aerobic other source
|
$187.80 |
$187.80 |
$187.80 |
$63.45
|
|
Culture screening strep group a
|
$120.60 |
$120.60 |
$120.60 |
$76.00
|
|
Culture typing immunologic
|
$96.00 |
$96.00 |
$96.00 |
$38.58
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$392.40 |
$392.40 |
$392.40 |
$392.40
|
|
Culture urine each isolate
|
$108.60 |
$108.60 |
$108.60 |
$44.80
|
|
Cyanocobalamin unsat binding capacity
|
$151.20 |
$151.20 |
$151.20 |
$64.28
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$42.47 |
$42.47 |
$42.47 |
$17.58
|
|
Cyclic citrullinated peptide antibody
|
$199.80 |
$199.80 |
$199.80 |
$91.20
|
|
Cyclosporine 2 hour
|
$271.80 |
$271.80 |
$271.80 |
$126.10
|
|
Cyclosporine oral 100 mg
|
$1,187.49 |
$1,187.49 |
$1,187.49 |
$19.50
|
|
Cystatin c
|
$143.40 |
$143.40 |
$143.40 |
$83.20
|
|
Cystine urine quantitative
|
$303.00 |
$303.00 |
$303.00 |
$112.50
|
|
Cytogenetics 25-99
|
$424.80 |
$424.80 |
$424.80 |
$188.40
|
|
Cytomegalovirus (cmv) antibody igg
|
$168.00 |
$168.00 |
$168.00 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$178.80 |
$178.80 |
$178.80 |
$95.00
|
|
Cyto/molecular report
|
$120.00 |
$120.00 |
$120.00 |
$91.65
|
|
Cytopathology cellular enhancement technique non-gyn
|
$251.40 |
$251.40 |
$251.40 |
$163.43
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$140.40 |
$140.40 |
$140.40 |
$98.00
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$118.80 |
$118.80 |
$118.80 |
$90.88
|
|
Cytopathology concentration technique smears & interpretation
|
$223.20 |
$223.20 |
$223.20 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$113.40 |
$113.40 |
$113.40 |
$129.90
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$292.80 |
$292.80 |
$292.80 |
$205.00
|
|
Cytp urine 3-5 probes cmptr
|
$830.40 |
$830.40 |
$830.40 |
$779.00
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$2.18 |
$2.18 |
$2.18 |
$1.80
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$3,300.15 |
$3,300.15 |
$3,300.15 |
$4,542.99
|
|
Dch glucoscan
|
$42.00 |
$42.00 |
$42.00 |
$28.10
|
|
Dch validity tests
|
$42.60 |
$42.60 |
$42.60 |
$25.00
|
|
Deamidated gliadin antibody iga
|
$21.60 |
$21.60 |
$21.60 |
$53.95
|
|
Debridement (>20 cm) charge pt
|
$586.20 |
$586.20 |
$586.20 |
$313.30
|
|
Decalcification
|
$147.00 |
$147.00 |
$147.00 |
$72.15
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$1,264.80 |
$1,264.80 |
$1,264.80 |
$482.35
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$225.60 |
$225.60 |
$225.60 |
$220.43
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$319.80 |
$319.80 |
$319.80 |
$8.23
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$78.83 |
$78.83 |
$78.83 |
$37.50
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$78.65 |
$78.65 |
$78.65 |
$68.25
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$49.75 |
$49.75 |
$49.75 |
$48.56
|
|
Dextrose 5 % IV bolus
|
$78.86 |
$78.86 |
$78.86 |
$46.35
|
|
Dhea-s (dehydroepiand sulfate)
|
$534.00 |
$534.00 |
$534.00 |
$110.50
|
|
Diabetes (HbA1c) Test
|
$198.00 |
$198.00 |
$198.00 |
$70.00
|
|
Diagnostic digital breast tomosynthesis bil
|
$53.40 |
$53.40 |
$53.40 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$53.40 |
$53.40 |
$53.40 |
$75.93
|
|
Diagnostic Mammogram (both breasts)
|
$324.00 |
$324.00 |
$324.00 |
$381.60
|
|
Diagnostic Mammogram (one breast)
|
$228.00 |
$228.00 |
$228.00 |
$276.60
|
|
Diatrizoate meglumine 18 % urethral solution
|
$0.22 |
$0.22 |
$0.22 |
$58.24
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$80.83 |
$80.83 |
$80.83 |
$42.12
|
|
Dicyclomine injection
|
$193.54 |
$193.54 |
$193.54 |
$153.53
|
|
Diffusing capacity
|
$267.60 |
$267.60 |
$267.60 |
$336.80
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$191.62 |
$191.62 |
$191.62 |
$29.85
|
|
Digoxin immune fab 40 mg intravenous solution
|
$6,815.78 |
$6,815.78 |
$6,815.78 |
$6,815.78
|
|
Digoxin total therapeutic drug level
|
$152.40 |
$152.40 |
$152.40 |
$92.95
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$308.90 |
$308.90 |
$308.90 |
$297.86
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$38.75 |
$38.75 |
$38.75 |
$9.29
|
|
Dna antibody native/double stranded
|
$152.40 |
$152.40 |
$152.40 |
$101.40
|
|
Dna gardnerella
|
$69.60 |
$69.60 |
$69.60 |
$67.68
|
|
Dna trichomonas
|
$69.60 |
$69.60 |
$69.60 |
$69.60
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$65.84 |
$65.84 |
$65.84 |
$95.06
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$104.59 |
$104.59 |
$104.59 |
$60.21
|
|
Doppler echo complete
|
$917.40 |
$917.40 |
$917.40 |
$517.94
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$997.80 |
$997.80 |
$997.80 |
$642.00
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$657.60 |
$657.60 |
$657.60 |
$463.20
|
|
Drug of abuse screen urine
|
$142.80 |
$142.80 |
$142.80 |
$58.50
|
|
Drug test def 1-7 classes
|
$394.20 |
$394.20 |
$394.20 |
$316.80
|
|
Drug test def 8-14 classes
|
$394.20 |
$394.20 |
$394.20 |
$249.10
|
|
Drug test prsmv instrmnt
|
$142.80 |
$142.80 |
$142.80 |
$76.70
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$214.20 |
$214.20 |
$214.20 |
$278.85
|
|
Drvvt confirm - quest
|
$214.20 |
$214.20 |
$214.20 |
$108.55
|
|
Ductogram sgl duct
|
$514.20 |
$514.20 |
$514.20 |
$346.42
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$1,006.80 |
$1,006.80 |
$1,006.80 |
$740.80
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$1,402.80 |
$1,402.80 |
$1,402.80 |
$852.57
|
|
Ear irrigation 69209
|
$186.00 |
$186.00 |
$186.00 |
$152.50
|
|
Ecg 12 lead tracing only
|
$273.60 |
$273.60 |
$273.60 |
$222.30
|
|
Ecg external < 48 hours recording
|
$643.20 |
$643.20 |
$643.20 |
$461.76
|
|
Ecg external < 48 hours scanning analysis w/report
|
$912.00 |
$912.00 |
$912.00 |
$541.73
|
|
Ecg external > 48 hours up to 7 days recording
|
$298.80 |
$298.80 |
$298.80 |
$180.00
|
|
Ecg external >7 days up to 15 days recording
|
$595.80 |
$595.80 |
$595.80 |
$213.20
|
|
Echocardiogram (Heart Ultrasound)
|
$2,909.40 |
$2,909.40 |
$2,909.40 |
$2,021.12
|
|
Echocardiography doppler color flow mapping
|
$795.00 |
$795.00 |
$795.00 |
$450.40
|
|
Echocardiography transthoracic 2d followup/limited
|
$888.60 |
$888.60 |
$888.60 |
$720.60
|
|
Echocardiograpy doppler follow up/limited study
|
$588.60 |
$588.60 |
$588.60 |
$348.80
|
|
Echo tee probe placement image acquisition interpretation & report
|
$3,094.20 |
$3,094.20 |
$3,094.20 |
$1,946.10
|
|
Echo transesophageal
|
$2,796.00 |
$2,796.00 |
$2,796.00 |
$1,737.60
|
|
Egfr gene com variants
|
$665.40 |
$665.40 |
$665.40 |
$619.04
|
|
Electrical stimulation/unattended 97014
|
$79.20 |
$79.20 |
$79.20 |
$79.20
|
|
Electrolyte panel
|
$174.60 |
$174.60 |
$174.60 |
$68.56
|
|
Enoxaparin 30 mg/0.3 ml subcutaneous syringe
|
$43.20 |
$43.20 |
$43.20 |
$43.20
|
|
Entamoeba histolytica ag eia - sendout
|
$127.80 |
$127.80 |
$127.80 |
$68.90
|
|
Epoprostenol (arginine) 1 mg in 50 ml ns inhalation syringe - cnr
|
$182.13 |
$182.13 |
$182.13 |
$178.29
|
|
Epstein barr early antigen antibody
|
$136.20 |
$136.20 |
$136.20 |
$85.20
|
|
Epstein barr nuclear antigen antibody
|
$231.00 |
$231.00 |
$231.00 |
$88.80
|
|
Epstein barr viral capsid antigen antibody igm
|
$197.40 |
$197.40 |
$197.40 |
$112.50
|
|
Eptifibatide 0.75 mg/ml intravenous solution
|
$15.59 |
$15.59 |
$15.59 |
$62.40
|
|
Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr
|
$364.08 |
$364.08 |
$364.08 |
$138.28
|
|
ER Visit (level 1, minor)
|
$251.40 |
$251.40 |
$251.40 |
$270.00
|
|
ER Visit (level 2)
|
$450.00 |
$450.00 |
$450.00 |
$469.39
|
|
ER Visit (level 3)
|
$688.20 |
$688.20 |
$688.20 |
$821.52
|
|
ER Visit (level 4)
|
$1,060.80 |
$1,060.80 |
$1,060.80 |
$1,320.00
|
|
ER Visit (level 5, high severity)
|
$1,492.20 |
$1,492.20 |
$1,492.20 |
$1,900.20
|
|
Esmolol 2,500 mg/250 ml (10 mg/ml) IV wrapper osm only
|
$45.48 |
$45.48 |
$45.48 |
$406.83
|
|
Established Patient Office Visit (level 1)
|
$174.00 |
$174.00 |
$174.00 |
$118.20
|
|
Established Patient Office Visit (level 2)
|
$196.80 |
$196.80 |
$196.80 |
$138.60
|
