|
CT orbit/sella/fossa w/wo contrast
|
$2,686.20 |
$2,686.20 |
$2,686.20 |
$1,728.18
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$2,361.60 |
$2,361.60 |
$2,361.60 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$1,869.00 |
$1,869.00 |
$1,869.00 |
$1,360.00
|
|
Ctrl nosebld postir subsq 30906
|
$293.40 |
$293.40 |
$293.40 |
$437.04
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$6,093.00 |
$6,093.00 |
$6,093.00 |
$3,493.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$4,987.20 |
$4,987.20 |
$4,987.20 |
$2,971.80
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$3,796.80 |
$3,796.80 |
$3,796.80 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$2,910.60 |
$2,910.60 |
$2,910.60 |
$1,690.32
|
|
CT thoracic spine without contrast
|
$2,566.80 |
$2,566.80 |
$2,566.80 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$2,080.20 |
$2,080.20 |
$2,080.20 |
$331.50
|
|
CT t-spine w /wo contrast
|
$3,442.80 |
$3,442.80 |
$3,442.80 |
$2,027.52
|
|
CT upper extremity w/contrast (both sides)
|
$2,361.60 |
$2,361.60 |
$2,361.60 |
$1,694.16
|
|
CT upper extremity without contrast (both sides)
|
$1,869.00 |
$1,869.00 |
$1,869.00 |
$1,430.20
|
|
CT uppr extremity w/o&w/dye
|
$2,686.20 |
$2,686.20 |
$2,686.20 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$124.80 |
$124.80 |
$124.80 |
$68.64
|
|
Culture afb any source
|
$160.20 |
$160.20 |
$160.20 |
$109.20
|
|
Culture anaerobic except blood
|
$178.80 |
$178.80 |
$178.80 |
$120.00
|
|
Culture bact stool aero addl path ea
|
$29.40 |
$29.40 |
$29.40 |
$51.45
|
|
Culture body fluid
|
$160.20 |
$160.20 |
$160.20 |
$126.75
|
|
Culture fungi skin/hair/nail
|
$25.20 |
$25.20 |
$25.20 |
$74.88
|
|
Culture mycoplasma any source
|
$27.60 |
$27.60 |
$27.60 |
$85.26
|
|
Culture screening strep group a
|
$14.40 |
$14.40 |
$14.40 |
$81.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$25.80 |
$25.80 |
$25.80 |
$392.50
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$24.00 |
$24.00 |
$24.00 |
$25.20
|
|
Cyclic citrullinated peptide antibody
|
$120.60 |
$120.60 |
$120.60 |
$70.72
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$2,944.80 |
$2,944.80 |
$2,944.80 |
$1,305.02
|
|
Cyclosporine 2 hour
|
$186.00 |
$186.00 |
$186.00 |
$129.48
|
|
Cystatin c
|
$123.00 |
$123.00 |
$123.00 |
$77.50
|
|
Cystogram >= 3 views supervision & interpretation
|
$291.60 |
$291.60 |
$291.60 |
$542.10
|
|
Cytomegalovirus (cmv) antibody igg
|
$82.20 |
$82.20 |
$82.20 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$95.40 |
$95.40 |
$95.40 |
$97.50
|
|
Cytopathology cellular enhancement technique non-gyn
|
$97.80 |
$97.80 |
$97.80 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$39.00 |
$39.00 |
$39.00 |
$91.84
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$112.80 |
$112.80 |
$112.80 |
$87.50
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$87.60 |
$87.60 |
$87.60 |
$187.28
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$87.60 |
$87.60 |
$87.60 |
$209.23
|
|
Dacarbazine 100 mg intravenous solution
|
$55.80 |
$55.80 |
$55.80 |
$58.22
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$116.40 |
$116.40 |
$116.40 |
$168.53
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$26,504.40 |
$26,504.40 |
$26,504.40 |
$21,063.03
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$2,581.20 |
$2,581.20 |
$2,581.20 |
$6,072.48
|
|
Dch glucoscan
|
$30.00 |
$30.00 |
$30.00 |
$28.10
|
|
Dch validity tests
|
$36.00 |
$36.00 |
$36.00 |
$24.50
|
|
Deamidated gliadin antibody iga
|
$11.40 |
$11.40 |
$11.40 |
$43.60
|
|
Debridement (>20 cm) charge pt
|
$148.20 |
$148.20 |
$148.20 |
$260.61
|
|
Debridement bone <= 20 sq cm
|
$1,954.80 |
$1,954.80 |
$1,954.80 |
$2,316.00
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$480.60 |
$480.60 |
$480.60 |
$810.50
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$907.80 |
$907.80 |
$907.80 |
$639.60
|
|
Debr musc/fascia 20sq cm/< 11043
|
$727.80 |
$727.80 |
$727.80 |
$1,160.00
|
|
Decalcification
|
$26.40 |
$26.40 |
$26.40 |
$68.90
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$431.40 |
$431.40 |
$431.40 |
$543.00
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$7,392.60 |
$7,392.60 |
$7,392.60 |
$6,324.98
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$312.00 |
$312.00 |
$312.00 |
$408.10
|
|
Desmopressin 4 mcg/ml injection solution
|
$2,074.80 |
$2,074.80 |
$2,074.80 |
$89.78
|
|
Dexamethasone 4 mg tablet
|
$4.20 |
$4.20 |
$4.20 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$18.00 |
$18.00 |
$18.00 |
$21.17
|
|
Dexmedetomidine film, 1 mcg
|
$422.40 |
$422.40 |
$422.40 |
$171.39
|
|
Dhea-s (dehydroepiand sulfate)
|
$275.40 |
$275.40 |
$275.40 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$70.80 |
$70.80 |
$70.80 |
$79.20
|
|
Diagnostic Mammogram (both breasts)
|
$578.40 |
$578.40 |
$578.40 |
$399.30
|
|
Diagnostic Mammogram (one breast)
|
$289.20 |
$289.20 |
$289.20 |
$301.55
|
|
Dialysis one evaluation
|
$1,500.00 |
$1,500.00 |
$1,500.00 |
$919.55
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$91.80 |
$91.80 |
$91.80 |
$74.76
|
|
Diffusing capacity
|
$192.00 |
$192.00 |
$192.00 |
$332.00
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$19.20 |
$19.20 |
$19.20 |
$69.03
|
|
Digoxin total therapeutic drug level
|
$175.20 |
$175.20 |
$175.20 |
$102.00
|
|
Diltiazem 5 mg/ml intravenous solution
|
$24.90 |
$24.90 |
$24.90 |
$47.94
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$4.80 |
$4.80 |
$4.80 |
$17.75
|
|
Disability dlco
|
$179.40 |
$179.40 |
$179.40 |
$282.40
|
|
Dna antibody native/double stranded
|
$279.60 |
$279.60 |
$279.60 |
$97.50
|
|
Dna gardnerella
|
$37.20 |
$37.20 |
$37.20 |
$62.50
|
|
Dna trichomonas
|
$37.20 |
$37.20 |
$37.20 |
$67.80
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$42.60 |
$42.60 |
$42.60 |
$98.43
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$1,834.20 |
$1,834.20 |
$1,834.20 |
$904.81
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$65.40 |
$65.40 |
$65.40 |
$65.40
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$205.20 |
$205.20 |
$205.20 |
$662.35
|
|
Doxorubicin 2 mg/ml intravenous solution (wrapper)
|
$1,065.60 |
$1,065.60 |
$1,065.60 |
$423.95
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$96.60 |
$96.60 |
$96.60 |
$84.80
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$249.60 |
$249.60 |
$249.60 |
$800.00
|
|
Drain finger abscess;simple 26010
|
$307.80 |
$307.80 |
$307.80 |
$419.00
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$246.60 |
$246.60 |
$246.60 |
$392.40
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$195.60 |
$195.60 |
$195.60 |
$344.00
|
|
Droperidol 2.5 mg/ml injection solution
|
$9.00 |
$9.00 |
$9.00 |
$31.07
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$193.15 |
$193.15 |
$193.15 |
$289.05
|
|
Drug of abuse screen urine
|
$25.20 |
$25.20 |
$25.20 |
$63.75
|
|
Drug screening tapentadol
|
$61.20 |
$61.20 |
$61.20 |
$36.00
|
|
Drug test def 15-21 classes
|
$146.40 |
$146.40 |
$146.40 |
$263.25
|
|
Drug test def 1-7 classes
|
$320.40 |
$320.40 |
$320.40 |
$250.52
|
|
Drug test def 8-14 classes
|
$156.60 |
$156.60 |
$156.60 |
$282.00
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$220.80 |
$220.80 |
$220.80 |
$278.85
|
|
Drvvt confirm - quest
|
$518.40 |
$518.40 |
$518.40 |
$109.20
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$819.60 |
$819.60 |
$819.60 |
$887.25
|
|
Durvalumab 50 mg/ml intravenous solution
|
$11,861.40 |
$11,861.40 |
$11,861.40 |
$7,973.90
|
|
Ear irrigation 69209
|
$216.60 |
$216.60 |
$216.60 |
$149.76
|
|
Ecg 12 lead tracing only
|
$234.60 |
$234.60 |
$234.60 |
$226.50
|
|
Ecg external < 48 hours recording
|
$127.20 |
$127.20 |
$127.20 |
$462.00
|
|
Ecg external > 48 hours up to 7 days recording
|
$51.60 |
$51.60 |
$51.60 |
$147.28
|
|
Ecg external >7 days up to 15 days recording
|
$82.20 |
$82.20 |
$82.20 |
$161.85
|
|
Echocardiogram (Heart Ultrasound)
|
$2,035.80 |
$2,035.80 |
$2,035.80 |
$2,001.17
|
|
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler
|
$2,053.20 |
$2,053.20 |
$2,053.20 |
$1,943.50
|
|
Echocardiography transthoracic 2d followup/limited
|
$540.60 |
$540.60 |
$540.60 |
$703.25
|
