|
CT lwr extremity w/o&w/dye
|
$2,115.00 |
$2,115.00 |
$2,115.00 |
$1,854.05
|
|
CT neck soft tissue w/contrast
|
$1,861.80 |
$1,861.80 |
$1,861.80 |
$1,652.00
|
|
CT neck soft tissue without contrast
|
$1,473.60 |
$1,473.60 |
$1,473.60 |
$1,327.95
|
|
CT neck soft tissue without & w/contrast
|
$2,115.00 |
$2,115.00 |
$2,115.00 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$2,014.80 |
$2,014.80 |
$2,014.80 |
$1,728.18
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$1,773.60 |
$1,773.60 |
$1,773.60 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$1,473.60 |
$1,473.60 |
$1,473.60 |
$1,360.00
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$4,989.00 |
$4,989.00 |
$4,989.00 |
$3,493.80
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$4,282.80 |
$4,282.80 |
$4,282.80 |
$2,971.80
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$3,258.00 |
$3,258.00 |
$3,258.00 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$2,329.80 |
$2,329.80 |
$2,329.80 |
$1,690.32
|
|
CT thoracic spine without contrast
|
$2,027.40 |
$2,027.40 |
$2,027.40 |
$1,464.00
|
|
CT thorax low dose for lung screening without contrast
|
$1,788.00 |
$1,788.00 |
$1,788.00 |
$331.50
|
|
CT upper extremity w/contrast (both sides)
|
$1,970.40 |
$1,970.40 |
$1,970.40 |
$1,694.16
|
|
CT upper extremity without contrast (both sides)
|
$1,473.60 |
$1,473.60 |
$1,473.60 |
$1,430.20
|
|
CT uppr extremity w/o&w/dye
|
$2,111.40 |
$2,111.40 |
$2,111.40 |
$1,845.36
|
|
Culture aerobic additional method definitive id each
|
$112.80 |
$112.80 |
$112.80 |
$68.64
|
|
Culture afb any source
|
$149.40 |
$149.40 |
$149.40 |
$109.20
|
|
Culture anaerobic except blood
|
$164.40 |
$164.40 |
$164.40 |
$120.00
|
|
Culture bact stool aero addl path ea
|
$27.00 |
$27.00 |
$27.00 |
$51.45
|
|
Culture body fluid
|
$154.80 |
$154.80 |
$154.80 |
$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 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
|
$118.20 |
$118.20 |
$118.20 |
$70.72
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$2,944.80 |
$2,944.80 |
$2,944.80 |
$1,305.02
|
|
Cyclosporine 2 hour
|
$172.20 |
$172.20 |
$172.20 |
$129.48
|
|
Cylinder pump set 20cm titan zero angl
|
$15,521.44 |
$15,521.44 |
$15,521.44 |
$22,803.38
|
|
Cystatin c
|
$122.40 |
$122.40 |
$122.40 |
$77.50
|
|
Cystogram >= 3 views supervision & interpretation
|
$277.80 |
$277.80 |
$277.80 |
$542.10
|
|
Cystoscopy (Bladder Scope)
|
$216.00 |
$216.00 |
$216.00 |
$1,493.80
|
|
Cytomegalovirus (cmv) antibody igg
|
$79.20 |
$79.20 |
$79.20 |
$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 fna adequacy evaluation first episode each site interp/rpt
|
$95.40 |
$95.40 |
$95.40 |
$209.23
|
|
Cytopath smear oth prep screen & interp
|
$28.80 |
$28.80 |
$28.80 |
$96.20
|
|
Dalbavancin 500 mg intravenous solution
|
$5,117.40 |
$5,117.40 |
$5,117.40 |
$3,480.35
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$116.40 |
$116.40 |
$116.40 |
$168.53
|
|
Dch glucoscan
|
$30.00 |
$30.00 |
$30.00 |
$28.10
|
|
Dch validity tests
|
$31.80 |
$31.80 |
$31.80 |
$24.50
|
|
Deamidated gliadin antibody iga
|
$11.40 |
$11.40 |
$11.40 |
$43.60
|
|
Debridement (>20 cm) charge pt
|
$135.00 |
$135.00 |
$135.00 |
$260.61
|
|
Debridement bone <= 20 sq cm
|
$1,486.80 |
$1,486.80 |
$1,486.80 |
$2,316.00
|
|
Debridement/bone/20 sq cm or less 11046
|
$542.40 |
$542.40 |
$542.40 |
$663.00
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$542.40 |
$542.40 |
$542.40 |
$810.50
|
|
Debride nail1-5 11720
|
$87.00 |
$87.00 |
$87.00 |
$148.80
|
|
Debride/subq tissue/ea add 20sq cm 11045
|
$542.40 |
$542.40 |
$542.40 |
$639.60
|
|
Debr musc/fascia 20sq cm/< 11043
|
$542.40 |
$542.40 |
$542.40 |
$1,160.00
|
|
Decalcification
|
$21.60 |
$21.60 |
$21.60 |
$68.90
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$452.40 |
$452.40 |
$452.40 |
$543.00
|
|
Degarelix 120 mg subcutaneous solution
|
$1,710.00 |
$1,710.00 |
$1,710.00 |
$1,807.08
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$3,946.80 |
$3,946.80 |
$3,946.80 |
$6,324.98
|
|
Destroy premlg lesns;1st lesn 17000
|
$50.40 |
$50.40 |
$50.40 |
$199.50
|
|
Destruct ben lesion 15/> 17111
|
$72.00 |
$72.00 |
$72.00 |
$235.13
|
|
Destruction 2-14 lesions 17003
|
$30.00 |
$30.00 |
$30.00 |
$72.60
|
|
Destruction benign lesions < 14 lesions
|
$58.20 |
$58.20 |
$58.20 |
$235.13
|
|
Destruction premal lesions 15/> 17004
|
$188.40 |
$188.40 |
$188.40 |
$436.64
|
|
Device intraute mirena
|
$3,258.00 |
$3,258.00 |
$3,258.00 |
$2,125.00
|
|
Dexamethasone 4 mg tablet
|
$4.20 |
$4.20 |
$4.20 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$33.00 |
$33.00 |
$33.00 |
$21.17
|
|
Dhea-s (dehydroepiand sulfate)
|
$252.60 |
$252.60 |
$252.60 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$70.20 |
$70.20 |
$70.20 |
$79.20
|
|
Diagnostic Mammogram (both breasts)
|
$729.60 |
$729.60 |
$729.60 |
$399.30
|
|
Diagnostic Mammogram (one breast)
|
$364.80 |
$364.80 |
$364.80 |
$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
|
|
Dicyclomine injection
|
$268.20 |
$268.20 |
$268.20 |
$153.29
|
|
Diffusing capacity
|
$208.20 |
$208.20 |
$208.20 |
$332.00
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$19.20 |
$19.20 |
$19.20 |
$69.03
|
|
Digoxin immune fab 40 mg intravenous solution
|
$12,133.20 |
$12,133.20 |
$12,133.20 |
$10,079.82
|
|
Digoxin total therapeutic drug level
|
$163.80 |
$163.80 |
$163.80 |
$102.00
|
|
Dilate urethra stricture
|
$142.20 |
$142.20 |
$142.20 |
$490.00
|
|
Diltiazem 5 mg/ml intravenous solution
|
$22.20 |
$22.20 |
$22.20 |
$47.94
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$4.80 |
$4.80 |
$4.80 |
$17.75
|
|
Disaccharidases
|
$969.00 |
$969.00 |
$969.00 |
$216.00
|
|
Dna antibody native/double stranded
|
$271.80 |
$271.80 |
$271.80 |
$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)
|
$1,451.40 |
$1,451.40 |
$1,451.40 |
$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
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$223.80 |
$223.80 |
$223.80 |
$471.17
|
|
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
|
|
Drain blood from under nail 11740
|
$126.00 |
$126.00 |
$126.00 |
$170.50
|
|
Drain finger abscess;simple 26010
|
$278.40 |
$278.40 |
$278.40 |
$419.00
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$234.00 |
$234.00 |
$234.00 |
$392.40
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$199.20 |
$199.20 |
$199.20 |
$344.00
|
|
Dress/debrid prtl-thick burn l 16030
|
$426.60 |
$426.60 |
$426.60 |
$523.00
|
|
Drng of finger abscess comp 26011
|
$2,068.80 |
$2,068.80 |
$2,068.80 |
$1,943.50
|
|
Drng of hydrocele 55000
|
$716.40 |
$716.40 |
$716.40 |
$832.60
|
|
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm
|
$193.15 |
$193.15 |
$193.15 |
$289.05
|
|
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
|
$471.60 |
$471.60 |
$471.60 |
$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
|
$358.20 |
$358.20 |
$358.20 |
$278.85
|
