|
CT lower extremity without contrast (both sides)
|
$1,744.60 |
$1,744.60 |
$1,744.60 |
$1,328.00
|
|
CT lwr extremity w/o&w/dye
|
$2,403.70 |
$2,403.70 |
$2,403.70 |
$1,618.50
|
|
CT neck soft tissue w/contrast
|
$1,262.95 |
$1,262.95 |
$1,262.95 |
$1,603.55
|
|
CT neck soft tissue without contrast
|
$1,147.90 |
$1,147.90 |
$1,147.90 |
$1,191.45
|
|
CT neck soft tissue without & w/contrast
|
$1,403.35 |
$1,403.35 |
$1,403.35 |
$1,781.25
|
|
CT orbit/sella/fossa w/wo contrast
|
$1,403.35 |
$1,403.35 |
$1,403.35 |
$1,661.25
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$1,329.90 |
$1,329.90 |
$1,329.90 |
$1,521.58
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$1,065.35 |
$1,065.35 |
$1,065.35 |
$1,301.36
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$2,525.25 |
$2,525.25 |
$2,525.25 |
$3,133.65
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$2,374.45 |
$2,374.45 |
$2,374.45 |
$2,737.80
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$2,148.25 |
$2,148.25 |
$2,148.25 |
$2,245.00
|
|
CT thoracic spine w/contrast
|
$1,329.90 |
$1,329.90 |
$1,329.90 |
$1,619.25
|
|
CT thoracic spine without contrast
|
$1,168.70 |
$1,168.70 |
$1,168.70 |
$1,381.20
|
|
CT thorax low dose for lung screening without contrast
|
$237.90 |
$237.90 |
$237.90 |
$418.50
|
|
CT upper extremity w/contrast (both sides)
|
$2,260.70 |
$2,260.70 |
$2,260.70 |
$1,686.68
|
|
CT upper extremity without contrast (both sides)
|
$1,744.60 |
$1,744.60 |
$1,744.60 |
$1,408.54
|
|
CT uppr extremity w/o&w/dye
|
$2,403.70 |
$2,403.70 |
$2,403.70 |
$1,707.60
|
|
Culture aerobic additional method definitive id each
|
$74.75 |
$74.75 |
$74.75 |
$61.03
|
|
Culture afb any source
|
$139.75 |
$139.75 |
$139.75 |
$93.50
|
|
Culture anaerobic additional method definitive id each
|
$135.85 |
$135.85 |
$135.85 |
$73.50
|
|
Culture anaerobic except blood
|
$172.90 |
$172.90 |
$172.90 |
$112.45
|
|
Culture body fluid
|
$139.10 |
$139.10 |
$139.10 |
$116.00
|
|
Culture fungi definitive id mold
|
$43.55 |
$43.55 |
$43.55 |
$70.00
|
|
Culture fungi definitive id yeast
|
$111.15 |
$111.15 |
$111.15 |
$68.00
|
|
Culture fungi other (except blood)
|
$152.75 |
$152.75 |
$152.75 |
$92.95
|
|
Culture fungi skin/hair/nail
|
$125.45 |
$125.45 |
$125.45 |
$75.40
|
|
Culture mycoplasma any source
|
$63.05 |
$63.05 |
$63.05 |
$94.00
|
|
Culture screening strep group a
|
$64.35 |
$64.35 |
$64.35 |
$76.00
|
|
Culture typing immunologic
|
$16.25 |
$16.25 |
$16.25 |
$38.58
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$488.80 |
$488.80 |
$488.80 |
$392.40
|
|
Culture urine each isolate
|
$102.70 |
$102.70 |
$102.70 |
$45.60
|
|
Cyclic citrullinated peptide antibody
|
$170.95 |
$170.95 |
$170.95 |
$92.95
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$1,187.92 |
$1,187.92 |
$1,187.92 |
$1.44
|
|
Cyclosporine 2 hour
|
$269.75 |
$269.75 |
$269.75 |
$127.20
|
|
Cystatin c
|
$107.90 |
$107.90 |
$107.90 |
$83.20
|
|
Cytomegalovirus (cmv) antibody igg
|
$107.25 |
$107.25 |
$107.25 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$105.95 |
$105.95 |
$105.95 |
$95.00
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$49.40 |
$49.40 |
$49.40 |
$98.00
|
|
Dalbavancin 500 mg intravenous solution
|
$3,469.30 |
$3,469.30 |
$3,469.30 |
$3,469.30
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$27,400.17 |
$27,400.17 |
$27,400.17 |
$15,683.37
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$7,546.50 |
$7,546.50 |
$7,546.50 |
$3,483.00
|
|
Dch validity tests
|
$3.90 |
$3.90 |
$3.90 |
$25.00
|
|
Deamidated gliadin antibody iga
|
$34.45 |
$34.45 |
$34.45 |
$53.95
|
|
Debridement (>20 cm) charge pt
|
$332.15 |
$332.15 |
$332.15 |
$315.59
|
|
Decalcification
|
$15.60 |
$15.60 |
$15.60 |
$72.15
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$31,926.24 |
$31,926.24 |
$31,926.24 |
$482.35
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$27.95 |
$27.95 |
$27.95 |
$173.55
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$8,668.80 |
$8,668.80 |
$8,668.80 |
$4,681.80
|
|
Desmopressin 4 mcg/ml injection solution
|
$16.98 |
$16.98 |
$16.98 |
$39.50
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$156.00 |
$156.00 |
$156.00 |
$220.43
|
|
Dexrazoxane hcl 250 mg intravenous solution
|
$842.89 |
$842.89 |
$842.89 |
$567.96
|
|
Dhea-s (dehydroepiand sulfate)
|
$176.80 |
$176.80 |
$176.80 |
$110.50
|
|
Diabetes (HbA1c) Test
|
$87.10 |
$87.10 |
$87.10 |
$70.00
|
|
Diagnostic Mammogram (both breasts)
|
$176.15 |
$176.15 |
$176.15 |
$388.05
|
|
Diagnostic Mammogram (one breast)
|
$246.35 |
$246.35 |
$246.35 |
$279.55
|
|
Digoxin total therapeutic drug level
|
$129.35 |
$129.35 |
$129.35 |
$95.00
|
|
Disaccharidases
|
$15.60 |
$15.60 |
$15.60 |
$224.58
|
|
Dna antibody native/double stranded
|
$87.75 |
$87.75 |
$87.75 |
$101.40
|
|
Dna gardnerella
|
$59.80 |
$59.80 |
$59.80 |
$67.68
|
|
Dna trichomonas
|
$59.80 |
$59.80 |
$59.80 |
$68.50
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$905.45 |
$905.45 |
$905.45 |
$463.20
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$864.24 |
$864.24 |
$864.24 |
$715.22
|
|
Drug of abuse screen urine
|
$92.30 |
$92.30 |
$92.30 |
$58.40
|
|
Drug test prsmv instrmnt
|
$191.10 |
$191.10 |
$191.10 |
$76.70
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$50.05 |
$50.05 |
$50.05 |
$276.14
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$1,086.80 |
$1,086.80 |
$1,086.80 |
$838.98
|
|
Durvalumab 50 mg/ml intravenous solution
|
$10,737.75 |
$10,737.75 |
$10,737.75 |
$213.60
|
|
Ecg 12 lead tracing only
|
$139.75 |
$139.75 |
$139.75 |
$222.30
|
|
Ecg external < 48 hours recording
|
$384.80 |
$384.80 |
$384.80 |
$461.76
|
|
Ecg external > 48 hours up to 7 days recording
|
$72.80 |
$72.80 |
$72.80 |
$166.84
|
|
Ecg external >7 days up to 15 days recording
|
$118.95 |
$118.95 |
$118.95 |
$212.00
|
|
Echocardiogram (Heart Ultrasound)
|
$999.05 |
$999.05 |
$999.05 |
$1,996.15
|
|
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler
|
$1,495.65 |
$1,495.65 |
$1,495.65 |
$1,899.00
|
|
Echocardiography transthoracic 2d followup/limited
|
$603.85 |
$603.85 |
$603.85 |
$714.35
|
|
Eeg monitor/record/awake/drowsy 95816
|
$582.40 |
$582.40 |
$582.40 |
$835.00
|
|
Egd guide wire insertion
|
$5,750.22 |
$5,750.22 |
$5,750.22 |
$1,247.13
|
|
Ehrlicha chaffeensis amp prb
|
$51.35 |
$51.35 |
$51.35 |
$112.50
|
|
Electrical stimulation/unattended 97014
|
$89.70 |
$89.70 |
$89.70 |
$79.20
|
|
Electrolyte panel
|
$85.15 |
$85.15 |
$85.15 |
$68.56
|
|
Elotuzumab 300 mg intravenous solution
|
$5,778.81 |
$5,778.81 |
$5,778.81 |
$4,699.17
|
|
Endoscopy swallow (fees) vid
|
$529.75 |
$529.75 |
$529.75 |
$457.50
|
|
Epoetin alfa-epbx 40,000 unit/ml injection solution
|
$881.50 |
$881.50 |
$881.50 |
$336.66
|
|
Epoetin alfa in ns IV syringe 100 unit/ml (neo/ped) - cnr
|
$2,084.55 |
$2,084.55 |
$2,084.55 |
$379.58
|
|
Epstein barr early antigen antibody
|
$15.60 |
$15.60 |
$15.60 |
$85.80
|
|
Epstein barr nuclear antigen antibody
|
$198.25 |
$198.25 |
$198.25 |
$86.40
|
|
Epstein barr viral capsid antigen antibody igm
|
$198.25 |
$198.25 |
$198.25 |
$112.50
|
|
Eribulin 1 mg/2 ml (0.5 mg/ml) intravenous solution
|
$3,444.67 |
$3,444.67 |
$3,444.67 |
$296.58
|
|
ER Visit (level 1, minor)
|
$40.95 |
$40.95 |
$40.95 |
$270.00
|
|
ER Visit (level 2)
|
$204.75 |
$204.75 |
$204.75 |
$469.39
|
|
ER Visit (level 3)
|
$448.82 |
$448.82 |
$448.82 |
$814.19
|
|
ER Visit (level 4)
|
$1,313.00 |
$1,313.00 |
$1,313.00 |
$1,320.00
|
|
ER Visit (level 5, high severity)
|
$3,660.21 |
$3,660.21 |
$3,660.21 |
$1,920.00
|
|
Esoph egd dilation <30 mm
|
$7,716.16 |
$7,716.16 |
$7,716.16 |
$2,638.57
|
|
Established Patient Office Visit (level 1)
|
$180.05 |
$180.05 |
$180.05 |
$116.13
|
|
Established Patient Office Visit (level 2)
|
$209.95 |
$209.95 |
$209.95 |
$136.50
|
|
Established Patient Office Visit (level 3)
|
$242.45 |
$242.45 |
$242.45 |
$183.00
|
|
Established Patient Office Visit (level 4)
|
$635.70 |
$635.70 |
$635.70 |
$213.21
|
|
Established Patient Office Visit (level 5)
|
$538.85 |
$538.85 |
$538.85 |
$270.00
|
|
Estradiol total
|
$322.40 |
$322.40 |
$322.40 |
$142.20
|
|
Estrogens total-sendout
|
$79.30 |
$79.30 |
$79.30 |
$112.76
|