|
Culture aerobic additional method definitive id each
|
$53.30 |
$53.30 |
$53.30 |
$61.03
|
|
Culture afb any source
|
$122.20 |
$122.20 |
$122.20 |
$93.50
|
|
Culture anaerobic additional method definitive id each
|
$100.75 |
$100.75 |
$100.75 |
$73.00
|
|
Culture anaerobic except blood
|
$123.50 |
$123.50 |
$123.50 |
$110.00
|
|
Culture bact stool aero addl path ea
|
$50.70 |
$50.70 |
$50.70 |
$49.40
|
|
Culture body fluid
|
$125.45 |
$125.45 |
$125.45 |
$111.15
|
|
Culture fungi definitive id mold
|
$87.10 |
$87.10 |
$87.10 |
$70.00
|
|
Culture fungi definitive id yeast
|
$87.10 |
$87.10 |
$87.10 |
$68.00
|
|
Culture fungi other (except blood)
|
$117.65 |
$117.65 |
$117.65 |
$92.95
|
|
Culture fungi skin/hair/nail
|
$84.50 |
$84.50 |
$84.50 |
$74.75
|
|
Culture mycoplasma any source
|
$172.25 |
$172.25 |
$172.25 |
$94.00
|
|
Culture screening strep group a
|
$87.75 |
$87.75 |
$87.75 |
$76.00
|
|
Culture typing immunologic
|
$41.60 |
$41.60 |
$41.60 |
$38.58
|
|
Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets
|
$754.65 |
$754.65 |
$754.65 |
$392.40
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$28.60 |
$28.60 |
$28.60 |
$100.20
|
|
Culture urine each isolate
|
$72.80 |
$72.80 |
$72.80 |
$44.80
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$7.15 |
$7.15 |
$7.15 |
$17.58
|
|
Cyclic citrullinated peptide antibody
|
$108.55 |
$108.55 |
$108.55 |
$91.20
|
|
Cyclosporine 2 hour
|
$180.70 |
$180.70 |
$180.70 |
$126.10
|
|
Cystatin c
|
$92.30 |
$92.30 |
$92.30 |
$83.20
|
|
Cystic fibrosis cftr
|
$1,190.80 |
$1,190.80 |
$1,190.80 |
$1,041.95
|
|
Cytogenetics 25-99
|
$104.65 |
$104.65 |
$104.65 |
$188.40
|
|
Cytomegalovirus (cmv) antibody igg
|
$102.70 |
$102.70 |
$102.70 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$94.90 |
$94.90 |
$94.90 |
$95.00
|
|
Cytopathology cellular enhancement technique non-gyn
|
$169.00 |
$169.00 |
$169.00 |
$163.43
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$76.70 |
$76.70 |
$76.70 |
$98.00
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$80.60 |
$80.60 |
$80.60 |
$90.88
|
|
Cytopath tbs c/v manual
|
$49.40 |
$49.40 |
$49.40 |
$57.94
|
|
Dalbavancin 500 mg intravenous solution
|
$4,741.39 |
$4,741.39 |
$4,741.39 |
$3,480.61
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$146.25 |
$146.25 |
$146.25 |
$1.80
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$10,313.55 |
$10,313.55 |
$10,313.55 |
$4,542.99
|
|
Dch validity tests
|
$22.10 |
$22.10 |
$22.10 |
$25.00
|
|
Deamidated gliadin antibody iga
|
$93.60 |
$93.60 |
$93.60 |
$53.95
|
|
Debridement (>20 cm) charge pt
|
$286.00 |
$286.00 |
$286.00 |
$313.30
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$323.70 |
$323.70 |
$323.70 |
$482.35
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$147.55 |
$147.55 |
$147.55 |
$165.60
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$222.30 |
$222.30 |
$222.30 |
$220.43
|
|
Dexamethasone 4 mg tablet
|
$4.87 |
$4.87 |
$4.87 |
$4.87
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$7.15 |
$7.15 |
$7.15 |
$8.23
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$42.25 |
$42.25 |
$42.25 |
$48.56
|
|
Dhea-s (dehydroepiand sulfate)
|
$109.20 |
$109.20 |
$109.20 |
$110.50
|
|
Diabetes (HbA1c) Test
|
$77.35 |
$77.35 |
$77.35 |
$70.00
|
|
Dialysis one evaluation
|
$978.90 |
$978.90 |
$978.90 |
$920.00
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$15.04 |
$15.04 |
$15.04 |
$42.12
|
|
Dicyclomine injection
|
$59.96 |
$59.96 |
$59.96 |
$153.53
|
|
Diffusing capacity
|
$390.65 |
$390.65 |
$390.65 |
$336.80
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$7.15 |
$7.15 |
$7.15 |
$29.85
|
|
Digoxin total therapeutic drug level
|
$77.35 |
$77.35 |
$77.35 |
$92.95
|
|
Diltiazem 5 mg/ml intravenous solution
|
$7.15 |
$7.15 |
$7.15 |
$49.92
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$7.15 |
$7.15 |
$7.15 |
$9.29
|
|
Disability dlco
|
$354.90 |
$354.90 |
$354.90 |
$289.08
|
|
Disaccharidases
|
$21.45 |
$21.45 |
$21.45 |
$224.58
|
|
Dna antibody native/double stranded
|
$104.00 |
$104.00 |
$104.00 |
$101.40
|
|
Dna gardnerella
|
$70.85 |
$70.85 |
$70.85 |
$67.68
|
|
Dna trichomonas
|
$75.40 |
$75.40 |
$75.40 |
$69.60
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$69.47 |
$69.47 |
$69.47 |
$60.21
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$406.90 |
$406.90 |
$406.90 |
$463.20
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$117.78 |
$117.78 |
$117.78 |
$81.30
|
|
Drainage ext aud canal abscess 69020
|
$317.20 |
$317.20 |
$317.20 |
$828.59
|
|
Drainage external ear complex 69005
|
$386.10 |
$386.10 |
$386.10 |
$3,016.11
|
|
Drainage external ear simple 69000
|
$299.00 |
$299.00 |
$299.00 |
$800.00
|
|
Drainage mouth roof lesion
|
$304.20 |
$304.20 |
$304.20 |
$408.80
|
|
Drain blood from under nail 11740
|
$94.90 |
$94.90 |
$94.90 |
$173.21
|
|
Drain finger abscess;simple 26010
|
$396.50 |
$396.50 |
$396.50 |
$451.20
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$167.70 |
$167.70 |
$167.70 |
$353.60
|
|
Drng of finger abscess comp 26011
|
$731.25 |
$731.25 |
$731.25 |
$1,908.09
|
|
Drug assay caffeine
|
$110.50 |
$110.50 |
$110.50 |
$89.17
|
|
Drug assay posaconazole
|
$143.65 |
$143.65 |
$143.65 |
$96.75
|
|
Drug assay voriconazole
|
$102.70 |
$102.70 |
$102.70 |
$96.75
|
|
Drug test prsmv instrmnt
|
$95.55 |
$95.55 |
$95.55 |
$76.70
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$236.60 |
$236.60 |
$236.60 |
$278.85
|
|
Drvvt confirm - quest
|
$111.80 |
$111.80 |
$111.80 |
$108.55
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$702.00 |
$702.00 |
$702.00 |
$852.57
|
|
Dxa bone density axl vrt fx
|
$462.80 |
$462.80 |
$462.80 |
$365.14
|
|
Ear irrigation 69209
|
$111.80 |
$111.80 |
$111.80 |
$152.50
|
|
Ecg 12 lead tracing only
|
$126.10 |
$126.10 |
$126.10 |
$222.30
|
|
Echocardiogram (Heart Ultrasound)
|
$1,541.15 |
$1,541.15 |
$1,541.15 |
$2,021.12
|
|
Echocardiography transthoracic 2d followup/limited
|
$594.10 |
$594.10 |
$594.10 |
$720.60
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$1,380.60 |
$1,380.60 |
$1,380.60 |
$997.40
|
|
E coli 0157 ag ia
|
$71.50 |
$71.50 |
$71.50 |
$32.00
|
|
Egfr gene com variants
|
$726.70 |
$726.70 |
$726.70 |
$619.04
|
|
Ehrlicha chaffeensis amp prb
|
$144.95 |
$144.95 |
$144.95 |
$112.50
|
|
Electrical stimulation/unattended 97014
|
$68.25 |
$68.25 |
$68.25 |
$79.20
|
|
Electrolyte panel
|
$83.20 |
$83.20 |
$83.20 |
$68.56
|
|
Enoxaparin 30 mg/0.3 ml subcutaneous syringe
|
$45.43 |
$45.43 |
$45.43 |
$43.20
|
|
Epinephrine 0.1 mg/ml injection syringe
|
$73.61 |
$73.61 |
$73.61 |
$66.06
|
|
Epinephrine 1 mg/ml im kit - adult
|
$11.99 |
$11.99 |
$11.99 |
$10.76
|
|
Epoetin alfa in ns IV syringe 100 unit/ml (neo/ped) - cnr
|
$712.22 |
$712.22 |
$712.22 |
$379.58
|
|
Epstein barr early antigen antibody
|
$89.70 |
$89.70 |
$89.70 |
$85.20
|
|
Epstein barr nuclear antigen antibody
|
$79.95 |
$79.95 |
$79.95 |
$88.80
|
|
Epstein barr viral capsid antigen antibody igm
|
$96.20 |
$96.20 |
$96.20 |
$112.50
|
|
Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr
|
$676.65 |
$676.65 |
$676.65 |
$138.28
|
|
ER Visit (level 1, minor)
|
$294.45 |
$294.45 |
$294.45 |
$270.00
|
|
ER Visit (level 2)
|
$405.60 |
$405.60 |
$405.60 |
$469.39
|
|
ER Visit (level 3)
|
$761.15 |
$761.15 |
$761.15 |
$821.52
|
|
ER Visit (level 4)
|
$1,111.50 |
$1,111.50 |
$1,111.50 |
$1,320.00
|
|
ER Visit (level 5, high severity)
|
$2,888.27 |
$2,888.27 |
$2,888.27 |
$1,900.20
|
|
Established Patient Office Visit (level 1)
|
$137.15 |
$137.15 |
$137.15 |
$118.20
|
|
Established Patient Office Visit (level 2)
|
$148.85 |
$148.85 |
$148.85 |
$138.60
|
|
Established Patient Office Visit (level 3)
|
$133.25 |
$133.25 |
$133.25 |
$183.60
|
