|
Culture mycobacteria definitive id each isolate
|
$60.80 |
$60.80 |
$60.80 |
$100.00
|
|
Culture mycoplasma any source
|
$64.00 |
$64.00 |
$64.00 |
$81.62
|
|
Culture quantitative aerobic other source
|
$40.00 |
$40.00 |
$40.00 |
$90.35
|
|
Culture typing immunologic
|
$21.60 |
$21.60 |
$21.60 |
$43.00
|
|
Culture typing nucleic acid probe amplified per culture/isolate each organism
|
$143.20 |
$143.20 |
$143.20 |
$138.40
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$20.00 |
$20.00 |
$20.00 |
$25.16
|
|
Cyclic citrullinated peptide antibody
|
$54.40 |
$54.40 |
$54.40 |
$72.15
|
|
Cyclophosphamide 1 gram intravenous powder for solution
|
$1,045.00 |
$1,045.00 |
$1,045.00 |
$1,305.02
|
|
Cyclosporine 2 hour
|
$75.20 |
$75.20 |
$75.20 |
$129.48
|
|
Cyclosporine modified 25 mg capsule
|
$4.00 |
$4.00 |
$4.00 |
$7.48
|
|
Cystatin c
|
$77.60 |
$77.60 |
$77.60 |
$76.48
|
|
Cystine urine quantitative
|
$96.00 |
$96.00 |
$96.00 |
$100.70
|
|
Cystogram >= 3 views supervision & interpretation
|
$531.20 |
$531.20 |
$531.20 |
$564.85
|
|
Cystoscopy (Bladder Scope)
|
$1,134.40 |
$1,134.40 |
$1,134.40 |
$1,445.41
|
|
Cytarabine 20 mg/ml injection solution
|
$116.80 |
$116.80 |
$116.80 |
$90.00
|
|
Cytomegalovirus (cmv) antibody igg
|
$60.00 |
$60.00 |
$60.00 |
$95.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$69.60 |
$69.60 |
$69.60 |
$100.00
|
|
Cytopathology cellular enhancement technique non-gyn
|
$204.80 |
$204.80 |
$204.80 |
$159.45
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$112.00 |
$112.00 |
$112.00 |
$92.40
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$82.40 |
$82.40 |
$82.40 |
$86.86
|
|
Cytopathology concentration technique smears & interpretation
|
$144.00 |
$144.00 |
$144.00 |
$131.36
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$144.00 |
$144.00 |
$144.00 |
$124.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$212.80 |
$212.80 |
$212.80 |
$209.92
|
|
Cytp urine 3-5 probes cmptr
|
$283.20 |
$283.20 |
$283.20 |
$664.80
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$1,312.40 |
$1,312.40 |
$1,312.40 |
$171.19
|
|
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln
|
$23,557.00 |
$23,557.00 |
$23,557.00 |
$21,063.03
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$7,104.40 |
$7,104.40 |
$7,104.40 |
$6,273.69
|
|
Dch validity tests
|
$13.60 |
$13.60 |
$13.60 |
$25.00
|
|
Deamidated gliadin antibody iga
|
$49.60 |
$49.60 |
$49.60 |
$42.75
|
|
Debr musc/fascia 20sq cm/< 11043
|
$342.40 |
$342.40 |
$342.40 |
$1,160.00
|
|
Decalcification
|
$103.20 |
$103.20 |
$103.20 |
$68.90
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$387.20 |
$387.20 |
$387.20 |
$546.84
|
|
Degarelix 120 mg subcutaneous solution
|
$3,183.20 |
$3,183.20 |
$3,183.20 |
$1,855.50
|
|
Delivery of placenta 59414
|
$3,380.00 |
$3,380.00 |
$3,380.00 |
$2,822.68
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$279.20 |
$279.20 |
$279.20 |
$182.40
|
|
Dentoalveolar/drain abs/cyst/hema 41800
|
$616.00 |
$616.00 |
$616.00 |
$399.93
|
|
Design mlc device for imrt
|
$7,554.40 |
$7,554.40 |
$7,554.40 |
$1,739.10
|
|
Desmopressin 4 mcg/ml injection solution
|
$468.60 |
$468.60 |
$468.60 |
$93.84
|
|
Devel tst phys/qhp 1st hr
|
$276.00 |
$276.00 |
$276.00 |
$350.40
|
|
Device intraute mirena
|
$6,609.80 |
$6,609.80 |
$6,609.80 |
$2,125.00
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$323.20 |
$323.20 |
$323.20 |
$227.15
|
|
Dexamethasone 4 mg tablet
|
$3.40 |
$3.40 |
$3.40 |
$6.00
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$34.00 |
$34.00 |
$34.00 |
$21.20
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$28.80 |
$28.80 |
$28.80 |
$36.00
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$30.40 |
$30.40 |
$30.40 |
$42.50
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$33.40 |
$33.40 |
$33.40 |
$46.12
|
|
Dhea-s (dehydroepiand sulfate)
|
$92.00 |
$92.00 |
$92.00 |
$111.60
|
|
Diabetes (HbA1c) Test
|
$25.00 |
$25.00 |
$25.00 |
$79.20
|
|
Diagnostic anoscopy spx 46600
|
$211.20 |
$211.20 |
$211.20 |
$190.68
|
|
Diagnostic digital breast tomosynthesis bil
|
$88.80 |
$88.80 |
$88.80 |
$117.94
|
|
Diagnostic digital breast tomosynthesis unil
|
$59.20 |
$59.20 |
$59.20 |
$75.93
|
|
Diagnostic laryngoscopy 31575
|
$560.00 |
$560.00 |
$560.00 |
$334.95
|
|
Diagnostic Mammogram (both breasts)
|
$208.00 |
$208.00 |
$208.00 |
$413.50
|
|
Diagnostic Mammogram (one breast)
|
$222.00 |
$222.00 |
$222.00 |
$312.72
|
|
Dialysis one evaluation
|
$464.80 |
$464.80 |
$464.80 |
$936.00
|
|
Diatrizoate meglumine 18 % urethral solution
|
$5.60 |
$5.60 |
$5.60 |
$115.15
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$143.60 |
$143.60 |
$143.60 |
$77.25
|
|
Dicyclomine injection
|
$158.80 |
$158.80 |
$158.80 |
$150.91
|
|
Diffusing capacity
|
$548.80 |
$548.80 |
$548.80 |
$335.20
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$35.80 |
$35.80 |
$35.80 |
$65.84
|
|
Digoxin immune fab 40 mg intravenous solution
|
$19,087.80 |
$19,087.80 |
$19,087.80 |
$10,079.82
|
|
Digoxin total therapeutic drug level
|
$55.20 |
$55.20 |
$55.20 |
$102.07
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$460.00 |
$460.00 |
$460.00 |
$297.86
|
|
Diltiazem 5 mg/ml intravenous solution
|
$46.60 |
$46.60 |
$46.60 |
$46.56
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$33.80 |
$33.80 |
$33.80 |
$18.35
|
|
Disability dlco
|
$262.40 |
$262.40 |
$262.40 |
$292.03
|
|
Dna antibody native/double stranded
|
$57.60 |
$57.60 |
$57.60 |
$100.00
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$366.40 |
$366.40 |
$366.40 |
$98.29
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$121.00 |
$121.00 |
$121.00 |
$67.28
|
|
Doppler echo complete
|
$602.40 |
$602.40 |
$602.40 |
$558.00
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$836.00 |
$836.00 |
$836.00 |
$679.64
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$443.20 |
$443.20 |
$443.20 |
$473.76
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$150.60 |
$150.60 |
$150.60 |
$84.80
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$496.80 |
$496.80 |
$496.80 |
$794.82
|
|
Drainage external ear simple 69000
|
$683.20 |
$683.20 |
$683.20 |
$779.45
|
|
Drainage mouth roof lesion
|
$373.60 |
$373.60 |
$373.60 |
$405.60
|
|
Drainage of arm bursa 23931
|
$3,966.40 |
$3,966.40 |
$3,966.40 |
$2,271.01
|
|
Drainage of kidney lesion
|
$1,200.00 |
$1,200.00 |
$1,200.00 |
$1,506.00
|
|
Drain blood from under nail 11740
|
$144.80 |
$144.80 |
$144.80 |
$177.04
|
|
Drain cath image guided visceral pq
|
$1,651.20 |
$1,651.20 |
$1,651.20 |
$2,885.30
|
|
Drain finger abscess;simple 26010
|
$525.60 |
$525.60 |
$525.60 |
$428.40
|
|
Drain thigh/knee lesion 27301
|
$4,005.60 |
$4,005.60 |
$4,005.60 |
$3,824.50
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$304.80 |
$304.80 |
$304.80 |
$352.00
|
|
Drng of finger abscess comp 26011
|
$2,483.20 |
$2,483.20 |
$2,483.20 |
$2,029.60
|
|
Drng of scrotum abscess 55100
|
$4,305.60 |
$4,305.60 |
$4,305.60 |
$1,997.89
|
|
Drug assay posaconazole
|
$111.20 |
$111.20 |
$111.20 |
$96.75
|
|
Drug assay vedolizumab
|
$144.80 |
$144.80 |
$144.80 |
$157.00
|
|
Drug test def 1-7 classes
|
$443.20 |
$443.20 |
$443.20 |
$263.25
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$253.60 |
$253.60 |
$253.60 |
$280.95
|
|
Drvvt confirm - quest
|
$116.00 |
$116.00 |
$116.00 |
$109.20
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$828.80 |
$828.80 |
$828.80 |
$745.00
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$934.40 |
$934.40 |
$934.40 |
$903.50
|
|
Dxa bone density axl vrt fx
|
$501.60 |
$501.60 |
$501.60 |
$410.25
|
|
Dx bronchoscope/brush 31623
|
$1,023.20 |
$1,023.20 |
$1,023.20 |
$2,040.67
|
|
Dx bronchoscope/lavage 31624
|
$1,023.20 |
$1,023.20 |
$1,023.20 |
$2,400.95
|
|
Dx bronchoscope/wash 31622
|
$1,023.20 |
$1,023.20 |
$1,023.20 |
$2,322.60
|
|
Ear irrigation 69209
|
$114.40 |
$114.40 |
$114.40 |
$150.00
|
|
Ecg 12 lead tracing only
|
$314.40 |
$314.40 |
$314.40 |
$226.50
|
|
Ecg external > 48 hours up to 7 days recording
|
$525.60 |
$525.60 |
$525.60 |
$147.28
|
|
Ecg external >7 days up to 15 days recording
|
$525.60 |
$525.60 |
$525.60 |
$161.85
|
