|
CT neck soft tissue without contrast
|
$6,036.00 |
$6,036.00 |
$6,036.00 |
$1,316.71
|
|
CT neck soft tissue without & w/contrast
|
$8,610.00 |
$8,610.00 |
$8,610.00 |
$1,959.75
|
|
CT orbit/sella/fossa w/wo contrast
|
$8,451.00 |
$8,451.00 |
$8,451.00 |
$1,661.25
|
|
CT orbit/sella/ or posterior outer inner or middle ear w/contrast
|
$7,746.00 |
$7,746.00 |
$7,746.00 |
$1,543.83
|
|
CT orbit/sella/ or posterior outer inner or middle ear without contrast
|
$7,181.00 |
$7,181.00 |
$7,181.00 |
$1,345.05
|
|
CT scan for therapy guide
|
$3,461.00 |
$3,461.00 |
$3,461.00 |
$777.00
|
|
CT Scan of Abdomen and Pelvis (with and without contrast)
|
$16,614.00 |
$16,614.00 |
$16,614.00 |
$3,328.00
|
|
CT Scan of Abdomen and Pelvis (with contrast)
|
$12,632.00 |
$12,632.00 |
$12,632.00 |
$2,883.20
|
|
CT Scan of Abdomen and Pelvis (without contrast)
|
$12,172.00 |
$12,172.00 |
$12,172.00 |
$2,370.63
|
|
CT thoracic spine w/contrast
|
$6,899.00 |
$6,899.00 |
$6,899.00 |
$1,732.50
|
|
CT thoracic spine without contrast
|
$8,478.00 |
$8,478.00 |
$8,478.00 |
$1,436.50
|
|
CT t-spine w /wo contrast
|
$8,504.00 |
$8,504.00 |
$8,504.00 |
$2,030.60
|
|
Culture aerobic additional method definitive id each
|
$79.00 |
$79.00 |
$79.00 |
$62.65
|
|
Culture afb any source
|
$740.00 |
$740.00 |
$740.00 |
$107.50
|
|
Culture anaerobic additional method definitive id each
|
$79.00 |
$79.00 |
$79.00 |
$75.29
|
|
Culture anaerobic except blood
|
$245.00 |
$245.00 |
$245.00 |
$120.00
|
|
Culture bact stool aero addl path ea
|
$221.00 |
$221.00 |
$221.00 |
$52.50
|
|
Culture fungi definitive id mold
|
$58.00 |
$58.00 |
$58.00 |
$70.00
|
|
Culture fungi definitive id yeast
|
$128.00 |
$128.00 |
$128.00 |
$79.00
|
|
Culture fungi other (except blood)
|
$298.00 |
$298.00 |
$298.00 |
$94.90
|
|
Culture fungi skin/hair/nail
|
$10.00 |
$10.00 |
$10.00 |
$76.05
|
|
Culture typing immunologic
|
$58.00 |
$58.00 |
$58.00 |
$41.19
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$247.00 |
$247.00 |
$247.00 |
$26.73
|
|
Cyclic citrullinated peptide antibody
|
$475.00 |
$475.00 |
$475.00 |
$85.03
|
|
Cyclosporine 2 hour
|
$508.00 |
$508.00 |
$508.00 |
$119.40
|
|
Cystatin c
|
$206.00 |
$206.00 |
$206.00 |
$82.50
|
|
Cystogram >= 3 views supervision & interpretation
|
$1,817.00 |
$1,817.00 |
$1,817.00 |
$527.50
|
|
Cytogenetics 25-99
|
$1,454.00 |
$1,454.00 |
$1,454.00 |
$180.00
|
|
Cytomegalovirus (cmv) antibody igg
|
$205.00 |
$205.00 |
$205.00 |
$101.25
|
|
Cytomegalovirus (cmv) antibody igm
|
$205.00 |
$205.00 |
$205.00 |
$101.94
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$418.00 |
$418.00 |
$418.00 |
$84.50
|
|
Cytopathology concentration technique smears & interpretation
|
$191.00 |
$191.00 |
$191.00 |
$142.94
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$205.00 |
$205.00 |
$205.00 |
$122.40
|
|
Cytopathology fna adequacy evaluation each separate additional episode same site
|
$227.00 |
$227.00 |
$227.00 |
$75.60
|
|
Cytopathology fna adequacy evaluation first episode each site
|
$227.00 |
$227.00 |
$227.00 |
$185.00
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$383.00 |
$383.00 |
$383.00 |
$203.08
|
|
Cytopath smear other source
|
$741.00 |
$741.00 |
$741.00 |
$135.27
|
|
Cytotoxic antibody screening
|
$2,254.00 |
$2,254.00 |
$2,254.00 |
$75.20
|
|
Dch pulmonary stress test
|
$3,917.00 |
$3,917.00 |
$3,917.00 |
$964.41
|
|
Decalcification
|
$298.00 |
$298.00 |
$298.00 |
$75.38
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$407.00 |
$407.00 |
$407.00 |
$182.40
|
|
Deodorant ostmy adapt lube 8ml
|
$8.00 |
$8.00 |
$8.00 |
$5.00
|
|
Dermagraft
|
$383.00 |
$383.00 |
$383.00 |
$220.24
|
|
Design mlc device for imrt
|
$7,933.00 |
$7,933.00 |
$7,933.00 |
$1,641.90
|
|
Desoxycorticosterone
|
$373.00 |
$373.00 |
$373.00 |
$109.28
|
|
Device intraute mirena
|
$3,815.00 |
$3,815.00 |
$3,815.00 |
$2,289.60
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$375.00 |
$375.00 |
$375.00 |
$68.25
|
|
Dextrose 5 % IV bolus
|
$306.00 |
$306.00 |
$306.00 |
$68.25
|
|
Dhea-s (dehydroepiand sulfate)
|
$418.00 |
$418.00 |
$418.00 |
$107.50
|
|
Diabetes (HbA1c) Test
|
$408.00 |
$408.00 |
$408.00 |
$78.03
|
|
Diagnostic radio unlisted proc
|
$1,577.00 |
$1,577.00 |
$1,577.00 |
$236.93
|
|
Dialysis one evaluation
|
$4,805.00 |
$4,805.00 |
$4,805.00 |
$827.97
|
|
Diffusing capacity
|
$1,209.00 |
$1,209.00 |
$1,209.00 |
$357.50
|
|
Digoxin immune fab 40 mg intravenous solution
|
$13,715.00 |
$13,715.00 |
$13,715.00 |
$9,684.65
|
|
Digoxin total therapeutic drug level
|
$408.00 |
$408.00 |
$408.00 |
$99.35
|
|
Dimenhydrinate injection
|
$219.00 |
$219.00 |
$219.00 |
$24.68
|
|
Diphtheria-tetanus toxoids 0.5 ml (peds)
|
$247.00 |
$247.00 |
$247.00 |
$100.80
|
|
Disability dlco
|
$1,244.00 |
$1,244.00 |
$1,244.00 |
$302.40
|
|
Dna antibody native/double stranded
|
$58.00 |
$58.00 |
$58.00 |
$101.40
|
|
Dna probe chlamydia
|
$292.00 |
$292.00 |
$292.00 |
$82.20
|
|
Dna probe gc
|
$183.00 |
$183.00 |
$183.00 |
$88.67
|
|
Dornase alfa non-comp unit
|
$425.00 |
$425.00 |
$425.00 |
$500.29
|
|
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm
|
$134.00 |
$134.00 |
$134.00 |
$189.68
|
|
Drsg wnd 8.2x9cm sq bilayer theragenesis ster-74sq cm-cost per sq cm
|
$525.00 |
$525.00 |
$525.00 |
$127.14
|
|
Drug assay vedolizumab
|
$80.00 |
$80.00 |
$80.00 |
$169.26
|
|
Drug assay voriconazole
|
$101.00 |
$101.00 |
$101.00 |
$96.75
|
|
Drug test def 15-21 classes
|
$1,041.00 |
$1,041.00 |
$1,041.00 |
$142.17
|
|
Drug test def 1-7 classes
|
$581.00 |
$581.00 |
$581.00 |
$263.86
|
|
Drug test def 8-14 classes
|
$683.00 |
$683.00 |
$683.00 |
$172.25
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$305.00 |
$305.00 |
$305.00 |
$278.85
|
|
Drvvt confirm - quest
|
$217.00 |
$217.00 |
$217.00 |
$102.30
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$4,376.00 |
$4,376.00 |
$4,376.00 |
$885.60
|
|
Ecg 12 lead tracing only
|
$1,093.00 |
$1,093.00 |
$1,093.00 |
$243.61
|
|
Ecg external < 48 hours recording
|
$3,167.00 |
$3,167.00 |
$3,167.00 |
$461.76
|
|
Ecg external < 48 hours scanning analysis w/report
|
$2,339.00 |
$2,339.00 |
$2,339.00 |
$567.00
|
|
Echocardiogram (Heart Ultrasound)
|
$5,611.00 |
$5,611.00 |
$5,611.00 |
$2,049.45
|
|
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler
|
$8,378.00 |
$8,378.00 |
$8,378.00 |
$1,818.05
|
|
Echocardiography transthoracic 2d followup/limited
|
$4,267.00 |
$4,267.00 |
$4,267.00 |
$773.30
|
|
Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast
|
$8,378.00 |
$8,378.00 |
$8,378.00 |
$686.88
|
|
Echocardiograpy doppler follow up/limited study
|
$1,917.00 |
$1,917.00 |
$1,917.00 |
$354.90
|
|
Echo exam of fetal heart
|
$4,801.00 |
$4,801.00 |
$4,801.00 |
$855.38
|
|
Echo exam of fetal heart
|
$4,801.00 |
$4,801.00 |
$4,801.00 |
$481.55
|
|
Echo exam of fetal heart
|
$2,848.00 |
$2,848.00 |
$2,848.00 |
$431.41
|
|
Echo exam of fetal heart
|
$2,848.00 |
$2,848.00 |
$2,848.00 |
$323.40
|
|
Echo guidance radiotherapy
|
$2,487.00 |
$2,487.00 |
$2,487.00 |
$769.18
|
|
Echo guide for amniocentesis
|
$2,033.00 |
$2,033.00 |
$2,033.00 |
$377.11
|
|
Echo guide for transfusion
|
$1,832.00 |
$1,832.00 |
$1,832.00 |
$324.60
|
|
Echo guide villus sampling
|
$1,818.00 |
$1,818.00 |
$1,818.00 |
$355.80
|
|
Echo stress
|
$5,389.00 |
$5,389.00 |
$5,389.00 |
$1,607.45
|
|
Echo tee probe placement image acquisition interpretation & report
|
$4,809.00 |
$4,809.00 |
$4,809.00 |
$1,938.95
|
|
Echo transthoracic
|
$5,004.00 |
$5,004.00 |
$5,004.00 |
$1,475.25
|
|
Echo transthoracic
|
$1,917.00 |
$1,917.00 |
$1,917.00 |
$944.14
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$5,327.00 |
$5,327.00 |
$5,327.00 |
$1,020.09
|
|
Eeg 41-60 minutes 95812-26
|
$4,190.00 |
$4,190.00 |
$4,190.00 |
$934.05
|
|
Eeg monitor/record/awake/drowsy 95816
|
$3,921.00 |
$3,921.00 |
$3,921.00 |
$861.12
|
|
Eeg over 1 hour 95813 - 26
|
$4,341.00 |
$4,341.00 |
$4,341.00 |
$1,100.40
|
|
Eeg/record in coma or sleep only 95822
|
$3,295.00 |
$3,295.00 |
$3,295.00 |
$911.00
|
|
Egfr gene com variants
|
$1,008.00 |
$1,008.00 |
$1,008.00 |
$646.75
|
|
Electrolyte panel
|
$79.00 |
$79.00 |
$79.00 |
$86.33
|
|
Electron microscopy diagnostic
|
$3,593.00 |
$3,593.00 |
$3,593.00 |
$1,006.20
|
