|
Cytomegalovirus (cmv) antibody igg
|
$115.20 |
$115.20 |
$115.20 |
$96.00
|
|
Cytomegalovirus (cmv) antibody igm
|
$115.20 |
$115.20 |
$115.20 |
$100.00
|
|
Cytopathology cellular enhancement technique non-gyn
|
$236.80 |
$236.80 |
$236.80 |
$159.90
|
|
Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review
|
$116.80 |
$116.80 |
$116.80 |
$92.40
|
|
Cytopathology cervical/vaginal thin layer manual screening
|
$92.00 |
$92.00 |
$92.00 |
$87.45
|
|
Cytopathology concentration technique smears & interpretation
|
$253.60 |
$253.60 |
$253.60 |
$135.20
|
|
Cytopathology fluids/washings/brushings smears with interpretation
|
$162.40 |
$162.40 |
$162.40 |
$127.50
|
|
Cytopathology fna adequacy evaluation first episode each site interp/rpt
|
$244.00 |
$244.00 |
$244.00 |
$213.85
|
|
Cytopath smear other source
|
$149.60 |
$149.60 |
$149.60 |
$92.50
|
|
Cytopath tbs c/v manual
|
$89.60 |
$89.60 |
$89.60 |
$59.28
|
|
Dalteparin sodium
|
$66.64 |
$66.64 |
$66.64 |
$469.55
|
|
Daptomycin 500 mg/10 ml intravenous solution
|
$73.43 |
$73.43 |
$73.43 |
$171.19
|
|
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe
|
$2,156.00 |
$2,156.00 |
$2,156.00 |
$6,281.29
|
|
Dch validity tests
|
$36.80 |
$36.80 |
$36.80 |
$25.00
|
|
Deamidated gliadin antibody iga
|
$54.40 |
$54.40 |
$54.40 |
$43.35
|
|
Debrid ecz/inf skin up tp 10% body 11000
|
$787.20 |
$787.20 |
$787.20 |
$668.55
|
|
Debridement (>20 cm) charge pt
|
$114.40 |
$114.40 |
$114.40 |
$284.00
|
|
Debridement subcutaneous tissue <= 20 sq cm
|
$885.60 |
$885.60 |
$885.60 |
$835.20
|
|
Debr musc/fascia 20sq cm/< 11043
|
$1,008.00 |
$1,008.00 |
$1,008.00 |
$1,165.50
|
|
Decalcification
|
$69.60 |
$69.60 |
$69.60 |
$68.34
|
|
Decitabine 50 mg intravenous solution
|
$288.26 |
$288.26 |
$288.26 |
$1,073.52
|
|
Declotting thrombolytic agent implanted vas access device 36
|
$595.20 |
$595.20 |
$595.20 |
$572.95
|
|
Deferoxamine 500 mg solution for injection
|
$83.64 |
$83.64 |
$83.64 |
$95.85
|
|
Degarelix 120 mg subcutaneous solution
|
$1,161.24 |
$1,161.24 |
$1,161.24 |
$1,856.85
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$215.20 |
$215.20 |
$215.20 |
$185.17
|
|
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution
|
$2,617.06 |
$2,617.06 |
$2,617.06 |
$6,324.98
|
|
Depo-estradiol cypionate inj
|
$90.27 |
$90.27 |
$90.27 |
$71.51
|
|
Device sut capio slim opn
|
$2,086.40 |
$2,086.40 |
$2,086.40 |
$1,860.95
|
|
Dexa bone density study >=1 sites appendicular skeleton (peripheral)
|
$369.60 |
$369.60 |
$369.60 |
$227.25
|
|
Dexamethasone 4 mg tablet
|
$62.08 |
$62.08 |
$62.08 |
$5.85
|
|
Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr
|
$60.76 |
$60.76 |
$60.76 |
$20.76
|
|
Dextrose 5 % and 0.9 % sodium chloride intravenous solution
|
$120.00 |
$120.00 |
$120.00 |
$36.05
|
|
Dextrose 5 % and lactated ringers intravenous solution
|
$120.00 |
$120.00 |
$120.00 |
$42.25
|
|
Dextrose 5 % in water (d5w) intravenous solution (non-pvc)
|
$600.00 |
$600.00 |
$600.00 |
$46.35
|
|
Dhea-s (dehydroepiand sulfate)
|
$203.20 |
$203.20 |
$203.20 |
$112.00
|
|
Diabetes (HbA1c) Test
|
$91.20 |
$91.20 |
$91.20 |
$79.30
|
|
Diagnostic Mammogram (both breasts)
|
$618.40 |
$618.40 |
$618.40 |
$420.35
|
|
Diagnostic Mammogram (one breast)
|
$503.20 |
$503.20 |
$503.20 |
$314.00
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$68.84 |
$68.84 |
$68.84 |
$79.71
|
|
Dicyclomine injection
|
$89.14 |
$89.14 |
$89.14 |
$154.33
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$62.46 |
$62.46 |
$62.46 |
$65.84
|
|
Digoxin immune fab 40 mg intravenous solution
|
$4,438.71 |
$4,438.71 |
$4,438.71 |
$10,279.62
|
|
Digoxin total therapeutic drug level
|
$139.20 |
$139.20 |
$139.20 |
$102.07
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$123.04 |
$123.04 |
$123.04 |
$297.86
|
|
Dilate esophagus
|
$2,903.20 |
$2,903.20 |
$2,903.20 |
$2,142.40
|
|
Dilate esophagus 1/mult pass
|
$2,684.00 |
$2,684.00 |
$2,684.00 |
$1,548.00
|
|
Diltiazem 5 mg/ml intravenous solution
|
$68.48 |
$68.48 |
$68.48 |
$45.60
|
|
Diphenhydramine 12.5 mg/5 ml oral elixir
|
$1.20 |
$1.20 |
$1.20 |
$1.20
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$60.56 |
$60.56 |
$60.56 |
$18.32
|
|
Dna antibody native/double stranded
|
$124.80 |
$124.80 |
$124.80 |
$100.00
|
|
Dna gardnerella
|
$100.80 |
$100.80 |
$100.80 |
$61.83
|
|
Dna probe chlamydia
|
$122.40 |
$122.40 |
$122.40 |
$82.20
|
|
Dna trichomonas
|
$100.80 |
$100.80 |
$100.80 |
$63.00
|
|
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution
|
$139.76 |
$139.76 |
$139.76 |
$95.06
|
|
Docetaxel 20 mg/ml intravenous solution (wrapper)
|
$880.44 |
$880.44 |
$880.44 |
$949.39
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$168.48 |
$168.48 |
$168.48 |
$65.40
|
|
Doppler echo complete
|
$743.20 |
$743.20 |
$743.20 |
$558.00
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$1,048.80 |
$1,048.80 |
$1,048.80 |
$679.64
|
|
Doppler upper/lower extremity arteries limited bilateral
|
$672.00 |
$672.00 |
$672.00 |
$481.65
|
|
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension
|
$1,921.33 |
$1,921.33 |
$1,921.33 |
$1,718.24
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$73.85 |
$73.85 |
$73.85 |
$89.34
|
|
Drainage absc/cyst/hmtma/vestibule mouth smpl
|
$632.00 |
$632.00 |
$632.00 |
$800.00
|
|
Drainage external ear simple 69000
|
$499.20 |
$499.20 |
$499.20 |
$790.40
|
|
Drain blood from under nail 11740
|
$178.40 |
$178.40 |
$178.40 |
$182.40
|
|
Drain finger abscess;simple 26010
|
$546.40 |
$546.40 |
$546.40 |
$428.40
|
|
Dress/debride pt-tck burn/5-10% bs 16025
|
$196.80 |
$196.80 |
$196.80 |
$397.65
|
|
Dress/debride pt-thick burn/<5% bs 16020
|
$220.00 |
$220.00 |
$220.00 |
$349.50
|
|
Dress/debrid prtl-thick burn l 16030
|
$563.20 |
$563.20 |
$563.20 |
$541.00
|
|
Drsg interceed 3x4in adh wnd barr absorb
|
$2,189.60 |
$2,189.60 |
$2,189.60 |
$1,818.32
|
|
Drsg sht 5.625x4.625in std
|
$7.28 |
$7.28 |
$7.28 |
$123.24
|
|
Drug assay vedolizumab
|
$204.80 |
$204.80 |
$204.80 |
$154.00
|
|
Drug of abuse screen urine
|
$58.40 |
$58.40 |
$58.40 |
$67.89
|
|
Drug test(s) presumptive any class instrument chemistry analyzers
|
$237.60 |
$237.60 |
$237.60 |
$278.85
|
|
Drvvt confirm - quest
|
$152.80 |
$152.80 |
$152.80 |
$109.20
|
|
Duplex scan bilateral study 93985
|
$866.40 |
$866.40 |
$866.40 |
$691.08
|
|
Dup scan/hemodialysis access 93990
|
$772.00 |
$772.00 |
$772.00 |
$489.72
|
|
Dup scan/lwr xtr vasc stdy bilat 93924
|
$978.40 |
$978.40 |
$978.40 |
$745.00
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$1,175.20 |
$1,175.20 |
$1,175.20 |
$904.78
|
|
Durvalumab 50 mg/ml intravenous solution
|
$4,630.77 |
$4,630.77 |
$4,630.77 |
$8,445.90
|
|
Ear irrigation 69209
|
$168.00 |
$168.00 |
$168.00 |
$154.70
|
|
Ecg external < 48 hours recording
|
$620.80 |
$620.80 |
$620.80 |
$467.40
|
|
Ecg external < 48 hours scanning analysis w/report
|
$618.40 |
$618.40 |
$618.40 |
$541.20
|
|
Ecg external > 48 hours up to 7 days recording
|
$181.60 |
$181.60 |
$181.60 |
$147.28
|
|
Ecg external >7 days up to 15 days recording
|
$218.40 |
$218.40 |
$218.40 |
$173.40
|
|
Echocardiogram (Heart Ultrasound)
|
$2,751.20 |
$2,751.20 |
$2,751.20 |
$2,024.64
|
|
Echocardiogram (Limited Follow-Up Heart Ultrasound)
|
$1,036.80 |
$1,036.80 |
$1,036.80 |
$720.60
|
|
Echocardiography doppler color flow mapping
|
$748.00 |
$748.00 |
$748.00 |
$511.55
|
|
Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast
|
$1,200.00 |
$1,200.00 |
$1,200.00 |
$866.87
|
|
Echocardiograpy doppler follow up/limited study
|
$475.20 |
$475.20 |
$475.20 |
$371.25
|
|
Echo exam of fetal heart
|
$340.00 |
$340.00 |
$340.00 |
$318.34
|
|
Echo exam uterus 76831-
|
$908.00 |
$908.00 |
$908.00 |
$561.00
|
|
Echo guide for amniocentesis
|
$693.60 |
$693.60 |
$693.60 |
$455.57
|
|
Echo stress
|
$2,222.40 |
$2,222.40 |
$2,222.40 |
$1,609.44
|
|
Echo transthoracic
|
$2,300.00 |
$2,300.00 |
$2,300.00 |
$1,361.75
|
|
Echo transthoracic
|
$1,428.00 |
$1,428.00 |
$1,428.00 |
$1,052.40
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$1,617.60 |
$1,617.60 |
$1,617.60 |
$1,033.00
|
|
Eeg monitor/record/awake/drowsy 95816
|
$1,083.20 |
$1,083.20 |
$1,083.20 |
$835.00
|
|
Eeg/record in coma or sleep only 95822
|
$997.60 |
$997.60 |
$997.60 |
$871.00
|
|
Eeg recording awake and asleep
|
$1,245.60 |
$1,245.60 |
$1,245.60 |
$931.20
|
|
Egd remove foreign body
|
$2,748.80 |
$2,748.80 |
$2,748.80 |
$1,571.40
|