|
Culture fungi skin/hair/nail
|
$1,156.00 |
$1,156.00 |
$1,156.00 |
$74.88
|
|
Culture quantitative aerobic other source
|
$1,242.00 |
$1,242.00 |
$1,242.00 |
$90.35
|
|
Culture typing added method
|
$90.60 |
$90.60 |
$90.60 |
$38.58
|
|
Culture typing immunologic
|
$20.72 |
$20.72 |
$20.72 |
$44.00
|
|
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution
|
$67.65 |
$67.65 |
$67.65 |
$25.20
|
|
Cyclophosphamide 25 mg capsule
|
$69.13 |
$69.13 |
$69.13 |
$19.49
|
|
Cyclosporine oral 100 mg
|
$112.80 |
$112.80 |
$112.80 |
$34.88
|
|
Cystogram >= 3 views supervision & interpretation
|
$1,129.07 |
$1,129.07 |
$1,129.07 |
$542.10
|
|
Debridement (>20 cm) charge pt
|
$1,213.44 |
$1,213.44 |
$1,213.44 |
$260.61
|
|
Deferoxamine 500 mg solution for injection
|
$524.98 |
$524.98 |
$524.98 |
$95.85
|
|
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device
|
$391.34 |
$391.34 |
$391.34 |
$185.17
|
|
Dextrose 5 % IV bolus
|
$81.78 |
$81.78 |
$81.78 |
$48.00
|
|
Diab manage trn ind/group
|
$247.53 |
$247.53 |
$247.53 |
$56.55
|
|
Diagnostic Mammogram (both breasts)
|
$982.30 |
$982.30 |
$982.30 |
$399.30
|
|
Diazepam 5 mg/ml injection solution (wrapper)
|
$146.58 |
$146.58 |
$146.58 |
$74.76
|
|
Dicyclomine injection
|
$578.16 |
$578.16 |
$578.16 |
$153.29
|
|
Diffusing capacity
|
$859.92 |
$859.92 |
$859.92 |
$332.00
|
|
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution
|
$67.65 |
$67.65 |
$67.65 |
$69.03
|
|
Digoxin immune fab 40 mg intravenous solution
|
$14,570.63 |
$14,570.63 |
$14,570.63 |
$10,079.82
|
|
Dihydroergotamine 0.05 mg/ml IV syringe - cnr
|
$3,389.61 |
$3,389.61 |
$3,389.61 |
$297.86
|
|
Diphenhydramine 50 mg/ml injection (wrapper)
|
$87.98 |
$87.98 |
$87.98 |
$17.75
|
|
Discography cerv/thor spine
|
$7,868.64 |
$7,868.64 |
$7,868.64 |
$2,565.00
|
|
Dopamine 40 mg/ml intravenous solution (wrapper)
|
$369.46 |
$369.46 |
$369.46 |
$65.40
|
|
Doppler echo complete
|
$2,668.77 |
$2,668.77 |
$2,668.77 |
$540.00
|
|
Doppler upper/lower extremity arteries complete bilateral
|
$3,442.60 |
$3,442.60 |
$3,442.60 |
$662.35
|
|
Dornase alfa non-comp unit
|
$1,568.24 |
$1,568.24 |
$1,568.24 |
$446.75
|
|
Doxycycline hyclate 100 mg intravenous powder for solution
|
$245.16 |
$245.16 |
$245.16 |
$84.80
|
|
Droperidol 2.5 mg/ml injection solution
|
$33.48 |
$33.48 |
$33.48 |
$31.07
|
|
Dup scan/ue art/graft/bilat/comp 93930
|
$2,156.52 |
$2,156.52 |
$2,156.52 |
$887.25
|
|
Ecg 12 lead tracing only
|
$737.81 |
$737.81 |
$737.81 |
$226.50
|
|
Ecg external < 48 hours recording
|
$1,666.97 |
$1,666.97 |
$1,666.97 |
$462.00
|
|
Ecg external < 48 hours scanning analysis w/report
|
$1,666.97 |
$1,666.97 |
$1,666.97 |
$541.20
|
|
Ecg external > 48 hours up to 7 days recording
|
$1,666.97 |
$1,666.97 |
$1,666.97 |
$147.28
|
|
Ecg external >7 days up to 15 days recording
|
$1,666.97 |
$1,666.97 |
$1,666.97 |
$161.85
|
|
Echocardiogram (Heart Ultrasound)
|
$4,792.76 |
$4,792.76 |
$4,792.76 |
$2,001.17
|
|
Echocardiography doppler color flow mapping
|
$1,880.06 |
$1,880.06 |
$1,880.06 |
$469.95
|
|
Echocardiography transthoracic 2d followup/limited
|
$1,096.97 |
$1,096.97 |
$1,096.97 |
$703.25
|
|
Echocardiograpy doppler follow up/limited study
|
$2,606.33 |
$2,606.33 |
$2,606.33 |
$362.50
|
|
Echo stress
|
$6,127.21 |
$6,127.21 |
$6,127.21 |
$1,592.05
|
|
Echo tee probe placement image acquisition interpretation & report
|
$6,960.96 |
$6,960.96 |
$6,960.96 |
$1,849.50
|
|
Echo tte 2d comp wo ctrst wo clr/dplr
|
$6,022.39 |
$6,022.39 |
$6,022.39 |
$985.15
|
|
Eeg monitor/record/awake/drowsy 95816
|
$1,406.10 |
$1,406.10 |
$1,406.10 |
$835.00
|
|
Eeg recording awake and asleep
|
$1,406.10 |
$1,406.10 |
$1,406.10 |
$931.20
|
|
Eeg wo vid ea 12-26hr unmntr
|
$2,298.73 |
$2,298.73 |
$2,298.73 |
$1,502.40
|
|
Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr
|
$1,936.46 |
$1,936.46 |
$1,936.46 |
$222.98
|
|
Erythromycin in ns IV syringe 5 mg/ml (neo/ped) - cnr
|
$1,410.50 |
$1,410.50 |
$1,410.50 |
$223.99
|
|
Established Patient Office Visit (level 2)
|
$723.44 |
$723.44 |
$723.44 |
$132.72
|
|
Established Patient Office Visit (level 3)
|
$817.32 |
$817.32 |
$817.32 |
$183.00
|
|
Established Patient Office Visit (level 4)
|
$1,114.54 |
$1,114.54 |
$1,114.54 |
$231.75
|
|
Established Patient Office Visit (level 5)
|
$1,114.54 |
$1,114.54 |
$1,114.54 |
$280.33
|
|
Evaluation of speech fluency 92521
|
$422.33 |
$422.33 |
$422.33 |
$311.50
|
|
Exemestane, 25 mg
|
$225.18 |
$225.18 |
$225.18 |
$35.75
|
|
External pretreatment of serum for use in antibody identification by dilution
|
$825.38 |
$825.38 |
$825.38 |
$61.10
|
|
Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr
|
$17.28 |
$17.28 |
$17.28 |
$22.20
|
|
Fetal biophys profile w/nst 76818
|
$1,397.61 |
$1,397.61 |
$1,397.61 |
$535.37
|
|
Finasteride, 5 mg
|
$55.64 |
$55.64 |
$55.64 |
$7.71
|
|
Fluoroguide for spine inject 77003-26
|
$1,354.55 |
$1,354.55 |
$1,354.55 |
$496.03
|
|
Fluoroguide needle placement
|
$2,523.19 |
$2,523.19 |
$2,523.19 |
$510.00
|
|
Fomepizole 1 gram/ml intravenous solution
|
$5,141.16 |
$5,141.16 |
$5,141.16 |
$2,581.14
|
|
Formoterol fumarate, inh
|
$133.00 |
$133.00 |
$133.00 |
$59.40
|
|
Fresh frozen plasma frozen within 8 hours of collection each unit
|
$407.46 |
$407.46 |
$407.46 |
$156.60
|
|
Fresh frozen plasma thawing ea un
|
$130.98 |
$130.98 |
$130.98 |
$122.00
|
|
Gadobutrol 1 mmol/ml intravenous solution (wrapper)
|
$774.36 |
$774.36 |
$774.36 |
$102.00
|
|
Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution
|
$1,049.46 |
$1,049.46 |
$1,049.46 |
$250.83
|
|
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr
|
$1,882.30 |
$1,882.30 |
$1,882.30 |
$197.40
|
|
Gemcitabine 1 gram intravenous solution
|
$456.06 |
$456.06 |
$456.06 |
$207.51
|
|
Ghs flow volume loop
|
$504.67 |
$504.67 |
$504.67 |
$308.69
|
|
Ghs o2 uptake rest & exercise
|
$546.24 |
$546.24 |
$546.24 |
$230.01
|
|
Ghs o2 uptake rest & indirect
|
$144.47 |
$144.47 |
$144.47 |
$173.50
|
|
Ghs sensitivity (per antimicro)
|
$38.89 |
$38.89 |
$38.89 |
$57.60
|
|
Ghs st - re-eval for alt comm
|
$590.70 |
$590.70 |
$590.70 |
$309.00
|
|
Glucagon 1 mg solution for injection
|
$4,630.64 |
$4,630.64 |
$4,630.64 |
$601.79
|
|
Haloperidol decanoate 50 mg/ml intramuscular solution
|
$1,194.56 |
$1,194.56 |
$1,194.56 |
$90.14
|
|
Haloperidol lactate 5 mg/ml injection solution
|
$75.44 |
$75.44 |
$75.44 |
$23.06
|
|
Hbot, full body chamber, 30m
|
$1,555.11 |
$1,555.11 |
$1,555.11 |
$526.90
|
|
Head CT scan (with and without contrast)
|
$7,332.92 |
$7,332.92 |
$7,332.92 |
$1,849.90
|
|
Hemodialysis one evaluation
|
$5,375.20 |
$5,375.20 |
$5,375.20 |
$1,319.44
|
|
Hemolysins/agglutinins auto
|
$35.08 |
$35.08 |
$35.08 |
$57.14
|
|
Hemolysins and agglutinins incubated
|
$48.44 |
$48.44 |
$48.44 |
$57.14
|
|
Hepatobiliary system imaging
|
$2,806.37 |
$2,806.37 |
$2,806.37 |
$1,438.58
|
|
Herpes simplex virus isolation
|
$932.00 |
$932.00 |
$932.00 |
$104.10
|
|
Hla i low res one antigen equiv ea
|
$1,574.00 |
$1,574.00 |
$1,574.00 |
$161.70
|
|
Hla i typing low res one locus ea
|
$64.81 |
$64.81 |
$64.81 |
$320.70
|
|
Hocm 350-399mg/ml iodine,1ml
|
$1,587.50 |
$1,587.50 |
$1,587.50 |
$79.78
|
|
Homogenization tissue
|
$23.52 |
$23.52 |
$23.52 |
$39.20
|
|
Human prothrombin complex concentrate (pcc)-lans 500 unit (400-640 unit) IV solution
|
$5,248.80 |
$5,248.80 |
$5,248.80 |
$5,836.20
|
|
Hyaluronidase, human recombinant 150 unit/ml injection solution
|
$1,317.57 |
$1,317.57 |
$1,317.57 |
$142.40
|
|
Hydralazine 20 mg/ml injection solution
|
$182.30 |
$182.30 |
$182.30 |
$46.74
|
|
Hydroxyurea 500 mg
|
$50.28 |
$50.28 |
$50.28 |
$14.00
|
|
Hydroxyzine hcl 50 mg/ml intramuscular solution
|
$97.44 |
$97.44 |
$97.44 |
$72.65
|
|
I-123 sod iodide diag per 100 uci
|
$604.36 |
$604.36 |
$604.36 |
$139.20
|
|
I131 iodide cap, rx
|
$142.99 |
$142.99 |
$142.99 |
$78.75
|
|
Ibutilide fumarate 0.1 mg/ml intravenous solution
|
$749.52 |
$749.52 |
$749.52 |
$980.94
|
|
Imatinib 100 mg tab
|
$998.68 |
$998.68 |
$998.68 |
$248.00
|
|
Implant ureth bulk agent
|
$3,695.00 |
$3,695.00 |
$3,695.00 |
$2,139.62
|
|
In-111 oxyquinolin per 0.5 mci
|
$1,951.21 |
$1,951.21 |
$1,951.21 |
$2,568.98
|
|
Infect ag genotype na hiv-1 revr trn/prt
|
$1,029.80 |
$1,029.80 |
$1,029.80 |
$603.75
|
|
Infect ag if pneumocystis carinii
|
$47.92 |
$47.92 |
$47.92 |
$67.46
|
|
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies
|
$923.00 |
$923.00 |
$923.00 |
$100.00
|
|
Infectious agent antigen immunoassay ql/sq multi step rotavirus
|
$801.49 |
$801.49 |
$801.49 |
$97.50
|